630 THE LYMPHATIC SYSTEM 



front and side of the abdomen, or the hand, forearm, and arm, the axillary glands are liable to 

 be found enlarged. 



The lymphatic vessels of the upper extremity are divided into two sets, super- 

 ficial and deep. 



The superficial lymphatic vessels of the upper extremity commence on the fin- 

 gers, two vessels running along either side of each finger, one on the palmar and 

 the other on the dorsal surface. Those on the palmar surface form an arch in the 

 palm of the hand, from which are derived two sets of vessels, which pass up the 

 forearm, taking the course of the subcutaneous veins. The lymphatics from the 

 dorsal surface of the fingers form a plexus on the back of the hand, and, winding 

 around the inner and outer borders of the forearm, unite with those in front. Those 

 from the inner border of the hand accompany the ulnar veins along the inner side 

 of the forearm to the bend of the elbow, where they are joined by some lymphatics 

 from the outer side of the forearm : they then follow the course of the basilic vein, 

 communicate with the glands immediately above the elbow, and terminate in the 

 axillary glands, joining with the deep lymphatics. The superficial lymphatics from 

 the outer and back part of the hand accompany the radial veins to the bend of the 

 elbow. They are less numerous than the preceding. At the bend of the elbow 

 the greater number join the basilic group ; the rest ascend with the cephalic vein 

 on the outer side of the arm, some crossing the upper part of the Biceps obliquely, 

 to terminate in the axillary glands, whilst one or two accompany the cephalic vein 

 in the cellular interval between the Pectoralis major and Deltoid, and enter the 

 subclavian lymphatic glands. 



The deep lymphatic vessels of the upper extremity accompany the deep blood- 

 vessels. In the forearm they consist of four sets, corresponding with the radial, 

 ulnar, and interosseous arteries ; they pass through the glands occasionally found 

 in the course of those vessels, and communicate at intervals with the superficial 

 lymphatics. In their course upward some of them pass through the glands which 

 lie upon the brachial artery ; they then enter the axillary and subclavian glands, 

 and at the root of the neck terminate on the left side in the thoracic duct, and on 

 the right side in the right lymphatic duct. 



LYMPHATICS OF THE LOWER EXTREMITY. 



The Lymphatic Glands of the Lower Extremity are divided into two sets, super- 

 ficial and deep. The superficial are confined to the inguinal region, forming the 

 superficial inguinal lymphatic glands. 



The superficial inguinal lymphatic glands, placed immediately beneath the 

 integument, are of large size, and vary from eight to ten in number. They are 

 divisible into two groups : an upper oblique set, disposed irregularly along Pou- 

 part's ligament, which receive the lymphatic vessels from the integument of the 

 scrotum, penis, parietes of the abdomen, perineal and gluteal regions, and the 

 mucous membrane of the urethra ; and an inferior vertical set, two to five in num- 

 ber, which surround the saphenous opening in the fascia lata, a few being some- 

 times continued along the saphenous vein to a variable extent. This latter group 

 receives the superficial lymphatic vessels from the lower extremity. Leaf 1 figures 

 some of the efferent vessels from these glands as terminating directly in the veins 

 of this region. 



Surgical Anatomy. These glands frequently become enlarged in diseases implicating the 

 parts from which their lymphatics originate. Thus in malignant or syphilitic affections of the 

 prepuce and penis, or of the labia majora in the female, in cancer scroti, in abscess in the peri- 

 naeum, or in any other diseases affecting the integument and superficial structures in those parts, 

 or the subumbilical part of the abdominal wall or the gluteal region, the upper chain of glands 

 is almost invariably enlarged, the lower chain being implicated in diseases affecting the lower 

 limb. 



The deep lymphatic glands are the anterior tibial, popliteal, deep inguinal, 

 gluteal, and ischiatic. 



1 The Surgical Anatomy of the Lymphatic Glands, 1898. 



