Lymph nodes were first described in the Hippocratic era and the concept of a system that absorbed any excess fluid pooling in the interstitial space was probably developed soon after. Massa [1a] described lymphatics in the kidney in 1532, but it was Gasparo Aselli [1b] who, as a professor of anatomy in Pavia, Italy, first extensively described lymphatic vessels in many different animals. He called them ''lacteal veins'' because of their milky color. Lymphatic channels in the abdomen were identified and studied in the seventeenth century. The thoracic duct was described in 1651 by Von Pecquet of Montpellier . At about the same time, Bartholin of Copenhagen and Rudbeck of Uppsala wrote about lymphatics in the liver, attributing much of the early knowledge of the lymphatic system to Galen [1c]. In the eighteenth century, several British authors, including William Cruikshank and William Hewson, emphasized the important functions of the lymphatic system and documented differences between the superficial and internal lymphatics. In the nineteenth century, Sappey made his seminal contributions to the understanding of the lymphatic system.
During the first half of the twentieth century, radiographic methods were developed which allowed images of the lymphatic system to be recorded in individual patients. In 1939, Gray [1d] used contrast material to make a radiograph of the lymphatic system, and in 1952 Kinmonth [1e] described the technique of radiographic contrast lymphangiography. Much of the information in standard teaching textbooks about lymphatic drainage is still based on the radiographic contrast lymphangiogram. This technique, however, was designed to display as many lymphatic channels and lymph nodes as possible with the aim of detecting tumor involvement of the nodes and, therefore, did not reflect physiological lymphatic drainage.
Lymphatic flow patterns were also examined by using blue dye, a technique first described by Gerota [1f]. In 1950 [1g], Weinberg injected blue dye into the wall of the stomach during surgery and was able to follow the blue lymphatic channels to the draining lymph nodes. In 1951 he used the same approach to locate the draining lymph nodes in lung cancer patients. Eichner, in 1954 [1h], adapted this approach and used it in patients with gynecological cancer.
The technique of lymphoscintigraphy, which was developed in the 1950s, was designed to map patterns of lymphatic drainage without disturbing the physiology of the lymphatics. It is the development and progress of this and related techniques which will therefore occupy most attention in this chapter.
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