Three lectures on the pathology and treatment of diabetes mellitus viewed by the light of present-day knowledge / by F.W. Pavy.

  • Pavy, F. W. (Frederick William), 1829-1911.
Date:
1908
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Licence: In copyright

Credit: Three lectures on the pathology and treatment of diabetes mellitus viewed by the light of present-day knowledge / by F.W. Pavy. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    Amongst text-book authorities, Michael Foster speaks of its having been calculated that in a well-fed animal, a quantity of lymph and chyle equal to that of the whole blood may pass through the thoracic duct in 24 hours, and that of this, about half comes through the lacteals from the abdominal viscera, and therefore to a large extent from food/ Upon this basis he reckons that for a man of average weight the quantity discharged into the blood per hour would be a quarter of a kilogramme, or a little under a quarter of a litre, a ratio giving something less than six litres for the 24 hours. It is a matter that is beset with difficulties to obtain precise information experimentally regarding the rate of flow taking place under natural conditions. Hence many widely conflicting statements have been made by different authorities. Cases are from time to time come across in the human subject where from some unnatural condition connected with the thoracic duct an obstruction is offered to the flow of chyle in its proper direction and it becomes dis- charged from the lymphatics belonging to a particular portion of the skin. One such case has recently formed the subject of a com- munication from the physiological laboratory of University College, London, by J. Molyneux Hamill in the Jotmial of Physiology: Yol. XXXV., 1906. The patient, who was an inmate in University College Hospital, was a man in a fairly healthy state, 20 years of age, and 140 pounds in weight. When a boy of 10 years, the cutaneous lymphatic disten- sion showed itself and led on to the formation of a per- manent fistulous opening in the upper part of the right thigh close against the groin. Through this opening lymph and chyle, when not controlled by a pad and bandage, escaped. When escape was prevented, accumulation took place in the affected parts and led on to a state of tension which required to be from day to day relieved by allowing a certain amount of exit to take place. An observation was conducted on THE BATE OF CHYLE FLOW by leaving the opening free and allowing the chyle to trickle into a vessel placed to receive it. In this way, over four litres, it is stated, were collected in the course of 12 hours Further escape was then stopped at the patient's request owing to the great exhaustion it produced. It is seen that the rate of flow was here greater than in the estimate given