Cervical Lymphatic Glands 37 



must be used with discretion, and for the most part only at the ends 

 of the gash, as to close the wound might be to lock discharges beneath 

 the deep fascia and to have them guided into the chest. Still, in these 

 days of antiseptic surgery, so much may be done to prevent suppuration 

 that the edges of the wound may in appropriate cases be sutured, 

 especially if tracheotomy have been resorted to. If there be a wound 

 of the trachea there is great risk of emphysema being set up if the 

 skin-wound is closely sutured. Death may result from entrance of 

 air into the veins. As deglutition disturbs the muscles and tissues 

 of the hyoid region, the man should be fed by a soft cesophageal tube. 



lymphatic glands are scattered in the occipital and posterior 

 auricular regions. They are often enlarged in constitutional syphilis, in 

 inflammation of the scalp, and in otorrhoea. Other glands are found 

 in the parotid, zygomatic, buccal, and submaxillary regions. 



The arrangement of the lymphatic vessels which enter the respec- 

 tive glands usually corresponds to that of the neighbouring veins. 



The superficial cervical glands are grouped along the external 

 jugular vein, and in the subclavian triangle they receive communica- 

 tions from axillary glands, and tributaries from the windpipe and gullet. 

 They may be enlarged in malignant disease of the breast, and also of 

 the oesophagus and stomach. 



The deep cervical glands are grouped along the internal jugular 

 vein ; they receive supplies from the mouth, pharynx, tongue, and 

 larynx, and from the tissues of the neck generally. They are in free 

 communication with the axillary and thoracic glands. 



The course taken by the lymphatic vessels is often erratic and 

 peculiar ; those coming from the occipital scalp, for instance, may 

 enter glands beneath the anterior border of the sterno-mastoid, and 

 those from the right side of the tongue may pass to the glands of the 

 left side of the neck. 



MEMBRANES OF BRAIN AND VENOUS SINUSES 



The dura mater, though forming the internal periosteum of the 

 skull bones, is but loosely attached to them, except in the neighbourhood 

 of the sutures and foramina : thus it is often separated from them in a 

 considerable area by haemorrhage from the middle meningeal artery, 

 or by suppuration the result of a blow on the head. It is firmly 

 attached at the base of the skull and at the margin of the foramen 

 magnum. From the foramen magnum it becomes continuous with the 

 dura mater of the spinal cord. Its outer surface is rough, and from 

 it small veins pass into the diploe. Its inner surface, paved with endo- 

 thelium, is smooth, and bounds the subdural space. 



Tubular sheaths of the dura mater emerge with the cranial 

 nerves, and blend eventually with the external periosteum. In the 



