The vasa efferentia of the axillary glands, four or five only in number, but of large size, receive the lymph conveyed to these glands from the various sources just described; they pass associated with the axillary vessels under the subclavius muscle, unite into one or two branches, which usually pass over the subcla vian vein, to , terminate either separately in this vein, close to its union with the internal jugular, or else join the lymphatic trunks.
The lymphatics of the head and face may be divided as in other parts of the body into the superficial and the deep-seated. They all have to pass through the glands situated in the cer vical region. The superficial accompany prin cipally the veins of the head and face. Those from the head form two groups : one anterior associated with the temporal veins, descends in front of the ear, joins the small glands situated at the root of the zygoma, and in the substance of the parotid gland; it passes with the temporal vein through that gland and below the angle of the jaw continues to follow the course of the vein over the digastric and stylo-hyoid muscles, where it meets with lymphatic glands which it enters ; the posterior group accompanies the occipital and posterior auricular veins, traverses the glands behind the mastoid process, and afterwards those situated at the back and upper part of the neck. The facial lymphatics, like the facial veins, receive branches from the forehead and eyelids, pass fiom the inner canthns of the eye along the side of the nose and over the bucci nator muscle, where they meet with one or two small glands ; they then gain the anterior edge of the masseter, from whence they pass be low the margin of the jaw, to traverse the glands there situated. These three groups of vessels communicate freely with each other in the cervical glands, and are joined by some of the deep-seated lymphatics. These latter may be divided into those of the cranium and those of the face ; the former as well as the lymphatics of the interior of the orbit are not sufficiently known to admit of our stating the exact course which they take. Fohmann and Mascagni both conceive that they have discovered the lymphatics of the brain and its membranes and have had them delineated in their published plates ; but they differ so ma terially from each other, and their descriptions are so far from satisfactory that we must be content to say that we are ignorant not only of the course they take but even of their existence.
Fohmann represents them to be very large and numerous, situated principally between the arachnoid membrane and pia matey, while Mascagni figures them on the pia tnater as exceedingly small and as accompanying some of the veins ; others are also depicted as asso ciated with the meningeal vessels ; the trunks of these vessels are supposed to descend with the carotid, vertebral, and meningeal arteries and with the internal jugular veins ; while Fohmann throws out a hint that they may ter minate in the venous system within the cra nium.
The deep-seated lymphatics of the face are associated with the bloodvessels; those accom panying the internal maxillary arteries enter the gland or glands in the substance of the pa rotid, and join the temporal lymphatics. The rest accompanying their bloodvessels reach the upper cervical glands, and communicate freely with the superficial lymphatics already traced to the same glands ; the further progress of the lymphatics in the neck is regulated by the position of the glands, which it will be re membered form two groups, one situated be tween the ster.lo•mastoid muscle and the trachea, and associated more with the internal jugular vein, the other located in the cellular interval between the sterno-mastoid and tra pezius muscles in the neighbourhood of the external jugular. The former receives the lym phatics from the tongue, pharynx, and larynx, and lower down from the thyroid gland, trachea, and esophagus; while the latter col lects them from the muscles of the posterior region of the neck and of the shoulder. The afferent and efferent vessels of these two series of glands have frequent communica tions with each other. At the root of the neck they unite freely with the lymphatics emerging from the chest and with those of the upper extremities, until ultimately one large vessel is formed on either side, which receives the con tents of the whole, and which terminates either by opening separately into the internal jugular vein close to the entrance of the lymphatic trunk, or into that trunk itself.
(S. Lane.)