chain along the internal jugular vein, beneath the
sterno-mastoid muscle. They drain the various
groups of glands which lie nearer the surface, also
the interior of the skull, the larynx, trachea, thyreoid,
and lower part of the pharynx, and pour their lymph
into the main trunks at the root of the neck.
Belonging to this group is one large gland (the tonsillar
gland) which lies behind the posterior belly of the
digastric, and rests in the angle between the internal
jugular and common facial veins. It is commonly
enlarged in affections of the tonsil and posterior
part of the tongue. In the same group are three
or four glands which lie entirely under cover of the
upper end of the sterno-mastoid muscle, and surround
the accessory nerve before it perforates the muscle.
The deep cervical glands are commonly infected by
tubercle and also by epithelioma secondary to disease
in the tongue or throat.
The inferior deep cervical
(supra-clavicular) glands lie in the posterior
triangle, above the clavicle. They receive lymph
from the lowest cervical glands, from the upper part
of the chest wall, and from the highest axillary glands.
They are frequently infected in cancer of the breast;
those on the left side also in cancer of the stomach.
The removal of diseased supra-clavicular glands is
not to be lightly undertaken, as difficulties are
liable to ensue in connection with the thoracic duct,
the pleura, or the junction of the subclavian and
internal jugular veins.
The retro-pharyngeal glands
lie on each side of the median line upon the rectus
capitis anticus major muscle and in front of the pre-vertebral
layer of the cervical fascia. They receive part
of the lymph from the posterior wall of the pharynx,
the interior of the nose and its accessory cavities,
the auditory (Eustachian) tube, and the tympanum.
When they are infected with pyogenic organisms or
with tubercle bacilli, they may lead to the formation
of one form of retro-pharyngeal abscess.
#Upper Extremity.#—The epi-trochlear
and cubital glands vary in number, that most commonly
present lying about an inch and a half above the medial
epi-condyle, and other and smaller glands may lie along
the medial (internal) bicipital groove or at the bend
of the elbow. They drain the ulnar side of the
hand and forearm, and pour their lymph into the axillary
group. The epi-trochlear gland is sometimes enlarged
in syphilis. The axillary glands are arranged
in groups: a central group lies embedded in the
axillary fascia and fat, and is often related to an
opening in it; a posterior or subscapular group lies
along the line of the subscapular vessels; anterior
or pectoral groups lie behind the pectoralis minor,
along the medial side of the axillary vein, and an
inter-pectoral group, between the two pectoral muscles.
The axillary glands receive lymph from the arm, mamma,
and side of the chest, and pass it on into the lowest
cervical glands and the main lymph trunk. They
are frequently the seat of pyogenic, tuberculous, and
cancerous infection, and their complete removal is
an essential part of the operation for cancer of the
breast.