632 THE LYMPHATIC SYSTEM 



and accompany the external saphenous vein along the back of the leg, where they 

 enter the popliteal glands. 



The deep lymphatic vessels of the lower extremity are few in number and 

 accompany the deep blood-vessels. In the leg they consist of three sets, the 

 anterior tibial, peroneal, and posterior tibial, which accompany the corresponding 

 blood-vessels, two or three to each artery ; they ascend with the blood-vessels and 

 enter the lymphatic glands in the popliteal space ; the efferent vessels from these 

 glands accompany the femoral vein and join the deep inguinal glands ; from these, 

 the vessels pass beneath Poupart's ligament and communicate with the chain of 

 glands surrounding the external iliac vessels. 



The deep lymphatic vessels of the gluteal and ischiatic regions follow the 

 course of the blood-vessels, and join the gluteal and ischiatic glands at the great 

 sacro-sciatic foramen. 



LYMPHATICS OF THE PELVIS AND ABDOMEN. 



The Lymphatic Glands in the Pelvis are the external iliac, the internal iliac, 

 and the sacral. Those of the abdomen are the lumbar and coeliac glands. 



The external iliac glands form an uninterrupted chain round the external iliac 

 vessels, three being placed round the commencement of the vessels just behind the 

 crural arch. They communicate below with the deep inguinal lymphatic glands, 

 and above with the lumbar glands. 



mi 



Ihe internal iliac glands surround the internal iliac vessels; they receive the 

 lymphatic vessels corresponding to the branches of the internal iliac artery, and 

 communicate with the lumbar glands. 



The sacral glands occupy the sides of the anterior surface of the sacrum, some 

 being situated in the meso-rectal fold. These and the internal iliac glands are 

 affected in malignant disease of the bladder, rectum, or uterus. 



The lumbar glands are very numerous ; they are situated on the front of the 

 lumbar vertebrae, surrounding the common iliac vessels, the aorta, and vena cava ; 

 they receive the lymphatic vessels from the lower extremities and pelvis, as well as 

 from the testes and some of the abdominal viscera : the efferent vessels from these 

 glands unite into a few large trunks, which, with the lacteals, form the commence- 

 ment of the thoracic duct. In addition to these there are a few small lateral lum- 

 bar glands which lie between the transverse processes of the vertebrae, behind the 

 Psoas muscle, and receive lymphatics from the back. In ome cases of malignant 

 disease these glands become enormously enlarged, completely surrounding the aorta 

 and vena cava, and occasionally greatly contracting the calibre of those vessels. 

 In all cases of malignant disease of the testes and in malignant disease of the lower 

 limb, before any operation is attempted, careful examination of the abdomen should 

 be made, in order to ascertain if any enlargement exists ; and if any should be 

 detected, all operative measures should be avoided as fruitless. 



The Coeliac Glands, nearly twenty in number, surround the coeliac axis and lie 

 in front of the aorta near the origin of that vessel. They receive the lymphatic 

 vessels from a large part of the liver, from the spleen, pancreas, and stomach. 

 Their efferent vessels join the lacteals from the intestine and open into the 

 receptaculum chyli. 



The Lymphatic Vessels of the Abdomen and Pelvis may be divided into two sets, 

 superficial and deep. 



The superficial lymphatic vessels of the walls of the abdomen and pelvis follow 

 the course of the superficial blood-vessels. Those derived from the integument 

 of the lower part of the abdomen below the umbilicus follow the course of the 

 superficial epigastric vessels and converge to the superior group of the superficial 

 inguinal glands ; a deeper set accompany the deep epigastric vessels, and commu- 

 nicate with the external iliac glands. The superficial lymphatics from the sides 

 of the lumbar part of the abdominal wall wind round the crest of the ilium, 

 accompanying the superficial circumflex iliac vessels, to join the superior group 



