Part 15

Sympathies.

The absorbent system is much disposed to receive the sympathetic influence of the other organs. This disposition relates, 1st, to the glands; 2d, to the vessels themselves.

One of the phenomena which the examination of dead bodies perhaps most often exhibits, is the swelling of the lymphatic glands from the organic affections of the principal viscera. We observe this phenomenon, 1st, in the neck from the affections of the thyroid gland and sometimes of the larynx, in the jugular glands; 2d, on the chest from cancer in the breast, in the axillary and often in the mammary glands, from every kind of phthisis in those that surround the bronchiæ, very rarely if ever from diseases of the heart, whether aneurism, ossification or diseases of the valves; 3d, in the abdomen, from cancerous diseases of the stomach, especially of the pylorus, and most of those in which the texture of the liver is altered, in the numerous glands that accompany the biliary vessels and those surrounding the pancreas; from schirrus of the intestines, from their cancers, which are in general rather rare, in the mesenteric glands; from the affections of the womb, the rectum, and the bladder, in the glands of the pelvis; from schirrus of the testicles, diseases of the urethra, in the inguinal and lumbar glands, &c.; 4th, on the superior extremities from punctures, bites and most of the inflammatory affections in the axillary glands; 5th, on the inferior extremities from many affections in the inguinal glands.

These swellings of the lymphatic glands are of the same nature as the affection that produces them; if that is acute they are so, if chronic they pursue the same course. The swelling of the glands in the axilla is acute, if it is the consequence of a prick of the finger, of a whitlow, &c. and chronic, if it arises from cancer.

I am far from considering all these different swellings as the result of a sympathetic influence exerted upon the gland. No doubt the conveyance of absorbed matter produces the effect, as happens when there is some virus, punctures with poisoned instruments, &c. producing the swelling. But sometimes also sympathy alone is the cause. When by the acute pain that a whitlow, a splinter under the nail or a bruise of the finger occasion, the axillary glands swell; when the same glands swell from the effect of a blister applied to the arm or fore-arm, &c.; when this phenomenon happens in the inguinal glands from a blister on the thigh or the leg, of which I have seen many cases, &c. &c. there is certainly no matter conveyed to the gland; it is an effect of sympathy.

Most surgeons believe that every cancer in the breast, with swelled glands, requires their extirpation. I believe that in some cases they may become cancerous, but I doubt if this happens in the greatest number. 1st. In old ulcerated cancers of the breast, they continue most often swelled during the whole of life, without suppurating. 2d. After operations, in which some deep seated ones have been left, we rarely see them become cancerous. When the cancer is reproduced, it is the wound that opens again. 3d. I have many times compared the texture of a gland of the axilla enlarged by a cancer of the breast, with that of the bronchial glands enlarged in phthisis, with that of the sub-hepatic glands swollen from steatomatous tumours, hydatids of the liver, &c. and I could discover no difference. 4th. Finally, all those who open many dead bodies may be convinced that almost all the organic diseases of the viscera which have many glands around them, are accompanied with their enlargement, whatever may be the nature of those diseases. This phenomenon struck me so much, that at one time attributed the effusions which terminate almost all these organic diseases, to the difficulty the lymph experiences in passing through these glands. But the absence of these swellings in the diseases of the heart attended with dropsy, the frequent absence of swelling of the superior extremities when the axillary glands were enlarged, the tumefaction of the lower parts, the glands of the superior being alone swelled, and many other similar proofs, which made me consider the serous effusions that take place then, as passive exhalations, analogous to those that produce hemorrhages, did not permit me to adopt this first opinion.

It is essential to distinguish the swellings of the lymphatic glands by the influence of the diseases of the neighbouring viscera, from those which arise from tabes mesenterica and other analogous, scrophulous diseases. 1st. In the latter case, the texture of the gland is always primarily affected; it is only secondarily in the other. 2d. The one from scrophulous affections appears exclusively in childhood; the other at all ages. 3d. Finally, a gland swollen from the affection of another organ, most frequently preserves a texture, and colour analogous to its natural state. It is only in the last periods that the texture becomes sometimes hard, like cartilage, and even suppurates; but it is not with the same phenomena as the texture of the mesenteric and bronchial glands swollen by scrophula. The appearance and structure are wholly different. This last exhibits in this case a white substance which is found in small quantity in the first periods; so that when we cut the gland, we easily distinguish this substance from the texture of the gland that remains, where it still exists, with its natural colour and arrangement. In the latter periods, this white matter has encroached upon the whole gland, the texture of which has disappeared. However in phthisis, and sometimes, though more rarely, in cancers, the swelled glands exhibit in consequence an analogous appearance; but in all the other cases it is different.

We know that nature often chooses these glands in important fevers, as the place of the crisis. They are the seat of what are very improperly called parotid tumours, in adynamic fevers.

The absorbents are, like their glands, influenced by the affections of the neighbouring organs. I am well persuaded that the different alterations which the absorption of chyle undergoes, the absorption of the aqueous part of the bile and the urine, and the derangement of those of the serous surfaces in many diseases, are effects purely sympathetic. But it is not very easy to distinguish when they are not so. There are certainly sympathetic absorptions, as there are sympathetic exhalations and secretions.

On the other hand, the absorbent system being affected, the other organs very often experience sympathetic influences. In tabes mesenterica, and in the enlargement of the bronchial glands that correspond with it, there are many symptoms that evidently arise from the sympathetic relations that connect these glands to the other organs. It is not my province to point out these symptoms.

As to the influence of the diseases of the absorbents upon the other organs, we know but little of it. When their course is inflamed from a puncture, from a wound with an instrument having on it some virus, &c. there are often vomitings, diarrhœa, &c.

ARTICLE FOURTH.

OF ABSORPTION.

I. Influence of the Vital Forces upon this Function.

The functions of the absorbents are not at the present day a subject of doubt with any anatomist; but the manner in which these functions are performed, are far from being so well agreed upon. The first idea has been to compare the action of the absorbents with that of capillary tubes. But if we reflect a little upon this action, it is easy to see that these phenomena are wholly different from those of inert, capillary tubes. I think that we never should be able to say precisely, how an absorbent orifice, being immersed in a fluid, takes it up, seizes its particles and makes them ascend in its tube. But what is undoubted in absorption is that the vessels derive this faculty from the vital forces which they have; that it is only the relation existing between the particular kind of organic sensibility with which they are endowed, and the fluids with which they are in contact, that is the immediate cause of the phenomenon. Do you wish numerous proofs of this? See the lacteals choosing only chyle from among the variety of matter contained in the intestinal canal; see the absorbents of the bladder and the gall-bladder leaving many of the elements of the urine and the bile, to take only the aqueous part of these fluids; see the cutaneous absorbents, the mucous ones of the bronchiæ, &c. selecting only certain principles from the air and leaving others. Often inactive for a long time, they immediately recommence action when any substances in relation with their sensibility are presented to them. Observe the fluids injected or effused into the cellular texture, they are taken up or left by the absorbents of this texture, disappear promptly, or remain and occasion suppuration, according as they agree with or are repugnant to their sensibility.

We cannot deny that in the natural state the sensibility of the absorbents has a particular type, to which certain substances are alone accommodated, and which alone on this account can be absorbed. The exercise of the organic sensibility then always pre-exists in absorption, as it does in secretion, nutrition, &c. Thus in the physical phenomena, the exercise of gravity always precedes the fall of heavy bodies. Thus the power of attracting is put into exercise before the motion of the planets takes place, &c. &c.

II. Varieties of Absorption.

It follows from what I have said, that whenever the organic sensibility of the absorbents is altered in any way, absorption must necessarily experience a corresponding derangement; now this is what constantly happens. Serum often bathes for whole months the absorbent orifices, in dropsy, without raising their sensibility sufficiently to be taken up by them. Let any cause increase this property, instantly absorption takes place. Observe some indolent tumours which remain for a long time in the same state by the stagnation of their fluids, they are immediately discussed when certain medicines applied to them rouse the dormant sensibility of their absorbents. Discutients do not act upon the fluids themselves; they do not attenuate, or cut them, according to the vague language of physicians, but by changing the degree of force of the absorbents, they render them able to act. It is so true that it is in this way that different resolutions are effected, that often a slight degree of inflammation is previously necessary to their development; all surgeons know this. Desault did not consider most of the swellings of the testicles as an obstacle to the operation for hydrocele by injection. On the contrary it often happened, that after the irritation produced in the testicles by the surrounding membrane, the enlargement disappeared, which was only kept up by the want of energy in the absorbents.

The alterations of organic sensibility can diminish, increase, or variously modify this property. Let us cease to wonder then at the extreme variety of the absorptions; let us not be astonished, if many fluids, besides those ordinarily taken up, can pass into the blood by the absorbents; if the bile, the urine, the mucous fluids, which are usually rejected, can enter the circulation; if the blood effused in the cellular texture is taken up by these vessels. The forces of life impress, by their extreme variety, the same character on all the functions over which they preside.

Much has been said of putrid matters passing into the blood, and there serving as a cause for diseases. This infection of the blood has undoubtedly been exaggerated; but I am convinced that in many cases it is real. Why are the colour, consistence, odour, and nature of the excrements so very variable? If the same substances are always absorbed from the aliments, it is evident that the residue of these aliments would always be the same. Observe the innumerable varieties of the urine, the bile, the mucous fluids, &c. according to the difference of the principles that concur to form them. Why should not the chyle present the same variations? it would be the only fluid of its kind in the animal economy if it did not change under many circumstances. Now, whence can these changes come, if not from this, that the lacteals present numberless varieties in their organic sensibility, varieties, each of which admits only certain principles and rejects the others?

The absorption of the lacteals, which, in an ordinary state, introduces into the blood only nutritive substances, can then often be a way open for the admission of many morbific principles. Thus in the lungs, the vessels which take from the air the substances proper to colour the blood, often draw in principles injurious to their functions, according to the different alterations that their sensibility can experience.

In the ordinary state, the kind of organic sensibility and of tone of the cutaneous and mucous absorbents, shuts out all external substances that are hurtful. But when this kind is changed, the way can in an instant be open to them. Does not pus remain without mischief on the cellular texture, in most wounds? Let an imprudent application raise there a little the forces of the absorbents, it is taken up by them; the ulcer dries up; the pus passes into the blood; and then follows the whole sad train of the symptoms of re-absorption which commences.

We can say, that a thousand channels are incessantly open in our organs, to morbific principles. The organic sensibility, placed as a sentinel at their mouths, indicates according to the manner in which it is affected, to the insensible contractility when it is necessary to open or shut them.

It is exhalation that contributes to the formation of most tumours; it is absorption that serves for their cure.

If I were to run over the phenomena of absorption in the different ages, sexes, seasons and climates, I could show constantly the differences of organic sensibility always preceding the differences of this function. I shall speak of them in the different ages.

The causes that vary the natural type of the sensibility of the absorbents, are, as in all the other functions, direct or sympathetic; 1st, direct, as when by previous friction on the skin, we excite the absorbents, and force them to act, which they would not have done without this; 2d, sympathetic, as when the absorbents, feeling the affection of a distant viscus, increase or diminish their action, according to the kind of influence they receive. We have spoken of this phenomenon in the sympathies of the different systems.

III. Motion of the Fluids in the Absorbents.

The fluids once absorbed on the different surfaces of which we have spoken, are carried by a successive motion to the common trunks, which transmit them to the black blood.