Hepatolymphomania

Abstract

After three years of penning Landmarks in Hepatology, it is a unique pleasure to have the occasion to respond to a letter to the editor from an avid fan, albeit one who is a little miffed by her perception that lymphology was given short shrift in a couple of articles. Although the writer's letter would probably not pass muster for inclusion in a collection of letters to the editor of The Times,1 like the curate's egg it was good in parts. I am grateful that Dr. Witte has offered the opportunity for greater recognition of the role of the lymphatic system in cirrhosis than was possible in “My Cup Runneth Over,” the main focus of which was intended to be The Overflow Hypothesis, proposed by Telfer Reynolds, as a landmark in hepatology from an historical perspective. Perforce, such a format undoubtedly may overlook competing hypotheses, and scholarly scientific reviews should be consulted for a more balanced account of any given topic. Of course, as the writer reminds us, ascites only accumulates if there is an imbalance between the rate of formation and absorption of visceral lymph, as described so elegantly in the cited reference 2 by her late illustrious husband, Charles L. Witte, herself, and Allan Dumont. Finally, Gaspar Asellius did indeed rediscover the lymphatic system in the postprandial dog by seeing the glistening chyliferous vessels that Hippocrates before him saw as “white blood,” Aristotle described as vessels containing a colorless fluid, and both Herophilus and Erasistratus noticed too. The eminent Danish physician, naturalist, physiologist, and anatomist Thomas Bartholin's contribution was to confirm the existence of the human thoracic duct, in the cadavers of two criminals (donated by the king), following Jean Pecquet's discovery of this structure in dogs. Adrian Reuben M.B.B.S., F.R.C.P.*, * Division of GI/Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, SC.