1108 SURGICAL AND TOPOGRAPHICAL ANATOMY 



and partly in the substance of the parotid gland. (4) The submaxillary, under 

 the cervical fascia, in the digastric triangle. This very ini])ortant group receives 

 lymph from the lower part of the face, lips, front of tongue, floor of mouth, and 

 all the salivary glands. Tliey drain into the superficial and deep cervical glands. 

 (o) Superficial cervical glands. These lie along the external jugular, between the 

 platysma and deep fascia. They receive lymphatics from the occipital, posterior 

 auricular glands, the ear, and upper neck, and also some of those from the parotid 

 and sulmiaxillary regions. They drain partly into the deep cervical, partly into the 

 axillary glands. (6) Deep cervical. These consist of two sets, — upper and lower, 

 — lying along the carotid sheath. They receive lymph from the superficial cervical 

 and submaxillary glands, the inside of the cranium, and pterygoid region, deep 

 muscles of neck, palate, tonsils, larynx, pharynx, thyroid body, and upper part of 

 trachea and oesophagus. The deep cervical glands empty into each other and below 

 into the mediastinal and axillary lymphatics, the right lymphatic duct, and thoracic 

 duct. Two other groups of glands — the one superficial, the other deep — must be 

 remembered. (7) The suprahyoid group is a term given to a few glands 

 situated in the middle line under the deep fascia below the chin. (8) Retro- 

 pharyngeal glands. These lie between the up])er part of the ])harynx and the 

 rectus capitis anticus major. They receive lymph from the naso-phar3'nx and drain 

 into the deep cervical glands. 



SUPERFICIAL ANAT03IY OF THE THORAX 



Bony points. — The top of the sternum corresponds (in inspiration) to the 

 fibro-cartilage between the second and third thoracic vertebra^, and is distant aljout 

 two and a half inches from the spine. If traced downwards, the sul^cutaneous 

 sternum presents a ridge opposite to the junction of the manubrium and body, and 

 the second costal cartilages on either side. At its lower extremity the xiphoid carti- 

 lage usually retires from the surface, presenting the depression of the scrobiculus 

 cordis, or ' pit of the stomach. ' This is opposite to the seventh costal cartilages 

 and the expanded upper end of the recti, and corresponds to the ninth thoracic 

 verteljra 1 behind. 



Sterno-clavicular joint. — The expanded end of the clavicle and the lack of 

 ])roportion between this and the sternal facet, on which largely depends the 

 moliility of this, the only joint that ties the ujiper extremity closely to the trunk, 

 can be easily made out through the skin. Behind the joint lie, on the right side, 

 the innominate artery, right innominate vein, and pleura; on the left, the left 

 innominate vein, the left carotid, and the pleura. 



Acromio-clavicular joint. — On tracing the clavicle outwards, it is found to 

 rise somewhat to its articulation with the acromion. This joint has very little 

 mobility, and owes its protection to the strong conoid and trapezoid ligaments hard 

 by. Owing to the way in which the joint-surfaces are bevelled, that of the clavicle 

 looks ol)li(iuely downwards, and it is an upward disi)lacement of the clavicle which 

 usually takes place on to the acromion. 



Ribs. — In counting these, the position of the second is denoted by the trans- 

 verse line at the junction of the manubrium and body of the sternum. The nipple, 

 in the male, lies between the fourth and fifth, nearly an inch outside their cartilages. 

 The lower border of the great pectoral corresponds to the fifth rib. The seventh, 

 the longest of the ribs, is the last to articulate with the sternum. AMien the arm 

 is raised, the first three digitations seen of the serratus magnus correspond to the 

 fifth, sixth, and seventh rihs. The ninth rib is the most ol)li(jue. The eleventh 

 and twelfth can l)e felt outside the erector s|)in{e. Owing to the ol)li(iuity of the 

 ribs, their sternal ends are on a much lower level than their vertebral extremities. 

 'Thus the first rib in front corresponds to the fourth rib behind, the second to the 



