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Meckel JF. Handbook of Pathological Anatomy (Handbuch der pathologischen Anatomie) Vol. 2. (1812) Leipzig.

Ligaments: I. Trunk | II. Head | III. Extremities   Muscles: I. Trunk | II. Head | III. Extremities   Angiology: I. Heart | II. Body or Aorta Arteries | III. Body Veins| IV. Pulmonary Artery | V. Pulmonary Veins | VI. Lymphatic System | VII. A Comparison of Vascular System   Nervous System: I. Central Nervous System
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This historic 1812 textbook by J. F. Meckel, Professor of Anatomy at Halle, was translated firstly from German Into French (with additions and notes) by Prof. A. J. L. Jourdan and G. Breschet. Then translated again from French into English (with notes) by A. Sidney Doane.



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Section VI. Lymphatic System

§ 1637. We have already mentioned the general characters of the lymphatic vessels, in the first volume : they accompany the two sections of the vascular system already described, particularly the veins, which they resemble much more than the arteries in their arrangement, and correspond to them so exactly, that their history is already partially given in that of the sanguineous system. The topography of the lymphatic system is generally stated without any regard to the difference of the two principal parts which compose it, the vessels and the glands. But the method adopted by some anatomists, among others by Cruickshank and Bichat, and which is to desciibe first the glands and then the vessels, is preferable. We also have adopted it, because, by insulating the history of the glands, we can not only present a more general picture of the distribution of the lymphatic vessels, but can form more exact ideas of the most essential particulars presented by the glands, in respect to their existence, number, situation, and size, in different parts of the body.

Authors are not agreed as to the order of describing the lymphatics. Some, as Scemmerring and Portal, examine first those of the head, next those of the limbs, finally those of the thoracic and abdominal cavities and of the parts they contain. Others again, as Hewson and Cruik

(1) Sandifort, Obs. anat. path., book iii. p. 41, book ir. p. 91.

Vol. II, 48


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shank, regard only the position, and begin with the lymphatics of the lower limbs, then pass to those of the abdomen and chest, and terminate by those of the upper extremities and of the head. Many, of whom we shall mention Mascagni and Bichat, whose method resembles the preceding very much, describe the lymphatics according to the relations between them and the principal trunk ; so that they divide them first into two large sections, comprising, first, those which communicate with the thoracic canal within the abdomen and the chest, second, those which open in the neck, either in this canal or directly into the subclavian and jugular veins.

Although the method of describing the lymphatic vessels of the lower limbs is preferable, because we can then commence with the most considerable part of the system, and particularly because it allows us to state beforehand the origin of the principal trunk, whence it is generally followed in treatises, it seems to us more convenient, in a complete treatise on anatomy, to examine these vessels in the order in which we have described the other sections of the vascular system ; and consequently, as we take the history of the arteries as the base of that of the other vessels, to treat, first of the lymphatic vessels of the head and neck, then those of the upper extremities, next those of the viscera of the chest and of the abdomen, and lastly those of the lower extremities. By this method we finally arrive at the principal trunk, and the description follows the same course as the lymph does in the system.


CHAPTER I.

LYMPHATIC GLANDS.

I. LYMPHATIC GLANDS OF THE HEAD AND NECK.

I. LYMPHATIC GLANDS OF THE HEAD.

§ 1638. The lymphatic glands of the head are, proportionally speaking, very small and very few. They have not as yet been demonstrated strictly to exist within the skull, either in the brain or in the parietes. At least we cannot consider certain tumors, as those of scrofula, which are not unfrequently found in greater or less quantity in the substance or on the surface of the brain, as proving that lymphatic glands exist in this viscus;(l) for we have no proof that these tumors arise from enlarged glands and are not new formations.

We cannot assent to the opinion that the pituitary and pineal glands are lymphatic glands.

Those formations called glands of Pacchioni and the other analogous corpuscles which appear in the choroid plexuses are very different


(1) Reit, Manor, clin., vol. îi. f. 1, p. 39.


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Those small bodies found in the carotid canal, and which are lymphatic glands, according to 6ome anatomists, as Winterbottom(l) particularly, seem to us to be the upper ganglions of the great sympathetic nerve. We have formed this opinion after frequent examinations of them.

§ 1639. On the contrary there are evidently lymphatic glands on the outside of the head. They are much more rare in the cranial than in the facial portion. In fact, in the skull they exist only at the lower part, behind the ear ; even there they are not constant and very small.

They are more numerous in the face. They are found also at its lower part, under the zygomatic arch, and around the parotid gland in all its extent. The superficial glands cover the outer face of this gland ; the deep glands are situated on the buccinator muscle and behind the parotid gland. We also find very constantly within this gland one or more, which are small and almost, either alone or with those near them, the primitive seat of those tumors which are generally considered, but very wrongly, as developed in the substance of this gland. (2)

The largest and most constant of these glands are situated along the lower edge of the lower maxillary bone, on the anterior part of the inferior belly of the digastricus muscle.

II. LYMPHATIC GLANDS OF THE NECK.

§ 1640. The lymphatic glands of the neck are distinguished into superficial and deep.

The superficial are smaller and less constant than the rest, and are found along the external jugular vein, between the platysma myoides and the sterno-cleido-mastoideus muscles.

The deep glands are much larger and more numerous ; this region contains more than any other excepting the mesenteric.

There are none in the anterior part of the neck nor in the middle part of its lateral face, or we find at least only two or three of them which are small, which are not larger than a seed of hemp, and which are situated on the sides of the larynx, and between it and the hyoid bone. One or several of them are found on the mucous membrane of the trachea and of the esophagus imbedded in a great quantity of fat. They sometimes swell very much, and then may cause suffocation.(3)

The lymphatic glands are small and inconstant also on the posterior part of the neck.

The largest and most numerous are those in the upper and in the lower part of the lateral faces of this region of the neck.

The upper and anterior ( G . concatenate , s. jugular es), which are the largest, extend under the sterno-cleido-mastoideus muscle, from the

(1) De vasis absorbentibus, Edinburgh, 1781.

(2) Burns, Surgical anatomy of the head and neck.

(3) Burns, loc. cit., p. 85, tab. 5.


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mastoid process, along the carotid artery and the internal jugular vein, to the upper extremity of the cavity of the thorax. Some are placed outward, before the carotid artery, others inward, between this artery and the vertebral column. The most and the largest of these glands are found at the upper part of the neck, where the large vascular trunks divide.

The nearness of the carotid artery renders it possible to confound the tumors produced by their enlargement with an aneurism.(l) These tumors derange respiration and digestion because they compress the great sympathetic and pneumo-gastric nerves.

When the glands behind the large vessels swell, they usually embrace these trunks, and also the nerves, and are blended with them in a single mass.

The inferior and posterior are usually smaller. They are surrounded with a very loose cellular tissue ; they occupy the triangular space between the sterno-cleido-mastoideus muscle, the clavicle, and the trapezius muscle, and frequently extend to the axillary glands, along the vessels of the shoulder.

II. LYMPHATIC GLANDS OF THE UPPER EXTREMITIES.

§ 1641. The lymphatic glands of the upper extremities are divided into the brachial and the axillary.

I. BRACHIAL GLANDS.

§ 1642. The brachial glands rarely exist below the humero-cubital articulation. We however sometimes find several on the course of the radial and ulnar vessels, but they are few and very small.

The glands of the elbow are situated on the anterior face of the arm, especially on that of the inner condyle of the humerus. They vary in number from one to four.

From the elbow to the axilla are from four to seven, placed successively on the inner and anterior side of the arm, along the superficial brachial artery.

II. AXILLARY GLANDS.

§ 1643. The axillary glands in number and size exceed the preceding : we number as many as twelve which surround the large trunks of the vessels. They exist principally between the serratus magnus and the pectoralis minor muscles and the internal part of the vascular trunks, to which they are sometimes very intimately united, but extend below the pectoralis major muscle and the clavicle.


(1) Burns, loc. cit., p. 81


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The deepest are the largest, and are covered by the pect oralis minor muscle.


III. LYMPHATIC GLANDS OF THE TRUNK.

§ 1644. The lymphatic glands of the trunk are divided into those of the thorax and those of the abdomen.

I. LYMPHATIC GLANDS OF THE THORAX.

§ 1645. The lymphatic glands of the thorax comprise the glands of the parietes of the thorax, those of the mediastina, and those of the lungs.

I. OF THE GLANDS OF THE PARIETES OF THE THORAX.

§ 1646. They are very small, and their number varies exceedingly. They are found in no determinate order, principally between the external and the internal intercostal muscles, particularly along the heads of the ribs, on the side of the vertebral column. Opposite these latter there are from six to ten on the anterior face, along the course of the internal mammary artery.

II. GLANDS OF THE MEDIASTINA.

§ 1647. The glands of the mediastina are distinguished into those of the anterior and those of the posterior mediastinum.

The glands of the posterior mediastinum, descend along the esophagus and the aorta, and communicate outwardly with the posterior glands of the parietes of the chest. They are numerous but small. The largest are those which correspond to the central dorsal'vertebræ. They not unfrequently swell and cause dysphagia, as Van Geuns has remarked.

Those of the anterior mediastinum are from eight to ten in number, and reascend along the anterior face of the pericardium from the diaphragm. They are rarety diseased, as Cruikshank has observed, and as we also have remarked.


III. BRONCHIAL GLANDS.


§ 1648. The bronchial glands (G. bronchiales, pulmonic œ, Vesalianœ) (1) are situated around the bronchi, but they penetrate, although gradually diminishing in size, in the substance of the lung along the ramifications of these channels. They are always numerous and large, and sometimes to an extraordinary degree. The largest usually exist

(1) Portal, Sur la struct are et sur les alterations des poumons, avec des remarques sur la nature de quelques symptômes de la phthisie; in the Mem. de Paris, 1760


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before the bifurcation of the trachea between the two bronchi. In the adult they are more or less black. Sometimes this tint extends uniformly to every part; sometimes it exists in more or less broad and deep colored patches. In infancy, on the contrary, the bronchial glands are reddish, like those of all other parts of the body. We have observed, that before becoming entirely black, their surfaces are covered to a greater or less extent with black spots, which probably depends on the mode in which the lymphatic vessels are distributed. Generally they do not begin to be colored until the age of ten years, frequently not till twenty years. They do not all become dark at the same time, and their color gradually deepens.

The extent and the degree of coloring immediately relate not only to the age of the subject, but also to the state of the lungs, and perhaps even to the nature of the air which is breathed, particularly to the quantity of carbon it contains ; at least the bronchial glands are always proportionally larger and blacker in subjects affected with chronic disease of the lungs. They were even blacker than usual in a person affected with this disease, and who was in the habit of smoking.(l)

The black coloring matter is situated not only in the substance of the gland, but also in the fluids they contain, as it may be obtained by expression. The coloring substance seems to be pure carbon, (2) which Pearson thinks is not derived wholly from without.

Although these bodies are generally considered as true lymphatic glands, they are not admitted as such by all authors. Some, as Portal, distinguish the lymphatic glands of the lungs from the bronchial glands, or admit in the lung only a single species of glands, to which they refer the bronchial glands also ; but instead of regarding these bodies as lymphatic glands, consider them secretory organs. This is particularly the opinion of Senac.(3) This anatomist thinks, and in regard to the bronchial glands, Portal also, that they inclose a cavity communicating with the trachea by a canal, which may be easily demonstrated in a diseased state, by passing into it a bristle, and through which it is easy to cause the fluid they contain to pass into the trachea.

Not unfrequently, also, the most perfect similarity exists between the liquid contained in these glands, and that which lines the parietes of the trachea. Senac thinks that they do not act in the fetus : according to Portal, their action continues during life.

According to Portal, the bronchial glands differ from the lymphatic glands of the lungs admitted by this anatomist to exist independently of them, in their situation, volume, and form, since the lymphatic glands are not placed like them below the ramifications of the trachea, but are dispersed irregularly in the substance of the lung, and are collected

(1) Pearson, on the color ing matter of the black bronchial glands and on the black spots of the lungs ; in the Phil. Irans., 1825, plate ii. p. 166.

(2) Pearson, loc. cit., p. 164.

(3) Sona t, TV. du cœur, vol. ii. p. 686.


ADENOLOGY.


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particularly on the surface of this organ ; they are also smaller, rounder harder, and evidently receive lymphatic vessels. They are also distinguished from them by their changes produced by disease, as the two kinds of pulmonary glands may be affected independent of each other.

We are, however, inclined to agree with those who make no distinction between the bronchial and the lymphatic glands of the lungs. All the characters assigned to them are purely accidental ; the bronchial glands even frequently differ from each other in all these characters, as one may judge from the details we have previously mentioned.

In examining bronchial glands which are very much swelled and which manifestly contain a liquid, we have never discovered any canal going from these bodies to the trachea ; and when these two organs communicate, it may depend on the enlargement or the morbid alteration of the glands, and their pressure upon the trachea ; and farther, some persons have expectorated ossified portions of these glands.

In fact, our observations have shown that the bronchial glands are more subject to ossification than all others, within the substance of the lung, or around the bronchi.

II. GLANDS OF THE ABDOMEN.

§ 1649. The abdominal glands occupy principally the cavity of the abdomen. We find but seldom one or more of small size in the paiietes of this cavity, for instance, above the umbilicus on the linea alba.(l)

The abdominal cavity of all the regions of the body, contains the most lymphatic glands, because there the form and functions of the lymphatic system are most completely developed.

They are principally situated in the folds of the peritoneum which unite the abdominal viscera with each other, and with the paiietes of the abdomen, and they may be divided into mesenteric, gastric , cœliac and lumbar.

I. MESENTERIC GLANDS.

§ 1650. The mesenteric are the largest and most numerous of all the abdominal lymphatic glands. (2)

They are divided into the proper mesenteric glands (Gr. mesenteric æ) and the mesocolic glands (Gr. mcsocolicœ.)

The proper mesenteric glands are situated principally on the left and convex side of the superior mesenteric artery. They are incomparably more numerous and larger than the mesocolic glands. We usually number more than one hundred of them, sometimes even more than

(1) Mascagni, lue. cit., p. 90.

(2) Werner and Feller ( Vasorum lacteorum atque lymphatieorum analomico-physiologica descriplio, Leipsic, tab. i), have figured some mesenteric glands and the lymphatic vessels of the small intestine. Barth, De glandularummesaraicaruminflammatione, Halle, 1820.


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twice that number, differences which depend only partially on the length of the intestinal canal. Those which correspond to the jejunum are more completely developed in every respect, than those which receive the lymphatics of the ileon. They are rarely less than two inches from the intestine. From this point to the base of the mesentery, they gradually enlarge and approach each other, so that sometimes many are blended in one mass, resembling what is seen in many mammalia, where they are termed the panceas aselli.

These are principally the glands which are swelled in scrofulous patients.

The mcsocolic glands are much smaller and fewer than the preceding. There are seldom more than thirty ; sometimes there are only twenty ; in some rare cases there are fifty. They are situated nearer the intestine than the mesenteric glands, and sometimes rest directly upon it. There are still more in the transverse mesocolon, at the lower part of the ascending colon and in the sigmoid portion of the descending colon, than in the other regions.

These glands are rarely swelled even when the preceding are so.

II. G ASTRO-EPIPLOIC GLANDS.

§ 1651. The gaslro-epiploic glands ( G. stomacho-epiploce) are situated along the large ( G . ventriculi inferiores) and the small (G. ventriculi superiores) curves of the stomach. They are small and few, and not more than four or five to each curve.

III. CELIAC GLANDS.

§ 1652. Under the term celiac glands we may include, as Bichat does, the hepatic , the pancreatic , and the splenic glands. They surround a greater or less portion of the trunk of the vena porta, the splenic vessels, and the trunk of the celiac and superior mesenteric arteries.

IV. LUMBAR GLANDS.

§ 1653. The lumbar glands ( G. lumbar ts) are generally very numerous and very large, and surround, forward and on the two sides, the abdominal aorta and the ascending vena-cava, and also the renal vessels. The anterior are larger than the lateral, which are placed on the sides of the bodies of the vertebrae, and before their transverse processes.

IV. LYMPHATIC GLANDS OF THE LOWER EXTREMITIES.

§ 1654. The lymphatic glands of the lower extremities may be divided into the crural and pelvic.


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1. CRURAL GLANDS.

§ 1655. Lymphatic glands are rarely found below the femoro-tibiai articulation. Cruikshank(l) and Hunter have never seen them. Sometimes, although very rarely, there exists on the anterior face of the leg, between the tibia and the fibula, a little below the middle of the limb(2) or higher, near the upper extremity of the interosseous membrane, a small gland, which we have once seen double ; this is called the anterior tibial gland (G. tibialis antica). The popliteal glands ( G. poplitece) are larger than the tibial, although they are very small. They are rarely more than three or four in number, and are situated deeply in the fat, and surround the popliteal vessels.

II. PELVIC GLANDS.

§ 1 656 . The pelvic glands ( G. pelvianæ ) are divided into the inguinal, the external iliac or hypogastric, and the sacral glands.

I. INGUINAL GLANDS.


§ 1657. The inguinal glands (G. inguinales ), are the largest in the body except the mesenteric. They are divided into superficial and deep.

The superficial vary in number from six to thirteen, and are situated directly under the skin, between it and the fascia-lata aponeurosis. They sometimes commence on the internal face of the middle of the thigh. The upper, which are constant, are always closer to each other than the lower ; they surround the upper part of the internal cutaneous vein of the thigh and extend to the symphysis pubis.

The deep are fewer in number, and vary from three to seven. They are placed below the crural aponeurosis, between the adductor, the sartorius, and the iliacus muscles, and surround the superficial crural arch.

The deep glands are not so constant as the superficial.

II. EXTERNAL ILIAC GLANDS.

§ 1658. The external iliac glands (G. iliacce. externat ) are six, eight, or ten in number, and extend along the external iliac vessels, from the crural arch to the beginning of the lumbar region, where they are continuous with the lumbar glands.

(1) Loc. cit., p. 117.

(2) Hewson, loc. cit., p. 27.

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III. HYPOGASTRIC GLANDS.

§ 1659. The hypogastric or internal iliac glands ( G . hypogastricœ, s. iliac ce internez ) also vary in number ; but generally they are more numerous than the external. These glands accompany the internal iliac vessels.

IV. SACRAL GLANDS.

§ 1660. The sacral glands (G. sacrales) are situated between the rectum and the sacrum. They are united laterally with the preceding and above with the mesocolic glands.

CHAPTER II.

LYMPHATIC VESSELS.

§ 1661, We may divide the lymphatic vessels of all parts of the body into superficial and deep. We shall describe them in the same order as we have the glands.


ARTICLE FIRST.

LYMPHATIC VESSELS UF THE HEAD AND THE NECK.

I. SUPERFICIAL LYMPHATIC VESSELS.

§ 1662. The superficial lymphatics of the head proceed under the skin. They are divided into those of the skull and those of the face.

The superficial lymphatics of the skull unite in from four to eight trunks, which form two fasciculi, an anterior and a posterior. The anterior descend along the temporal arteries, the posterior along the occipital artery. The first pass through some of the superficial zygomatic glands, the latter those which exist behind the ear. Both unite with the superficial lymphatics of the neck.

The superficial hjmphatics of the face are more numerous than those of the skull, because there is more of cellular tissue in the face. They descend along the vessels of the face, pass through, partly, the glands situated on the buccinator muscles, but principally and constantly across those which occupy the lower edge of the maxillary bone and the upper part of the neck.

In this place the superficial lymphatics of the skull and face anastomose frequently together, and with the deep lymphatic vessels of the head ; descend, in three or four trunks, some on the sides of the tra


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chea, others on the posterior part of the neck, along the internal and the external jugular veins, receive the lymphatic vessels of the thyroid gland and of the muscles of the neck, and pass over the inferior lateral glands.


II. DEEP LYMPHATIC VESSELS.

§ 1663. The deep lymphatic vessels of the head are also divided into those of the skull and those of the face.

The deep lymphatics of the sfcull have not been pursued with clearness and certainty into the substance of the brain, but only into its membranes. They are seen here and there, especially when serum is effused upon the surface of the brain, both in the outer face of this organ, in the pia-mater and the arachnoid membrane, and likewise in the dura-mater, where they follow the course of the bloodvessels. Their trunks descend from the skull, along the internal carotid and vertebral arteries and the internal jugular vein, and unite with the superficial lymphatics of the skull and head, some in the superior, others in the inferior cervical glands. (§ 1662)

The deep lymphatics of the face , arise from the muscles of this region, from the nasal fossæ, and from the buccal cavity, penetrate into the superior cervical glands and unite, both within these glands and after emerging from them, with those which arise from the trachea and pharynx.

§ 1664. The trunks of all the superficial and the deep lymphatics of the head and neck, pass through the inferior cervical glands which they unite, anastomose very frequently with each other and with some vessels which come from the upper extremities and horn the cavity of the thorax, which arrive at the lowest of these glands, and unite in one or several trunks which open into the upper part of the thorac.ic canal, either directly into the angle of union of the jugular and subclavian veins, or finally into one of these last two, and then into the internal jugular, more frequently than into the subclavian vein.


ARTICLE SECOND.

LYMPHATIC VESSELS OF THE UPPER EXTREMITIES.

§ 1665. We must consider, at the same time with the lymphatic vessels of the upper extremities, particularly the superficial, the superficial lymphatics of the dorsal face of the trunk, and of the middle part of its anterior face : for all these vessels terminate in the axillary glands. This arrangement is demonstrated not only by dissection, but by the swelling of the axillary glands, when the vessels remote from these regions have been irritated ; as when, for instance, a blister has been applied to the epigastric region.


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I. SUPERFICIAL LYMPHATIC VESSELS.

I. SUPERFICIAL LYMPHATIC VESSELS OF THE DORSAL FACE OF THE TRUNK.

§ 1666. The superficial lymphatic vessels of all the dorsal face of the trunk, from the neck to the lumbar region, terminate in the axillary glands.

The superior, which arise from the neck, descend on the trapezius muscle, pierce the deltoides, and in this place, before arriving at the axillary glands, receive those which arise from the skin of the shoulder.

The middle and the inferior proceed transversely upward on the trapezius muscle, pass through this muscle, arrive outward, between it and the teres major muscles, and terminate in the axillary glands.

II. SUPERFICIAL LYMPHATIC VESSELS OF THE LATERAL AND ANTERIOR

FACES OF THE CENTRAL REGION OF THE TRUNK.

§ 1667. These vessels arise from the chest, and from that portion of the abdomen above the umbilicus.

The lateral , which extend lower than the others, penetrate through the obliquas externus abdominis, and the serratus magnus muscles.

The anterior and superior, the highest of which arise from the lower part of the neck, proceed on the pectoralis major muscle, turn on the lower edge of this muscle, and go backward to the axillary glands.

Some of these vessels, the deepest, pass through the rectus abdominis muscle in some subjects, into the internal lymphatic vessels of the thorax. Others, which are situated above, proceed through the deep muscles of the parietes of the thorax, and anastomose with the intercostal lymphatics.

These lymphatic vessels frequently communicate with the inferior, which descend from the anterior face of the abdomen to the inguinal glands.

III. SUPERFICIAL LYMPHATIC VESSELS OF THE UPPER EXTREMITIES.

§ 1668. The superficial lymphatic vessels of the upper extremities, are distinguished into external and internal.

The external commence on the dorsal face of the fingers, proceed first on their sides, follow the course of the cutaneous vessels on the back of the hand, and ramify in this place and in the fore-arm, on the external and posterior faces of which they principally ascend, and where they are farther increased by the lymphatic vessels which arise from this region. They proceed gradually forward and inward, so that near the humero-cubital articulation, the } 7 are situated entirely on the inner face of the limb.


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The internal arise from the internal face of the hand, also proceed along the lateral faces of the fingers, attended by the palmar vessels, anastomose in this place with the dorsal lymphatic vessels, and unite in the hollow of the hand hr three or four trunks, two of which are formed by the lymphatic vessels of the thumb and little finger, and a third and sometimes a fourth is formed by those of the other three fingers. They then ascend on the inner face of the fore-arm, and there receive several of the lymphatic vessels from the integuments of this region. All, or at least most of them, pass through the glands of the elbow, and unite at this point and higher with the external. The largest trunks which result from this union, and which are the fewest, ascend along the inner face of the arm, and following the course of the large blood-vessels, terminate principally in the axillary glands.

Some of them, but very few, attend the cephalic vein between the deltoides and pectoralis major muscles, and go to the inferior cervical glands.

II. DEEP LYMPHATIC VESSELS OF THE UPPER EXTREMITIES.

§ 1669. The deep lymphatics of the upper extremities accompany the deep vessels so exactly, that it is useless to describe them, and they may be known well enough by the terms radial, ulnar , and interosseous ( vasa l. radialia , ulnaria et interossea ). They proceed principally on the inside of the hand, the fore-arm, and the arm, frequently anastomose with the superficial, and receive at the upper part of the arm the small trunks which come from the pectoral muscles.

These deep lymphatic vessels partly penetrate into the glands which are rarely formed in the fore-arm, and all terminate in those of the axilla.

III. TERMINATION OF THE LYMPHATICS OF THE UPPER EXTREMITIES

AND TRUNK.

§ 1670. The lymphatic vessels hitherto described, and which pass through the axillary glands, unite in larger trunks within these glands and in the spaces between them, and are finally reduced to four or five in number, which surround the subclavian artery. They unite anew into two or three large trunks, in the place where this artery comes to the upper part of the chest ; these ascend behind the subclavius muscle, above the subclavian vein, and open directly into it, either alone or united with the deep lymphatics of the trunk, the head, and even also those of the left side, with those of the lower extremity.


390


DESCRIPTIVE ANATOMV.


ARTICLE THIRD.

DEEP LYMPHATIC VESSELS OF THE THORAX.

§ 1671. It is most convenient to describe the lymphatic vessels of the abdomen separately from those of the chest, and to place the history of the former after that of the lymphatic vessels of the lower extremities.

We distinguish the deep lymphatics of the chest into those of the parietes and those of the organs it contains.

I. LYMPHATICS OF THE PARIETES OF THE THORAX.

§ 1672. The deep lymphatics of the parietes of the thorax are divided into lateral, posterior , and anterior.

I. LATERAL AND POSTERIOR LYMPHATIC VESSELS.

§ 1673. The lateral and posterior lymphatics ( Vasa l. intercostalia poslericra ) arise from all the muscles which surround the chest and contribute to form its parietes, also from the pleura, and reunite with the posterior intercostal trunks, which proceed along the intercostal vessels. They also receive on the side of the vertebral column the lymphatic vessels which come from the muscles of the back and from the vertebral canal, pass through the lateral glands of the vertebral column, frequently anastomose and communicate, particularly the upper, with the glands of the lung, principally follow a more or less descending direction, and gradually terminate in the thoracic canal.


II. ANTERIOR LYMPHATIC VESSELS.

§ 1674. 'The anterior lymphatics of the parietes of the thorax, or the internal mammary lymphatic vessels ( Vasa l. thoracica profunda aniica, s. mammaria interna), arise by their deepest branches from the upper and anterior part of the abdominal muscles and the diaphragm, penetrate into the chest, below the xiphoid cartilage, proceed on both sides of the sternum and along its posterior face, pass through the glands in this place, and receive, on each side, the anterior intercostal lymphatic vessels ( Vasa l. intercostalia antica).

Those of the left side rarely reunite in two trunks, usually in one, which ascends obliquely before the left subclavian vein, passes through the inferior cervical glands, afterward descends on leaving this point, and opens into the thoracic canal, more rarely into the venous system.

Those of the right side commonly empty into the right subclavian and internal jugular veins ; but they also sometimes unite previously with the lymphatics of the head and of the upper extremities.


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II. LYMPHATIC vessels of the thoracic viscera.

§ 1675. The lymphatic vessels of the thoracic viscera are divided into those of the lungs, the pericardium, the thymus gland, and the heart.

I. LYMPHATIC VESSELS OF THE LUNGS.

§ 1676. The superficial lymphatic vessels of the lungs arise on the surface of this organ from the pulmonary portion of the pleura, and form, on the lungs, a very complex network, with irregular meshes, which corresponds to the lobes of the viscus. Some of the trunks formed penetrate within the fissures of the lobes, and within the glands at the base of these spaces ; others proceed along the internal face of the lungs and empty into the bronchial glands.

The deep lymphatics of the lung arise from the substance of the viscus, anastomose very frequently with the superficial, proceed along the ramifications of the trachea and the pulmonary vessels, also enter into the bronchial glands, anastomose with the superficial vessels within them, and then proceed along the air-passages.

After leaving the bifurcation of the trachea, the lymphatic vessels which come from the bronchial glands, soon unite in three or four trunks, of which only one exists on the right and the others belong to the left side.

Both pass through some inconstant glands situated before and on the sides of the trachea, go behind the internal jugular vein on their side, and empty immediately, or in connection with the lymphatic vessels of the neck and upper extremities, into this or into the subclavian vein.

The pulmonary lymphatic vessels receive, on the trachea, those of the pericardium and of the thymus gland, which ascend into the anterior mediastinum after passing through some glands placed before the aorta and the vena-cava.

II. LYMPHATIC VESSELS OF THE HEART.

§ 1677. The lymphatic vessels of the heart principally accompany the large vessels of this organ, leave the pericardium and ascend on the aorta and the pulmonary artery, pass through the glands on the former of these two vessels, and unite, on one side, with the lymphatic vessels of the lung, the thymus gland, and the pericardium, and on the other, usually empty, by several small trunks, either into the thoracic canal or directly into the left jugular and left subclavian veins.


392


DESCRIPTIVE ANATOMY.


ARTICLE FOURTH.

LYMPHATICS OF THE LOWER EXTREMITIES, AND SUPERFICIAL

LYMPHATICS OF THE LOWER PORTION OF THE TRUNK AND

OF THE EXTERNAL GENITAL ORGANS.

§ 1678. The most proper mode of describing the lymphatic vessels of the lower extremities is to pursue the order adopted for the upper extremities and for the superficial vessels of the neck and back, and connect their description with that of the superficial lymphatics of the lower portion of the trunk and of the external genital organs.

I. LYMPHATIC VESSELS OF THE LOWER PORTION OF THE TRUNK.

§ 1679. The superficial lymphatic vessels of the lower portion of the trunk arise from the skin and the cellular substance of that portion of the abdomen below the umbilicus, the lumbar region, the haunches, and the perineum frequently anastomose with each other or with the superficial vessels of the lower extremities, communicate also, at least the former, with the superficial lymphatics of the upper part of the trunk, and empty into the inguinal glands.

II. SUPERIOR LYMPHATIC VESSELS OF THE EXTERNAL GENITAL ORGANS.

§ 1680. The superficial lymphatic vessels of the external genital organs arise in the male from the scrotum and penis, in the female from the labia pudenda and clitoris. Those of the penis and clitoris proceed, in two or three trunks, along the sides and back of these parts. They anastomose frequently with the superficial lymphatics of the thigh, and empty into the inguinal glands.

III. LYMPHATIC VESSELS OF THE LOWER EXTREMITIES.


I. SUPERFICIAL LYMPHATIC VESSELS;

§ 1681. The superficial lymphatic vessels of the lower extremities are situated between the fascia-lata and the skin, and are divided into anterior , which correspond to those of the anterior face of the fore-arm, and posterior , which are repetitions of those in the hollow of the hand and of the inner side of the fore-arm. The anterior arise from the back and sides of the toes, and from the back of the foot, ascend on the anterior and lateral faces of the leg, are finally placed on the inside of this limb, and then ascend along the internal face of the thigh.


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The posterior come from the sole of the foot, ascend along the posterior face of the leg, and anastomose frequently -with the anterior.

The largest and fewest trunks which are formed by the union of both, ascend along the internal and anterior part of the thigh, and empty at the summit into the superficial inguinal glands.

The superficial lymphatic vessels of the thigh, proceed principally along its internal and its anterior face. Even those which arise from its posterior face take the same direction. They anastomose with those of the leg, and go to the inguinal glands.

II. DEEP LYMPHATIC VESSELS.

§ 1682. The deep lymphatics of the lower extremities, are fewer than the preceding, and also differ in their situation, being placed below the aponeurosis.

They form four fasciculi, each of which unites in one or two small trunks, which proceed along the three arteries of the thigh and the external saphena vein. They arise from the same parts as those to which these arteries proceed, and from whence this vein arises, and all unite an the ham, in the popliteal glands.

The anterior tibial lymphatic vessels sometimes pass through the anterior tibial glands (§ 1655), which are not constant.

From three to six trunks come from the popliteal glands which are united by these vessels : these trunks ascend along the superficial popliteal and crural vessels which they surround, and receive principally the deep crural lymphatic vessels, which accompany the deep blood-vessels of the thigh.

These deep crural lymphatic vessels, which anastomose frequently with the superficial, enter, some into the deep, others into the superficial inguinal glands. Some pass before these glands, to the inferior iliac glands.

§ 1683. The superior deep lymphatic vessels which arise from the adductor and extensor muscles, and those which rotate the thigh outward, and also from those of the perineum, accompany the obturator, ischiatic, and gluteal vessels, and terminate in the hypogastric and sacral glands.


ARTICLE FIFTH.

ABDOMINAL LYMPHATIC VESSELS.

§ 1684. The abdominal lymphatic vessels divide like the thoracic, into those of the abdominal parietes, and those of the organs contained, in the cavity of the abdomen.


VOL II.


50


394


DESCRIPTIVE ANATOMY.


I. OF THE LYMPHATIC VESSELS OF THE ABDOMINAL PARIETES.

§ 1685. The lymphatic vessels of the abdominal parietes, are divided into the anterior , the lateral , the posterior, and the inferior.

The anterior arise from the skin, from the aponeurosis of the abdominal muscles and from the rectus muscle which they perforate, accompany the epigastric artery, and terminate in the external iliac glands.

The lateral come from the integuments, and from the lateral parts of the abdominal muscles, perforate the broad muscles in this region, proceed along the crest of the ilium, and arrive at the external iliac glands.

The posterior have their origin in the skin of the lumbar region, the quadratus lumborum muscle, the posterior part of the abdominal muscles, and the spinal canal, go inward with the lumbar arteries which they accompany, extend to the vertebral column, penetrate into its lateral glands, and anastomose frequently with those of the side opposite, on the anterior face of the vertebral column, thus giving rise to the lumbar plexus.

The inferior are distinguished into lateral and posterior. The lateral arise from the iliac bones, from the iliacus muscle, and from the levator ani muscle. They pass below the psoas magnus muscle, and go to the external and the internal iliac glands.

The posterior arise from the pyramidalis muscle, from the sciatic plexus, from the sacrum, and from the cavity of this bone. They terminate in the lumbar and the internal iliac glands.

All these lymphatics anastomose either at their origins, or within the glands which they enter.

II. LYMPHATIC VESSELS OF THE ABDOMINAL VISCERA.

§ 1686. The lymphatic vessels of the abdominal viscera, are distinguished into the deep lymphatic vessels of ihe genital and urinary organs, and into those of the digestive apparatus.

X. DEEP LYMPHATIC VESSELS OF THE GENITAL AND URINARY ORGANS.

§1687. The superficial lymphatic vessels of the genital organs, have already been described.

Among the deep, those of the penis and clitoris enter the pelvis along the deep blood vessels of those parts, go to the internal pelvic glands, and anastomose with the inferior lymphatic vessels of the parietes of the abdomen.

The lymphatics of the testicle, which are very numerous and proportionally very large, form two layers, of which the external arises from the tunica vaginalis, and the deep or internal from the substance of the gland. They unite in from eight to twelve trunks, ascend along


ADENOL0GY.


395


the spermatic cord to the inguinal ring, and go to the lumbar glands, following the course of the spermatic artery.

The lymphatics of the prostate gland and vesiculæ séminales, anastomose with those of the bladder.

The lymphatics of the vagina and lower part of the uterus, penetrate into the internal pelvic glands ; a part of those of the lower part of the vagina accompany the round ligament of the uterus, pass through the inguinal ring, and anastomose with those of the uterus. Those of the upper part of this latter organ which unite with those of the ovary, follow the course of the spermatic vessels, and terminate in the lumbar glands, like the corresponding vessels in the male.

§ 1688. Among the lymphatic vessels of the urinary passages, those of the bladder go to the internal pelvic glands.

Those of the ureters enter the external pelvic and lumbar glands, and anastomose with those of the bladder and kidneys.

Those of the kidneys arise from the outside and inside of these organs. The former, or the superficial , unite with the second or the deep , either directly or after forming several small trunks. The first is true of the internal, and the second of those which arise from the rest of the surface of the kidneys.

The trunks formed by the union of the deep lymphatic vessels, leave the renal fissure, accompany the renal vessels, anastomose frequently with those of the genital organs and of the capsulæ renales, and empty into the lumbar glands. Several of them open into the thoracic canal.

Those of the renal capsules unite, some with those of the kidneys, others with those of the liver, the spleen, and the intestinal canal.

IX. LYMPHATIC VESSELS OP THE DIGESTIVE ORGANS.

§ 1689. The lymphatic vessels of the digestive organs are divided into those of the intestinal canal, those of the stomach and the omenta, the liver, the spleen, and of the pancreas. They are also called the lacteal or chylifierous vessels , on account of the fluid they cany at the time of digestion. If however, we except at most the final branches, we ought not to distinguish between the lymphatic vessels which take up the chyle from the intestinal cavity and those which receive the lymph in the substance of the organ, since both fluids follow precisely the same direction.

I. LYMPHATIC VESSELS OP THE INTESTINAL CANAL.

§ 1690. The lymphatic vessels of the intestinal canal ( V. 1. intestinalia ), like the glands, are much more numerous in the small than in the large intestine : there are more also in the duodenum and the jejunum than in the ileon. They may be distinguished into superficial and deep.


396


DESCRIPTIVE ANATOMY.


The superficial arise from the peritoneum, between this membrane and the muscular tunic, and from the latter. They proceed along the intestine, and frequently anastomose together above and below.

The deep arise from the vascular and villous tunic, principally receive the radicles which absorb the chyle, follow a transverse direction, surround the intestinal canal like rings, and anastomose with the superficial, both on the intestine and between the folds of the mesentery. All unite in small trunks, which, two, three, or four in number, proceed between the folds of the mesentery, follow the course of the intestinal vessels, pass through the series of the mesenteric glands, gradually enlarge as they proceed, but become fewer in the same proportion, and anastomose near the pancreas with the lymphatic vessels of this organ, the spleen, and the liver, and concur with the latter to form one of the great roots of the thoracic canal . The lymphatic vessels of the descending colon however do not unite to produce the small trunks. They empty very low into the lumbar and sacral glands.


II. LYMPHATIC VESSELS OF THE STOMACH AND OF THE OMENTA.

§ 1691. The lymphatic vessels of the stomach and of the omenta, or the gaslro-epiploic ( Vasa l. gaslro-epiploica), also form a superficial and a deep layer. We may divide them, in respect to their course, into three fasciculi, which follow the course of the principal blood-vessels of the stomach.

Those of the left side, which arise from the base of the stomach, accompany the short vessels and go to the left, where they anastomose with those of the spleen.

The middle superior arise from the upper part of the rest of the surface of the stomach, go upward and to the left, pass through the glands of the small curvature of the stomach, and reunite at the left orifice of this viscus. Thence they go to the right, pass through the other glands, and anastomose under the liver with the inferior lymphatic vessels of this gland.

The middle inferior, which come from the rest of the surface of the stomach and from the large epiploon, proceed, in company with the blood vessels, along the large curvature of the stomach, pass through the glands in this place, go towards the right side, partially reunite with the middle superior, and go downward behind the pancreas to unite around the cceliac and superior mesenteric arteries, with the intestinal lymphatic vessels, with which they form one of the principal roots of the thoracic canal.

III. LYMPHATIC VESSELS OF THE SPLEEN AND THE PANCREAS.

§ 1692. Among the lymphatic vessels of the spleen and pancreas (F. /. splenico-pancrcatica), the superficial vessels of the spleen arise from its peritoneal coat, and the deep vessels from its substance. Tha


ADENOLOGY.


397


former are reflected around the edge of the spleen, and all, after reuniting in its fissure, leave this cavity, go to the right, accompany the splenic vessels, and anastomose there with the other lymphatics of the digestive organs.

Those of the pancreas soon join those of the spleen and the middle inferior lymphatics of the stomach.

IV. LYMPHATIC VESSELS OF THE LIVER.

§ 1693. The lymphatic vessels of the liver (V. I. hepatica ){\ ) are extremely numerous, and seem to differ from most of the others by the fewness and smallness of their valves. In fact we can generally succeed in injecting them from the trunks, and when injected their course is much more uniform than the others. They may be distinguished into superficial and deep.

a. Superficial lymphatic vessels.

§ 1694. The superficial lymphatic vessels of the liver (2) may in turn be divided into those of the upper and those of the lower face.

1. Lymphatic vessels of the upper face of the liver.

§ 1695. The superficial lymphatic vessels of the upper face of the liver form several fasciculi, which vary in number from four to ten.

Those of the middle fasciculus, which is the largest, arise from the middle region of the right lobe, partly also from the left lobe. They reunite in six or eight trunks, which enter into the suspensory ligament of the liver, and pass into the chest, between the diaphragm and the xyphoid cartilage of the sternum. There they reunite with the lymphatic vessels of the upper face of the diaphragm, form oné or two trunks, enter into the mediastinum, through which they pass from below upward, receiving several lymphatics from the pericardium, the thymus gland, and from the anterior wall of the thorax, and usually open into the left thoracic canal, just before it terminates. They frequently also empty partially or wholly into that of the right side. Sometimes several trunks of this fasciculus do not unite with the rest, but go to the left, pass into the coronary ligament of the liver, between the diaphragm and the left lobe, join the other fasciculi of the hepatic lymphatic vessels, and empty into the lower part of the thoracic canal, within the abdominal cavity or in the chest.

The second fasciculus arises from most of the surface of the right lobe, sometimes in a greater and sometimes a less extent. The trunks reach the right ligament of the liver, pass through the diaphragm in

(1) Schmiedel, De habitu naturuli venarum hjmpha.tica.rum in hepate , Erlangern

(2) Werner and Feller, De vasis hepatis superjicialibus, p. 34-44. — hoc. cit ., tables ii. iii. iv.


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DESCRIPTIVE ANATOMY.


this place, proceed from below upward, and from behind forward on the convex face of this muscle, along its costal edge, and empty into the trunks of the first fasciculus. Others, which are smaller, go backward, and open into the lower part of the thoracic canal, anastomosing with the inferior diaphragmatic lymphatics.

The third fasciculus arises from most of the surface of the left lobe. Its trunks go to the left triangular ligament of the liver, separate in this place, unite with the upper lymphatic vessels of the stomach, and open into the lower part of the thoracic canal, which is still within the abdominal cavity.

2. Lymphatic vessels of the lower face of the liver.

§ 1696. The superficial lymphatic vessels of the lower face of the liver generally form fewer fasciculi than those of the upper face. Those too on the right side generally unite with those on the left. All anastomose with the superficial and the deep lymphatic vessels of the upper face, and give origin to small trunks. The latter approximate each other near the vena portæ, descend along the course of the hepatic bloodvessels, and reunite with those of the intestinal canal.

Other superficial lymphatic vessels of the liver enter into the substance of this gland but do not reunite to those described, and empty into the deep lymphatic vessels.

b. Deep lymphatic vessels.

§ 1697. The deep lymphatic vessels of the liver are much more numerous than the superficial, and accompany the hepatic blood-vessels and the biliary canals, emerge with the latter through the fissure of the vena portæ, and unite in the small epiploon, with the superior lymphatics of the stomach, emptying into the glands of this part, and reunite with the superficial lymphatics of the lower face of the liver, the lower lymphatic vessels of the stomach, those of the spleen and pancreas, descend along the hepatic vessels, anastomose at the base of the mesentery with the intestinal lymphatics, and form, in connection with them, one of the principal roots of the thoracic canal, the middle.


ARTICLE SIXTH.

OF THE THORACIC CANAL. (1)

§ 1698. All the lymphatic vessels open into the venous system of the body in two different places, at the union of the right and left inter (1) J. A. Leitersperger, Prœs. Salzmann, Encheiresis nova, qua ductus thoracicus una cum rcceptacula chyli in quovis subjecto humano demonstrari potest, Strasburg, 1711. — J, S. Henninger, De mesenterio, Strasburg, 1714. — C. P. Wium, De viis aTi

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liai jugular and subclavian veins. Most ol them empty into the left side ; this is the case with the lymphatic vessels of the left portions of the head and neck, those of the left upper extremity, the superficial vessels of the left portion of the trunk, all the deep lymphatic vessels of the chest, except those which arise from the right lung, those from the right portion of the heart and of the thyroid gland, generally also those of the right portion of the diaphragm, and of the right portion of the anterior wall of the chest, finally with those of the lower extremity and of the abdomen, except some which arise from the right half of the upper face of the liver.

On the contrary, the lymphatic vessels of the right portion of the head and neck, those of the right upper extremity, those of the right portion of the diaphragm, partially or wholly, and those of the right portion of the liver, go to the right side.

Those of the lower extremities, the intestinal canal, the stomach, and the spleen, most of those of the liver and the intercostal lymphatic vessels, do not empty directly into the venous system ; but they always open(l) one after another, into the left thoracic canal ( ductus thoracicus sinister), which is formed by their union. Those of the other organs, on the contrary, which we have described, do not empty except into the upper part of this canal, and in part also open directly into the internal jugular and subclavian veins.

I. LEFT THORACIC CANAL.

§ 1699. The lacteal vessels and the lymphatic vessels of the lower extremities, unite towards the first or the second lumbar vertebra, some mentorum et chyli., Copenhagen, 1717. — A. F. Walther, Obs. de ductu hepatico bipartite, vena bronchiali pinistra et inferiore, arteria hepalica, superioris mesaraicce sobole, Leipsic, 1731. — J. C. Bohl, De via lactea, Konigsburg, 1741. — C. M. Bussmann, Prces. Haller, De ductu thoracico, Gottingen 1741. — F. J. Narcissus, De generations et receptaculis chyli, Leyden, 1742. — C. H. Velse, De mutuo intestinorum ingressu et aliis machines humanæ extraordinariis, Leyden, 1742. — A. Portal, Sur la struct, du canal thoracique et sur celle du reservoir du chyle ; in the Mem. de Paris, 1770, p. 393402. — Sabatier, Remarques sur le canal thoracique de l'homme ; in the Mem. de Paris, 1780, p. 693.

(1) Lippi, demonstrator at the hospital, Santa-Maria-Nuova at Florence, seeking some unknown channel by which nature conducted the white fluids into the sanguineous system, without carrying them by a long rout to the thoracic canal, has found a large lymphatic trunk, which emptied into the ascending vena cava, at about the third lumbar vertebra, after passing from above downward, between the trunks of this vein, into which it opened in a direction opposite to that of the course of the blood. The orifice had a kind of valve. Some days after, the same anatomist remarked four distinct trunks which opened, one into the primitive iliac vein, and others into the vena cava. Having injected an inflamed liver, he saw some lymphatics of its triangular ligament, entering into the ramifications of the vena portæ. As he first injected the right side, Lippi undertook to do the same on the left. Having pushed the mercury into the external iliac lymphatics, whence this metal arrived at those situated behind the vertebral column, in the lumbar region, he saw several lymphatics on the left side, entering into the vena cava, some passing above, others below the aorta he also saw some emptying into the splenic and mesenteric veins : Lippi believed that he could distinguish the lacteals which open into the thoracic canal, from those of the external face of the peritoneum, which empty in great part into the veins with those which arise from the lower extremity. F. T.


40ö


DESCRIPTIVE ANATOMY.


times also between the second and the third, or even upon the twelfth dorsal vertebra, between the internal pillars of the diaphragm, and not below, to form the left or the proper thoracic canal. The chyliferous vessels frequently do not form a trunk, but open into this canal very near each other, and nine or ten in number. Most generally, however, the thoracic canal is formed by three trunks, a right, a central, and a left trunk. The first arises by the union of the lacteal vessels ; the other two are formed by the lymphatic vessels of the lower extremities. The right and the central are situated on the right side, and the left on the left side of the aorta. The first two unite before the third joins them. The latter sometimes unites to the principal trunk only by small branches.

§ 1700. The ancient anatomists admitted at the union of these vessels, and consequently at the commencement of the thoracic canal, a dilatation called the reservoir or cistern of Pecquet ( receptaculun , s. cy sterna chyli). This dilatation, however, is often very much contracted, and its apparent existence depends on the manner in which the lacteal vessels arrive at the thoracic canal. In fact they turn upon it, are enveloped by a common cellular sheath, and united by cellular tissue : when this sheath and this tissue are raised, the pretended reservoir almost always disappears.

In some subjects, however, the thoracic canal presents in this place a considerable dilatation, a kind of reservoir.

§ 1701. The thoracic canal passes into the chest behind the aorta, and on the right of it, between the internal pillars of the diaphragm. It is at first placed in the centre of the dorsal vertebrae, rather more to the right than to the left, between the aorta and the azygos vein, a little however before the latter, and directly behind the right layer of the posterior mediastinum. In ascending it goes to the left, but does not always preserve the same situation, although it is placed from the third to the sixth dorsal vertebra behind the esophagus, and is covered by this canal in a greater or less extent. After leaving the third dorsal vertebra, it ascends at the side of the esophagus, and passing behind the arch of the aorta, leaves the chest to extend to the upper edge of the last cervical vertebra. Thence it goes downward and forward, which much favors the progress of the chyle, and in most subjects, it empties itself at the angle of union of the left subclavian and internal jugular vein, usually by one trunk, rarely by several. It rarely opens into one of these two veins.

§ 1702. It is always a little narrower at the middle dorsal vertebra, but below this point again dilates more or less, as it receives the superior and pulmonary intercostal lymphatic vessels. It presents in its course no projections, but describes greater or less curves, and it does not receive many lymphatic vessels, except towards its upper extremity, where the trunks of the left half of the head and of the left upper extremity, open into it directly before it joins the venous system.

It is rarely or never perfectly single ; being always attended with a


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greater or less number of accessory branches, which open with it, and immediately arise again from its parietes.

It very frequently divides, especially a little above the centre of the chest, into two, and sometimes into three branches, which almost always reunite after proceeding a greater or less distance. Sometimes it divides in this manner in more than one place ; the accessory vessels enlarge more or less, and assume the characters of real trunks. When this reticulated structure exists in the greatest degree, the whole of the thoracic canal is divided into two halves.(l)

§ 1703. The valves in this canal are not numerous, either near its origin, or near its termination. One pair exists above and opposite the upper dorsal vertebra. Higher up they are double or triple. The convex edge of these valves is turned downward, and their loose or concave edge upward. They are generally arranged in pairs, and rarely three and three, or singly.

We almost always observe, where the thoracic canal opens into the venous system, before its mouth, two very perfect valves, the loose edges of which are turned toward the cavity of the vein, and prevent the reflux of the blood into the canal. They are sometimes concealed by the valves of the internal jugular vein, so that some have pretended, but very unfortunately, that they were unconnected with the thoracic canal, because that they are farther from the heart than the orifice of the canal.(2)


II. RIGHT THORACIC CANAL.

§ 1704. The right thoracic canal, the formation of which we have already mentioned, is much smaller than the preceding (§ 1698), and is usually only an inch long. It descends to empty into the angle of union of the right internal jugular and subclavian veins, rarely into one of these two vessels. Sometimes it does not exist ; this occurs when the vessels which give origin to it open separately into the venous system.

§ 1705. There are always considerable anastomoses, not only between the vessels which unite to form the two common trunks, but also between these trunks.

The insertion of the large thoracic canal in the right half of the venous system(3) is undoubtedly only a greater development of these anastomoses, in accordance with the same law by which analogous phenomena are seen also in other parts of the vascular system ; for instance, the origin of the arteries of the fore-arm above the usual point, and that of the obturator artery by a trunk in common with the epigastric artery. This anomaly is indicated also by the division of the thoracic canal into two halves, which we have already mentioned

(1) Sœmmerring 1 , loc. cit. p. 487.

(2) Portal, loc. cit., p. 393.

(3) Meckel, Ep. ad Hallerum, p. 30. — Cruikshank, in Ludwig, p. 152.



(§ l 701 )- ,

When the great thoracic canal empties into the right side of the venous system, the lymphatics of the left half of the head, the neck, the arm, the lung, the heart, &c., do not join, but are arranged like the corresponding lymphatic vessels of the right side in the normal state.

Thus when we consider the gradual development of this anomaly, we see in it the first degree of lateral inversion.(l)

The insertion of the large thoracic canal, which takes place on the left side in the normal state, seems to depend on an effort to re-establish the symmetry which is deranged by the distribution of the venous trunks on the right side.



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