On the origin of the abdominal lymphatics in mammals from the vena cava and the renal veins.код для вставкиСкачать
ON THE ORIGIN OF THE ABDOMINAL LYMPHATICS IN MAMMALS FROM THE VENA CAVA AND THE RENAL VEINS FLORENCE R. S A B I N If’rom Thc Ancctoiiiical Lnbol atory, The Johns N o p k i n s Uriizwszty It is a pleasure t o have for study Mr. Kampmeit.r’s ablc and valuable paper on the thoracic duct, as seen in one of my specimens, in the June number of The Anatomical Record. His direct dorsal view of a wax reconstruction of the jugular lymphatics brings out one point better than my profile reconstruction shown to the American Association of Anatomists in 1910. This point is the crossing of the thoracic duct t o the right side which I have often, though not always noted. in injections of later stages. Moreover, his paper is a clear and excellent presentation of the theory of the growth of lymphatics by the addition of tissue spaces. My own work on the thoracic duct is t o appear in a forthcoming number of the Ergebnisse fur Anatomie und Entwicklungsgeschichte, but I should like to present this preliminary note. Lymphatics in mammals arise in two places, (1) from the anterior cardinal veins in the neck, ( 2 ) from the inferior vena cava and the adjacent veins of the Wolffian body or kidney. The budding of the jugular lymphatics is from the anterior cardinal veins near the duct of Cuvier but is not strictly limited to the anterior cardinal veins. I n different forms the budding may extend along some of the adjacent8 vein?, namely the posterior cardinal, the primitive ulnar and the capillaries that eventually make the root of the external jugular vein. The lymphatics which bud off from the inferior vena cava, which is a part of the large vein which connects the two Wolffian bodies, and from some of the veins in the edge of the Wolffian body grow in three directions. Those that grow ventral to the aorta make the retroperitoneal sac; those that grow caudalward, lateral t o the aorta, make the iliac. sacs; and those that grow dorsal t o the aorta make the cisterna chyli and the lower part of the thoracic duct. There are therefore two pairs of symmetrical primary sacs in mammals, the jugular and the iliac, 335 336 FLORENCE R. SABIN and two median sacs, the retroperitoneal and the cisterna chyli. I t might be said that there are three different sacs in mammals, the jugular (paired), the iliac (paired) and the retroperitoneal (unpaired) and these threc sacs are connected with each other by the cisterna chyli and the thoracic duct. However as I shall define primary lymph sacs as thosc which bud directly off from the veins, it is necessary t o include the cisterna chyli with the primary lymph sacs. The primary lymphatic sacs and the thoracic duct make the primary lymphatic system. The thoracic duct arises in part as a down growth from the left jugular lymph sac and in part from a plexus of lymphatics which buds off from the veins of the Wolffian body. While the thoracic duct is incomplete, it is excessively hard to inject. The specimen which I loaned to Mr. Kampmeier is not a perfect injection since i t has extravasations; it is, however, the first and until the past month the only injection ever mad(. of a mammalian thoracic duct before i t is complete. It was niadr indirectly through the jugular sac. I filled the sac with ink and then bent the h a d forward and to my surprise the ink shot into the thoracic duct. As mill be readily seen a n injection into the jugular sac almost invariably runs by the path of least resistance or the physiological path into t h r veins and does not back into the thoracic duct. Perfect injections of lymphatic capillaries without any extravasations can be made. as for example Mrs. Clark’s injection of the jugular lymphatic plexus in thc chick shown on page 263 of the June number of The Anatomical Record for this year, 1912, but t o obtain perfection i t is necessary t o xwtch the entire field of injection under the microscope in ordcr to regulatc the pressure. Mr. Kampmeier’s figure 1 shows the jugular portion of the thoracsic duct which arises as sprouts from the jugular sac. These sprouts form a plexus dorsal t o the esophagus from which ducts grow downward. The shorter left duct follows the vein t o the root of the heart and I think subsequently grows t o the left side of the heart and the left lung. A longer ductJ crosses t o the right side and is the upper thoracic part of the thoracic duct. The abdominal portion of the thoracic duct in the pig buds off from the two sides of the large vein which connects the Wolffian bodies ant1 forms part of the vena cavn and from the large veins in the capsule of the Wolffian body itself. Dr. and Mrs. E. R. Clark have shown in tho ,June number of The Anatomical Record for 1912 that the lymphatics for the. posterior lymph hearts of tht. chick bud off from t h r coccygcnl vein ant1 i t 5 hranchrs, and these lymphatic buds are filled with stagnant ORIGIN O F ABDOMINAL LYMPHATICS I N MSMMALS 337 blood by a back flow from the parent vein. These lymphatic buds first make a plexus out of which the lymph heart is formed. I n the chick thelymphatics while they are still in the bloodfilledstagegrowout t o form the peripheral capillaries in the skin. Moreover they are closed vessels, first because the blood in them is held within the contour of the vessel, and secondly because a little ink injected into one vessel will fill the entire lymphatic system and empty into the veins without any extravasation. I n reworking all of the sacs in the pig, I have found that the primary buds are packed with blood (fig. 7 in 14) and that the blood empties gradually so that the sacs are subsequently partially filled and finally empty. The jugular lymphatics bud off from the jugular veins making the well known jugular sacs. All the rest of the lymphatics in the pig bud off from the mesonephritic veins. The retropcritoneal sac comes off from the ventral surface of the mesonephritic vein in themidline of the embryo. I found out the fact that the abdominal part of the thoracic duct comes from the same vein by direct puncture of the cisterna chyli in the blood filled stage. I saw the ink enter the mesonephritic vein. I have three injections of the abdominal sacs or rather plexuscs made in embryos 23 mm. long. No one of them is perfect and none shows the cisterna chyli since the ink around the point of injectioii obscures it. They all show that the beginning thoracic duct, two symmetrical plexuses along the edge of the Wolfian body and the retroprritoneal sac connect. I shall subsequently describe these injections more in detail when I can also present views of the veins of the region as well. For the present I want t o describe the blood filled lymphatic buds as they appear in 23a which Kampmeicr studied, as well as in another specimen from the same litter and in a human embryo of about thtl same stage. I n the series 23a, which measured 23 mm. in its greatest length in the fresh specimen the blood packed lymphatic buds are to be setn in sections at the level of the median mesonephritic vein. They arc in the angle between the vein and the medio-dorsal edge of the Wolffian body. These buds while still packed with blood form (1) the iliac lymphatics and (2) the cisterna chyli. I n a seriesmeasuring 22 mm., I have found the earliest blood filled iliac budr arising from the large veins in the capsule of the Wolffian body, as wc~llas the dorso-lateral surface of the mesonephritic vein ncar tht. Wolffian body. I n 23a the iliac plexus of blood pucakcd lymphatics has groun caudalward along t,hc dorso-medial border of the Wolffian body as far as the hilum of the 338 FLORENCE R . SABIN permancnt kidney. This plexus of blood filled lymphatic capillaries is spreading out in the capsule of the kidney and in later stages I have injected a plexus of lymphatic vessels from the iliac sac intd the hilum of the permanent kidney around its pelvis. This explains why the permanent kidney is supplied by iliac lymphatics, while on the other hand the retroperitoneal sac spreads into the ventral capsule of the Wolffian bodies as far as the edge of the reproductive glands. Their lymphatics therefore grow from the retroperitoneal or prae-aortic sac. The iliac sac is not complete in 23a; the iliac plexus grows down to a point exactly opposite the bifurcation of the aorta where it swells into a sac which I first identified as the posterior sac in 1901 in a n embryo pig 25 mm. long. From this enlarged end grow three main groupsof lymphatics, (1) a n abundant plexus of vessels surrounding and following the umbilical arteries, (2) the femoral and (3) the ilio-lumbar vessels ivhich together drain the leg and abdominal wall. The cisterna chyli is not present in 23a, but in an embryo 23b from the same litter as 23a, the blood filled plexus which arises on either side in common with the iliac plexus has arched across the midline, d o r d t o the sympathetic ganglia and the aorta. Immediately dorsal to the aorta a t the level of the anlage of the adrenal bodies the blood filled lymphatics have enlarged into a cisterna chyli. I n my article in the Ergebnisse I have shown this important point, that all of the primary lymphatics bud into non-vascular zones; if the non-vascular areas are large, the sacs are large, as for example the jugular and the retroperitoneal s&s in the pig; if the non-vascular areas are small, the sacs are small, as for example the iliac sac and the cisterna chyli in thc pig. The cisterna chyli develops opposite the adrenal anlage just a t the tip of the developing azygos veins. Caudal t o this point the segmental venous plexus drains through the Wolffian body and the transition zone is a small non-vascular area. Tracing the thoracic duct by the presence of the blood, the vessels have not yet grown beyond the region of the adrenal bodies, the blood filled plexus has, however, grown caudalward dorsal to the aorta t o a point opposite the hilum of the permanent kidney. The rest of the thoracic duct forms rapidly, and is probably complete a t the stage measuring 25 mm. I have completely reconstructed it a t 27 mm. The lower segment is always characterized by being an exceedingly abundant plexus which surrounds the aorta as is shown in Pensa’s figures (111, while the portion from the heart t o the neck is often a single trunk or at least a few vessels. I n a third specimen meas- ORIGIN OF ABDOMINAL LYMPHATICS I N MAMMALS 339 uring 23 mm. in which I washed out the blood vessels with Locke’s solution, the abdominal lymphatics are partially filled with blood and the veins are empty. This shows that the blood packed stage is a short one. I n this specimen lymphatics from the retroperitoneal sac are growing around the aorta t o connect with the cisterna chyli. . Subsequently the main connection is around the cerebral surface of the adrenal. All of the abdominal sacs become connected with each other. A new embryo in the Mall collection, No. 460, measuring 21 mm. is of great interest in connection with the abdominal lymphatics. A careful reconstruction of this specimen with abundant illustrations will be of value, but for the present I can only give a brief description. I injected the embryo with India ink through the umbilicaI artery while the heart was still beating. The vascular injection is almost perfect. The embryo was then put directly into bichloride-acetic and the fixation is excellent. I n marked contrast to the embryo pig of about the same length the Wolffian bodies are disappearing, being pushed caudalward by the growing permanent kidneys. Thc cerebral pole of the Wolffian bodies, now far to the side, lies opposite the large median vein which still drains the Wolffian bodies. This vein is now markedly assymmetrical, owing to the enlargement of the right side of it, due t o the vena cava. From the sides of the median vein extends a plexus of veins t o the permanent kidneys. From the ventral surface of this vein in the midline is a group of blood filledlymphatic buds, lying in the root of the mesentery. This area is very small in the human embryo, in marked contrast with the large area of the pig, and the human retroperitoneal or prae-aortic sac is consequently of small size. It is of considerable interest t o note that thc connective tissue near these lymphatic buds has wider spaces than along the rest of the border of the vein. They can, however, be distinguished from the lymphatics. Some lymphatics are growing from the dorsal surface of the median vein, and, pushing between the masses of cell? of the sympathetic ganglia, have reached the ventral surface of the aorta. The iliac lymphatic sacs are of great interest. They are farther advanced than the retroperitoneal sac, because (1) they are larger and (2) they are only partly filled with blood. They arise not from the veins of the Wolfian body but from the veins of the permanent kidney. Along the dorso-medial border of the kidneys between the kidney and the segmental veins are two long Sacs, the one on the kft being about 1.8 340 FLORENCE R. SABIN mm. long. The left sac reached the bifurcation of the aorta; the caudal part of the right sac is less developed, and the place for it is small, on account of the size of the vena cava. Instead of a sac there are some blood packed buds along the vena cava itself. The cerebral ends of the iliac sacs meet in a small plexus of blood filled vessels dorsal to the aorta opposite the adrenal bodies. This marlis the position of the future cisterna chyli. The abdominal part of the thoracic duct can be traced for some distance in the sections. The trunk for the jugular sac is present but I do not think that the two parts have met. Another point of great interest in the specimen is that it shows many areas of widened tissue spaces along the aorta. They can, however, be distinguished from the lymphatics. The question a t issue between Mr. Kampmeier and myself is the method of growth of the thoracic duct between the two anlagen, the jugular and the renal segments. I admit a t once that I have not seen the duct grow in the living form, nor have I mastered tho cJifficu1tiw of injecting i t so as t o demonstrate its gradual growth from two vt‘nous anlagen. The isolated spaces shox-n in Mr. Kampmeier’s figure 1, I submitted to most careful study before the meeting in 1910 and discussed them there; they are endothelial lined and I believe them t o be lymphatics. I believe that adequate injections would show that they connect with the rest of the system. It was these vessels which made me consider whether tlic origin of the thoracic duct was not from a series of vessels from the azygos veins, but this point has now been clcared up by finding that the cisterna chyli arises as blood filled buds from the mesonephritic or renal veins. The fact that the injection mass extravasated just above the long apparently isolatedlymphatic on the right side is not an unsurmountablc difficulty, for it has been noted by a long list of observers among whom arc Sigmund Mayer (9), Ranvier (12), MacCallum (8), Bartels (1) and myself (13) that it is an especial characteristic of lymphatic capillaries that tiny sprouts in which extravasations may readily occur often lead to wide bacs or vesscls. I n fact both Stricker (16) and Sigmund Maycr have seen blood capillaricxs contract down t o a thread in a living tadpole’s tail, 50 it is known that endot helium is contractile. I n regard t o the method of growth of the intermediate division of the thoracic duct, I know that the peripheral lymphatic capillarirc grow by budding of their endothelial wall, having seen them in t h r living tadpole, I know that the lymphatics in the chick bud off from the veins and grow to the peripheral cnpillarici in skin a\ closcd endothelial vess~lh ORIGIN OF ABDOMINAL LYMPHATICS IN MAMMALS 341 having seen them in the Clark’s specimens. I know as nearly as possible without actually sceing thc process in the living form, that the thoracic duct begins in mammals as a down growth from the jugular sac and as a n up growth from the cisterna chyli which comes from the meEonephritic or renal veins, I therefore do not believe that its further growth is by a process different from the rest of the lymphatic and blood vascular systems. The discovery that all the abdominal lymphatics in mammals come from the veins of the Wolffian body or kidney brings out the significance and the importance of Silvester’s (15) beautiful injections in South American monkeys. He showed that in this one form the renal connections are permanent. It also allows us t o consider the question of the relation of the mammalian lymph sacs t o the lymph hearts and sacs of the amphibia. Thc anterior lymph hearts of the arhphibia bud off from the vertebral veins (Knower (7) and Hoyer ( 5 ) ) and as Knower has shown gets its muscle from the myotomes; the posterior lymph hearts of amphibia and birds arise from the coccyges1 veins, they lie against the myotomes and have muscle in their walls. The anterior lymphatics of birds and mammals arise from the anterior cardinal vein and do not develop muscle. The abdominal lymphatics of mammals bud off from the renal w i n s and form three sacs, the retroperitoneal, the iliac and the cisterna chyli. These sacs are likr the amphibian lymph hearts in their most fundamcntal point, namely that they bud directly from the veins, thcy dift’rr from them in position not, lying against the myotomes and in not dcveloping muscle. They arc’ not analogous t o the amphibian lymph sacs which are secondary structures, transformed from lymph ducts. The mammalian sacs therefore might be called primary lymphatic sacs. As a matter of fact the following is the cmhryological classification. Primary lymph sacas : (a) those which develop muscle in their wall, forming true lymph hearts, for example the anterior and posterior lymph hearts of amphibia and the posterior lymph hearts of birds; (b) those which do not develop muscle, but become partially transformed into lvmph glands, for example the jugular lymph sacs of birds and mammals arid the mesonephritic (renal) lymph sacs of mammals. I n a word, primary lymph sacs may become lymph hearts or lymph glands. 342 FLORENCE R. SABIN LITERATURE C I T E D (I) BARTELs, P. 1909 Das Lymphgefsisssystem. Anatomie des Menschen. Fig. 9. (2) BAETJER, W. 1908 Amer. Jour. Anat. vol. 8. (3) CLARK. E. L. (4) CLARK,E. R. ( 5 ) HOYER, H. Bardeleben's Handbuch der 1912 Anat. Rec. vol 6, p. 247 and p. 261. AND E. L. 1912 Anat. Rec., vol. 6, p. 253. 1908 Bull. de L'Acad. dcs Sciences de Craronc. (6) I<AMPMEIER, 0. 1912 Anat. Rec., vol. G. ( 7 ) KNOWER, H. McE. 1908 Anat. Rec., ~ o l 2. . ( 8 ) ~ I A C C A L L UW. M ,G. 190243 Arch. f . Anat. und Phys., Anat. Abth., and Bulletin of the Johns Hopkins Hospital, vol. 14. (9) RIAIER, SIGMUND. 1885 Sitzungsber. der k. Akad. der Wissenshaften Wien, Abth, 3, Bd. 91 and 92. (10) RICCLURE,C. F. W. 1912 Anat.'Rec., vol. 6. (11) PEXSA1908-1909 Lab. di Anat. norm. della Univ. di Roma, T. 14. (1'2) RAXVIER1897 Arch. d'Anat. Inicroscopique, T. 1. (13) SABIN,F. R. (14) 1901 Amer. Jour. Anat., vol. 1. 1909 Amcr. Jour. Anat., vol. 9. (15) SILVESTER, C. F. 1912 Amcr. Jour. Anat., vol. 12. (16) STRICKER1865 Sitzungsbr. der Math.-Naturwissen. Classc d. k. Akad., Wien. BOOKS RECEIVED THE ESSENTIALS O F MORBID HISTOLOGY, For the use of Students, Albert S.Grunbaum, with 22 colored plates and 139 other illustrations, 220 pages including Index, 1912, $2.00. Longmans, Green and Company, London, New York, Bombay and Calcutta. MANISCH-DEPRESSIVES GND PERIODISCHES IRRESEIN ALS ERSCHEINUNGSFORM DER KATATOXIE, Eine Monographie von Dr. Med. aurycy Urstein, Warschau, 650 pages, U r b m und Schwarzenberg. Berlin, 1912. Agents for the United States. Rehni:tn Company, 1123 Broadway, Xew York, $7.50.