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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    capillaries, such as those in the limbs, without causing any appreciable increase in the lymph-overflow from the limbs. On the other hand, where the capillaries are very permeable very little pressure will be required to cause a transudation, since no work is done in the concentration of a proteid solution, and we find, as a matter of fact, that capillaries where the pressure is lowest — i.e., in the liver—are also those which are the most permeable. Here, moreover, the absorbing force will be insignificant, since there is very little difference in the percentage of aibumin between liver blood and liver lymph. This osmotic difference between blood plasma and tissue fluid will not serve to explain the absorption of proteids by the bloodvessels and would certainly not explain the absorption of serum from the serous cavities. It is difficult, however, if not impossible, to prove that serum or proteid is absorbed by the bloodvessels. In some of my transfusion experiments I have rendered a limb oedematous by means of serum, and in these cases have obtained no evidence at all of absorption by the bloodvessels. There is no doubt that serum may be absorbed from the pleural and peritoneal cavities, but the absorption of these fluids is very much slower than the absorption of salt solutions, and is in fact so slow that the whole of it can in most cases be effected by the lymphatic channels. A slow absorption of serum from tissue spaces by means of the bloodvessels is also physically possible. As the cells of the tissues feed on the proteids of the fluid the serum will tend to become weaker and weaker, so that the watery and saline constituents corresponding to the proteid used up can then be absorbed by the bloodvessels in the way I have indicated. The physical process which I have described above as causing the absorption of lymph by the bloodvessels must be in action at all times in the body and must, therefore, be a predominant factor in the process of absorption. I have not been able to absolutely exclude the absorption of proteids by the bloodvessels, but, in the absence of direct experimental evidence that such an absorption does occur, the physical factors I have described in this lecture suffice to explain the phenomena of absorption observed both under normal and under pathological conditions.