490 LYMPHATICS. 



the deep bloodvessels. In the leg, they consist of three sets, the anterior tibial, 

 peroneal, and posterior tibial, which accompany the corresponding vessels, being 

 two or three in number to each ; they ascend with the bloodvessels, and enter the 

 lymphatic glands in the popliteal space. The efferent vessels from these glands 

 accompany the femoral vein, and join the deep inguinal glands ; from these, the 

 vessels pass beneath Poupart's ligament, and communicate with the chain of 

 glands surrounding the external iliac vessels. 



The deep lymphatics of the gluteal and ischiatic regions follow the course of 

 the bloodvessels, and join the gluteal and ischiatic glands at the great sacro-sciatic 

 foramen. 



LYMPHATICS OF THE PELVIS AND ABDOMEN. 



The Deep Lymphatic Glands in the Pelvis are, the external iliac, the internal 

 iliac, and the sacral. Those of the abdomen are the lumbar glands. 



The external iliac glands form an uninterrupted chain round the external iliac 

 vessels, three being placed round the commencement of the vessel just behind the 

 crural arch. They communicate below with the femoral lymphatics, and above 

 with the lumbar glands. 



The internal iliac glands surround the internal iliac vessels ; they receive the 

 lymphatics corresponding to the branches of the internal iliac artery, and com- 

 municate with the lumbar glands. 



The sacral glands occupy the sides of the anterior surface of the sacrum, some 

 being situated in the mesorectal fold. These and the internal iliac glands become 

 greatly enlarged in malignant disease of the bladder, rectum, or uterus. 



The lumbar glands are very numerous ; they are situated on the front of the 

 lumbar vertebra?, surrounding the common iliac vessels, the aorta, and vena cava ; 

 they receive the lymphatic vessels from the lower extremities and pelvis, as well 

 as from the testes and some of the abdominal viscera. The efferent vessels from 

 these glands unite into a few large trunks, which, with the lacteals, form the com- 

 mencement of the thoracic duct. In some cases of malignant disease, these glands 

 become enormously enlarged, completely surrounding the aorta and vena cava, 

 and occasionally greatly contracting the calibre of these vessels. In all cases of 

 malignant disease of the testis, and in malignant disease of the lower limb, before 

 any operation is attempted, careful examination of the abdomen should be made, 

 in order to ascertain if any enlargement exists ; and if any should be detected, 

 all operative measures are fruitless. 



The lymphatics of the pelvis and abdomen may be divided into two sets, superficial 

 and deep. 



The superficial lymphatics of the walls of the abdomen and pelvis follow the course 

 of the superficial bloodvessels. Those derived from the integument of the lower 

 part of the abdomen below the umbilicus follow the course of the superficial 

 epigastric vessels, and converge to the superior group of the superficial inguinal 

 glands ; the deep set accompany the deep epigastric vessels, and communicate with 

 the external iliac glands. The superficial lymphatics from the sides and lumbar part 

 of the abdominal wall wind round the crest of the ilium, accompanying the super- 

 ficial circumflex iliac vessels, to join the superior group of the superficial inguinal 

 glands; the greater number, however, accompany the ilio-lumbar and lumbar 

 vessels backwards, to join the lumbar glands. 



The superficial lymphatics of the gluteal region turn horizontally round the outer 

 side of the nates, and join the superficial inguinal glands. 



The superficial lymphatics of the scrotum, and perinseum follow the course of the 

 external pudic vessels, and terminate in the superficial inguinal glands. 



The superficial lymphatics of the penis occupy the sides and dorsum of the organ, 

 the latter receiving the lymphatics from the skin covering the glans penis; they 

 all converge to the upper chain of the superficial inguinal glands. The deep 

 lymphatic "vessels of the penis follow the course of the internal pudic vessels, and 

 join the internal iliac glands. 



