LYMPHATICS OF CPPER EXTREMITY 655 



I. THE SUPERFICIAL LYMPHATIC VESSELS AND GLANDS OF 

 THE UPPER EXTREMITY 



1. The superficial lymphatic vessels hcuin around the nialrix of the nail 

 and in tlie pulp of tlie lintier. Thence thev run ujjwards, in tlie form of fourmain 

 channels, along the side of the linger — two on the dorsal and two on the palmar 

 aspect. 



The palmar set end on the convexity of a lymphatic palmar arch. From the 

 arch, lymphatic vessels run up the forearm, more or less in two sets — an outer and 

 an inner — roughly following the course of the superti(;ial veins; a third or median 

 set, starting as a plexiform arrangement in front of the wrist, runs up ])etwcen the 

 other two. The communication, however, between tlie three main sets of vessels 

 is so free that, when they are minutely injected, the front of the forearm appears 

 covered with a dense plexus of lymphatics (fig. 399). 



The dorsal set of digital lymi)hati('S ends in a plexus on the l)ack of the hand. 

 From this plexus numerous lymphatic vessels stream up the back of the forearm, 

 and, winding round the inner and outer borders respectively of the limb, join the 

 lymphatics on the anterior aspect. 



From the bend of the elbow the lymphatics run up the arm, the greater numlier 

 following the course of the basilic vein, and, dipping lieneath the pectoralis major, 

 converge to end in the axillary glands. The lymphatics from the outer side of the 

 arm run in chief part obliquely across the bice])S, toAvards the axilla; but a few 

 accompany the cephalic vein to the infraclavicular lymi)hatic glands. The lym- 

 phatics over the deltoid also mainly end in these glands. 



2. The superficial lymphatic glands are feAv in number. There are none, 

 as a rule, below the bend of the elbow. Occasionally there is one at the bend 

 of the elbow, and constantly two or three are found above the internal condyle 

 (epitrochlear glands), in the course of the lymphatic vessels running Avith the 

 basili<' vein. 



II. THE DEEP LYMPHATIC VESSELS AND GLANDS OF THE 



UPPER EXTREMITY 



1. Tlie deep lymphatic vessels accompany the arteries of the upjier extremity. 

 Hence in the forearm they are found along the course of the radial, the ulnar, the 

 anterior interosseous, and the posterior interosseous arteries. At the bend of the 

 elbow they converge, and follow the course of the brachial and axillary arteries to 

 the axilla, and there end, together with the superficial lymphatics of the u]t])er 

 extremity and the superficial lym])liatics from the side of the chest and liack of 

 the shoulder, in the axillary lymphatic glands. They comniunicate Avitli the 

 superficial lymphatics at the Avrist. 



2. The deep lymphatic glands. — A few small glands are occasionally found 

 in the course of tlie lymi)hatic vessels accom])anving the arteries of the forearm, 

 and. more often, a few in the course of those accom])anying the lirachial artery. 

 But the first imjmrtant set of deep glands is met with in the axilla. 



The axillary glands are numerous and of large size. They are about twelve 

 in number. They are arranged in four chief sets — a median set, three or more in 

 number, situated along the course of the axillary artery and vein ( axillary glands 

 proper); an inner or anterior set, four or five in number, situated l)elow the greater 

 p<'ctoral muscles in the course of the long thoracic artery, on the outer surface of 

 the scrratus magnus (pectoral glands); a )»ostcrior or external set, usually two in 

 number, situated along the coui-se of the subscapular artery, under cover of the 

 latissimus dorsi (subscapular glands); and a sui)crior set, usually two in number, 

 situated just below the clavicle close to the cephalic vein. U])on the cost(^-coracoid 

 meml)rane in the fossa beneath the pectoralis major and deltoid (subclavian or 

 infraclavicular glands). 



The axillary glands proper, or the glands along the course of the axillary artery 

 and vein, receive the larger number of lyin]»hatics from the arm. The pectoral 



