Diagram of the Superficial Inguinal and the Popliteal Nodes of the Right Side and their Superficial Tributaries, showing Areas Drained by Each Subgroup. Deep structures in red, superficial in black. Frequent variations in dotted lines. (Gerrish.)
PLATE XXXIII.
Diagram of the nodes of the trunk and their tributary vessels. (F. H. G.)
THE ARRANGEMENT OF THE LYMPH VESSELS AND NODES.
Inasmuch as most of the surgical infections, including cancer, are disseminated by means of the lymph vessels it is necessary that the surgeon should know the relation of vessels and nodes to the other parts of the body. The surgical anatomy of the lymphatics can be appreciated by reference to Gerrish’s admirable diagrams. (See [Plates XXXI], [XXXII], and [XXXIII].) They will indicate at a glance what it would take pages to describe. The reader should also make frequent reference to these diagrams in connection with studies of septic infection, tuberculosis, and especially of cancer.
OCCLUSION OF LYMPH VESSELS.
Occlusion of lymph vessel; may be either congenital or acquired. The congenital type is of extreme interest pathologically, but perhaps of less interest to the surgeon, since it rarely permits of a surgical remedy. The reader interested in this subject should consult the writings of Busey, who has contributed memorable monographs on the general subject of occlusion of the lymphatics. The acquired forms have to do with various conditions, such as thickening of vascular walls, the pressure of exudates or of tumors, or even of callus, and with the specific infections, of which syphilis and cancer are perhaps the most illustrative. The result which is brought about by these various causes is not so much the dilatation of the vessels as the saturation or water-logging of the tissues on the distal side of the obstructive lesion. The former is indicated by the formation of vesicles or bullæ which will frequently ooze or weep continuously. Should the pressure be localized and circumstances favor it, a truly cystic collection of fluid may result. The more common type is the so-called lymphedema, which, when chronic, is always accompanied by hyperplasia of the affected tissues, their overgrowth resulting from a superabundance of nutrition, the connective tissue apparently appropriating the larger amount of this material for itself. Therefore with the dimensions of a member enormously increased it will be found that almost every other tissue except the connective has been starved out. Lymphedema differs from that produced by venous obstruction by its obstinacy and the density of the infiltration; in fact, it has been sometimes spoken of as solid edema. If it continues for some time there are permanent changes which do not admit of later dispersion, and permanent enlargement is the result. The most unmistakable expressions of this kind occur in the legs and the external genitals of both sexes ([Fig. 184]).
Fig. 184
