The History of Lymphatic Anatomy and the Contribution of Frederik Ruysch

Abstract

Discovery of the lymphatic system is documented in numerous sources and can be attributed to a variety of persons. Like many other important developments in medicine, the recognition of the lymphatic system starts with Hippocrates (ca. 460–370 BC), who described a disease course consistent with metastasis to lymph nodes. Until the 17th century, knowledge about the anatomy and pathophysiology of the lymphatic system was limited, probably because of the difficulty of visualizing lymph vessels in animals and humans. Frederik Ruysch (1638-1731), a “praelector anatomiae” of the Amsterdam Guild of Surgeons, must be considered one of the pioneers in lymphatic research. His contribution relied on meticulous anatomical dissection of lymph vessels, and with his innovative preservation techniques, he was the first to visualize lymphatic valves. This major step provided a better understanding of lymphatic anatomy and the circulation of lymph. The German pathologist Rudolf Virchow (1821–1902) suggested that lymph nodes function as filters in the lymphatic system and could therefore contain cancer. He was the first to propose that lymph fluid from any given area of the body drains through lymphatics to a specific lymph node and subsequently to other lymph nodes. Consequently, clinicians began to recommend that local therapy of cancer should be supplemented with regional lymph node treatment to improve the cure rate. Subsequently, lymph node surgery became an essential element of surgical oncology. Lymphatic mapping and sentinel lymph node biopsy were developed several decades ago by Donald Morton (1934–2014) to stage melanoma accurately and to avoid unnecessary lymph node dissection. In a way, history is now repeating itself, as today there is renewed interest in imaging lymph vessels and lymph nodes from an oncological perspective, more than 300 years since Ruysch committed himself to visualizing the lymphatic system. From this perspective, it is important to acknowledge early contributions of Ruysch in providing the foundations to our knowledge of lymphatic anatomy.