Part 69

Two =anterior tibial veins= (Vv. tibiales anteriores) usually accompany the artery of like name; the outer vein is much the larger. In other cases there is a single large vein in the proximal part of the leg, two lower down. They arise from a number of anastomosing radicles on the front of the capsule of the hock joint, chiefly as the continuation of the perforating tarsal vein. The origin of the chief vein is connected with the saphenous by a large anastomotic branch.

The =posterior tibial vein= (V. tibialis posterior) is commonly double (Fig. 458). It arises at the level of the tuber calcis, where it has a communication with the recurrent tibial vein. It is a satellite of the artery.

The =internal= or =great metatarsal vein= (V. metatarsea dorsalis medialis) (Figs. 458, 460) arises from the venous arch above the sesamoids at the fetlock, but is practically the upward continuation of the internal digital vein. It ascends along the inner border of the deep flexor tendon, then in the groove on the inner aspect of the proximal part of the large metatarsal bone to the capsule of the hock joint, and is continued by the saphenous vein.

The =external metatarsal vein= (V. metatarsea plantaris lateralis) arises from the venous arch above the fetlock, but appears to be the upward continuation of the external digital vein. It ascends along the outer border of the deep flexor tendon in front of the plantar nerve, and is connected with the deep metatarsal vein at the proximal part of the metatarsus by a transverse branch. It then passes upward along the deep flexor tendon in relation to the plantar nerves and the inner tarsal artery and is continued by the recurrent tibial vein.

The =deep metatarsal vein= (V. metatarsea plantaris medialis) arises from the plantar venous arch, passes forward between the branches of the suspensory ligament, and ascends on the posterior face of the large metatarsal bone. At the proximal end of the metatarsus it is connected with the external metatarsal vein by a transverse branch. It then passes (as the perforating tarsal vein) through the vascular canal of the tarsus and forms the chief radicle of the anterior tibial vein.

The =plantar venous arch= (Arcus venosus plantaris) and the digital veins are arranged like those of the thoracic limb.

The Lymphatic System

The =lymphatic system= (Systema lymphaticum) is subsidiary to the venous part of the circulatory system, from which it arises in the embryo. It consists of the lymph vessels and glands.

The =lymph vessels= (Vasa lymphatica) contain a colorless fluid, the lymph, which contains numerous lymphocytes.[175] They resemble the veins in structure but have thinner walls and are provided with more numerous valves. The vessels are sacculated opposite the segments of the valves and have a characteristic beaded appearance when distended. The collecting lymph vessels do not usually form rich plexuses, as veins often do, their branching is more limited and less tree-like than that of the blood-vessels, and their caliber therefore increases less from the periphery toward their termination. All of the lymph is ultimately carried into the venous system by two trunks, the =thoracic duct= and the =right lymphatic duct=. Almost all of the lymph passes through at least one group of lymph glands before entering the blood-vascular system.

The =lymph glands= or =nodes= (Lymphoglandulæ) are intercalated in the course of the lymph vessels. They vary widely in size, some being microscopic, others several inches in length. In form they may be globular, ovoid and flattened, elongated, or irregular. In certain situations they are aggregated into groups, and a knowledge of the position of these and the territory drained into them is important. It is convenient, when possible, to indicate their position with regard to arteries on the course of which they are placed. In color they are usually gray or yellowish-brown in the dead subject, pink or reddish-brown during life, but this varies according to their position and functional state. The bronchial glands are often blackened by infiltration with carbon. The mesenteric glands are creamy or white while the chyle is passing through, but pink at other times. Vessels which carry lymph to a gland are called =afferent=; the =efferent= vessels which convey it away are larger and fewer. Each gland has a depression, the =hilus=, at which the blood-vessels enter and the efferent lymph vessels emerge.

=Lymph nodules= or =follicles= (Noduli lymphatici) are minute masses of lymphoid tissue which occur in certain mucous membranes. They may be solitary, as in the solitary glands of the intestine, or aggregated into masses or patches, as in the tonsils and the so-called Peyer’s patches.

The =lymph nodule= or =follicle= is the unit of structure of the lymph gland. It consists essentially of an artery surrounded by a =reticulum= of connective tissue, the meshes of which contain numerous =lymphocytes=. Surrounding this is a rich plexus of lymph vessels, forming the so-called =sinus=, inclosed in some cases by a fibrous capsule. The gland consists of a mass of follicles, inclosed in a fibrous =capsule=, from which =trabeculæ= pass in and unite the follicles. Beneath the capsule is the =peripheral sinus=, which consists of a very rich plexus of lymph vessels; to this the afferent vessels pass at various points of the surface. In the =cortical substance= the cells are in rounded masses, the cortical nodules, while in the =medullary substance= they lie around the arteries, forming the so-called medullary cords. The =medulla= is redder than the cortex, since it is more vascular; it contains the =central lymph sinuses=, which have a similar structure to the peripheral sinus.

The =hæmolymph glands= differ from the lymph glands in color and structure. They are of a deep red color, which is due to the high vascularity of the cortical substance. The peripheral sinuses especially are greatly developed and contain numerous red blood-cells. There is no clear division into cortical and medullary substance, and the trabeculæ contain smooth muscle-cells. Some have afferent and efferent lymph vessels and others do not. They resemble the spleen in some respects, but their significance is not yet clear. They are numerous in the ox and sheep, much fewer in the dog, and apparently are absent in the horse. They occur along the course of the aorta, in the perineal fat, at the portal fissure, and with the gastric and mesenteric lymph glands. In the ox they are also found under the trapezius muscle, under the skin of the upper part of the flank, and in other places less constantly.

The =tissue= or =lymph-spaces= are interstices of varying size between cells or in the meshes of connective tissue. They contain a fluid derived from the blood-plasma, which is usually called =lymph=. They are drained by the veins and lymph vessels. The large serous sacs are often included in this category.

The exact relationship between the lymphatic capillaries and the tissue spaces is still a matter of controversy. It is held by some that the lymph vessels are in direct communication with the tissue spaces, while others maintain that the lymphatics are complete closed tubes. Communication between the spaces and vessels is in general very free. Mall has shown that granules injected into the hepatic artery are returned by the lymphatics as well as by the veins, and intramuscular injections will enter the lymph vessels of the tendon in spite of the absence of lymphatics in muscle.

LYMPHATIC SYSTEM OF THE HORSE

THE THORACIC DUCT (Figs. 428, 429)

The =thoracic duct= (Ductus thoracicus) is the chief collecting trunk of the lymphatic system. It begins as an elongated irregular dilatation, the =cisterna= or =receptaculum chyli=, which is situated between the right side of the aorta and the right crus of the diaphragm at the first and second lumbar vertebræ. The duct enters the thorax through the hiatus aorticus and runs forward on the right of the median plane between the vena azygos and the aorta, covered by the pleura. At the sixth or seventh thoracic vertebra it inclines somewhat ventrally, crosses obliquely over the left face of the œsophagus, and passes forward on the left side of the trachea to the inlet of the thorax. The extrathoracic terminal part passes downward and forward a variable distance (3 to 4 cm.) on the deep face of the left scalenus muscle, bends inward and backward under the bicarotid trunk, and opens into the upper part of the origin of the anterior vena cava just behind the angle of junction of the jugular veins. The terminal bend is ampullate and sometimes divides into two very short branches which open close together.

Since the duct develops from a plexus of ducts in the embryo, considerable variation from the more usual course occurs. There is often a left duct which arises at the cisterna or at a variable point from the right duct, runs across the left intercostal arteries parallel to the latter, and unites with it over the base of the heart or further forward. The two are connected by cross-branches. In some cases the left duct is the larger, and there may indeed be none on the right side. Other variations are common.

The chief tributaries of the thoracic duct are as follows:

1. The two =lumbar trunks= (Trunci lumbales) are formed by the confluence of the efferent ducts of the lumbar glands, and commonly unite with each other and with the posterior intestinal trunk before opening into the cistern.

2. The =intestinal trunks= (Trunci intestinales), two or three in number, receive the efferents of the lymph glands of the intestine, stomach, liver, and spleen.[176]

In its course through the thorax the thoracic duct receives efferents from the intercostal, mediastinal, and bronchial glands. At the thoracic inlet it is joined by ducts from the prepectoral and right axillary glands, and by the left tracheal duct. The duct is provided with several pairs of valves; the best developed are at its termination.

THE RIGHT LYMPHATIC DUCT

This vessel (Ductus lymphaticus dexter)—when present—collects the lymph from the right side of the head, neck, and thorax, and from the right thoracic limb. It is most frequently absent, being represented by a number of short ducts which terminate in the thoracic duct, the right jugulo-brachial junction, or the origin of the anterior vena cava. When present in its typical form, it results from the confluence of efferent ducts from the right axillary and prepectoral lymph glands with the right tracheal duct. It lies on the deep face of the scalenus muscle above the terminal part of the right jugular vein. It is more or less ampullate and usually opens into the anterior vena cava to the right of the thoracic duct. It may be connected with the latter by considerable anastomoses and may join it.

The duct is very variable in form and in regard to its afferents. Often it is a very short, irregular, and bulbous trunk; in some cases it is about an inch and a half (ca. 3 to 4 cm.) in length and receives the tracheal duct at its terminal bend. The lymphatico-venous connections here need further study.

THE LYMPH GLANDS AND VESSELS OF THE HEAD AND NECK

1. The =submaxillary lymph glands= (Lg. submaxillares) (Figs. 437, 462) are arranged in two elongated groups in the submaxillary space along each side of the omo-hyoid muscles. The two groups are in apposition in front of the insertion of these muscles and diverge posteriorly in the form of a =V=, extending backward about four or five inches (ca. 10 to 12 cm.). They are covered by the skin and a thin layer of fascia and panniculus, and are therefore palpable. Anteriorly they are firmly attached to the mylo-hyoidei, but otherwise they are rather movable in the normal state. Each group is related externally to the external maxillary artery and the anterior belly of the digastricus, below to the external maxillary vein, and above to the lingual and sublingual veins.

They receive =afferent vessels= from the lips, nostrils, nasal region, cheeks, the anterior part of the tongue, the jaws, the floor of the mouth, and the greater part of the hard palate and nasal cavity. The =efferent vessels= pass to the anterior cervical and pharyngeal glands.

The superficial lymph vessels of the face converge to twelve to fifteen trunks which turn around the lower border of the jaw with the facial vessels. Those of the lips form plexuses at the commissures. The nasal mucous membrane is richly supplied with lymph vessels which accompany the veins; posteriorly they communicate with the subdural and subarachnoid spaces and send efferents to the pharyngeal and anterior cervical glands.

2. The =pharyngeal lymph glands= (Figs. 436, 437, 569) may consist of two groups. One lies on the lateral surface of the pharynx along the course of the external carotid artery. These glands are related externally to the stylo-maxillaris and digastricus and often to the submaxillary gland also, above to the guttural pouch. Other glands (Lg. retropharyngeales) are commonly found on the guttural pouch along the course of the internal carotid artery. They lie below the artery and are covered by the aponeurosis of the mastoido-humeralis and the cervical end of the submaxillary gland.

They receive afferent vessels from the cranium, the posterior part of the tongue, the soft palate, pharynx, guttural pouch, larynx, posterior part of the nasal cavity, and efferents from the submaxillary glands.

3. The =anterior cervical lymph glands= (Lg. cervicales craniales) are situated chiefly along the course of the common carotid artery in the vicinity of the thyroid gland, under cover of the cervical angle of the parotid gland. Some occur between the thyroid and the submaxillary salivary gland, others above and partly upon the thyroid. They are related deeply to the posterior part of the larynx, the trachea, the thyroid gland, and the œsophagus; below to the external maxillary vein and the outer border of the omo-hyoideus.[177]

These glands are variable. Often there are none in front of the thyroid and the group may extend back a considerable distance along the course of the carotid artery.

Their afferents are deep lymph vessels from the head, the pharynx, larynx, guttural pouch, and thyroid gland, and efferents from the submaxillary and pharyngeal glands. Their efferent vessels go to the middle and posterior cervical glands.

4. The =middle cervical lymph glands= (Lg. cervicales mediæ) form an inconstant group situated a little in front of the middle of the neck on the trachea below the carotid artery. The group is usually small and in some cases is absent, being replaced by a number of glands occurring at intervals along the course of the carotid artery. In other subjects the group consists of several glands of considerable size. They are intercalated in the course of the tracheal lymph ducts.

5. The =posterior cervical= or =prepectoral lymph glands= (Lg. cervicales caudales) form a large group below the trachea at the entrance to the thorax (Fig. 466). They occupy the interstices between the vessels and muscles and extend forward a variable distance on the ventral aspect of the trachea. They are covered by the panniculus and sterno-cephalicus. Their afferent vessels come from the head, neck, thorax, and thoracic limb. They receive efferent ducts of the anterior and middle cervical, prescapular, and axillary glands. Their efferents go to the thoracic duct on the left, to the right lymphatic duct on the right, or open directly into the vena cava.

6. The =prescapular= or =superficial cervical lymph glands= (Lg. cervicales superficiales) lie on the anterior border of the anterior deep pectoral muscle, in relation to the omo-hyoideus internally and the mastoido-humeralis externally (Figs. 431, 441, 466). They are on the course of the ascending branch of the inferior cervical artery. They receive afferents from the neck, breast, shoulder, and arm. Their efferents pass to the prepectoral glands.

The =tracheal ducts=, right and left (Ductus trachealis dexter, sinister), are collecting trunks for the lymph of the head and neck. They lie on the trachea in relation to the carotid arteries. The right one goes to the prepectoral glands or to the right lymphatic duct, the left one to the terminal part of the thoracic duct.

THE LYMPH GLANDS AND VESSELS OF THE THORAX

1. The =intercostal lymph glands= (Lg. intercostales) are small and are situated at the sides of the bodies of the thoracic vertebræ, in series corresponding to the intercostal spaces. They receive afferents from the vertebral canal, the spinal muscles, the diaphragm, intercostal muscles, and pleura. The efferent vessels go to the thoracic duct.

In the young subject these glands are more numerous than in the adult, and there are also glands along the dorsal face of the thoracic aorta which seem to disappear later.

2. The =anterior mediastinal lymph glands= (Lg. mediastinales craniales) (Fig. 428) are numerous. Some are situated on the course of the brachial arteries and their branches; on the right side they are related deeply to the trachea, on the left to the œsophagus also. They are variable in size and disposition and are continuous in front with the prepectoral glands. Other glands lie along the ventral face of the trachea on the anterior vena cava and the right atrium of the heart; these are continuous behind with the bronchial glands. A few glands usually occur along the dorsal surface of the trachea, and there is often one at the angle of divergence of the brachiocephalic trunk. The afferent vessels come chiefly from the pleura, the pericardium, the heart, the thymus or its remains, the trachea, and the œsophagus. Their efferent vessels pass to the prepectoral glands and the thoracic duct.

The glands along the ventral face of the trachea are frequently enlarged and usually pigmented in dissecting-room subjects. The left recurrent nerve lies above them on the ventral face of the trachea.

3. The =bronchial lymph glands= (Lg. bronchiales) are grouped around the terminal part of the trachea and the bronchi. One group lies on the upper surface of the bifurcation of the trachea and is continued a short distance backward under the œsophagus (Fig. 428). Others lie below the trachea and bronchi and also occupy the angle between the aortic arch and the pulmonary artery, concealing the left recurrent nerve and often covering the vagus in this part of its course. Small glands occur along the chief bronchi in the substance of the lungs (Lg. pulmonales). They receive the deep and most of the superficial lymph vessels of the lungs, and the efferents from the posterior mediastinal glands. Their efferent vessels go to the thoracic duct and the anterior mediastinal glands. The deep lymph vessels of the lung arise in plexuses which surround the terminal bronchi and accompany the bronchi to the root of the lung. The superficial vessels form a rich network under the pleura; most of them pass to the bronchial glands.

The bronchial glands are commonly pigmented except in young subjects and are often enlarged and indurated.

4. The =posterior mediastinal lymph glands= (Lg. mediastinales caudales) are usually small and are scattered along the posterior mediastinum above the œsophagus. They receive afferent vessels from the œsophagus, mediastinum, diaphragm, and liver. The efferents go to the bronchial and anterior mediastinal lymph glands, partly to the thoracic duct directly.

Sometimes one or two small glands are situated in the acute angle between the posterior vena cava and the diaphragm.

THE LYMPH GLANDS AND VESSELS OF THE ABDOMEN AND PELVIS

The =lymph glands of the abdomen= consist of two main groups, parietal and visceral. The =parietal glands= lie in the subperitoneal or subcutaneous tissue; they receive the lymph vessels from the abdominal and pelvic walls, from parts of the viscera, and from the proximal lymph glands of the pelvic limbs. The =visceral glands= lie on the walls of the viscera or in the peritoneal folds which connect the organs with the wall or with adjacent viscera. They receive all or most of the lymph vessels from the organs with which they are connected.

The =parietal glands= comprise the following:

1. The =lumbar lymph glands= (Lg. lumbales) lie along the course of the abdominal aorta and posterior vena cava (Fig. 450). Some are placed along the lower surface and sides of the vessels, others above. A few small glands may be found above the sublumbar muscles. The small nodes which are situated at the hilus of the kidneys are often termed the renal lymph glands. They receive afferent vessels from the lumbar wall of the abdomen and the paired viscera (kidneys, adrenals, genital organs), also the inguinal vessels and the efferents of the iliac glands. Their efferents go to the thoracic duct, constituting the lumbar trunks of origin of that vessel.

2. The =internal iliac lymph glands= (Lg. iliacæ internæ) are grouped about the terminal part of the aorta and the origins of the iliac arteries (Fig. 450). Their afferent vessels come chiefly from the pelvis, pelvic viscera, and tail, and they receive efferent vessels of the external iliac and deep inguinal glands.

3. The =external iliac lymph glands= (Lg. iliacæ externæ) form a group on either side on the iliac fascia at the bifurcation of the circumflex iliac artery (Fig. 450). Their afferent vessels come from the flank and abdominal floor, the outer surface of the thigh, and the precrural glands. The efferent vessels go to the lumbar and internal iliac glands.

4. The =sacral lymph glands= (Lg. sacrales) are small nodes situated along the borders of the sacrum and on its pelvic surface. They receive afferents from the roof of the pelvis and from the tail, and their efferent vessels pass to the internal iliac glands.

5. The =superficial inguinal lymph glands= (Lg. inguinales superficiales) lie on the abdominal tunic in front of the external inguinal ring (Fig. 457). They form an elongated group along the course of the subcutaneous abdominal artery, on either side of the penis in the male, above the mammary glands in the female; in the latter they are often termed =mammary=. Their afferents come from the inner surface of the thigh, the abdominal floor, the sheath and scrotum in the male, and the mammary glands in the female. The efferent vessels ascend through the inguinal canal and go to the deep inguinal and lumbar glands.

6. The =ischiatic lymph gland= (Lg. ischiadica) is a small node which may be found at the lesser sciatic notch. It receives lymph from the adjacent parts and from the popliteal glands, and sends efferents to the sacral and internal iliac glands.

The =visceral glands= include the following:

1. The =gastric lymph glands= (Lg. gastricæ) are situated along the course of the gastric arteries. Several occur along the attachment of the gastro-phrenic ligament. A group lies at the lesser curvature a short distance below the cardia. There is another small group on the visceral surface where the posterior gastric artery divides into its primary branches. Two or three small nodes are usually found on the ventral aspect of the pylorus. Other small glands are scattered along the course of the gastro-epiploic and short gastric arteries in the great and gastro-splenic omenta. The efferent vessels pass largely to the cœliac radicle of the thoracic duct, but along the left part of the great curvature they go to the splenic glands.

2. The =hepatic lymph glands= (Lg. hepaticæ) lie along the portal vein and hepatic artery and in the lesser omentum. Their efferent vessels go to the cœliac radicle of the cisterna chyli.