55 4 THE LYMPHATICS OF THE ABDOMEN. 



The lymphatics of the liver are divided into superficial, which run beneath 

 the peritoneum on the upper and lower surfaces of the organ, and deep, which 

 accompany the hlood-vessels within its substance. 



On the upper surface of the liver, the lymphatic vessels are disposed in the following 

 groups, which differ in their course and termination, viz : 1. Those from the 

 mesial portions of both lobes ascend in the falciform ligament, and pass through the 

 diaphragm behind the ensiform process to enter the glands of the anterior medi- 

 astinum. 2. The lateral lymphatics of each lobe are directed backwards to the 

 corresponding lateral ligament, and descend to the cceliac glands. 3. The lymphatics 

 from the hinder part of this surface converge to the coronary ligament, perforate 

 the diaphragm, and terminate in a small group of glands surrounding the upper end 

 of the inferior vena cava. 4. At the fore part of the liver a few vessels turn down- 

 wards and join those of the inferior surface, while a larger number penetrate the 

 liver-substance and unite with the lymphatics accompanying the portal vein. 



The greater number of the lymphatics of the under surface of the liver converge 

 to the transverse fissure, and descend with the deep lymphatics issuing at that part 

 in the small omentum ; but some pass deeply to join the portal lymphatics, while a 

 few at the back of the right lobe enter the glands on the inferior cava. 



The deep lympliatics of the liver accompany the branches of both the portal and 

 hepatic veins. The vessels running in the portal canals issue by the transverse 

 fissure and, being joined by most of the lymphatics of the under surface of the 

 organ, pass downwards in the small omentum, where they traverse some small hepatic 

 (/lands, to end in the coeliac glands. The lymphatics accompanying the hepatic 

 veins form five or six trunks which pass through the diaphragm with the inferior 

 vena cava, and enter the glands placed around that vessel, in union with the 

 posterior lymphatics of the surface of the liver. The efferent vessels from these 

 glands descend on the upper aspect of the vertebral portion of the diaphragm, and 

 open into the lower end of the thoracic duct (Sappey). 



LYMPHATICS OF THE THORAX. 



The lymphatic glands of the thorax form the following groups, viz. : 



1. Along the course of the internal mammary blood-vessels there are placed 

 from six to ten small sternal glands, which receive lymphatics from the anterior 

 thoracic and abdominal walls, from a portion of the diaphragm, and from the inner 

 part of the mamma. The efferent vessels of the lower glands run partly to the upper 

 glands of the same group and partly to the anterior mediastinal glands ; those of 

 the upper glands ascend to join the lymphatic trunks at the root of the neck. 



2. On each side of the spine in the line of the heads of the ribs, and sometimes 

 extending outwards between the intercostal muscles, is a set of small intercostal 

 glands, from one to three in each space, which receive lymphatics from the 

 thoracic parietes and the costal pleura. Their efferent vessels terminate mostly in 

 the thoracic duct, those from the lower three or four spaces on each side uniting into 

 a trunk which descends through the aortic opening of the diaphragm to enter the 

 receptaculum chyli ; but some of the upper ones on the right side generally ascend 

 to the right lymphatic duct. 



3. The anterior mediastinal glands are three or four in number, and lie 

 behind the lower part of the body of the sternum, between that and the pericardium ; 

 they receive, besides some of the efferent vessels of the lower sternal glands, 

 lymphatics from the mesial part of the upper surface of the liver, and others from 

 the fore part of the diaphragm. Their efferent ducts pass upwards with those of 

 the sternal glands to the right and left lymphatic trunks. 



