THE PRODUCTION AND ABSORPTION OF LYMPH. 
By Ernest H. Starling. 
Contents. — The Production of Lymph, p. 285 — The Physical Forces concerned in 
the Movement of Lymph, p. 299 — The Absorption of Lymph from the Con- 
nective Tissues, p. 302 — On the Functions of the Lymph in the Nutrition of 
the Tissues, p. 310. 
The Production of Lymph. 
The spleen is the only part of the body where the blood comes in actual 
contact with the living cells of the tissue. In all other parts of the 
body the blood flows in capillaries with definite walls consisting of a 
single layer of cells, and is thus separated from the tissue elements by 
these walls and by a varying thickness of tisstie. All the interstices of 
the tissues are filled with a fluid, lymph, 1 which thus acts as an inter- 
mediary between blood and tissues. The tissue spaces, which are filled 
with lymph, are always found in association with connective tissue. 
They have an incomplete lining of endothelial cells, and are connected 
with definite channels, lymphatics, by which any excess of fluid in the 
part is drained off. The lymphatics all run towards the chest, where 
those from the lower limbs as well as from the viscera join to form 
a large vessel, the receptaculum chyli, which is continued into the 
chest as the thoracic duet. This runs on the left side of the oeso- 
phagus, to open into the large veins at the junction of the left internal 
jugular with the subclavian vein. A small vessel on the right side 
drains the lymph from the right upper extremity and side of the 
chest. 
Lymph may be collected for examination by placing a cannula in 
one of the main lymphatics of a limb, and inducing a How by move- 
ments of kneading and massage, from the lymphatic duct of the neck, or 
from the thoracic duct. Since, moreover, the serous cavities of the pleura, 
peritoneum, pericardium, and tunica vaginalis are in free communication 
with the lymphatic system, any fluid which is normally found in them 
may be looked upon as lymph. The various analyses of lymph that 
have been made, show that its composition may vary considerably 
according to the locality from which it is derived and the circumstances 
under which it is obtained. Certain general characteristics are, how- 
ever, common to all specimens of lymph. It is always slightly alkaline, 
and clots spontaneously at a variable time after it has left the vessels, 
1 Adler and Meltzer (Journ. Expcr. Med., Baltimore, 1896, vol. i. No. 3) draw a sharp 
distinction between the interstitial fluid of the tissue spaces, and the lymph obtained from 
the lymphatics which drain these spaces. 
