AFFLUENTS OF THE THORACIC DUCT. 643 



duct or the great lymphatic vein, the majority of them through the medium 

 of the prepectoral glands. These vessels receive, on their course, those 

 which are brought from the inferior part of the intercostal spaces into the 

 suprasternal granulations. 



The other lymphatic vessels of the costal wall ascend between the two 

 muscles which close these spaces, and go to the subdorsal glands, which 

 afterwards eject them, near the origin of the thoracic duct, in the form of 

 one or two long vessels proceeding in a retrograde manner on each side of 

 the dorsal column. - 



LYMPHATIC VESSELS OF THE HEAD, NECK, AND ANTERIOR LIMB. 



These vessels are all directed towards the entrance to the chest, and are 

 gathered into a group of glands, called the prepectoral, which, with regard 

 to the lymphatics of the anterior part of the body, play the same part as 

 the sublumbar glands do to the vessels of the posterior region. 



Before arriving at this common point of convergence, they are inter- 

 cepted on their course by other glands, which form four principal groups : 

 1, The guttural or pharyngeal glands; 2, The submaxillary glands; 3, The 

 prescapular glands ; 4, The brachial glands. 



In studying these different glandular groups in succession, with their 

 afferent and efferent vessels, we will give a sufficient idea of the entire 

 lymphatic apparatus iu the region which remains for us to examine. 



1. Prepectoral Glands. 1 



They form, on each side of the terminal extremity of the jugular, within 

 the inferior border of the scalenus muscle, a very large mass which extends 

 into the chest by passing beneath the axillary vessels, and ascends to the 

 inner face of the first rib. 



Into these glands pass the lymphatic vessels emerging from the pre- 

 Bcapular and axillary glands, those which descend along the trachea with 

 the common carotid, and which come from the pharyngeal glands, as well 

 as the majority of those which follow the internal thoracic vessels. 



They give rise to several short and voluminous branches : those from 

 the glands of the right side form, by their junction, the great lymphatic 

 vein ; and those from the left side join the thoracic duct, or are inserted 

 separately beside the latter, at the summit of the anterior vena cava. 



2. Pharyngeal Glands. 



Very numerous, soft, and loosely united to one another, these glands are 

 disposed in an elongated mass that occupies the lateral plane of the pharynx, 

 below the guttural pouch, and which is prolonged backwards even beyond 

 the thyroid body. 



They receive all the lymphatics from the head : some come directly 

 from the base of the tongue, the soft palate, the pharyngeal walls, and the 

 larynx ; the others are derived from the submaxillary glands, and from a 

 lobule lodged in the substance of the parotid gland. 



The efferent branches which leave it are four or five in number. 

 Always voluminous, they descend along the trachea, some separately, but 

 the majority are united in a fasciculus which follows the carotid artery; 



1 These are glands, we believe, which ought to be regarded as the representatives of 

 the axillary glands of Man. 



