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Byron Robinson, M. D. 1907 CHAPTER XXXVIII. THE PATHOLOGIC PHYSIOLOGY OF
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.
1. TRACTUS LYMPHATICUS. 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.
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.
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.
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.
(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.
(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).
II. THE LYMPH (LYMPH PLASMA). 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).
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).
(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 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.
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).
I. SENSATION (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.
II. PERISTALSIS (EXCESSIVE, DEFICIENT, DISPROPORTIONATE). 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.
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.
III. SECRETION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE). 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.
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.
IV. ABSORPTION (EXCESSIVE, DEFICIENT, DISPROPORTIONATE). 10. Excessive; 11, deficient; 12, disproportionate, absorption of lymph plasma is difficult to demonstrate and time and space here forbids. THE DIAGNOSIS OF PATHOLOGIC PHYSIOLOGY IN THE TRACTUS LYMPHATICUS 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
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.
RELATIONS OF THE TRACTUS LYMPHATICUS TO PRACTICAL MEDICINE. 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.
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. TREATMENT OF PATHOLOGIC PHYSIOLOGY OF THE TRACTUS LYMPHATICUS AND THE LYMPH. 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.
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).
I. VISCERAL DRAINAGE BY FLUID. 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.
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:
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.
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.
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.
(B) VISCERAL DRAINAGE BY FOOD. 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.
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.
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.
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.
(C) HABITAT IN VISCERAL DRAINAGE. 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.
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.
(D) AVOCATION IN VISCERAL DRAINAGE. 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. CONCLUSIONS REGARDING VISCERAL DRAINAGE. 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. |