Rate of Lymph Flow in Edematous Skin of Cardiac and Renal Disease

Abstract

In normal skin an intradermal injection of deeply colored vital dye renders the lymphatics visible. 1 In a few minutes some of the dye drains away into the deeper channels appearing like colored streamers when seen through the skin. Scores of tests on normal volunteers have shown these colored streamers to be long or short under conditions known to increase or decrease lymph flow respectively. The method, to be described elsewhere, has been used to compare the rate of lymph flow in the edematous skin of cardiac and nephritic patients.

In more than 60 experiments upon 14 individuals with cardiac disease and edema of the lower limbs, we have found the lymphatic capillaries widely dilated and dye entered them more readily than in normal skin. The intercommunication between the channels was extremely rich and the injection of the superficial network very complete, showing that they were fully open. Dye was carried farther in the channels to color a wider area and escaped from them more rapidly than in normal skin.

In instances of long standing cardiac edema, isolated colored “islands”, skin regions in which the superficial lymphatics contained dye, appeared during the course of the intradermal injection several centimeters away from where the needle had entered and separated from the immediate area of staining by skin of normal hue. These are never seen under normal circumstances. It is plain that some of the injected pigment entered the deeper plexus, passed along this unseen and emerged again at some distance in the superficial plexus. The “islands” appeared below the site of injection as well as elsewhere around it. A valvular incompetence of the deeper lymphatics, due to widening of them, will explain the retrograde flow.