DISSECTION OF SUPERFICIAL STRUCTURES 67 



be the case, because the lymph vessels and lymph glands are of great 

 clinical importance, and their positions and connections must always be 

 kept in mind when infection by micro-organisms and the spread of malig- 

 nant growths is under consideration (Fig. 30). 



For the main part the lymph vessels accompany the blood-vessels, but 

 they are much more numerous than the latter ; they are present in all tissues, 

 except cartilage ; and they contain a colourless fluid called lymph, which 

 drains into the smaller lymph vessels from the tissues amidst which they 

 lie. The lymph vessels unite together, like the veins, to form gradually 

 larger and larger vessels, which are however always relatively small as 

 contrasted with blood-vessels, and the lymph they carry finally enters two 

 terminal lymph vessels, the right lymph duct and the thoracic duct. Both 

 the terminal lymph vessels join big veins at the root of the neck behind 

 the sternal part of the clavicle, the right lymph duct ending in the 

 right innominate vein and the thoracic duct in the left innominate vein. 

 Therefore, eventually, all the lymph gathered from the tissues is poured 

 into the blood. In ordinary circumstances the lymph carries materials 

 which are distributed by the blood throughout the body, to the organs 

 which must utilise them or excrete them in order that the bodily health 

 may be maintained, but if micro-organisms have invaded the tissues or 

 malignant tumours have formed amidst them, the micro-organisms or 

 the poisons they form and cells of the malignant tumours may enter the 

 lymph vessels, and when that occurs it necessarily follows that they may 

 be distributed by the blood to all parts of the body. That naturally 

 occurs rapidly in the cases of any dissolved poisons, but the process may 

 be delayed in the cases of micro-organisms and the cells of malignant 

 tumours, for the lymph glands are interposed, like small filters, in the 

 courses of the lymph vessels, and micro-organisms and malignant cells are 

 frequently caught in them. The micro-organisms so caught may cause 

 inflammation of the glands and the malignant cells develop into new 

 malignant tumour formations. It is important therefore, in the considera- 

 tion of all cases of micro-organic infection and malignant tumour growth, 

 that the doctor should have a very clear idea of the possible lymph path- 

 ways by which the infection or the tumour may spread, and the positions 

 of the lymph glands which may, for a time, retard disaster and give 

 him the opportunity to deal successfully with the conditions which are 

 threatening. 



It is probable that all lymph passes through at least one lymph gland 

 before it enters the terminal lymph vessels, and most lymph passes through 

 many glands. The lymph vessels which convey lymph to lymph glands 

 are called afferent lymph vessels, and those which convey it from glands 

 are efferent lymph vessels. Both the lymph vessels and the lymph glands 

 in the superior extremity, as in other parts of the body, form two main 

 groups, deep and superficial. 



The deep glands are: (i) the deep cubital glands; (2) the brachial 

 glands ; (3) the axillary glands : (a) lateral, (b] anterior, and (c] posterior 

 (see p. 29) ; (4) the delto- pectoral glands ; (5) in some cases there are 

 a few scattered lymph glands associated with the deep arteries of the front 

 of the forearm. 



The lymph from all the structures deep to the deep fascia is carried by 

 lymph vessels which accompany the blood-vessels to the nearest available 

 lymph glands. The deep cubital glands receive the lymph from the deep 

 parts of the hand and forearm, and part of the lymph from the elbow, and 

 pass it on to the brachial glands, which also receive lymph from the elbow 

 and the deep parts of the arm. From the brachial glands the lymph passes 

 to the lateral group of axillary glands. 

 I 5 a 



