Applied Anatomy of the
F. P. Millard, D.O.
LYMPHATICS OF THE ABDOMEN AND PELVIC REGION
Lymphatics of the Diaphragm
While there is a free anastomosis between the plexuses
of lymph vessels on the thoracic and abdominal surfaces of the diaphram,
yet the drainage vessels collect from above and below. The diaphragm
occupying a dome-shaped area of considerable extent empties its lymph on
the thoracic surface into the lymph nodes that lie in the various adjacent
regions. The pleural sac contains lymph vessels that communicate
freely with those of the thoracic surface of the diaphragm. The lymph
vessels are more numerous at the points of contact of the pleura and diaphragm.
Thus the lymph vessels in the region of the aorta,
where it passes in relation to the diaphragm, enter these nodes, while
the esophageal nodes collect from a more central portion, and the sternal
nodes from the anterior vessels. Two of the three areas mentioned
contain nodes that join or help to form the mediastinal drainage system.
The drainage of the thoracic surface of the diaphragm will depend upon
the normal functioning of the nodes on the aorta and esophagus first, and
upon the mediastinal nodes second, before the final efferents enter the
subclavian veins. The anterior area is drained by the nodes behind
the sternum and costal cartilages. These nodes give afferents to
the internal mammary chain of nodes that follow the course of the internal
mammary artery. We see then that a portion of the thoracic lymph
drainage of the diaphragm is collected by the lymph vessels and nodes lying
behind the sternal ends of the ribs and a portion is collected by the mediastinal
nodes that lie in relation to the aorta and posterior mediastinal glands.
The attachment of the outer border of this drum-head-like
muscle membrane suggests the possibility of costal lesions affecting its
vascular and lymph drainage. The nerves to the diaphragm are given
off high up, in the cervical region, and lesions in that area may disturb
its innervation. The most probable and most likely disturbance of
the lymph flow in the diaphram is through the lymph vessels in the pleura
The presence of septic conditions in the pleura will
affect the lymph stream in the diaphragm. The portion of the pleura
adjacent to the diaphragm is drained by common efferents. While this
is only a small portion of the pleura, yet we find in septic conditions
a great amount of lymph blockage and nodular enlargement.
The correction of costal lesions and the regulation
of the circulation will clear the lymph stream unless there is a great
amount of septic poisoning. The abdominal surface of the diaphragm
on the right side is in contact with the liver and the communicating lymph
vessels are numerous.
The subperitoneal tissue vessels also anastomose
at the periphery of the diaphragm with its lymph vessels. Here we
may again have septic infection through the lymph vessels that anastomose
so freely. The aortic nodes collect the lymph on the right side.
There are also a few nodes on the inferior phrenic artery.
The esophageal nodes, also aortic, collect lymph
from the diaphragm on the left side. The esophageal nodes are near
the stomach end of the tube. The aortic nodes are to the side and
in front of the artery. These nodes have efferents leading directly
or indirectly into the receptaculum chyli or lower portion of the thoracic
The liver if diseased will reflect its disorder upon
the lymph vessels and nodes that drain the diaphragm. Thus we see
the diaphragm lies in a position that allows of septic infection through
the pleura, diaphragm and subperitoneal tissue.
Unless there is a malignant condition in the adjacent
organs and tissues the lymph flow can be regulated through correction of
lesions and the re-establishing of lymph and blood flow. If there
is malignancy it is better to not attempt drainage.
PLATE XVIII. The terminal
drainage of the liver through the three-fold channels. -- (1) Internal
mammary chain. (2) Mediastinal lymph drainage. (3) Nodes near
inferior vena cava. (4) Thoracic duct. (5 & 6) Lymph
channels from nodes back of ensiform cartilage. (7) Receptaeulum
Lymphatics of the Liver
As pointed out in the lymph drainage of the lungs
and pleura, also of the diaphragm, the collecting lymph vessels drain areas
according to the portion of the organ or tissue that is approximate.
The liver, having a great surface and occupying a position that for convenience
sake we will call horizontal, necessarily must have a lymph drainage that
will be divided into parts corresponding with the mediastinal divisions.
To make it simple to the student, we will state again that lymph drainage
usually follows lines of least resistance, so to speak, and that place
is along the course of vessels or of tubes. The hepatic veins lead
to the inferior vena cava and we find the lymph vessels from the posterior
surface, both deep and superficial, follow along this path. These
collecting vessels pass to the nodes around the uppermost part of the inferior
vena cava and communicate with the posterior mediastinal nodes. You
will remember the short terminal distance the vena cava has after receiving
the hepatic veins, also the relation of the vena cava to the posterior
mediastinum. The convex surface of the liver that is in relation
to the diaphragm has at a few places lymph vessels common to both and we
find the nodes on the anterior superior surface of the diaphragm behind
the ensiform cartilage collecting lymph for the internal mammary nodes.
The under surface of the liver and the bile ducts
have lymph vessels that pass to the hepatic nodes and pericardial nodes
of a chain that supplies the gastric lymph area. The lymph vessels
in the esophageal opening of the diaphragm convey lymph from portions of
the liver in that region to the gastric chain of nodes. These are
also in communication with the lymph vessels of the pancreas. Thus,
we have the lymph vessels passing along the hepatic veins to nodes on the
vena cava inferior, others passing through the diaphragm near the front
to enter the anterior mediastinal nodes that form a part of the internal
The lymph from the under surface of liver is collected
by tributaries of the receptaculum chyli directly or indirectly.
These latter vessels follow the hepatic artery, bile ducts, portal vein,
and through the hepatic nodes. This arrangement makes the lymph drainage
simple to understand; the hepatic veins, inferior vena cava, esophagus,
hepatic artery, bile ducts and portal vein are all followed by lymph drainage
vessels. The lymph vessels pass through the diaphragm at three points.
The inferior vena cava opening, the esophageal opening and direct traversing
of the diaphragm at the anterior portion to reach the nodes behind the
This three-fold system of lymph drainage has various
points of termination. The lymph vessels that follow the hepatic
veins and inferior vena cava are received by nodes that are in the chain
of the posterior mediastinal node group. These nodes have terminals
in the right lymphatic duct unless, as sometimes is the case, they have
separate terminals in the subclavian vein. The second drainage point
is through the internal mammary nodes that have final efferents into the
subclavian vein or the larger right lymphatic duct; the third drainage
vessels are those that are collected in the receptaculum and its tributaries
to be conveyed by the thoracic duct.
PLATE XIX. Lymphatics
of the surface of the liver.
To summarize the drainage: there are, first, the
right posterior mediastinal; second, the right internal mammary chain;
and third, the thoracic duct collecting lymph from the liver through hepatic,
gastric and pancreatico-duodenal nodes in the region of the receptaculum
In diseases of the liver we have then three different
sets of lymph vessels conveying toxic or possibly septic products.
The internal mammary chain of nodes may be blocked or enlarged. This
will interfere with the collecting of lymph from the anterior intercostals
and the inner surface of the breast, as well as from the deeper areas of
the anterior thoracic wall which includes the portion of the pleura in
The posterior mediastinal nodes receive lymph that
has followed along the lymph vessels in relation to the hepatic veins,
and inferior vena cava. Should there be an enlarged condition of
these nodes through lung affection, or from any congestion or infection
of the various tissues and organs drained by these nodes, we will find
the liver flow checked. This may cause other lymph vessels in the
liver to take up in part the work of lymph drainage.
The third drainage point is through the thoracic
duct and here we may find the greatest amount of blockage. The hepatic
nodes, the gastric nodes, and the pancreatico-duodenal nodes receive and
convey to the thoracic duct a large part of the liver’s lymph. In
gastric disorders, not necessarily malignant, we may look for enlarged
nodes, also in disturbances of the pancreas. There may be lymph blockage
from a gastro-duodenal ulcer. All these may reflect upon hepatic
The lymph vessels of the liver are numerous and are
divided into the superficial and deep, but they all pass through the three
sets of terminals outlined above. Eventually they reach the subclavian
veins. In malignancy the liver may convey septic products through
any of these three separate channels. The puffiness above the clavicles,
including involvement of the supraclavicular nodes, mentioned by Osler,
as occurring through the internal mammary chain, is not as likely to occur
as in the more direct involvement through the other two drainage systems.
The posterior mediastinal collect hepatic lymph more direct than does the
internal mammary chain and the vessels are from a deeper portion of the
liver. These mediastinal nodes send efferents that have a terminal
similar to that of the internal mammary chain of nodes and the involvement
of the supraclavicular nodes of the former is much more likely. The
thoracic duct drainage of the liver lymph is less direct as the lymph must
pass through various nodes before being received by the thoracic duct.
There is a lessened chance of liver malignancy if
we keep the lymph drainage free. We have pointed out elsewhere that
the liver is the chief organ in systemic pollution--that in the majority
of cases the liver is involved primarily and the other organs are affected
secondarily. If the lymph drrainage of the liver is blocked it is
only a short time before some other organ will take on a diseased condition.
The three drainage systems from the liver include the three systems that
also drain the major portion of the body’s lymph.
The right mammary chain of nodes collects the lymph
of the liver from a small area only. The left mammary chain may receive
part of this as the two chains are connected by lymph vessels, but Osler
refers to the involvement of supraclavicular nodes on the left side in
particular. We find the right side is the important one as the right
chain conveys most of the lymph from the anterior diaphragmatic nodes through
the nodes back of the ensiform cartilage.
The right broncho-mediastinal trunk likewise collects
some lymph from the convex surface of the liver. Very little lymph
from the convex surface of the liver reaches the left subclavian.
The liver has so many vessels and ducts that the
lymph stream is well conveyed, but at the same time, there is no organ
that blocks itself quicker than the liver. The many functions of
the liver and the receiving of the portal vein with its vast distribution
and the hepatic veins collecting and emptying into the vena cava, along
with the biliary ducts carrying bile into the duodenum, gives us an insight
into the lymph vessel blockage that may occur if this organ becomes diseased.
The hepatic artery supplying the liver has vasomotor regulation and indirectly
the lymph stream is augmented by the normal tone of the artery and its
branches. The better the blood circulation the better the lymph flow.
Thoracic lesions that interfere with the blood flow to the liver will cause
a lymph retardation through the organ. Lesions that interfere with
the lymph vessels and nodes between the liver and the subclavian veins
must be corrected if we expect good lymph drainage. The left subclavian
collects the major part of the liver’s lymph; the right lymphatic trunk
only part from its convex and posterior surface.
We must look to the left postclavicular area for
thoracic duct drainage. Cervical lesions, first rib, or clavicular
subluxations may have a bearing on the liver’s lymph drainage. We
usually think that we reduce an enlarged liver or restore its various functions
to normal by the correction of thoracic lesions at the nerve centres to
the liver, but we must not overlook the lymph drainage which has its terminals
through three different courses before it reaches the subclavian veins.
Lymphatics of the Stomach and Intestines
In the cardiac lymphatic system we spoke of the lymph
flow being accelerated by a constant moving of the lymph vessels located
in an organ that is beating almost continuously. In the stomach we
have lymph vessels in and on the walls of an organ that has a churning
movement and is capable of great expansion through its contents as well
as by the presence of gases. The stomach has a goodly number of nodes
lying between the folds of the omenta, as well as being distributed around
the cardiac end of the stomach, the pericardial, also the pyloric end,
The mucous membrane lymph vessels pass to the sub-mucous.
Collecting trunks pierce the muscular coat in the lesser and greater curvatures
and these afferents are received by the gastric chain. Efferents
from the gastric enter the preaortic nodes of the coeliac group to enter
the receptaculum chyli as separate trunks or as the combined channel known
as the intestinal lymphatic trunk.
After all, the lymph drainage of the stomach as well
as of the spleen and pancreas eventually is collected by the coeliac group
of nodes which lie in front of the aorta in relation to the coeliac axis.
The main lymph nodes and vessels, as in the other organs, lie along the
course of the blood vessels. The lymph drainage of the stomach is
such that certain areas are drained quite independently of others.
This is of value when there is a pyloric diseased condition, the fundus
of the stomach may not be blocked or involved. The splenic nodes
receive a part of the stomach’s lymph along the splenic artery Again we
will note, as in cancer of the breast and other organic infectious areas,
there may be a regurgitation of lymph.
In treating the stomach for a better lymph flow,
we will find it necessary to work with the view of, first, a free thoracic
duct drainage by keeping the terminal clear in the clavicular region, and
second, by a free lymph flow in the coeliac region.
PLATE XX. Lymphatics
of the Stomach. -- (1) Cervical node. (2) Tracheal nodes. (3)
Thoracic duct. (4) Mediastinal efferents. (5) Bronchial nodes.
(6) Aortic nodes. (7) Esophageal lymphatic vessels. (8)
Left Pericardial nodes. (9) Right Pericardial nodes.
(10) Right gastro-epiploic nodes. (11) Gastric and pancreatic nodes.
(12) Subpyloric nodes.
The vasomotor control of the gastric blood vessels
will help to clear the lymph vessels and nodes. Should there be lesions
that cause gastric atony we will expect lymph retardation.
Gastroptosis will prevent gastric lymph vessel efferents
from clearing the lymph spaces. As the lymph vessels of the stomach
have a common duct drainage with the spleen, pancreas, and mesenteric area,
in some instances we must try and determine the amount of blockage that
already exists when there is stasis or ptosis of the abdominal viscera.
The receptaculum chyli is quite protected by the abdominal aorta and if
no aneurism exists or thickened tissues in this region the most important
lymph area to note will be that of the preaortic nodes. The reduction
of lesioned areas that control the blood vessels that supply and drain
the gastric area is of primary importance. On first thought, the
student may picture the receptaculum chyli as lying in front of the aorta
and subject to gastric pressure and even contact, but we will remember
the relation of the aorta to the receptaculum chyli and note that it is
the ducts leading to it that are subject to compression and blockage.
The diaphragm may be drawn unduly by cervical lesion affecting phrenics,
and by lumbar or costal lesions, and this may affect the lymph flow to
some extent. The thoracic duct follows along the aorta in its relation
to the diaphragm, but lies in a position that is more subject to vertebral
lesions. The great proposition in abdominal lymph drainage is one
of stasis and ptosis. The entire alimentary tract may have a ptosic
expression, a general visceroptosis.
About 90% of white people are constipated.
The vast majority are slaves to laxatives. Some take oil, others
anything from senna to salts. It is easy to reason out the effect
constipation has on the lymphatics. The great receptaculum chyli
with its numerous tributaries is in a constant state of over taxation.
Ptosis and venous stasis are inevitable. The lymph vessels and nodes
in the mesentery are chronically enlarged and overburdened. The dragging
down of the transverse colon, including the hepatic and splenic flexures,
interfere with the drainage of the lymph in the reservoir. Auto-intoxication
includes lymph retardation. Toxic accumulation is obvious when ptosis
or stasis is present.
Splanchnoptosis is one of the vital causes of lymph
blockage. The vasomotor control of the abdominal viscera normally
is possibly one of the best arranged systems in the body.
PLATE XXI. Lymph drainage
of the caecum and appendix. The ileocaccal, enterior caecal
nodes and vessels are shown, also the node of the appendix.
The vasomotor nerves in the visceral vessels are
more elaborate than found elsewhere. The preganglionic fibres are
longer and are not supplanted by the postganglionic fibres until the solar
plexus is reached. This gives unusual tone to the vessels given off
from the abdominal aorta. But ptosis alters this normal condition
and we find not only a lack of tone in the vasomotors, but a faulty innervation
impulse in the peristaltic arrangement and control. The sagging of
the bowels produces stress upon vessels, nerve and lymph channels.
No organ or tissue remains normal where there is
an altered position in the respective regions. Perfect tone is found
where vascularization and innervation remains unimpaired. If the
intestines are sagged out of normal line the mesentery is likewise malpositioned
and the lymph vessels are not free to carry away their load of lymph.
There is only one method of correcting stasis and
ptosis, and, thanks to the osteopathic technique, we may by adjustment
relieve the stress and restore the sagging viscera. We find the spinal
column a container of these nerve impulse centers that control not only
the circulation but the nerve tone and vermicular action of the alimentary
tract. We must look to the correction of lesions and scoliotic conditions
for a remedy in abdominal disturbances.
First we must correct innominate lesions, if they
exist, as it is useless to attempt spinal correction with the expectancy
of permanent results without first having the foundation of the spine in
perfect alignment. The sacrum must be true to its axis in relation
with the innominates. A tilt of the sacrum may be detected when least
expected. The limbs must be of equal length, unless a previous break
or faulty malnutirion has shortened one. Perfect alignment of osseous
tissue first is necessary.
Various vertebral and lower costal lesions, so often
found in ptosis, must be corrected as nearly as it is possible before we
may expect a free flow of lymph. The region of the diaphragm is also
very important. An enlarged liver, spleen or pancreas with gastroptosis
must command consideration before we attempt to secure a normalization
of the transverse colon.
In order to reach the innervation and vasomotor control of the
organs and tissues that are within the region of the diaphragm we must
need look higher up for costal and vertebral lesions. This reverts
to the statement that the entire framework must be in perfect alignment.
Just recently I assisted in an autopsy which gave
me additional data. The case was of peculiar interest as I knew the
subject had been given serum treatment for a duodenal growth. We
spent some time in this post mortem and I examined with care the state
of the lymphatics. Each organ below the diaphragm was overhauled
to determine the amount of lymphatic involvement. It was almost beyond
comprehension. I never knew so many nodes existed. Every node
seemed enlarged and indurated. The jaundiced condition due to duct
blockage, and the gastric outlet almost beyond recognition was surrounded
by a lymphatic enlargement and nodular retention that had defied correction.
PLATE XXII. -- The lymphatic
nodes, in some regions, not only contain vasomotor nerves but have
definite nerve plexuses. The mesenteric nodes lie in relation to
the vessels and are more numerous in diseased visceral areas than
is commonly thought. The vasomotor arrangement of the mesenteric
arteries is shown in relation to the cord and sympathetic nerve chain.
Just today I examined a woman with hepatic congestion
and biliary obstruction that showed, on palpation, the abnormal condition
of the lymph glands.
If one is sufficiently interested in lymphatics to
carefully palpate in every accessable region, it is astonishing how the
condition of the nodes will index the patient’s complications.
We have called attention to the fact that no organs
containing lymphatics can be involved without a corresponding lymphatic
disorder. We may not be able to palpate the lymphatics in all abdominal
organs, but in many instances we can learn to detect enlarged nodes or
In a measure we can estimate the amount of lymph
blockage by the degree of ptosis. We can also determine to a certain
extent the lymphatic involvement by the torsion in the duodenum when gastroptosis
The question of lymph regurgitation in gastric trouble
is verified in operations for duodenal and pyloric constrictions.
The relation of the kidneys and suprarenals to the
cisterna chyli is also significant. The pancreas, with its peculiar
position and relation to the stomach and duodenum, gives us an insight
into the lymphatic disturbances found in gastric malpositions.
We have a lot to learn yet as to the real part played
by the lymphatics in their relation to the ductless glands, but we have
come to believe the physiological chemistry of the body is dependent upon
the state of the lymph. Faulty metabolism must include a blocked
lymphatic system at some point at least. The restoration to health
depends upon the degree of lymphatic vessel tone and freedom from obstruction.
The nerve centers that control the abdominal lymphatics
correspond in a measure to those of the vasomotors to the abdominal blood
vessels. Perfect alignment of osseous tissue and reduction of organic
congestion will clear the lymph vessels if ptosic conditions are remedied,
unless there is malignant trouble. Recently I examined a woman of
53 who complained of gastric disorders. Upon thorough examination
I discovered a growth in the region of the duodenum. X-ray confirmed
the diagnosis. The case was typical one of lymphatic engorgement.
The growth suggested malignancy. Upon reconsideration I decided to
pass the case up. The involvement was too great and if malignancy
existed it seemed too great a risk to overstimulate the lymphatics.
This case was an extraordinary one and in her atonic condition I felt justified
in not attempting what might prove a fruitless task. It seems wise
sometimes to give in to doubt rather than to face a defeat later and be
accused of spreading the toxins.
There is a limit to the clearance of lymphatic blockage
and it is well to know when to halt. An overtaxed system with constitutional
disorders of numerous phases may not be cleared even by the most dexterous
adjustment and correction. The lymphatics are sometimes so badly
complicated that to attempt to clear them may mean adding fuel to the fire.
I have admitted this point just to show how I feel in these severe cases.
But the ordinary cases, where no indication of malignancy is present ,
justify us in attempting at least to clear the circulation and lymphatic
glands of their load.
In this age when cancer is so prevalent it is well
to be on constant guard to detect growths or conditions that indicate an
incurable phase. We are laboring to clarify in our minds as nearly
as possible the state of the abdominal viscera in their various relations
to the benign and malignant classifications. This may not be possible,
but we can come nearer to it by study and research.
The lymph drainage of the appendix is of particular
value. There is usually at least a node which collects the lymph
from the afferent vessels. We have found that in appendicitis there
is an enlargement of the inguinal nodes of that side. This may be
accounted for in two ways. First, there is sufficient lymph blockage
in this region to cause enlargement of the cecal nodes. The mesenteric
nodes are also enlarged and through the tissue congestion and venous stasis
the lymph stream is checked by an overtaxed drainage centre, the beginning
of the thoracic duct. This reflects upon the emptying of the lymph
from the inguinal region and there is a blocking and enlargement of the
inguinal glands. This may be noted in almost every instance where
appendicitis is present. Second, there are lymph channels in the
inguinal region that have collecting tubes from around the appendix, but
not anastomosing. These lymph afferents are blocked or overloaded
through congestion and disturbed vascularization of the cecal area.
If pus is present in the appendix, the inguinal nodes are more readily
palpable. We have stated elsewhere that surgical resort may be determined
absolutely by the condition of the right inguinal glands. For years
I have based my final diagnosis in operable cases on this finding.
After all other tests are made, the index as to pus finding is determined
by the palpation of these nodes.
Lymphatics of the Kidneys
The kidneys lie in a position that is relative to
the beginning of the thoracic duct. The lymphatic vessels follow
the arteries, as usual, and are of more significance than usually ascribed
to them. The numerous lymphatic capillaries in the medulla and cortex
have an influence on the tubules. The vascularization of the kidney
substance aids the lymph stream in that there are more definite channels
than found in some organs. We find that a blockage of the lymph stream
in the region of the nodes that receive afferents from the liver, stomach
and pancreas reflects itself upon the lymph stream from the kidneys.
The blocking of preaortic nodes that receive lymph vessels from the kidneys
causes a blockage of the lymph in the cortex and medulla. The effect
upon the kidneys is marked, and we have noted that in certain kidney disturbances
that normal functioning did not return until the lymph stream was cleared
and allowed free drainage from the deeper lymph vessels. Again we
note the disturbance of the lymph flow when there is faulty innervation,
not only to the kidney blood vessels but to the nerve fibres to the tubules.
The lymph stream is influenced by the nerve supply to the vessels and tubules
to the extent of causing a variation in the flow of urine. The correction
of lesions that have caused instability of nerve tone brings about a more
normal flow of lymph, and the organ functions better. A lower costal
lesion may cause vascular and lymph irregularities of flow, and derange
the finer mechanism in the medulla and cortex of the kidney. Lower
thoracic vertebral lesions interfere with the renal plexus of nerves and
in this way bring about variations in the secretory cells.
We have noted in Bright’s disease that the lymph
stream was blocked decidedly, and that by indirectly influencing the lymph
channels through vasomotors to the blood vessels the change in the tubules
made repair quite satisfactory. Bright’s disease is to a great extent
a lymphatic disorder. The treatment should be to the end of freeing
up the efferent lymph channels in order that the kidney drainage of lymph
may be more complete. The collection of the lymph from the superficial
vessels is of less importance. The channels eventually end in the
nodes around the aorta and the lymph is collected at the beginning of the
thoracic duct. There are so many lymph nodes and vessels in this
small area that it is reasonable to expect an overtaxed condition of the
nodes if there exists any organic disease of any of the adjacent organs.
The blockage of the nodes and channels from the stomach or mesenteric region
will have its influence upon the renal lymphatics. Ptosis of the
stomach will also have a bearing. Correction of all lesions to this
area will relieve the kidneys and make the urine more normal in color and
quantity. We have never paid sufficient attention to the lymphatics
of the kidneys in the various diseases of these organs. While diabetes
is a constitutional disturbance, we find the liver and kidneys almost invariably
taxed and the renal lymphatics blocked. If you apply specific treatment
to the lymphatics in diabetes you will get good results. The hepatic
nodes and renal nodes, as well as the mesentery, must be kept free from
blockage. If they are blocked you will soon see it reflected upon
the drainage of the pelvis and even the inguinal and popliteal nodes.
The lymph drainage below the kidneys will not be normal if there is enlargement
of the nodes and blockage in the lymph channels in the region of the receptaculum
chyli. First we must work to secure good vasomotor control of the
branches of the abdominal artery, also the corresponding collecting veins.
If we secure this, we can reasonably expect an effect upon the lymph drainage.
The lymph vessels follow the blood vessels so closely that we can usually
aid lymph flow by vasomotor control of the blood vessels. We are yet to
determine just how extensively vasomotor fibres are scattered over the
lymph vessels that are so closely associated with the blood vessels.
We are inclined to believe that there is more influence brought to bear
than we have given credit for. A little further research work will
clear this point. We are also yet to determine just how much lymph
is collected in the veins over the body outside of the subclavians.
As mentioned elsewhere, we believe that in time we shall determine that
the entire venous system collects lymph at numerous intervals, as it seems
incredible that the entire lymph collection of the body should be confined
to the two veins in the base of the neck. If this reasoning is true,
it will account for the clearing up of the lymph stream when we secure
normal vasomotor control of the blood vessels. The close relation
of the lymph vessels and nodes to the veins in many instances allows for
collection of lymph in the veins at various point in minute quantities.
This is a solution to the problem of the lymphatics in various conditions
where there is a lymph blockage and an edematous condition.
PLATE XXIII. The lymnphatics
of the kidneys.
The lymph drainage of the kidneys is most important
in any and every systemic disturbance. The degree of normal functioning
of the kidneys means the blocking or clearing of the other tissues and
organs. Specific treatment to increase lymph flow in the vessels
leaading from the kidneys is most essential.
The internal secretions are influenced by the lymph
more than in any other way. Every organ has a blood supply, and along
the vessels we find lymphatics with few exceptions. In order to stabilize
the body metabolism we must secure perfect lymph drainage. This will
allow ductless glands as well as all glands and tissues to put forth normal
secretions. The nodes must be kept reduced to normal size and the
lymph channels free. There are enough palpaable glands to serve as
an index to internal systemic disorders. No organ or ductless gland
can be involved to any great extent without reflecting its disturbance
and blockage on some palpable area. We must look for edematous areas.
There are cetain areas that denote specific organic lymph blockage.
The watching of these regions that are prone to “puff” is very essential.
Learn to detect “puffy” areas. They may exist on most any part of
the body. There may be zones that are puffy and cool to the hand.
Trace out the lymph drainage and you will locate the organs with blocked
If the kidney lymph drainage nodes are blocked you
may find a general edema over the kidneys in the back, or it may be reflected
on the abdomen over the beginning of the thoracic duct. Next go above
the clavicles and note any edema, and by comparing the three areas you
can pretty well decide the drainage of the kidney lymph. If there
is a splanchnoptosis present it will be necessary first of all to correct
lesions that will allow a return to normal position of the viscera.
General alignment will be necessary from the arches of the feet upward
to the atlas. General vasomotor tone of the body will greatly accelerate
lymph flow. Specific work in one area will not always clear the trouble.
The lymphatic system must be considered in its entirety, and we must work
to the end of freeing the lymph channels, nodes and ducts in order to reach
some specific organ or tissue.
Lymphatics of the Pelvic Region
The organs in the pelvic basin are subject to great
stress when innominate lesions exist, and such lesions are not uncommon.
Even one innominate in lesion will draw out of line the uterus and ovaries.
This unevenness of the basins’ walls causes muscles and ligaments attached
to the innominate bones to draw in a manner that blocks the blood vessels
and lymph channels. Nodular enlargement follows, and a congestion
of the tissues is also noticed. If allowed to remain uncorrected,
marked symptoms appear, especially at the menstrual periods. Cramps,
retarded flow, and sometimes flooding are the result, depending upon the
age and general condition of the patient.
As long as osseous lesions exist there will be blockage
of blood and lymph vessels. Careful palpation over the ovaries will
reveal the change in the tissues. The effect upon the lymphatics
in the legs will be apparent. There may be a slight edematous condition
around the ankle, and the popliteal spaces are sure to record the blockage
that is present higher up.
If the kidneys are active and no constipation is
apparent the symptoms are minimized, but in a tilted pelvis there is almost
sure to be constipation of haemorrhoids. There is stress upon all
the muscles attached to the pelvic basin.
The lymphatic arrangement in the pelvic organs is
like that of a great net. These vesesels all find an emptying place
eventually through one tube, the thoracic duct. This duct collects
from all points below. The uterine and ovarian lymphatics are blocked
when there is undue pelvic congestion. We need not refer to venereal
diseases and then marked effect upon the lymphatics. We will confine
this article to pelvic lymphatic blockage, through lesions, with resulting
ptosis and nodular enlargements.
In order to have a regulated blood supply in the
pelvic organs there must be good vasomotor tone at the nerve centers that
control the blood vessels, and indirectly the lymph vessels. Cervical
and thoracic lesions affect vasomotor control clear down to the feet.
PLATE XXIV. Lymphatics
in relation to the pelvis.
To relieve pelvic congestion and lymph blockage
there must be not only adjustment of the pelvic bones but correction of
all lesions up to the occuput. A scoliosis will disturb the ovarian
nerve centre even though no marked innominate lesion exists. First,
last and always in pelvic congestion, we must secure perfect alignment.
It is so easy to disturb the pelvic plexus of nerves through osseous lesions,
and there is a tremendous reflex following pelvic nerve instability.
Splanchnoptosis will produce pelvic lymph blockage in any and every instance.
The lymph vessels, when there is no abdominal visceral ptosis and vascular
stasis, normally clear themselves and empty into tributaries of the thoracic
duct, but if you lesion one or more vertebrae directly, or through innominate
or sacral tilts, the whole arrangement is changed. Nerve impulses
are lessened, lack of tone is noticed and a congestion or inflammation
may be the result. We must keep the organs in the abdomen in their
proper tone and respective regions if we expect to have normal pelvic organs.
The moment there is venous stasis we have the beginning of lymphatic blockage.
Weakened ligaments allow misplacements, and we find
flexions and versions causing nodular enlargements. Varicose veins
and edema follow in many instances. If there is a continued lymph
blockage in the ovarian and uterine regions, leucorrhea may be the result
and often is very persistent. The vascular and lymphatic arrangement
is peculiar in the pelvic basin. This allowance is made to accommodate
the changes during pregnancy. The lymph vessels are arranged so that
the gravid uterus will not obstruct them sufficiently to cause white swelling
under normal conditions.
Pelvic and vertebral lesions existing before and
during pregnancy cause many symptoms that would not exist had the lesions
been corrected before conception.
Where there is albumin during pregnancy, we find
the lymph nodes more noticeable and the lymph drainage down the leg more
blocked than in a normal kidney condition.
Before any woman contemplates pregnancy there should
be perfect adjustments made, and a free drainage of the pelvic lymphatics.
The presence of lacerations, long neglected, are
causative of nodular enlargement. The absorption of secretions and
discharges reflect the abrasion upon the nodules. This may produce
sufficient nodular enlargement and lymph blockage to cause intrauterine
growths. Any abrasion is followed by lymphtic disturbance.
In cases of a prolapsed uterus we find stress upon
the numerous lymph vessels and nodes, preventing the return of lymph through
the tributaries of the receptaculum chyli. Constipation with enlargement
of the haemorrhoidal veins produces a nodular enlargement that is readily
palpable in the posterior walls of vagina, especially back of the cervix.
A lesioned coccyx will cause, through pressure and
traction, a series of lymph irregularities.
During the menstrual period there is a temporary
lymph stasis and you will notice, sometimes, the inguinal nodes slightly
enlarged and yet quite compressible to touch. These clear up shortly
after the period.
PLATE XXV. -- The lymph
drainage of the pelvic regions and lower extremity is clearly outlined.
In ptosis of the abdominal viscera the lymph nodes are blocked and the
lymph vessels drawn downward with the viscera.
In rheumatic cases we find the most general disturbance.
The presence of uric acid with possibly a mild nephritis, allows the careful
palpator to observe some interesting points.
If you will keep the lymphatics in mind constantly
and look for nodular variations in all disorders of the organs and tissues,
you will be surprised in time to note a peculiar fluctuation of the various
palpable nodes in the accessible regions.
I have become so accustomed to palpating nodes that
I invariably go over the popliteal, inguinal and axillary regions, just
to satisfy myself that the lymphatic system fluctuates, so to speak, according
to the chemistry of the body.
The slightest organic disturbance reflects itself
upon the lymphatic system at some point. An abcessed tooth, an enlarged
tonsil, a bronchial cough, a ptosis or stasis in the mesentery, a pelvic
congestion or organic prolapsis, all record themselves on the lymphatic
system that becomes blocked so readily when poisons or toxic products are
found within the system.
Enlarged lymph nodes are a true index of some pathological
phase at some point within the body.
There is a communication between the lymph vessels
of the uterine area and the superficial inguinal nodes. This allows
of more ready palpation of the inguinal nodes in a case of diseased uterus.
The majority of the lymph vessels of the uterine walls and coverings follow
along the broad ligaments. The aortic nodes eventually collect the
lymph. The iliac nodes collect from the cervix, according to the
direction of the various lymph vessels from that part. The vagina
is lymph-drained by the nodes that lie along the iliac vessels and their
branches. The lymph drainage from the bladder is separate from that
of the vaginal region until the iliac nodes are reached.
On the sacrum we find a few nodes which collect with the
mesenteric nodes the lymph from the muscular coat of the rectum. The lymph
vessels follow the course of the haemorrhoidal vessels where nodes are distributed
that send efferents to the mesenteric. The sacrum, if tilted in relation
to the innominates, may disturb these lymph nodes.