LYMPHATICS 
 
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 1921 
 
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 QP 115.G13 
 
 Lymphatic system. 
 
 3 1924 000 312 086 
 
REFERENCE HANDBOUK OF THE MEDICAL SCIENCES. 
 
 Liyiupliaiin^loina, 
 Lyiupliansitis. 
 
 of the alTection at Ijirtli or in early life, by the groups of 
 Ihick-walled vesicles, often accompanied by telangiecta- 
 sis and warty surface changes, by the discharge of lymph, 
 when they are incised, and by the slow course. On su- 
 perficial inspection the affection may resemble most a 
 grovip of warts. 
 
 PiK>C)Nf)sis. — The lesions usually incri'asc slowly until 
 they have attained a certain degree of development, 
 when they remain nearly stationary. In one recorded 
 case there has been spontaneous involution. After oper- 
 ative interference, as in all forms of lymphaugiomala, 
 the lesions are very likely to reappear. 
 
 Treatment. — Excision and caustics have been tried, 
 but recurrence after the operation is not uncommon. 
 Electrolysis has been thought hy some to offer the most 
 hope of success, but in this case also recurrences have 
 been recorded. Each vesicle is to be transfixed by a 
 needle attached to the negative pole of a galvanic bat- 
 tery, eight or ten cells being employed. The poor results 
 of treatment probably are due to the presence of deep 
 seated anastomoses. Jo/m T. Bvwen. 
 
 LYMPHANGIOSARCOMA. See S,tre<>imt. 
 
 LYMPHANt3ITIS.~All the tissue elements may be re- 
 garde<l as being bathed in lymph, which appears first in 
 innunu'ralile, minute, irregular gaps in the tissues, wliicli 
 gaps communicate in various ways with each other, and 
 with miiuite lym|)hatic vessels, which latter, when traced 
 onward from their l)eginuings, ])i-e,sently assume a struct- 
 ure comparable to tliat of narrow veins with very deli- 
 cate wallsand extremely numerous valves. These valves 
 open aw.-iy from the gaps of tlie tissues, as the vidves of 
 the veins open away from the capillaries. Tlie lymphatic 
 vessels etiierging from thenetwdrk of gaps unite to form 
 somewhat larger ones, which pass eitliei' lo a neighlioring 
 lymphatic gland or to join some larger lyuipluitic trunk. 
 The Ij'mphatics are arranged into a su|ierHcial and a deep 
 set. The superficial lympliatics on tlie surface of llie 
 body are placed immediately beneath the integument, 
 accompanying the superficial veins; they join tlu' deep 
 lymphatics in certain siluations by perforating the deep 
 fascia. The dee|) lymphatics, fewer in uumlxT and 
 
 larger than the sujierficial, accomi>any the deep lil 1- 
 
 vessels. Finally, the entire .system ends in numerous 
 vessels which open into two main trunks of very uneipial 
 importance — the thoracic duct and the right lymphatic' 
 duct. Lymphatics are found in nearly every texture and 
 every organ of the body which contains blood-vessels. 
 Interposed at nunu'rous points in the course (.if the lym- 
 phatic vessels are the lymphatic nodes, which are small, 
 solid, glandular bodies through which the lym|ihatic 
 vessels pass. Ljniph is the exudate of some of the liijuid 
 constituents of the blood as it circulates through the 
 capillary blood-vessels into the tissue gajis or spaces, and 
 carries nutriment to the tissues. It then receives from 
 the tissues the products of their activity, and is collected 
 from the lymph spaces into the lymph channels, ■\vlieuee 
 it is carried to the lymph nodes, which act as filters for 
 the lymph, besides adding to the lymph the lyin|iho- 
 cytes, which act as scavengers (phagocytes) in the lymph 
 and blood. 
 
 Reticular lymiihangitis is applied to iiiHammation of 
 circumscribed areas of lymphatic radicles, tubular lym- 
 phangitis to that of the larger continuous lymphatic 
 trunks. Both forms often coexist. Either may be acute 
 or chronic. Since we now know that all infiammation of 
 lymph vessels is of microbic origin, we may drop tlie 
 terms " idiopathic " and " traumatic " as being no longer 
 descrijitive. The lymphatics are so widely distriliuted 
 that they must be severed or torn in e\ery cut or bruise 
 to a greater or less extent; but, as a rule, they collapse 
 at once and give no trouble. From their open mouths, 
 during the first hours following the recci|it of a wound, 
 comes much of the serous flow, to dispose of which drain- 
 age is necessary. This outward flow of the lymph, to- 
 gether with its coagulation and the collapse of the lymph 
 vessels themselves, prevents the absorption into the or- 
 
 ganism, in most instances, of septic material. While lym- 
 phangitis is. generally syjeaking, the consequence of a 
 wound, yet tliis is not an invariable rule, since infection 
 has been known to penetrate through the unbroken skin 
 of the hand, as seen in sepsis following immersion of the 
 unwounded hands in the fluids of a cadaver at an autopsy, 
 and also through mucous membranes in which there is no 
 abrasion or scratch to be found, especially in the case of 
 the throat, uterus, etc. The absorption of infective ma- 
 terial is imdoubtedly greatly facilitated by friction, pres.s- 
 ure, the removal of the outer corneous layer, or the con- 
 fining of a discharge tmder tension. Recent woiuids are 
 much more likely to be attacked than granulating ones, 
 because granulations themselves, .so long as they are un- 
 injured, do not absorb, the current selting in the o|)posite 
 direction toward the surl'ace. Whatever the irritant may 
 be, it probalily does not cause inflammation of the wall of 
 the vessel unless it is arrested ; if this does not take place, 
 it is luu'ried on to the neighboring lymphatic glands, and 
 sets u|i infiammation there. Illustratiim of this is seen in 
 cases in ndiieli singeons have received the tiniest needle 
 prick, so slight as to leave no mark, in which the first in- 
 timation of scjisis is foimd in inflamed lymph nodes in tlie 
 neighborhood. The heat of the sun and the Roentgen 
 rays produce an inflammation of the skin in which the 
 lymphatics share to a certain extent. Lymphangilis is 
 incidental to the course of specific disea.ses, such as sear- 
 let fever, measles, diphtheria, tidierenlosis, syphilis, and 
 gonorrhiea: in these, however, the inflainmation of the 
 lymphatic nodes is the mori' pronunent feature. A typi- 
 cal lymphangitis is seen in erysijielas (which .see). It 
 may also result, from the liites of insects and venomous 
 re]itiles. It is a constant lesion in bubonic i)lague. 
 
 P.VTIIOI.ooY. — The changes are best seen in the larger 
 trunks. Their eiidothidial cells swell, lo.se their distinct- 
 ness of outline, and to a variable extent become detached. 
 The walls of the lymph vessels and the delicate sur- 
 rounding cellular tissue become more or less den.sely infil- 
 trated with pus cells, Hb}'in, and senun. The lumen of 
 the vessel, the interstices in its walls, and the cellular 
 sheath are filled with a coagulating exudation. The 
 stream of lymph through the ves.sel ceases because of the 
 thrombus. The lilood vessels surrounding the inflamed 
 area dilate, and the lilood circulates more ra]iidly and 
 in greater iiiiaiility. The fulnro course, whether it is 
 to be either resolution, organization, or supimration, de- 
 IXMids uiion the cause. If the irritant be slight and tran- 
 sient, resolution may begin at once. The thrombus 
 liquefies within the lumen, and the exudate within and 
 without the walls is absorbed. The endothelium is re- 
 generated and the circulation is re-established. Organi- 
 zation is likely to occur if the irritant action is chronic 
 and persistent, as in sy]iliilis. The lumen becomes oc- 
 cluded througli transformation of the thrombus into con- 
 nective tissue, and the coats of the vessels and the cellu- 
 lar tissues in which they lie become hard, dense, and 
 sclerosed, likewise from organization of the exudate into 
 connective tissue, and some degree of permanent thick- 
 ening results in the ti.ssues. Suppuration takes place 
 when virulent micro-organisms are the exciting cause, 
 producing coagulation-necrosis of the thrombus and exu- 
 date, and death of the vessel wall and surrounding 
 tissues, resulliiig in cellulitis, or abscess, which may be 
 circumscribed, or diffuse and spreading. The related 
 neighboring lymph nodes are usually implicated also. 
 The results of the extension of infection along the lym- 
 jihalic channels are seen in some cases of siqipurativeap- 
 peiidicilis, where we may find inflamed mesentei'ic glanils, 
 isolated abscesses about the liver, emiiyema, et<'. 
 
 Sv.MPTONrs. — In the reticular form the inflammation 
 shows itself in I'ed, tender, a'dematous, swollen jiatches, 
 which may succeed each other up the limb, one fading as 
 a neighboring area blooms out. The inflammation ex- 
 tends from the ]ieriphery. Pain is always present and 
 varies, like the other symptoms, with the severity and 
 extent of the ]irocess; it is increased by movement, and 
 is accompanied by a feeling of tension in the part. Or- 
 dinary erysipelas presents a typical form of reticular 
 
 623 
 
liynipliatio System. 
 Liymphatlc System. 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 lymphangitis in Avbich the infiammatioa is produced by 
 tlie invasion of tlie lymi^hatic cliannels by the streptococ- 
 cus of erysiiK-las. If tlie iiiflannnation is extensive there 
 niaj' be a consideral>le Ij'niphatic ledenia and the circum- 
 ference of a limli may be much increased. Some celluli- 
 tis accompanies all lymphano'itis, and some lymphangitis, 
 on the other hand, attends all cellulitis. Which element 
 preponderates is very often a matter of uncertaint}', but 
 tlie question is not an important one, because both re- 
 quire the same treatment. 
 
 The tubular variety shows itself most plainly when the 
 .superficial vessels are involved. Tljese latter appear in 
 the skin as wavy red lines travelling toward the neigh- 
 boring lymphatic glands. They are \'ery teinler to the 
 touch, slightly raiseil fnrai the surface, with a cord-like 
 leaded feel, due to the infiltration and plastic thrombosis 
 in and around them. Sometimes the}' are qiute narrcjw ; 
 sometimes, when the i>oison is very active, an inch or 
 more in breadth, from extension of the inflammation to 
 the surrounding cellular tissues. At the same time the 
 glanils are swollen and tender, and, if the affection is ex- 
 tensive, the limb below may be (edematous. Here and 
 there the red lines disappear, wlieie the stqierficial lym- 
 phatics empty themselves into the deeper set, or swell 
 ovit and become broader opposite plexusi-s and valves. 
 In cases of virulent infection the inflammation may result 
 in the formation of small abscesses at intervals along the 
 course of the vessels before the glands are reached. 
 
 When the deeper vessels are affected, the diagnosis 
 may not be easy if no superficial inflammatifin be pres- 
 ent. Usually, however, faintly outlined patches of red- 
 ness are visible here and there upon the skin, where the 
 superficial plexu.ses conununicate with the deep ones. In 
 an}' ease deep pressure along the course of the affected 
 vessels is painful, but otherwise most of the usual signs 
 are wanting. Diagnosis between it and ordinary cellu- 
 litis is difficult. In both varieties the glands are apt to 
 be sAvollen and tender. 
 
 The constitutional S3'mi>toms will vary according to 
 the extent of the local inflammation, the severity of the 
 cause, and the general health and resi.sting power of the 
 patient. Simple lymphangitis is accompanied by a vary- 
 ing degree of fever, with the usual results thereof — mal- 
 aise, thirst, headache, anorexia, etc. When stippuration 
 sets in, the general symptoms become much aggravated, 
 pain is severe and prostration extreme, and higli fever 
 with possibly chills aud sweating makes itself evident. 
 In severe eases septica'mia may develop. 
 
 PnoGNOSis. — Simple lymphangitis is rarely serious and 
 runs its course iu from a few da3's to several weeks; the 
 general health and robustness cjf the patieut have a 
 marked infiuence, recovery being slow in the subjects of 
 alcoholism, chronic gout, diabetes, and renal disease, and 
 in those debilitated by Jioor living and overwork. When 
 sup|>iiration supervenfs (leading to a cellulitis) or when 
 some virulent septic ])oisi)n is the cause of the troid)le, 
 the illness may ass\nni; a grav(; eharaeler, viz., that of 
 septicaania. If thi/ vessils Avhich run in groujis are ex- 
 tensively destroyed, a condition of scjHiI (etleina is likely 
 to persist which may leave the limb more or less cripiilecl. 
 
 Di.voxcisis. — Phlefjitis is closely rehitecl to lymphan- 
 gitis iu its symptoms, but a thrombosed \f\n foims a 
 deeper-seated, coarser cord tlian doi.'S a siniilai'ly alTected 
 Ij'mph vessel, the cutaneous redm^ss is not so \ivi(l, tla^ 
 pain is less acute, the general f(;ver is not so intense, and 
 the tendency to glandular jnvf)lvemenl. is miii'li less. In 
 flammation of the deep lymjihatics may at times be 
 differentiated from ordinary cellulitis by an earlier in 
 volvement (in the case c)f the former of these two inllam- 
 mations) of the neighboring lymphatic glands, by th<' 
 presence of lymphatic (edema, and by the appeariuiee of 
 psitclies of superficial reticular lymphangitis at points of 
 anasto}nosis with deeper ti-unks. 
 
 TiiE.VTMr-.NT. — The first indication is to lemove the 
 cau.se, if that can be detected. All jiossible sources of 
 infecti(]n should b(- sought for and ajjpropriately treated. 
 Pustules and abscesses slajuld be ojiened and drained, 
 unhealthy wounds are to be cleaned thoroughly and 
 
 opened further if drainage is not sufficiently free. These 
 avenues of infection should be encased 'in compresses 
 which are kept wet with some antiseptic solution. The 
 part should be put at rest, and the limb elevated to di- 
 minish the amount of blood entering it, as well as to fa- 
 cilitate the retui'n of the Ij'iiqjh. Tension within tlie area 
 of lymphangitis, if very great, should be relieved by in- 
 cision and drainage, without waiting for suppuration to 
 take place. The whole affected area should be kept cov- 
 ered with compresses continually wet witli some sooth- 
 ing, antiseptic solution, such as aluminum acetate, 
 Thiersch's solution, creolin (one-half per cent.), bichlor- 
 ide (1 in 2,(J(J0), or a solution of lead and opium. These 
 wet dressings should extend above and include the swol- 
 len lynqiliaJie glands. Hot fomentations in some ca.ses 
 may be more grateful than tliec(joler solutions. As .soon 
 as pus forms or is suspected, the abscess should be freely 
 incised, evacuated, and drained. In severe cases in which 
 the process threatens to spread and is difficult to control, 
 a very eifectual means of combating this is found in the 
 continuous iininersion of the Ihnb iu an iced solution 
 such as any one of those mentioned above. 
 
 Constitutional treatment C(]nsists iu supporting and 
 eliminating measures. The diet should be liberal and 
 solid food should not be withheld unless a high degree of 
 fever causes it to disagree. The bowels should be kept 
 freely open. Quinine, and later iron in addition, are the 
 most efficient medicines. Stimulants will be neede(f only 
 in severe cases and should then be given in large doses 
 (one to two ounces of whiskey every two hours). It seems 
 remarkable (much discu,ssi(m to the contrary notwith- 
 standiug) how favorably a free exhibition of alcohol in 
 severe septic infections will affect the constitutional 
 symptoms, as shown by a drj', brown tongue becoming 
 cleaner and moister, by improvement in the appetite and 
 in the cerebral sj'mptoms, b.y strengthening and slowing 
 of the heart, and by a diminution in the degree of the 
 luostration. Persistent a?dema and stiffness in muscles 
 and tendons, after subsidence of the inflammation and 
 healing of the wounds, are to be overcome by bandag- 
 ing, hydrotherapy, electrieit}', and massage. It may be 
 necessary to give analgesics aud hy]inotics, such as the 
 bromides, codeine, and trioual, during the acute stage. 
 Opium should be used only as a last resort. 
 
 (J/iroiiic Lt/iiij)h<uif/itis. — This is seen in the course of 
 certain diseases, such as elephantiasis (which see), bu- 
 bonic plague, tuberculo.sis, syphilis, etc. Tuberculous 
 lymphangitis occurs both in large and in small lymph 
 vessels in whose walls miliary tubercles and diffuse tuber- 
 cle tissue may grow, producing i)artial or comidete ob- 
 struction. Tills may occur independently, but it is most 
 frequently seen in connection Avith tubeiculous inflam- 
 mation of adjacent structures, jiarticularly the lymph 
 nodes. In the vicinity of tubeiculous ulcers in the intes- 
 tines, the subserous lymi)li vessels, which pass from the 
 ulcers, are often distended with tlie products of tubercu- 
 l(]us inflammation, which makes them look like dense 
 white knobbed cords. Syphilitic infianimation of the 
 lymjili vessels not iufretjuently occurs in (he vicinity of 
 syphilitic ulcers iu the primary stage. In later stages 
 tiiere may be tlii('kening of the walls of the vessels and 
 the development of gummy tumors in and about them. 
 Vhiri'iirc Aiilinr Mc Wil/iiniig. 
 
 LYMPHATIC SYSTEM.— (Symaiy ins: Abs.n-bcnt sys- 
 tem ; Latin, Siistciiut liiiiiphitlicttni : French, Sjinti'ine 
 Jijiiijihiiliqiic ; Italian, Sixlciint linfniicii ; (ierman, Ij/iiipli- 
 si/itriji oiler Sniif/iKler.ii/nti'ni.) The lymphatic or lymph 
 vas(aila,r .sy.stem consists of the \'essels and spaces con- 
 taining lymph or chyle (colorless or white blo(.)d), and of 
 the lyiii|)liatic or conglobate glands situated in the course 
 of the vessels, and through which the lymph must perco- 
 late in somewhat the same manner as water passes 
 thnjugh a sponge. This system is an a])pendage of the 
 blood-va.scular system, its two terminal trunks, the 
 thoracic duct and the right common lymphatic trunk, 
 ending in the great veins at the base of the neck. 
 
 A tolerably correct jiictorial idea of the entire vascular 
 
 <;2-i 
 
 ^A 
 
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 lyyiiiplaatic System. 
 Lynipliatie System. 
 
 system may be formed by considering tlie blood-vascular 
 part as made up of a great tree, the heart forming a 
 short trunk and the arteries, veins, and capillaries, tlie 
 branches; but there is present tlie untree-like character 
 of the direct union of the terminal twigs of the arteries 
 and veins, that is, the venous and arterial capillaries are 
 continuous. The lymphatic system may then be repre- 
 sented by two vines of uneijual .size, but which togellier 
 follow all the blood-vessels to their ultimate ramifica- 
 tions, antl in many jjlaces even send minute twigs be- 
 yond them. Tlie analogy with a vine is further borne 
 out liy I lie lympliatic ves.sels, as they remain of a more 
 uniform diameter than the blood-vessels; and, tinally, the 
 terminal twigs, like tliose of a real vine, end freely or 
 blindly, often in slight exjiansions like leaves, thus form- 
 ing a marked coiitra.st with tlie terminal twigs of arteries 
 and veins, which cannot be properly said to terminate at 
 all. In a word, the blood-vascular system forms a com- 
 plete circle or circuit in itself, while the lymph-vascular 
 system joins the blood-vaseidar system at its central or 
 trunk end, but ends blindly at the periphery, 
 
 His'r(iKic.\i.. — It is not to he wondeied at that the 
 l_ymi)hatic system should not have been discovered and 
 investigated before the circulation of the blood and the 
 general lelatioiis of the blooil-vaseular system had been 
 investigaleil and understood; and yet, from the ]in>ini- 
 nence of the lymphatic glamls, they were seen )iy Hip- 
 pocrates; but, lijiving no iiDliiinof llieir true I'elalinns. 
 he classed them willi the oilier glandular siruetures of 
 the body; so, too, there is si rung reason Inr bi'lie\-ing 
 that the laeteals were seen in aninials liy llie two famous 
 Ale.\andrian iiliysieians. Erasislratus and H"rn]iliilus ; 
 liut their .significance was not enniprehended. Alioiit 
 the middle of the si.xfeeiith century (I "ilif), Euslaeliius 
 found tlie thoracic duct in the horse, and traced it, Imlli 
 to its beginning in the abdomen, when' he became be\\il 
 dercd, and to its termination in the great \eins in I he 
 neck. He did not ])rofess to uiidi'rstand I lie sigiiilie:niee 
 of this x'essel, but named il, friiiii its enldr and posilimi, 
 com iilhii thoniris. 
 
 It was not until 1033, when Aselliiis saw the laete;ils 
 in a dog, that the real significance of ihese vessels was 
 appreciated. The whole scieiilific world was about this 
 time aroused liy till' cpocli-niakiiig discussions and dis- 
 coveries of Hai'\'ev on the circulation of the blood, and 
 everything like a vessel was scrutinized willi ini|uiiing 
 eyes. The story of Aselliiis in conneclion with tlii' dis. 
 eovery and eomiu'ehension of the significance of the lac- 
 teals will never lose ils iiilerest as long as the human 
 mind is striving to compreheml the uui\'eise, eillier in its 
 details or in t]w c/ixeiiihli'. Having opened the abdomen 
 of a living dog, to show to some friends the arrange- 
 ment of the nerves and the Avorking of the diaphragm, 
 Asellius saw in the mesentery some white cords in addi- 
 tion to the ner\es and vessels with which he was famil- 
 iar, and upon cutting one of them and seeing a white 
 liipiid exude, he' immediately recognized that tliej' were 
 a new kind of vessel. 3[ost birtunately for him and for 
 .scienc<\ the dog, killed on the following day to find out 
 .still more about these curious white veins, showed none 
 of them. Fortunati'ly, hecau.se it leil Ascdlius to con- 
 sider llie conditions under which they appeared in the 
 hrst ilog, and wherein the conditions din'ered in the sec- 
 (Uid. With the sure comprehension of a scieutitic mind, 
 he saw that the oii)y essential difference lay in the jires- 
 ence of parti}' digesled fond ill the tirst case, and in the 
 absence of food in the second. When this condition was 
 realized in a third dog, the lacteal vessels reappeared, 
 and the ndation between the piroducts (d' digestion and 
 these vessels was fully establislied for the dog. 
 
 Not content with the experiments on tlie dog, Asellius 
 examined many otlier animals, showing in every ease 
 thai there was a constant relation betwei'u digestion and 
 the jiresence of the white fiuid in the lacteal vessels. 
 Owing to the powerful infiuence of the prevailing o]iin- 
 ion that all matter must first go to the liver to be assim- 
 ilated, Asellius siijiposed that the newly found laeteals 
 extended to the liver. It is difficult to ccauprehend how 
 Vol v.— 40 
 
 a mere hypothesis could blind the eyes of .so skilled an 
 anatomist, but so it was, and the belief that the laeteals 
 passed to the liver continued to prevail for nearly 
 twenty -five years. 
 
 About 16.50, the great facts concerning the l3"mphatic 
 system, as they are understood at the present day, were 
 discovered by four men in different quarters of Europe. 
 In France, Pcc(piet showed that the reiiie aqiinxie Itepatis, 
 or lymphatic vessels connected with the liver, were not 
 the continuation of the laeteals to the liver, but were 
 vessels extending either to the laeteals, or with them 
 into a common reservoir into wdiieh both ojiened, and 
 that the reservoir was continued as a somewhat smaller 
 vessel (the thoracic duct) through the tlajrax, to termi- 
 nate in the great veins in the neck. The same facts were 
 observed by Rndbeck, in Sweden, at about the .same 
 time, and completely overthrew the notion that all ab- 
 sorbed food must hrst pass to the liver for assimilation 
 before entering the blooil; for here was ti/ij>iirnil/i/ the 
 only path of the absorbed food, and it terminated di- 
 rectl)' in the great veins on their way to the heart. 
 
 At about tills date, Bartholin in Denmark, .lolive in 
 England, and Rudbeck in Sweden, discovered tlie gen- 
 eral lymplialics of the body. They also showed that 
 these Ij'inpliatics {nixn li/iiiphnlini of Bartholin, nixii 
 ii(/iiiis<( of Kudlieck), or serous vessels, either united wdth 
 the laeteals in the r/ii/Znri/sl. or joined the thoracic duct, 
 and consei|uenlly the lymph and chyle or lacteal Huid 
 unite, and togetlier How into the great veins. In other 
 Avords, they sho\\'ed that the laeteals lorm only a S]iecial 
 part of a great system distributed throughout the entire 
 body. It may lie said, in jiassing, that when the facts 
 coiieerniiig these new vessels were |iresented to Harvey, 
 he dill nol welcoine tlie newly ac.'iiuired knowledge. 
 I)oiibtli-ss the weight (d' years liad iiiienched the enthu- 
 siasm of iinestigation, and lie may have been troubled 
 lesl these newlv' disco\-ered vessels might in some way 
 prii\ e a stiimbling-bloi-k to his siiii]ile and easily compre- 
 lieiided exi>laiiation of llie lilood-X'asciilar syslem. 
 
 Not much was added to the knowledge of the Ij'in- 
 |iha,lic syslem for m^arly one hundred years after the 
 main facts were established, and naturally, in those early 
 times, with bolli undeveloped methods and sii])erstitioii 
 as inipediinents, knowledge was only general iind ob- 
 tained princi]ially liy iin'estigating the lowia- animals. 
 And yet, in 103S, a criminal was ]iro]ierly fed before 
 execution, and the laeteals demonstrated in the mesen- 
 tery aftia- death, thus showing conclusively that the ab- 
 sorbi'd food in man takes the saim^ course as in animals. 
 
 ISrtween ITIiO and ITMT there was a renewed activity 
 in investigating tiie lymphatic system. In England the 
 Hunters, Hewson, and (Jriiikshank, not only investi 
 gated the liimian lymjiliatics, but ])ushed their investi- 
 giilions to all forms of vertelirates, and they were found 
 abundantly in all forms. The Miinros, in Scotland, were 
 also very active. In Italy the great anatomist, Masca- 
 gni, was preparing his magniflccut work on the human 
 lymphatics, a work which remains a standard to the pres- 
 ent day; and reduced copies of his splendid folio plates 
 are stitl to be found in every extensive account of this 
 system. 
 
 As in all departments of human activity, the crowning 
 discoveries in the lymphatic system are due to the work 
 of an almost untold ntimber of men; and j'ct a few pre- 
 sent the principal and salient features so unencumbered 
 with useless, distracting, or foreign details that they are, 
 fir the majority of minds, the true discoverers. Thev 
 make the special knowledge a part of the knowledge lif 
 the race. So in the above historical sketch many names 
 have been omitted, and undue prominence may have 
 been given to others; barring these ilefects, it is hoped 
 that it represents fairly well the jirogress from vague 
 and uncertain to certain knowledge of this system. 
 
 Since the work named above, something noteworthy 
 has appeared almost every decade, liut it has been usu- 
 ally toward the elucidation of special iletails of function, 
 origin, distributifin, or structure, rather than an investi- 
 gation of the whole field. The work of Sappey ' foi'iiis au 
 
 ^>_'.^ 
 
Lyiupliatic System, 
 liympliatlc System. 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 exception to this general statement. His investigations 
 have extended over more than forty j'ears, and witli a 
 rare slvill and all the refinement of modern anatomy, he 
 has not only done much on the general subject both in 
 human and comparative anatomy, but some of the diffi- 
 cult points have been elucidated by him. His atlas is 
 probably, without qualification, the most important mon- 
 ograph that has appeared since Mascagni's.'^ 
 
 General Structure in Man and Animals. — Consid- 
 ered as a whole, the lymphatic system consists of minute 
 and larger spaces, of definitely walled capillaries and 
 larger tnmks. Lymphoid or adenoid tissue seems also 
 to be an integral part, and in man and the higher forms 
 this adenoid tissue is, in part, aggregated into special 
 masses, the lymphatic glands or nodes, situated in the 
 course of the vessels and forming a sort of sponge-work 
 through which the lymph nuist jx'rcolate on its course to 
 join the blood-vessels. 
 
 Like the blood-vessels, the lymphatics ma}^ be divided 
 into groups according to their position, useetal — subcuta- 
 neous, subserous, or superticial, and entnl, — subaponeu- 
 rotic, submucous, or deep, and also as vm-eral — those be- 
 longing to tlie heart, lungs, urinary and generative organs, 
 and the alimentary canal. Part of these, i.e., those from 
 the small intestine, are called lacteals or chyle vessels. 
 All of the larger vessels possess more numerous valves 
 than do the veins. 
 
 In distriljution, the lymiihatics follow mostly the 
 course of the blood-vessels, but this does not apply to 
 the subcutaneiius lymphatics, as will be seen by compar- 
 ing Figs. 3267, 3368, and 336i), with figures showing sub- 
 cutaneous veins. Furthermore, in many situations 
 lymph vessels, or Ij'mjih canals and spaces, extend be- 
 yond the blood-vessels and more intimately envelop the 
 tissue elements. 
 
 In general, however, it may be stated that the eetal 
 or superficial lymphatic trunks follow the veins, and tin' 
 deep or ental lymi)hatie trunks follow the arteries. This 
 anatomical relation was shown in 1K36 by Breschet for 
 the adult, and in 1902 by Dr. Florence Sabine'" for the 
 embryo. 
 
 Tlie lymphatic capillary network, although agreeing 
 in general api)carance with a blood capillary network, is 
 composed of larger vessels and its mesh is coarser. With 
 the larger vessels the anastomoses are more freqiient, 
 but ditt'er in character from the anastomoses of blood- 
 vessels inasmuch as the parallel vessels divide e(|ually 
 or unequally, and imite at a very acute angle, making a 
 long, narrow-meshed network (Fig. 3268); and nowhere 
 is found such great disparity in the size of tlie vessels 
 as is found with the great arterial and venous trunks. 
 Even the terminal lymphatic trunks are minute as com- 
 pared with the veins into which tliey empty. The entire 
 lymphatic sy.stem is supposed to have a capacity one- 
 lialf as great as the arteries, and perhaps more, but no 
 very close appro.xiTnation can b(^ made on account of the 
 structural ])eculiurities of the lymphatics, and the im- 
 mense number of valves. In man and the higher forms, 
 all lymph traverses one or more lymphatic glands before 
 joining the common lymphatic ti-unks. The exceptions 
 to this rule which have been reported from time to time 
 have not been verified. 
 
 In the higher mammals the general arrangement and 
 distiibution of the lynqjliatics is as in man. So far as 
 has been investigated, however, the lymphatic vessels 
 are fewer in number; this is markedly the case with the 
 cutaneous and subcutaneous vessels. The lymiiliatic 
 glands, although abundant in the horse and o.x, are less 
 numerous in mo.st other forms. Groups of glands in man 
 are often represented by a single one or are wholly ab- 
 sent. Althcjugh this is the case, a vessel never joins the 
 main trunk without first traversing one or more glands 
 (Figs. 3281, 3384, and 3286). In the lowest manunals 
 there is a strong tendency to synnnetry in the lymphatic 
 system, the right and left terminal trunks being more 
 nearly equal in size, and in area from which the vessels 
 come. This tendency is also marked in the horse, and 
 especially so in the rabbit; it is frequently observed in 
 
 the cat, and occasionally in man. The crossing of con- 
 siderable trunks from one side to the other is more 
 marked in the lower manunals than in the higher, but 
 even in man considerable trunks not infrequently cross 
 from one side to the other (Figs. 3264, also 3281, 3386); 
 and in all the forms there is the closest possible relation 
 between the two sides through the lymphatic plexuses, 
 that is, networks formed by groups of lymphatic glands 
 and their connecting lymphatic vessels. While it is not 
 uncommon to speak of a network of lymphatic vessels as 
 a plexus, the term is coming to be restricted rather to a 
 lymphatic network in which the glands form the nodal 
 points of the mesh (see Fig. 3363). 
 
 (If the animals below the manunalia, the birds possess 
 few lymphatic glands, and these are mostlj- restricted to 
 the neck. A cutaneous and subcutaneous lymph net- 
 work has not been demonstrated in the birds. Those 
 that have been shown, it is siqiposcd, correspond with 
 the ental and visceral lymphatics of mammals. The two 
 trunks opening into the veins of the neck are symmetri- 
 cal, that is, equal right and left trunks. There are also 
 two openings for the lympliatics in the pelvic veins, and 
 lymph hearts are found in this region, but they have 
 muscular walls in only few adult forms (ostrich, casso- 
 wary, stork, and sea-gull), although they are contractile 
 in the embryos of birds so far as investigated. Contrac- 
 tile lymph hearts are nevei- present in man and the other 
 mammals (but see below imder Development). In addi- 
 tion to the birds mentioned, they are found in reptiles, 
 amphibia, and some fislies. They are mostly situated in 
 the pelvic region, and possess striated muscle which is 
 paralyzed by curare like the skeletal nuiseles (Kolliker 
 and Ranvier). In the tailhss amphiliia (Uanida?) there is 
 a pair of lymph hearts on the thoracic ducts as well as 
 in the pelvic region; and with some elongated amphibia, 
 SiiJaniitndj'a m(ii'nloi<ii^ and t^lirdon. piM-ifo^-iini^, eight to 
 twelve lymph hearts exist along the sides of the body 
 and tail, at the junction of the dorsal and ventral body 
 muscles. Finally, in some elasinobranch fishes the num- 
 lier of lymph hearts is vci'y great (Sappey). 
 
 Below the birds the lynqihatic glands are ab.sent, their 
 place being supplied by lymphoid tissue and by special 
 fine vascular rete or networks into which the vessels 
 break up in their course (f)wen has described mesenteric 
 glands in the crocodile). Perfect valves like those pres- 
 ent in manunals are fomid in birds, less perfect ones in 
 rejitiles and amphibia, and finally in the fish-like forms 
 none at all are found, so that the system may be injected 
 toward the periphery like the arteries. 
 
 TorooRAi'iiiCAL Anatomy tw the Lymi-hatics. — 
 While it would seem more |ihilosophical to treat the vari- 
 ous parts of the lymphatic system in their entirety 
 tlu-oughout the whole body — viz., the eetal. supei-ficial, 
 or subcutaneous; the ental, subaponeurotic or deep, and 
 the visceral lymphatics with the <iiiTes|)on(ling glands 
 and lymphoid tissue — it is better practically, both i'or the 
 purpcses of demonstration and study, to consider all the 
 lymphatic structures belonging to a given region at one 
 time. This method is also really in accord with nature, 
 because all the lym])hatle structures in any moderately 
 well-defined region of the body are, sooner "or later, inti- 
 mately associated and really fcinn one whole for the given 
 region. 
 
 Following the plan ordinarily i)uisued, the lymphatic 
 vessels will be considered as extending in the direction 
 in which their contents flow as with the veins, and also 
 in order in which they must be demonstrated by injec- 
 tions. This will require the investigati(m to coi'nmence 
 at the periphery and extend toward the centre. In the 
 descriiitions here givcTi, usually only the trunks contain- 
 iTig valves will be considi'ved. The origin of the vessels 
 in the ti.ssnes and the valveless networks will be con.sid- 
 ercd below, under the origin and relations of the lym- 
 phatics. When the term plexus is useil in this article 
 it will be restricted to a lym])hatic plexus composed of 
 lymphatic glands with their connecting lymphatic ves- 
 sels, and will not apply to a netwoi'k of vessels without 
 glands. After the vessels of a region have been de- 
 
 6'2H 
 
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 Lyiupliatie System. 
 Lyiiiplkatic System, 
 
 scribed, there will be given a list of the groups of the 
 lymphatic glands and the plexuses belonging to the re- 
 gion, together with the source and destination of the 
 afferent and efferent vessels. This will serve both to 
 give the proper information concerning the number and 
 position of the glands, and also to form a condensed sum- 
 mary of the lymphatic s}'stem in the region. 
 
 Lymphatic Vessels of the Head, Face, and Neck. 
 — Tlie ectal or subcutaneous lymphatic vessels of the 
 head and face are very abundant and follow, in general, 
 the course of the occipital, temporal, and facial blood- 
 vessels, converging somewhat toward the great vessels 
 of the neck ; they traverse one or more of the lymphatic 
 glands which form an irregular zone nearly around the 
 base of the head (Fig. 3363), and finally enter the internal 
 jugular plexus, and terminate in the thoracic duct on the 
 left, or the common lymphatic trunk on the right (Fig. 
 3279). In addition to the general description just given, 
 the lymphatics of the eyelids, nose, and ear require spe- 
 cial mention. 
 
 The lymphatics of the eyelids and palpebral conjunc- 
 tiva form a very abundant network, although it is some- 
 wliat difficult to demonstrate. Those from the conjunc- 
 tiva wind round the edges of the lids and mingle with 
 those of the integinnent, which are especially abundant 
 at the edges of the lids. The branches unite into two 
 great groups at the canthi of the lids, those at the lateral 
 canthus extending to the parotid Ij'mpliatic glands, 
 while those at the nasal canthus join those from the mid- 
 dle of the forehead and tlie nose, and extend to the sub 
 maxillary lymphatic glands (Fig. 32(J3). 
 
 The skin of the nose, especially the thicker part around 
 tlie tiji, where the large sebaceous glands are so abun- 
 dant, is pos.sessed of a very dense network of lym)di 
 capillaries and minute trunks. These trunks are joineil 
 by the abundant lymphatics from the vestibule, whicli 
 in turn are continuous wilh the lymphatics of the nasal 
 mucosa. Finally, the collecting trunks from the vest! 
 bule and the nasal integument extend obliquely across 
 the face to the submaxillary lymphatic glands. 
 
 The lymphatics of the exteiual ear and meatus form 
 three principal gi'oups: 1. Those of the helix, antihelix. 
 and convex (posterior) snrfaci'. Those of the helix and 
 antihelix wind round the free border of the car to the 
 convex surface, where they join the tnuiks of that sui 
 face, and uniting into several (four to five) considerable 
 vessels, they extend to tli<' mastoid lymphatic glands. 2. 
 The lymphatics of the c-xternal auditory meatus, also thi' 
 membrana tympani (see bel(>« ), the concha and tragus, 
 terminate by two or three trunks in the parotid lym- 
 phatic glands. 3. The lymphatics of the lobule uniti' 
 into seven or eight considerable trunks which extend to 
 tlie caudal or lower of the mastoiil lymphatic glands. 
 
 Ental Lyinpli(itli-j< of tlir Fare mid Ikad. — These are 
 exceedingly abundant, and extend mostly to tlie deep 
 cervical glands, but the relations of the vessels and the 
 terminal glands are so various that a special description 
 is required for each of the principal organs. Nasal cav- 
 ities and sinuses opening into them: The existence of 
 lymphatic vessels in the nasal mucosa was not demon- 
 strated until 1850, when E. Simon showed by successful 
 puncture injections that they were numerous. He also 
 showed their relation with the network of the naso- 
 pharynx. The existence of these vessels has been veri- 
 fied by Sappey in man and numerous animals. Accord- 
 ing to Sappey, the demonstration is comparatively easy 
 w'herever the mucosa is of <-ousiderable thickness. 
 Schwalbe, and later Key and Retzius, showed that the 
 nasal lymphatics could be injected from the sul.idural 
 space; Key and Retzius- further showed that the injec- 
 tion was equally successful from the subarachnoid space 
 of the brain, the subarachnoid and subdural spaces of the 
 myel (spinal cord). They also found that wdiile in most 
 cases the perineural sheaths of the olfactorj^ nerves were 
 injected at the same time, yet triie lymphatic vessels did 
 not communicate with these, but had special passages 
 through the himina cribrosa, and were often injected 
 when the jierineural sheaths were not injected; and 
 
 sometimes the perineural sheaths were injected without 
 the injection of the Ij-mphatics. They were not success- 
 ful in injecting the nasal lymphatics of man from the 
 cranial lymph spaces, although the perineural sheaths 
 of the olfactory nerves were in some cases filled. The 
 freshly sacrificed dog and rabbit furnished the most suc- 
 cessful preparations. The lack of success in man was 
 
 >-li!— Fitil I Miiptntiis lit till Hcail mil Tn'e, Uie Entfll I^yin- 
 l.hitii^ lit till NiiK mil till Rvlit (iiiiiiiiiin Lyiiiiiliatii; Trunli. 
 (Sipi)H\ 1 ) t L\int'tiitns til nil llii fi until rnjaon ^^oinf? to the 
 inr itiit iMiipliitii Llinils „ \pss(]s tn iiijr near ttie inidrlje nf 
 the fiiri lie 111 the nppei lines (.oin-r Pi Uie pdintlil, the lower ones to 
 the siilintixitl 11 \ hiiiphitii i-liriils 4 -t m ssels from the parietal 
 ihfl tempoial it(,inn i \1i niliiu to the iiiistoid lymphatic Li-|anils ; 
 
 b \essflsfrotn tin pinetil mil oi i ipit il ie{_ion joining theoc- 
 
 1 ipit il pli \ils 7 tiLiiik tioiii 111 ( ipit il plexus lo the supraclavicular 
 -linds s trunk tioin tin oiiiintil to the i eplialic ental (superior 
 (it I p) ( i-i\i( it ^l mils to ]ll on unl il l\ iiiph an glands : if, cepha- 
 in ental (supinor deijii iiimi iI gl mils and plexus; 12, mastoid 
 glinds ti pirotid l\ni))hitii f,laiiils 14 pait ot supraclavicular 
 blinds 1") li l^nipli \essels from the nosi to the subinaxiltary 
 glands lb lb Uiiijilntn s from the lijis to the same glands ; 17, 
 suliiiiaxilUn j-linds Is \essel fiom the lip to 19, the snpra-hyold 
 -|-|ind 211 ri.-lit * oiiinion hmphttii trunk opi ning into the \-eins at 
 tht m^le foimeil h^ the pini tlon of the sulji la\'ian and internal 
 lui-ul ir ^ems 
 
 attributed to the inabilitj' to obtain sufheiently fresh 
 material; it was also suggested that in man the lymph 
 from the cranial lymph spaces might have a sulflcient 
 number of other outlets. 
 
 The lymphatic network covers the entire nasal mu- 
 cosa, both on the olfactory and the respiratory part, 'and 
 that lining tlie septum. In man this network is directly 
 continuous with that of the vestibule of the nfise, but 
 the collecting trunks extend toward the pharynx. The 
 network is also continued into the frontal, and presu- 
 mably the other, sinuses opening into the nasal f os.sa'. As 
 they approach the pjliarynx, the collecting trunks of the 
 nasal mucosa are continuous with those of the dorsal 
 surface of the soft palate and of the pharynx, especially 
 the dense network around the Eustachian orifice. From 
 
 ti27 
 
Iiymptaatlc System. 
 I^ymphatic System. 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 these situations tlie collecting trunks accompany those 
 of the soft palate and the pharynx, sending one trunk 
 through the wall of the pharynx to the large lymphatic 
 gland ventrad of the atlas. This gland, according to 
 Sappey, is the most cephalic (superior) of any in the body, 
 and becomes involved in diseases of both" the nose and 
 the pharynx. The other trunk traverses the pharyngeal 
 wall, and extends along the neck to the level of the per- 
 foration of the sterno-mastoid muscle bj^ the accessorius 
 uerve, where it bifurcates and enters the two deep cervi- 
 cal glands, covered by the stei-no-mastoid muscle at this 
 point. No doubt, also, minute branches join tlie pala- 
 tine trunks which follow the posterior pillars of tlie 
 fauces, and enter the deep cervical glands near the thyro- 
 hyoid ligament (Plate XLIL, 13)." Jii the dog all" the 
 l.ymphaties from the nasal mueo.sa are shown bj' Key and 
 Retzius as entering the deep cervical glands (o,"3, of 
 Fig. 3285). Sappev figures and describes the exceed- 
 ingly abundant lymphatics of the nasal mucosa in the 
 horse and ox. In both tlie.se animals, but especially in 
 the hor,se, the lymphatics of tlie mucosa lining the nasal 
 septum are very abundant, and in both animals, besides 
 the trunks extending toward the pharynx, there are large 
 trunks extending toward the prenares, where tlie,y be- 
 come subcutaneous, and extend with the ectal facial" ves- 
 sels to the submaxillary lympliatie glands. 
 
 LjiiiipliKtirs (if the Ei/e niid the. Orbit. — The lymphatics 
 of the palpebral conjunctiva wind round the edge of the 
 eyelid, and join those of the integument as described 
 above, and finally reach the parotid and submaxillary 
 lymphatic glands. Sappey denies the presence of lym- 
 phatics in the eyeball itself, but most anatomists consider 
 that, while the eye ma.y not be supplied witli numer- 
 ous independently walled lymphatics, nevertheless it is 
 abundantly supplied with lymph passages, etc., many 
 f)f which have an endothelial lining. The lymph chan- 
 nels of the cornea, which are exceedingly abiinilant, fol- 
 h)wing the nerves as well as the corneal cor]iuselcs and 
 their co-anastomosing processes, communicate with the 
 conjunctival vessels, and also with the Ij'inpli clefts of 
 the sclerotic; the aqueous chamber al.so communicates 
 indirectly with the conjunctival lymphatics thrfiugh the 
 cornea. In the suprachoroidea have been described dis- 
 tinct anastomosing lymphatic vessels by Altmann, and 
 tlieir presence has been lately contirmed by one of his 
 jiiipils.' 
 
 The retinal blood-vessels are well supplied willi peri- 
 vascular lymph sijaces like those of the central iicrvuus 
 system, anil may be injected from the lymiih spaces of 
 tiie optic nerve. Both chambers of the eye and I he pcri- 
 clioroidal, and the space enclosed by the ca]isulc (it 
 Tenon, and tli(! lymph spaces of the optic nerve, all ccmi- 
 municate; and as shown aljove, the corneal sjiaccs, and 
 the aqueous chamber through tlu! cornea, communicate 
 oil tlie one hand with the conjunctival lymphatics, and 
 on the other with the lymph clefts in t\\v. sclerotic. In 
 accordance with this complicated relalioi} of the lymph 
 paths of the eye, the lym|)li streams have lii'cn likewise 
 found of equal comiilexity — jiassing from the vitreous 
 to the papilla ojitici, and along tlie central canal of the 
 optic nerve with the blood-vessels, and ultimately reach- 
 ing the cranial cavity. This has been shown to bi' the 
 ilirection in the cat, dog, rabbit, and guinea pig, and is 
 sii|iposed to be also tla^ ease in man. Thei'(^ is also a 
 stream flowing from the sidiarachnoid and subdural 
 s|)aces in the cranium, which follows the ])roloiigations 
 fif those spaces around the optic nerve; these finally 
 reach the eye and communicate with its various lymph 
 s|iaces, and through the perichoroid S|iace Avitli the 
 Ivmidi space in the capsule of Tenon, and presumably 
 through this with the lymphatic ves.sels in the rirliil. 
 That is, there is a lymph stream flowing troiu the eye to 
 the cranial cavity, and another from the cranial cavity 
 back to the eye through a different channel.-' If the as 
 sumption is correct, that the lymphatics of the eyeball 
 communicate through the capsule of Tenon with the 
 lymphatics of the structures in the orbit, their deslina 
 tion is to the lymphatic glands of the eiital cervical 
 
 group in the sphenomaxillary fossa. Through the crania,! 
 cavity the lymph from the eye might also extend with 
 the lymph of the subarachnoid and subdural spaces to 
 any point with which these spaces communicate. (See 
 lymphatics of the central nervous system, below.) 
 
 LynijilKilicH of the Kitr — The lymphatics of the mem- 
 brana tympaui are like the blood-vessels in three layers, 
 corresponding to the cutis, the mucosa, and the interme- 
 diate fibrous framework. Thijy extend to the external 
 auditory meatus and, joining these, finally enter the pa- 
 rotid lymjihatic glands, as described above for the exter- 
 nal ear. Those of the tympanum or middle car are nu- 
 merous, butapparently confined mostly to the submucosa. 
 They are directly e(aitinuous with the lyiriphatics of the 
 Eustachian lube, and extend with them to the abundant 
 network in the pharynx around the Eustacliian orifice, 
 and finally extend to the ental cervical lymphatic glands. 
 The lymphatics of the internal ear con.sist mostly of 
 spaces which are in communication with the subaraciinoid 
 and sulidiiral spaces through the perineural spaces of the 
 auditory nerve, thus agreeing with the eye and nose. 
 
 Lyiiipliiilirs if tlir Muiith, Ph.(iiijii:i\ mid Ldiiiii.r. — The 
 immense richness of the Ij'mphatic network in these re 
 gions, their connection with the nose, and through the 
 
 Fic. ;»U.— I,ympliatii-s of \Xw. R.iofiif llie Moutli and ttie Gums in a 
 Cliild at liirtli. (Sappey, Alias.) l.Tlie lyinpliatli-s iiijeeted bv one 
 punofuiv at. 'Z; tlie trunk formed on Uie ritrhl crosses to tlie left, and 
 those from the teft to tlie right. CrossiiiKsof the lymphatics in man 
 are most frequent in tliis .situation, according to Sappev. fn the 
 lower animals such iiitercro.ssinfr is not infreipient ; ;; and 4 point 
 wliere the cannula was inserted to malie tlie injections; 3, lym- 
 phatics of the gums, connected on one side with those of the palate 
 and on the other with those of the cheeks, the trunks usually ex- 
 tend with those of the cheeks to the sulmiaxillarv lymphatic glands, 
 those nearest the parotid lymphaiic glands frequently enter them 
 instead of going U> the suliniaxillaries ; !<. crossing point of the trunks 
 from the roof of the iiionlh; li, 11, group of ental cervical glands 
 near the liifiircatlon of tlii; common carotid. 
 
 nose with the cranial lymph spaces, wilh the nnddle ear, 
 cesophagus, and trachea, and the Viiried termination of 
 the collecting trunks, give the lyin)iliatics of this group 
 an es]ieeial anatomical interest. They are not less im- 
 |)ortaiit iiathologieally from tlieir involvement in the 
 grave disorders of the mouth, nose, and throat. 
 
 The lyiniihatic network of the buccal mucosa, gums, 
 roof, and floor of the moutli, palate, and pharynx, may 
 be said to be continuous, but the collecting "trunks in 
 dilferent regions have (piite dilferent destinations. At 
 the lips the network is also continuous with that of the 
 integument, but the course of the lymjih stream is away 
 from the lips. For the gums of the maxilla or upper 
 jaw, the lymphatics extend tietween the teeth and join 
 those of the mucosa of the cheek ; these follow in general 
 the contour of the jaw ;ind penetrate the check at vari- 
 ous jioints, extend in part to the parotid lymphatic 
 glands, but mostly to the submaxillary glands! Nearer 
 the pharynx they join the palatine lymphatics (Fig. 
 33()4). A large number of those from the gums of the 
 
 628 
 
REFERENCE IIAXDB(,)OK OF THE .MEDICAL SCIENCES. 
 
 I^yiiiphatic System. 
 Lytiipliatic System. 
 
 lower jaw join the lymphatics of the elieek and extend 
 to the submaxillary lymphatic glands. A part also join 
 those of the pillars of the fauces. 
 
 The lymphatics of the hard and soft palate, while 
 directly continuous with those of the gums, have a direc- 
 tion toward the pharyn.v, the trunks of the two sides 
 often crossing. They join those of the pillars of the 
 fauces, and go with them to the ental cervical glands 
 near the larynx (Fig. 3264; Plate XLII. ). Sonu- also 
 extend to the glands near the liifurcalion of the conunon 
 (carotid with the trunks from the soft palate (Fig. 3264). 
 The lymphatics of the siift palate on the pharyngeal or 
 supci'ior surface are only nidderatcly dcveliiped, and 
 communicate with those from the nose and from the 
 Eustachian tulje; the collecluig trunks extend in part 
 along the posterior pillai' of the fauces to enler the 
 »lglands along the larynx (Plate XLII. , 13). But a greater 
 number of collecting trunks pass laterad and i)cnctrate 
 the pharyngeal walls to enter the gland on the ven- 
 tral aspect of the atlas. The ventral or lower face of 
 the soft palate dift'ers from the dorsal or upper face in 
 having a greater niunber of lymphatic vessels, iuid the 
 uvula is so richly supplied that it ap[iears almcist like 
 erectile tissue, increasing two or three tin\es in volume 
 when successfully injected. The collecting trunks from 
 the uvula and ventral aspect of the soft palate e.vtcnd 
 along the two pillars of the fauces, and join the trunks 
 from the base of the tongue; fjut the greater number 
 pass laterad through the wall of the pharynx and extend 
 to the ental cervical lymphatic glands aiound the l)ifur- 
 cation of the comnu)n carotid. 
 
 The Ij'mpbaties of the tongue escaped discover}' until 
 4847, when Sappej' demonstrated them. They are ditti- 
 cult to demonstrate in the adult on aectiunt of the num- 
 ber and calibre of the veins, l)ut in the infant ami child 
 the veins cause less trouble, and the lymphatics are easily 
 injected. They fiirm a rich network over the entire fi'ee 
 surface to a point slightly beyond the circnmvallate ])a- 
 pillte. Around the circumvailate papilhe they rea( h their 
 greatest development. Up to tlie present no lymphatics 
 have been demonstrated as arising in thc^ subslance of 
 the tongue itself, the vessels traversing tlic tongue licing 
 collecting trunks from the nuieosa. Amund llic edges 
 of the tongue the network of the dorsal and ventral siu-- 
 faces freely anastomose. But the main course of the col- 
 lecting truueules is toward the middle, on the doisal side, 
 and toward the base. A few small trunks penetiale the 
 tongue and after traversing the lingual glands, when 
 those are present, extend to the ental cervical glands 
 near the bifurcation of the conunon carotid. Jlost of 
 the trunks, however, continue aUmg the dorsum of the 
 tongue, unite into large trunks beyond the circumvailate 
 papillae, and extend in a wide curve to the ental cervical 
 lymphatic glands situated near the thyro-hyoid ligament 
 (Plate XLII., 13). The lymphatics on the ventral .side 
 of the tongue extend mostly through the substance of 
 the organ, traversing the lingual glands wdien jiresent, 
 and tinally extend with those which i)eneti'ate from the 
 dcu'sal side, to the lymphatic glands around the bifurca- 
 tion of the common carotid. 
 
 The tonsils, although composed of Ij-mphoid tissue, 
 were not shown to possess a lymphatic network until 
 Sappej' succeeded in demonstrating it, in 1876. This 
 network, which covers the surface -dud extends into the 
 depths of the tissue, is much more easily injected in the 
 new-born child than in the adult. The network anasto- 
 moses with that of all the surrounding structui-es, and 
 the collecting trunks pass with those from the timgue 
 and pillars of the fauces to the glands next the tlivro- 
 hyoid ligament (Plate XLII.). the lymphatics of' the 
 pharj'nx also resisted demonsti-ation for a long time. 
 They were found by Sappey to be directly continuous 
 with those of the bordering structures, and while the 
 trunks all eonununicate at their origin, there are three 
 groups on each side: 1. A dorsal group extending along 
 the dorsal or posterior wall of the pharynx nearly to the 
 postuarcs, and then turning laterad and penetrating the 
 pharyngeal wall, enters the gland on the ventral side of 
 
 the atlas. 2. Several lateral trunks which extend along 
 the sidi- of the larynx and enter the lymphatic glands 
 near the thyro-hyoid ligament. 3. Several vcntial 
 trunks extending m.)stly in a caudal (inferior) direction 
 to join the supraclavicular lymphatic glands along the 
 U'Sophagus and ti'a(4iea. 
 
 Liiri/ii.r. — The lymiihalics of the larynx form one of 
 the densest net woiks known in the body. Commencing 
 with the epiglottis the number is almost inlinitc, the ap- 
 [learance being as if all the soft struci ores were composed 
 of nothing but lymphatics. With the infant the abun- 
 danc'c of lymphatics is continued without intei'ruptiou 
 along the trachea; but as age adx'anees, the network in 
 the larynx i|uite suildenly diniinishes. so that, conuuem- 
 ing with the vocal cords. Ihc network in the larynx and 
 trachea is eomiiai'atively slight. From the epiglottis. 
 \'estil)ule of the larynx, the sinus or ventricle, and the 
 vocal cords, collecting trunks extend through the lateial 
 wall of the veslibidc, pi'rforate the thyro-hyoid meiu 
 braiic, and terminate in the ental cervical glands bi'side 
 the larynx (Plate XLII.. 13). 
 
 Lyiiiiilnftiis iif tin: C'litnil Ai /•/></(,%■ Si/ntciii. — The spaces 
 and mendiranes of the brain and the myel are so direclh 
 continuous that a discussion of the lymphatics of both 
 si'cms desirable. Sappey denies lymphatics to the entire 
 niavous system, both cent ral and [leripheral, but this is 
 not in accordance with most observers who have made 
 special investigalions upon the subject. It is true that 
 indepindcnt vessels with liefiiute walls are not found to 
 exist iii the nervous suljst.ance proper ; but from the in - 
 N'estigations of Kiilliker. Virchow, Robin, ^ and Key and 
 Ri'tziiis, it has bcrn shown I hat, in the nervous substance 
 of the brain luid my(4, the blood vessels ramifying in it 
 aie jjossi'ssed of a loose adveutitia which is continue(l 
 from the pia. tlio so-ealleil pial futmels; and in tin- 
 meshes of this adviaititia are long s|iaces, like those 
 around the blood-vess(4s of reptiles. It is suii|)osed thai 
 thi'SC communicating spaces form the lymph |iassages ot 
 the ner\dus substance. Tlicy may be injected for a con- 
 sideralile distance into the nervous sidistancc from Ihe 
 subara(4moid space, and injections by the puncture 
 method into the nervous matter not infre(|nently till 
 these passages, and extenil into the subarachnoiil .space. 
 After reviewing carefidly all the e\'i(lcuce. Key a)id 
 Retzins' consider the perivascular space of His — lliat is, 
 a space entirely oulside all the walls of the blood-vessel 
 — as an artifact, as is also the pi'csence of a subiiial 
 lymph space into which it opens. Fi(jm the standpoint 
 of Key and Retzius, then, flu; nervous matter of the ceii- 
 tial nervous system is drained of its lymph through the 
 adventitial lymph spaces of its blood -ves.sels, and these 
 spaces o])en into the subarachnoid s])ace. 
 
 The lymphatics of the m(aiinges are still in souk- 
 doubt. In the dura there are wide-meshed, often ain- 
 pulliform, vessels with endothelial walls that are sup- 
 posed by some to be true lymphatics. Although their 
 form is so strikingly like lymph vessels, Key and Ret- 
 zius found, on making the crucial test, that they com- 
 municate with the blood-vessels and do not extend to 
 lymphatic glands. There are, however, in the dura a 
 great number of elongated clefts which arc probably 
 lymph clefts or cliannels. In the pia a very distinct anil 
 undoubted network of lymph vessels has been described 
 and tigured. It is probably largely through these that 
 the lymph of the sidjdural and subarachnoid spaces is 
 drained away. 
 
 The subarachnoid .space commujiiciites directly with 
 the neuroctele (ventricles of the brain) throui;h the fora- 
 men of JIagendie, and both the subarachnoid and sub- 
 dural spaces of the optic, auditory, and olfactory nerves, 
 and, in fact, all the nerves arising from the lirain and 
 myel except that in the ordinary nerves the arachnoid 
 as a special membrane soon disappears, and the subdural 
 and subarachnoid spaces become one. 
 
 The cnto-cranial lymphatics converge to form larger 
 and larger trunks, those from the vascular plexuses^oi- 
 telas accompany the eeini /imr/na Galeiii to the base of the 
 brain, wdiere they are joined by the Ivraphatic trunks 
 
 629 
 
L.yiupIiatlo System. 
 JLymphallc System. 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 from the surface of the brain. The eomliineil trunks 
 follow the great blood-ve.ssels out of the cranial <"ivity 
 mostly througli the jugular foramen, and enter the deep 
 cervical lymphatic glands. Small trunks are described 
 as traversing the spinous and oval foramina with the 
 middle meningeal vessels, finally to enter tlie ental cervi- 
 cal glands in the spheno-ma.xillary fossa; but the exist- 
 ence of these lymphatic tnmks is disputed. 
 
 As stated, the subarachnoid and subdural spaces of the 
 brain aie direeflj' continuous with the eonesiiouding 
 spaces of the myel, and are also projected out with the 
 nerves, most completely with the 0])fie, auditory, and 
 olfactory, and in this way conmiunication is .gained with 
 the lymphatics of the structures to which the nerves arc 
 distributed. 
 
 Tile exact relations of the ento spinal lymphatics do 
 not seem to have been wi'll worked o\it, but they are 
 described as following the blood-vessels, and terminating 
 in tl]e glands in course of the blood-vessels which they 
 follow. The lymphatics of the central nervous system 
 then extend to all great groups of glands in tlie neck and 
 trunk. 
 
 Lyiiiphatki of the j\>cA'. — These are ectal and ental (su- 
 perficial and deep), and include the lymphatics of the 
 structures of tlie neck proper, and also all the tnink.s 
 from the head and face. The vessels frijni the integu- 
 ment extend mostly to the ectal cervical glands, but part 
 of them enter the supraclavicular ylands directly (39, 29, 
 of Fig. 3269). 
 
 Lymphatic Glakds of tiik Head a.nd Nkck. — These 
 are vcrv numerous and important. They are all con 
 
 Fio. :):;«.').— i;pnpral View of tlie Head. Neflt, ami Therax, alHO the 
 ■IVniiination of tlie Tlioracie Oiict. (Masi-af.'tii.l I, Tliorarii- liiift 
 as it Miieri-'es frotri Itie thora.v o],|»isitP ttii- Itrst rili; li, teMiiiiiatioii 
 of thethorauic dnft at an ant'le forineil by tlio jiinclioii of tin- knIj- 
 clavjan and internal Inpular veins, hi the original folio i.late there 
 Is a (-(.nsiileratile swellinff shfuvii on the thoracic .liict alioiit !:> liiiii. 
 before its tHniiiiiatlon. At the lower hart uf the tltrare is the arch- 
 in(T itlaphratnn with vessels exteiiilini; to the sternal (.'lands; thc 
 heart is displaced to the left from the o|ieni-d i.ericanllinn. This cut 
 does scant .1ustii:e to the heautlfiii oriKinal, in whiidi e\ery dc-tail is 
 clear and ciearl.v marked by letters or numerals. 
 
 lined to the sides of the face, around the base of the 
 hi'ad, none having bi'cn found -within the skull, and 
 along the great cervical blood-vessels. They have been 
 
 divided intfi I wo great paired groups or plexuses, the 
 ectal or exteinal, and the ental or infernal jugular lym- 
 phatic plexu.ses; the ectal jugular plexus including all 
 the ectal glamls and linidlj' |)Ouring its lymph into the 
 ental ]ilcxus, which includes all the ental cervical glands. 
 This, while communicating with the glands in the thorax 
 and axilla, sends a main ellcrent trunk, tninnix jiignlnru, 
 to join the thoracic duct on the left, the common lym- 
 phatic trunk on the right; or in some cases the jugular 
 trunk ends jitirtly or wholly indcpcnilentlj' in the veins 
 (4 and .O of Fig. 33S8). These plexuses form a kind of 
 double and closely connected chain along the course of 
 the great cervie;^l vessels, anil yet, for convenience of 
 description and refci-ence, they have been described as 
 several groups; but here, as in other parts of the body 
 of man, the groups merge so insensilily into each other 
 that the same gland might be placed in one group by- 
 one anatomist, and in the adjoining group by another. 
 Furthermore, it should not be lost sight of that from a 
 limited region lym])hatics may go to quite widely sepa- 
 rated groups of glands, and also that the number and 
 size of the glands in a giotip are subject to considerable 
 individual variati(jn. (For examples, see Fig. 3268 B. 
 and 3270, also the ilescription of the lymiiliatics of the 
 liver. Fig. 3273.) 
 
 The ectal glands of the head and neck, i.e., the glands 
 of the ectal or external jugidar lymphatic plexus, are 
 divided into the five following grotips; 
 
 1. The occipital lymphatic glands ((ilnmliiUv lympliatico' 
 orcipihiles, s. xiihoeripiiiileti), one or two, usually small 
 glands on the complcxus muscle between the cranial at- 
 tachment of (h(^ traiiezius and the sternomastoideus. 
 The allei-ent vessels aie from the occipital, partly, also, 
 from the temporal and parietal regions; the efferent ves- 
 .sels extend partly to the ectal cervical, ;ui(l partly to the 
 supraclavicular glands (Figs. 3263 and 3265). 
 
 2. Parotid lymphatic glands {r/liiiidulu' lijjiijihnliftupnro- 
 tideo', .1. aiinciiliiivK ciiiterivren, x. fuciitlns sij])erficiidcs, s. 
 zj/goiiiatiriB). There are usually ten to twelve of these on 
 the surface and in the substance of the ptirotid salivary 
 gland. The affej-ent vessels are from the temiiond and 
 frontal i-egions, the sides of the face, lateral part of the 
 eyelids tuid conjunctiva, concha, tragus, membrana tym- 
 pani and external auilitory meatus of the car; from part 
 of the mucosii of the cheeks and the gums of the maxilla 
 or upp(;r jaw. The efferent vessels ])ass to the submax- 
 illary and cetiil cervical lyin]-)liatic glands. 
 
 3. ^histoid lymiiliatic glands (ijhindijla lyiirphnticip 
 iinistoidc(p, .S'. xiihdti ririilnrtx^ ,v, nil rirultirrx poxteiiorex). 
 Scvertil small glands on the cianial attachment of the 
 sternomastoid muscle, iieai' the mastoid process and base 
 of the ear. The iilferent vessels are from the parietal, 
 tenipoi-al, and occipital regions in part, fi'om the helix, 
 antilielix, convex surface, tmd lobule of the ear. The ef- 
 ferent vessels extend to till' ectal iind enttd cervical glands. 
 
 4. Submaxillary lym|)ljatie gltuids {yliiiidiiln- mihiiiu.ril- 
 hiri',1). There are sevei-;d of these I'Xteniling along til- 
 most the entire extent of the body of the niiindible. In 
 this group ai-e included tin; ghiiids on the buccinator mus- 
 cle, sometimes described as ti .septirtite group (glandtdte 
 biicctiles, s. bueeitiatores) and sometimes chissed with 
 th<; enttil glanils. 'V\\v. subiutixillary gltinds extending 
 near the ehin are ttlso soiiietimi'S called submental, and a 
 single one iietir the meson hits been named sniirtihyoid by 
 Sappe)-. The airei-ent vessels of this groii]) tire from Ihe 
 middle of the forelietid. the nastil caiithus of the eye, the 
 integiinient of the nose tind M'stibule. and in the horse 
 and ox also pttrlly from the iiastil fosste ; from the cheeks 
 tind lips, the gitins of the nitiiidible in part, and the floor 
 of the tiioittli, part of the efferent vessels from the |)arotid 
 lyiti])lititie glands; the cfTcrent vessels pttss to the cclal 
 and entiil cervical gltinds. 
 
 .'). Eettil cervietil lyinphtitic glands {g/inidii!ir /yjii/ihiit- 
 ini' rci-rifiilrx ,'rtiili'X, .1. nil pei-fciiili's, .v. jiKpilare-'i xiijifi-fi- 
 ciiilcx). Several small gltinds along the ectttl jugular vein, 
 lint (■xtending on both sides of it.' They arc between the 
 platysma and the .sternomastoid muscles. The afferent 
 vessels tire from the ectal structures of the neck, ptirt of 
 
 6.']0 
 
REFERENCE IIAKDBOOK OF THE .AIEDK'AL SCIEXCES. 
 
 Ij}'iii|>lkatio System. 
 Li> iiipliatio S}'!«(oiii. 
 
 t]ii' (_'tt'erent vessels from the oceipitul, parotid, mastoid, 
 and svibmaxilUuy groups; efferent vessels extend to tlie 
 supraclavieulav glands. 
 
 The eetal or external jiigular IjMnphatic plexvis in the 
 larger animals — hor,sean(l ox — is approximately lil-C(' that 
 of man; l)ut in the rabbit it is represented nidy liy the 
 s(il)maxillary lympliatic glands and two small glands 
 neai- the ear (3 and 4 ot Fig. 32«(5). In the dog only tlie 
 submaxillary lymphatic glands seem to belong to this 
 plexus (b of" Figs. 3281 and 3'2y4); in the cat the mastoid 
 glands are large and may he injected from the inner or 
 concave aspect of the external ear. It is possible that 
 the small gland on the trunk following the external jug- 
 ular vein, shown in Fig. 3282, may also belong to the 
 octal jilexus. One cannot hel]) being struck with the 
 fewness of the glands in the dog, cat, and rabbit. 
 
 The ental glands of th(- head and neck, or the glands 
 of the ental jugular plexus are situated on the course of 
 the great vascidar truidis and extend from the atlas to 
 the thorax. The h'mphaties of the entire head and neck 
 ultimately traverse this jilcxus. 
 
 The glands of this plexus have been quite commonly 
 divideil into three great groups, with some minor gioups 
 — th(! deep facial, tlie sujicriorand inferior dee]) cervical; 
 but in actual descriptions of the lymphatics of the vari- 
 ous organs the anatomists of the present day, although 
 tliey recognize three grcnijis, and some of them minor 
 groups, actually divide all the glands of the ental jugu- 
 lar plexus into two groups, viz., those extending fi-om 
 the level of the base of the cranium, along the dei']i ves- 
 sels, to the bif\ireation of the conunon carotid, and thnse 
 from (he bifurcation of the carotid to the junction of the 
 jugular and subclavian veins. Thisdivisiou Avas adopted 
 in the previous descri])tion, and has lieen called (1) ental 
 cervical, and (2) supra<lavieular. (1) Ental cervical 
 lymphatic glands (f/liiii<Jiil<i' li/iiip/iutirw cerrinilis ciitnlrx, 
 .s. jirofunili^, ,s'. ijlutitlitht' lii!tij}lintine jiifpiUu'ea ccji/itiUrir), 
 The ental cervical, or jugular group of glands, includes 
 all the ental glands annuul the deep structures from lijc 
 bifurcation of the C(nnni(m carotid artery jiearly to the 
 base of the skull, aTid ineludis the glands on the inteiiial 
 maxillary ves.sels in the sphenomaxillary fossa, which 
 are usually given a sejiarale gioup tuider the name of 
 deep facial or internal ])aroti(l, internal maxillary, etc. 
 It also includes the glands generally grouped iis the su- 
 perior jugular or sujierior deep cervical. 
 
 The glands in this group are munerous and ([uite 
 widely separated from one another, extending from the 
 ventral face of the atlas to the side ot the laiynx, being 
 about as variously arranged as the organs of this region. 
 The one between the atlas and ]iliaivnx is said to be the 
 mcjst cephalic of idl the lym|)liatie glands of the body. 
 
 The alferi'ut vessels of tliis grou)! are from the orbit, 
 nasal cavity, the cheek, roof and floor of the mouth, in 
 piart from the tongue, jiharynx, tonsil, tymjianum, and 
 Eustachian tube, the larynx, the thyroid, and the brain 
 and its membranes. The elferent vessels ]iass to the su- 
 ])raelavicular glands. 
 
 (2) The supraclavicular glands (r/hnidiilir liiiiiplmiirii' 
 sii pfiirhirietihire^i, s. Ci'i'rirnlrs pi'i>finiihf-: inferio/rs, fi,jiii/ii- 
 liins uifrriiin'i). Tlu'se glands are arranged along the 
 carotid artery and internal jugular vein from the bifui- 
 cation of the common cafotid to the junction of the sub- 
 clavian and internal jugular veins. All the efferent 
 trtiiiks from the eetal jugular jilexus and from the ental 
 cervical glands enter this grmip, also many of the lym- 
 ]iliatics of the phaiynx, (eso[ih.'igus, trachea, the lyni- 
 ])hatics accompanying the vertebral artery and \'ein, also 
 sonu' of the eetal and ental lymphatics of the neck and 
 the clavicular region. They also comnumieate with the 
 anterior mediastinal and Avith the axillary glands. The 
 ell'erent vessels fortn a single or multiple trunk (tninnix 
 uiiiijiliiitifiin jiirjtihiris) and terminate on the left in the 
 thoracic duet, or on the right in the right common lym- 
 phatic trunk, or sometimes partly or wholly l>v an inde- 
 pendent opening into the great veins (Figs. 3203 and 
 3283). 
 
 In the iKU'se and ox the glands of theueek are approx- 
 
 imately like tliosi' of man: l.mt in the eat. dog, and rab- 
 bit there is but a single ental cervical lym|iliatie gland, 
 and the jugular trunk is usually large and lung, and not 
 infreciuently opens i)artly or whollv into the vein inde- 
 ])endenlly '(Figs. 3282. 3283, 
 3285, and 328rK 
 
 Li/iiiiihiitir ]'('x.s<'lsi>f (lie TIki- 
 iiirii' jAiiih (. \riji inif] Slimihler). 
 — The lymphatics of the arm 
 and shoulder form an eetal and 
 ental set, as in most parts of 
 the body. The lymphatics of 
 the hand arise by a com])lex 
 network on the dorsal and pal- 
 mar surface of the fingers, and 
 extend toward each side of the 
 finger, where they unite into 
 two or three anastomo-sing 
 trunks which follow the direc- 
 tion of the collateral arteries to 
 the hand w hen they reach the 
 dorsal surface. From tlie palm 
 many vessels wind round both 
 edges to the dorsal side also; 
 but; many next the wrist ex- 
 tend directly upon the ventral 
 or flexor aspect of the arm and 
 extend to the axillary region. 
 The trunks on the dorsum of 
 the hand and the extensor side 
 of the entire arm graduall}' 
 wind round to the flexor sur- 
 face in their course to the ax- 
 illa. j\Iost of the vessels enter 
 directly the axillary glands, 
 but a few of those from the 
 lourth and fifth fingers and 
 the ulnar side of the antibra- 
 ehium traNci'se one or two 
 glands (eetal lu'achial or sn- 
 pra-ei)itroehlear glands in the 
 flexure of the elbow, Fig. 3267) 
 lief ore proceeding to the a.xil- 
 lary glands. Freipiently, if 
 not constantly, one or more 
 trunks follow th<: cephalic vein 
 and goto the subclavian glands 
 instead of going to the axilla, 
 and nut infre(picnfly there is 
 a gland in the course of these 
 near the insertion of the del- 
 toiil, or even farther along (13 
 ofFig.32(n; seealso Fig. 3209). 
 
 the shoulder either join the trunk follo^ving the cephalic 
 vein or extend rciund to the axilla. The ental lymphat- 
 ics of the arm arise in the deep structures and follow the 
 principal binnd-vessels much more closely than do the 
 eetal lymphatics. In the antibrachiutu there are, there- 
 fore, three groups following the radial, ulnar, and inter- 
 osseous blo(id-\-essels. There are occasionally a few 
 small lymphatic glands in the antibraehium (autibruchial 
 glands) thnaigli which a jiart ot the vessels pass; but 
 usually none are reached until in the tiexure of the el- 
 bow, where, extending along the brachial vessels, there 
 are regularly met thn-e or four glands (ental or deep 
 brachial glands), wdiieh must nf the vessels traverse. 
 Before reaching the axillary glands, according to most 
 authors, there is a free anastomosis lietween the eetal 
 and ental lyin])hatics at the wrist and elbow, but Sappey 
 deines any such anastomosis. 
 
 Aeeording to the description "f most veterinarians, the 
 lymphatics of the arm and shmdder of the horse and ox 
 are quite contiiarable with those of man lieith as to glands 
 and vessels, except that there is a larger lymphatic gland 
 in the fold between the scapula and the neck — the pre- 
 scapular gland. In the dog and cat the arrangement is 
 exceedingly simple. All of the vessels, except a few 
 cutaneous ones wdiose course is somewhat irregular, 
 
 ic. :ei!fi.-Ei>lal f.yiiipliatlos 
 of a b'int^i^r. (sappey.) To 
 sliow tile e.xtreiiie ahun- 
 ilance of tlie lyinptiaties and 
 tile llneiiess of the network 
 on tlie end and tbe palmar 
 a.spect, also that the \'essels 
 from lioth the dorsal and 
 ventral siirfaees extend to 
 the side where two or three 
 eonsiderahle trnnlis, par- 
 allel with the collateral 
 artery, convey the lymph 
 toward the hand. By eoni- 
 piiriiiK Fij.^ :S2(J7, It will be 
 seen that these trunks al- 
 ways e.xtend upon the dor- 
 sum of the hand. 
 
 The octal lymphatics of 
 
 (i31 
 
liympltatic System. 
 Lymphatic System. 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 which can be injected from the pads of the manus (fore- 
 paw), tinaliy extend upon the dorsum of the paw, and 
 extend from there by two or more frequently anastomos- 
 ing trunks along the radial nerve to the elbow, and then 
 follow the cephalic vein to the prescapular gland, no ax- 
 illary glands being present (Figs. 3281 and 3284). Oc- 
 ^ casionally in the 
 
 cat one oi more 
 branchi b tuinin the 
 -7 bend ol the elbow 
 to follow the bra- 
 chial \ easels 1o the 
 It axilla and hnally 
 entti th( nearest 
 peetoial gland 
 
 In th( 1 lb bi t, 
 vessels likewise fol- 
 low the 1 idi il nerve 
 to th( elliow then 
 extend oblieiuely 
 around the ladial 
 side ot the biachi- 
 
 riG. 32fi7. 
 
 um to the axillary glands. Other trunks follow the large- 
 blood-vessels, and enter the axillary glands. The lym- 
 phatic vessels of the arm, whatever "tlieir course, traverse 
 but a .single gland in the dog and eat, sometimes two 
 glands in the rabbit. 
 
 Ly.MPHATIC Gl.\NDS op the Ali.M AND Siiori.DKn. — 
 Eetal brachial gVdnds (r/la nduliB bnichiales ecUilea, s. siiper- 
 JiHdlen, H. oihitale.i siiperjiciales, s. siipratroddedren), two 
 glands often found in the course of part of the trunks 
 from the fourth and fifth fingers anel the ulnar .side of 
 tlie arm. The gland in the course of the ti-unk following 
 the cephalic vein has not been named. 
 
 The ental glands. Tliere aie sometimes a few in 
 the antibraohium {f/fa/idiila! lymphaticn' iiHtilji'drliitilea), 
 through which traverse the ental antibraehial lym- 
 phatics, on their way to the ental brachial glands (tjlitn- 
 diilre IjiiiipliittictP hrni'Iiidlen eiilnles, .«. ]irofunda\ x. nibitideK 
 pnifiiiidd'). These are ju.st pi-oximal of the elbow-joint 
 on the biachial vessels. Through them pass part of the 
 ental lymiibatics. 
 
 The axillary lymphatic glands ((jlii,iidiilii>. lyinphittAccp 
 (ixillares. Fig. 3269) are situateel in the axillai'y region 
 arounel the great vessels and nerves, and covered by the 
 pectoral muscles and extending frf)in the edge of the 
 great pectoral into the subclavian fossa, where they are 
 in communication with the supraclavicular glands. All 
 the Ij'inpliatic vessels of the arm and most of those of the 
 shoulder emter these glands ; also many from the supra- 
 umbilical part of the abrlomeu, side, and back ; also the 
 lymphatics of the mammary glanel anel the other struct- 
 ures of the bre-ast, inclueling the eiferent vessels of the 
 pectoral lymphatic glanels. The efferent trunk (triinoin 
 
 Fie:. 32*57.— Eetal Lymphatics of the Hand and Arm. (Sappcy, Alias.) 
 To show the number and course of The trunks, and tlii^ fineness of 
 the network in the liand and arm. E.xcept a srnall area around the 
 shoulder and in Ihe axilla where the skin is removed, tlie lymphatics 
 are represented as if the skin were transparent. A, Ventral as- 
 pect of the ris,^ht arm. 1, 1, Network of lymphatics on ttie palmar 
 aspect of the finders; 3, 2, the collateral trunks on each side of the 
 tinkers- the c.iUecting truncules from both palmar and dorsal side 
 wind round th*i Anger to the edge and, uniting inti;) t\vo or more 
 trunks (Fi^r. ;i;itSij), extend upon the dorsum of the hand; 3. .3. trunks 
 coming from the palm to join those from the thumb ; 4, 4, collecting 
 trunks from the distal part of the palm which wind round bet\veen 
 the Hngei's to n^ach the dorsal surface (see JJ); .5, 5, collecting 
 trunks at the ulnar side of the hand, likewise winding round upon 
 the dorsal suiface; li, *>, collecting trunks from the palm next the 
 wrist— they extend directly along the flexor aspect of the arm : 7, 7, 
 large trunks formed by the union of many of those from the palm 
 and tliumb; S, 8, trunks winding round the radial side of the anti- 
 brachium from the extensor to the flexor side; 9, 9, similar trunks 
 winding round the ulnar side of the antibrachium, from the dorsal 
 or extensor to the ventral or flexor side ; 10, lymphatic trunks curv- 
 ing round from the ditrsal or extensor to the ventral or flexor side 
 of the brachium to enter the axillary glands ; 11, trunk following 
 the course of the cephalic^ vein and traversing the gland at 13 : 12, 
 12, trunks winding round the arm and shoulder to join the gland 
 on the cephalic vein; 14, 14, lymphatic trunk accompanying the 
 cephalic vein and entering the subclavian glands; lo, vessels from 
 the scapular region to the trunk accompanying Ihe cephalic vein ; IB, 
 cephalic vein in the furrow between the deltoid and pectoral mus- 
 cles : 17 and 20, ectfl-brachial or supra-epitrochlear lymphatic glands 
 -through these pass part of the vessels from the little flnger and 
 the ulnar side ot the arm ; 18, 19, trunk entering the more distal and 
 joining the two glands— the efferent trunk from 20 is one of the 
 largest of the arm. It penetrates the tissues and accompanies the 
 basilic vein to the axillary glands; 21, 21, collecting trunks extend- 
 ing toward the axilla; 22, 22, cut edge of the skin ; 23, 23, brachial 
 aponeurosis; 2t, axillary lymphatic glands showing through the 
 aponeurosis; 2.^, axillary aponeurosis covering the glands ; 2ti, bor- 
 der of the axillary space formed by the teres and latissimus muscles ; 
 27, clavicidar fa.scia of the pectoralls seiiaiated from the deltoid by 
 the groove containing the cephalic veiTi with its acconipanying 
 lymph:U.ic trunk; 28, sternal fascia of the pectoralls; 29, border of 
 the pec,t<jralis, forming also the border of the axilla; 30, ;}0, 30, 
 points on the brachitun and antl-brachium where the line network 
 of vessels has been injected—in a completely injet^ted preparat)(m 
 the entire skin would be covered with such a nelwork. B. Ulnar 
 side of the hand and extensor aspect of the antibrachium and part 
 of the brachium, to show lliat the trunks from the fingers and palm 
 extend largely upon the dorsal aspect and then wind round the arm 
 to I'each the ventral or flexor aspi^ct. 1, 1, 1, Lymphatics of the 
 Angers, the collecting trunks extending uprm tlie dorsum of the 
 hand; 2, 2, vessels on the dorsum ot the liand ; 3, 3, lymphatic 
 trunks winding round the ulnar side of the antibrachium to reach 
 the flexor aspect; 4, 4, 4, vessels winding round the radial side of 
 the atitibrachium to reach its flexor surface; .5, 5, vessels on the 
 brachium curving round to the axilla; ti, group of vessels converg- 
 ing toward the axillary lymphatic glands ; 7, lymphatic network 
 at the convexity of the elbow ; R, 8, 8, spots In which the fine lym- 
 phatic network of origin is shown. 
 
 632 
 
liEFERE^•CE HANDBOOK OF THE MEDICAL [SCIENCES. 
 
 Lyiupliatlo System. 
 L.yiiiplia«K- System. 
 
 suhHaoiii,i) is om- of the impoitant tributaries of the com- 
 mon lymphatic trunl^s. As hero used the axilhxry group 
 of glands includes the subclavian or infraclavicular glands 
 into which flow the trunks following the cephalic vein. 
 By some authors the pectoral glands are also included in 
 the axillary group (Quain). 
 
 In the dog and cat no axillary glands are present, all 
 the trunks going to the prescapiilar gland (gljuidula pi-r- 
 sciqmlaris) (Pigs. 3381-33H5). In the rabbit all go to axil- 
 lary glands more nearly as in man (Figs. 3386 and -iiST) 
 
 Li/Mji/iiUif Vcsxi'lx of i/i<> I'i'/pic Li/iiii. — The ectal 1> m 
 Ijhatics of the foot, leg, and tliigli are almost pre 
 cisely like those of tlie hand and arm. The ves 
 sels of the toes and sole extend mo.stly to the 
 dorsum of the foot, and then wind round the leg 
 to the inguinal region, and enter the subcutaneous 
 inguinal lymphatic glands (Figs. 3368 and 3369). 
 A limited nunilter of vessels from the heel and 
 fibular side of the foot accompany the short sa 
 pheiious vein to the po]]liteal space where they 
 enter the popliteal glands and join the enlal 
 lymphatics. 
 
 Tlie subaponeurotic or ental lymphatics also re- 
 semlde tlio.se of the arm, following the main vas- 
 cular trunks; hence iu thecrus there are three 
 groups: one on the extensor side of the crus fol 
 lowing the anterior tibial vessels, and .sometimes 
 traversing one or two anterior tibial glands at 
 about the middle of the crus. The lymphatics 
 penetrate the interosseous ligament near the knee 
 to cTdcr the popliteal glands. The other two 
 
 FKi. ;i2t)S.-.iOctiil Lympliatii's of the Fciot anil Lee, to show 
 tlic Ori(,'ln, Niuiiher, anil Coiirsi' of Ihi- l.vMjphatii- Trunks, 
 anil the Popliteal anil Inftiiinal Lymphatii- lilands. The 
 skin is repri'.senti'il as transparent, e.xi-ept where renioveil 
 in the popliteal spare anil in the iiitxninal ivLnon. iSappey, 
 Atlas.! A, The unlal side of the foot anil entire lee:. 1,1, 
 Trniii'iiles arisinir from the sole, f?reat toe. and side of the 
 foot; '^, ;i, tmiiksatisintiat the toes and extending aero.s.s the 
 dorsum of the foot to reaiii the tibial side of the Wk : it, 
 great trnnk ai'isiriff from the plantai' aspert near the in- 
 step, and skiftine the tiliial or internal malleolus on its 
 
 way tothe inguinal re^'ion ; 4, 4, 4, trunks riiinintr fr the 
 
 heel and e.xleniliuK aloni? the ankle and lot;; ."),.'>, and II, ti, 
 trunks I'Xtendinfi alonf; Hie erus [larallel with the ralf ; 7, 7, 
 7, 7, trunks winding round the edstp of the tihia to ivarh 
 the tibial or inside of the le.ff ; 8, S, lyniphalie trunks wind- 
 mu ronnrl the knee to rearli the inside of the leji:. They 
 are very tortuous when the knee is extonded. more lirarly 
 straiirht wliett it Is flexed ; '.I, 'J, trunks i-urvinc: round froiii 
 the exteiisof side of the iuitos, or tliif^h, toreaeh the in- 
 pninal ttlands; III, IP, HI, Iu, niuneious trunks wiudint; 
 round lioin the llexor side of the thigh to the inguinal 
 glands; 11, 11, II, trunks i:iirving round from the e.xtonsor 
 side of the thigh Uj the inguinal glands; l:i, 12, trunks from 
 the gluteal region; KJ, ]:{, trunks from the perineal and 
 anal region to the inguinal glands: 14, trunks froin the 
 scrotum (ef. Fig. r!26y) ; 15, trunk from the penis ; Hi, the 
 large distal gland of the ei-tal inguinal group, into whieh 
 enter so many of the trunks of the leg; 17, another hirge 
 gland at the same level: Is, large efferent trunk from IH, it 
 follows the course of the feiniiral artery; 19, lympliatii: 
 trunks following the i-ourse of the femoral vein ; '2'1 large 
 gland receiving many of the trunks from the extensor 
 sides of the thigh ; 'JU gland reeeiving many of the trunks 
 from the flexor side of the thigh : 2:i, :i2, I'ut end of the 
 vena saphena magna ; 2:!, gland in the groin to whii;h ex- 
 tend many of the lymphaties from the penis (cf. Fig. :i~H9l: 
 24, large corner gland receiving most iif the trunks wind- 
 ing round the iliiun from the lumbar and gluteal region ; 
 ^.f), 2.'>, proximal riiw of glands in the fold of the groin to 
 which extend many of the trunks from the ventral \vall 
 of the abdomen ; 27, inguinal riiu: wilh tlie i-ontained sper- 
 matic cord. B, Flexor Asppi-t of the liistal half of the Leg. 
 1, 1, Trunks from the heel and tliiularside of the foot .■ 2, 
 3, two lymphatic trtiriks following the eoin-se of the vena 
 saphena to the popliteal glands ; A and .'J, thn two lymphatic 
 trunks, ;i on the tibular, .5 on the tibial side of the vein; 
 6, vena saphena parva ; 7 and S. cut edge of the skin, and 
 aponeurosis removed to bring the |)i;ipliteal glands int.i.i 
 view ; 9, great trunk on the Obular side of the crus ; it fol- 
 lows the contour of the calf, and by its branches furnishes 
 nearly all the trunks on the fibular or outside of thecrus; 
 10-12, bifurcations and branches of 9; i:t, i;!, trunks on the 
 tibial side of the cms. They curve round to tlie inner side 
 of the leg, and extend to tiie inguinal glands : 14 and Ui, 
 trunks on the Qbnlar side of the thigh, which wind round 
 to the extensor aspect, and then to the inguinal glands 
 (cf. II and .-1); ir>, large trunks on the tibial or inside of 
 the knee, on its way from the heel, cms, and thigh, to the 
 inguinal glands : 16 and 17, trunks winding round the thigh 
 In opposite directions to reach the inguinal glands. 
 
 groups follow the peroneal and posterior tibial blood- 
 vessels to the popliteal glands. After traversing the 
 popliteal glands the lymphatics follow the femoral ves- 
 sels to the inguinal region, Avhere they enter the ental 
 inguinal glands anil after traversing these accotiipany 
 the femoral vein and artery into tlie abdomen to the 
 
 iliai glands. Besides these 
 tin if ire lymphatic trunks 
 iceonipiinyiiig the sciatic 
 mil ^lute-ill vessels, which 
 ti n CISC one or moix". .small 
 gluuls, gluteal and isehia- 
 ti< gl mds, at the sacro- 
 s( 1 itic foramen and then 
 enln the hypogastric 
 ^linds. The trunk fnl- 
 lining the obturator ar- 
 ti n constantly traverses, 
 uioiding to Cruveilhier, 
 I ( nsiderable gland 
 ( /I iiiilii/a fiiraiiiiiih ohln- 
 I It III) befoie entering 
 till h\ pogastric glands. 
 
 In the dog, cat, and rab- 
 bit there is the same sim- 
 jilidtv of the lymphatic 
 ti links its pointed out for 
 till iim. Injections into 
 tin p ul of the pes (hind. 
 
 y^*" — ■ 
 
 FIG. 3388. 
 
 633 
 
Lynipliatio System. 
 Lynipliatlc System, 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 paw) demonstrate missels (in 
 the dorsum and ^k it t(M skU 
 of tlie foot. Put (it tl]es( 
 trunks follow tin eiiuis( ( t 
 tlie long sapli( 11 lus m m otlicis u u 
 ally larger tiuiiks -vmhiI louud tlu 
 calf, with the shiut siphmous \(.m 
 to the poplil( il spK(. md cntci i 
 popliteal gland (ti^ 3281 lb) In th(. 
 rabhit, brautlK s 
 e.xteud to the pop 
 liteal space from 
 both sides of the 
 
 33Sh 
 poph 
 
 crus (Fig. 
 From the 
 teal gland 
 the m a i n 
 e ff e r e n t 
 vessels in 
 all pass 
 between 
 the perone- 
 al and tibi- 
 al nerves, 
 and accom- 
 pany the 
 femoral ar- 
 t e r y a n d 
 vein, free- " 
 1}' anasto- 
 mosing with the 
 trunk along the 
 saphenous arter\ 
 No inguinal ^l^Dds aie 
 present, and the ^ csscK e\ 
 tend directly to the lum- 
 bar glands (Fig. 3281, 23). 
 Lymi>ii.\tic Glands in 
 THE Leg. — The most dis- 
 tal gland is the anterior 
 tibial, situat(;d on the in- 
 terosseous ligament near 
 the middle of the cms. 
 Through it pass the ental 
 trunks, following the an- 
 terior tibial vessels on their 
 
 Fig. ;1269.— Ectal and C'litaneoua 
 Lynipbatics of the Trunk 
 and External (ienitalia and 
 the Eotal Inguinal and Ax- 
 Ihary Glands to which they 
 Extend. Thetlne-stnetworl 
 has heen otriltted for clear- 
 ness, and tlie skin is repre- 
 sented as transparent: in 
 the inguinal region it has 
 heen removed, and in Ihe 
 axillary region a part of ttie 
 great pcctora] lias also heen 
 removed to expose the 
 glands. ISiippey, Atlas.) 1,1, | 
 
 Thedisial glands of (hi- ecial g 
 
 inguinal group— into tliese f 
 
 enter nearly all of those fr 
 
 troiii the foot, •■rus, and — 
 thigli : ~, :3, ini'dian or inner 
 glands of this group— to ttiese ( 
 of the vena saphciia magna, \vl I 1 
 scrotum : 4, a large gland forn 
 or, in the female, finm tlu^ clit 
 
 w n to the popliteal glands. This gland is fre- 
 (Hunth diseut The popliteal glands {glandnlv 
 the fill in tlie poplite- 
 al space. 
 Two are 
 near the 
 surface and 
 receive the 
 lymphat- 
 ics accom- 
 panying 
 the s h o r t 
 saphenous 
 vein. Their 
 e ff e r (; n t 
 trunks pass 
 to' the two more deeply 
 situated glands around 
 the popliteal blood-ves- 
 sels; through the deeper 
 ones pass all the ental 
 vessels of the foot and crus 
 and part of those from the 
 knee. The efferent ves- 
 sels pa.ss with the femoral 
 blood -ves.sels to the in- 
 guinal glands. 
 
 Inguinal glands ((/^(rjirf';;'?! 
 lyiitpliitticm iiigiiimiles, Figs. 
 " 3368 and 8209).— There are 
 two layers of these — the ectal or 
 subcutaneous and the ental or 
 subaponeui'otie. 
 
 The ectal inguinal glands, 
 forming an oblong irregular four- 
 sided figure with one bordef next 
 Pou])art's ligament. The affer- 
 ent vessels are the octal 13'mphat- 
 les of the entire leg, the subum- 
 bilical part of the body, and the 
 external genitalia. The efferent 
 vessels traverse the cribriform 
 ipoiietirosis and enter the deep 
 or ental inguinal glands; 
 frequently a few truidis 
 pass into the body cav- 
 ity and join the iliac 
 gliuids. 
 
 The ental inguinal 
 gliinds are situated along 
 the femoral artery and 
 vein in the inguinal re- 
 gion iiiid are usually 
 three or four in number, 
 ill though there may be 
 six or seven. Thev are 
 covered by the femoral 
 fascia and aie in intimate 
 contact with the femoral 
 M'ssels; one nf them is 
 
 n\ of the trunks fioni th( tiiu il 1 r lipi 1 r ind inner lsp( 
 r PS UK st of thi l\m|)h UK s lioni tin ijm ifi ill ,,lul( U ill 
 
 t! e I ixini li did iiK dl m I oini r I f till 1 1 1 il ingniii il gn up 
 ai I I III of thi lilui 5 the I 111 1 II 01 oiiti r „l mil f llu^ 
 
 1 1 of the thigh ; :!, gland near Ihe cut end 
 
 inal, and tlie perineal regions, and the 
 
 il receives the lyuiphatics from the penis, 
 
 gioup, receiving many vessels from the 
 
 thigh ; 0, li, jiroximai glands ne t fie I I >mi 11— the\ n 1 1 ivi the Ivriiph ilu s fiom tin \i uti il siiluuiibilical legion ; 7, large gland forming 
 the lateral and proximal angli f ti _iiinil gioup— to it 1 xti nd tin tiunlvs from Ihe huuliir, gluteal, and partly, also, from the 
 
 ahd'Hiiiiial reglMii ; s, s. lymphah f II i tiim I Mssflsfr 111 thi pn piii e III 10 \ 1 ss{ Is fioui the integument of tlie penis, extending 
 
 along the lateral and dorsal asfiect of tin oig in II il issi I miking iiiiili uouiid II ton i of the glans - ordiniirily these unite to 
 
 loriu a siugle dorsal vessel, hut iierc tlicv rem nu si p ir iti uid 1 \ti ml 111 i |iiiilltl lomsi to tin pubis, wlierc each one turns to the corre- 
 sporiiling inguinal gland ; lii and 111, IIk tw ti links fioiii thi 1 1 i m 1 of tin ^liiis uinn tin si unite into one they bifurcate o|iposite the 
 IHihis and extend tothe two sides as do tliesi iiidi pi iidi nt tiiinks 14 14 uhumbiin il h iu|)li ilK s of the abdomen- they inteidigitate at 
 tile ventrliiiesoii Willi those from tlie light snli I tin l)od\ iiist is is sin w n b\ lliosi i \ti inliiu toward the axilla, so that in this inter- 
 mediate area an in,1ectioii might fill tin VI SSI Is gi iiig in lioili dm (in us illhoiigh llii ii iiiighl 1 1 no true anastomoses of the two groups 
 of vessels ; 15, lo, suliiimbilicai lymph itK triuiks If If trunks iiising fii 111 the hiiiiliu lud gliileal region; 17, 17, area or zone where 
 the siibiimbilical and thoracic lyrnplialKs inti rdigltati IH IK aiei of inl( idi„il itin^ (essels along the veutrimeson ; 111, 1!), 19, 111, I'J, 19, 
 beginnings of the trunks along the \entriiiiesoii «(1 II flunks m tin I itei d ispi 1 1 of tin ttiiii ix on their way to the axilla : 21, 21, 21 
 trunks from the dorsal part of the thorix on their u o to the ixill ii\ gl mds ' ^ tiunks fioiii the mammary region (cf. Fig. il274): 
 21!, 2:^ trunks from the dorsal .scapular ri ^ion 24 '4 ti unl s fioiii tin iiiii ((f 11,. Ji ) ih 1 11 ge trunk from the eiaal brachial or supra- 
 eiiitroctilear glands (cf. Fig. :3;3*i7); 26 trunk u (oniiiaioing itii 1 1 plialii vein mil tiiminiling in the subclavian glands (cf. Fig. ;l2ti7); 
 27, cut through the tissues to bring into view Ihe ixillny gl mils „s i\iii irv Iviuphitii gimds— onlj part of them are exposed; 29, 29, ves- 
 sels from thedoi.sal and lateral aspects of the neck— the> ttiminite m the supi idaMculai gUiids 
 
 634 
 
REFERENCE ILVNDBOOK OF THE MEDICAL t^CIENCES. 
 
 L)'iii|>liati<' SyHtoin. 
 LyiiiplialU' Sjsleni. 
 
 fouud almost constantly in tlie nioutli of tlic iunur fem- 
 oral or crural ring, wliicli, acccjrding to llcnlc, it as 
 sists in closing. Tlic afferent vessels of tliis group are 
 derived froiu the ental lynipliatics of tlie foot, crus, and 
 thigh (ill part); tlie elTerent trunlcs from the popliteal 
 and most of those from the cctal inguinal glands. 
 
 A part of the efferent vessels traverse the abdominal 
 wall with the femoral artery, liut most of them accom- 
 pany the f(niioral vein through the crural canal. They 
 join the iliac glands, sending a few branches, however, 
 to the hypogastric glands. 
 
 In the larger domestic animals (horse and o.\) the glands 
 of the leg are about as numerous as in man, but with the 
 cat, dog, and rabbit they are re]iresented only by the 
 popliteal gland, the inguinal glands being alisenl. unless 
 the gland on the external eiiigastric vessels may repre- 
 sent the cctal inguinal glands. As the iliac glands arc 
 also absent, ves.sels maj' pass fi'oiu the foot (i.e.. those 
 accompanying the saphenous artery) dircctlj' to the lum- 
 bar glands (Figs. 3381, 3284, and 3286). 
 
 Ly.mpiiatics of thk Abdo.men and E.ytf.unal Grm- 
 T.4IJA. — The cctal lymphatics of the abdomen have three 
 (juite sharply detined areas of origin, and from these the 
 vessels extend in opposite dii'ections. The areas are the 
 dorsimeson, the veutrini(;,son, and a somewhat irregular 
 zone surrounding the body at the level of the umbilicus 
 (Fig. 3269). The vessels cross these boundaries and inter- 
 digitate in a complex manner; frequently a puncture 
 made in the bouiulary will give rise to an injection in 
 both directions, although injections made at either side 
 would inject only the corresponding side. In the lower 
 animals especially investigated for this— cat and opo.s- 
 sum — the communication from side to side is more inti- 
 mate, an injection of one side often filling that of the 
 other. This is especially marked oi)]>osite the jmbis of 
 the opossum, where there is (■onstantly a large transverse 
 lymphatic, recalling the transverse vessels between the 
 jugular veins. 
 
 As seen in Fig. 3269, the lyniphatic-s of the undiili- 
 cal region of the body cxtiaid in the most direct manner 
 on the abdomen to the ingiunal or the axillary glanils. 
 Those from the lumbar and gluteal regions extend 
 around in great cur\-es, often following the crest of the 
 ilium, to the lateral inguinal glands, titliers fmm the 
 gluteal region curve round the nates to the perineal and 
 anal regions, tinally to join the ])erineal and anal vessels 
 and extend with them to the median glands of the ecbil 
 inguinal group. 
 
 The lyniiiliatict network around the anal upening is 
 very dense and is continiunis with the lymphatics of the 
 rectum. Those of the perineum are less dense. From 
 both these regions the ve.ssels wind round the thigh to 
 the median or inner of the cctal inguinal glands. In the 
 female the uuinber of the trunks from the ]ierineum is 
 reduced aiiparently in direct proportion to the reduction 
 in area of the region. The lymphatics nf the external 
 genitalia of the male are nidurally divisible into those of 
 the scrotum and the penis. The vessels of the scrotiiiu 
 are very numerous, perhaps more so than in any other 
 e({ual area, of integument in the liody. As in the trunk, 
 the meson— here indicated by the ni]il)e — forms a natural 
 dividing line for the two sides. The vessels extend in 
 great curves, partly to the ]uibis and iKirtly on the thigh, 
 io enter the nu'ilian row of cctal inguinal lym]iliatic 
 glands; those on the thigh eoinmunicating \\\t\\ the ves- 
 s(ds from the perineum, and those of the ]uibis with the 
 cutaneous vessels of the jienis. The vessels of the integ- 
 ument of the penis, commencing on both surfaces of the 
 prepuce and from the line(d theurethrii. wind round the 
 tw(] sides to the so called dorsum of the organ when the}" 
 extend toward the pubis, and curve laterally towaid the 
 two sides to enter the large gland forming the corner of 
 the cctal group (Fig. 3369, 4). The lymphatics of thi' 
 glans penis are exceedingly numerous, and in se\ei'id 
 superim]iosed layers of networks. The collecting trunks 
 cimvergc toward the fra-num preputii, where they are 
 joinecl bv the trunks from the urethra. 
 
 The urethral lymphatics begin at the prostate, aiiasto- 
 
 the ])ubis, when it 
 eai'h side, finally to 
 iif till' eclal inguinal 
 
 niose \',ith the prostatic lymphatics, with the ni'twork of 
 the I'jaeulatory canals, and through them \\'ith the iisic- 
 iihi' xniiiiiidis. They extend to the mnitux ii riiiiii-i iix, 
 forming a hollow cylindrical network of large, densely 
 jiacked lymphatics (Fig. 3370), which reaches its great- 
 est development op]iosite the fossa naviculari.s. Oppo- 
 site the fra'uum two or threi' trunks ]ienetrate the 
 urethral wall and join tlie li'unks from the glans, then 
 penetrate the substance of the penis and reach the dorsal 
 aspect of the rmiins .iiiiniiiidxii m. where the trunks of the 
 two sides usualh' unite into one, which folloAvs the 
 course of the dee]! blood-vi'ssels ti 
 again divides, sencling a branch to 
 terminate in the lai-ge median gland i 
 group (Fig. 3269). According to most authors, the ure- 
 thral and glandular lym))liatics of the ])enis follow the 
 internal pudic blood-vessels into the abdomen and enter 
 the hypogastric glands. But Sappey is very definite, 
 both in his atlas and anatomy, in stating that they enter 
 the large gkuid forming the corner of the octal group.' 
 
 Tlie lymiihatics of the external genitalia of the female 
 very closely resemble those of the male in their arrange- 
 ment and termination. Tlic collecting trunks from the 
 clitoris and the surrounding parts extend nearly directly 
 to the i)ubis, where they curve to the right and left, and 
 terminate in the large median gland forming the corner 
 of the ectal inguinal group, and, according to Krause," 
 they also corumunicate with the lymphatics of the round 
 liganient of the uterus. 
 The lymphatics of the 
 female urethra are less 
 abundant than in the 
 male. The trunks from 
 the urethra, meatus uri- 
 narius, laliia, and the ex- 
 ternal or inferior fourth 
 of the vagina extend lat- 
 erally to reach the vulvo- 
 crural bild, in which they 
 wind around the thigh, 
 with a few small triudis 
 from the perineum to the 
 median of the eetal in- 
 guinal glands, only a fe\v 
 reaching the I u'ge corner 
 gland bi « hieh so many 
 from the ui.ale genitalia 
 extend. 
 
 Till' ental lym|iliatics of 
 the abdoniinal wall and 
 the lumbal' pai't of the 
 trunk follow the deep 
 blood-vessels; part, theri'- 
 bire, extend to the sternal 
 and axillary glands; part, 
 with the t}ri:\\ e|iigastric 
 vessels, totheiliae glands; 
 |iart, with the lumbar and 
 ileo-liimbai' \"i.'^si'ls, to (he 
 lumbar glands. Still 
 others follow the eirciim- 
 tli'X iliac vi'Nsels, often 
 tra\"i'i'sing one or more 
 glands along the crest of 
 the ilium liefore finall)' 
 entering the iliac glands. 
 
 With the dog, i''af, and 
 rabbit, the lymphatics of 
 the abdominal wall and 
 the external genitalia are 
 as in nian, cxceiif that the 
 tendency to form anasto- 
 moses across the meson is 
 more niiirked, and that 
 there is constantly present along the external epigastric 
 vessels, about oii])ositc tlie brim of the pelvis, a consid- 
 erable gland. To this gland pass the ectal abdominal 
 lymphatics, also part of those from the elongated mam- 
 
 Flo. 3270.— Hiuiiaa Penis, opened 
 IjiniritiidiniiUy to sliow tlie Ure- 
 tliruILyinphiitii's. (Sappi'V, Atlas, l 
 1, 1, 'i'lio very Mtiundant. loni-'"ituiti- 
 iial ni'twurk of vessels in the nre- 
 ttiial iiiiirosa : 2, eriiiiinuilv of tlie 
 uretliral lyiii[iliatlrs witli those of 
 the flails at the meatus urinariiis ; 
 ;5, y, ;}, 1 ranks traversiii;,^ the ure- 
 thral watt opjiosite the foenuni 
 and .i'lininy: (hose of the trlans ; 
 4, 4, 4, 4, trunks from the periphery 
 of ttie (riaiis .ioinin;/ those froiii 
 the urethra; .">, .5, dartre trunks 
 formed fiy tiie union of llie ure- 
 (liral lympbalics and those from 
 the L'laiis ; tliey penetrate the sub- 
 stance of the penis and loliow the 
 deep blood-vessels to the pubis, 
 whenee, areordinff to Sappev, they 
 e.xteiid to the inguinal, but, ac- 
 eordin^r to niany authors, to the 
 liypnij'astrir' lymphatic glands : 
 t'l, ti, iMujihatics uf the integument 
 of the penis. 
 
 635 
 
liymphallc System. „„„„„ 
 
 I^ymphatU- System, REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 Fig. 3271.— Lymphatifs of the Kidneys, Adrenals, and Internal Genitalia of a Girl of Thirteen Years. (Sappey, 
 Atlas.) A. abdominal aorta; /?, I?, common iliac arteries; C, 1\ the external and internal iliac arteries 
 formed by the bifurcation of the common Iliac ; D, po.st-cava ; E and F, left and right renal veins : O', common 
 iliac veins ; /f, if, ureters ; J, cut end of the rectum ; K, uterus; i>, neck of the uterus (the line points to the 
 OS uteri); A/, yi, cut edge of the vaginal wall ; iV, N, Fallopian tubes; P, P, ovaries ; Q, Q. round ligauietit.s. 
 1, ental lyujphatic trunks from the kidney and the glands of the lumbar plexus into which they enter : ;;, ~', :i, :i, 
 surface or ectal lymphatics of the kidney which extc^nd first to the lateral aspect, and then converge around tiie 
 ends of the kidney t*} the hilus, where they join the ental lymphatics, or enter the same group of gkjTids inde- 
 pendently; .3, 3, ves.sels on the broad surface of the kidney converging directly to the hilus io join the ental 
 lymphatics ; 4, gland receiving the ectal lymphatics of the caudal third of the kidney on the right ; .5. lymphatic 
 network of the adrenal, it freely anastomoses with that of the kidney, and many of the trunks enter a gland 
 Situated in the angle between the adrenal and the kidney on the mesal aspect ; 6, lymphatics gland through 
 which pass rnatiy of the lymphatics of the adrenal, and some from the kidney ; 7, 7, subfivarian lymphatic net- 
 work ; it is joined by a itirge trunk from the base of the uterus, and together they follow the utero-ovarlan vein 
 to the lumhar lynrphatic plexus ; 8 and », trunks from the subovarian network to lumbar glands at the termi- 
 nation of the ovarian vein ; 10, 10, lumbar glands receiving the lelt ovarian trunks ; part of these are common 
 to the lymphatics of the kidney ; 11, 11, glands receiving those from the right ; 12, 12, trunks from the Ijase of 
 the uterus to the subovarian network ; 13, 13, trunks from the borders and the ventral fai« of the uterus, they 
 extend to 14, the iliac group of glands ; 1.5, vessels arising from tlie neck of the uterus, the uterine mucosa, the 
 vaginal part of the uterus, and from about three-fourths of the extent of the vagina ; they extend to IB, the 
 uteri>vaginal gland ; 17, 17, efferent vessels from the utero-vaginal gland tcj the iliac glands ; 18, 18, vessels 
 from the dorsal part of the neck of the uterus, extending to the hypogastric lymphatic glands; 19, trunk frouj 
 the neck of the uterus to a gland on the hixiy of the Ofth lumbar vertebra ; its presence is exceptional ; 20, iliac 
 gland receiving an unusual trunk from the neck of the uterus. 
 
 636 
 
 mary glands and 
 from the external 
 genitalia. There i.s 
 another glandalong 
 the external epigas- 
 tric blood - vessels 
 about opposite the 
 umbilicus, in the 
 cat at least. After 
 travci-sing these 
 glands the efferent 
 vessels either join 
 or accompany Ihe 
 fcmoial lymphatics 
 to the lumbar 
 glands. In the cat 
 they peneti-ate the 
 abdominal wall 
 with the epigastiic 
 artery, and extend, 
 in part, to the hy- 
 pogastric, and in 
 part to the lumbar 
 glands (Fig. 3281, 
 14, 21). The epi 
 gastric glands may 
 represent the ectal 
 inguinal glands of 
 man. In the rabbit 
 thei'e is also con- 
 stantly present a 
 gland on the ilio- 
 lumbar vessels, 
 next the abdominal 
 wall, and along the 
 edges of the sar- 
 torius muscle; the 
 efl'ei'ent ves.sels pass 
 to the lumbar 
 glands (see 23 of 
 Fig, 32^6). 
 
 Lymphatics of 
 THE Pelvic and 
 Abdo-mtnal Vis- 
 cera. — luternal 
 genitdh of the male 
 — Ustidc, Kpermi- 
 diict, vesiculf-K semi- 
 nales, and proKtaic. 
 — Pi'obably no or- 
 gan in the mascu- 
 line body is moie 
 richly supplied 
 with lymjihalics 
 than the testicle. 
 Those of the alliu 
 gincaaie sometimes 
 describeil as the ec- 
 tal lyiiii)l)utiis of 
 the testis. 
 
 Tlicy are only 
 moderately numer- 
 ous, and" extend 
 upon the speriiii- 
 duet td jciin those 
 from the testicle 
 proper. Tho.se of 
 the leslicle proper 
 fciUow the seuiiiial 
 tul)iilcs Io tile epi- 
 didytnis. iind join- 
 ing those of' tlie 
 epididymis extend 
 with the sperniulic 
 cord tliioiigli the 
 inguinal Ciinal. 
 After reaching the 
 body cavity they 
 
REFERENCE HANDBO«)K OF THE MEDICAL SCIENCES. 
 
 Lyiiipliatic System. 
 Lyinphatio Sysleni. 
 
 follow tlip liliMid- vessels, and finall}' terminate in tlie 
 lumbar glands near the end of the spermatic vein. 
 
 The lymphatics (if the testis of a mature animal are 
 exceedingly easy to inject by the puncture metliod, and 
 the collecting ti'unks accompanying the spermatic vein 
 are so prominent, straight, and well supplied with valves 
 that they arc among the most striking of the lymphatic 
 trunks in the body. 
 
 The lymi)liatics of the spermiduct arc abundant at the 
 ends, but very few along the middle jiart. Those from 
 the testicular half follow the lymphatics of the testis, 
 while those froiTi the other half join the lymphatics of 
 the vesicuUe seminales. The lymphatics of vesicultc 
 scminales form a close network, which was first de- 
 scribed by Hcw.son ; they unite into two ])rinci|ial trunks. 
 Those next the siienniduct join the lymphatics of the 
 latter, and together they enter one of tlie iliac glands. 
 The other trunk jiasses betwe(.'u the prostate and m'- 
 sicula' sennnalcs, so as to join an iliac gland. The lym- 
 phatics of the prostate were discovered and descrilied by 
 Sappey in 1854, who found them abundant, and with 
 two collecting trunks on each side. (Jiie of the trunks 
 passes qviite (lirectly to one of the hypogastric glands, 
 while the other extends upon the walls of the urocy,st, 
 or urinary bladder, and then curves to the side to enter 
 a liy])ogastiic giand. The trunks extending upon the 
 lU'ocyst were mistaken by jMascagni and Cruikshank for 
 the lymphatics from the bladder itself. 
 
 Iiiteriiiil Fciiiiili: (Jciiiliiliii — I'lir/iim, UU'nix, FiiUojiimi 
 Tuhefi, (iiiil Oi'iin'rs. — As describeil abin'c, the external 
 or inferior fcjurth of the vagitia sends its lym|)hatics to 
 the ectal inguinal glands; from the remaining three- 
 fourlhs the collcclin.g Iriuiks extend toward the uterus, 
 ])enetrate the wallsof thi^ vagina, and traverse Ihe utero- 
 vaginal lymphatii gland on the way to the hypogastric 
 glands. Up to the present, no lymphatics have been 
 demonstrated in the nuiscular wall of the vagina iu the 
 human being, but their presence has been shown in that 
 of the large domestic animals. 
 
 The uterine. lym|>hatics arc naturally divided into 
 those of the nuicosa and those of thi' muscularis. Those 
 of the mucosa are dilheult or iinpossiljle to demonstrate 
 in a gravid uterus, and often so in a non gravid adult 
 uterus, and Sa.p|>ey states that he never succeeded iu 
 demonstrating them in the uterine mucosa of any of the 
 lower animals. It is only in girls before puberty that 
 these lymphatics are demonstrable by the ordinary meth- 
 ods. No doubt they exist in the adult W(anun, and also 
 in the uterine miu-osa of the lower animals, luit they 
 have not been satisfactorily demonstratetl. When de- 
 monstrated in a child they .showed a di'licate network 
 whose collecting trunks traverse the walls of the neck of 
 the uterus and enter the uterovaginal lymphatic glands 
 {15 and Ui, of Fig. 3271). At the os uteri they are con- 
 tinuous with those on the vaginal part of the uterus and 
 the vaginal nuieosa. 
 
 The lym|)hatics of the uterine walls are numerous and 
 easily demonstraleil in most animals. The collecting 
 trunks extend laterally in the broad ligament on each 
 side to three different groups of glands; those from the 
 siuiiniit follow the Fallopian tubes out to the ovary, 
 where they join the ovarian network, and accompany 
 the collecting truidis of the ovary to the lundjar glands 
 arfuiud the terminatiou of the ovarian veins (Fig. 3371). 
 Those from the body of the m-gan extend across the 
 broad ligament, curve round the Fallopian tubes, and 
 enter thi' iliac glands; while those from the cervical re- 
 gion extend with those from the utero- vaginal glands to 
 the hypogastric ])lcxus. 
 
 Lymphatics have been demonstrated only on the ute- 
 rine ami ovarian ends of the Fallopian tubes. But it is 
 probable that they are present throughout the whole ex- 
 tent. The collecting tnmks accompany the ovarian lyiu- 
 phatics. 
 
 The lymphatics of the ovary, like those of the testis, 
 are in prodigious nimibers, and are very easily injected. 
 The collecting trunks are very long and straight and 
 accompany the ovarian vein, and consequently those 
 
 on the left are opposite the hiliis of the kidney {Fig. 
 3371). 
 
 In the lower animals, .so far as has been investigated, 
 the lym|)hatics of the internal genitalia agree in all es- 
 sential particulars with those of the human being. In 
 the dog, cat, and rabbit, wliih' the ovarian aiul testicular 
 lymphatics follow the same general cinii>:e, they almost 
 always enter the lumliar glands, and therefore do not 
 follow the spermatic or ovarian veins to their termina- 
 tion (Fig. 33S1, 31, i'l). 
 
 Un'iini-i/ (Ji'jiiiiiK mill Ailr-im!. — I'p to the present time 
 all efforts to demnnsti-ate lymphatics in the muco.sa of 
 the urocyst or urinary bladder have failed Imth Avitli 
 men and Avith animals, but the nnise\dar coat has been 
 shown to be plentifully suinilied. The ves.sels form a 
 Avide-meshed network at the sunuuit and on the bod}-. 
 This network unites into one or more trunks on each 
 side, and the trunks extend nearly or (piite In the neck 
 wfen they ttirn aside and enter the hypogastric lym- 
 l)hatic glands. The trtmks described by Cruikshank 
 and jMascagni as urncystic lymiihatics were really from 
 the prostate. Saii]iey succeeded only once in injecting 
 them in man, liiit almost constauth' in the dog and 
 ralibit. 
 
 The nuiscularis of the ureters has been shown to ]ios- 
 sess lymphatics in the horse, but all attem|its bi demon- 
 strate them in the mucosa have failed. Although not 
 demonstrated in man they are jircsinnably jiresent. 
 
 The lym])hatics of the kidney form an ectal network 
 over the surface and an cntal netw cuk in the substance 
 of the organ. The (iiudis were first seen in 1583 by 
 Massa, liut first described carefully by Nuck in 15!)(l. 
 Those of the surface lorin a. wide-iiu'shed network, the 
 collecting trunks of which extend in part diri'ctly tow- 
 ard tb<' hilusof the kidni'V and join tlie cntal lymjihatics 
 and part extend towaid the con\'ex bonier and then wind 
 round the ends to Ihe hiliis. .Next the adrenal the lym- 
 iihatics of the two oj-gans aic closely connected. The 
 cntal lymphatics follow the blood-vessels and terminate 
 in a group of the lumbar gliuiils situated on the renal 
 vessels. 
 
 Although the blood-vessels of the adrenal have been 
 long known, the lymphal ics were not so early discovered. 
 It is now known that the lymphatics are as aliundant 
 as the lilood-\'essi'ls, extending throughout the sidistanee 
 as well as upon the stu'face. The collecting trunks, 
 many of them join those of the kiilney, and all extend to 
 a gland near the junction i.if the adrenal and kidney (5, 
 0,''of Fig. 3371). ■ 
 
 jAluijiIiiitifx iif till- liiti'diiii: mill Stiiiiiiirli. — Throughout 
 the entire alimentary canal, it lias been shown that where 
 a distinct luusculai' coat exists the lym]ihiitics form two 
 layers or sets, one in the mucosa, including the submu- 
 cosa, and one in the muscularis. In those jiarts sup- 
 ported by duplicatiHcs of serosa (mesenteries) the finer 
 network of the mucosa jiroper extends to a coarse and 
 characteristic network in the submucosa (Fig. 3398), 
 and finally the collecting trunks penetrate the wall at 
 the attached edge and join the h'mphatics of the mu.scu- 
 laris. The lymiihatics of the mu.scularis are throughout 
 its entire thickness, but soon become subserous and wind 
 round to the attached edge, and with those from the mu- 
 cosa extend between the layers of the supporting mem- 
 brane mostly in company with blood-vessels to lym- 
 phatic .glands, which are also situated between the 
 serosal walls (Fig. 3273, 3, 3. 4; Plate XLIV.). 
 
 The intestinal lymphatics at the anus are directly con- 
 tinuous with those of the skin. The trunks from the 
 muscularis and mucosa of the rectum extend between 
 the folds of the mesorectuni. often Iraversing minute 
 glands in their course, and tlieu enter the sacral lym- 
 phatic glands and ultimately go to the lumbar glands on 
 their way to the chylocyst. The lymiihatics of the main 
 part of the i-oloii dfxniidi us pass tei tin.' lumbar lymphatic 
 plexus. Those of the enriim. rnliiii iixniiili'iis li t rmisrur- 
 smii. also part of the rolnii ilixniiili uk pass through one 
 or more of the numerous mesocolic glands and then enter 
 the mesenteric glands imd mingle with the larteals from 
 
 »i37 
 
Lymphatic System, 
 liymphatic System. 
 
 referenc;e handbook (jf the medical sciences. 
 
 the small intestine, und with these go throiia:!! the tnin- 
 cus iiiteMinaUs to the ch3'locyst, 
 
 L<ieteah.—The. Ij'mphatics of the small intestine are 
 usually called laeteals or chyle vessels, from the fact that 
 (lurmg digestion they have a cloudy or milky ai)pearance 
 owing to the contained chyle (Figs. 3392", 3398, 3294, 
 
 ooUU), 
 
 As the small intestine has two planes of lymphatics 
 like the rest of the alimentary canal, it is really only 
 
 Fig. i.J7.J— Iijcip <f the Small Intfstinc nf Via to •iliow the Mesi nterii dUnds and Blucid lessel.s aurt thi' 
 LyDipliatKs from tlip Mum ularis (VippH\ All is I 1 1 The ends of the liioii i)f iiiti-stine; a, 3, 3, 3, 3, 
 Ivmphatu \Hsst-ls insin^ in the Qiu')( ul II 1 i\pr J J i s\\f■Illnr'^ or pnlarfTPini nts in these \essels near the 
 mps( ntf nc pd^*' of the intHstitip 4 4 4 inistntHin (^1 inds alon? the rouis* of thf* IjmphulK s ; .5, branch of 
 the sui t n r niHSfntf n( aitt-n b inesfntim \oin * ttie mesHnteiy 
 
 those of tlic mucosa which alisorb and convey the chyle, 
 and wliicli, therefore, should properly tie ilenominated 
 laeteals, as tho.se fi'om IIk; inuscularis always convey 
 lymph only. A furtlioi- and tiiier distinction still has 
 been made liy Saii|iey,' ^\ ho holds that the vessels of the 
 intestinal villi are the only ones wliich absorl) the chyle, 
 and thc3' do notliin.t,' else, so that they alone are the true 
 laeteals, and that the other lymph vessels of the mucosa 
 and suluiiueosa, including those from the Peyerian 
 piatches and other lympjhoid tissue, should be consiilered 
 .simply lyui|ihaties, as Ihey take no jiart in the absorp- 
 tion of the chyle. The submuco.sal net woik simply re- 
 ceives the chyle jioured into it by the laeteals of the villi. 
 As stated aliove. this is not tin; common view. It is or- 
 dinarily Iielii^ved that the laeteals coiit.iin lymph like 
 other l3'mphatics, except during digestion. It is also 
 common to call all the vessels fnmi Die small intestine 
 lacteal vessels, without regard to their origin from the 
 muscularis or the mucosa. Whatever the origin, all the 
 vessels unite at the adached border and extend to the 
 nearest gland, where tlieir contents are mixed, so that 
 usually all the collecting trunks in the mesentery appear 
 
 milky and are called laeteals or chyle vessels, although 
 some ot them might really have come from the large 
 intestine. In man there are usually several tiers of mes- 
 enteric glands through which the chyle passes before 
 tiually emptying into the large trunk along the superior 
 mesenteric artery. This trunk, which also receives tlie 
 efferent vessels of the cadiac and mesocolic glands (trun- 
 ciiK lyiiiphUieus iittesUimliK), is either single or multiple, 
 and forms one of the most important constituents of the 
 
 chylocyst (Figs. 3281- 
 3287). 
 
 Stmnach. — The lym- 
 phatics of the stomach 
 are continuous with 
 those of the cesopha- 
 gus and duodenum. 
 Those of the mu.scu- 
 laris form a most 
 beautiful network 
 throughout the entire 
 thickness of the coat; 
 the collecting trunk 
 lets penetrate the tis- 
 sue and become aulj- 
 serous, and from an 
 intermediate area on 
 both faces extend to 
 the nearest of the chain 
 of lymphatic glands, 
 extending almost 
 around both curva- 
 tures; those in the 
 lesser curvature being 
 known as the r/larululit 
 lijmplinlirii' gastro-ejii- 
 jiliiirfp miperiores. and 
 those around the great 
 curvature as the (jliiiiO' 
 Ilia' Ij/iiipliiilirrt yitstro- 
 epiploictr i n f <■ r i o r e « 
 (Plate XLIII.). The 
 lympJiatics of tlie gas- 
 tiic mucosa form a 
 remarkalile network 
 throughout the entire 
 thickness of the coat, 
 being very line in the 
 mucosa projjer and 
 coar.ser in the submu- 
 <"sa. The collecting 
 vessels penetrate the 
 muscularis along the 
 curvatures, join those 
 of the muscularis, ex- 
 tend to the same 
 glands, and tinally to 
 the intestinal lymphatic trunk (Plate XLIV.). 
 
 Piiriiyrenx.—Thv lymphatics of this oigan are dilHeult 
 to demonstrate, but when well injected are found to form 
 a tine network around the tubules, and the collecting 
 trunks emi-rge (juite directly to the surface, and form 
 U])on the surface a round-meshed, rather coarse network 
 around th(; lobules. From this network vessels extend 
 in three direetion.s — part of them going to th(! tail or 
 splenic end of the pancreas to joiii the glands at the 
 hilus of th(^ sjili'di, |iart to the gastric edge of tli(' pan- 
 creas to enter .sidiie of the numerous glands aloii"- the 
 coursi^ of the siilenic vessels, and still ol'hers exteniUow. 
 ard the duodenum to enter a large gland which also re- 
 ceives |iart of the lymplialies of IIk- iluodenum The 
 lymph tinally readies the intestinal trunk after travers 
 ing one or more of the e<eliac glands. No lymphatics 
 have been dcincuistrated in the pancreatic duets. 
 
 Hpkeu.—Thti lyni|>hatics of the spleen are in enormous 
 numbers. Their origin seems to be from the lymph fol- 
 licles so abundant throughout the organ. According to 
 Sappey, the usual division of the Ivmphatics into a 
 superlicial and deep set does not hold with man, in whom 
 
 638 
 
REFERENCE lIANDliooK OF THE ilEDlCAL SCIENCES. 
 
 LyiiiphalK- Sjslfin. 
 I.yiii)>liati4' S}Nl4'i>i. 
 
 any vcssl'Is on the surface quickly ciitci- tlie substance 
 of the organ and accompany the cntal blood-vessels. 
 With tlio horse, ox, and pig, however, there is a true 
 eetiil networli extending over tlie entire surface. The 
 collecting trunks pa.ss to the hilus of the organ and ter- 
 minate in the numerous glands there situated. The effer- 
 ent trunks from these glands pass to the C(eliac glands 
 and the intestinal lymphatic trunk, or S(jme may enter 
 tlie chylocyst directly. 
 
 Liver. — The lympliatics of the liver were very early 
 seen, and the efferent tnmks/;'o»« the hilus were, for a 
 long time, supposed to be the continuation of the lac- 
 teals to the liver. It has been found that the lymphatic 
 system of the liver is quite as remarkable as the blood 
 supply. In general there are both ectal and ental lym- 
 phatic vessels, and the ducts and gall l)ladder pfissess a 
 rich supply. The collecting trunks form three great 
 groups and take thiee main courses, following the portal 
 
 or extend to tlii' glan<ls ar(.)und the posteava as it entrrs 
 the thorax. On both .sides of the suspen.sory ligament 
 the trunks collect in great numbers, and extend between 
 j the folds of the suspensory ligament to the diaphragm, 
 which they penetrate, and enter two or three glands 
 whose elferents join the sternal jilexus ( f-i of Fig. 8375, 
 and 13 of Fig. 337ti). Still farther to the left, a group 
 passes round to the posteava as it enteis the thorax on 
 the right, still others penetrate the triangular ligament 
 and enter the glands arcjund the <e.sophagus. Many <jf 
 the apparently suiierfieial lymphatics of tliis lolie pene- 
 trate the substance of the liver and join the ental l3'ni- 
 phatics as with the right lobe. In fact, in most animals 
 this is the normal condition, and a true ectal set of lym- 
 phatics is not present. On the concave surface of the 
 liver, many of the surface lymphatics penetrate the liver 
 substance and join the ental lymphatics, but the greater 
 number join the glands in the hilus and thus mi]igle Avith 
 
 Fig. 33r:i. -I,ympatiOii and Lymphatic Glands on the Concave Aspect of the Liver of Man. iSappev. Atlas.) A, A, Richt lolie uf the liver: 
 Ji, 7!, left lohe ; I', quadrate lobe; D, Spitrelian lotie: J-;, round ligament or rciiinaiit of uinhiliciil vein ; F. cholecyst or trail bladder ; 'V, 
 posteava leceiviiitt the hepatic veins .iiist as it tra\erses the diaphrag'nt ; //, left tnani-'ular liLMinent of the liver ; 7. diaphrai:ni ; /\', the 
 most proieetioff part of the convex surface of the liver. 1. 1. Two trunks near the .■ephalic edtre of the rifrht lobe e.xtendins to the frlands 
 on tlie [lostcava just within the thorax; ~, snitrle trunk from the middle of the ritrht lol)e to the lymphatic }-'lands in the hilus of the liver Ijy 
 the neck of the choleeyst: 3, o, trunks U|)on and at the border of the cholecyst to the .crlands in the hilus ; t, two vessels hiuintt the sairie 
 orit;tin and termination, but covered by the cholecyst : their course is indii-ated by the dotted lines : o, ;i, trunks arisintr on tlie surface of 
 tlie rifrht lolie, but penetratinir the sultstance of tlie liver to accompany the ental vessels ; ail the vessels from the surface take this i-ourse 
 in most animals; 6, ti ti, trunks from the Spigeliait lobe, and the flands around tlie tiostcava receivinfr them; 7, 7, vessels belontrinu to the 
 quadrate lobe ; 8, 8. principal trunks of the left lolie ; it. 9, vessels arising on the surface, but soon "entering the liver to join the deefi 
 lymphatics like '> of the right lolie ; Hi, trunks from the convex surface of the liver following the round ligament and finally entering the 
 glands at the hilus; 11. H, 12, several trunks from the convex surface of the left lobe, winding over to the concave surface and entering 
 glands in the Assure of the ductus venosus ; l;!, lo. lymphatic glands in the tlssure of the cluctus venosus, their efferent vessels i-xtend to 
 the glands in the hilus; 14, glands corresponding to the terminal end of the (esophagus; 1.5, l.'i. lymphatic glands receiving the lymphatics 
 from most of the concave surface of the liver and tlie ental lymphatics following the portal vein. 
 
 vessels to the hilus, the hepatic vessels to the posteava. 
 anil the suiiensoiy ligtuiient to the diaphragm. 
 
 The ectal or supertit iai lymphtitics of the convex sur- 
 fticc extend in four directions, according to their posi- 
 tion. Jlost of those near the caudal or inferior border 
 peuetrtitc the surface and join the entiil lymjiliatics. In 
 the right cephalic (superior) part, they wind round the 
 border and join the glands at the bead of the jiancreas. 
 
 the entiti lymphatics ( Fig. ;-!37?,l. The ental or deep lym- 
 phatics, according to Sapjiey. are divided into two dis- 
 tinct, although anastomosing sets, one set following the 
 portal vessels and bile-tlucts. the other the hepatic vi-s- 
 sels. Those follnwing the hepatic vessels enter the 
 thorax, traversing some glands on the posteava. ami 
 mingling with the ectal lymphatics, follow the pilhirs of 
 the diaphragm to join the thoracic duct. The l_ynipliat- 
 
 t;39 
 
liymphatlc System. 
 Lymphatic System. 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 ics following the portal veins reach the hihis of the 
 liver, and traverse one or more of the glands there situ- 
 ated (Fig. 3273). From these glands in the hilus, 
 branches extend to the glands in the lesser curvature of 
 
 Fig. :KT4.-Left Mammary Gland of a Woman during Lactation. Tbe skin and adipose tissue 
 have been removed to bring tlie lympbatics plainly into view. At tliree of the corners of 
 the ngure blood-vessels are represented. (Sappey, Atlas and Anat.) 1, 1, Netiyork of 
 lymphatics so dense that they make almost a continuous layer. The entire gland is Dlled 
 throughout In this way ; 2, 3, truneules surrounding the lobules, the flner network being 
 omitted : 3, 3 3, large trunks at the border ot the gland : 4, 4, network ot large vessels 
 around the nipple ; they originate in the depth ol the mamma ; 5, 5, great trunk arising at 
 the mesal side of the nipple, and extending across the gland and pectoral region to the 
 axillary lymphatic glands ; li, large trunk from the lateral aspect of the nipple extending 
 directly toward the axilla ; 7, large trunk from the caudal (interior) border of the mamma, 
 and uniting with the preceding on its way to the axilla ; 8, 8, the two great trunks from the 
 mammary gland going to terminate In the axillary lymphatic glands. 
 
 the stomach, and to those on the splenic vessels; but 
 finally all pass to the cjeliac glands, and then some 
 branches may enter the chylocyst independently, but 
 most of them" join the intestinal trunk. 
 
 Lymphatic Glands, Pi.exl'ses, and Trunks of the 
 Abdominai, and Pelvic Cavities.— The glands in the 
 abdominal and pelvic canities form a continuous net- 
 work from the inguinal glands to those in the (esopha- 
 geal opening; they also c-xtend out on the gieat vessels 
 of the viscei-a. Although there are no sliarjily defined 
 limits and limited grouping of the two hundred to four 
 liundred glands in this part of the liody, grouiishave been 
 made as in the neck for convenience. F'ollowiug Krause, 
 the following groups may be recognized, commencing 
 with the iliac region: (1) Iliac; (2) hypogastric; (3) sacral; 
 (4) lumbar; (5) mesenteric, including those of the meso- 
 colon ; (0) creliac. Each of these gioups ot glands with 
 the connecting vessels is also called a ple.xus. As the 
 elferent vessels of all these grouiJS unite to form the 
 rliylori/Hi and thoracic duet by three main trunks, these also 
 have 'received names: (1, 2) The two lumbar trunks (a 
 tniiicus hiiiipluitinjii liiriihiiliH of each side) from the iliac, 
 hypogastric, sacral, and lumbar plexuses, and (3) a single 
 \.n\nk(trviictii< li/iiijihdtuus inUKUnalix) from the mesente- 
 ric and cceliac lymphatic plexuses. As was remarkeil in 
 discussing the cervical glands, different authois may iis- 
 sign a collecting trunk from an organ to dill'ereiit groujis 
 of glands, although the same gland is nieanl. As the di- 
 
 vision into groups is artificial, and the glands vary con- 
 siderably in position and in different individuals, even in 
 number, this confusion is probablj' inevitable. 
 The iliac lymphatic glands and plexus fer/ajidwio; iliacm, 
 s. iliacrc, s. nnter lores ; plexus lym- 
 jihaticns iliacvs, s. iliacus externvs, 
 s. anien'o!-) form a chain along the 
 external and common iliac blood- 
 ves.sels. At the crural ring this 
 ]>lexus is continuous with the in- 
 guinal plexus. The afl'erent ves- 
 sels are from the inguinal plexus, 
 those accompanying the internal 
 epigastric and circumflex iliac 
 blood-vessels, those from the vcsic- 
 uhe seminales and the bod}' of the 
 uterus (those from the last two 
 soiiices are often said to extend to 
 the Ijypogastric plexus). This 
 |)lexus is connected with the liypo- 
 gastiic and sacral by several com- 
 niuuicatiiig branches, but the main 
 elferent trunks pass to the lumbar 
 plexus. 
 
 Hypogastric Glands and Plexus 
 (ghfiidf'lfP lymplf<itii:ii' hiipixjiisl fiap., 
 s. ilidein inleniip. x. peliiii'iti' ; pif.nis 
 Jiijpiogadrirtis, s. ilu/eiis intern if n, s. 
 pel ri nils). These are on the sides of 
 the pelvis, around the liy|iogastric 
 and internal iliac lilood-vessels. 
 The afferent lymphatics are froin 
 the gluteal, sciatic, and obturator 
 vessels, part of the spermiduet, the 
 pi-ostate, uroeyst, most fd' tin/ va- 
 gina, the uterine muco.sa. and neck 
 of the uterus. According to most 
 authors, the ental lyiniilialics of 
 the external genitalia in both sexes 
 pass to these glands. Sometimes 
 also ]iiirt of the inguinal eiferents 
 ]iass to this group. This plexus is 
 closely connected with the iliac and 
 sacral, but ils prineipiil elferent 
 trunks ])ass to the lumbar jilexus. 
 
 Sacral Glands and Plexus (.(/?((«f/- 
 'nhf lipnp}iiitli-in siinrifes ; jili'xns 
 lyinjiliiitiriis stirriilis). This group 
 of glands is between the folds of 
 tlie mesorectum next the sacrum. 
 The afferent ves.scls come fiom a part of the pelvic wall, 
 and the vertebral canal, and from the rectum. Ijike the 
 other pelvic plexuses it is connected with all the others, 
 but its efferent trunks pass to the lumbar plexus. 
 
 The Lumbar Glands and Plexus (f//rt//rfH/(p lipnphiiticiv 
 IvnihaJes, s. lumhares; ple.rns h/iiijihiitii-ns Innihnlis). The 
 lumbar glands form three irregular rows, one mesal and 
 two lateral, extending along the gi'eat blood-vessels from 
 the bifurcation of the aorta nearly to the origin of the 
 superior mesenteiic artery. Its afferent vessels are the 
 efferent trunks from the iliac, hypogastric, and sacral 
 plexuses, lymjihaties accompanying tlie ilio-luinbar and 
 part of the lumbar blood-vessels, those from the testis, 
 spermiduet in part, ovary, summit of uterus, Fallopian 
 tubes, kidney, adrenal, and most of the colon descen- 
 dcns. It is also connected by a greater or less number of 
 communicating branches with the codiac )ilexus. Its 
 efferent vessels unite to fcuiii two luineipal trunks, a 
 right and left lumbar lymphalic trunk (trnnrnx fi/mphii- 
 tii-iis liinihiilis). which with the iiitesliual ti-unk fdiin the 
 rliyliiCjist, tlie enlarged beginning ot the thoracic iluct. 
 
 CVeiiac Glands and F\cxuK{ffliiiiiliilir/yinji/iiitinfi'ii'liii<-ir' ,■ 
 plfj'iis lymjilidticiis nvliiicns). The co'liae plexus is situ- 
 iited along the cceliac vessids, the portal vein and th(- be 
 ginning of the superior meseiitei-ie artery on the dorsid 
 side of the pancreas, duodenum, anil "pylorus. This 
 group was formerly reckoned as|)ait of the lumbar plex- 
 us. The effereiU lympbiitics come from the stoiniich. 
 
 640 
 
KEFEPiKNCK llANDKOOK OF TlIK MKDICAL SCIENCES, 
 
 Lyniphatio SyMteni, 
 Ijyniplialic Sysloni, 
 
 part, of tlic tt'sophagiis and duiKlfiuiin, pail, of tlie liver, 
 the pancreas, and spleen. The efferent vessels .ioin the 
 intestinal trunk, or sometimes one or moie branches pass 
 directly to the cliylocyst. 
 
 Mcsenlerie Glands and Plexus (glan<liiln' iiiexciUcricii'^ x. 
 'mtmvrnicm ; plexus lymphaUni.i iiiesentericnx, k. mesi'irniciis). 
 The mesenteric glands and plexus (one hundred to two 
 hundred) lie along the blood-vessels between tlif folds of 
 the mesentery and the mesocolon. They are usually In 
 three irregular tiers, one tier being near the intestine, one 
 near the niiddle, and one near llie root of the mesentery. 
 The afferent vessels are fi'om the small intestine, except 
 part of the duodenum, and the laige intestine to the 
 sigmoid He.\ure. The efferent vessels receive the efferent 
 trunks from the 
 C(eliac iilc.\us, and 
 then terminate in 
 the cliylocyst as the 
 intestinal trunk 
 (trnneiis lyiiiplKiti- 
 cus intexHiKiUii). 
 
 As will be seen by 
 a glance at Figs. 
 8281-8386, the lym- 
 phatics and the 
 glands in the ab- 
 dominal cavity of 
 the dog, cat, and 
 rabbit are essential- 
 ly as in man, but 
 there is a great con- 
 centration of the 
 glands, so that the 
 groups are well de- 
 tined. No sacral 
 glands were cer- 
 tainly found in any 
 of them.* 
 
 LVMriI.\TICS OF 
 
 Tim TiioK.w. — The 
 tiioracic lymphat- 
 ics ar(^ divisible 
 into three fairly 
 distinct, although 
 comm nil icuting, 
 groups: (1) Those 
 of the skin and 
 other surface struc- 
 tures; (2) the ental 
 lymphatics of the 
 thoracic walls, in- 
 cluding the dia- 
 phragm; (8) the 
 lymphatics of the 
 thoracic viscera — 
 heart, lungs, tra- 
 chea, and o'sopha 
 
 * Sappe.v describes 
 :iii(l figures in bis Atlas i 
 (I'liite XLVIII., Fig. ill.) 
 tin; luiiihar trunks in 
 tlie rabbit anU Ibe 
 triinlis from tlie ovary 
 euteriiifj tlu'iii without 
 Irav<-rsiii{x any plantls. 
 He says furtluT ronceru- 
 inji; the lumbur trunks, 
 in describing ttie fig- 
 ure : "(Jros troni's lym- 
 plia tiq ues provenant 
 dcs ineniltres posterieurs 
 et (ill bassin ; its se ren- 
 (lent direi-tement dans 
 Torigine i\n canal tbo- 
 raciipK^ saus a\oir tra- 
 verse dans leur trajet 
 ancuii ganglion [lyni- 
 phatiquej." Sucb aeon- 
 ditiOD was never ob- 
 served by the writer in 
 any of the white ral>- 
 bits dissected. 
 
 Vol. v.— 41 
 
 Fig. 327.5.— The Ental or Pleural Aspect ot the Sternum, Parts of the Ribs and the Dia- 
 phragm, to show the Slerniil Ple.xus. (Sappey, Atlas.) --l,.l, stcnunu ; B to AT, 
 the lirst nine ribs: L, M, the ventral part, of the liiaphragni, part of the central 
 tendon being shown at M \ 1, 1, I, 1, 2, 2, 2, the sternal plexus of lymphatic glands 
 and the connecting vessels : 'A to 10. lymphatic network and trunks in the intercostal 
 spaces. The trunks extend along the caudal margin of the ribs to reach the stemul 
 glands. These trunks are directly continuous doisad with the intercostal ple.xus 
 Tcf. Fig. :i2S()t : 1 1, IK vessels on the pleural surface of the riiaphragm, rtnally extend- 
 ing to the sternal glands : 12, 12, 1:3, sternal glands opposite the eiLdidi and ninth ribs 
 and their efferent trunks: U, glands receiving tlie lymphatics from the suspensory 
 ligament of the liver. 
 
 The ectal Ij'mphaties, like those of the alidfdueii, are 
 quite sliarply ilixided into those of the right anil those of 
 tlie left side, although on both the dorsi- and ventii-me- 
 son the vessels interdigitate. 
 
 The beginning of many of the subcutaneous trunks of 
 the thorax is likewise from an oblique zone surrounding 
 the body at about the level of the umbilicus (Fig. 32(i9), 
 and tliere is a somewliat similar, although less clearly 
 defined, limiting zone between the neck and thorax. 
 The collecting trunks extend in the most direct manner 
 to tlie axillaiy lympluitic glands (Fig. 32(10). Fart of 
 tliosc, howc'ver, in the subclavicular and adjoining pec 
 toral regions |iass to the supraclavicular ghinds. This 
 is stip])osed toex])lain the involvement of these glands in 
 some cases of cancer of the breast.' 
 
 Bel n^m^ t 1 this ctal gioupare the lym- 
 Iihities t Ihc m unniary gland. Inihe 
 mill 111 > IK but little more dcvelo])ed 
 111 in the suiKunding inlcgtiment; but 
 m the t( mill i specially in jireparation 
 1 1 lud duiuig laclation, they are 
 puseut m enormous numbers, and 
 then size is also greatly increased. 
 Th s if the mammary integu- 
 •f ment lu especially numerous in 
 I> till irt la, but it is in Ihc gland 
 ilii substance itself tliat 
 each their highest de- 
 pment. From the sub- 
 ice of the gland they 
 ach the surface in 
 our places, and extend 
 as four principal 
 ruiiks toward tlie 
 axilla, but most oft- 
 en unite to form 
 two large trunks 
 before entering the 
 axillary glands. 
 Most authors as- 
 sign part of the 
 lymphatics of the 
 breast to the inter- 
 nal inammary or 
 sternal plexus, but 
 Sapjiey states that 
 the course is as de- 
 sci'ilied above. 
 
 Besides the lyrn 
 phatics from the 
 mammary glands, 
 many of those from 
 the ectal muscles 
 pass to the axillarj' 
 glands. These 
 trunks pass along 
 the great pectoral 
 muscles and the 
 vasa thoracica lon- 
 ga, and usually 
 t r a V e r s e a few 
 small glands (pec- 
 toral glands) in 
 their course. 
 
 The lymphatics 
 of till' i.liaiihragm 
 were discovered by 
 Kudbeck, and fully 
 described by Nuck. 
 They are among the 
 most easily demon- 
 strated of any in 
 the liody, and from 
 the thinness of the 
 diaphragm and the 
 c 1 e a r n e s s with 
 which the lymphat- 
 ics may be fol- 
 
 641 
 
L.yini>liatiC' System. 
 L.yinx>Iiatlc System. 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 lowed, this organ is a favorite object for study. Tlie 
 lymphatics extend from the peritoneal to tlie" pleural 
 surface, hence it is upon the thoracic face that the great 
 trunks are found (Fig. 3376). These are arranged into 
 three paired and one azygos group. The lymphatic 
 trunks of the diaphragm practically surround the whole 
 organ and the openings through it. From the ventral 
 group, occupying somewhat more than the ventral half, 
 the trunks extend toward the sternum, traverse a gland 
 
 about opp(Jsite the seventh rib, and then extend to 
 the sternal ple.xus, those of the right going to the 
 right lymphatic trunk, and tho.se of the left going 
 to the thoracic duct (Fig. 3276). The azygos group 
 appears opposite the xiphisternum, and is represented 
 by three glands (supraxiphoid of Sappey, anterior 
 mediastinal of authoi's), and their efferent trunks. 
 These ijce not properly diaphragmatic lymphatics, for 
 they eonie from the surface of the liver and suspensory 
 
 
 Yin, 3276.— ThP Lymphatic Vi-ssi-ls and (Hands on tli« Pli-iiral ur Tlioraclf ,\s|n-i't uf tin- Hniiian THaphraKni. (Sappey, Atlas.) A. Xlphl- 
 aternum- B <\ D. E. F. G, 1 1, A", r,. ll, 7, k, (i, hi, 11, and 1:;. rllis: L, L, inii.srular ]iart <.r tlin diaphragm next tlie ribs: ,V, M. pillars of 
 thK dlaphrafi-in ; N, the three parts r,( the ivaiUuI leiHl..n ..r the rtjapliratrni ; (/, passa^'e for thi- jKistcava: /', lesophageal lu'lhce ; Q, hiatus 
 aorttcus hetvye(!n the two pillars (■{ thi- diaphraKni. The j-dands in tlie opening are In tile abdomen and heloni; to 
 plexus. 1 and 3, The netw(a'k in the ri(,'lit and left dorsal prjints of the I'cntral tendon ; ;l, :l, network . 
 meaal part of the central tendon ; 4, 4, 4, (.'lands around the postcaval openini.' for the recepticai of p" 
 tendon; 5, .5, two glands at the o'sophai.'eal opening, they receive the nciuhborlnK lymphatic 
 
 tlie (celiac lyniptiatic 
 iiind the border of thi* ventral or 
 of the lymphatics of the Central 
 , trunks coniinff from the dorsal part of 
 the central tendon alontr Ihe pillars of the diaphnKriii to enter the (.'lands in the aortic" openinfr at (Q): K, H. K, line lymphatic network of 
 the muscular part of the diaphrap-m ; 0, 0, 9. fl. ivmpliatlc- trunks wiiidln(,' ar.aind the eil(;e of the dlaphrafriii to enter the coeliac lymphatic 
 glands; HI and II, trnnciiles and trunks extemlin(r toward llie sternal plexus; 1:3, lymphatic (iland on tJiediapliragni near its ventral 
 Attachment opposite the seventh rib; it is double on the left side; 13, three lymphatic glands ventrad of the pericardium, and usual y 
 buried in tat. To them extend the lymphatics from the suspensory ligament of the liver; 14, 14, glantls of the sternal plexus recelvlnjf the 
 efferent vessels from 12 and 13 (cf. Fi(;. 3275). 
 
 642 
 
REFERENCE HANDBOOK OF THE jMEDICAL SCIENCES, 
 
 Lyiupliatio System. 
 Liyiiiphatio System. 
 
 ligament (see Liver). The efferent trunks join tlie ster- 
 nal plexus. 
 
 Prom the dorsal part of tlie diapliragm the trunks eon- 
 verge to the aortic or (esophageal opening (dors il ^loiq ) 
 and enter the glands there situated. Other trunks «n I 
 round tlie pillars ot the diaphra,gm and enter tli dj 1 
 men. As part of tlie glands in tiie aortic, and iK in tht 
 cpsopliageal opening, are in the abdomen, it foil -w s thit 
 part fif fhe lymphatics starting on the periton xl ( i d 
 dominal side of the diaiihragm extend to the pkui d oi 
 thoracic side, and tlicn turn hack througli these 
 trunks into tlie aljdomeii before finally termi- 
 nating in the thoracic duct. 
 
 The deep structures of the thoracic walls are 
 drained \>y lymphatics following the inter- 
 costal spaces. As will lie seen by consulting 
 Figs. 3375 and 3380, tlie codecting 
 trunks form a lialf-circle, the vessels 
 extending both ton-ard tlie sternal and 
 toward tlie intercostal jilexus. In their 
 course along the intercostal spaces they 
 usually traverse one or more glands. 
 Near the spinal column is a row of 
 glands whose efferent trunks may ex- 
 tend directly to the thoracic duct, but 
 usuall}' two or three of them unite to 
 form a common trunk, which opens 
 into the thoracic duct. It is a re- 
 markable fact that those from the last 
 three inter- 
 A costal siiaces 
 
 unite to 
 f o r m 
 trunks 
 on each 
 side, which ex 
 tend through 
 the diaphragm 
 into the abdo- 
 men to join 
 the ch.ylocyst, 
 instead of en- 
 tering the tliora u 
 the thorax (cf. Fig. 33no, 
 where ves.^els pass frnm 
 the abdomen to the tho- 
 rax ). 
 
 From the first few in- 
 tercostal spaces the col- 
 lecting trunks on the right 
 side pass to thcri.ght lym- 
 phatic trunk; and from 
 tlie sternal half of all of 
 the spaces the collecting 
 trunks joiu the ster- 
 nal plexus, those on 
 the right extending 
 therefrom to the 
 right lymjihatic 
 trunk, and those on 
 the left to the tho- 
 racic duct. This 
 offers a very strik- 
 ing illustration of 
 the close connection 
 between the light 
 and left lymphatic 
 trunks in man, a 
 condition much 
 more full}' realized 
 in many of the 
 1 o w c r a n i m a 1 s. 
 The lymphatics of 
 the spinal canal and 
 the muscles of the 
 back follow theii' 
 blood - vessels and 
 enter the intercos- 
 
 tal jilexus 
 racic duct. 
 Oixopliagus 
 
 the 
 
 greater number linally reaching the tho- 
 -The lymphatics of the cesophagus are in 
 
 H^ -^ 
 
 E 
 
 Fig. 3277.— Trachea and Brnnolii Opened on 
 ttie Dorsal Side to Show the Abundant 
 Lymphatic Network of the Mucosa ; from 
 a Child at Birth. (Sappey, Atlas.) .1, 
 epiglottis; B, section of the cricoid carti- 
 lage to e.xpose the interior of the larynx ; 
 C, C. tra<'hca ; D, D, the membranous 
 portion of tile trachea drawn to the left, 
 exposiup: the interior ; E and F, the two 
 bronchi. 1, The lymphatic network of 
 the epiglottis ; 2, 2, ental cervical iyiu- 
 pbatic [i-lands (ct. Plate XMI., 13) ; sub- 
 glottic network in the larynx ; this is 
 very spai-ing in the adult; 4, -t, network 
 of the tracheal mucosa ; 5, .'>, ental cervi- 
 cal glands along the trachea into which 
 the collecting trunks enter ; 6, 6, the 
 lymphatic network in the bronchi ; it will 
 be seen from this figure that the lym- 
 phatic network from the epiglottis into the 
 bronchi is uninterruptedly dense ; in the 
 adult there are comparatively few lym- 
 phatics in the larynx proper and in the 
 trachea ; 7, 7, bronchial lymphatic glands. 
 
 i.-,s. — Ettal OI subserous L.\mphatlcs of the Dorsal Surface of 
 iaingsof a child at liirth. (Saj>pev, Atlas.) ^, trachea— the 
 line piiinls to the membranous portion ; 73, U, summit or cephalic 
 lohcs of the twn lungs ; D, the llssuie dividing the left lung into 
 tw(j Icibes; E, b\ (1, llssurcs dividing the right lung into three lobes. 
 1, lA'njphatic netwcik on the cejilialic lobe; 2, 2, ni'twork on the 
 cau.lal lobe; ni-twnik on the middle lobe of the right lung. The 
 tine network surrouniliiig and covi-ring the puhnonary lobules is 
 not shown in this llgiire. 
 
 two sets, as in the rest of the alimentary canal, viz., 
 those of the muscularis and those of the mucosa; they 
 penetrate the muscular wall and enter the small glands 
 scattered along its course. The lymphatics are directly 
 continuous with those ot the pliarynx at one end and 
 with those of the stomach at the other. At the gastric 
 enil the collecting trunks, after reaching the surface, ex- 
 tend toward the stomach, and ]iart of them traverse the 
 (esophageal opening and enter tlie glands around theear- 
 dia of the stomach (Plate XLIIL). Those of the mid- 
 dle region enter the dorsal (posterior) mediastinal glands, 
 while those in the neck join the internal jugular jdexus. 
 Vp to the present time the lymidiatics of the muscularis 
 have been actually demonstrateil only in the larger domes- 
 tic animals (horse and ox), but the probability is very 
 strong, that they exist in the human (esophageal muscu- 
 laris. 
 
 Jli'dii. — The cardiac lymphatics are in two groups — a 
 .subpericardial and a subendocardial network— but in 
 both cases they are derived from the muscular substance, 
 and not from the serosa. The ectal or subpericardial 
 network commences with the apex of the heart and ex- 
 tends over the whole surface, but the larger trunks oc- 
 cupy the dorsal and ventral grooves or dejircssions con- 
 taining the large cardiac blood-vessels. The ental or 
 subendocardial vessels unite into collecting trunks which 
 penetrate the myocardium near the apex and near the 
 auricido-ventricular groove, and anastomose with the 
 
 643 
 
Lyinpliatli' !<i)Kloiii. 
 liymphatlc System. 
 
 UEFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 ectal lymphatics, and all together extend to the groove 
 between the auricles and ventricles, and form an anasto- 
 mosing circle aroimd the base of the ventricles. The 
 rather few lymphatics of the auricles mostly extend tow- 
 
 FiG. 3279.— Diagram of the Thoracic Duct, the Riffht Lymphatic 
 Trunk, and the Lymphatic Plexuses of the Human Body. (After 
 Quain.) 1, Left jugular plexus ; 2, arch of the thoracic duct near 
 its entrance into the angle between the subclavian and internal 
 jugular veins ; 3, left subclavian vein ; 4, left axillary lymphatic 
 plexus ; .5, the thoracic duct in the thorax ; 6. trunk from the inter- 
 costal plexus to the abdomen where it joins the chylocyst ; there 
 should be a similar trunk on the left (cf. Fig. 32811); 7, lacteals; 8 
 and 9, inguinal aud iliac plexuses on the left and right ; 10, chylo- 
 cyst or chyle receritacle ; 11, the sternal, bronchial, and mediastinal 
 plexuses ; 12, axillary plexus on the right ; 13 and U, right sub- 
 clavian and internal jugular veins : the right lymphatic trunk 
 enters the vein at the angle between the subclavian and Internal 
 jugular, as does the thoracit duct on the left: 1.5, right jugular 
 lymphatii; plexus. 
 
 nrd the auriciilo-ventricalar groove and join the anas- 
 tomosing ring, ))Ut some extend directly to the main 
 trunks along tlie two sides of tlie puhnonary arterj-. 
 From tlie anastomosing ring in the auriciilo-ventricnlar 
 groove two trunks arise, tin; one leprescnting the left 
 heart extendsaloiig the left sideof tlie pnlinonary artery, 
 and between it and the li-ft aui-iclc to llie left bronchial 
 glands, and therefore finally to the thoracic duct. The 
 trunk representing the right heart follows the right si<le 
 of the pulmonary artei-y, and jiasscs between this vessel 
 and the arch of the aorta to reach the right bronchial 
 glands, ultimately to teiiniuate in the right common lym- 
 phatic trunk. 
 
 LuivjH. — The lymi>liatics of tlic^ lungs ai'e exceedingly 
 numerous. Tiny arise in the lung substance between 
 the alveoli, and in the bronchial mucosa. Those near 
 the surface extend tovvaid the periphery and become 
 subserous, and then extend to the root of the lung to en- 
 ter the broncliial glands (Figs. 3277 and 3278). The en- 
 tal lymphatics follow the bronchi and finally, after tnt- 
 versing a few small glands on the bronchi (the so-called 
 pulmonary lymphatic glands), they enter the bronchial 
 glands. Fio'ni these glands extend trunks to the left to 
 enter the thoracic duct, and to the right to enter the 
 light common lymjihatic trunk. 
 
 Trachea and Bronchi. — As seen above, the epiglottLs 
 and entire laryngeal opening pos.sess an almost inliuite 
 number of lymphatics (Plate XLIL). la the infant this 
 wealth of vessels continues throughout the entire larynx, 
 and trachea and its branches; but as age advances the 
 lymphatics of the larynx, commencing at the level of the 
 vocal cords, and the trachea become less and less, until 
 in the adult they are comparatively few ; but in the 
 smaller bronchi the abundant lymphatic network per- 
 sists. The vessels arise in the mucosa and the intercar- 
 tilaginous tissue, penetrate the tracheal wall, and are 
 distributed to the glands so abundantly supplied to the 
 neck along the trachea and bronchi (Fig. 3387). 
 
 TuOKACic Ly.mphatic Glands. — The lymphatic 
 glands of the thorax are only second in importance and 
 number to tho.se in the abdomen. Within the thorax 
 they form a continuous network, and are closelj' con- 
 nected with those of the abdomen on the one hand, and 
 with those of the neck on the other. Those without tlie 
 cavity- are continuous with the axillary glands. 
 
 The pectoi'al ^.\imAfi (fjlamlulo! lyinphaticm jiectornlex, •<. 
 thonicicn' xtiperjictales) are sitnateci along the caudal (in- 
 ferior) border of the great pectoral muscle, and some 
 more deeply along the vasa thoracica longa. Through 
 them pass many of the trunks following the long tho 
 racic blood-vessels, and many of those from the thoracic 
 region on their way to the axillary lymphatic glands. 
 
 Within the thorax there are several named groups witli 
 corresponding plexuses. The sternal glands and plexus 
 {glandiili'e lympJiatine uternales, a. substenudes, s. tlioracicfp 
 'profiuidi'p, .1. mammana', s. presternales ; pjlexus hjmphati' 
 ctis steriadis, s. mammariiis internus) commence opposite 
 the xiphistcrnnm and extend along the thorax on each 
 side of the sternum in company with the stei'nal blood- 
 ves.sels (Fig. 3275). The atferent vessels of this plexus 
 coine fi'om the deep abdominal muscles in the supra- 
 umliilical region of the abdomen, the ventral two-thirds 
 of the diaphragm, part of the convex surface of the liver 
 through the suprahyoid glands, the structiu'cs in the in- 
 tercostal spaces in the ventral part of the body. The 
 atferent ves.sels usually jcjin the ventral (anterior") media- 
 stinal glands, and witli their trunks pass to the two great 
 common lymph-trimks. Sometimes one or more, or all, 
 of the trunks pass directly to the great lymph-trunks 
 without traversing the mediastinal glands. 
 
 The intercostal glands and p\exus{glandiilmli/mpfiaiicce 
 iiiierciiHlides ; ple.rnH lyiiiphiiticim inlercuntalis) are found 
 on each side of the thorax, in the intercostal spaces, and 
 along the vertebral column. The afferent vessels are 
 from the intercostal structures, the spinal canal, and the 
 dee]) muscles of the back. The efferent tnmks pass 
 mostly to the thoi'acic duct, but part of those on the 
 right pass to the right lymphatic trvink. 
 
 The dorsal or posterior mediastinal glands and plexus 
 ( gliindida: luiiipluiiifin niediii.ilinales dorsales, s. posteHores : 
 ple.riix /yuijdiatieiis mediax/uialis dorKnlix, s. pnsterinr) are 
 situated along the thoi'acic aorta and the cesopliagus, in 
 the dor.sal or posterior mediastinal folds. The afferent 
 vessels ai'e from the tt>sf>phagus, the doi'sal third of the 
 diaphragm, and some from the liver. The efferent ves- 
 sels enter the thoracic duct, directly, or join the bronchial 
 glands. 
 
 The ventral (anteiior) mediastinal glands and plexus 
 (rihiiididiv Iji ii)]}haUc.(e media xtiiiales rentrales, s. anleiiorex, 
 x. f/l. I. rardiac<n : plrxiix ly inplaUicns mediasii iialix rciitra- 
 Ux, s. anterior) are in the ventral mediastinal fold, and 
 are i)rincipally concentrated around the arch of the aorta 
 and the roots of the great lilood-vessels. The glands 
 called supra-xiphoid by Sappey (14 of Fig. 3275) are fre- 
 i|ucntly assigned to this group. The afferent vessels are 
 from the stermd plexus, and thrfingb this many vessels 
 from the convex surface of the liver; the lymphatics of 
 the thymus, and, according to some authors, the lym- 
 ]>halicsof tlie heart. The efferent vessels either go to 
 the bronchial glands or join the vessels from these, and 
 extend from the right half to the right lymphatic trunk, 
 and from the left half to the thoracic duct. 
 
 The l)ronchial glands and plexus (glandiila< lymph<dira' 
 
 <ii44 
 
REFERENCE HANDB(J(JK OF THE .MEDICAL SCIENCES. 
 
 l..yiii)>liatio Sy»^teiii. 
 L.)'iiipliatic' 8y»tciii. 
 
 broncliuili'fi ; pk.xvslyiitphittinis broiichalis) are situated in 
 tbe bifurcatidii of tlie tracbeu, and extend upon the tra- 
 chea (where they are called tracheal lymphatic jilands) 
 to tlie internal jug\dar plexus, and others extend out 
 along the bronclii into the lungs (pulmonarj' lymphatic 
 glands). In childhood and youth they are pink, but 
 with advancing age they become dark and even black, 
 if the individual has inhak (1 i pii ntilul sup 
 ply of coal dust or other e iibon k ( ous m it 
 ter. These glands are \ci> liigi ind un 
 portant. The alTerent \csstls in fioni 
 the lungs, and, according lo somi lu 
 thors, tli(; heart, the brom In tin dlii 
 ent vessels of the dorsal iiKdustinil 
 glands, and sometimes tin 
 mediastinal glands also. 1 li 
 ent vessels extend from tin 
 side to the thoracic dm 1 
 from the right to tlie light l\ 
 pbatic trunk. Freciueiith 11 
 efferent vessels of the stem il 
 ventral, mediastinal, iiid 
 bronchial glands unite to 
 form a largi; sin.gle 
 multiple trunk (tniiicii 
 lyiitplniilrH!< hroiirjiinni'- 
 
 ntriliii>^li litis, ,v. bivii- 
 rhoitn'dl'ilsti II if.lis), 
 which extends to 
 the conunoii lym- 
 phatic trunk of the 
 right or left. iSueli 
 a truidv is nioi'e 
 common on the 
 right. (.)n the left 
 tbe elTerent trunks 
 are usually sniallei' 
 and less concen- 
 trated. 
 
 C o M M o N Ij Yi\l 
 PII.VTIO TmiNKS. — 
 In man and the 
 mammals there are 
 but two common 
 lymphatic trunks, 
 one on the right, 
 and one on the left 
 side; and these 
 trunks terminate al 
 two points in the 
 great veins of the 
 neck, usually at the 
 junction of the jug 
 ular and siilie!a\ iaii 
 veins — that is, just 
 before the i'oima- 
 tion of the brachio- 
 cephalic venous 
 trunks, or in ani- 
 mals like the rabbit 
 (Fig. SiSi) with a 
 right and left pre- 
 cava, just before 
 the formation of 
 these. Ill man and 
 the higher animals 
 these trunks are of 
 different length and 
 size, ami receive the 
 lymphatics of very 
 unequal portions of 
 the binly, that on 
 the left side being normally 
 In the lowest mammals the 
 
 Thoracic Duet {r/ii/lniliirtiif:, ilurtiia f/innirirux, s. tnm- 
 CIIS, .V. Ciiliilli.'i ll/iilji/iilfii'll.s nininiil liili .si in\^fi'l\ s. iiiiljor. .v. 
 ductus rliijllfi nis, .v. ] ii nihutJioriirinis ; rrmi nihil tliorariy 
 [Eustachius, ir)(i4]). — The common lym]ihatic duet, 
 canal, or trunk of the left side collects and empties iiilo 
 the venous system, the lymph of the jielvic limbs, the 
 reproductive and urinary organs, the alimentary canal. 
 
 pancreas, s|ileeii. 
 •-'^ much of that of the 
 
 \\,! * liver, (.r the left 
 
 '• ■ half of the bodv 
 
 ee])ljaladof (abov/^) 
 the umbilicus and 
 a part of that from 
 the I'ight half of Ihe 
 thoraei<' w all (Fi^^. 
 
 :-!-,^r!Mo a-:;s;). 
 
 Ill mall the tlm- 
 laeie duct is formed 
 in tlii^ abdoiiicu o|i- 
 posile the tirst, .sec'- 
 oiid, or third lum- 
 bar vertebra by the- 
 union of the trunks 
 of the lumbar and 
 111 esc 11 1 e rie lyiii- 
 ])liatic |)lexilse> 
 The caudal end is 
 lorined bv the union 
 of the right and lell 
 lumbar trunk (Irim- 
 
 I'jili II tie II f 
 
 much the more extensive. 
 
 tendency is very strong to 
 equalize these trunks, and also the area drained by them ; 
 and in the animals below mammals, the two are approxi- 
 mately equal. 
 
 Iiinitmlis ih.rler rt 
 siiiislir). The large 
 trunk thus formed 
 is then inereased 1)\ 
 the addition of tiiV 
 unpaired or az\ - 
 gous trunk (trim- 
 I'tix i II frsti/iiilis) 
 I'rom Ihe stomach 
 ami intestines, part 
 of the liver, the 
 s|ileeii and pan- 
 creas, and the right 
 and left trunk from 
 the intercostal plex- 
 uses (Fig. S'i'ii)). 
 At the beginning- 
 of the duet when- 
 all these coulluents 
 unite there is usu- 
 a 1 I y a m a r k e d 
 dilatation, the cliy- 
 locyst, chyle recep- 
 tacle, (U- cistern of 
 Pe c q u !■ t ( c/ii/loaj.s - 
 tis, s. n'l'ijitiii'iilii'iii 
 c/ii/li, .V. risieiiii' 
 clit/li). This is 
 sometimes abseni 
 in man as the con- 
 fluents form a kind 
 of network instead 
 of one large trunk. 
 In this case the 
 thoracic duet is 
 formed l.iy the union 
 of the n e t w o r k 
 without there being 
 present a special 
 enlargement or cliy- 
 locyst. Thiscomii- 
 tion is .said by Owen to be normal in the marsupials ex- 
 amined by him, but in the dog, cat, rabbit, and most of 
 the higher animals there is usually a very well-marked 
 chylocyst. From Ihe chylocyst the thoracic duct tra- 
 verses the diajihragm with the aorta, usually on the 
 
 . 3:28(1.— Port of tlie Thoracic Duct and Intercostal Lymphatics. (Sappey, Atlas.) 
 A , vertehral ('i>luinn opposite the first lumbar vertebra : Jf, ( ', fx E, F, (•', H, J, 
 tifth to the twelfth ribs inclusive ; JT, ectal intercostal luusi'les between the ribs ; 
 the ental or internal intercostals have been renioverl to show the intercostal lyiii- 
 pliatic pli^xiis : 1, the thoracic duet near the chylocyst ; it exfemls alonq: the \'cr- 
 tebral column nearly on the meson ; 2, 2, trunks arisinff in the intercostal spaces; 
 3, 3, 3, lymphatic J2:lands in the course of the vessels ; 4, 4, Iar[,^e trunk conveyine 
 the lymph from the three or four intercostal spaces into the abdomen and then 
 pourinjr It into the chylocyst; .5, 5, similar trunk on the leftside; tj, li, and 7, 
 trunks on the riffht and left, from the intercostal spaces to the thoracic duct. 
 
 645 
 
K>yiiipl>atlc System. 
 Iiyiupliatlc System. 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 right side, and extends along tlie 
 tliorax mostly on the right and 
 dorsal side of the aorta until op- 
 posite the sixth to the third tho- 
 racic vertebra it gradually inclines 
 to the left, passes dorsad of the 
 arch of the aorta, reaches the left 
 side of the O'sophagns which it 
 follows for a shoi't distance, pass- 
 ing on with it along the dorsal 
 side of the great blood-vessels 
 until opposite the seventh cervit'al 
 vertebra when it forms an arch 
 something like the 
 arch (.)f the aorta, 
 curving vent rad 
 and to the left be- 
 tween the verte- 
 bral blood vessels 
 and the jngular 
 vein to terminate 
 at the junction of 
 the left internal 
 jugular and the subclavian vein. 
 The opening is guarded by a 
 double valve, so that reversal of 
 the diicctiou of the stream is 
 avoided. 
 
 The thoracic duct difl'ers in 
 length with the length of the 
 trunk. The average in an adult 
 is al)out 40 cm., and its diameter 
 is about 2 to 3 mm., it being 
 greater near its origin than near 
 its termination. It in many cases 
 divides into two or more parallel 
 and anastomosing vessels, which 
 tiually unite to enter the vein to- 
 gether. The chylocyst is from 
 40 to oO mm. long and to 8 mm. 
 
 Fig. ;i!2sl.— General View of the Lym- 
 pbatie System of tbe Cat. (l'"eli.^ Dn- 
 it'te^t'K-a.^) (Drawn by Mrs. Guire.) a. 
 Stomach ; h, small intestine ; c, Ciceum ; 
 (}, large inte.stine ; c, ereliac a.xis; /', 
 superior mesenteric artery : )/, inferior 
 mesenteric artery ; h, e.xternal epi^^as- 
 tric artery retlecti-d from the alidominal 
 wall upon (he thit^h : i", sciatic nerye 
 (liyiding into the peroneus and tibialis : 
 /-,-, saphenous or inter-nal cutaneous ar- 
 tery ; m. ?i, fetnoi-al artery: o. cut edge 
 of tbe abdominal wall ; p, ilio-lundjar 
 artery; q, right kidney; r, cut edf^e of 
 the iliapbraffin ; .s, thrn-aclc aorta ; ^ 
 tjrachial artery, e.xien<lintr into the antl- 
 bracbiuiii as the radial artery; n, sub- 
 clavian vein; c, external iugnlarvein; jc, 
 trachea. 1, Lyuipllatics I'roiti the- venlral 
 lipand Hci..r..f the miaitb lotlictwo 
 Tiiaxillary iyiii|)hatic Ldands. As shown 
 Jn the. ll£,on-e, these trunks crossto the 
 
 opposite side fruni whicii they arose; 2, tninks from the facial 
 region injected froiri the bare spot on the snout and dorsal lip; :J, 
 the two slibmaxtliary lymi'hatic irlanris, otie on each side of the 
 facia] vein ; 4, sin^de enlal cervical gland on the side of the ti'acbi'a 
 and next the carolhl artery; into this enter ria.stof the ellerent 
 trunks from the siibina.xillai'y lyinTihatic glands; .^), (rj/,n(0(s lijiii- 
 lihiiticii^ jiiijid'iri^ Irntii tiie ental cei-yical glands to the tbitracic 
 -iluct on the iefr. and thc^ right common lymphatic trunk on the 
 right ; i». termination of the thoracic duct at the junction of tla^ 
 suliclavian and external jugular veins; 7, lymphatics from t\u: 
 stomach to tbe co-liac glands; s, lymphatics from tla^ liver lo a 
 <'0-liac gland : 0. gland neai' the duodennm inio which many of the 
 duodenal lymiihatics (■nler; 10, the twoenoirnoiis ira'senterlc glands 
 near the ciei-iim, often called iheglands or patM'reas of Aselliiis, into 
 which Tfjost (if tbe lymphatics <if (he small intestine, c;ecum, and 
 part of the colon enrptv. From these glands extends the grciit 
 tniiii-iis li/iiii)hiiliivH iiiti'.-iliiinlix to the chylocyst, receiving the 
 trunks from the diiodenmrt, liver, and stomach on its way ; in tlii' 
 <-at, as shown in the figure, (he triincns intestinalis is ver'y long and 
 usually single, making it very easy to iriseit a caininia for a starch 
 or plaster injection ; II, trunks and ghuids in tliiM-iecal I'egion ; 1:;, 
 lymphatics fnan the colon, there are usually si'veial small glands 
 near the attachment of the mi'sentery ; Ki, ghuids in the mesoi-olon 
 
 around the interior mesenteric hi l-vesseis ; U, hypogastrw'. lym- 
 
 pbaUc glands; I;'., gland at the side of tlie external epigastric blood- 
 
 ve.s.si'ls." It receives tlie lymphatics fr the abdominal wall, part 
 
 of the mammary gland and tbe exteraal genitalia, its ellerent ves- 
 
 
 in diameter, and in the arch near the 
 termination there is sometimes, if not 
 regularly, found a dilatation something 
 that shown in the dog and the 
 rabbit (Figs. 328.5 and 3287). Tlie tho- 
 racic duct receives confluent branches 
 throughout its entire course, and near 
 the termination enter the important 
 trunks from the arm, lungs, and lieird 
 and neck (the jugular, subclavian, and 
 broncho-mediastinal trunks). The en- 
 trance of each of these vessels is usu- 
 ally gtiarded by a ittiired vtilve. 
 
 VaruUes. — There are sometimes two 
 ducts — one opening 
 into the right, and one 
 into the left veins of 
 the neck. Sometimes 
 a single duct divides, 
 sending one brancli to 
 the right and one to 
 the left, as shown in 
 the tlguie of the cat 
 and rabbit (Figs. 3282 
 and 3287). Rarely 
 there is a tran.sposi- 
 tion, the left thoracic 
 dtict opening on the 
 right. "in Iwo in. 
 stances the thoracic 
 duct has been seen to 
 terminate in the vena 
 a ?.y gi )s. " M u 1 1 i p 1 e 
 openings into the veins 
 are not uncommon (cf. 
 Fig. 3283). 
 
 liifllit nniinioii lyiii- 
 ]i]i<ilir trunk {truiici/s 
 lyniphaticHu cviiiminiis 
 dewier, !<. irunor ; vena 
 
 sels go partly to the hypo- 
 gastric and partly to the 
 lunihar lymphatic glands; 
 the gland has been reflected 
 from the abdominal wall 
 with the external epigasiric aiteiy to the 
 muscles of the thigh, it may I'epresent 
 the octal inguinal group of man ; Itl, pop- 
 liteal gland In a mass of fat in tbe pop- 
 liteal space. It receives most of the 
 yiiiphatics of the foot and criis. and 
 sends its ellerent tninks between the 
 two great branches of the sciatic nerve 
 to follow the femoral artery; IT, trunks 
 from the dorsiini -if the foot, winding 
 round the lllmlar side of tbe cms wdtli 
 tbe ext+Maial siiplienous vein across the 
 calf of the leg to the popliteal gland, part 
 of the course is indicated by broken 
 lines; IS, lymphatic trunk fi-oiii' the dor- 
 sum and tibial side of tb*' foot follow- 
 ing the saphenous or internal cutaneous 
 artery, about opposite to the middle of the thigh it anaslomoses 
 fre(^!y with those following the femoral vessels; lu, lymphatic 
 
 trunks accompanying the femoral hi l-vessels and finally entei'ing 
 
 the lumbar glands, no inguinal glands heiiiL' present : MO, lymphatic 
 
 trunk iu'ciimpanying thc^ llio-lumbar hi l-vessels and entei'ing tbe 
 
 lumbar lymphatic glands; 21, iimibar lviii|ihatic gljoids ; 22, lumbar 
 glands inbi which pass the lymphatic Iriinks from the iiiternaJ geni- 
 talia, (liese are freilnently merged with (he Jireci'ding; 2:!, trunnin 
 
 l}linii}iiilii-ti>i /um/id/is, tliere is n each side, but freiiuenlly tbe 
 
 trunks are multiple, and the branches of llie two sides anastoiimse, 
 they nirm principal nmstitiicnts of the chylocyst; 21. chylncyst 
 formed by tbe junction of tbe intestinal and himliar trunks ; 2.'), 
 thoracic duct, a small branch is Indicated as goiiii.^ to the right side 
 of the body; 2H, lymphatic glands in tbe thorax, near the' arch of 
 tlie aorta and bronchi; 27, pecbirjd lymphatic glands in course of 
 the long thoracic blood-vessels; 2s, lymphatics froin Ihe doi-suin 
 of the manus following tlie radial nerve and cepbalii- vein and 
 llnally terminating in tlie prcscapular gland. The course iii Ihe 
 brai'lihnii, where not visible in this view, is indicated by broken 
 lines, oci-iusionally one or more branches turn at the elbow to billow 
 the hracbial vessels into tlie axilla ; in this case they enter the |iec- 
 biral gland opposite tbe third rili. Irne axillarv glands appearing to 
 be absent; 211, termination of the right, <-oiiimiiii Ivmplmtic trunk at 
 the jinictinn of the suliclavlan and external jngnlai' vein ; lib, pre- 
 .scapular gland receiving the lympbalics of the arm and shoulder, 
 and usuatly iin anastomosing branch from tbe jugldar trunk, its 
 efferent vessels join tlie jugular trunk. 
 
 646 
 
REFERENCE HANDBOOK OF THE MEDICAL SCIENC^ES 
 
 Fni. 3282— Ven- 
 tral View of the 
 Cbyloeyst and the 
 Great Lyniphatie 
 Trunks and their 
 Term i nation in 
 the C!at (Fclia 
 D o Ml. e »t ica) . 
 A b( tut natural 
 size. (Drawn by 
 Mrs. riuge.") a, 
 Tra<.'hea ; /^ /j,ex- 
 ti^rnal jugular 
 veins; e, f, inter- 
 nal ju^,^ ul ar 
 veins ; (/, ((, 
 su li (■ 1 a V i a n 
 veins; c, pre- 
 -cava. opposite 
 
 t<> the Ipft; HI. 
 small ffland ahuut 
 (»pposite the he:id 
 of the tlrst rib, 
 there is one also 
 OQ the left lint it 
 lias been oniided ; 
 11, 11, i.eetoral 
 t^lands and lyni- 
 p h a t i ("' vessels, 
 they follow the 
 1-ves- 
 seis after rearhinff 
 tli'^ axilla and ter- 
 minate dirertlv in 
 tlie arch of the 
 thoracic duct on 
 
 the entrance of the common 
 trunk of the sternal veins ; /, /, 
 subela\ian arteries; f/, bracldo- 
 cephalie artery opposite its di- 
 vision into the rii-dit subclavian, 
 the riLdit an<l left carotids ; /(, //, 
 arch nf tlie aorta and abdominal 
 aorta; i", i, cut ed^i'es of tlie Ibo- 
 racic walls and tlie endsdf the 
 ribs; /,, /,% jiillars (.if thi' dia- 
 phra.Lnn; ni, cn^liac axis : ((.su- 
 perior mesenteric artery; 
 
 0, n, tlie renal arteries. 
 
 1, Ental cervical gland; ,.; 
 
 2, tnnivifs luiiijiliatirus /- 
 jiKjiiltiris; 3, 3, trunk I'' 
 and jrland alont.' the ex- 
 ternal jiiputar vein, the 
 trunk is one of the elTer- 
 ent vessels from the lat- 
 eral of the two subma:?^- 
 illarv lymphatic t-dands u'^'i,/', 
 (cf. Fi'i'. 32.^1) ; 4. anas- ^ ' 
 tomosiniir branches be- 
 tween the jugular trunk 
 and the elTerents from 
 the i>rescapiilar gland; 
 5, 5, the right and left 
 prescapidargland : t>, ter- 
 mination of the thoracic 
 duct in the veins at the 
 angle of the suliclavian 
 and external jugular, a 
 short seuniieut has been 
 remo\eil from the exter- 
 nal jugular to show more elearlv 
 the arch of the terminal part o'f 
 the thoracic duct: 7. the right 
 eomnion lym|ihalic trunk at its 
 termination ; .^. lymphatic gland 
 on the trachea, its efferent ves- 
 sels extend both to therightand 
 to the left ; il, hirge gland in the 
 ventral mediastinum around the 
 sternal vessels, its efferent ves- 
 sels extend both tu the right am* 
 
 the left, but join other 
 . trunks on the right he- 
 fore entering the mm- 
 mon trunk ; 12, 12, 12. 
 lymphatic glands and 
 trunk near the arch of 
 the aorta, the etferent 
 vessels form prominent 
 constituents of the 
 right lymphatic trunk ; 
 13"", iirauch of tlie tho- 
 racic duet turning to 
 the right and ilnally 
 terminating in the 
 riL'-ht Ivmphatic 
 trunk; 14, U, 
 thoracit:' duct . 
 As indicated by 
 the cons t r i c - 
 tion s the 
 valves are 
 CO n s i d <■ r - 
 ably farther 
 apart in the 
 cephalic lialf ; 
 15, 15, chylocyst 
 on the I'ight side 
 of the aorta :ind 
 extending fop a 
 cons i d e ra b 1 e 
 distance i n to 
 the thorax ; 16, 
 t nniois iiitcs- 
 
 iiinu trunk fruin 
 t he stnmach, 
 iver, and intes- 
 tines (cf. Fig. 
 32S1). Tiefore 
 terminatini: in 
 the cliylncy-T it 
 di\-ides into sev- 
 eral brauciies. 
 
 of Wllirli 
 
 ^yinds rcmnd the 
 l^dt ^ide of the 
 
 iiat 
 
 t h oi'ji c i I- 
 duct iusi be- 
 yond the 
 ch vlocvst ; 
 still another 
 brjiiich iiM- 
 
 ;isto III i),so s 
 
 th. 
 
 w i ( h 
 1 u III b a r 
 trunks ; the 
 Ivmphati cs 
 fnriii a [ter- 
 fi'it maze in 
 this regidii, 
 so that it is 
 no wonder 
 Faistach i u s 
 w;is l.iewil- 
 dereil in his 
 llrst investi- 
 g a t i n of 
 t h em ; 17, 
 lyiiifi h a t Ic 
 vessels fi'oiii 
 the abdo- 
 men t(.. en- 
 ter the tho- 
 riicic liuctin 
 the thorax; 
 tills seems 
 like an ex- 
 act reversal 
 of the con- 
 dition in 
 man where 
 some of the 
 Ivmphat i cs 
 of the tho- 
 r;ix (inter- 
 costal plex- 
 us") enter 
 tlie abdo- _ 
 111 en to ^ 
 assist in 
 forming 
 tlM' ch vlo- 
 cvst Ccf. Ficr. 
 32SII ): IS, 
 left and 10, 
 right anas- 
 tomosing 
 trunks from 
 the lumbar 
 glands. 
 
 r<yiiipliati<- Sy»iteni« 
 Lyiiiplialie S>stoiii. 
 
 Fio. ;i2S3.— 
 Dorsal V i p w 
 of the rhylo- 
 cyst and the 
 i_i rea t Lym- 
 phatic Trunks 
 in their Rela- 
 tion to the 
 Blood-vessels 
 of the Cat iF<- 
 
 tica). Slight- 
 ly more ilian 
 natural size . 
 The blanks 
 and dotted 
 's iiMlicafe 
 t h e oiiiis>ion 
 of a part of 
 the length. 
 I I) r a w n by 
 Mrs. (iage. t a. o. Ex- 
 ternal .jugular veins ; b. 7(, 
 internal jugular veins ; 
 c. (', subcljuian \ eins; 
 '', precava; >\ the right 
 and left subclavian art- 
 eries; .'■, left thyi'oid axis; 
 !/. between the two caro- 
 tid arti-ries; //, bi'achio- 
 cephalic aitery ; /, /, (, 
 aorta ; /., /,, upper oiu^ an 
 Intercostal, lowei' a lum- 
 bar arleiy : mi, cudiac 
 axis : /(. siiiierior mesen- 
 teric ai'tery ; o, o. renal 
 arteries. 1, Left jugular 
 lymphatic trunk, bifur- 
 cating and joining the 
 thoracic duct ; 2, rJLdit 
 i u g u 1 a r trunk, liifur- 
 cating and one luanch 
 joining the right cnni- 
 mim lymi)lialic trunk, 
 the other terminating in- 
 deiiendentlv in the niesal 
 aspe,-t of the e.xterTial 
 jugular; 3, 3, trunks from 
 the right and left pre- 
 scapular glands: 4, 4, the 
 two openings of the tho- 
 racic duct, the lateral (.ne 
 being at the junction of 
 the subclavian and ex- 
 termd jugular, the mesal 
 one into the external 
 jugular about oj.posite; 
 5, 5, the two openings of 
 the right I y m p h a t i c 
 trunks— they are similar 
 in position to the opi-n- 
 ings of the tlioracic duct; 
 C, ti, pectia'al lym|)hatics ; 
 7, 7, thoracic l\ni|i|iatics 
 (cf. II and 12 .d Fig. 
 32.^2); .s, branch of the 
 thoracic duit. on the 
 ventral side of the great 
 sui)c|;i\'ian vessels, some- 
 times the eiiiire duct is 
 on the ventral side; It, 
 branch of the thpracic 
 duct on the dorsal side 
 of the su lie la vian 
 blood-vessels this is 
 the po-ition of the 
 entire duct in about 
 tluve-fonrths of the 
 numerous specimens 
 ex a in i n imI ; 10, 10, 
 greatly divided tho- 
 racic duct. The tho- 
 racic duct is never 
 simple in tlie cat 
 throughout its whole 
 course, but this one 
 is lU'ire than com- 
 monly divided; 11, 
 11. 11, chylo.'yst. on 
 the right is drawn 
 a section at this point 
 to show that the 
 ch vl oc y s t nearly em- 
 braces the aorta ; 1 2, 
 intestinal 1 y m p h a t ic 
 trunk sending a large 
 branch cm both sides <>t 
 the aorta to enter the 
 chylocyst: 13. lefi lumbar 
 trunk greatly divided ; 14, 
 right lumbar lymiihaTic 
 trunk anastomosing with 
 the left and with a 
 branch fri>m the intes- 
 tinal truuk. 
 
 64:7 
 
Liyinpliatic System. 
 Lyiupliatic System. 
 
 REFERENCE HANDBOOK OP THE MEDICAL SCIENCES. 
 
 lympliiiticii, ik'Xtra). — The riglit common Ij'mphatic trunk 
 is only about 14 mm. long, but is nearly as great in di- 
 ameter us the thoracic duct. It is formed by tlie con- 
 fluence ot the lympliatics from the right side of the head 
 {truneii.i lyiiqiliaticus jvgularis dexter), thrjse from tlie 
 riglit arm, shoulder, and breast {truueiis li/mji/iatieiifi 
 suhelficiiix), the efferent trunks from the right half of 
 the sternal, and ventral mediastinal and bronchiid jilex- 
 uses (triiiiens bronehomer1i(tstinalis dexter). As stated 
 above, a part of the lymphatics of the right custal re- 
 gion open into the left thoracic duct (Fig. :!2K0). As 
 on the left side there is a tendency for the trunk to ter- 
 minate b}' a multiple instead of a single opening. Not 
 infrequently, there is no true common trunk formed, b\i 
 the great trunks from the ditfeient regi(jns ojien se])- 
 aratel_y. 
 
 The great lymphatic trunks in the higher mammals con- 
 form quite closely to those of man, but the termination 
 varies .soiuewhat. When the internal jugular is small it 
 is generally near the junction of the subclavian and ex- 
 ternal jugular (Figs. 3382, 3285, and 3287), in the horse 
 
 Fio. d;'M. 
 
 FIG. :!:;«.-,. 
 
 H48 
 
REFERENCE HANDBOOK OF THE MKDICAL S('IEN( ES 
 
 Lyiiipliatli- SyMft-fii, 
 L.3 iiiplialic Sjsti-iii. 
 
 Fig. 3284.— Genf-ral View of tlie Lymphatic System of the Dog (Scotch 
 Terrier). (Drawn by Mrs. <jage.) a, stomach ; b, />, sniall Intes- 
 tine ; c, caecum ; t/, large intestine ; c, coeliac axis ; /, superior mes- 
 enicric aricry; f/, inferior mesenteric ariery; /;, epigastric artery 
 displared fiom the abdominal wall to the muscles of the thigh: 
 i, sciatic norvi* and other popliteal stnictiirps brought into view by 
 removing a Hcgmeut of the thigh mu.scli's ; h\ saphenous or inti-rnal 
 cutaneous artery ; in, ii, the femoral aitery; o, cut Klge of tlie ab- 
 dominal wall ; ■[>, ijio-Uimbar artery ; 'y, right kidney ; r, cut I'dge 
 of the diaphragui ; .s, aorta; t, brachial artery and its continmition 
 as the rauiiil artery in the anti-lirachium ; », sulirlaviiin vein ; i\ 
 external jugnhir vein; ic, trachea. I, Lyinphatii- trunks fnim llie 
 ventral lip to tlie mesat of the two sidimaxillui-y lyiuphatic glands ; 
 3, lymphatic trunks from the face and uose, and dorsal lip, injcrtpd 
 from the snout; ;.i, the two subuiaxillary lymphatic glands with the 
 facial vein between them -the mesal glands of the two sides are 
 connected by seveial transverse vessels; 4, enlal cervical gland; 
 .lingular tunphatic trunk liualiy joiniug the themcic dui't on the 
 left, the right lymphatic trunk on the I'ight; tj, leruiiiiatinn ef the 
 thoracic du<-t at the jiiuctiiu): of the suliclavian and external jugular 
 veins; 7, cof^Iiac, glands receiving the lym|ihatics of the stituiacli, 
 and sending elTerent trunks to the intestinal trunk ; X, lymphatic nr 
 lacteal trunks fi'i.Dii the small iutesluie; 9, twi.) laru'e mesenteric 
 glands (so-called glands of Asellius ur pancreas Asellii ; from these 
 originates th(^ intestinal lyuj[)hatic ti'uuk, which is (juite short in 
 the d(jg and mudi more ditllcult hi iuji^ct tiian in tlie cat; lb. ^daiid 
 receiving triuiks from the du<.>deniim, ilinuu, and large intestine 
 near the clccumi ; 11, glaruis recei\'ing the lymfihatics frttm the 
 ctccurn. and part of th(^ large intestine ; 12, glands in the meso- 
 colon along th(! inferior mesenteric nr'tery; they receive \'essels 
 from the large intestine, and the elTereiit vessels go to the chylncyst 
 and to the lumbar glands; 13, gland on the abdomen besi<ie the 
 ext<:*rnal epigastiic artery ; 1-t, pophteal gland ; 15, lyinphalics from 
 the foot, following the external or short saphenous \ein arouml the 
 calf of (he leg into the popliteal gland ; tlie parts of the vessels that 
 would l>e hidden in this view are intlicated by broken lines ; Hi, lym- 
 phatic trunk following the saphenous artery. 'I'he saphenous li'unk 
 freely anastomoses with tln^ trunk following the femoral arlerv. 
 and wilh U. passes to the lumbar glands; IH, liniil)ar lymphatic 
 glands ; 19, lymphatic trunk, accompanying tlie ilio-hiiubar aiiery, 
 and terminating in tlie luml.iai" glands ; 2u, himba 
 trunks; ;;i, cbylocyst; ^*'~, thoracic du<'t, doutih' foi- a < 
 
 tipl 
 
 distance; 2.{, [lectoral lymiihatic gland and ves: 
 trunks following the cephalic vein, and terriiii 
 scaiuiiar gland. The course along the braidiiu 
 broken lines, as the vessels would not api>ear in 
 minatiun of (he right lymphatic trunk ; 'M, pre: 
 gland of the right side. 
 
 hatic 
 ■al)le 
 
 els; 'M, lympliatic 
 lating in the |fi'e- 
 M isindicated bv 
 ihis view ; :,':». ter- 
 ca|iLilai' lympliatic 
 
 Flfi. 3:^Hij.— Ventral View of the Chylocyst and the lireat l-.\ 
 
 Trunks in their Itelation to the l*riiii-j|>al Blood-\essels of 
 
 (Scotch Terrier). The blanks with dotted line 
 
 gion, and the blank in the thi.)rax, 
 
 has been rimitted. About natural 
 
 a. Larynx; /», trachea.; <\ c, the right and left 
 
 veins, with segments removed; </, d, the two 
 
 veins; c, c, subclavian veins; /, pr 
 
 claviau arteries; //, brachio-cephalii 
 
 the suliclavian anil the (wo carotii 
 the diaphragm ; */, ii, cu-liac axis 
 p, p, renal arti-ries. 1, 1, Right am 
 phatic glands, re('eiving irunks froii 
 3, 2, mesal snbnia.xillary lymiihatic 
 
 phatic 
 
 le Dog 
 
 Die ceiAical le- 
 
 de that part of the length 
 
 (Drawn bv Mrs. liage.) 
 
 xiei-nal jugular 
 
 iilcrnal juLadar 
 
 a ; f/, !/, rii,dit and left sub- 
 
 lerv, near its division into 
 
 of 
 
 s : /,, /r, aorta ; in. tn. \ 
 ; o, super-loi' mesenteric arterv; 
 I lefi, lateral submaxillary lym- 
 i the face, nose, and dorsal lip; 
 glands, recei\iiur trunks from 
 
 the ventral li[t ; 
 toiuosing and cr 
 the elTerents fro 
 cervical gland 
 
 s t.< 
 
 these two glands are connected b\' numerous anas- 
 ossing'" trunks ; 3, 3, en'al i'i*r\'ical glands, ri'ceivinsi' 
 m 1 and ~ ; 4, o, 4, .5, jugular trunks from iht- eiital 
 the thoracic duct and right comnn.m lym|)haiic 
 
 trunk; li, (j, trunks from llu^ prescapiilar glands, only the right 
 glaiul being shown ; 7. termination of the thoracii; duct on the 
 mesal surface of the exteiiial jugular, Tiear its junction with the 
 internal jugular \ein. The arch in the duct is on the dors!il side nf 
 the great subclavian vessels, and It arches toward the meson instead 
 of laterad as with the cat, and before terminating enlargi's ci/ii- 
 siderably. Into the enlargement terniinate the jugular trunks and 
 the one fnini the [irescapular gland ; the enlargi-'meiit narrows 
 Duirkcdly before enterimz tiie \ein ; S, enlargement and termination 
 of the right l>uiphatic tinuk : !.t, U. pecioial glands and trunks; the 
 one on the left terminates iudependeiittv in the lateral aspect of the 
 external jugular, near its iiinction with tlii^ subclavian ; 111, H), tho- 
 racic duct;" it is considerably diviiied just within the thorax, and 
 then again just biToreerdarging near its termination ; 11, II, chylo- 
 cyst on the ventral and right side of the aorta, and extending for a 
 short distance into the thorax; 1^', 1;,', imestinal lymphatic irnnks ; 
 one branch winds round the left siile of the aorta, and terminates 
 finally on the right side of the cliylocyst ; 13, left lumbar lymphatic 
 trunk; 14, right lumbar lymphatic trunk. 
 
 Fi(^. 32Sfi.— fJeneral View of the rAinphalii' System of a White Rabbit. 
 (firawn by Mt's, (Jage.) o. Shnnach: //, /), small intestine: <-,(■. 
 ca'cnm ; */, the so-called vermihirm appendix: r, laroe intestine; 
 /, cadiac axis; </, superior mesenteric, ami /i, inferior mesenteric 
 artery; f. external epigastrii- artery displaced from the abdominal 
 wall to the muscles of the thigh ; /..sciatic nerve and other popliteal 
 structures exposed by remo\a I of a segment of the thigh muscles; 
 ?n, saphenous or internal cutaneous artery; ;;, o, femoral arlery ; 
 p. cut edi-^e of the abdominal wall ; (/. ilio-lumlur artery: r, right 
 kidney; the left has been oniitled. although the beginning of the 
 renal artery is shown; s, cut edge of (he\liaphragiii ; /, aorta : ". 
 brachial and ulnar arrery : r, subclavian vein : h\ external iugulai' 
 vein : .r, traidiea. 1. Trunks from the vcntrid lip and sides uf the 
 mouth; :?. trunks from the snout: 3, the two submaxillary lym- 
 phatic gtjuuls on either side of the facial vessels: 4, lymphatic 
 glands neai' the base of the ear; 5, ental cervical lymphatic gland ; 
 tJ, left juLadiir lymphatic trunk on its way to join the thoracic duct ; 
 
 7, thoracic du<;l near its tei'inination in the vein ; s, cu|ia<' ^-laraN. 
 receiving th<.' lyniphati<'s of the stomach; 0, li, lacteals from the 
 small intestine to lu, thi^ great mesenteric gland (gland or pancrea-. 
 of Asellius); it gives rise to two intestinal trunks, which are sliort, 
 small, and dilhcult to inject with a cuarse mass; 11. iartie mesen- 
 teric gland receiving tlie\essels from the mass of Ivmphoid follicle- 
 at the termination of the ilenm ; i:,, Ivmphoid tissue, M/cc///(fs ro- 
 /■und(/s, at tne termination of the ileum; 13. gland receiving the 
 lymphatic trunks from the \ermifoi-m ajipendix ; 14, glands in the 
 mesocolon alonu" the inferior mesenteric \essids; the ellVretit ves- 
 sels pass to the iimbar Irunks: lo. livpoeastric ny ^aiTal h'nipharir 
 glanrl : lu, i.dand on the abdomen bv the external epigastric ve>si'l~ 
 — it has been displaced with (he arlerv to the thigh muscles ; IT. 
 popliteal glands receiving vessels from both sid<-s of the (-rus, send- 
 ing efferent branches between llie peroneal and tibial lU'rves t" 
 follow the femoral artery, and another to accompanv the ischiadic 
 artery; IM, lym|)|iatic trunks from the dorsum of the'fDot, windiiiL'- 
 round the tibial or oiin'r si<le of the ralf to join tbi' popliteal gland : 
 111, lymphatic following the saphenous ai!er> ; it usually divide- 
 near the knei', sending one liranch to the pojiiiiral M:land : ™ll, lym- 
 phatic trunk extending along with the femoral artery ; u. is formed 
 by the intimate anastomosis of those accompanying'llie saphenous 
 and deefi femoral arteries ; .".'l. lumbar lymiihatic glands ; ~~, subcu- 
 taneous lymphatic gland near the ilio-lumbar liIood-vessel>, just at 
 the lateral margin of (he sartorius muscle; the eiTerenl iMupbatic- 
 follow the iliodiimbar \e.sseis and (filter the lumbar Ldamls; 23, 
 lumbar lymphatic trunks ; the right one is much more di\ided than 
 the left; ~'4, cbyloi.-yst ; '^5, thoracic duct : this is almost invariably 
 more w less liivided and sends out a considerable branch to ttie 
 right lymphatic trunk; :i'l. pectoral l.\inphatic Ldands; :.'7, anasto- 
 
 ^s^^s=i 
 
 t;4; 
 
L,ynii>liatic System. 
 I>}iiipUatic System. 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 raosinp: trunks foUowiiifr the radial and brachial artery to the axillary 
 glands ; 28, trunk foUowint,' the radial nerve, winding round the 
 brachium to terminate In the axillary glands also; the broken hne 
 indicates that the trunk would be out of sight in this ^^ew•. 21t, 
 axillary lymphatic glands ; these are not very closely connected 
 with the axillary vessels; ^0, termination of the right lymphatic 
 trunk. 
 
 the aorta; i, (, cut tboracic wall and ends of Ave of the ribs; /f, ft, 
 aorta; hi, m, pillars of the diaphragm; lu coehacaxis; o, superior 
 mesenteric artery ; p. left renal artery, the right not being shown 
 1, 1, Two ental cervical glands; 3, 2, elferent trunks of the ental 
 
 cervical glands; 3, :J, I'ctiil lymphatic trunks from the glands near 
 the ear; thi-y follow the external jugular vein for a Considerable 
 distance, then penetrate the tissues to join the jugular trunk ; 4, the 
 termination of the thoracic duct; this is very complex, forming a 
 ring around the jugular, and becoming ampuinform, it terminates 
 by a narrowed neck nt the junction of the external and internal 
 jugular veins; the numerous trunks (<pe)iing into theexpanded end 
 of the ihorai'ic duct, have their umuths guarded liy a jjaii'ed valve; 
 5, termination of the riglit lyiiiphiitie trunk ; it is expanded like the 
 thorat'ie dm-t and receives many trunks. The external jugular 
 vein is encircled as on the left. A segment of the vein has been 
 removed, l)et(er to show the parts. The right trunk opens into the 
 vein at the junctiim of the riglit subclavian and external jugular, as 
 is the usual method on botii sides in the dcig and cat; ti, li, right 
 and lelt trunks from the uxillary glands; T, tracheal gland with 
 trunk going to the right; there is |jrohably <ine going lo the left 
 also, as Willi the cat ; X, s, gjiinds in th*' thorax sending their effer- 
 ent trunks to the ci.u'n^siionding comuMin trunks; It, !), pe<-tora.l 
 glands, ami trunks on the two sides; their- eflVrent trunks unite 
 with those fi-oni the axiilarv glands to foi'in Ihe subclavian iyin- 
 jihatic irnnk ; III, !.\mi)liatic gland on the right, near the second rib, 
 through which passes (he branch from Ihe tlioracic tlucf to the right 
 lymphalic trunk ; II. hranch of the thoracic du<>t going to the right 
 side : this riglit hranch is a \i'r'y fret|Ment, if not a constant, feature 
 in the rabliit; 12, 12, thoracii; diu-t; it is fiT([uentIy much more 
 divided than is shown in this [Igure. The blank sjiace near the 
 niiddle indicates that a part of the length was omitted ; 13, chylo- 
 cyst ; tliis is as in tlie (lug and cat. inclined to the right side of the 
 aorta, but it doi-s not extend so far into the iliorax; U. intestinal 
 lymphatic trunk ; this is small, usually nudtiple, short, and dilllcult 
 to inject with a coarse mass; 15, ]lj, the right aud left lumbar 
 trunks; they form a h.mg-nieshed netwoi'k. and in this specimen 
 terminate in the chylocyst by three trunks. 
 
 
 if^/,- ^ ^' 
 
 / 
 
 
 f^vM"Vi 
 
 // 
 
 Tk;. -32S7.— Vpntra] Vie\v of the C'hvlorvst anrl the Prini^ipal Lym- 
 phatic Truiiks In their Relation tli thi- (in^at III l-vessels in t.lie 
 
 White Kaljlilt. (iiraun liy Mrs. (iage.) n, Trarliea : /..)), external 
 jugular veins ronneeti-'l hv a transverse vessel ; c, e, internal jutrn- 
 lar veins; on the rifjiit a sep-nient is removi'd from tho iiiKiilar 
 better to show thp hranr-hes forinin;.' the liplit lyniiihatlo triuik ; 
 c, c, the two internal juf-'"lar veins; i(, il. tlie snijciavlan veins; 1,1:, 
 the rif-'ht anfl loft preeavte; t\ f, the I wo sniielavian arterios; (;, 
 hrarhloeeiilialie artery ilividing into the riglit siihelavlan and tho 
 right earotui ; h, h, earotid arteries, the left arises fioni the areli of 
 
 no. :KH«.- a Pr'ni 
 (tlnenluni of a 
 I.vriiph-\ossols t 
 ]aVv witll the 
 small artery sh' 
 small bi'anehes 
 ei'lls in the sur 
 tlielium of a lyn 
 tissue ; these 
 /, wandering 
 
 ■Hied aiK 
 Italihit, 
 . thr Ti 
 llinos of 
 ng SI 
 to the I 
 ronnilini 
 pheaiiil 
 llsaroal: 
 
 1 Silvi 
 to Sh 
 «iie ( 
 lis en 
 .iiiilli' 
 i-fl; r. 
 r lissu 
 lary w 
 itt; 
 
 T-stained T^ri 
 ow Ihe lie! 
 Vlls. (Kli-i 
 dothelial erll 
 -shapeil end 
 caiiillary ht 
 e; r, dirert e 
 ith liranrhed 
 irhed direetl 
 
 eparation 
 tion of II 
 
 'I ((, Ly 
 s st;iined 
 alielial li 
 .od-yessel: 
 onliruiati 
 
 cidlsof tl 
 y to the t 
 
 )f Iho Normal 
 
 e lil 1- and 
 
 nplialic eaiiil- 
 wil 11 silver ; /i, 
 ning, and two 
 s ; (/. hranehed 
 in f the endo- 
 sur'rounding 
 lood capillary ; 
 
 660 
 
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 Lyiiiplmlic System. 
 Lyiiipliatic Sysli'iii. 
 
 
 FiG. 32Sfl.~P('ricill(.'(t anil Sllver-stairirrl Prcparatiiin .if the Pli-ural Aspwt nf llii- Ci-iitnil Ti-mlnn .if 
 aKiil.liit's Iiiaplirasiii. t.. sIidw Lviiiiiliafi.'. ('a|iillani's ami tlii'ir Hi-lati..ii uitli III.- c.-ll S]ia.'ps. 
 (R.-.'kliiiftliluisi'n.") Mafniilli'ii :!llll ilialni-liTs. /). P,i-KliiiiiliL' "f thi- ]viii|ili rapillarii's liv a 
 i-oiitiliuity with the cell Kpai-es; .', r, r, i-rll span-s surrniitided bv tlin ilaik (rriHinil siilislani'e. 
 These spares ruiilain eells, Ivliiph-i'iiiialiriilai' rells, arid the .'.'11 pniri'sses parllv 1111 the white 
 lines I'onnei-tNi!; the oell spares (rt. H'Il'. ICSSi. ,/, <), ,1, ,/, Lyuiphatir rapillaries with Ihe ser- 
 rated endnthelial eells. 
 
 tlii.s (hict teriniiiates in tlie jirecava, anil in (lie fr.x 
 usually :it the jinictinn iif the left; jiir-ular ami tin- pn-- 
 
 cava. In tire ii.\ alsii 
 
 \ 
 
 
 
 It usually traverses a 
 sjiee-ial opening in 
 tile (liai>lifai;'ni. In 
 the 111 use the iluct is 
 dilateil at its tenui- 
 naliiiu, as it is also 
 in the iloij; and rab- 
 bit. (Figs, 328,") and 
 
 nulls both trunks tend to ojien 
 bv two or nnii'e nioutlis (Fig. 
 3283), and in all tlu- thoiaric 
 duet shows a strong tendeney 
 to conform to Ihe lynriihatics in 
 general and break up into a kind 
 of network instead of remaining 
 of considerable size. Souictinies 
 this net work encloses the aorta. 
 Intt more frei|Uently it assumes 
 tile condition shown in Fig. 
 3283. In the rabliit almost con- 
 stantly, and very frei|neiitly in 
 the cat. there is a branch of the 
 thoracic duct c-xtendine- to tjie 
 right (Figs. 3282 and 3287). 
 
 The cliylocyst is lai-ge in the 
 dog, cat, and rabliit, and in 
 many other animals, and there 
 is a strong tendency foi' its com- 
 ponent trunks (intestinal and 
 lumbar) to divide befort' enter- 
 ing it, so tliat it is foi-mcd by 
 the union of a coarse network 
 rather than by a few simple 
 vessels (Figs. 3282, 3283, 328.5, 
 and 3287). " 
 
 In the uon -mammalia, birds, 
 reptiles, amphibia, and fishes, 
 the great trunks are symmetri- 
 cal, that is, iieai-ly ciiual on the 
 two sides. They open into the 
 great veins neai' the hcai't. 
 There is also a jiair of vessels 
 iipening into Ihe ischiailic or 
 other pelvic veins, and in the 
 fi-og and toail there is a lym]ih 
 heart on each great trunk, near 
 the opening. In the non-am- 
 phibian forms, wliere lymph 
 hearts are ]ii'esent, tliey are con- 
 fined to the iielvic region. (fSce 
 under I)evelo]imenf, below.) 
 rffifofN .\Ni) STiiiCTrfii; OF TH1-; LYMfii.\ii( Vi;ssi-;f,s. 
 — There an- tJii-ee distinct views as to the uUimate origin 
 of the lymphalic vessels: 1. That they are in dire<-t com- 
 munication with the lilood-vesscls at lire peiipherv by 
 means of connecting radicles so small thai in iionnal con- 
 ditions only file lilooil plasma can traverse them, and that 
 undei' pathological conditions these connecting radicles 
 luay increase siilliciently in size to admit the jiassage of 
 blood-corpuscles. Thiswasoneof thecai-liest views^aud 
 it is su|iporteil by the fact of the ready ajipciu-atice of 
 water or even colored gelatin iu the lymphatics soon 
 after the Id 1-vessels were injected. This was, and 
 
 Fig. 3:3fln.- Fonnatlon of a Lymphatic 
 Ciipillarv in the skin nf the Exterrral 
 Ear-. (Sappey, Atlas, 1 1, Lymphatic 
 capillary; '^ and -t, twe minute 
 bi-anclres unitin.ir te form tbe lar-ijer 
 capillai-y : ;i, If, :!, lacunes or dilata- 
 tions for-rrred by the union of the 
 itrirrrrtest lymphatic yessels. the .-ap- 
 illicirles. The nrtion of a rnnltitiide 
 of these lacnnes forms a lytnpharic 
 capillary. This is shown Ijest at the 
 lower part of the Qgine. 
 
 
 i. 32111.— A simple Papilla from the Ciaiiim nf the Hairy Slun of the I-lead, showirij,' the P.looil- 
 cessels and Tlu'ee Stages of Lyniphatir frrjertinn. iSappey. Atlas, i ,1, A pa|iilla, Ihe simple 
 bloiid-rapillary Inop 11 and ii with very few lyrirplratie lacnnes cii and no sign .if :r lympliatir 
 rapillai-y, I!. The lyraphalir capillary i:!l has aiijieared, and the Ivarphalir lacnnes ami cafiil- 
 
 licnles i3i are very pruminpiit, but the bl l-rapidarv loop i] i is stid eyident. r. Tin- hi 1- 
 
 capillary loop lli is almi.st iriyisihle frmii fin- .leiise network nf lymphatic lacnnes an. I capil- 
 liciiles i-i; the lympliatlc capillar'y i:i. is |.r'..minint. This series is an cxci-di-nr illnsiiaii.in 
 of the slrrrrUir-es that r.-rrrain in\"rsililH in ..r.lrmn \ prv|iarTiti..ns. Pr.ibalily in \.-r> f.-\\- iii-i..- 
 logieal preiiaiations are more than half or orre-thrrd ..f the strtretures seen. 
 
 051 
 
lij-mpliatle System. 
 L.ympliatlc System. 
 
 REFERENCE HANDBOOK OF THE .AIEDICAL S(;IENCES. 
 
 Fig. 3392,— Lacteals of the Intestinal Villi o{ the Dor. (Cadlat.) o. 
 Artery extending into tbe villi to form a capillary network (light 
 shading); h, lacteal e.xtending from the villi into the submucosa 
 (dark shading); e, c, blood capillaries in the villi; rf, rf, central 
 lacteal of the villi. In one it forms a loop, in the others it ends 
 blindly ; c, crypts of Lieberbiihn. 
 
 Still is, a fovorite methnd of demoiistrutitig the ij'mplj 
 tics of an organ. In objection to tlie doctrine of tlie d 
 
 rcct connection of tbe two systems of vessels, it 
 
 di- 
 
 was 
 
 Fig. .3393.— Transection of a Villus (Mall '*) in which the Lymphatics 
 have been Injected witti Berlin blue The blue is I'cprcscDtcd by 
 black in the llgure. From tbe centre Dne streams of ilic bijectbig 
 mass have penetrated to the epithelium and even bc-twei-u the epi- 
 thelial cells, a. secti(mal view of tbe epithelial lells with tbe lymiib 
 channels in section ; h, Ik l"bEis(a;tions of tbe epithelial cells show- 
 ing the lymph channels between them. 
 
 pointed out by Hunter that, when the coarser matters 
 injected into the blood-vessels appeared in the lympha- 
 tics, it was due to a breakage somewhere in the wall of 
 the blood-vessel; and further, that the filling of the lym- 
 phatics by injecting water or gelatin into the blood -ves- 
 
 
 
 
 
 Fig. 3394.— Longisection of the Terndnal Part of a Villus (Mall " i to 
 show the narrow, spiral extension of the tentral lacteal, with line 
 branches reaebing out froui it toward the surface. Tbe epithelium 
 has been removed and tbi' lvinptiati<'S have been injected with Berlin 
 blue (cf. Plate XLIV. and Fig. 3393). 
 
 sels was but natural, as it is one of the properties of I he 
 blood-vessels to alloAv the contents to diifuse through 
 their walls, and the lymphatics, from their office as a 
 drainage system, take up the exuded liquid. This does 
 
 F]<;. :W15.— Portion of the Cisterna Lympbatica Magna of the Frog, to 
 show Kndotbeliuili and slomata. (Prudden.) <u Ordinary endo- 
 tbelial cells, tbi^ nuclei n(jt being shown; b, h, slomala leading 
 from th(^ periloneal cavity into tbe dorsal lymph sac; c, c, germi- 
 nating endotbelium suTTounding the stomata ; </, germinating 
 dotbelia among the orilinary ■■ells; these aie tre<iucntly 
 pseudostomata. 
 
 died 
 
 not, however, show how the exuded liquid gets into the 
 lymphatics. Tbe pressure which forces the plasma 
 tliroiigli the walls of the blood vessels would seem rather 
 to collapse the lymphatics, as the pressure is on the 
 outside. In a word, there litis been no conclusive proof 
 
 655 
 
REFERENCE HANDBOOK OF THE IVIEDICAL SCIENCES. 
 
 Lyntpliatic S}t!»teni. 
 Ij^'mpliatic System. 
 
 
 Fig. ;)29u.— Silver-stained I'ei-itoneal Aspect of the Cen- 
 tral Tendon of a Rabbit's Diaphragm, to show Stom- 
 ata. (Klein.') U Lymph eliannel between the tendon bundles; .v, 
 .s, Ave stomata, surrounded Ity gerininatintr endotlielium and lead- 
 ing into the lymph t-hannel between the two tendinous bundles. 
 Part of tiie stomata are open and [lart closed; /, t, two tiundles 
 of the central tend(m, between which is the Ivmph channel into 
 which the stomata open. Over the tendinous bundles the end'>- 
 thelial covering is comiiosed of inarliedly larger ceils than over the 
 lymph chaiHiel. 
 
 given tliiit there is or is nnl a direct coimeelidii l)etween 
 blood-ves.sels and lyiiipliaties. 
 
 2. Tliat tlieie i.s a networli of minute spaces in tlie tis- 
 
 Fir,. 3397.~Peritoneal Endothelium from file (Central Tendon of the Rabbit's Diaphragm, 
 to show the Difference in the Size of the Cells, and the Pseudostomata between them. 
 IKleln.) a, a, frregular rows of large nucleated endotheUal cells, corresponding to 
 underlying tendinous luindlcs ; />. rows of smaller endothelial ceils with numerous 
 pseudostomata between them (the dark spots). The rows of small celts correspond 
 to the lymph channels bi'tween the bundles (cf. Fig. 3U>9(i). 
 
 sues Ix'tuecn and aniuiid tlii' individuiil .stnictviral ele- 
 ments, throiiijli wliicli the dill'iised pltisma slowly moves, 
 bathing all the cells and tibres, giving to them oxygen 
 and the other nutritive elements, and taking in return 
 carbon dio.xide and tlie other products of waste. Part of 
 this waste, especially the carbon dio.xide, difluses hack 
 into the blood ea|>illaiies. This system lias been called 
 jiiire x/nircx mill i:, nulls by Recklinghausen ' and the lipnpfi- 
 raiiidiciihir synleiii by Klein.' These minute channels and 
 spaces are all interconnected and continuous with the 
 
 Fig. .3298.— Finer and Coarser Lymphatic Network of the Muscularis of the SmidI Intestine cif a Child at Birth. (Sappey, Atlas.) Magnitled 
 2IX) diameters and reduced about one-third. 1, 2, and (), Coarse network of lymphatics resting upon the longitudinal muscles -3457 
 and s, finest lymphatic network around the muscular Ilbres, and uniting to form the laj'ger network, - • - ' ' ■ » , 
 
 fi53 
 
liyinpliatlc System. 
 L.yini>IiaIIc System, 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 blood-vascular s.ystcm through the intercellular cement 
 and spaces, and with the lymphatic vessels in the same 
 way, and further, these spaces trecpiently, if not con- 
 stantly, contain branched cells, the cell body filliiii,^ tlie 
 
 Fig. 3299. Surface View of the Lymphatic Network In the Siibmucnsa of the Rabbit's 
 Ca?cuin, showing the Form of the Network and the Relation of the Lymphatics and 
 Blood-vessels. Ma^iOed .5.5 diameters. (Drawn by Mrs. Gage.) ^, ^, Small arteries; 
 V. small vein ; G, the blood capillaries in the upper part of the flgure ; 3, 2, 2, 2, lym- 
 phatic vessels, (cf . Fig. :^300. } Throughout the entire figure is shown the tendency of 
 the lymphatics to follow the blood-vessels and partly to surround them. The prepara- 
 tion was made by injecting Hoyer's chrome yellow mass into the appendix vermiforuiis. 
 yvhen it extended into the submucosa of the adjoining part of the caecum (see Fig. 32H(i) . 
 The blood-vessels were then injected with fine red gelatin mass from the superior mes- 
 enteric artery. After the gelatin had cooled the c£ecun:iwas distended with alcohol, and 
 the preparation finally mounted in Canada balsam. 
 
 larger spaces and tlie processes tlie connecting channels. 
 These cell processes are often pi-ojected between the en- 
 dothelial lining of the capillaries, thus forming the so- 
 called pseudostomata, and therefore bring tlie lymphatics 
 and blood-ve.ssels really into continuity by the interven- 
 ing cells and the spaces sur- 
 rounding them. This is well 
 shown at e, in Fig. '3'2>^>i. 
 
 3. The third view is that of 
 Sappey, who has represente(l 
 with marvellous clearness tlie 
 entire lymphatic sj'Stem from 
 origin to termination. He be- 
 lieves, and thinks he has proved 
 by new and special means of 
 research, that tlie lymphatic 
 system at its origin is invari- 
 ably coiTiposcd of minute vessels 
 (capillicules) from 1 // to 4 u in 
 diameter, with structureless 
 walls, which extend around and 
 between all the structural ele- 
 ments. These capillicules are 
 closed at the free end, but join, 
 in nearly the same way as do the 
 caualiculi of bone, to form some- 
 
 what larger spaces, the lacunes, which vary from 3/i to- 
 8fi in diameter, and like tlie capillicules have structure- 
 less walls. By the union of many lacunes the true lym- 
 phatic capillaries are f(n-med, and in them first appears 
 the endothelial lining. Further, al- 
 though the capillicules around and 
 between the structural elements have 
 blind terminations, those connected 
 with the blood-vessels extend into 
 the lumen between the endothelial 
 cells, and have open motiths into 
 which the plasma of the blood can 
 freely enter, and in .some pathological 
 conditions they may become so large 
 that the blood corpuscles may pass 
 through the capillicules to the lym- 
 phatic vessels. This view is in part 
 a return to the original doctrine, and 
 it also differs from the doctrine of the 
 lympli-canalicular origin in excluding 
 the cells from the spaces or lacimes, 
 and in giving distinct but structureless 
 walls to the capillicules and lacunes. 
 
 The second view seems to the writer 
 to be more in accordance with the 
 teachings of modern biology' and his- 
 tology, by which the body is shown 
 to be composed of a continuous net- 
 work of interconnected structural ele- 
 ments independent only in the form of 
 blood corpuscles, lympl'i, and wander- 
 ing cells, but all the other elements 
 being united either by cell cement or 
 by delicate protoplasmic processes, 
 and any spaces left between the struc- 
 tural elements being tilled by the pro- 
 duct of cell aclivit3^ Avhich is known 
 as ground or intercellular substance. 
 This is very abundant in some tissues, 
 as cartilage, very slight in amount in 
 others, as epithelia. All of these .struc- 
 tural elements are constantly bathed 
 with lymph, and it is more in accord 
 with what is at present known of ab- 
 sorption and excretion (see articles 
 Absorption. Dige.HtKni, and Metabolism) 
 to suppose that the lymph depends 
 for its movement in certain definite 
 directions upon the action of the liv- 
 ing cells rather than on merely ph3'si- 
 cal conditions. From the latest and 
 most satisfactory work on the de\'clop- 
 ment of the lymphatics (see below) it would appear that 
 the lymphatic sj'stem is a closed one, and all passage of 
 lymph to it from the tissues or vice ver.sa, must take place 
 by diffusion as with the blood-vascular .system. 
 
 The rcadilj' demonstrated or apparent origin of the 
 
 Fig. 3.3(XI.— Side view tif the Lymphatics and Blood-vessels in the CfECum of the Rabbit. (Drawn 
 by Mrs. Gage.) vl, ^1, artery ; T, 1', veins ; I>, i, lymphatics ; C, villi. This Ilgure shows the 
 villus-like elevatitms iiersisting in the ciecum of the rabbit (Hilton '2) with the vascular and 
 Ivmph vessels. It will be noted that the artery for each villus extends to the summit and 
 breaks u[p a nc.twijrk of capillaries which form a kind of mantle or tent. The lymphatics show 
 the usual appearance, hut with a kind of network in the villus at the right. On the left the 
 whoU^ villus is present at the top ; on the right the part toward the observer has been removed, 
 from Ihe two villi. 
 
 654 
 
REFERENCE HANDBOOK OF THE JIEDK'AL SCIENCES. 
 
 Liympliatic SystoTii, 
 Lyiupliatic SyNlelii. 
 
 -a(xS- 
 
 Fig. aSfil.— Eiidotiielial Cells from a 
 Small Lyitiiiliatic Capillary nf IIih 
 Central Tendon uE the Rabbit. This 
 flffiuv shows well the characteristic 
 sinuous outlines and the nuclei of 
 the endothelial cells. iPrudden.) 
 
 lymiihatic vessels is in a ple.xiform network of valveless 
 capillaries of varj'ing sizes (Plates XLH., XLIII. , and 
 XLIV., and Figs. 3398 and 3399). From this capillary 
 network extend collecting trunks with aljundant valves 
 
 (Fig. 33«7). The serous 
 cavities are likewise di- 
 rectly connected with 
 the lymphatic vessels 
 through the stomata or 
 pseudostomata (Fig s. 
 3395-3397). But the 
 plcuro - peritoneal cav- 
 ities are not primarily 
 connected with the Ij'ni- 
 phatic system, but come 
 to be so connected later. 
 A distinct plexus of 
 origin has been satis- 
 factorily demonstrated 
 in all the tissues and or- 
 gans except the follow- 
 ing, and in some of 
 these, as the cornea, the 
 lym|ih is known to cir- 
 culate, although not in 
 an indepenilent net- 
 work of vessels. 
 
 1. The central and 
 peripheral nervous sys- 
 tem and retina. The lymph in these situations is either 
 in perivascular spaces or in perineural spaces. In the 
 optic nerve, however. Key and Retzius figure a well- 
 detincd lymphatic network. 
 
 2. A lymjihatic network has not been satisfactorily 
 made out for bone or cartilage, and Sappe^v denies the 
 presence of lymphatic vessels in these structures. 
 
 3. All forms of epithelia, including hair, nails, and 
 teeth. But Klein figures and describes processes of 
 branched cells projecting between epithelial cells and 
 serving as lymph channels; but no distinct caiiillaries 
 with endothelial walls are present. (See also Mall,'^ anil 
 Fig. 3393.) 
 
 4. Cornea and, according to Sa])pey, all forms of fi. 
 brous ti.ssue, tendons, aponetirosis, fascia, and all serous 
 membranes. Where a plexus of origin appears to be in 
 these it belongs to the underlying ti,ssue. According to 
 many authors the connective tissue is a favorite place 
 for the origin of the capillary lymphatic networks. 
 There is no doubt of the ju'esenee of the network, the 
 only question is whether it belongs t(j the connective tis- 
 sue or to the surrounding tissues. 
 
 The ducts of some glands (as the pancreas) have never 
 yet been .shown to contain l_ymphatics, although in the 
 ducts of other glands, as the liver, lymphatics have been 
 shown in great niunbers. 
 
 These netwoi'ks or plexuses of origin show consider- 
 able variety in different parts of the body. As a rule, 
 the lymph capillaries are consideriibly larger than the 
 blood" capillaries (Figs. 3399, 3300), arid there is a great 
 tendency to form 
 blind, often ampul- 
 liform enlarge- 
 ments (Fig. 3300). 
 In the villi of 
 elongated narrow 
 form, the origin by 
 a blind central ves- 
 sel is normal, or 
 there may be a sim- 
 ple loop instead 
 (Fig. 3394). In 
 man, where the villi 
 are mostly short 
 and broad, there is 
 a complicated network something like the blood capil- 
 laries, except that the lacteal capillaries are much larger. 
 The simple blind end and loop are also seen in some of 
 the more elongated villi. The presence of timpuUiform 
 
 Fig. 3:302.— Nucleated Endothelial Cells fron: 
 One of the Larger Lymph Channels of tb' 
 Central Tendon of the Rabbit's Dia- 
 phragm, to show the Elongated Form oi 
 the Cells in the Larger Vessels. Cf. Fig", 
 3301. (Prudden.) 
 
 enlargements, or even blind endings, in a vessel is not 
 enough to determine whether it is a blood-vessel or a 
 lympliatic, for some blood-vessels in muscle (Ivanvicr) 
 and in the dura of the brain (Key ami Kelzius) have 
 the form which is usually cnnsidered so characteristic of 
 lymphatic vessels. The'fliial test must be the connec- 
 tions of the vessel with a lymphatic gland or with an 
 undotd.itcd blood-vessel. 
 
 Structure nf Lymplintic T>.v.\'f'?.«.— Begiiuiing with the 
 lymph capillaries the wall is composed'onlv of endothe- 
 lial cells arranged mostly in tlie fdiiu of a" tube. They 
 may, however, be more like Hatti-ncil clefts, the walls of 
 which are in apposition except when containing lymph. 
 The lining cells have .sinuous edges (Fig. 3301). On ihe 
 larger vessels the liinng endothelium has more elongated 
 cell outlines 
 (Fig. 3302). and 
 there progress- 
 ively a p p e ;i r 
 coats like those 
 of the blood-ves- 
 sels, except that 
 they are thinner. 
 The adventitia 
 is easily separat- 
 ed from the ves- 
 sel, is composed 
 of a network of 
 fine elastic tibres 
 and a few longi- 
 t u d i n a 1 1 y ar- 
 ranged muscu- 
 lar fibre cells. 
 The middle cuat 
 has, besides the 
 fine elastic tis- 
 sue, many cir- 
 cularly arranged 
 muscular tilire 
 cells. This cir- 
 cular arrange- 
 m c n t is n o t 
 strictly adhered 
 to, esi)ecially in 
 the t horac i c 
 duct. Finally, 
 the imier layer 
 has its elastic 
 tibres mostly in 
 a longitU(linal 
 direction, and 
 the endotheliiun 
 covers the ental 
 surface. In the 
 thoracic duct 
 there is usuallj- 
 a considerable addition of white fibrous tissue to the 
 middle layer, and, as stated above, many of the muscu- 
 lar fibres of this layer may be obli(iue or even longitu- 
 dinal. In general, then, the lymi)liatic vessels agree 
 with the veins quite closely in structure. The amount 
 and the fineness of the elastic tisstie present is suppo.sed 
 to exert a marked intiuence in causing the speedy re- 
 turn of the vessel to its normal calibre after its disten- 
 tion by the lymph. 
 
 Like the veins, the lymphatics are distinguished by the 
 presence of valves; but they are much more abundant, 
 there being, for example, sixty to eighty doulilc valves 
 from the hand to the axilla (Fig. 3303). In examining 
 a well-injected preparation, it is very easy to determine 
 the direction of the lyniph stream as the segments of 
 the vessel are approximately conical, the apex of the 
 cone pointing in the direction of the stream (Fig. 3303). 
 This is more marked in the smaller than in the larger 
 vessels. 
 
 Valves are not found in the lymphatics of fishes, and 
 are much less numerous in the other groups than in 
 mammals. 
 
 Flfi. 3303.— Valves of a Lymphatic Trunk, and 
 a Lymiih.'itic (iland with its Afferent and 
 ElTerent Vessels. ISappey.) .1, Lympliatic 
 trunk slit lengthwise and opened to show that 
 tlie valyes are In paii's— they are close logether 
 and they are at the level of Uie enlargements ; 
 further, that the intervalviilar segments are 
 in general of a conical shape, the ape.x of the 
 '■one poiiuing In the dir'ection of the current, 
 up in this llgiire. 7?, Lymphatic giami ; ((.a,a., 
 the numerous afferent lymphatic vessels ; e, 
 the two voluminous elTerent lymphatics. 
 
 655 
 
Xympltatic Sstcin. 
 Lymphatic System, 
 
 REFERENCE HANDBOOK OF THE MEDICAL SCIENC:ES. 
 
 Lymphatic Glands or Nodes and Lymphoid Tissue. 
 —The lymphatic glands or ganglia or conglobate glands 
 are rounded or flattened bodies placed in the course of the 
 lymphatic vessels. These glands were known to Hippoc- 
 
 F]G. 33IJ4.— Diagrammatic Sectiuii of a Lymphatic (jiland. (Sharpey.) o, J, Afferent 
 trunk breakin^r up into several smaller trunks before entering the glanrl ; c, J, 
 etferent lymphatic trunk formed by the union of several smaller trunks emerging 
 from the gland (the arrows indicate the direction of the current); C, cortical 
 glandular substiince: cp., capsule sending septa into the gland ; /.?(., reticulated 
 cords of medullary substance (it is shown in only a small part of theHgure; the 
 entire area shadnd with lines possesses similar glandular substance); l.i?., lymph 
 sinus or channel ; 3/, central or medullary part of the gland (it is directly con- 
 tinuous with the cortical substance); (r., trabeculse or fibrous substance continu- 
 ous with the capsule and forming a coarse meshwork in the gland (in this mesh 
 Is the proper gland substance). 
 
 rates, but Avere regarded by him as forming a part of 
 the general glandular system. Naturally their true na- 
 ture was discovered only after the discovery of the lym- 
 phatic vessels. In the higher mammals it is believed 
 that no lymphatic vessel reaches one of the common ter- 
 minal trunks without first traversing 
 one or more of these glands. They 
 first appear in the birds, or perhaps 
 some of the highest reptiles, but lym- 
 phoid tissue is present in all the forms; 
 and us the glands are practically con- 
 centrations of this lymphoid tissue 
 their absence is not so important as 
 might at first appear. The glands are 
 sometimes solitary but usually are in 
 groups or chains; they are mostly near 
 blood-vessels, and so ])luced and loosely 
 attached that tliey readily move aside 
 to avoid pressure. In the limbs press 
 ure is further avoided by position in 
 the flexures of the joints. The glands 
 vary greatly in number and size in 
 the different mammals. In man tliey 
 reach the highest number (five hun- 
 dred to si.x hundred) and vary fioni a 
 few millimeties to two or more centi 
 metres in diameter. 
 
 Afferent eiiid Efferent VeHsels.—Thu 
 vessel approaching a gland is said to 
 be afferent or iiiferrent; the one leav- 
 ing the gland is called eifereiit. (Jn 
 ajiproaching a gland the afferent usu- 
 ally breaks uj) into several smaller 
 vessels which enter the gland (Figs. 
 3803 and 3304). Aff(;r traversing the 
 gland the vessels leaving the surface 
 unite usually in larger trunks than the 
 
 afferent vessels, and continue to the next gland, where 
 the process is repeated, or the vessel may terminate in 
 one of the common trunks. 
 
 The structure of the lymphatic glands was long enig- 
 matical. It was held by many, and is still so 
 held, that the gland was really a kind of fine 
 capillary network, like a renal glomerulus, or 
 a rete mirabile. of blood-vessels; but it is 
 now quite generally agreed that a lymphatic 
 gland consists of the following parts; (1) A 
 fibrous framewoik forming an enclosing cap- 
 sule and sending into tlie interior a multi- 
 tude of anastomosing trabccula'. The cap- 
 sule and larger trabecuiss may also contain 
 muscular-fibre cells. (2) Embedded in the 
 meshes of this fibrous network is the proper 
 glandular substance, which consists of lym- 
 phoid tissue ; that is, a fine network of branch- 
 ing and anastomosing cells and fibres con- 
 taining in their meshes lyniphoid corpuscles 
 or young lymph cells. Near the surface of 
 the gland the lymphoid tissue is arranged in 
 quire regular masses (cortical lobes or aveoli) 
 by the projecting trabecuUe (Fig. 3304). 
 This is the .so-called cortical portion, while in 
 the central part (medullary portion) the lym- 
 phoid tissue is in more cylindrical masses 
 (the medullary cylinders or lymphoid cords), 
 but the tissue in the two parts is diiectly 
 continuous. (3) The lymph sinus or channel. 
 This is the path taken by the lymph in pass- 
 ing through the gland from the afferent to 
 the efferent vessels. It is a narrow space 
 filled with rather coarse retiform tissue, be- 
 tween the proper glandular substance and 
 the fibi-ous framework (Fig. 3304, l.s.). The 
 relations of this space may be clearly un- 
 derstood b}' comparing the fibrous frame- 
 work to a mould and the proper glandular 
 substance to the material poured into the 
 mould and which, upon cooling, had shrunken 
 evenly from the mould throughout the entire gland, 
 thus leaving a narrow space which would represent 
 the lymph channel. The afferent lymph vessel p(!ne- 
 trates the sheath or capsule of the .gland and pours it* 
 contents into the lymph sinus. The lymph then slowly 
 
 Fi<; 
 
 . :h0.5.— Figures of Fresh Preparations of an tEdeuiatmis ( Hucntuui of a Guinea-pig suf- 
 fering from Chronic I'erit^mitis, to Show Developing Lyuipliatic Nodules seen in Optical 
 Section. (Klein.') yl, Perilymphatic or lymplmngial nodule ; a, lymphatic vessel : b, 
 aportlcm of the lymphangeal nodule on the side of th(^ vessel ; c,' endothelial wall of 
 the lymphatic seen In iiroille; (/, blood capillai'y of the nodule; c, lymph corpuscles in 
 the lyTuphutic v<*ssel (tills nodule is like the reticular substance forming the proper 
 glaniiuljir stihstancc of the lyui|ihatic glands, and as seen hoth in .t and B the cells of 
 the reOcuIuiri are in direci connection with the endothelium of the lymphatic vessel). 
 li. An eiKlolymphatic or lymphangial nodule in which the recticular tissue is within 
 instead nf lieing on the side of the vessel ; a, vein ; />, artery ; c, blood capillaries ; t/, a 
 lymphatic vessel enclosing the whole system of blood-vessels ; e, reticulum of nucleated 
 branched cells or lymphoid tissue connected with the wall of the lymphatic and filling 
 the entire lumen. 
 
 656 
 
REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 Lyinpliatio System.. 
 Lynkpliatio System. 
 
 
 1 
 
 i. 
 
 4% ' 
 
 4=5 
 
 1 
 
 
 moves along the labyrinthine channels until it reaches 
 the efferent vessels, when it enters them and continues 
 toward the common lymph trunk. In passing tlirough 
 tlie sin\is the lympli bathes the glandular substance and 
 pr(>bably soaks into it. Along ibe edge of tlje eliannel 
 th(! new'ly developed lymph cells enter the lymph stream 
 and are carried along to the efferent vessel. 
 
 Blood-vessels aie very abundant in the lymphatic 
 glands and are found almost exclusively in the proper 
 g I a n d u 1 a r substance. 
 
 Tliese l)lood-vessels are jj 
 
 also accompanied by 
 nejves. In some glands 
 the efferent vessels and 
 the blood - vessels are 
 found mostly in a small 
 depression which, in an- 
 alogy with the kidney, 
 has been called the hilus. 
 Tliis is not a marked fea- 
 ture and is absent in 
 many eases. 
 
 In infancy and youth 
 the glands near the sur- 
 face are grayish in color 
 while tliow' in the interior 
 of tlie l)0(ly are pinkish. 
 In adult and ad\iiueed 
 life the glands an' usu- 
 ally somewhat atro)iliied 
 and darker in cohjr, and 
 those of the brojiclual 
 )ilexus are often dark 
 i)rown or even black. 
 
 L\'m[ilioid or adenoid 
 tissur islik<'tliat de.sci'ibed 
 for the proper glandular 
 sulislaiiee of the lym- 
 jihalic glands; that is, a 
 line net work of lirancli- 
 iiig and anastomosing 
 cells or libres with the 
 meshes eiowded with 
 lymphoid cells. Some- 
 times this tissue is (piite 
 sharply delined. when it 
 is ea.lle<l a follicle or sim- 
 ple lym]ihatie gland; in 
 other situations it is dif- 
 fuse. The ti.ssue is abun- 
 dantly supplied with 
 blood - vessels, and the 
 lymphatic vessels on its 
 surface and emerging 
 from the interior are in 
 great alnuidanee (Fi.i;'. 
 3:!()6). The <liffuse and 
 follicular foini of the tis- 
 sue is founil in great 
 abundanci- in the alimen- 
 tary canal of man and thi> lower aidmals. In the 
 tonsils aial the pharyngeal tonsil it is aggregated in con- 
 siderable masses; so also in the Peyerian patches, which 
 are simply an aggregation of lymph nodules, follicles. 
 or .solitary glands. The mucosa of the verndform ap- 
 pen(li.>; of the rabbit (Fig. t!2sr>) is almost entirely oc- 
 cupied by a great Peyer's )iatch : and the so-called soli- 
 tary glands (Fig. 33ll(i)are lymphoid nodides or loltieles 
 with a dense meshwork pervaded by blood eai)illaries 
 and filled with lynpih corpuscles. They are surrounded 
 by a capillary netw(jrk which helps to separ;ite them 
 somewdiat from the surroiniding less condensed lym- 
 phoid tissue (Fig. iSliOti). 
 
 Ihi'iiioliiiiipli Ohiiiih. — Deep red or chocolate-colored 
 bodies from 1 to 'Jtt mm. in diameter with the general 
 structure of lymph glands but with the sinuses tilled 
 ■with bloo<l instead of lymph. 
 
 In structure the parenchyma of these glands resembles 
 Vol. v.— 43 
 
 spleen or red marrow (splenolymph or marrow-lymph 
 glands). The glands resendiling spleen are naisl com- 
 mon. Intermediate or transition forms between hanio- 
 lymph glands and the ordinary lymph glands occur. 
 
 H;emolymph glands have been reported in the follow- 
 ing animals: Hen. tuikey, rat, dog, sheep, goal, ox, pig. 
 horse, and in man. They occur most fiequently ahjng 
 file great blood-vessels, especially tliose of the abdomen. 
 They are most easily found in the root of the mesentery. 
 
 
 t 
 Iff' 1 
 
 
 
 + — 
 
 Fig. ?>^0b - 
 Mm 
 
 seen fi 
 oil 11 P ' 
 
 Ivmphati \ ' 
 MPI ^ \ths 
 1 1 tl sul mu 
 f i 
 
 of LieberkiihD. 
 
 ^( Is irism^^^ fr m 
 
 ) Md^nillel 10 1 
 
 w 2 ^ l\mi I Ui 
 
 nunklefs f lu pd Ly th' 
 
 1 I \ r |1 f- III 1 1 
 li iiiiPiHr-, jri 1 re lu 
 I ]i |ps ir sm 
 nni n f tl 
 
 "4'. 
 
 f tl e Large Intestine of 
 nth L Lynipti follicle 
 .,111111*" leftbrfllj friliclp ;irnj appearinff 
 MU ill St radii les 4 4, ba^e ef Uie erypti. 
 
 s 111 in ( till I 
 e I it ut ne r 
 
 and in the neighborhood of the renal and adrenal vessels. 
 In tlie cervical region the\' are conimonlv near tlie para- 
 thyroids (Warthin ^ and Vol. IV. of this'Handbook). 
 
 Developme.n't or' the LYMPH.VTrc System. — While 
 in the past much serious study has lieim given to the de- 
 velopment of the lymphatic system in the einliryo, the 
 matter has remained in a very unsalisbictory condition 
 until receutljf. From the time wdieii this system was 
 discovered and worked out, in the adult it has been 
 known that it is an appendage of the venous system. It 
 has also been known for many yeai's tliat tlie lymphatic 
 system develops considerably later than the blood-va.seu- 
 lar system. Howevia', it is only within the jiresent year 
 (1902) that it has hem shown eonclii.sively tiiat this sys- 
 tem does not grow in from the exteriiu' part of the body 
 and finally form a union with the veins, but nn the uther 
 litiiifl tliiii it is a (Jirei't outijioicth <>}' tlie rni^nix system. 
 (Sabin '"). 
 
 Oc 
 
L.j-iiipl»atlc System. 
 Lymph Nodes. 
 
 HEFEREXCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 As worked out for the pig it was found that tlie lym- 
 phatic system is at first symmetrical and grows out from 
 the veins at four jioiuts, that is at 
 the junction of the veins of the 
 limbs with the cardinal veins, 
 viz., at the junction cjf the sub- 
 clavian and precardinal veins in 
 the base of the neck, and in the 
 lumbar region at the junction of 
 the sciatic and femoral veins with 
 the jiost-cardinals. Slightly be- 
 yond its origin from the vein each 
 of the four original lymiili flunks 
 or ducts dilates to form a lymjih 
 sac or lynijih heart. In lower 
 forms, as the frog, lymph heai'ls 
 contain striateil nuiscle and are 
 rhythmically contractile: it has 
 not yet been shown, however, 
 whether these sacs in the devel- 
 iping mauuual are contractile or 
 not. 
 
 As demonstrated in tlii' folhiw- 
 ing figures the lym[)halics de- 
 
 Fii;. 
 
 I:i07.-T)iatrraiii of 
 the Lyiiiphatie SyMeiii 
 of an Knihryo Pi<r L'( 
 Mm. Long. -. 3. (Sabin.) 
 AC}\ Precardinal vein ; 
 RLD, ?-i,ffIit lyniptiatio 
 
 duct ; 
 
 vein ; Pri', pnst-caniin. 
 al vein: TI'B. Woinian 
 body; K. liirtriey; .sT, 
 sciatic vein : F^\ fcai'")r- 
 al vein; AfjH, anlciior 
 IVTnpti sac or lyinpb 
 tieart: TD. thoracic 
 duct; PLII, posterior 
 lymph sac or Ivmjih 
 heart. It is to lie icited 
 that the lymphatic sys- 
 tem is syminetricai, hut 
 that in the cephalic part 
 i:>f the body it iscimsider- 
 a b I y more advanced 
 than in the canclal half. 
 
 rV. subclavian velop first in the eejjhalic lialf of 
 the body: the system issymniel- 
 rical, but soon the left side pre- 
 ponderates: the connection of tlie 
 lyiniihatics with the veins in the 
 Ciiudal half of the body is soon 
 lost ; tliei'e are very early two 
 elivlocysts, and two tlioraeie 
 ducts, but as both thoracic ducts 
 grow down to join the lumb;ir 
 duets fnau the left side, the 
 asymmetry of the lymph trimks 
 in the cephalic half of mammals 
 is original and not secondary. It 
 
 is also seen that the lymphatics as they grow out lo the 
 
 perijihery are in a close-iiieshed network, the ends of 
 
 the tubes forming thi' network ending blindly, and 
 
 extending farther and farther over the body by a con- 
 tinual sprouting of the tubes. 
 
 The lymphatic glands are de- ,- " "■, 
 
 veloped fi(;m a network of 
 
 lympli \essels by an ingrowth 
 
 of lymphoid tissue and by 
 
 the formation of a eonneciive- 
 
 tissiie ea|isule around the out- "- 
 
 sidi-. Fin.ally it should he 
 
 slated that beginning with _, 
 
 Kolliker in ]S7!:) un increasing (,.,./ 
 
 i]iind>er of eiiibr\"ologisfs ha\'e U 
 
 eome to beli,.i,c' tlial" the real ''^-t 
 
 " the l\lll|ih eoi|iuseles "-'( 
 
 I'i- , I .- 
 
 ..f tie 
 theliid e,. 
 (Beard >')- 
 J/e///"</.v 
 vesse' 
 they 
 
 bodv 
 
 n iii| 
 is ft 
 
 of 
 
 thi 
 
 ire 
 
 Th 
 . til 
 
 e Ihyi 
 
 lymph 
 hat uti 
 liii iiid 
 
 { 
 
 alle 
 less 
 
 iiilan 
 
 solid tliey are not visible. On 
 of the first ways of niakin; 
 the general lymjihaties \isibl 
 was ft 
 
 orL.'a]i. 
 nils tie 
 esp. 
 
 Flo. :;:;il.s. — Diafjtai 
 l.yuiplialic system 
 
 HlllllUM I'ie 'S MllL 
 
 :;. ISabin.) /), 
 
 inject waler or cijlored 
 ■latin into the itrti-ries of an 
 The iiiitss c-xudes and 
 lymph vessels; this is 
 ly successful if the 
 vein is tied. The lacteals are 
 made evident by h'ediiig the 
 animal some fatty food, like 
 milk, an hour or two before 
 dcjith. 
 
 Vessels of sullieient size may be injected eenti'ad with 
 starch or plaster-of-Faiis. It is not necessary to tie the 
 cannula in place; simply pressing upon it with the lin- 
 gers is sufficient. The iiiscrtion of the cannula is greatly 
 
 pbratoii ; y/, .hict to 
 beall; IjII, duct lo llje llllu;s. 
 Tlie oilier letters as In the 
 previous llKure. Iti Ibis l\<s- 
 are it is seen thai llie 1 VIII- 
 
 phatics in llie cephalic lialf 
 
 are mere ad\aliced on (lie 
 
 left than on the rijriit. 
 
 facilitateil by first inserting aVjeaded bristle into the lym- 
 phatic, then by raising the bristle the cut In the vessel 
 may be seen. VV^here the ves- 
 sels are too small to be seen, 
 very successful injections 
 may be made by the punc- 
 ture method. That is, a liy- 
 poderniic cannula is con- 
 nected with a sjiinge or a 
 constant -pressure apparatus, 
 and inserted where lymjihat- 
 ics are supposed to be. The 
 cannnla is forced in as in 
 ordinary hypodermic injec- 
 tions, and the mass allowed 
 to How or it is forced in. If 
 the attempt is successful, the 
 fine network and collecting 
 trunks of a limited area will 
 be injected. The toes and 
 the tingcr-tiiis of man are 
 favorite places foi' injection. 
 In luiimals the pads of the 
 feet and the Itare spot on 
 the snout are good. A lym- 
 phatic gland is alwa3's easy 
 to inject. Fai an injecting 
 mass mercury was much 
 used liy the older anatomists. 
 ( 'olored .gelatin was also used 
 and is now much more cm- 
 jiloyed than niercnry as it 
 tlows reailily through the 
 lymph glands. An excellent 
 gelatin mass is Iloyer's 
 chrome yellow: dry gelatin, 
 login.; water, 75 c.c. After 
 the gelatin is softened it is 
 melted over a water-bath and 
 heated lo HO' C., then Tf) c.c. 
 of a cold saturated solution 
 heated to SIC ('., is added to 
 of a cold saturated solution 
 
 Kio. :S!n9.— Diagram of the Lym- 
 phatic. System in the Emhrvo 
 Pig :3ii' Mm. Long. ■• :.■. 
 ISabin.) MP, Mesenteric 
 plex us ; RK, recept a c u ] u m 
 chvli tchvlocvst). The other 
 letters as in Fig, :5*7. It will 
 III' seen tliat (Q this llgure the 
 chvlocvst is double, and that 
 the thoVaeic duct is also double 
 neatly to its teniiination. Iti 
 this stage the caudal lymph 
 sacs ha\e lost their connection 
 with tile vein, and frrjm new 
 oil the only i-onneetieii witli 
 tlie vascular system is through 
 the thoracic duct as in the 
 adult. 
 
 of bichromate of potash, 
 the gelatin: tiiialh', T.'j c.c 
 of acetate of Icad'is heat- 
 ed to Sir C. and added 
 wilh constant stirring. 
 Berlin blue in gelatin is 
 ])referable I'm- microscopii- 
 sjieeiinens (Plate Xld\', 
 and Figs. :->-J93, Hyiloi 
 Iiidi;i ink in v\;iter is ;iKo 
 of grciit sei'vice, cs])eeially 
 in eiiiliry CIS. "' 
 
 The puncture nndhod 
 was used by Hunter, ]\las- 
 <"igni, and Cruiksluink. 
 Cruikshank, in his "Aii- 
 titoiny of the Absoiiiing 
 Vessels" (17!l(l), ji. 44, 
 says: " I have sometimes 
 injected the I;icte;ds frcnii 
 punctures made Iiy the 
 
 ;«10. - Composite Picture of 
 the spreading ot the Superllcial 
 Lympliatii-s in the Emhrvo PiL'. 
 (Sabin.) .1, Area of lyniphalics 
 in a pig IS mm. long; 7{, aieain a 
 pig -11 mm.; ( ', area in a pig :J0 
 mm. long, D, area in a pig of 40 
 null. long. In the stages shown 
 there are no lymphatics beyond 
 the outlines Indicated. 
 For iuvesligating llie em- 
 bryology of the lymphatics, embryos in which the 
 heart is still heating are best. After the embryos are 
 cold they cannot be satisfactorily injected (Sabin'"). 
 In man lymphatics have been demonstrated in organs in 
 
 side 
 
 of the 
 
 veil 
 
 s w 
 
 here 
 
 I k 
 
 new till 
 
 y must 
 
 be, 
 
 thou 
 
 gh they 
 
 Wl 
 
 re 
 
 then 
 
 invisible to 
 
 1h( 
 
 II 
 
 iked 
 
 eye. 
 
 ' He 
 
 tiso 
 
 iiip 
 
 Cted 
 
 the 
 
 Ivniphat 
 
 IC g 
 
 am 
 
 s liv 
 
 pIlIK 
 
 ■lure. 
 
 
 
 
 Vi 
 
 iimg jininuils 
 
 are 
 
 best 
 
 for 
 
 sliidyin 
 
 g tl 
 
 e 
 
 h III- 
 
 phat 
 
 ies, atii 
 
 till 
 
 ■ l( 
 
 aiier 
 
 the 
 
 animal 
 
 Ihe 
 
 III 
 
 ttel. 
 
 6.58 
 
REFEKENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 Cyiiipliatio System. 
 Lyinpli Nodes. 
 
 tli(! fa-tus when tliey could uot be in tlie adult. Mature 
 auiiuals are better lor the lynii)liatics of the reproductive 
 
 Eya 
 
 Fii; :jlill.-T(-rininaI I.viiiI>liatios nf the Skin IJft.wf-en tlji.' Ey<_^ and 
 i'Lai' io a Pi^ .'}(.) Mm. Li.ing. ' 11. <Sabin.) 
 
 organs, and, for the pancreas, an old man or aiiinial is 
 to Ije chosen. Siiiinn U'ln-y <ui(jt\ 
 
 BinLU.Kni.\i'nY. 
 
 The wfitrr wi^iics to "Witress liis ).qrat indf^iti^dness to I'rofcssdr 
 Wilder fur tri-nfi-ims siipi'lit-s of malcrial fur' investii,^ati<iiis in tin- 
 ru]iiiiarati\'f^ auatoiiiy cf Dim Ivinpliatir system, foi- aid in nnniiasin;-' 
 costly works, and foi- hoarty encouiaLtfinont ; to Hk- liiiraiy of tlio 
 Smyoiin-iioii.-iars Olllce for the loan of rare :ujd yaliialde works of 
 I'eferenee, and, tlnally, to the editor for eneoniat-amient and stilii:es- 
 tions. 
 
 In [jreparine; the aiticle fr'ee use has lieen made of the lari/er \yorks 
 on ptiysiolo^ry ; Flint's treatise, Laialols and StiiliiiLr : IMiha'-Kdwards, 
 l.e(;(jns, etc. In innnan anatiany, ,\llen, Gray, aial t,inain in laiLMish : 
 Sapjiey in Frenela ; llenle, Kratise, ( ieLfenhaiiel", and HoIVmann in 
 (ierman. The elinieid riMuaiks are esnerially eornplete and satisfac- 
 tory in Allen; many very su^-i^-estiM! remarks are also made in Sap- 
 pey's Atlas. In cfaujiaiaiive analomy (he woiks of ( >\yen, (;ee;eijhanr, 
 
 and Parki-r's Iraiislatiiai of Wiederslnam, in laialish, aial Md Eil- 
 
 wards' I^eeiMis, in French, are the mo.sl satisfaclca'v. For the liihlioc. 
 raliliy of tlie siihiect Ma.scaLOii, Milne-Kdwards, llolTaanin, an. I Kohin 
 (.see'helowl are espci-ially connniaidalile, as is al.so (he Index eata- 
 lo^du.^ of the snri^eiai-Ocneral's Ulnar v. specilli' refiavnces ha\e iiecn 
 made to the h)llo\yii}c: 
 
 ' ,sap[>ey, I'll. ('. : i»esia-i)ifiim et Ic, inot.n-apliie des A'aissemrx l\ni- 
 
 phalic[Ues i-onsidi-IVS che/ rilomi I les y.alehres. f.iliii. |i|i. l.'iii, IS 
 
 plales, I'aiis, lf<.Sil. Also Traite d'Analoiiiie di-scii|jtive, ilPid edition, 
 I'll lis, isrn. 
 
 - Key and Retains : Sliidien in der Anatomic des Ni.M'yens\'s(eiiis nnd 
 des Itindecewelies, two folio vols., T."i plates, Stockholm, hs;.'. and is^d. 
 
 ■'Alexander, A.: Ueher die l.vmphcapilliiren dca- Clioroidca. Arch, 
 f. Anat. iind I'livs., Anat. Alitli., p. IIT, l.ssil. 
 
 iiiilford, H.: The liirections of the Lyiiiiih .streams in the Eye. 
 Arclnyes of llphthalnioloe-y, yol. ,\y., IS.sii. 
 
 ^ Koliin, (111. : fin the reri\ascnlar Lymphatics of the Central Ner- 
 vous System, in .lonrnal de la I'liysiologie de I'llomnie et des Ani- 
 lliaux, \(il. ii., pp. a;>T-.-)-!S. l,s.'.!l; .lournal de r,\natomie et de la 
 
 I-hvsioloirie Niaiiiale et Path., vol. iv.. pp. 1-34, l.sr.T ; Article, svsti' 
 
 LymTihatii[lie, in ficchamnre's Iliedonnaire des Sciences niedtcules. 
 pp. :>sti-ir4, isril. At the end of this article ale over seven paces of 
 bihlio{i:raphy. 
 
 '■' Krause : Haudbuch der meiischlichen Anaiontie, tliird edition, 
 IKTtr 
 
 ' Klein. E. : The Anatomy of the l.ympliatic Sysleiii,2 vol.. Ill plates. 
 
 " Uccklin.chansen, F. : Tlie Lyniiihalic S.vstcin, in stiicki-r's lli^toi- 
 oe:v. 
 
 •■' Warthtn, A. S. : The Normal Hislology of the Human Ha-molymph 
 (ilands. Amer. .lour. Anat., vol. i., ,\o. 1. p. lilf-TH. Seeaiso arlicle ctn 
 Hiemolyinph (ilands in vol. iv. of this ILvmipook. 
 
 1" Sahin. Florence K.. .M.D. : tin the Oricin of the Lynnihatic system 
 from the Veins, and the lievelopmeiit of the Lymph Hearts and' Tho- 
 racic Ihict in tlie Pic. American .hairnal of Anatomy, vol. L. pp. 3nT- 
 3.s>l, I<I0L>, 
 
 " Beard: The Source of LencocN'tes and the True Function of the 
 Tlivmns. Anatomischer .\nzeicer. i'.d. .wiii.. pp. 5.Xk>73, I'.hh'. 
 
 '■■ Hilton, W. .A. : The Morpholocy and Develo)aneut of Intestinal 
 Folds and Villi in \ertehrates. .Vmer. .loiiru. Anat., vol. i.. No. 4. l!1ll.-.>. 
 
 '^Maseaffni. Paulo: \asorum Ivmrihaticorum cori;ioifs humani His- 
 toria et ichllograilhia, folio, MP( '('LXX.X VII. (IT.STl. 
 
 el MaII,F\ P. : Die Bint- nnd Lymph wecte ini Diinndarni des llundes. 
 Abhandlniii-n-n der math.-phvs. Classe ri. koniirl. siichs. (iesellschaft 
 der W issenschaften, Bd. 14. hs.ST : and the Vessels and Walls of the 
 no,c's stomach. Johns Hopkins Hospital Reports, vol. 1., LS'J3. 
 
 LYMPH NODES, DISEASES OF.— Anato.mical Con 
 siliKRATioNS. — The jn'oper appreciation of the patho- 
 logical changes met with in tlie lymph nodes presumes 
 a slight knowledge of the normal anatomy of these or- 
 gans. They are smtiU, bean-shaped or oval nodules 
 
 witli 
 
 of til, 
 Ivnipl 
 thev ; 
 .if till 
 
 wljicjj lie in the course of tlie lympliatic ves.'.els and "ii 
 tlie jinire protected portions of the body, as, for exam- 
 ple, ill the lateral regions of the neck, tlie axilhr, llie iii- 
 guitiai regions, about the peritoneal and pleural cavities, 
 and in the folds of the mesentery. A small depression, 
 known as the liilus, is usually present at one portion of 
 the node, marking the point of exit of the efferent lym- 
 phatics and the liliaid-vessels. The nodes lie in a .soft 
 connective tissue and are finite freely movable in the fat 
 which often surroiiuds them. They are normally of a 
 reddish-gray color, and a cross-scclion of a freshly n;- 
 inoved node is usually somewdiat trairslucent. 
 
 The nodes arc snrrouuiled by a thin, fibrous capsule 
 containing some fat tissue anil bluod-vessels, and occa- 
 sionally a few siiiooth muscle libres. The capsule sends 
 pioccsses into tlie node which are known as trabecuhe. 
 The capsule and tlie trabecuhe send off fine connective- 
 tissue fibres into the substance nf tlie node, forming- a 
 delicate network in the meshes of which lie the leuiai- 
 cytes forming the parenchyma of the organ. These cells 
 are chiefly of the variety kiioyvn as lymphocytes, which 
 possess a single large spherical niielrus and a relatively 
 small amount of cell body. 
 
 The mas.ses of lymphocytes near the periphery of I lie 
 node are collected into nmlules known as the follicles or 
 seconilary lymph nodules They are surrotuidcd bv a 
 lyiiiiili sinus, ilerivcd fnnu the division of tlie afferent 
 lymplial ics into an anastoninsiiig network of s|uices lined 
 llatteni'd endothelium. In the centre of thefolli- 
 ligliler area can ofleii be seen in stained sections, 
 I he cells are slightly largid' than in tlii' periphery 
 nnilule tiiid often slinw karyokinetic figures. The 
 K'cyti's are fiirmed in tliesc germinal ceirtres, :is 
 ire called, and pass fi'nm tlieiii to the |)eriphery 
 iiialule, fiMiii which they are set free in the lynipii 
 stream ^^[ 1 he sinus, 
 
 111 (lie centre of the lymph nodes the arrangement nf 
 the lym|ilincy|es is somewhat dill'erent. They ilo not lie 
 in masses as in (lie cortical iindules, liut are suspended in 
 strands in the cuiinecti ve-lissue ni'twork lying between 
 the trabecitbe, and are calleil mednlkiry cords. Each 
 ciiril is siirroundeil by a lymph sinus which separates it 
 from the trabeculae 
 
 Tlic lymph sinuses are linaiied frnm the afferent lym- 
 |iliatics, some of which cnler the nodi- :it the sinus, olli- 
 cis through the capsule. Tliey pass to the iicriphery of 
 llie nolle and lireak ii|i there into an anastomosing scries 
 of vessels wiiicli ]iass inward anil surround the follicles 
 and the medullary cords, and liiially reunite' to form the 
 (dVcrent lymjihal ics and jeissoutal thehilus. Tlielympli 
 sintiscs so formed are lined with liaLteued endothelium. 
 
 The blood-vessels enter cliielly at the liilus and are dis- 
 trilmteil li)-st to the niedullar.v cords and tlieii to the si-c- 
 niidnry nodules. 
 
 Reticular tissue containing lymphocytes is not con- 
 fined to the lym|ili nodes, but is found in the organs and 
 especially in tlie mnecnis membnine of the digestive 
 tract. The tonsils and cry|its in the tongue, the solitary 
 iind agminate follicles of llie intestine are exiuiiples lif 
 such collections. The struetiirc of tliesc deposits of lym- 
 phoid tissue varies from (hat of the lymph nodes. The 
 developiiieut of Ivmph sinuses and germinal centres is 
 much less complete than in the nodes. The lymphocytes 
 are also not wholly carrieil off' in the lyin])]i' circulation, 
 tint miuiy of them wander out tlinnigh the epithelial 
 layer covering these collections of lymphoiil tissue and 
 enter the digeslive tract. 
 
 The agents w-|iich incite pathological changes in lymph 
 nodes are as a rule ctirriial in tlie lynilihatics to the" node 
 and first enter the Ivmpli sinuses at the iieriphery of ilie 
 node. Coarser jiarticles of foreign matter, such as dust 
 or soot, are often deposited in this portion of the node, 
 and arc taken up by the [iliagocytic eiidotlielial cells of 
 the .sinus. The same is true of tlie cells of tumors which 
 are found first in tlie periphery of the node where thev 
 occupy the sinuses. The clTec'ts of bacterial poisons are 
 often most marked in the peripheral portions, tliough the 
 bacteria are usually caught in the filters of the nodules or 
 
 65y 
 
l^ympb Nodes. 
 I^yiupli Nodes. 
 
 UEFEKENCE HANDBOOK OF THE MEDICAL SCIENCES. 
 
 medullary cords. Thus, tulierculous foci generally begin 
 near the centre of the node and may leave the peripheral 
 portions in a more or less normal state. 
 
 The Pathological Changes in Ly.mph Nodes. — P/^- 
 mentation. The pigment which is most frequently found 
 in lymph nodes is derived from soot or coal dust. Sili- 
 cious material inhaled by stone-cutters or grinders may 
 also bo transported to the In-onchial lymph nodes. De- 
 posits of iron oxide are found in the nodes of iron work- 
 ers. The pigment may also be derived from the sub- 
 stances used in tattooing, which are cbietly India ink and 
 vermilion. Finally, the pigment may arise in the body 
 from the destruction of the^red blood" (•()r|)usclcs, eith('r 
 following hemorrhage or pi'odueed by parasites, such as 
 the Plasmodium malari;i?. The brown pigment which 
 colors the skin and mucous membranes of these suflering 
 from Addison's disease, may also be carried in the lymph 
 nodes. 
 
 The pigment collects tirst in the lymph siiuises at the 
 periphery of the node, being carried thither either l)y the 
 lymph stream or liy phagocytes. It may remain in this 
 position cither in the meshes of the tiltrous reticulum or 
 in the endothelial cells lying in the siiuis. If the amount 
 of pigment be very large, it is filially carried to all por- 
 tions of the node and tills the nodules and the lymph 
 cords. 
 
 A small mount of pigment may not cause any change 
 in the structure of the node, but large (juautities induce 
 a clironic hyperplasia of the fibrous tissue which may 
 result in a more or less eom|)lete destructiiai of the cells 
 and the reticulum of the node, and their replacement by 
 dense pigmented connective tissue. This chronic intlam- 
 mation may involve the periglandular structures and 
 give rise to dense connective-tissue masses about the 
 node. Such nodes are of course funetionless. 
 
 Atrofhy. The lymph nudes of children are larger than 
 those of adults, so that a slight atrophy of these struct- 
 ures takes place during life. In old age a more com- 
 plete atrfiphy, with a diminution in the number of lymph- 
 ocytes and thickening of the hbrous tissue of the nude, 
 is a regular occmrence. The node may be reduced to 
 a mere shell, the centre of wdiich is filled with fat tissue; 
 or it may be small and hard and the fat tissue lie about 
 it. Such nodes are ]ialer than normal owing to the in- 
 crease in the amrnint of coimecti\'e lissue and to a diini- 
 niition in the blor.d. sujiply. 
 
 Amyloii! ilfripricrnfinri of the reticulum and of the walls 
 of the blood-vessels may appear in the lymph nodes as a 
 part of a general amyloid degeiic'ration of the organs of 
 the body following prolonged suppuration, tubeicidosis, 
 or .syphilis, or it may be limited to the nodes. In the 
 
 Fro. 3313. —Pigmentation of I.yini* Node, with Chronic Inflarrima- 
 tlon. a, Caiisule; h, follicle; c, (ilbtcd slims hIIIi ph;igocytes 
 earrylnK pigineat. (Dr, V. C. W'ooil.; 
 
 latter case, amyloid degeneration is most freip'ently seen 
 in the hypei'plastic nodes of pseudoleiikiemia, and in 
 chronic or tuberculous inflammation. In advanced cases 
 the fibres of the reticulum may become greatly swollen 
 so as to cause the parenchyma of the node; to undergo 
 atrophy. Under such circumstances tlie node is hard and 
 
 transparent and gives a mahogany brown when treated 
 with tincture of iodine. Sections stained with methyl 
 violet or thionin show fhe metachromatic staining char- 
 acteristic of amyloid in the other portions of the body. 
 
 Ilynline derjenemtionoi the walls of the vessels and the 
 reticulum isoccasionally seen in tidjcrculous or carcinom- 
 atous nodes or in old age. 
 
 Fatty degeneration is seen chiefly in the lymphocytes in 
 connection with acute inflammation of the lymidi nodes. 
 
 Fatty infiltration of the nodes is occasionally seen in 
 obese persons, and may follow the atrophy resulting from 
 chronic inllammation or old age. 
 
 (Jalrifiration of the nodes is seen chiefly in old tuber- 
 culous or suppurative lesions where the lime .salts are 
 deposited in the neerctic areas, but occasionally carcinom 
 atous nodes will be found to be calcified, especially in 
 slow growing scirrhous carcinomata of the breast, when 
 the a.\illary nodes have been invaded for a long time and 
 degeneralion has taken ]ilace in the tissue of the new 
 grcovth. 
 
 AiiiiiKit fiaraxitex have been found in the lymph nodes 
 in rare cases. The embryos and adult worms of the fihi 
 ria sanguinis hoininis have been seen, and also the em 
 bryos of the tricliina spiralis. C3'sticercus and the echi- 
 nociiccus embrj'os Inive also been seen. 
 
 Ai-iit,: Lyniplauleriitin. Acute inflammation of the Ijunpli 
 nodes is due to the presence either of micro-organisms 
 or of their to.xins. In these conditions the lynipli nodes 
 are enlai'ged and cont;iin a considerable amount of se- 
 rum. The capsule is distended and the blood-vessels are 
 strongly injected. The color of tin; node under these 
 conditions is a much darker red than noriual. When the 
 condition is advanced, the node softens and the softened 
 tissue can easily be scraiied from the cut surface. Ac- 
 cording to the microscopical chiinges which take place 
 lyo)|)h;ulenitis may he divided inio the hyiierphistic and 
 the exudative forms. In the hyperplastic form the 
 changes are largely due to a proliferation of the cellular 
 elements of the follicles, of the endothelial cells of the 
 sinuses, and of the connective-tissue cells of the node. 
 The endothelial cells, especially in typhoid lever, can 
 often be found lying free in the sinuses or attached to 
 the traberuf-e and very much swollen. The germ cen- 
 tres may be large and may show numerous mitoses in 
 the early stages of the disease. Later, necrosis of the 
 hyperidastic tissue is trei|uently seen and the cells cease 
 to take any stain. In otlaa' eases Ihe inflammation \n 
 distinctly suppurative, and in addilion to the hyperplas- 
 ticchan.ges there are present lyin|)liiicytesand leucocytes 
 from the circulation, together with hemorrhagfs from the 
 blooil-vessels. The tissues in the centre of the node sof- 
 ten, break down, iuid form, in this way, larger or smaller 
 abscesses. 
 
 In very severe infections the inflaiT.mation takes on a 
 hemorrhagic character, and tin; sinrs may be filled with 
 blood and a fibrin network which may finally e.xlend be- 
 tween the necrosed cells of the follirles. The diphtheria 
 bacillus is usually the inciting agent in the production 
 of the liemorrhagic- type of acute l)'m|iliadenitis, though 
 the typhoid and imthrax biu'illi may act in a similar man- 
 ner. The bacillus of plague has a like action on the 
 lymph nodes, and the nodes iiiviuled by this organism are 
 quite constanlly the site of eMensive hemorrhages, due 
 to the necrosis of the walls of the blood-vessels produced 
 by the to.xin of this bacillus. 
 
 Very fre(|Uectly the i)rocess does not remain confined 
 to the lu de, but exterds to the perinodular tissues, form- 
 iii.g a periailenilis, Wlnai the )iioce,ss is confined to the 
 nodes, healing may take place by resor|)lioii of the con- 
 tents of the nccrotii; areas, and repair by the |iroduction 
 of fibrous tissue; or, if these areas are of considerable ex- 
 tent, it may take place by absorption of the fluid and 
 encapsulation of tiie dry mass by fibrous tissue. The 
 debris remaining often undergoes a final process of calci- 
 fication. 
 
 Chronic Lym]iha<1eiritii<. This condition is character- 
 ized by chronic hyperplasia of the various elements of 
 the node. It may be seen in condition.? In which the 
 
 f;6o 
 
EXl'LAXATION OF 
 PLATE XLII. 
 
EXPLANATION OF PLATE XLIL 
 
 Which ReprvscDts llic Base uf tlic' Tongue, tlie Tonsils, tlie Pharynx, and llie Opening of tlie 
 Larynx of Man. The Pharynx was Divided on the Dorsal 8ide, and (lie Walls were Reflected. 
 (Sappcy. "Atlas.") 
 
 1, 1, Lyniphalic network on the dorsum of the tongue, the general direction of the vessels is ob- 
 liquely towai'd the raphe (meson) and the base of the tongue; 3, 2, circumvallate papillfe in the 
 form of a V; 3, 3, 3, 3, vessels surrounding these papillae and soon converging to form mesal 
 and lateral tiuuks ; 4, 4, lymphatic trunks extending along tlie meson from the middle circum- 
 vallate papilla ; ■"), ■!), continuatit)n of 4, one on each side of the middle glcsso-glottic fold, and 
 finally penetrating the lateral fold, they enter the lymphatic glands (13) of the ental cervical 
 plexus near the lateral thyro-hyoid ligament; 6. 0, other trunks farther from the meson, taking 
 the same course; 7, 7, lateral trunks from the ba,se of the tongue, tonsil, etc. ; they penetrate the 
 pharyngeal mucosa and terminate in the same group of glands, but cress the dorsal instead of 
 the ventral surface of the great cornu of the hyoid ; 8, 8, trunks coming fi-om the anterior pillars 
 of the fauces, skirting the edge of the tonsils, and linally entering the cephalic, ental (superior 
 deep) cervical lymjihatic glands; 9, 9, the tonsils, covered by a dense network of lymphatics; 
 10, 10, 10, 10, the reflected sides of the arch of the palate (just below the '" 10" on each side is 
 the divided uvula); 11, dense lymphatic network covering the epiglottis and extending upon 
 the arytcno-epiglottic folds; 12, 12, a similar very dense and fine network of lymphatics upon 
 the pharjngeal mucosa covering the larynx ; 13, 13, several lymphatic glands belonging to the 
 cephalic, ental (superior deep) cervical lymphatic glands, situated at the level of the thyro-hyoid 
 ligament; as is evident from the plate, they receive the trunks from the base of the tongue, part 
 of the palatine arch, the tonsils, the larynx, and a great part of the pharynx; 14, lymphatics 
 arising from the ventral and lateral part of the pharynx ; 1.5, l.'i, lymphatics fi'OJii the pf)sterior 
 pillars of the fauces, they wind lound the ventral edge of the great cornu of the hyoid antl enter 
 the deep cervical glands at 13, 13; 16, 16, lymphatics arising from the dorsal and lateral asjiect 
 of the pharynx and extending to the cervical glands at 13, 13; 17, 17, lymphatic trunks on each 
 side of the larynx to the ental cervical glands at 13, 13; 18, 18, lymphatics from the dorsal and 
 lateral wall of the pharynx next the esophagus, they extend toward the thorax and enter the 
 chain of ental cervical glands along the trachea and (esophagus; 19, 19, lymphatics from the 
 ventral |)art of the pharynx, and extending to the chain of ental cervical glands in company 
 with 18; 20, summit of the great cornu of the hyoid exposed by the removal of the pharyngeal 
 wall; 21, end of the major horn of the thyroid, connected with the hyoid by the thyrohyoid 
 ligament ; 22, 22, dorsal border of the thyroid cartilage showing through the pharyngeal wall. 
 
REPEftENOe HANDBOOK 
 
 OF THE 
 
 MEDICAL SCIENCES 
 
 PLATE XLII. 
 
 -M 
 
 ^ 
 
 
 
 1 
 
 
 
 
 
 
 lit Fife^^-. ' 
 
 
 
 4/r^^^ / // 
 
 
 
 
 
 u i3 
 
 BASE OF THE TONGUE, THE TONSILS, PHARYNX, AND OPENING 
 
 OF THE LARYNX OF MAN 
 
 (SAPPEY, ATLAS) 
 
EXPLANATION OF 
 PLATE XLTY. 
 
EXPLANATION OF PLATE XLIV. 
 
 Which represents the arteries, veins, and lympliaticsof the different laj'ers of the stomach, and 
 the lymphatics of the layers of the small intestine of tlic dog. (From Fi-anklin P. Mall.) 
 
 Fig. 1. — " Reconstruction of a Small Portion of the Mid<Ue Zone of the Stomacli. The long diam- 
 eter of the drawing is in the direction of the longitudinal mnscle fibres. It was built up from 
 thirty -six drawings, and each di'awing is an exact representation of a specimen." Enlarged 
 about 10 times, (a) Mucosa; (h) muscularis miicosie; (c) submucosa; {d) circular muscular 
 layer; («) longitudinal muscular layer. Arteries, red; veins, blue; lymphatics, brown. 
 As shown in the drawing the arteries and veins form a coarse network in aljout the middle of 
 the thickness of the submuco,sa, and from this meshwork branches pa.ss directly through the cir- 
 cular muscular layer on one side and through the muscularis mueoste on the othci-. Between the 
 muscular layers another meshwork of vcs.sels is formed, but after passing through the muscularis 
 mucosae the arteries in the dog extend directlj' into the mucosa and break up into capillaiies be- 
 tween and around the glands. In the cat a network of arteries is formed after traversing the mus- 
 cularis mucos*, and from this network twigs pass intcj the mucosa and break up into capillaries. 
 
 The veins form a meshwork near the free surface of the mucosa. From this first meshwork 
 branches pass down to the )iuiscvdaris mucos* and there form a somewhat coarser network at the 
 base of the gastric glands. From this mucosal network the vessels penetrate the muscularis muco- 
 sae and accompany the arteries. 
 
 The lymphatics begin b}^ blind, branched, linger-like vessels between the gastric glands. 
 These finger-like beginnings unite and form a meshwork between mucosa and muscularis mucosa". 
 Another meshwork is formed on the opposite side of the muscularis mucosa' aud from that 
 point a coarse network is formed in the submucosa and between the muscular layers. Valves ap- 
 pear in the lymphatics as they penetrate the muscularis mucosae. The vessels penetrate the walls 
 of the stomach and pass to lymphatic glands along the greater or lesser curvature as .shown in Plate 
 XLIII. 
 
 Fig. 2.— Segment of the Small Intestine of a Dog to Show the General Distribution of the Lym- 
 phatic Ve.ssels. Mucosa and villi, white; muscularis mucosa', blue-green; submuco.sa, pink; 
 circular muscular layer, orange; longitudinal nuiscular layer, yellow; lymphatic vessels, bliii'. 
 (Fl) Lymph follicles in the nuicosa (cf. Fig. 3); (M.L.) muco.sal lymphatic network; (S.M.L.) 
 submucosal lymi)hatic network; (.T-Msl-L) intermuscular lymphatic network. The efferent 
 lymph vessels from the submucosal and intermuscular networks are shown below at the mesen- 
 teric edge of the intestine. From this point tliey pass to the lym]iliatic glands (cf. Figs. 3273, 
 3281-3286). 
 
 Some of the villi are represented with the club-shaped central lacteal or lymphatic. It will be 
 noticed also that at the base of the villi there is a lymphatic network, and that in passing from one 
 layer to another of the intestines the vessels pursue a nearly straight course (cf. Fig. 3). The pas- 
 sage through the muscularis mueosie is indicated by libie dots, thus giving it a sieve or punctate 
 appeal an ce. 
 
 Fig. 3. —Section of the Small Int(;stincof a Dog to Show the Arrangement of the Lymphatics in the 
 Villi and in (lie Different Layers. Lymphatics, blue; villi, two crypts of Lieberkiihn, muscu- 
 laris inncos.-e, a lymph follicle and the longitudinal muscular layer, pink; mucosa and circular 
 muscular layer, white; submucosa and one lymph tollieli-, gray. One of the villi is shown in 
 an uncontracted conditioii. The otheis were strongly I'etracted by the use of ten-per-cent. nitric 
 acid. 
 In this lignic is well shown the chdj-shiiped central lacteal or lymphatic with a slender, spiral 
 
 projection e\trnding nearly to the end of the villus (cf. Fig. 32!)-! ). In the second villas from the 
 
 left two central lacteals are shown. 
 
 From the network at the base of thi^ villi the vessels extend directly to the mucosal network 
 
 (Fig. 2, M.L.). From this point on they possess valves. Surrotmding the lymph follicles is a 
 
 dense lyniph network. The hgiire shows also that the muscularis mucoste is not iircsent over the 
 
 lyni|>l] follieh's 
 
Reference Handbook 
 
 OF THE 
 
 Medical Sciences 
 
 FIG.l 
 
 PLATE XLIV 
 
 ( FROM FF?ANKI_IN 1= MALL.)