. Anatomie, descriptif et appliquée. L'anatomie. Les SYSTÈMES VASCULAIRES 784 nœuds. Dans l'avant-bras il y a une trentaine de navires, au milieu du bras il n'y a de 15 à 18 ans (Sappey). Les vaisseaux lymphatiques du membre supérieur transmettre la lymphe de l'os, le périoste, muscle, ligament, etc. Ils passent vers le haut de la jambe avec le chef de navires, il y étant généralement deux lignes pour chaque artère. Dans le bras il y a deux ou trois navires. Certains quelques bateaux terminent dans les petits noeuds le long le radial, cubital, et brach- lia les artères, mais la plupart d'entre elles passent directement à la ganglions axillaires. Appliqué

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. Anatomy, descriptive and applied. Anatomy. 784 THE VASCULAR SYSTEMS nodes. In the forearm there are about thirty vessels, in the middle of the arm there are from fifteen to eighteen (Sappey). The deep lymphatic vessels of the upper extremity convey the lymph from bone, periosteum, muscle, ligament, etc. They pass up the limb with the chief vessels, there usually being two trunks to each artery. In the arm there are two or three vessels. Some few vessels terminate in the small nodes along the radial, ulnar, and brach- ial arteries, but most of them pass directly to the axillary nodes. Applied Anatomy. — In malignant diseases, or other affections implicating the upper part of the back and shoulder, the front of the thorax and mammae, the upper part of the front and side of the abdomen, or the hand, forearm, or arm, the axillary nodes are liable to be found enlarged. In secondary syphilis'the supratroch- lear node is found to be enlarged. This node is subcutaneous and readily palpa- ble against the subjacent bone when enlarged. Normal axillary nodes cannot be palpated. The axilla is a passage- way for structures between the neck or thorax and the upper extremity, and purulent collections or tumors may extend from the neck or thorax into the axilla or from the axiUa into the neck or thorax. The axillary nodes are involved early in cases of cancer of the mammary gland, and later the lower deep cervical nodes are involved, and, as Snow has pointed out, regurgitation of lymph containing cancer cells leads to retrosternal involve- ment and to secondary cancer of the head of the humerus. In operating for cancer of the breast, follow the principle of Hal- sted and remove the breast, the skin over it, the muscles and fascia, the lymph vessels, and the axillary nodes in one piece. By this plan thorough removal is possible, and as lymph vessels containing carcinoma cells are not cut across, the wound is not grafted with malignant epithelial cells. Diseased axillary nodes are

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