Sessional_Paper_1905 — Page 435

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"The deep lymphatics of the liver accompany the branches of both the portal" "and hepatic veins. The vessels running in the portal canals issue by the tranverse fissure and, being joined by most of the lymphatics of the under surface of the organ, pass downwards in the small omentum, where they traverse some small "hepatic glands, to end in the coeliac. glands. The lymphatics accompany- ing the hepatic veins are larger and more numerous; they form five or six trunks "which pass through the diaphragin with the inferior vena cava, and enter the "gland's placed around that vessel, in union with the posterior lymphatics of the upper surface of the liver. The efferent vessels from these glands descend on the upper aspect of the vertebral portion of the diaphragm, and open into the lower

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end of the thoracic duct.

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Lymphatics of the Upper Limb.

In the upper limb, as in the lower, the lymphatics are arranged in a deep and a superficial set. These two sets of vessels, together with the superficial lympha- "tics of the greater part of the back and of the chest, converge to the axillary glands.

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"The lymphatic glands found in the upper limb below the axilla are neither large nor numerous; a few, however, are found in the course of the brachial artery, "and occasionally even of the arteries of the forearm ; two or more small glands are sometimes found in connection with the superficial lymphatics at the bend of the elbow, and one or two, more constantly, near the commencement of the basilic "vein, a little above und in front of the inner condyle of the humerus.

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THE AXILLARY GLANDS are generally ten or twelve in number; they vary, how- ever, considerably in their number as well as in their size, in different individuals; they are mostly placed along the axillary vessels, and receive the lymphatics which "ascend from the limb.; but a few (pectoral glands) also lie farther forwards on the serratus magnus near the long thoracic artery, at the lower border of the pectoral "muscles, and receive the lymphatics from the mamma and front of the chest; while "others (subscapular glands) are situated at the back of the axilla, along the sub- "scapular vessels, and are joined by the lymphatics from the back. One or two "small glands (infraclavicular) are also found immediately below the clavicle in the hollow between the pectoralis major and deltoid muscles; they receive some lym- "phatics from the outer side of the arm and the shoulder, and are connected above "with the inferior cervical glands, below with the axillary glands.

"The efferent vessels of the axillary glands ascend with the subclavian vein, "and form by their union in some cases a single trunk (axillary lymphatic trunk), "in others two or three large vessels, which terminate on the left side in the thor- acic duct, on the right side in the right lymphatic duct.. Sometimes they open* separately into the subclavian vein near its termination.

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"THE SUPERFICIAL LYMPHATICS OF THE UPPER LIMB are usually described as forming two divisions corresponding with the superficial veins on the outer and inner borders. On the front of the limb they arise from an arch formed in the palm of the hand by the union of two lymphatic vessels proceeding from each "finger, becoming more numerous in the forearm, they are found thickly set over "its surface; whence they pass upwards in the arm; the inner vessels in a straight "direction, following the course of the basilic vein, and those placed further outwards inclining gradually inwards over the biceps muscle to reach the axillary glands. "On the back of the hand also, two lymphatics proceed from each finger; and from "the copious network on the back of the forearm vessels pass over the radial margin, "and in greater number round the ulnar side to join those in front.

A few lympli- "atic vessels ascend with the cephalic vein to the glands in the infraclavicular fossa, "and these are joined by others which pass forwards from the shoulder.

THE DEEP LYMPHATICS OF THE UPPER LIMB correspond with the deep "blood-vessels. In the forearm they consist, therefore, of three sets, associated "respectively with the radial, ulnar, and interosseous arteries and veins. In their "progress upwards, they communicate near the wrist with the superficial lymph- "atics, and some of them enter the glands which lie by the side of the brachial "artery near the bend of the elbow. They all terminate in the glands of the axilla.

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