Fig. 114. Lymphatic Glands connected with the Mamma in an Adult. 



This figure is not drawn from a dissection but is a diagram constructed from viany sources. (Essay 

 by Frohse on the Axillary Lymphatic Glands.) — On the right side the superficial layer, on the lefit 

 side the deeper layer and the breast with its bloodvessels and lymphatics are shewn. A large part of 

 the Pectoralis Major Muscle and the Clavicle have been removed. — The internal set of glands are 

 coloured blue, the external not coloured, the intermediate green and the deep red. 



It is absolutely necessary to adopt a definite and universally applicable classification 

 ot the Axillary Lymphatics in order to readily comprehend their distribution. The number 

 of Glands varies enormously (8 to 43) and into these enter the afferent Lymphatic Vessels from 

 the Thorax and Arm. 



Of the afferent lymphatics which come from the Thorax, those from the Mammary 

 Gland have the greater practical importance. A superficial and a deep set, separated by the 

 Intercosto-Humeral Nerve and the External Mammary Vessels can be made out. 



The first regional gland for the lymphatics of the Breast lies, when the arm is ab- 

 ducted to a right angle, just below the free border of the Pectoralis Major Muscle at the level 

 of the 3rd rib. An inconstant deep gland is sometimes present; this Paramammary Gland is 

 depicted in the figure at the outer border of the beast. By Lesser enlargement of this gland 

 is considered characteristic of Syphilis. 



Usually from the Breast the Lymph passes through i to 4 glands which lie under cover 

 of the Pectoralis Minor Muscle, parallel to the inner side of the Axillary Vein. 



Thus it passes through several smaller glands — Subpectoral and Subclavian Glands. 



In rare cases, which one should always bear in mind, lymphatic vessels pass between 

 the two pectoral muscles and are associated with an Interpectoral Gland. But the more usual 

 connection lies with the neighbouring External Gland called the Intermediate. Fortunately 

 there seldom exists a direct communication with the deep glands, the Subscapular Glands and 

 thence along the nerve to the Latissimus Dorsi Muscle. When this group becomes affected, 

 the Neuro-Vascular bundle cannot well be left untouched in the course of a operation inasmuch 

 as it is very frequently surrounded by the lymphatics (v. Origin of Subscapular Artery). 



The lymph from the arm passes usually with the superficial vessels to a gland which 

 lies (cf. Fig.) on the Axillary Vein; thence under cover of the Pectotalis Minor Muscle along 

 the outer side of the vein. 



A lymphatic channel may accompany the Cephalic Vein and disappear in the Infra- 

 clavicular Fossa, between the Deltoid and Pectoralis Major Muscles, to enter a Deltoideo- 

 Pectoral (Infraclavicular) Gland. 



The Deep Lymphatics lie partly on the Subscapularis Muscle, partly along the outer 

 Thoracic Wall — the Subscapular and Thoracic Glands. 



Accordingly it becomes advisable to classify the glands of the Axilla in the follow- 

 ing way : 



A. Superficial Glands. 



Pectoral, Intermediate, Brachial, Infraclavicular (Deltoideo-Pectoral). 



B. Deep Glands. 



Subscapular. 



To these regional sets of glands the following intermediate glands have to be added: 

 Subpectoral, Subclavian and Thoracic. 



An important variation in the Pectoral Glands is the presence of an Interpectoral Gland. 



Apart from the usual lymphatic channels leading to the Axilla there are two (blue) 

 other important 13'mphatic vessels which in obstruction or removal of the former carry lymph 

 from the lower border of the breast to the Umbilicus, or to the Internal Mammary Artery. 



From the supero-internal part of the Breast, lymphatics run into the Superficial 

 Internal Pectoral Gland whence the lymph may travel into deeper regions. On the other 

 hand, lymphatics may emerge towards the surface and connect the Internal Mammary Lym- 

 phatic Glands with the Superficial Glands of the Axilla. (Cf. the transverse black line at the 

 upper border of the Mamma.) 



