The Lymphatics and Lymph Flow in the Edematous Skin of Human Beings With Cardiac and Renal Disease

Abstract

Local intradermal injections of dye have disclosed the fact that the skin lymphatics in regions of cardiac edema are patent, full of fluid and much widened. Intercommunication between them is ready and dye escapes from them more rapidly than from the vessels of normal skin. A retrograde distribution of dye by way of the lymphatics often occurs and it may pass unseen along the deeper channels to emerge in the skin at unexpected, distant situations. A valvular incompetence of the lymphatics consequent on dilatation would appear to be the cause of these phenomena. In regions of cardiac edema lymph stagnates, despite the fact that the channels are open. In nephritic edema the lymphatic capillaries are wider than normal but not as wide as in cardiac edema. No sign of incompetency of the valves is to be observed. Instead lymph flow is considerably greater than normal, even when edema fluid is accumulating. It was noted to be greater in the periods of fluid equilibrium also and extraordinarily rapid in periods of diuresis.

Lymph Nodes as a Source of Neutralizing Principle for Vaccinia

“…of an isotonic 11 per cent aqueous solution of an innocuous vital dye, patent blue V 1 (1,2). 0.1 cc.…”

“…(Received for publication, March 9, 1937) Previous papers from this laboratory have shown that every intradermal injection is truly intralymphatic (1)(2)(3). Dyes introduced in this way enter the superficial plexus of lymphatics through channels torn by the needle; and particulate substances which are punctured, scratched or even "vaccinated" into the skin pass in some part directly into these channels and are carried to the regional nodes (4,5).…”

The Relative Pressures Within Cutaneous Lymphatic Capillaries and the Tissues

“…Doubtless because of the fact that lymphatic capillaries, unlike blood capillaries, are not readily visible under the microscope, no direct measurements of the lymph pressure in lymphatic capillaries of the skin have been reported previously. However, in the course of other studies (10)(11)(12)(13)(14)(15) from this laboratory, the difficulty had been overcome by the development of methods whereby the lymphatic capillaries are rendered visible as they pass through uninjured living skin. As a result, all that was lacking for the study of the pressure relationships inside the lymphatic capillaries and round about them was a suitable method for the measurement of fluid pressure in these channels.…”

“…Unfortunately visualization of the lymphatics did not always take place under the circumstances outlined. For this reason another technique was frequently used: a modification of one already described in many previous papers (10)(11)(12)(13)(14)(15)(16). Mice were anesthetized with nembutal, their ears were spread on porcelain plaques, and under the binocular microscope the skin of the ear was punctured with an especially sharp micro cannula, attached to the apparatus that had been filled with the solution containing vital red.…”

“…I t is well known that lymph formation and flow are often greatly enhanced by the pressure of inflammatory edema (14,15,(17)(18)(19). Further, in states of edema, free fluid is usually present in the skin and consequently the pressure existing outside the lymphatic capillaries can be accurately determined (4,5).…”