The Arris and Gale lectures on the physiological factors involved in the causation of dropsy : delivered before the Royal College of Surgeons of England on February 17th, 19th, and 21st, 1896 / by Ernest H. Starling.

  • Starling, Ernest Henry, 1866-1927.
Date:
1896
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Licence: Public Domain Mark

Credit: The Arris and Gale lectures on the physiological factors involved in the causation of dropsy : delivered before the Royal College of Surgeons of England on February 17th, 19th, and 21st, 1896 / by Ernest H. Starling. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    isotonic witli the blood plasma would contain from 5 to 6 per cent, of this body. When we inject a solution containing from 50 to 75 per cent, of dextrose it will attract fluid from the tissues until its percentage is reduced to 5 or 6 per cent,, that is to say, 45 c.c. of fluid containing 30 grms. of dextrose will attract water from the tissues until its total volume is increased to 500 c.c. Of course, this estimate is merely a rough approximation at the truth, since before the sugar has had time to attract all this fluid a considerable amount of it will already have left the vessels by diffusion. As a matter of fact, however, we find that injection of a strong solution of dextrose is followed in a few minutes by a considerable dilution of the blood, caused by an increase in its volume. In some experiments of von Brasol the volume of the circu- lating blood was ihus increased to twice or three times its previous amount; and these observations have been fully con- firmed in a series of careful experiments made by J. B. Leathes. As we should expect, this increase in the volume of the circulating blood is attended by a large rise of capillary pressures in the abdominal viscera, and we have here again to decide whether it is this rise of capillary pressure or the change in the chemical composition of the blood that determines the increased lymph - flow. This question can be solved by using the same method that we adopted when dealing with the production of the increased lymph-flow in fiydrsemic plethora. We can entirely obviate the rise of capillary pressure if we bleed first to 300 c.c. and then inject a concentrated solution containing 18 grms. of dextrose. In this case the fluid that is dragged by the sugar from the tissues into the blood- vessels only just suffices to make up for the previous loss of blood. No hydrsemic plethora is produced ; there is no rise of capillary pressure, and there is no increase in lymph-flow, although an abnormally large amount of dextrose is present in the circulation. We must conclude, therefore, that the increased flow of lymph caused by injection of the second class of lymphagogues is entirely due to the rise of capillary pressure thereby induced, and is in no wise conditioned by a stimulation of the secretory activities of the endothelial cells. There is one point in the effects of the injection of these bodies which has been looked upon as a strong argument for the secretory hypothesis, and which I must therefore mention shortly here. If we analyse the lymph and the blood at different periods after the injection we find that the amount of sugar in the blood steadily diminishes, while the sugar in the lymph first rises to a maximum and then diminishes parallel with that in the blood plasma At a given period after the injection it is found that the lymph contains more sugar than does the blood plasma, and this fact was held to point to an undoubted secretory activity of the endothelial cells in the production of lymph. This conclusion, however, is by no means justified. The lymph flowing at any given moment from the thoracic duct does not represent the tran-