628 THE LYMPHATIC SYSTEM 



in the middle line of the neck, between the anterior bellies of the two digastric 

 muscles ; and (3) cervical, placed in the course of the external jugular vein be- 

 tween the Platysma and deep fascia. They are most numerous at the root of the 

 neck, in the triangular interval between the clavicle, the Sterno-mastoid, and the 

 Trapezius, where they are continuous with the axillary glands. A few small glands 

 are also found on the front and sides of the larynx. 



The deep cervical glands (Fig. 839) are numerous and of large size ; they form 

 a chain along the sheath of the carotid artery and internal jugular vein, lying by 

 the side of the pharynx, oesophagus, and trachea, and extending from the base of 

 the skull to the thorax, where they communicate with the lymphatic glands in that 

 cavity. They are subdivided into two sets : an upper, ten to twenty in number, 

 situated about the bifurcation of the common carotid and along the upper part 

 of the internal jugular vein ; and a lower, ten to fifteen in number, clustered around 

 the lower part of the internal jugular vein, and extending outward into the supra- 

 clavicular fossa, where they are continuous with the axillary glands. Internally, 

 this set is continuous with the mediastinal glands. 



The superficial and deep cervical lymphatic vessels are a continuation of those 

 already described on the cranium and face. After traversing the glands in those 

 regions, they pass through the chain of glands which lie along the sheath of the 

 carotid vessels, being joined by the lymphatics from the pharynx, oesophagus, 

 larynx, trachea, and thyroid gland. At the lower part of the neck, after receiving 

 some lymphatics from the thorax, they unite into a single trunk, which terminates, 

 on the left side, in the thoracic duct ; on the right side, in the right lymphatic 

 duct. 



Surgical Anatomy. The cervical glands are very frequently the seat of tuberculous 

 disease. This condition is most usually set up by some lesion in those parts from which they 

 receive their lymph. This excites some inflammation, which subsequently takes on a tuberculous 

 character. It is very desirable, therefore, for the surgeon, in dealing with these cases, to possess 

 a knowledge of the relation of the respective groups of glands to the periphery. The following 

 table is extracted from Mr. Treves's work on Scrofula and its Gland Diseases: 



Scalp. Posterior part = suboccipital and mastoid glands. Frontal and parietal portions = 

 parotid glands. 



Lymphatic vessels from the scalp also enter the superficial cervical set of glands. 



Skin of face and neck = submaxillary, parotid, and superficial cervical glands. 



External ear = superficial cervical glands. 



Lower lip = submaxillary and suprahyoid glands. 



Buccal cavity = submaxillary and upper set of deep cervical glands. 



Gums of lower jaw = submaxillary glands. 



Tongue. Anterior portion = suprahyoid and submaxillary glands. Posterior portion = 

 upper set of deep cervical glands. 



Tonsils and palate = upper set of deep cervical glands. 



Pharynx. Upper part parotid and retro-pharyngeal glands. Lower part = upper set of 

 deep cervical glands. 



Larynx, orbit, <ntd roof of mouth = upper set of deep cervical glands. 



Nasal fossce = retro-pharyngeal glands, upper set of deep cervical glands. Some lymphatic 

 vessels from posterior part of the fossae enter the parotid glands. 



LYMPHATICS OF THE UPPER EXTREMITY. 



The Lymphatic Glands of the Upper Extremity (Fig. 340) are divided into two 

 sets, superficial and deep. 



The superficial lymphatic glands are few and of small size. There are occa- 

 sionally two or three in front of the elbow, and one or two above the internal 

 condyle of the humerus, near the basilic vein, while one or two may be found lying 

 beside the cephalic vein between the Pectoralis major and Deltoid muscles. 



The deep lymphatic glands are few in number, and are subdivided into 

 those in the forearm, the arm, and the axilla. In the forearm a few small 

 ones are occasionally found in the course of the radial and ulnar vessels. In the 

 arm there is a chain of small glands along the inner side of the brachial artery. 

 One, sometimes tAvo, fairly constant glands are situated a little above and in front 

 of the inner condyle of the humerus. In the axilla they are of large size, ;md 





