The Abdominal and Pelvic Brain
Byron Robinson, M. D.



An original and enterprising man is opposed - opposition develops strength, and criticism accuracy.

A fever in your blood!  Why, then, incision would let her out in saucers.
- Shakespeare, in Love's Labor Lost.


    The tractus lymphaticus begins and ends in the veins.  It is a venous appendage.  It was a late developmental addition, differentiation of the blood vascular system - an additional circulatory apparatus.
    The tractus lymphaticus resembles the tractus venosus, (a) in possessing afferent or converging vessels which course from periphery to center; (b) in being divided into two sets - superficial and deep; (c) in contour, the possession of valves - constrictions and dilatations.
    The tractus lymphaticus differs from the tractus venosus, (d) in traversing glands; (e) in its reverse arrangement - i. e., the lymphatic vessel does not increase in dimension from periphery to center like the vein; (f) the progressive movements of the lymph depend exclusively on the parietes of the lymphatic vessel-that of the venous blood chiefly on the cardiac action; (g)  the lymphatics communicate with intercellular spaces and serous sacs.
    The tractus lymphaticus consists of: (A), (VASA LYMPHATICA), Peripheral Anastomosing Plexuses of Lymph Vessels, which originate in the meshes of the connective tissue.  These lymph channels, converging and uniting, pass to the lymph glands, or nodes.  In the pathologic physiology of the lymph vessels redness (hyperaemia) along the line of vessels and oedema are conspicuous features.
    Vasa lymphatic or lymph vessels arising from all parts of the body were discovered almost simultaneously by George joylife (1637-1658), an English physician, in 1652; Olaf Rudbeck (1630-1702), a Swede of Upsala in 1651; Thomas Bartholin (1616-1680), a Danish anatomist of Copenhagen from 1650 to 1667.  Bartholin proposed the name vasa lymphatics.  The chief location of lymphatic vessels is the connective tissue especially associated with blood vessels.  The valves of lymphatic vessels are absent at their origin and in the capillaries.  The valves are paired and numerous but irregularly located in - the collecting vessels, however, rare in the final collecting trunks - thoracic ducts.  The arrangement of the vasa lymphatics consist of: (a) superficial or epif ascial set and (b) deep or subfascial set - communicating with each other.  The general organs or regions of the body are drained by converging, collecting lymphatic vessels - intermediate collecting trunks.      The lymph capillaries consist of valveless endothelial tubes.  The common collecting trunks consist of three coats, viz., (a) the internal endothelial layer; (b) the middle muscular layer; (c) the external connective tissue layer.

     Fig. 140.  The left thoracic duct with the chief (a) isthmus constriction in its central portion, the dilated (b) cisterna lymphatics at its distal end and the (c) cervical dilatation at its proximal end (which terminates in the vena subclavia sinistra), the right thoracic duct terminating in the vena subclavia dextra.  Is the caliber of the thoracic duct (left) sufficient to transport 5/6 of the lymph of the organism? (Gray).

Chyle Vessels (Lacteals).

    Vasa chylifera or the lacteals were first observed in the mesentery of man by Herophilus (310 B. C.). a Greek physician living in Egypt, while he was dissecting living criminals.
    Erasistratus (340-280 B. C.), a Greek physician, observed the chyle vessels or lacteals while dissecting kids but named them arteries.  However, Gasparo Aselli (1581-1626) professor of anatomy and surgery at Pavia, Italy, a prince among anatomists, discovered the lacteals while performing vivisection in a dog July 23, 1622, Aselli's work (lacteals) was published posthumous by his friends.
    (B), (GLANDULAE LYMPHATICAE), Lymph Gland or Nodes, which are structures that receive (afferent vessels) and emit (efferent vessels) lymph vessels.  The glands produce leucocytes and modify traversing material.  It is estimated that man has some 500 lymph glands or nodes and that the lymph traverses one or more glands before terminating in (subclavian) veins.  Glands alter lymph owing to slow circulation.  The glands modify the traversing inert or living particles and imprison them, as the carbon infiltration glands of the bronchia.  In pathologic physiology of the tractus lymphaticus hypertrophy or tenderness of the glands is a conspicuous characteristic.
    (C), (TRUNCI LYMPHATICI), Lymph Trunks, are large lymph vessels which conduct or transport the lymph from the lymph glands or nodes to the (subclavian) veins.  The chief ones are the left and right thoracic ducts.
    The lymph trunks are the thoracic duct (left) and the thoracic duct (right). Formerly it was thought the wounds of the thoracic duct were fatal, however, recent observation (H.  Cushing, P. Allen, and others) demonstrates that the thoracic duct wounds are frequently not fatal, recovery resulting from: (a) spontaneous closure (coagulation contraction of the duct wall); (b) free collateral circulation; (c) ligation (suture) of the wound.  If the duct leaks lymph it should be ligated proximal and distal to the perforation, allowing resumption by collateral circulation. (The lymphatic system includes the terms canalicular system. perivascular lymph spaces, lymph capillaries, chiliferous vessels - pleural, peritoneal, pericardial and synovial (serous) cavities, stomata, lacteals.)
     Fig. 141.  This figure presents the source (vasa lymphatica), glands (glandular lymphaticae) and termination of the right thoracic duct (in the right subclavian vein).  The direction of the lymph channels demonstrated why the lymph glands in the neck enlarge toward the clavicle.  (Sappey.)

    The number of lymph channels and glands are unequally or non-uniformly distributed in the organism, occurring most frequently in vascular parts.  The number and caliber depend on the density of tissue.  Lymph channels (closed, e. g., peritoneum, pleura), in general are lined by endothelium in contradistinction to (unclosed) channels, (e. g., digestive and genital tracts), which are lined by epithelium.  The valves of lymph channels are folds of endothelium.  The tractus lymphaticus possesses more variation than any other visceral tract.  The form of the whole branching lymphatic vascular system is that of a cone.  The cone base or periphery is the vast connective tissue spaces of the whole body.  The cone apex or center is the termination of the lymphatic trunk (thoracic ducts) in the veins (subclavian).  Lymphatic vessels arise from intercellular spaces, however, especially from immediately beneath free surfaces as skin serosa, mucosa.  The lymphatic vessels are solidly and compactly anastomosed.  Hence the lymph plasma may flow in all directions (like the blood in the utero-ovarian artery) direct or reverse to insure complete cell nourishment under complicated conditions.  The object of the tractus lymphaticus is universal cell nourishment and universal cell drainage.  The functions of the tractus lymphaticus (sensation, peristalsis, absorption, secretion) is controlled by the nervus vasomotorius (sympathetic).  The tractus lymphaticus is richly supplied by a plexiform, nodular network, a fenestrated anastomosed meshwork of the nervus vasomotorius which controls its physiology.  The lymphatic vessels accompany the veins.  The lymphatic vessels ensheath the veins as a plexiform anastomosing net or fenestrated meshwork - resembling the plexiform, nodular net or fenestrated anastomosing meshwork of the nervus vasomotorius ensheathing the arteries, i.e., the nervus vasomotori us ensheath the arteries as the tractus lymphaticus ensheath the veins.

     Fig. 142.  The lymphatic vessels ensheathing the portal vein as a plexiform, anastomosing nodular (valves) fenestrated meshwork.  The tabular lymph apparatus richly ensheathing the vein transports abundant fluid for nourishment. (Teichman.) 

Thoracic Duct (Unpaired).

    Ductus thoracicus sinistra, ductus pecquetianus, was discovered by Jean Pecquet (of Paris, France, 1622-1674) in 1649), in a dog.  It was discovered by Olaus Rudbeck (of Upsala, Sweden, 1630-1702) in man, in 1650.
    Also Thomas Bartholin (1616-1680) is credited with discovery of the thoracic duct in man.  John Wesling in 1634 saw the thoracic duct.  The thoracic duct is in general 1/6 of an inch in diameter and 18 inches in length with non-uniform caliber and sinuous course with minimum caliber at its middle portion.  It is especially dilated at the distal end (receptaculum lymphatics) and at the proximal end is an elongated ampulla (which I shall term its cervical dilatation).
    The thoracic duct may bifurcate, forming two or several branches, a network, and reunite in its course.  Its valves are the most limited in number and dimensions of any portion of the tractus lymphaticus.  Its two most remarkable valves are located at its ("cervical dilatation") termination in the subclavian vein where the free borders of the valves are directed toward the venous lumen in order to oppose influx of venous blood into the thoracic duct.  The two ductus thoracici - ductus thoracicus major (sinister) et minor (dexter) - flow in the direction of least resistance, i. e., they flow into the subclavian veins at the most distant point from the intra-thoracic and intra-abdominal pressure.  Has a duct of two lines or 1/6 of an inch in diameter ample lumen to allow 5/6 of the lymphatic fluid (constituting about 1/5 of the body weight) to traverse it?
    Ductus Thoracicus dextra is located at the right side and base of the neck.  Its dimensions are: length an inch, diameter 1-8 of an inch.  It terminates in right subclavian vein.  It is the common collecting lymph trunk for the right side of the head and neck, right proximal extremity, right lung, right heart. The thoracic duct is nonuniform in caliber, possessing dilatations (reservoirs) and constrictions (isthmuses).

(1)  Receptaculum Lymphatica (Distal Dilatation).

    Receptaculum chyli, cisterna chili, cisterna lymphatics or chyle reservoir was discovered by Jean Pecquet (1622-1674) of Paris, France, in 1649.  The cisterna lymphatics was independently discovered by Olaf Rudbeck (16301702), president of the University of Upsala, Sweden.  In general the dimensions of the receptaculum lymphatics is 1/5 of an inch in diameter and 2 1/2 inches in length.  It is an oblong formed sac or dilatation at the distal end of the thoracic duct, located opposite to the I and II lumbar vertebrae.

     Fig. 143.  The valved afferent vessels are more numerous than the valved efferent (Testut). 

(2)  Cisterna Lymphatica Cervicis (Proximal Dilatation).

    The thoracic duct in the region of the neck possesses a dilatation which may be termed the "cervical dilatation" or cisterna lymphatica cervicis.  It is a spindle or oblong formed swelling of the duct located at its terminal end.  It, as well as other dilations, has been termed an ampulla.

(3) Isthmus Medius (Middle Isthmus).
    The thoracic duct possesses a minimum caliber at its medial portion, hence I shall term this the middle isthmus.  It is the chief constriction or isthmus of the thoracic duct.


    The contents of the tractus lymphaticus consists of : (A) the lymph or lymph plasma - a fluid tissue; (B) the leucocyte - a guest of lymph plasma.

(A).  Lymph - Lymph Plasma.

    Lymph plasma originates from blood plasma.  The lymph or lymph plasma originates as a capillary infiltration from the blood serum.  Lymph is doubtless also a product of cell secretion.  In composition lymph plasma appears to be a mechanical and secretive product from the blood.  Perhaps lymph should be viewed chiefly as a secretion of the endothelial (blood capillary) cell.  Lymph is different from blood - it is more acid (is less in glucose), as urine is more acid than blood.  Lymph plasma is fluid that has escaped from the blood plasma in the capillaries and its composition varies according to source and organ activity.  It is a peculiarity that though the lymph should be viewed chiefly as the product of cell secretion, instead of being eliminated externally, it is returned to the venous blood, to retravel the arteries.  However, the lymph is modified by the lymph glands and pulmonary endothelium (oxygen).  It is a process which resembles the elaboration of the ductless glands (spleen, thyroid, ovary, thymus, adrenal).

     Fig. 144.  Observe anastomosing superficial and deep lymphatics as well as valves.  The number and caliber of the lymph channels demonstrate its functional transporting capacity. (Teichman.)

    Physically, the lymph is in general an odorless, colorless, viscid fluid.  Digestion produces a milky color in lymph plasma.  The quantity of lymph is estimated from 1/3 to 1/6 the weight of the body.  The quantity varies extensively according to corporeal activity.  Its specific gravity is 1.017. Practically the lymph is a transparent alkaline fluid, perchance, of reddish yellow color.  It is soluble in water, becoming turpid in alcohol.  Lymph coagulates with more facility than blood and becomes a scarlet red in contact with oxygen and purple red in contact with carbonic acid.  The lymph plasma performs an export and an import service.  It conducts nourishment (fluid) to the cell and floats waste material (fluid) from the cell.  It performs its labor through a fluid medium, saturating the cell (nourishment) and irrigating the cell (drainage).  Lymph plasma coagulation renders less fibrin than that of blood plasma.  This is significant, for fibrin is liable to obstruct vessels and produce thrombosis - eventually embolism.  The chief chemical constituents of lymph consists of albuminolds (less than that of blood) fats, various metalic salts (NaCl phosphates, sulphates, alkaline carbonates).

     Fig. 145.  This figure represents the course of the lymphatics from the genitals and rectum to the abundant inguina glands - barriers of infection which imprison, sterilize or digest (destroy) infections or inert material.  The inguina glands are affected by carcinoma and infectious materia from genitals and rectum. (Sappey.)

(B).  Letcocyte-WltiteBloodCorpuscle.

    The origin of the leucocyte is: (a) medulla (bone marrow); (b)mesoblast (blood vascular endothelium); (c) connective tissue; (d) lymph glands or nodes.
The location of the leucocyte is in order of frequency: (a) in the lymph plasma; (b) in the blood plasma; (c) in the connective tissue.
    The structure of a leucocyte consists of a nucleus and a surrounding protoplasm.
    The number of leucocytes in man to the cubic millimeter are about 8,000 (Ranvier).  The number of leucocytes are increased a f t e r passing t h r o u g h glands.  The number of leucocytes is greater in the center than in the periphery of the body organism.
    The neucleus of the leucocyte varies in number, dimension, form, location.  The nucleus is surrounded by protoplasm, an almost imperceptable zone of nonhomogenous matter. The polymorphism of the leucocyte nucleus has vigorously engaged numerous cytologists with consequent multiple views as to its cause.
    The protoplasm varies in form, dimension, structure.  The contents of the protoplasm varies from environments as iron granules, redblood corpuscles, debris, microbes or their products, particles of air and so forth.
    Physically the leucocyte is practically a colorless, soft, extensible nonhomogenous mass of protoplasm, noncapsulated (without covering).  It is viscous and adheres to the most smooth surface.  Thus when circulation slows it lodges against vessel wall.

     Fig. 146.  This illustration of the lymphatics after Dr. Wm.  Nagel and Porier demonstrates that the lymphatics accompany the vessels - in this figure they follow the utero-ovarian vascular circle (circle of Byron Robinson).  The lymphatics of the genitals are of practical importance on account of the frequent location of carcinoma in the genitals and their distribution of the carcinoma through the lymphatics. 


     Fig. 147.  The tractus genitalis is abundantly supplied by lymphatics and consequently possesses a rich lymphatic drainage.  The tractus genitalis is peculiarly liable to be attacked by bacterial infection and carcinoma - both manifest in the annexed tractus lymphaticus.  Infectious or carcinomatous material, on account of the luxuriant anastomoses of the genital lymph channels may appear to avoid certain of the adjacent genital glands and to attack glands more distant from the genitals.  In other words the infectious or carcinomatous material may not attack the genital lymphatic glands in the direct order of the course of their arrangements.  This illustration demonstrates the futility of attempting to extirpate all the lymphatic glands attending a carcinomatous infected genital tract - microscopically one is incapable of deciding whether a lymph gland be hypertrophied from bacterial infection or carcinomatous infection.

    The chief chemical constituents of a leucocyte are, albuminoids, nuclein, insoluble matter, fat cholestrin.  These substances are important in metabolism, e. g., the nuclein will produce uric acid.
    Biologically the leucocyte or white corpuscle possesses the primary properties of living matter, viz.: sensibility, mobility (rhythm), peristalsis, absorption, secretion, reproduction.  One of the most significant characteristics of the leucocyte is that of mobility endowing it with the quality of a protector, a body guard - a mobile sentinel.  It is a migratory cell (the wandering cell of Recklinghausen).  It is a mobile tissue inspector, a heraldic warner for bodily protection.  The leucocyte is a guardian against foreign invaders, it is a tester of ingesta, it is a filtering barrier, a retention prison.
    The leucocyte absorbs, imprisons, sterilizes matter.  It digests some material (food, bacteria), it imprisons some (indigestible, coloring matter), it sterilizes some (bacteria, ferments).  These properties enable the leucocyte to protect or supervise against excessive invasion of bacteria, poisonous matter, ferments.
    The leucocyte reproduces itself by amitosis (direct division) and karyokinesis (indirect division).  The leucocyte is a primordial factor of life and its perpetuation.  The leucocyte is a vital, primordial, protoplasmic element which retains its primary property of free and independent life - sensation, motion, absorption, secretion, reproduction - adopting itself to differentiation, environment.  It is a functionator preceding a constructor.

     Fig.148. This excellent illustration demonstrates the facility with which cervical and vaginal carcinoma(the most prevalent forms) may become distributed through the tractus lymphaticus annexed to the tractus genitalis.

    The vital resistance or constitutional power of a leucocyte is remarkable against destructive agencies.     Verworn demonstrated that 24 hours after bodily death of the organism the majority of the leucocytes are living.  They may retain their properties external to the general organism for 3 weeks (Recklinhausen, Ranvier).
    The chief classification of different leucocytes are: (a) microcytes; (b) macrocyses; (c) cells with neutrophile granules; (d) cells with acidophile granules; (e) cells with metachromatic basophile granules.  This classification demonstrates the extensive range of physiology (and consequent extensive field of pathologic physiology) included within the range of the leucocytes.  As disease is deviating or abnormal physiology the key to its etiology, therapuesis and prophylaxis accurate knowledge of organ functions.  The functions of the tractus lymphaticus are: I, sensation; II, peristalsis; III, absorption; IV, secretion.  Disease in the lymphatic tract consists in deviation, abnormal repetition, of one or all the above four functions.  The four functions manifesting pathologic physiology in the disease of the tractus lymphaticus will be recognized by being excessive, deficient, disproportionate.


    1.  Excessive sensation in the tractus lymphaticus may be associated with irritability of the, peripheral nerve ending in the endothelium.  Also the lymph plasma may contain irritating matter.
     2.  Deficient sensation in the lymphatic tract may be due to excessive or over-whelming poisonous substances in the lymph plasma or paresis (blunted sensibility) of the peripheral nerve ending in the endothelium (traumatic paresis from compression oedema).  Deficient bodily activity may cause deficient lymph flow and consequent deficient sensation.
    3.  Disproportionate sensation in the tractus lymphaticus may arise from anoesthesia, hypereesthesia in its different segments and also from different composition of lymph plasma from different organs. Also disproportional bodily muscular activity may share producing disproportional sensation.

     Fig. 149.  A, A, is a lymph channel from which I penciled the peritoneal endothelium and stained with AgNO3.  One can observe a dozen stomata vera on this lvmph channel, directly communicating with the peritoneum.  Note the sinuous outline of the endothelium composing the lymph channel.  Parallel to this lymph channel is a zone of peritoneal endothelium stained with AgN03, presenting stomata vera (S. V.) and endothelium without sinuous borders.


    4.  Excessive peristalsis may arise from irritating lymph plasma or irritation of the walls of the lymph tract from supersensitiveness of the endothelium.  The lymph vessels contract from their own parietes - no apparatus like the heart propel their contents.  Peristalsis in the lymph channel is obvious chiefly in the ductus thoracicus.  The rate and volume of lymph flow depends on the rate and volume of blood flow, on tissue pressure and muscular activity.  In certain localities the lymph flow must depend on the difference of blood pressure and that of the lymph in the tissue.  Obstruction of the thoracic duct would induce excessive, vain peristalsis in the lymph channels.  Extra distention of the left subclavian vein might induce excessive peristalsis in the thoracic duct.  Extraordinary muscular activity may induce excessive peristalsis.

     Fig. 150. a, beginning of lymph trunk: b, b, lymph reservoirs: magnified 15 times. (Teichman.)

    5.  Deficient Peristalsis or stasis of lymph occurs in tissue with limited elastic tension.  The same condition favors venous stasis.  Also force of gravity favors lymphstasis.  Hence general lymph oedema occurs in the ankle region or lumbar-sacral region.  The obstruction of a single lymph channel (or vein) does not necessarily produce oedema because the lymph (or venous channel) may assume a collateral circulation from rich anastomosis.  Transudation of lymph may not produce oedema as the lymph may be transported by the lymphatics.
    If general venous stasis exists the blood pressure in the left subclavian is raised and lymph oedema may be general and peristalsis of the lymphatics is vain.  Lymphatic peristalsis may be deficient when the tissues adjacent to the capillaries have been distended with consequent loss of elasticity and power of contraction.  Diminished elastic pressure of the adjacent tissue on the lymph spaces diminishes the rate of flow of lymph plasma.  Deficient peristalsis (lymph flow) occurs subsequent to tissue inflammation, for the elastic tissue pressure is diminished, paretic.
    6.  Disproportionate Peristalsis (flow) may be observed subsequent to different degrees and different localities of tissue distention following oedema from varying elastic tissue pressure.  Subsequent to inflammatory tissue processes the adjacent elastic tissue pressure is unequal, nonuniform, inducing lymphatic peristalsis or flow disproportionate.

     Fig. 151.  Subject dead from ascites. 1, thoracic duct 2, section of aorta. 3, adjacent aortic glands. 4, superficial lymphatics of intestines. 5,6, 7, lymphatic channels and glands of enteron and mesenteron.


    7.  Excessive secretion of lymph plasma may be manifest by oedema, tissue fluid accumulation, nephritic cedema.  Excessive secretion of lymph plasma is difficult to discriminate from insufficient drainage or transportation of lymph.  Excessive secretion of lymph may be found in tissue oedema and especially in the serous cavities.  In nephritic oedema (not accompanied by cardiac deficiency) the excessive lymph collected in the tissue is doubtless due to simple stasis, however, for our view, the lymph is excessive.  The nephritic oedema occurs first in the subcutaneous tissue and particularly in the tissue possessing limited elastic pressure, e. g., about the ankles and dorsal surface of the lumbar and sacral regions.  The lymph oedema may be excessive, lymph formation or accumulation being from obstruction to its escape.  The quantity of lymph which escapes from the blood capillaries depends on the difference in pressure between the lymph spaces and the blood capillaries.  Whether there be excessive lymph secretion or lymph stasis - lymph oedema - it is similiar in effect.  The stasis of blood in veins results in lymph stasis - lymph oedema.  The organs or tissue become most oedematous or swollen which possess the most limited elastic pressure - in fact exactly where venous stasis is at a maximum.  The lymph stasis may be local as when a vein is occluded by a thrombosis, or general as when a lung or heart is debilitated.  However, mere obstruction of a vein may not produce lymph or venous stasis as circulation in the vein and lymph channels is rich on anastomatic collateral routes.  An increased lymph transudation may produce no lymph oedema as the lymph channel anastomoses may transport the excess of lymph sufficiently rapid to equalize the lymph circulation.  If there be general venous stasis general lymph oedema may arise from rise of blood pressure in the left subclavian vein obstructing the flow of lymph from the thoracic duct. Local lymph oedema may arise from previous extradistention of tissue which consequently is deficient in elastic pressure.  It is evident that the elasticity of tissue and muscular activity exercises a powerful influence over the rate of lymph flow and local accumulation of lymph plasma.

    Fig. 152.  The centrum tendineum of the diaphragm is drained by lymph trunks - two anterior and two posterior (3, 3,) - which terminate in the thoracic duct 5, 5, valves of lymphatic trunks.  D,D, thoracic duct, 6, 7, 8, dilated lymph spaces in the diaphragm.  The dark circular disc represents the point of the central tendineum where the heart rests, in which disc there are no lymph spaces. 

    In regard to the nephritic oedema it may be noted that oedema occurs in parenchymatous nephritis - not in interstitial nephritis - and is no doubt due to retention within the body of the watery portion of the urine.  A test of this matter may be made by the administration of sodium chloride (which stimulates, irritates, excites renal epithelium).  In the nephritic oedema from lymph stasis less than normal urine is evacuated and the oedema increases as the urine diminishes and vice versa.  Now, administer 8 ounces of normal salt solution every two hours 8 times daily and the urine will rapidly increase in quantity and clarification, resembling spring water, while the oedema will diminish.  It must be well borne in mind that sodium chloride irritates, damages inflamed renal epithelium, hence should not be administered in parenchymatous nephritis.  Hammerschlag has shown that patients with parenchymatous nephritis possess diluted blood - an hydraemia or hydraemic plethora.  No doubt some damage, lesion, exists in the capillary wall in nephritic oedema, because the heart shares in the process by presenting hypertrophy.   Dr. A. W. Howlett asserts that nephritic oedema apparently depends in some subjects on excess of sodium chloride within the body, i. e., the subject secretes deficient quantities of sodium chloride on account of kidney defects (parenchymatous nephritis) which in turn necessitates an accumulation of fluids (lymph within the tissues).  Whatever the exact factors be I am distinctly convinced during the past decade as regard the action of sodium chloride on renal epithelium (irritation, excessive, or deficient secretion), that profound effects are exercised on the kidneys by the amount of sodium chloride ingested.  So-called indurated lymph oedema occurs subsequent to extirpation of the lymph gland in a territory of considerable dimension.
    8.  Deficient secretion of lymph plasma is difficult to demonstrate, although it undoubtedly occurs especially where tissue is dense and hence where little lymph will escape, however, in atrophic tissue doubtless deficient lymph is secreted.
    9.  Disproportionate secretion of lymph is evident in different regions of the body.  The resistance offered by the different degrees of tissue elasticity and pressure accounts for its share.  Also the lymphatics are unequally distributed.  The erect attitude presents disproportionate lymph secretion from force of gravity.  In the erect attitude the force of gravity exposes extra tissue pressure in certain localities, as the ankle and foot region.

     Fig. 153. 1, the cervical dilatation of the thoracic duct terminating in the left subclavian vein. 2, the isthmus of the thoracic duct in the dorsal region. 3, receptaculum lymphatica.


     Fig. 154.  The lymph vessels present elongated endothelium, valves, dilatation and construction. 


    10.  Excessive; 11, deficient; 12, disproportionate, absorption of lymph plasma is difficult to demonstrate and time and space here forbids.


    For rational views and practical purposes definite ideas should be entertained of the functions of an organ. It is evident that to the tractus lymphaticus the four common visceral functions (sensation, peristalsis, absorption, secretion) belong.  When these four functions of the tractus lymphaticus pursue a normal course there is no pathologic physiology - no disease exists - and no correction of function or therapeusis is demanded.  As water basins are the great centers of civilization, so the lymph channel is the great center of nourishment.  In both instances it is the facility of a transporting fluid medium which accomplishes the object.  The signification of the tractus lymphaticus is evident when it is realized that it is the highway of cell nourishment and cell drainage.  Along the borders of the great lymph stream every cell is a harbor for import and export service.  The object of the tractus lymphaticus is universal cell nourishment and universal cell drainage.  Pathologic physiology of the tractus lymphaticus is the zone between normal physiology and pathologic anatomy and should be amenable to therapeutics.  Pathologic physiology will constitute a useful field for the cultivation of physiology, diagnosis, therapeutics, rational practice and prophylaxis.  As the tractus lymphaticus is of vast utility in the animal economy, having an import service (transportation of cell nourishment) and an export service (transportation of cell drainage), its pathologic physiology comprises a correspondingly extensive zone.  Pathologic physiology in the tractus lymphaticus is disordered or abnormal function, the beginning of disease.  Pathologic anatomy is a disordered or abnormal structure, the establishment of disease.  Disease begins as abnormal function and its progress

     Fig. 155. a, b, a, b, Auerbach's Plexus (Plexus myentericus); c, narrow and d, larger lymph channels.  This excellent illustration demonstrates the intimate relation of the rich plexuses of the nervus vasomototius and rich plexuses of the vasa lymphatics.

consists in a repetition of the abnormal or deviating physiology.  Modern radical surgery in tuberculosis and carcinoma depends for its success on a knowledge of the anatomic distribution of the lymph channels and glands.  The pathologic physiology in the lymphatic glands and channels may suggest a diagnosis by leading the physician to a local lesion along their route as enlarging inguinal glands may indicate a genital or rectal lesion, they may lead to the discovery of septic foci or solutions of continuity in distant regions, e. g., an infected foot, a corn, a bunion.  A rising pathologic physiology in the axillary glands may enable the physician to diagnose advancing carcinoma.  The location of the lymphatic glands and the route of the lymphatic channels are the essentials in the diagnosis.  This is strikingly manifest in the phenomena that extensive removal of lymph glands may result in induration of lymph oedema.  The anatomy is the solid ground to determine the direction of lymph channels location of lymph glands.  Lymph glands enlarge generally from bacterial disease, carcinoma or sarcoma.  Enlarging lymph glands herald the advance of disease.  The tractus lymphaticus stands as a sentinel on guard over normal bodily nourishment.  It filters and checks the deleterious and poisonous substance from gaining access to the parenchymatous cell.  The lymph glands imprison inert substance and the carcinomatous cell, retarding the progress of carcinoma.        The detectable route of the most implacable and deadly enemy of man - carcinoma - is through the tractus lymphaticus.  The early detection and treatment of the precarcinomatous stage must be accomplished by the recognition of pathologic physiology of the tractus lymphaticus.  The lymph system presides as a tissue inspector and protector.  It digests, imprisons, sterilizes in the interest of the general organism.  The lymph plasma possesses a body guard in its guest - the army of leucocytes.

     Fig. 156.  This figure illustrates the route of carcinomatous or other infectious material through the numerous rectal lymphatics and glands (Gerota).


    Clinicians are recognizing the numerous relations of the lymphatic system to practical medicine and surgery.  Metastatic manifestations, both bacteriologic and neoplastic, extend through definite routes of lymph channels and their associated glands, and the object of pathologic physiology is to detect the process in ample time to save the organism from destruction by establishing irreparable pathologic anatomy.  Armed with a knowledge of the physiology of the tractus lymphaticus and its topographic anatomy the physician is forewarned as to its course of incipient pathologic physiology and considerations of rational treatment should engage his attention.  First and foremost the luxuriant anastomoses of the lymph channels appear to allow bacterial or carcinomatous material to avoid attacking certain lymph glands in the route of the lymph channels.  In other words the bacterial or carcinomatous material may not attack lymphatic glands in the direct order of their channels and topographic course.  The lymph channels are so richly anastomosed that the course of the lymph current may be direct or reverse.  Dr. Emil Ries has demonstrated this view as regards carcinoma in the route of the tractus lymphaticus draining the tractus genitalis.  Again the physician is unable to decide macroscopically whether a lymph gland is hypertrophied from bacterial or carcinomatous infection.  Hence from abundant anastomoses of lymph channels, thrombotic or other obstruction may induce metastatic manifestations in lymph tracts not primarily involved.  The extensive removal of lymph channels and glands, as those of the axilla for carcinoma of the mamma, seldom produces lymph oedema or stasis because the luxuriant anastomoses of lymph channels allow the lymph to flow in multiple directions.  The tractus muscularis through its activity, its massage, exercises a wonderful influence over the flow of the lymph.  In states of bodily repose the respiratory muscles pursue continuous rhythmical motion maintaining continuous lymph flow.  A comprehensive view of drainage may be secured by a study of the tractus lymphaticus, as cells are nourished and drained by the lymph fluid.  A lymphagogue is an agent which increases the flow of lymph.  Lymph increases its rate of flow under the influence of pilocarpin, ergotine.

     Fig. 157.  From rabbit's omentum.  The endothelium was brushed away and the base stained with 1/2 per cent of AgNO3 and haematoxlylin.  The stomata vera (s. v., 9 of them) are patent channels, communicating tubes, connecting the peritoneum with the sub-peritoneal lymph spaces and vessels.

    The rate of flow of any fluid depends on its consistency.  The consistency of the lymph depends on the quantity of fluid injected.  Drainage and nourishment of cells depends on the rate of lymph flow as well as on its quantity and quality.  The degree of muscular activity or massage determines relatively the rate of lymph flow.  Muscular activity or massage increases the cardiovascular action and consequently the blood pressure is elevated.  We frequently observe lymph oedema in the abdominal wall in subjects with large abdominal tumor.  Here the lymph accumulates in dependent tissue with deficient elasticity, and pressure or mechanical obstruction occurs.  The blood pressure within the artery is tenfold greater than the blood pressure within the vein and complete circulation of the blood requires less than a minute.  Hence the venous pressure is vastly greater than that of the lymphatics, however, experiments demonstrate that the lymphatic circulation is vigorous and rapid, e. g. salt solution injected - in the connective tissue (as beneath the mammae) rapidly enters the blood circulation.


    In general 9/10 of illness or complaints is pathologic physiology - disordered function - and  - 1/10 is surgery - pathologic anatomy - disordered structure.  Modern research is reinstating rational therapeutics, i. e., the correction of disordered function.  Practically the field of influence and utility of a physician is limited to the zone of pathologic physiology (which lies between physiology and pathologic anatomy).  The chief duty of the physician is to restore function.  The deviating functions to restore in pathologic physiology of the tractus lymphaticus are sensation, peristalsis. absorption, secretion.  Pathologic physiology of the tractus lymphaticus is best corrected and normal function maintained by natural methods or rational therapeutics.  The rational agent of therapeutics for the treatment of pathologic physiology of the tractus lymphaticus are: I, Fluids; II, Food; III, Habitat; IV, Avocation; V, Drugs; VI, Surgery; VII, Miscellaneous.

     Fig. 158.  A schematic illustration of a lymphatic gland with the entering vessels (vasa efferentia and departing vessels (vasa afferentia, 11).  9 points to the strorna in the hilum. 4, substantia corticalis. 1 and 5. connective tissue capsule. 6, surface of lymph tract. Observe that in the region of 9 and 10 are afferent and efferent vessels anastomoses without first entering the gland.

    Since pathologic physiology of the tractus lymphaticus is the zone between physiology and pathologic anatomy it should be amenable to treatment.  In the treatment of pathologic physiology of any abdominal visceral tract it must be remembered that the half dozen viscera tracts normally functionate in perfect harmony - no friction - and if any one tract be disordered the exquisite physiologic balance of all is disturbed. The pathologic physiology of the tractus lymphaticus is treated mainly indirectly, i. e., through the influence of other visceral tracts, e. g.,  (1) the tractus vascularis must be restored to normal as to composition (blood, plasma, oxygen) and pressure (cardiovascular function must be normal; venous flow depends on arterial blood pressure); e. g., (2) the tractus muscularis must functionate normally (lymph largely depends on muscular activity, on respiration, condition of veins).  The pathologic physiology of any viscus is frequently restored by stimulating the four common functions of other viscera (sensation, peristalsis, absorption, secretion).

     Fig. 159.  This illustration demonstrates the course of infectious material or carcinoma from mamma to axillary glands.  The tractus lymphaticus possesses numerous channels with ample lumen. (Sappey.)


    The most useful and safe diuretic is water.  It is the natural functionating medium for the kidney.  One of the best laxatives is water.  Thirst is nature's demand for fluid.  Water is the most important constituent of protoplasm, comprising some 70 per cent of it.  I was a watcher of Dr. Tanner 25 years ago when he lived 40 days on water alone - without  food.  However, a few days without water is imminently fatal.  The quantity of water required by the organism varies with the quantity eliminated.  The quantity of water eliminated, approximately, by a subject of 150 lbs. at rest, is for the tractus urinarius 45 ounces, for the tractus respiratorius 12 ounces, for the tractus perspiratorius 8, for the tractus intestinalis 5 ounces - a total elimination of 70 ounces, almost 5 pints of fluid.  It will therefore require two quarts for the demands of elimination or to satisfy living functionation.  Many subjects do not drink over three pints daily and that is administered chiefly at meal time, not only burdening the tractus intestinalis with solid food, but fluid also.  Many subjects drink insufficiently and suffer consequent oliguria, deficient drainage.  Such subjects are burdened with waste laden blood, inflicting irritation and trauma on the nerve periphery.  They are in conflict with their own secretions.  Many women oppose free drinking from the idea it creates fat.

     Fig. 160.  This illustrates well the terminating lymph trunks as an anastomosing network on the dorsal wall.  Note: (a) the isthmus of the thoracic duct (at its middle portion, 27); (b) the receptaculum lymphatics (25) at its distal end; (c) the thoracic dilatation or ampulia at its proximal end.

    Ample quantities of fluid at regular intervals is the safety valve of health and capacity for mental or physical labor.  Ample fluids not only flush the sewers of the body, but wash the internal tissues and tissue spaces, relieving waste laden blood.  The soluble matter and salts are not only dissolved (preventing calculus, trauma and infection) and eliminated, but the insoluble matter and salts are floated from the system, relieving waste laden blood by such powerful streams of fluid that calculus is not liable to be formed.  One of the most effective and natural stimulants to the renal epithelium is sodium chloride. (Note - Sodium chloride should not be employed in parenchymatous nephritis.) For ten years I have diluted the urine, increased its volume (consequently increased ureteral peristalsis) and clarified it by administering 8 ounces of 1/2 or 1/4 normal salt solution six times daily.  I have manufactured sodium chloride tablets (12 gr. each with flavor).  The patient places on the tongue a half tablet (NACI) and drinks a glassful of water (better hot) before each meal.  This is also repeated in, the middle of the forenoon (1O A.M.), middle of the afternoon (3 P. M.), and at bedtime (9 P. M.). The patient thus drinks 3 pints of (1/4 to 1/2) normal salt solution daily.  This practically renders the urine normal, and acts as ample prophylaxis against the formation of urinary, hepatic, pancreatic, faecal calculus, and drains the body of waste material.  The formation of calculus cannot occur when ample fluid in vigorous streams bathe, flood the glandular exit canals.  With a deficient fluid stream, crystals form a calculus with facility.  The maximum concentrated solution of urine, bile or pancreatic juice tends to crystallize with vastly more facility than dilute urine, bile and pancreatic juice.  In "visceral drainage" single crystals on first formation are rapidly floated with facility by the ample fluids present, while by diminutive quantities of fluid, and consequently aggregation, the crystals tend to precipitate, lodge, accumulate and form calculus.  Oliguria is a splendid base for calculus formation in the ureter.  For over ten years I have been using sodium chloride, normal salt solution, more or less in my practice.  During that time some practical clinical views have been demonstrated and repeated so frequently that they have become established, I think, beyond the shadow of doubt.  The following propositions have been repeatedly demonstrated hundreds of times - during the last ten years - in the clinics of Dr. Lucy Waite and mine and in our surgical cperations that I shall consider them established until otherwise disproven:
    1.  Sodium chloride (1/2 to 1/4 normal physiologic salt solution) is a powerful stimulant to the renal epithelium (tractus urinarius).
    2.  The administration of 8 ounces of 1/2 to 1/4 normal physiologic salt solution (better hot) every two hours for six times daily will increase the quantity and clarify the urine, by diluting its color and salts making it appear almost like spring water in 3 to 5 days. (Note - Sodium chloride should not be administered in parenchymatous nephritis - not in fluid or food - as it exacerbates, irritates, the diseased, inflamed parenchymatous cell.)
    3.  Sodium chloride (in 1/2 to 1/4 normal physiologic solution) is a vigorous stimulant to the epithelium of the tractus intestinalis and its appendages.  Normal salt solution is an excellent remedy to quench thirst subsequent to peritonotomy bv rectal lavage - a pint every hour.

     Fig. 161.  A, perivascular lymphatic of the turtle's aorta.  B, cross section of an artery from the cerebrum presenting perivascular lymph spaces divided by partitions.  It is known as the perivascular lymph space of His.  The Virchow-Robin space is the lymph space in the adventitia of blood vessel wall.

    4.  Sodium chloride is vigorously active stimulant to (glandular) epithelium as that of the tractus urinarius, intestinalis, genitalis, cutis respiratorius, salivary, hepatic and pancreatic glands.  It stimulates the four common visceral functions - sensation peristalsis, absorption, secretion.  It is a natural stimulant (to epithelium and endothelium) as it constitutes over 1/2 of 1 percent of the blood.  The lymph plasma arises from the blood plasma.  Whatever dilutes the blood plasma will therefore dilute the lymph plasma.  Eight ounces of partial normal salt solution 6 times daily will increase the blood volume and consequently increase the lymph volume which will irrigate, flush the lymph spaces and wash the cells.  Also increased blood volume increases the pressure or rate of lymph flow, perfecting visceral drainage.  Since the lymph plasma contains not only the nourishment for the cells but also the waste product of the cell the drainage of the tractus lymphaticus should be rather excessive than deficient as the abundant fresh nourishment vitalizes, energizes the cell.  Cell function is performed through a fluid medium, hence water, which is a fluid transporter, a solvent, an eliminator and regulator of temperature, is first and foremost essential in the pathologic physiology of the tractus lymphaticus.  We live in a fluid medium and elimination demands a compensatory supply so that the cells may continue their submerged aquatic life.  Living cells, which is life, will persist in a fluid medium only.  Ample water drinking affords a bath for the cells.  Absorption of fluids from the tractus intestinalis is especially stimulated by NaCl and C02, i. e., normal salt solution surcharged with carbonic acid gas passes into the tractus vascularis and consequently in t he tractus lymphaticus the most rapidly of any fluid.

     Fig. 162.  From the skin of a child's scrotum.  This cut demonstrates the magnitude and importance of the lymphatic apparatus. (Teichman.)

    Sodium chloride is the most important inorganic salt in the body, e. g., blood plasma contains 0. 7 percent; lymph plasma contains 0.6 percent; saliva contains 0.8 percent; gastric secretions 0.2 percent; pancreatic secretions 0.3 percent; bile contains 0.7 percent; muscle contains 0.7 percent; cerebro-spinal fluid contains 0.5 percent; milk contains 0.23 percent; cedematous contains 0.8 percent.  Sodium chloride, being universally distributed in the body, plays some role of maximum importance in the animal economy.  Sodium chloride maintains the body solutions at a fixed density, therefore maintaining the body tissue at a proper percentage of water.  It maintains blood plasma density in order to suspend red corpuscles, and lymph plasma density in order to maintain in suspension the guests - white blood corpuscles.  Cattle breeders know that a herbivore will not thrive well without a certain quantity of NaCl.  Deer will travel miles to frequent the "lick." Carnivora secure sufficient NaCl from their food.
    NaCl is required for a stimulus to muscular contraction.  NaCl is of special value to digest vegetables (vegetarians).  NaCl plays a maximum role in the physiology of the animal economy.  Its elimination from diet produces pathologic conditions.  In parenchymatous nephritis it should be administered in a minimum quantity as it excessively stimulates the inflamed renal cell.  For further details regarding NaCl see Dr. Herbert Richardson, American Medicine, July, 1906.

     Fig. 163.  This figure represents excellently the relation of the mesenteronic lymphatics and glands to the vasa mesenterica.  The several tiers, rows of mesenteronic lymphatic glands, present characteristic hypertrophy in pathologic physiology of tractus lymphaticus associated with the enteron. (Henle.)

    The power of rapidly absorbing water in the tractus intestinalis is in the following order, viz.: (a) absorption is rapid and vigorous in the enteron; (b) absorption is moderately rapid and vigorous in the colon - (however I have observed a pint an hour absorbed per rectum and sigmoid); (c) absorption occurs slowly and moderately in the stomach.  Ample water inhibited at regular intervals serves as a medium for prompt conveyance of nourishment to the cells.  It accelerates the current of the blood and lymph plasma - at once promptly nourishing and draining the cells.  Ample fluids at regular intervals increase the volume and rate of blood flow, hence circulation is more rapid and thus the blood absorbs more oxygen in a definite time to be transported in life to the tissue.  Visceral drainage furnishes a maximum nourishment, and drainage to cells and hence furnishes a maximum vitality to the organism.  In pathologic physiology of the tractus lymphaticus - as in tissue oedema or "dropsies" - ample fluids (carbonated normal salt solution) at regular intervals are beneficial, producing rapid relief, from extrarenal, cutaneous and intestinal elimination.  Insufficient fluid ingesta makes the body resemble a stagnant pool, while ample fluid ingesta invigorates it to a mountain stream.  Water is a vital stimulant for cell function.

     Fig. 164.  This figure demonstrates that rectal or genital infectious or carcinomatous material will be transported to the inguinal glands - hence the hypertrophy and tenderness of the inguinal glands are indicators of pathologic physiology in the genitals and rectum.


    To drain viscera by appropriate food may sound paradoxical, but 75% of food is fluid and both solid and fluid ingesta excite the four grand common visceral functions of the tractus lymphaticus, viz., sensation, peristalsis, absorption, secretion, which are initiated, maintained and subside by fluid and food.  The appropriate food produces the appropriate degree of sensation, peristalsis, absorption, secretion in the tractus intestinalis for functionation.  The food that will induce proper sensation, peristalsis, absorption and secretion is that which leaves a maximum indigestible residue to stimulate the enteron and colon, such as cereals and vegetables.   Peristalsis is necessary for secretion, for peristalsis massages the secretary glands in the tracius intestinalis, enhancing secretary activity.  The question of diet to determine is: (a) what kind of food causes calculus-producing material in the urine, pancreatic secretion or bile? (b) what kind of food influences the solubility of the calculus-producing material in the urine, pancreatic secretion or bile? (1) The meat eater is the individual with the maximum quantity of free uric acid in the urine.  Flesh is rich in uric acid.  Hence, in excess of uric acid in the urine flesh (meat, fish, and fowl are all about equal in power to produce uric acid) should be practically excluded, because it increases free uric acid in the urine, e. g., the rational treatment of excessive uric acid in the urine consists of administering food that contains elements to produce basic combinations with uric acid, forming urates (usually sodium) which are free soluble, this will diminish the free uric acid in the urine.  Excessive uric acid in the urine is an error in  metabolism.   Flesh  eaters  have  uric  acid  and  stone.   Vegetarians have phosphate, oxalate stone.  Generally the subject who suffers from uric acid is a generous liver, liberally consuming meat and highly seasoned foods, indolent and sedentary persons, and alcoholic indulgers. 33% of uric acid is nitrogen.  Uric acid is derived from the nuclei that form a constituent of all cell nuclei and which are taken in the body as food.  Beef bouillon may be administered because the extract matters in it will scarcely increase the uric acid.  A general meat diet largely increases the free uric acid in the urine. (2) The food should contain matters rich in sodium, potassium and ammonium, which will combine as bases with uric acid, producing alkaline urates that are perfectly soluble in the urine.

    Fig. 165.  This illustration demonstrates the relation of the mamma to the axillary glands and subclavicular glands.  This is especially important in pathologic physiology of the route of infectious and carcinomatous material.  It is evident that the only hope in controlling carcinoma is by observing its pathologic physiology in the precarcinomatous stage.


     Fig. 166. 1, First upper lymphatics within the intestinal villi. 2, next lower layer internal (submucous) lymphatic network. 3, next lower layer langlobate glands (10). 4, external layer of lymphatic network (observe the valves in this layer). 5, circular muscular layer. 6, peritoneal layer. (Teichman.)

    These typic foods are the vegetables which not only render the necessary alkalies to reduce and transform the free uric acid into resulting soluble urates, but leave an ample indigestible faecal residue to cause active intestinal peristalsis, aiding in the evacuation through the digestive tract.  Hence, the patient should consume large, ample quantities of cabbage, cauliflower, beans, peas, radishes, turnips, spinach in order that sodium, potassium and ammonium existing in the vegetable may combine as bases with free uric acid in the urine-producing solub1e urates, thus diminishing free uric acid.  A vegetable diet diminishes the free uric acid in the urine 35% less than a meat diet. Again the administration of eggs and milk (lactoalbumen) limits the production of uric acid.  The most rational advice is to order the subject to live on mixed diet, consuming the most of that kind of food which lessens the uric acid in the urine - vegetables.  Physiologic observations demonstrate that the character and quantity of the ingesta determine the character and quantity of the elimination.  If the appropriate food is so valuable in "visceral drainage" in the treatment of the typical uric acid subject the appropriate food selected for the subjects of binary and pancreatic, faecal calculus, will be relatively as useful.  The foods that make soluble basic salts with secretions should be selected.  Besides, the selection of appropriate food is frequently amply sufficient to drain the intestinal tract to prevent constipation.  It is true, foods alone are not a complete substitute for fluids, but vast aid in visceral drainage may be accomplished by administering food containing considerable coarse residual indigestible matter so that a maximum faecal residue will stimulate the intestines, especially the colon. to continuous vigorous activity, stimulating to a maximum action of the four grand functions - sensation, peristalsis, absorption and secretion.  For twenty years I have treated subjects with excess of uric acid in the urine by administering an alkaline laxative in fluid.  The alkaline tablet is composed of cascara sagrada (1/40 gr.), aloes (1/3 gr.), NaHCO3 (1 gr.), KHCO3 (1/3 gr.), MGSO4, (2 grs.). The tablet is used as follows: 1/6 to 1 tablet (or more, as required to move the bowels once daily) is placed on the tongue before meals and followed by 8 ounces of water (better hot).  At 10 A. M.. 3 P. M., and bedtime the administration is repeated and followed by a glassful of fluid.

     Fig. 167.  The ample transporting lymph apparatus is demonstrated by numerous channels with ample lumen. (Teichman.)

    In the combined treatment the appropriate dose of the sodium chloride and alkaline tablet are both placed on the tongue together immediately followed by the 8 ounces of fluid six times daily.  This  method of treatment furnishes alkaline bases (sodium and potassium and ammonium) to combine with the free uric acid in the urine, producing perfectly soluble alkaline urates and materially diminishing free uric acid in the urine.  Besides, the sodium chloride and alkaline laxative tablets stimulate the sensation, peristalsis, absorption and secretion of the intestinal tract (and all other visceral tracts)aiding evacuation.  I have termed the sodium chloride and alkaline laxative method the visceral drainage treatment.  The alkaline and sodium chloride tablets take the place of the so-called mineral waters.  Our internes have discovered that on entering the hospital the patient's urine presents numerous crystals under the microscope.  However, after following the "visceral drainage treatment " for a few days, crystals can scarcely be found again.  The hope of removing a formed, localized ureteral or other calculus lies in securing vigorous ureteral or other duct peristalsis with a powerful ureteral or other duct stream.  Transportation of ureteral calculus is aided by systematic massage over the psoas muscle and per vaginam.  Subjects afflicted with excess of the uric acid (and consequent ureteral calculus) in the urine or other form of calculus need not make extended sojourns to watering places, nor waste their time at mineral springs nor tarry to drink the hissing Sprudel or odorous sulphur, for they can be treated sucessfully in a cottage or palace by "visceral drainage."     The treatment of a uric acid or other calculus consists, therefore, in the regulation of food and water.  It is dietetic.  The control, relief and prophylaxis of uric acid diathesis or tendency to other calculus formation is a lifelong process.  When the uric acid or other calculus has passed spontaneously the patient does not end his treatment, but should pursue a constant systematic method of drinking ample fluids at regular intervals and consume food which contains bases to combine with free uric acid or other compounds producing soluble urates or other soluble compounds.

     Fig. 168.  The lymphatics are injected and present valves.  There are two conglobete glands.  This lymph apparatus can transport infection with facility on account of its numerous channels of large dimensions. (Teichman.) 

    I continue this treatment for weeks, months, and the results are remarkably successful.  The urine becomes clarified like spring water, and increased, in quantity.  The volume and rate of blood flow is increased, transporting increased oxygen to tissue. The volume and rate of lymph flow is increased, transporting increased nourishment to the cell and increasing cell drainage, energizing and vitalizing the organism.
    The tractus intestinalis becomes freely evacuated, regularly daily.  The blood is relieved of waste laden and irritating material.  The tractus cutis eliminates freely, and the skin becomes normal.  The appetite increases.  The four grand common visceral functions - sensation, peristalsis, absorption and secretion - are acting normally.  The sewers of the body are well drained and flushed.  The sleep becomes improved.  The feelings become hopeful.


    Habitat includes all methods of living from the sedentary to the athletic, from the paralytic to the traveler.  In general the habitat will refer chiefly to the tractus muscularis and tractus respiratorius.  Muscular activity, vigorous exercise, enhances two grand functions, viz., tractus vascularis and tractus glandularis.
    The muscles are powerful regulators of circulation (blood and lymph) hence their stimulation (exercise) increases the tone of vessels, magnifies blood currents to viscera which consequently multiplies common visceral function (sensation, peristalsis, absorption and secretion), ending in free visceral drainage.  Muscular activity increases blood volume, universally improving nutrition.  Maximum blood volume is the primary base of visceral peristalsis.  The most typical popular example of the muscles controlling the blood circulation is that of the uterus.  The myometrium like elastic living ligatures controls the uterine blood supply (and consequently its functions), (sensation,
peristalsis, absorption, secretion, menstruation and gestation), hence drainage with flaccid muscles drain glandular secretion, as in the uterus, may be excessive (leucorrhea).

     Fig. 169. a, a, superficial layer; b, b, deep layer, anastomosing lymphatics.  It shows a rich transporting tubular apparatus. (Teichman.

    Exercise is an essential for health.  Muscles exercise a dominating control over circulation (blood and lymph).  The abdominal muscles influence the caliber of the splanchnic vessels.  They exercise an essential influence over peristalsis, secretion, absorption, of the tractus intestinalis, urinarius, vascularis and genitalis.  The muscles massage the viscera, enhancing their function and the rate of circulation with consequent free drainage.  In the uterus, the most typical example (especially marked during parturition), is prominently demonstrated how the myometrium controls the blood currents like elastic living ligatures.  The myometrial bundles by continual contraction decreases the dimension and blood volume of the uterus at a moment's notice subsequent to parturition.  The muscular system is equally and continually influential, at all other time as it is parturition, over circulation and visceral function.  Regular vigorous habits enhance visceral drainage.
    The value of fresh air was never realized so effectively and practically as at present.  Fresh cold air cures pulmonary and other tuberculoses.  The success of the sanitorium is the continued use of fresh (cold) air.  The subject should sleep with fresh continuous cold air passing through an open window space of 3 x 3 feet.  Every physician should advocate the continuous open window, day and night for living and sleeping room.  It appears to be demonstrated that cold fresh air is more beneficial than warm fresh air.  It is common talk among people that one winter in the mountains is worth two summers for the consumptive.  Much of man's disease is house disease.  It is lack of oxygen and exercise.  The curative and beneficial effect of cold fresh air continually, day and night, for the family must be preached in season and out of season by the physician.  The windows should be open all night.  Fresh cold air is one of the best therapeutic agents in pathologic physiology of viscera.  It stimulates viscera to active function and consequent visceral drainage.  Observe the wonderful results of systematic deep breathing, chest expansion.  It utilizes ample oxygen which is rapidly transported to the tissue by the tractus vascularis.  If one observes the naked body in rapid deep breathing it will be observed that man's respiratory apparatus extends from his nostrils to his pelvic floor, i. e., it extends to the territory of the spinal (intercostal and lumbar) nerves.  Hence, by stimulating to a maximum the functions of the tractus respiratorius (sensation, peristalsis, absorption, secretion) - e. g., by systematic deep respiration - vast benefits result to the organism.  The habitat that furnishes opportunity for abundant fresh air, like an open tent on the plains and ample muscular exercise, is the one that affords the essential chances for recovery of pathologic physiology viscera.  It enhances visceral drainage.  Fresh air is required to transport a continuous, ample supply of oxygen to the muscular apparatus to maintain its normal tone, its contractions and relaxations.


    The suitability of avocation to health is a daily observation.  The prisoners confined in a cell, the clerk confined in a store, stand in contrast to the subjects living in the field, and the traveler continually exposed to sun and wind.  The sedentary occupation confining the laborer affords insufficient muscular exercise or fresh air to maintain ample visceral drainage.  Visceral drainage is required for health as nourishment.  Fresh air aids visceral drainage by transporting well oxygenized blood to the viscera which stimulates the four common visceral functions.  The avocation should suit the laborer's physique that the four common visceral functions mav be normally maintained.


    Normal visceral drainage is the key to health.  It is maintained by appropriate fluid, food, habitat, avocation.  Visceral drainage depends on the normal activity of the four common visceral functions (sensation, peristalsis, absorption, secretion).  The chief factor in appropriate visceral drainage is ample fluid administered at regular intervals.  It requires five pints of fluid daily to compensate for the visceral elimination.  The function of water in the organism is: - 1, elimination; 2, solvent; 3, transporter; 4, regulator of the temperature.  The cells of the body (parenchymatous and connective tissue) functionate in a fluid medium.  Life can persist in a fluid medium only.  Visceral drainage is a vast factor in correcting the pathologic physiology of viscera and especially the tractus lymphaticus.  Therapeutics must be rational, for nature alone can cure.  Therapeutics must imitate and aid nature in restoring function by natural agents.  Practically the influence of a physician is limited to pathologic physiology, i. e., the zone between normal physiology and pathologic anatomy.  The physician's chief duty is to correct function.  Visceral drainage produces maximum cell nourishment and maximum cell drainage, hence creates maximum energy and vitalizes the organism.  Practically ample fluids at regular intervals is recommended in pathologic physiology of the viscera, e. g., in obesity, in diabetes, in rheumatism, in fevers, cholelithiasis, nephrolithioses, constipation.  Water is a vital stimulant to the life of a cell.