The Flow and Composition of Lymph in Relation to the Formation of Edema

1. The experimental observations have been summarized at the end of an earlier section. The more important facts only will be recapitulated here. The capacity of the lymphatics for removing fluid from the tissues greatly exceeds the rate at which freshly formed tissue fluid can be made available for removal. Edematous regions can be rendered non-edematous by the application of measures, such as massage, passive motion, or normal exercise, which activate the lymphatics. During continuous activity the rate of lymph flow is first variable and later relatively constant. Constant rates of flow must correspond to the production of fresh lymph. A study of the constant rates indicates that lymph formation in the edematous animal is certainly only slightly greater, and possibly not greater at all, than under conditions of normality. When the protein of plasma decreases, the protein of lymph is also lowered. The loss of protein from lymph takes place at a faster rate than from plasma, so that the ratio of serum protein to lymph protein is greater in the edematous than in the normal animal. In edematous animals the concentration of protein in lymph is of the same order of magnitude as the concentration in edema fluids. The two fluids are not, however, identical in composition. Minor fluctuations in the protein content of lymph always occur during a period of continuous collection. 2. The factors involved in the circulation and accumulation of tissue fluid are discussed. Reasons are given for offering the following suggestions. Significant differences in tissue pressure or tension exist between the states resulting from quiescence and activation of the lymphatics. The differences give rise to variations in the relative areas of capillary wall, functioning for filtration and reabsorption. When the lymphatics are activated it is possible that capillary reabsorption may be completely in abeyance. A decline in the proteins of plasma may be associated with a diminished permeability of the capillaries. Such a lowering of capillary permeability would account for two features, both of which have been demonstrated: (1) failure to observe an appreciably increased rate of lymph formation in the edematous animal, and (2) the extremely low concentration of protein in lymph from edematous animals. Although the difference between the protein concentrations of edema fluid and lymph from the same region is small, the conclusion is not yet justified that a similarly small difference exists between normal tissue fluid and normal lymph.