LYMPHATIC AND LACTEAL SYSTEM. 
Fig. 58. 
Super ficial lymphatics of the upper extremity. 
( After Secs. 
a,a, Commencing lymphatic vessels which ac- 
company the branches of the cephalic and basilic 
veins. 
b, Lymphatic vessels passing from the posterior 
_ to the anterior surface of the forearm over its inner 
edge, with branches of the basilic vein. 
d, Lymphatic vessels passing from the posterior 
to the anterior surface of the forearm over its outer 
edge, with branches of the cephalic vein. 
c, Lymphatic vessels passing from the posterior 
to the anterior surface of the arm over its inner 
edge. 
The superficial lymphatics of the upper ex- 
tremity in their passage to the axillary glands 
follow more or less the course of the subcuta- 
neous veins. Those which accompany the ce- 
phalic and basilic veins commence on the 
dorsal surface of the fingers, where they com- 
-Municate with the digital lymphatics; from 
thence they proceed over the metacarpus to the 
_ posterior surface of the forearm, tending with their 
accompanying veins towards its ulnar and ra- 
231 
dial edges, over which, sooner or later, they 
pew to gain the anterior surface, and at the 
end of the elbow they have all collected in 
the neighbourhood of the internal condyle. 
The lymphatics accompanying _ median 
vein take origin from the palmar/Surface of 
the fingers, where they communicate with the 
digital lymphatics ; they take their course up- 
wards first on the palm of the hand, then on 
the anterior surface of the forearm, and at the 
bend of the elbow join those already traced to 
the same point. The great majority of these 
vessels now continue their course upwards 
over the internal condyle to the inner side of 
the arm, some of them traversing the little - 
gland or glands situated just above the internal 
condyle; from thence they take the nearest 
route to gain the axillary glands, of which they . 
form the principal vasa inferentia. Some three 
or four of the lymphatics, which in the forearm 
were associated with the branches of the ce- 
phalic vein as far as the bend of the elbow, 
separate themselves from the rest, and ascend 
with this accompanying vein on the outer side 
of the biceps, and in the interval between the 
deltoid and pectoralis major muscles, where 
they meet with a gland which they traverse and 
ultimately pass with the vein over the pectoralis 
minor muscle to gain the deep-seated lympha- 
tics accompanying the axillary artery. 
The axillary glands collect their vasa infe- 
rentia also from the upper half of the anterior, 
posterior, and lateral surfaces of the trunk. 
From the anterior surface those on the ab- 
domen above the umbilicus ascend; those on 
the upper part of the chest, joined by some 
from the cervical region, descend; those on a 
level with the axilla from the pectoral muscles 
and the glands of the breast take a transverse 
direction—all in short converging towards the 
axilla, where the glands in which they termi- 
nate are situated. From the posterior surface 
of the trunk in a similar way they concentrate 
from the lumbar, cervical, and dorsal regions 
to pass over the posterior border of the axilla 
to reach the same glands. 
The vasa efferentia of the axillary glands, 
four or five only in number, but of large size, 
receive the lymph conveyed to these glands 
from the various sources just described; they 
pass associated with the axillary vessels under 
the subclavius muscle, unite into one or two 
branches, which usually pass over the subcla- 
vian vein, to,terminate either separately in 
this vein, close to its union with the internal 
jugular, or else join the lymphatic trunks. 
The lymphatics of the head and face may be 
divided as in other parts of the body into the 
superficial and the deep-seated. They all have 
to pass through the glands situated in the cer- 
vical region. The superficial accompany prin- 
cipally the veins of the head and face. Those 
from the head form two groups: one anterior 
associated with the temporal veins, descends 
in front of the ear, joins the small glands 
situated at the root of the zygoma, and in 
the substance of the parotid gland; it passes 
with the temporal vein through that gland 
and below the angle of the jaw continues to 
