Applied Anatomy of the
F. P. Millard, D.O.
THE LYMPHATIC SYSTEM
Students of anatomy sometimes fail to grasp the relative
importance of collecting applied data as compared to that of gaining a
knowledge of the tissues, organs and general framework of the human body
as outlined in texts on that subject.
The physician in practice soon feels the need of
greater knowledge of the various vessels, nerves and organs along the line
of applied concept. As he advances in his work and studies his patients
at the office and bedside, there comes a longing to know just what relation
exists between the various parts of the body and the disease that he is
endeavoring to diagnose. He wonders always, or should, how great
an involvement is present in certain disorders where symptoms reveal specific
pathological phases. In neuritis, for instance, he asks what change
has taken place that has caused a normal nerve tone to be replaced by the
symptoms so strikingly impressed upon the patient. He had been taught
in college the general outline of the nerve tracts, their nerve root tracings
and their relation to the groups of muscles. He also was taught the
osseous framework and the relation of the nerves to the various bones.
But in some instances he had never worked out in detail the applied part
and felt that he did not understand the various stages of muscle tension
as related to nerve instability and irritability. The various causes
of the chemical change in the body fluids in perverted function, such as
the possibility of lymph blockage through the malposition of certain bones,
and the resultant organic disorders that allow a perverted blood supply
to the walls or substance of an organ, and the lack of vasomotor control
in some instances. As osteopathic physicians, we are more or less
familiar with this follow through system, and we reason from cause to effect.
We have familiarized ourselves with the general blood circulation both
from an anatomical and physiological standpoint, and then the pathological.
Applied anatomies have been written both from a surgical
and osteopathic standpoint that deal with many phases from a very practical
viewpoint. From these books we have learned much although we are
yet in our infancy, so to speak, as to the real significance of applied
As mentioned in the preface, no attempt as yet has
been made to devote a book to the subject of the lymphatics in all its
In dealing with the lymphatics first from an applied
anatomy standpoint, we do not claim in any way to be adding any new anatomical
features, but we hope to enable the student to get a mental picture of
the various structures so that he will more readily grasp the significance
of the causation of disorders in the body when symptoms manifest themselves.
We want to emphasize, in considering the lymphatic
system, the importance of any perversion of the tissues that may alter
the function of any part of the body.
In the various regions discussed, we hope to assist
the student in clarifying the various influences that may have a bearing
upon the structures affected thereby producing tissue changes to the extent
of causing some bodily disturbance.
The lesion theory, as propounded by Dr. A. T. Still,
will be given first place in all our discussions, because we know that
his reasonings were correct and can be demonstrated in any instance where
there remains sufficient impulses to carry out this idea.
We realize there are certain diseases so far advanced
that the reflexes are lost and the nerve impulses so disturbed or feeble
that it is quite impossible to restore normal functioning, but these cases
are extreme, and we will consider more particularly those cases that are
amenable to adjustment and restoration.
In dealing with the lymphatic system, let us go about
it in a manner that will first of all be broad enough in outline to realize
that the body is a machine that is so correlated that if one part suffers
there will be a corresponding reflex that will to some degree, at least,
affect other parts or all parts.
The tendency of the day is to specialize and narrow
ourselves to the point of believing that any organic disturbance is a localized
one, and that we must treat or deal with the affected part from a local
standpoint. This must be overcome, and we must fix in our minds the
fact that the circulation that bathes one part of the body one minute may
be bathing a remote part a little later; that the lymphatic system is so
arranged that the drainage continues to the point of emptying. The
blockage at a point in the abdomen or pelvis will reflect itself upon the
lymph flow possibly in the feet. We can also see how enlarged glands
in the neck may cause any number of disturbances in the organs of special
sense in the head.
Insufficient stress has been laid upon the points
of interference with the flow of lymph, and in these chapters on applied
anatomy we hope to show, in some degree, the possibilities of many diseases
being existent through a blockage of the lymph flow either in the nodes
Finally, we want to assist the student by demonstrating
that in any pathological condition there is invariably a relative lymphatic
disturbance, and try to show how adjustment will assist the body in clearing
up the retardation or obstruction.
NEW METHOD OF DIAGNOSING VARIOUS DISEASES BY PALPATING LYMPHATIC
(*First publication of the technique of the newest thing in diagnosis
-- and it is OSTEOPATHIC. Editor, Journal of the American Osteopathic
(Reprint of article by author from the Journal of the American Osteopathic
Association, July, 1920.)
Had Dr. A. T. Still lived a few years longer I sincerely
believe he would have given to the world a vast amount of information regarding
the lymphatic system. I have always felt that he had in his mind
some information along the line of new physiology dealing with this subject.
He hinted at the reduction of obesity by lymphatic control, and often mentioned
the lack of knowledge and research in relation to the lymphatics, but we
could never draw any definite conclusions as to his reasonings. One
day, twenty-three years ago, I ventured to ask him regarding the significance
of the lymphatic system, but he passed the subject, by simply stating that
he was still experimenting along that line.
Recognizing that there was a field only partially
worked out, I set about to determine if I could discover any hidden truth
that might be of value to the osteopathic profession. My first observations
were rewarded, some sixteen years ago, by a revelation that gave me grounds
for further research. The idea was so new I did not feel like announcing
it until I had satisfied myself that there was sufficient merit in the
theory to warrant its publication.
Three times during the past few years I have ventured
to throw out a few suggestions. One reference to the matter pertained
to swellings found in the breast and their relation to axillary disturbances;
a second was the inguinal disturbance found in the right groin in cases
of appendicitis; and the third, published in the May number of this JOURNAL,
dealt with enlargement of the lymphatic glands from outside infections
Allow me to state that I believe that few, if any,
physicians have made it a regular part in their diagnostic work, year in
and year out, to carefully examine the condition of the various lymphatic
glands as a part of their examination of patients, also the following up
of the state of these glands from time to time in cases where lymphatic
enlargement was found. This calls for the development of a peculiar
touch, as palpable glands vary so much in different systemic conditions
that it is almost incredible the number of phases these nodules assume.
For several years I have based, almost conclusively,
my diagnosis as to the surgical or nonsurgical nature of the appendix upon
the state in which I found the inguinal glands. They serve as an
index to the pathological condition existing around the caccum and appendix.
As stated above, I almost hesitate to announce this
new method of diagnosis and suggest that you will not criticise too severely
until you have gone through a period of personal findings, and have satisfied
yourself as to the merit of the method. I shall not try to cover
in this article all of the diseases in which lymphatics are disturbed,
but simply refer to three or four disturbances, and leave it to you to
think over and experiment for yourself.
Going back to appendicitis, let me state that you
will first have to familiarize yourself with the various conditions found
in the inguinal region. It is well to always palpate carefully both
groins, first with the limbs extended, and then flexed. When the
limbs are extended, the glands, if present and enlarged, will present a
different feeling than when the knees are bent.
The subject has so many phases that I find it difficult
to describe in a brief article the thoughts that will bring out the most
striking features. About the first thing that you will suggest is
the question. How can you differentiate when there is a pelvic congestion,
such as when a right ovary or tube is involved, also, how can you distinguish
if there exists an infection of a venereal nature. To say that it
is easy would be foolishness, but to state that skill will follow long
research would be on a par with the statement that months of practice are
often necessary for the student to detect some hidden spinal lesions.
We are all quite familiar with the almost set type
of glandular inguinal enlargement found in gonorrhea, for instance.
The nodules are usually quite enlarged and often indurat ed. They
ebb and flow, so to speak, as the disease is acute and active, or subside
with lack of congestion in the sexual organs.
I will admit that one difficult diagnosis to make
is when appendicitis is conjointly found with venereal infection.
Should there be simple ovaritis or salpingitis, with no venereal infection,
we usually find a disturbed lymphatic condition, accompanied with certain
reflexes. Ovarian colic or cramps, or a hypersensitive hypogastric
plexus will enable the examiner to determine the presence of tubal congestion.
In a case of appendicitis, with apparently no complications,
if pus is present and the caccal area is involved, the inguinal glands
are found slightly elevated and their nodular surfaces under the skin readily
palpable. This condition I have almost invariably found and verified
by judging as to the advisability of referring the case to a surgeon on
the strength of the amount of nodulation.
In a test covering a period of four years, some seven
years ago, I treated three hundred and ten cases, with the result that
three had to be operated upon after a trial to reduce congestion.
That was a small percentage. At one time I was treating eight cases
that had been told to be operated upon within twenty-four or forty-eight
hours. This strain was not small, as I appreciated the significance
of the situation. Fortunately I was rewarded by bringing these eight
cases out of danger and I followed up the acute attacks with corrective
work. I relied entirely upon my diagnosis in relation to the inguinal
In the March number of the A.O.A. JOURNAL, 1916,
there is a colored plate showing the lymphatic glands of this region.
The breast region is also a most significant one,
in that the axillary region is so directly concerned. Surgical operations
for removal are so very common that one almost wonders where it will end.
It is not uncommon to find lumps or swellings in one or both breasts.
The significance of these tumors depends upon the amount of lymphatic involvement
of a general nature.
If you will carefully trace the channels back to
the axilla in relation to the pectoral muscles, you can quite readily determine
the amount of glandular involvement. If the axillary region is comparatively
clear of nodules, and there seems to be no particular blocking of the connecting
channels, it is usually safe to say that the lumps found in the breast
are not of a malignant type, and may be reduced indirectly by corrective
work. As a rule, malignancy of the breast follows axillary warning
of some duration. Traumatic injuries of the breast should be attended
to at once, as the tendency is toward circumscribed induration, with secondary
Possibly the most patent instance of lymphatic abnormality
is found in the throat.
We are all familiar with the “kernels,” “lumps,”
and peculiar nodular enlargements found in children as well as in adults
accompanying various epidemics and tonsillar infections. In children
we have a range of swollen glands, from those found preceding measles,
chickenpox, etc., to those noted in scrofular and tubercular diseases.
Accompanying a simple rhinitis we often note a marked disturbance, while
in tonsillitis, even in the adult, there may be a most aggravated lymphatic
One more instance and we will close this abbreviated
The final reference is to septic infection of the
lymphatics of the popliteal space by absorption of material, including
perspiration, dirt, and dyes from stockings, through soft corns and skin
abrasions between the toes. We are all familiar with blood poison
and lockjaw from plantar punctures by rusty products, with dirt and cloth
carried into the wound. The resulting symptoms may include lockjaw.
Examining carefully the popliteal regions, in all
cases where a general examination is made, I have frequently observed enlargement
of these glands when this space should be comparatively clear. Upon
removing the stockings or the socks, as the case may be, I have found in
a number of instances skin abrasions between the toes. Through these
cracks or denuded slits perspiration, dust, or dyes are constantly being
absorbed, and the resultant effect is noted upon the nodules in the space
behind the knee. After instructions, and the careful healing of these
tissues between the toes, I have noticed the disappearance of the nodular
This last reference does not pertain to the diagnosing
of a hidden trouble, as in the instance of pelvic and breast involvement,
but carries out my idea that infection of a part is invariably manifested
by nodular interference at the nearest gland center.
Some other time I may write on other findings, especially
the determining of the degrees of tuberculosis by lymphatic enlargement,
according to the region of the body diseased, but I have given you my ideas
in part as to the possibilty of diagnosing more accurately the degree of
infection or accumulation of toxic products by lymphatic manifestations.
A LYMPHATIC EXAMINATION
This is an innovation. We have been accustomed
to general and special examinations, but to set out to make a lymphatic
examination is a new departure.
We have made a chart blank that outlines the points
where the physician is most likely to find lymphatic variations and disturbances.
First of all, let us consider the lymphatic system
as a whole--a general circulation, yet subsidiary to that of the vascular
We find that there is a field for applied anatomy
of the lymphatics just as of other tissues of the body. We find lymph
blockage and nodular enlargements, hyperplasia and adenitis, also in some
instances a backing up and a reverse in the flow of lymph. This has
been described in connection with the gastric lymph vessels by noted surgeons.
PLATE 1. Seven points of
palpation in making a lymphatic examination.
There is an ebb and flow, so to speak, in the lymph
stream. To illustrate this point we will note that when there is
mesenteric blockage or pelvic lymph nodular adenitis a corresponding disturbance
is found in the lymph areas of the popliteal space; also a slight edematous
condition in the ankles, usually on the outer side just in front of the
external mallcolus. Again, we note where there is a puffiness above
the clavicles, on one side or both, a corresponding blockage of the lymph
stream exists either at the emptying point of the thoracic duct and right
lymphatic duct, or we will find an over-burdened thoracic duct from too
much tension or too great an accumularion of lymph. The system is
constantly trying to clear itsself and the clearing house is partly made
up of the lymphatic system.
Again we note a puffiness around the eyes.
There is a cause for it. If we trace the lymph stream, we will soon
discover that there is a blockage in the cervical nodes, or possibly the
submaxillary, or nodes in the parotid region. There may be lesions
causing tensed muscles that prevent a free drainage. In all of the
lymph nodes and vessels in the throat and neck there is a possibility of
There is also a possibility of lymph obstruction
through the enlargement of the salivary glands or a subluxation of the
mandible or hyoid bone. The puffiness of the eyes may be due to over-burdened
kidneys, and an enlarged liver. Disorders of the spleen may also
cause it when the system is loaded with toxic products and elimination
is faulty. We may look then for a lymph stream blockage and puffy
areas in certain regions. Thus we see it is well to examine for areas
of lymph obstruction where there are evidences of edema.
Now that we have this viewpoint in mind, let us proceed
to make our lymphatic examination. With the blank before us, we will
start always at the emptying points of the lymph tubes or ducts.
On both sides these ducts empty into the subclavian veins. If the
drainage is fairly perfect there will be no puffiness above the clavicles.
If there is a blockage or over-loading, we will observe edema.
Let us take the presence of edema on the left side
and work out our examination and diagnosis. The second point we will
note will be the axillary region (No. 5). Note any nodular enlargement
or adenitis, and if present trace out the cause. See if there has
been a recent scratch or abrasion of the skin on arm, forearm or hand.
If there has been, note the presence or absence of pus or even a blister.
Also note the vasomotor tone in the entire arm. Cold hands affect
the lymph stream. Should there be signs of a recent vaccination or
serum injection, determine the amount of axillary adenitis that existed
at the time.
Next, palpate over the mammary region and note enlargement
of nodes and extent of induration if present. Connect up the arm
and pectoral regions, lymphatically speaking, and determine which area
was first affected and to what extent.
Note carefully what quadrant of the breast is nodulated,
and whether they are deep seated nodes or superficial. Go over the
thoracic vertebrae and costal areas, and determine the number and significance
of lesions. Adjustment of vertebral and costal lesions may clarify
the nodular enlargement if no abrasions or recent vaccine or serum injections
have taken place. We will go back to the neck now and palpate for
superficial and deep nodular enlargements (No. 6). Note presence
or absence of goitre, and determine if there have been recent symptoms
of laryngitis or pharyngitis. The presence of muscle tension and
venous stasis will be of value in tracing the lymph blockage. Corresponding
bony and muscular lesions may be found, and lymph nodes enlarged to the
extent of irritating the nerve cords in the neck. If there exists
any congestion of tissues due to tonsillitis, abscessed teeth or sinus
infection, note the effect on the cervical lymph nodes. Determine,
if possible, the amount of lymph suspended and retained in the vessels
and nodes at all points above the hyoid region (No. 7). After testing
and palpating the various nodes and edematous areas, including the tonsillar
and faucial areas, try and determine the relation of this blockage to that
found in the terminal area, back of and above the clavicles.
Again, we note the lack of drainage, if present,
from the bronchomediastinal trunks. Following bronchitis or a pleuritic
infection, there may be a difficult drainage that will reflect itself upon
the tissues above the clavicles. How often in throat and bronchial
troubles we note not only cervical nodular enlargement, but that peculiar
puffiness above the clavicles which is so hard to reduce unless we reason
out just why this blockage exists, and drain the lymph vessels.
In this brief chapter we must necessarily point out
only a few of the cardinal points. A thorough examination including
all applied anatomy findings would fill a book.
We will recall our anatomy teaching regarding the
collection of lymph on the two sides. This will explain the suggestion
just made that more often we find edema in the left supraclavicular region.
The epigastric region we will next discuss briefly
(No. 4). The liver, from a lymphatic standpoint, is more significant
than the spleen. The tendency of the liver to enlarge and become
torpid and sluggish makes lymph drainage uncertain. Part of the liver’s
drainage is above, and eventually empties into the right lymphatic duct
or indirectly into the thoracic duct in part. The principal lymph
vessels drain into the thoracic duct along with the drainage of the stomach.
If the patient is thin, you will observe on palpation
a peculiar enlargement of the receptaculum chyli when the knees are flexed.
Sometimes you can palpate the larger nodes and you can press the abdominal
aorta so readily against the receptaculum chyli that you can cause the
pulse beat to fluctuate. I have palpated the receptaculum chyli when
it could almost be picked up with the finger tips in a thin person when
there was a heavy mesenteric blockage.
Splanchnoptosis and venous stasis combined with ovarian
congestion or appendicitis, will soon prove to you the great amount of
blockage that takes place in the receptaculum chyli and thoracic duct.
In pelvic congestion the nodes are markedly enlarged,
as you will determine by special local examinations, vaginal and rectal.
The inguinal glands (No. 3) will reflect not only pelvic congestion but
appendicitis. The lymph blockage of the mesenteric glands and in
the receptaculum chyli will reflect itself upon the inguinal glands by
a blockage of lymph.
Lastly, we will go briefly over the lower extremities.
Palpate over the popliteal space (No. 2) with patient on the back, and
then with patient standing. You will find a new viewpoint when you
make this double test.
Look for varicose veins, even small ones; also palpate
the calf muscles deeply between thumb and fingers and determine presence
or absence of stasis. Recently I noticed a lymph disturbance in inquinal
region due to a bruise on the thigh; also a popliteal lymph enlargement
due to a soft corn. Go over the ankles (No. 1) and look for any swelling
that would indicate a lymph blockage higher up. Again, note vasomotor
tone in blood vessels and observe the effect upon the lymph nodes in popliteal
and inguinal regions.
1. For every congested tissue there is a corresponding
2. Wherever pus is present there is enlargement
in the nearest nodes.
3. An abscessed tooth or even a pimple
or small boil will reflect itself on the nodes.
4. The lymph stream ebbs and flows according
to the amount of blockage and nodular enlargement at certain points.
5. Edema is significant of lymph blockage.
6. Nodular enlargement is not always between
the terminal lymph drainage and distant disturbance.
7. There may be a backing up of lymph and
a reverse flow in spite of the numerous valves.
8. Collateral lymph circulation may take place
when indurated nodes or blocked lymph channels exist.
9. There is a direct and an indirect vasomotor
control of the lymph stream.
10. Enlarged nodes may irritate or over-stimulate
11. Vaccines and serums are as direct causes
of nodular involvement as poisons taken into the system.
12. The lymph stream must always be drained
first through the terminal areas.
13. Attempts to clear the lymph stream before
clearing the edema in the clavicular regions is to over-tax the general
lymph stream and cause profound reactions.
14. Any permanent results in treating the
lymphatics must be acomplished through the nerve centers that control the
vasomotor nerves of the blood vessels in the same region as the lymph blockage.
15. Never work over an enlarged or indurated
lymph node---free the efferents and the lymph will drain.
16. General exercises will stimulate lymph
flow, but if there is marked lymph blockage it is better to relieve the
lymph tension before exercises are given. This will save marked reactions.
17. In treating the extremities, see that
the axillary and inguinal regions are cleared first.
18. The only way to clear bronchomediastinal
lymph blockage is through cervical and thoracic adjustment. Deep
control can only be reached in that manner.
19. Indurated nodes may never reduce.
Establish drainage and collateral flow will follow.
20. Note from time to time the various accessible
lymph areas in any and every organic disturbance.
21. Learn to palpate nodes in every region
where they are accessible.
VENOUS STASIS AND LYMPH BLOCKAGE
In school we used to spend a few days on the subject
of lymphatics. Five years from now, or less, students will receive
daily instruction on this subject. It will be embodied in texts on
applied anatomy, and each organ and area will be considered from a lymphatic
standpoint. Under the discussion of every diseased organ or tissue
a few paragraphs will be included referring to lymph drainage. We
have devoted much time in the past to a study of the vascular system in
all its details, but have neglected to a great extent the tracing of lymph
flow and in accounting for edematous areas that indexed the amount of venous
stasis and lymph blockage that existed. We have paid so little attention
to the lymph stream that we have not gone beyond a few findings in two
or three regions, usually the cervical, axillary and inguinal.
Let us spend a few minutes going over the principal
findings that should be included in every examination, and at every treatment.
In the first place, wherever there is venous stasis there is bound to be
We will take the mesenteric region first. We
recall the innervation and vasomotor control of the vessels in this area.
With the osseous lesions that may cause an interference
with peristaltic action, secretion and vasomotor control, we are familiar.
If there is ptosis and stasis we must naturally expect lymph blockage.
The receptaculum chyli that drains this region is readily blocked when
the above conditions exist. We cannot expect to correct these changes
in blood and lymph streams unless we first of all correct the ptosis.
Organs that have sagged cause pressure on vessels and lymph channels.
Neither can we expect to free lymph drainage unless there is a normal thoracic
duct passage. If there exists a puffiness back and above the clavicle
on left side we must see that the edema is reduced before we attempt drainage
at a point in the region of the receptaculum chyli. This will necessitate
correction of lesions from the cervical area down to the pelvis.
It would be useless to correct cervical and thoracic lesions if a sacrum
was tilted sufficiently to cause an unbalanced spine. We must also
work to restore normal impulse to the mesenteric vessels in order that
venous stasis will disappear. Normal relations will come about only
by correction of all lesions causing ptosis and misplacement. A sagged
stomach dragging over the thoracic duct and receptaculum chyli will interfere
with lymph drainage.
Venous stasis must be cleared up by securing first
of all a normal liver condition. Any lesions affecting the various
functions of the liver will check the clearing of the veins and lymph vessels.
It is in this region that we find the many tumors, benign and malignant.
The lymphatics are involved, the nodes enlarged, and lymph vessels obstructed.
If you want to see this object lesson make a few post mortems in cancer
of stomach or associated parts and observe the lymph blockage.
While venous stasis is relatively important, yet
we believe lymph blockage the more significant in foreign growths and in
While venous stasis may precede lymph blockage, yet
it is the lymph disturbance that spells disaster to the tissues.
In the final analysis the veins are much less important in relation to
a pathological phase than are the lymph vessels and nodes. It is
easier to re-establish venous drainage than lymph drainage.
The nodes once enlarged and indurated are not easily
reduced. True, the lymph vessels have valves more numerous than the
veins, but they also have a lesser calibre and the lymph flow is constantly
checked by the flow through the nodes. While some nodes have vasomotor
nerve fibres, the blood vessels are much better supplied with these fibers.
Thus we have to contend in lymph blockage first, with a venous stasis that
must be cleared, then a lymph drainage that must include a reduction of
the nodes when enlarged, and a free lymph flow at the terminals of the
lymph ducts. The blood vessels that supply the nodes may have vasomotor
nerves, but we must depend in freeing the lymph stream upon indirect vasomotor
control through the nerves to the vascular system. The vasomotors
to the nodes are not constant. Again, in order to clear the lymph
stream in the mesenteric region, we must consider the possibility of an
unusual lymph flow from the pelvic region. If this exists there will
be found an additional tax upon the receptaculum chyli from the lymph below,
and this additional burden upon the thoracic duct in cases of pelvic disturbance
will make mesenteric drainage more difficult.
Normally, the receptaculum chyli and afferent ducts
are sufficiently taxed, but abdominal and pelvic venous stasis will overtax
the lymph stream in every instance. This will reflect itself upon
the lymph drainage of the various organs in this region and only the insurance
of a normal venous and lymph flow will clear the area and remove the tax
upon the lymphatics of the receptaculum chyli.
The majority of ailments of the human body have their
beginning in the epigastric region. A sluggish, inactive liver may
start a stasis and lymph blockage that will reflect itself upon not only
the immediate organs and tissues but, by blockage, prevent pelvic drainage
of the lymphatics. We will then note a little puffiness in the ankles,
a similar condition back of the knees in the popliteal spaces, and unless
we free the ducts and chyli nodes, the edema will persist.
It is easy to block drainage below the second lumbar
segment. An obstructed alimentary tract will produce lymph blockage
very nicely. A lessened vasomotor tone will also block the lymph
vessels and nodes when venous stasis is present.
There must be tone and there is only one way to get
tone, and clear the congestion, and that is by good technique and specific
You will recall the peculiar vasomoto control in
the mesenteric region. The second relay, so to speak, to give extra
impulse to the mesenteric vessels. This will call for lesion findings,
and corrections higher up than is usually found in other organic disturbances.
It is well to re-read anatomies occasionally and
keep in mind the nerve centers that control the vasomotors. It is
through these nerves that we make headway in clearing stasis and secondary
In this brief chapter we can discuss only one region, but
we have tried to emphasize a fact that may be applied to any lymph area, namely,
that a venous stasis will invariably cause a lymph blockage. We have not
included in this chapter conditions where lymph obstruction maya be primary,
such as direct poisoning of the system through introduction of vaccines, serums,
or ptomaine substances. This phase of the subject must be dealt with from
a different angle.