662 . THE LYMPHATICS 



The median group ( aortic lumbar glands i consit^ts (»f about six large glands 

 placed along the abdominal aorta and vena cava. They extend from the bifurcation 

 of the aorta to the second luml)ar vertebra. 



The median group receive the efferent vessels of the external and internal iliac 

 and sacral glands, the lymphatics accompanying the spermatic or ovarian vessels 

 from the testicle or ovarian plexus respectively, and the lymphatics of the kidneys, 

 suprarenal bodies, and hinder portion of the diaphragm. They also receive most 

 of the efferent vessels from the lateral sets. Their efferent vessels commonly unite 

 about the level of the second lumbar vertebra to form a right and a left lumbar 

 lymphatic trunk, which open, with some small vessels from the lateral sets, into 

 the receptaculum chyli. The left lumbar trunk also receives the lymphatics of the 

 descending colon and sigmoid flexure. 



The lateral lumbar glands, transverse lumbar or psoas glands, are situated 

 behind the psoas between the transverse processes of the lumlxir vertebrae. They 

 are twenty or thirty in number, and smaller than the glands of the central group. 

 The lateral glands receive the lymphatics accompanying the lumhar arteries, 

 the lymphatics from the muscles of the back, the spinal canal, and from the deeper 

 parts of the parietes of the posterior abdominal walls. Their efferent vessels 0]jen, 

 in part into the median set, and in part, as separate vessels, into the receptaculum 

 chyli. 



The coeliac glands, sixteen to twenty in number, are grouped around the coeliac 

 axis in front of the aorta, above the origin of the superior mesenteric artery. At 

 the back of the transverse meso-colon they receive the efferent vessels from some 

 of the hepatic glands, the superior gastric glands, the inferior gastric glands, the 

 splenic and the pancreatic glands. Their efferent vessels join the intestinal lymphatic 

 trunk, and open into the receptaculum chyli. 



II. THE VISCERAL LYMPILiTIC VESSELS AXD GLAXDS OF 

 THE ABDOMEN AND PELVIS 



The lymphatics of the pelvic and abdominal viscera are considered separately. 



1. The lymphatics of the pelvic viscera. — The lymphatics of the bladder 

 pass partly backAvards, beneath the peritoneum, to join the rectal lymphatics, or 

 the lymphatics of the uterus and vagina in the female; and partly forwards, to 

 join the prostatic lymphatics and the lymphatics of the vesiculse seminales. These 

 anterior sets of lympliatics. together with tliose from the prostate and vesiculee 

 seminales, pass through the anterior true ligaments of the bladder, in which there 

 is a small gland, into the internal iliac lymphatics. 



The lymphatics of the rectum run backwards between the two layers of the 

 meso-rectum, in which tliere are four or five glands, through the sacral to the 

 luml)ar glands. At the lower part of the rectum the lymphatics become continuous 

 with the cutaneous lymphatics round the anus, and for this reason disease of the 

 lower part of the bowel involves the inguinal glands. 



The lymphatics of the uterus, vagina, ovaries, and Fallopian tubes. — 

 The su})crtici;d lympliatics of the uterus, whicli lie l)eneath tlie i)eritoneuni, pass, 

 together with those of the substance of the fundus and upj)er part of the body of 

 the organ, outwards, in the broad ligament, wliere they join the lymphatics from 

 the ovaries and Fallopian tubes, and pass up, with the ovarian vessels, to the 

 lumbar glands. The lymphatics from the lower part of the body and from the 

 cervix of the uterus run, together with most of the lymphatics of the vagina, along 

 the course of the uterine and vaginal vessels, and terminate in the internal iliac 

 glands. The Ijunphatics from the lower part of the vagina join the superficial 

 inguinal glands. 



The lymphatics of the testicle accompany the spermatic vessels, and terminate 

 in the lumbar glands situated immediately below the renal arteries. Hence in 

 carcinoma of the testicle the lumbar glands are those which first become enlarged, 

 the inguinal not being affected until the skin of the scrotum becomes involved in 

 the disease. 



2. The lymphatics of the abdominal viscera are divided into — fl) The 



