Abstract
It has long been known that serous cavities have the capacity of absorbing certain injected substances, Cunningham 1 showed that, when a mixture of erythrocytes, large unfiltered carmine granules, and fine lampblack granules, made up in isotonic NaCl solution, was injected into the peritoneal cavity of animals, all 3 types of material reached the anterior mediastinal glands shortly after injection. His results indicate that most, if not all, of the transfer of granular material from the peritoneal cavity into the diaphragmatic lymphatics, during the first 30 minutes, takes place by means of a type of phagocytosis. His important findings give a clearer understanding of the high phagocytic capability of the lymphatic endothelial cells to remove large amounts of particulate matter from the peritoneal cavity. The diaphragm is rich in lymphatics and its lymphatic vessels anastomose with the lymphatic vessels of the pleura and the peritoneum, which, in turn, connects with the right and left lymphatic ducts. The thoracic duct, terminating in the internal jugular vein, conveys the great mass of lymph and chyle into the blood. It is the common trunk of all lymphatic vessels below the diaphragm. The right lymphatic duct receives lymph from the right upper extremity, the right thorax, right lung, right side of the heart, and from parts of the convex surface of the liver. It opens into the junction of the internal jugular and the subclavian veins separately. Absorption in this region is extremely rapid due to this network of lymphatics. The practical application of this knowledge is found in the Fowler position, whereby, upon elevating the head of the bed after operation for abdominal infection, the infected material is permitted to gravitate toward the pelvic peritoneum.
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