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crossed by the pancreas and splenic vessels. Sometimes these structures lie at: lower level, when the whole antero-lateral surface is covered by peritoneum of the omental bursa.

Blood and Lymph Vessels.-Typically, each gland receives three arteries: one direct from the aorta, one from the inferior phrenic, and one from the renal artery; and is drained by on vein, which emerges at the hilum, the right to join the vena cava inferior, the left to join the left renal vein. Numerous lymph vessels pass from the suprarenal glands to the lateral aortic lymph glands.

Nerves. The nerves passing to and from the glands constitute the suprarenal plexuses They connect with the renal and coeliac plexuses and with the coeliac ganglia, and include numerous fibres from the greater splanchnic nerves, with a smaller number from the vagus and phrenic nerves. Most of them are medullated, but lose their sheaths on passing into small ganglia in, or just within, the fibrous capsule of the gland. Thereafter they pass to the chromaphil tissue of the medulla, either directly, or after first supplying the cortex.

Structure. A suprarenal gland consists of a highly vascular central mass of chromaphi tissue, the medulla, enclosed within a thick capsule of cortical substance, the cortex, which in turn is enclosed within a capsule of fibrous tissue, tunica fibrosa. From the deep aspect of the fibrous tunic trabeculae pass inwards to support the glandular tissue. In the superficial part of the cortex the trabecula interlace freely to enclose rounded loculi, zona glomerulosa; in the intermediate part they run vertically to the surface to enclose columnar spaces, zona fascicula: in the deepest part of the cortex they become broken up and form a reticulum, zona reticulata. The cortex consists of polyhedral cells arranged in the interstices of the fibrous trabecula These cells contain a lipoid substance, which is present in sufficient quantity to give the cortex. yellow colour.

The medulla is formed of a spongework of cell columns bounding anastomosing venos sinuses. The cells are large, contain numerous granules, and possess the specific chromaph reaction. In a fresh gland the medulla is of a dark red colour owing to the presence of blood in

its sinuses.

The blood-vessels enter at numerous points in the fibrous capsule and run in the trabecula. forming a network around the cell masses and columns of the zona glomerulosa and zor fasciculata. In the zona reticulata the blood-vessels open up to form a venous plexus, which is continued through large sinuses in the medulla to reach a central vein. This is the ve which emerges at the hilus.

Development of the Cortical System and of the Suprarenal Glands.-The cortical syste is a derivative of the cœlomic epithelium (mesoderm). The first indication of its developme is given, when the embryo is about 6 mm. in length, by the rapid proliferation of the epithelia cells placed between the mesonephros and the root of the mesentery. Numerous buds formand penetrate the mesenchyme at the sides of and ventral to the aorta. In an 8-mm. embryo the buds have already lost their connexion with the colomic epithelium. By the time the embry is 9 mm. long the developing cortical masses are vascularised. In man the greater part of th tissue thus formed is ultimately included in the cortex of the suprarenal glands, but small mass may escape, either at this stage or subsequently, to form independent cortical bodies.

In 12-mm. embryos the developing suprarenal glands lie in a caudalward continuation of th dorsal portion of the pleuro-peritoneal membrane called the suprarenal ridge, and are composed. cortical tissue only. When the embryo is about 20 mm. in length sympatho-chromaphil o destined to form the medulla of the gland, begin to migrate into the developing cortex. T two kinds of tissue are in contact in 10-12 mm. embryos, but penetration of cortical masest sympatho-chrommaphil cells has not been observed earlier than the stage mentioned.

At first the immigrating cells are scattered in numerous columns and strands, and it is until the embryo is about 10 cm. in length that they begin to reach the central vein and to fort true medulla. When the process of immigration ceases is unknown, probably not until after hint The final specialisation of the cortex is a late phenomenon, and does not take place until log after birth. The zona reticularis develops early and is recognisable in a 15-mm. embryo; t zona glomerulosa is not formed until the second or third year, but is represented until then by layer of small incompletely specialised cells immediately under the fibrous capsule.

During foetal life the cortex is relatively enormous. This is due to a great proliferation the cells of the foetal zona reticularis, which differ from the adult cells of the same zone in containing lipoids. This foetal cortex begins to undergo a fatty degeneration soon after bir and by the end of the first year has disappeared. The new cortex which replaces it devel? from the small, superficially placed, incompletely specialised cells already referred to,

Comparative Anatomy of the Chromaphil and Cortical Systems. A knowledge of th main facts of the comparative anatomy of the chromaphil system is a help to understanding distribution in man. Chromaphil tissue is first recognised with certainty in the cyclostomati which it is arranged in thin strips on the walls of the larger arteries and their branches! elasmobranchs chromaphil bodies are present and are arranged segmentally on branches the aorta in close relation to the ganglia of the sympathetic chain. Cortical tissue is al cognisable in the cyclostomata, in which it is arranged in small lobulated masses in the walls the posterior cardinal veins and renal arteries. Even in this rudimentary form it is rich lipoids. In the rays (elasmobranchs) the cortical system is represented by a pair of ye coloured, rod-shaped structures in the region of the kidney. In batrachians the chromaphila cortical representatives first begin to come together. In the frog the adrenals are golden yel

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treaks on the ventral surface of the kidney. The greater part of these are made up of columns f cortical cells, but at the borders or ends of the cell columns masses of chromaphil cells occur. his arrangement is transitional between the complete independence of the chromaphil and cortical ystems in elasmobranchs and the partial inclusion of chromaphil tissue within cortical charcteristic of the higher mammals (Swale Vincent). But even in man the union of the systems is ar from complete. All the chromaphil tissue except the medulla of the suprarenal gland lies ut of touch with cortical substance. It appears therefore (i.) that the paraganglia of the ympathetic trunk are homologous with the segmental chromaphil bodies of elasmobranchs; (ii.) hat the chromaphil bodies of the abdominal plexuses are a new formation confined to the higher vertebrates; (iii) that the inclusion of chromaphil tissue within a capsule of cortical tissue, as n the suprarenal glands, is a still later development confined to the highest classes of animals.

2. THE DUCTLESS GLANDS OF ENTODERMAL ORIGIN. A group of ductless glands, (i.) the thyreoid gland, (ii.) the parathyreoid glands, (iii.) the thymus, and two pairs of inconstant, apparently functionless structures, (iv.) the cervical thymus glands, and (v.) the ultimo-branchial bodies, are developed from the entodermal lining of the embryonic pharynx.


The thyreoid gland (O.T. thyroid body) is placed in the neck, firmly bound by fibrous tissue to the anterior and lateral aspects of the upper part of the trachea and to the sides of


the larynx. It is yellowish
red, soft, and vascular.
varies in size with age, sex,
and general nutrition, being
relatively large in youth, in
females, and in the well nour-
ished. In women it increases
temporarily with menstrua-
tion and pregnancy.
average dimensions are, height
5 cm., breadth 6 cm., weight
25 gm.; but these measure-
ments are of little value be-
cause of the range of varia-

Conventionally, the thyreoid gland is said to consist of two conical lobes united across the middle line by a narrow strand of gland tissue, the isthmus. To many thyreoids this description is inapplicable. In men and thin elderly spinsters the gland is not uncommonly horse-shoe shaped; in young


Common carotid artery

Inferior thyreoid vein

well-nourished women and in FIG. 1058.-DISSECTION OF THE THYREOID GLAND AND OF THE PARTS pregnancy its general contour

suggests a sphere, deeply notched


superiorly to accommodate the larynx and deeply grooved posteriorly for the trachea and esophagus. Rarely, the gland is in two parts. Not infrequently, it is asymmetrical. In about 40 per cent of specimens a process of gland tissue, the pyramidal lobe, extends from the upper border of the isthmus, upwards, in front of the cricoid and thyreoid cartilages, towards the hyoid bone. This process is seldom median, lying more often on the left than on the right. In rare cases, it is double. Less rarely, it is double below and single above. Sometimes it is represented by a strip of fibrous tissue or a narrow muscle (lig. suspensorium, or m. levator, glandula thyreoidea).

Small oval accessory thyreoid glands are common in the region of the hyoid bone, and are occasionally met with in relation to the right and left lobes.

The relations of the gland are variable, depending upon its size and its relative level.

In a majority of cases the isthmus covers the second, third, and fourth rings of the 13 trachea, but it may cover the cricoid cartilage, or the fourth, fifth, and sixth tracheal rings. Anteriorly, the gland is clothed by the pretracheal fascia, which separates it from the sterno-thyreoid, sterno-hyoid, and omo-hyoid muscles. Extensions of this fascial laver form an indefinite capsule for the gland. Postero-medially, the thyreoid gland is mouldeí by the sides of the trachea and lower part of the larynx, and, when large, comes inte contact, behind them, with the pharynx and œsophagus. Postero-laterally, it is in relation to the common carotid arteries, and when large is in intimate relation to the recurrent nerves. Further, it has important relations to the parathyreoid glands see Parathyreoid Glands, Relations).

Blood and Lymph Vessels.-The blood supply is effected through the superior thyreo| arteries, branches of the external carotids, and through the inferior thyreoid arteries, branches of the thyreo-cervical trunks. Occasionally a fifth artery is present, the thyreoidea ima, 3 branch of the innominate. The pyramidal lobe, if well developed, receives a special branch from one of the superior thyreoids, usually the left. These arteries are remarkable for the large size and for the frequence and freedom of their anastomoses. An anastomosing trunk courses up the posterior aspect of each lateral lobe, uniting the inferior and superior thyreo arteries. It is of interest in connexion with the recognition of the parathyreoid glands Typically, three pairs of veins drain the gland. The upper two pairs, the superior and midd thyreoid veins, join the internal jugulars; the lower pair, the inferior thyreoid veins, join the left innominate. These vessels take origin from a venous plexus on the surface of the gland cr in the case of the inferior, from a downward extension of the plexus in front of the trachea When the gland is very large, accessory veins are present, sometimes in considerable number Most of these pass to the internal jugulars. A free, transverse, venous anastomosis is effectel along the borders of the isthmus through the superior and inferior communicating veins.

The lymph vessels anastomose freely in the substance and on the surface of the gland. Most pass direct to the deep cervical lymph glands, a few descend in front of the trachea to the pretracheal lymph glands.

Nerves. The nerves are derived from the middle and inferior cervical ganglia of the sympathetic. They accompany the blood-vessels.

Structure. The gland is enclosed in a fibrous capsule (tunica propria) which send prolongations inward to form a framework for the gland tissue proper. This consists spheroidal vesicles, '04 mm. to 1 mm. in diameter, lined with cubical epithelium, and filled wit "colloid." The size, shape, and cellular characters of the vesicles vary with diet and envirerment. The vesicles are surrounded by networks of blood capillaries and of lymph vessels.

Development. The thyreoid gland takes origin from a single median outgrowth fr the pharyngeal floor (entoderm). It is recognisable as a shallow bay in a 18-mm. embry practically simultaneously with the demarkation of the foregut. As the bud grows its expands whilst its stalk narrows to form the thyreo-glossal duct.

In a 4-mm. embryo an elevation is present round the pharyngeal opening of the duct. T is the tuberculum impar. It migrates forwards, the duct backwards, so that in a 5-mm. entry the duct opens into the furrow immediately caudal to the tuberculum (see Tongue, Development At about this stage the duct begins to obliterate. This process proceeds slowly and is sellor quite complete, a vestige of the duct, the foramen cæcum of the tongue, remaining in the adult.

While these processes are proceeding growth and lateral expansion of the bud continue. It becomes bilobed and has a divided lumen, and all the while it undergoes a continuous ret displacement caudalwards. Soon its lumen disappears. In a 9-mm. embryo the develop thyreoid gland is a transverse bar composed of transversely disposed cell columns. At about th tenth week of development, 55-mm. embryo, the formation of vesicles commences but is not pleted until after birth. The remaining changes are due to simple growth and the moul effects of the pressure of surrounding structures.

The thyreoid gland does not arise in any of its parts from any of the pharyngeal o (see Ultimo-branchial Bodies).

The developmental history of the gland affords a ready explanation of its variations in adult. Thus the development of a pyramidal lobe and its variations, partial and comp duplication, are due to the development of gland tissue from that part of the thyreo-glossal which has a double lumen and the more or less complete fusion or separation of the masses! formed. Accessory thyreoid glands near the hyoid bone are the result of a similar process connexion with isolated remnants of the duct.

The occurrence in the adult of a duct leading from the foramen cæcum to, or towards hyoid bone (lingual duct) is due to a persistence of the upper part of the thyreo-glossal i Similarly, thyreo-glossal cysts are due to the persistence of short intermediate lengths of the


The parathyreoid glands (O.T. parathyroid bodies; Synonyms. epitha. bodies, parathymic glands, branchiogenic glands) are finely granular, yellow brown, lenticular or spheroidal structures, from 2 to 20 mm. in diameter and fr

1 to 3 gm. in weight. Most commonly they are lenticular, 5-7 mm. in length, -2 mm. in thickness, and from '01 to 1 gm. in weight. Normally there are two pairs f parathyreoids, distinguished by the Roman numerals IV. and III. to signify that hey develop from the fourth and third pharyngeal pouches. Sometimes, in course f development, the parathyreoid buds divide so that more than four, five to twelve, lands may be present: the numerals are then applied to the groups of glands ormed from the pouches.


Parathyreoid IV. is commonly embedded in the tunica propria of the thyreoid gland nd lies posterior to the corresponding lateral lobe of that organ, about its middle. hyreoid III., similarly embedded, usually lies on the posterior aspect of the inferior exremity of the lateral lobe of the thyreoid gland. As a rule the anastomosing channel, which connects the inferior and superior thyreoid arteries (see Thyreoid Gland, Blood Supply), passes near both parathyreoids and furnishes the best guide to their discovery, but the range of the exceptional positions which the glands may occupy is wide. Thus, parachyreoid IV. may be found (1) behind the pharynx or oesophagus, (2) in the fibrous tissue at the side of the larynx, above the level of the thyreoid gland, (3) behind any part of the corresponding lobe of the thyreoid gland or even embedded in the thyreoid substance (internal parathyreoid); whereas parathyreoid III. may be found (1) near the bifurcation of the common carotid artery, (2) behind any part of the corresponding lobe of the thyreoid gland, (3) on the sides of the trachea, or (4) in the thorax.


Blood-vessels.-The blood supply of each parathyreoid is effected by a single artery which enters the gland at its hilum. It may spring from any branch of the inferior or superior thyreoid arteries, but most commonly is a branch of the Common carotid artery large anastomosing channel already referred to.

Structure. The para

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Common carotid artery
Internal jugular vein

Band connecting
thymus with thyreoid
Vagus nerve

Subclavian artery

tive tissue between them. The cells are of two kinds, one clear, the other, the minority, containing oxyphyl granules. Sometimes they surround spaces recalling thyreoid vesicles but there is no formation of "colloid," except possibly after thyreoidectomy.

Development. - The parathyreoid bodies develop from the dorsal diverticula of the third and fourth pharyngeal pouches. The first indication of their development is a proliferation and thickening of the epithelium on the cranial and lateral aspects of the diverticula. This is present in both the third and fourth pouches in 9-10 mm. embryos but appears to be rather irregular in the time of its

appearance. The cells forming it are vacuolated, difficult to stain, and indistinct in outline. Cords of cells grow out from the thickening and fibrous tissue penetrates between the outgrowing cords, which soon lose their connexion with the pharynx. The differentiation of the two kinds of cells takes place after birth.



Parathyreoid III. is normally drawn by the thymus, as it migrates, caudal to parathyreoid IV. As a rule it halts at the level of the inferior extremity of the lateral lobe of the thyreoid gland, but may continue its descent into the thorax or may not descend at all. In the latter case it remains near the bifurcation of the common carotid artery, where it is apt to be confused with th the glandula carotica. It is from this confusion that the idea, that the chromaphil glandular, carotica arises from the third pharyngeal pouch, has obtained a foothold in anatomical teaching

(iii.) THYMUS.

Strictly, there are two thymus glands, a right and a left, but they are so closely bound to one another that it is customary to speak of them as a unit,

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Pulmonary fissur


the thymus. This is an irregular pinkish mass of glandular tissue placed in the lower part of the neck and in the superior and anterior mediastina. Its size varies, relatively and absolutely, with age, sex, and nutrition, being relatively largest in infancy, absolutely largest at puberty; larger in females and the well nourished than in males and the emaciated; large in healthy adults accidentally killed; small in persons, even children, who have died of a slow wasting disease. It is supposed that it undergoes a premature permanent involution as the result of severe illness even though, to all appearance, the individual completely recovers.

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