Part 15

This insulation of position coincides very well with the insulation of vitality which is remarked in all the organs, and especially in those that we have just noticed. Each has its peculiar life, which is the result of a particular modification of its vital forces, a modification which necessarily establishes one in the circulation, nutrition and temperature. No part feels, is moved and nourished like another, unless it belongs to the same system. Each organ executes on a small scale the phenomena which take place on a large one in the economy; each takes from the circulation the aliment that is proper for it, digests it, throws back into the mass of blood, the portion which is heterogeneous to it, and appropriates to itself that which can nourish it; it is digestion in miniature. No doubt the ancients wished to give an idea of this truth which has been so well explained by Bordeu, when they said that the womb was a living animal within another. A very important use then of the serous membranes is to contribute, by rendering independent the position of their respective organs, to the independence of the vital forces, life and functions of these organs.

Let us not forget to consider under the same point of view, the moist atmosphere with which they are constantly surrounded, an atmosphere analogous to that which the cellular texture forms for various other organs. In this atmosphere all the morbific emanations of the organ go and are lost, if we may so say, without these emanations injuring the other organs. We have seen that this atmosphere in the cellular system is sometimes the seat of phenomena wholly different, and serves to transmit diseases from one organ to another. Now the serous membranes are a barrier much less easily surmounted, because they have not filaments which go from one organ to another, there is only contiguity as I have said, with the organs that they surround. We very rarely see in the abdomen a disease of the liver communicated to the intestines, one of the spleen passing to the stomach, &c.

The smoothness of the free surface of the serous system greatly facilitates the motions of the organs which it covers. We have already observed that nature employs two principal means for this object, viz. the membranes and the cellular texture. By distributing externally the second of these means, it has designed the first especially for internal motions. The smoothness and moisture of the serous surfaces are singularly favourable for them. These internal motions are usually regarded only in an insulated manner, as relating to the functions of the organ that executes them, as in relation to the circulation for the heart, respiration for the lungs, digestion for the stomach, &c. But they should also be considered in a general manner; they should be regarded as carrying through the whole machine a continual excitement which supports and animates the forces and the action of all the organs of the head, the chest and the abdomen, which receive less sensibly than the organs of the extremities, the influence of external motions. It is these internal motions that excite, sustain, and develop within, the nutritive phenomena, as the motions of the thigh, the arm, &c. without, favour the nutrition of the muscles which are found there; this is seen very evidently in bakers and other mechanics who exert more particularly this or that part. It is thus that the serous membranes contribute indirectly to the nutrition and growth of their respective viscera; but they never have a direct influence upon this nutrition, because their organization and life are different from the life and organization of these viscera.

The free surface of the serous system differs essentially from that of the mucous, in this, that it contracts frequent adhesions. The pleura is of all the serous organs, that in which these adhesions are the most evident. We find almost as many dead bodies in which they exist, as we do those in which they do not. Next to the pleura is the peritoneum, then the pericardium, then the tunica vaginalis, then the arachnoides, which is that of all the serous surfaces in which adhesions are the least frequent, though I have observed them in it. These adhesions exhibit many varieties which can be studied best on the pleura, which are as follows.

1st. Sometimes the costal and pulmonary portion are so identified at many points or in every part, that they make but a single membrane, and are united as closely as the two edges of the lip in a hare-lip that has been operated upon with success. 2d. At other times the adhesion is so slight, that the least effort is sufficient to destroy it. I have many times noticed this fact in the pericardium. I saw it once in the tunica vaginalis of a man who had been operated upon for hydrocele by means of injection, at the time I was surgeon for operations at the Hôtel Dieu. Separated then from each other, the two surfaces were uneven; they lost their polish. 3d. Frequently between the costal and pulmonary portion of the pleura, between the surfaces of the peritoneum, &c. there are several elongations of various lengths, which form a kind of loose bridles, traversing the serous cavity, having the same organization and polish as the membrane of which they appear a kind of fold, containing in their interior a species of small canal, because they are formed by two layers united together, resembling very much the elongation of the synovial membrane of the knee, which goes from the posterior part of the patella to the space between the condyles of the femur, having also an appearance analogous to the different natural folds of the peritoneum. We can hardly conceive that these filaments so regularly organized can result from inflammation. I am inclined to believe that they are owing to an original conformation. 4th. Frequently between the two portions of the pleura, there are seen many other elongations wholly different, which are not smooth, and do not form canals, but which appear to be flocculent and really analogous to the cellular layers; so that where they exist it may be said, that the membrane is entirely changed into this texture, which is besides, as we shall see, the essential base of its organization. 5th. I do not speak of the adhesions produced by false membranes, by albuminous flakes, intermediate to the two portions of a serous surface, &c. These adhesions are to a certain point foreign to these surfaces.

II. Adherent Surface of the Serous System.

The external surface of the serous membranes adheres almost everywhere to the neighbouring organs; it is rare in fact to see these membranes detached on both sides. The arachnoides at the basis of the cranium, and some other examples are exceptions. This adhesion of the serous membranes to their respective organs, is wholly different from that of the fibrous membranes. In this last, the passage of the vessels so unites the two parts, that their organization, seems to be common, and when one is removed, the other almost always dies, as is seen in the periosteum in relation to the bones, &c. On the contrary, every serous membrane is almost foreign to the organ it surrounds; their organization is different. The following are proofs of it;

1st. We very often see these membranes abandon and cover again successively their respective organs; thus the broad ligaments, at a great distance from the womb in the ordinary state, are to it like a serous membrane during pregnancy. An intestine when distended borrows from the mesentery a covering that quits it when it contracts. The omentum is by turns, as Chaussier has well observed, a loose membrane in the abdomen and a covering of the stomach. The peritoneal envelope of the bladder often leaves it almost entirely. Has not the hernial sac of those enormous tumours of gastric viscera originally served to line the parietes of the abdomen? Now it is evident, since the different organs can exist separate from their serous membranes, that there is no connexion between their organization. 2d. It is always a loose texture, easily stretched in every direction, that serves as a means of union, and never a sanguineous vascular system, as in most of the other adhesions. 3d. The affection of an organ is not a necessary consequence of that of its serous membrane, and reciprocally the organ is often affected and the membrane does not become diseased. For example, in the operation for hydrocele, the testicle remains almost always sound in the midst of the inflammation of its tunica vaginalis. The inflammation of the mucous membrane of the intestines is not a consequence of that of their peritoneal covering; and reciprocally in the various acute catarrhal affections of the organs with a mucous membrane within and a serous one without, this last is never found inflamed. In a word, the affections of the mucous membranes are everywhere very distinct from those of the serous, though most commonly both contribute to the formation of the same organ. It is evident that a line of demarcation so great in the affections supposes one of course in the organization. The life of the serous membranes then is entirely distinct from that of their corresponding organs.

Yet there are cases where these membranes do not present this loose adhesion, and where they become so united to the organs which they line, that frequently the most delicate scalpel cannot separate them. Observe the tunica vaginalis on the albuginea, the arachnoides on the dura-mater, and other membranes which form what I have called the sero-fibrous, &c.; such is the connexion of these different surfaces, that many have been mistaken to the present time for a single membrane. There is however no more identity in the organization, than where the serous membranes are more loosely attached to their respective organs, as is seen in the peritoneum, the pleura, &c. Diseases sometimes make this difference very evident. I have seen the arachnoides in a subject that had been affected with a chronic inflammation, evidently thickened on the internal surface of the dura-mater, without this having experienced the slightest alteration; it was detached without difficulty and torn with great ease.

III. Serous Fluids.

Every serous membrane is moistened on its internal surface by a fluid almost the same as the serum of the blood. The exhaling orifices constantly pour it out and it is constantly taken up by the absorbents. Its quantity varies. A mere dew in the natural state, it is exhaled in vapour when the serous surfaces are laid bare and allow the air to dissolve it. It is in general more abundant in dead bodies than in the living, because on the one hand the transudation which the tonic forces prevent, then easily takes place from the destruction of these forces, and supplies the place of the vital exhalation, by transmitting mechanically by their weight, the fluids of the surrounding organs to the different serous cavities, and because on the other hand, this destruction of the tonic forces prevents every kind of absorption; hence the stagnation and accumulation of this fluid. We know to what an extent this increases in various dropsies, especially in that of the abdomen.

Does this quantity vary according to the different states of the organs which the serous membranes cover? It has been long said, that the synovia is exhaled in greater abundance in the motion of the articulations, than in their state of rest. I have no data on this point founded upon experiment; but I am certain that I have many times observed in living animals, that the exhalation of the serous surface of the abdomen does not increase during digestion, or at least if it is greater, absorption becomes more active, and thus the surface of the peritoneum is not more moist than at another time. I have opened the thorax of many small guinea-pigs, after having first made them run a long time in the chamber in order to accelerate their respiration, and I have not observed greater moisture on the pleura. Yet it cannot be doubted, as we shall see, that the quantity of the serous fluids may be very variable in the different acute diseases; that the serous membranes exhale more or less of them, according to the manner in which they are sympathetically affected.

In the first periods of inflammations, in which the exhalants of the serous membranes are full of blood which is preternaturally introduced into them, the serum does not ooze in greater quantity from their free surface. Then as they are on the one hand very sensible, and very dry on the other, the motions of the organs that they cover are wonderfully painful. It is in these first periods that adhesions take place. If they are not formed either on account of the motion, or for other reasons, and if resolution of the inflammation does not take place, then happens to the serous surfaces what happens to a wound not united; they suppurate, but this suppuration is never attended with ulceration or erosion of their substance. However abundant the purulent collections may be, these membranes always remain sound; their texture is only more or less thickened; pus is thrown out by them, like the natural serous fluids, that is by exhalation. We know how much this fluid varies in consistence from milky serum, to the thickest false membrane that adheres strongly to the surface that has exhaled the materials of it.

The nature of the fluids of the serous system is very evidently albuminous. The instant one of the membranes of this system is plunged into boiling water, I have observed that it is covered with a white layer which is concrete albumen, and which being removed some time after, leaves the surface nearly of its original colour. All the substances which coagulate albumen produce a similar layer upon the serous surfaces. The experiments of Hewson, who has collected some spoonsful of these fluids in the great animals, confirm their albuminous nature. Rouelle and Fourcroy who have analyzed the water of dropsies have also found albumen predominant in it. Observe upon this subject that all the white flakes swimming in this water, that the false membranes that form in it and the white fluids which give it the appearance of milk, appear to be only albumen which is found in different degrees of consistence. It might be said that the heat of inflammation has produced the same phenomenon during life, that common caloric does upon the white of an egg, the water of dropsies, &c. I shall not treat of the other accessory principles that enter into the composition of the serous fluids.

ARTICLE SECOND.

ORGANIZATION OF THE SEROUS SYSTEM.

The first characters of the structure of these membranes are a white, shining colour, less brilliant than that of the aponeuroses; a variable thickness, very evident upon the liver, the heart, the intestines, &c. hardly discoverable upon the arachnoides, the omentum, &c.; a remarkable transparency whenever these membranes are raised for a considerable extent, or are examined where they are detached on both sides, as on the omentum.

All have but a single layer which it is possible, at the places where it is thick, to raise from the cellular layers, but which can never be neatly divided into two or three portions; a character essentially distinct from those of the mucous membranes. The action of a blister on their external surface first laid bare, for example, on a portion of intestine drawn out in a living animal, does not make a pellicle rise upon it, as upon the skin, a pellicle under which the serum is collected. I have frequently made this attempt. What is the immediate structure of this single layer of the serous membranes? I shall now examine it.

I. Cellular Nature of the Serous Texture.

Every system is in general, as we have thus far seen, an assemblage, 1st. of common parts, which are especially the cellular texture, the blood vessels, the exhalants, the absorbents and the nerves, which form as we have said the outline and the frame of it, if I may so express myself; 2d. of a peculiar fibre formed by a substance which is deposited in this outline, by gelatine, for example, for the cartilages, by gelatine and phosphate of lime for the bones, by fibrin for the muscles, &c. That which makes these organs resemble each other then is the cellular organ, the vessels and the nerves; that which distinguishes them, is their peculiar texture, which depends itself upon a peculiar nutritive matter. A bone would become a muscle, if, without changing its texture at all, nature had imparted to it the faculty of secreting fibrin, and of encrusting itself with it, instead of separating the phosphate of lime and being penetrated with it. But the serous system does not appear to have in it a distinct nutritive matter, and consequently a peculiar texture. It is only formed of the mould, the outline of others, and is not penetrated by a substance that characterizes it. Almost wholly cellular, it does not differ from this system in its common form, except by a degree of condensation, by an approximation and union of cells which are found scattered in the ordinary state.

The following are the proofs that the texture of the serous system is wholly cellular. 1st. There is an identity of nature where there is an identity of functions and diseases; now it is evident that the uses of these membranes and of the cellular texture, as it respects the continual absorption and exhalation of lymph are completely the same, and that the phenomena of the various dropsies are common to them, with the difference only of the effusion in the one and infiltration in the other. 2d. The inflation of air into the texture subjacent to these membranes terminates by bringing them almost to a cellular state, when it succeeds and is pushed for some time; an experiment which is frequently very difficult. 3d. Maceration, as has been remarked by Haller, produces at length the same effect, but in a still more evident manner. 4th. The various cysts, hydatids, &c. whose appearance, texture and nature even are entirely the same as in the serous membranes, as we have seen, always arise in the midst of the cellular texture, grow at its expense and are wholly formed of it. 5th. No fibre is found in the serous membranes; a character that distinguishes it from all the other organs and analogous to that of the cellular texture.

To these various proofs of analogy, of identity even of the cellular and serous systems, we can add the action of different reagents, which give results precisely similar in both. 1st. Every serous membrane when dried, becomes transparent, does not turn yellow like the fibrous and the mucous membranes, preserves a pliability foreign to these membranes when dried, and gradually resumes its original state when it is immersed in water. 2d. It becomes putrid much slower than the mucous surfaces, the muscular layers, the glands, &c. This is remarkable in the abdomen, upon the peritoneum which is frequently almost untouched, when every thing is putrid around it, as may be seen by removing it; for its transparency would make you believe at first view that it was altered, if you examine it upon the fleshy and mucous surfaces. 3d. Maceration at the ordinary temperature of cellars, reduces with great difficulty to a pulp the serous membranes. The omentum, the finest and most delicate of these membranes has resisted it for a very long time in my experiments. This phenomenon is particularly striking when compared with the maceration of tendons which are so resisting, and which support such great efforts during life. These become pulpy in water before the omentum is touched. The same phenomenon takes place with regard to all the other serous surfaces. 4th. In boiling water, these surfaces acquire the horny hardness like the fibrous system, but furnish infinitely less gelatine; they do not become yellow like it. The pleura in those portions of the thorax of animals that are brought to our tables, has almost its ordinary appearance; only it is less shining, has lost the faculty of crisping from the action of caloric, is no longer affected in the same way by acids, &c. If it was of a fibrous nature it would have disappeared in gelatine, on account of its delicacy. I shall say the same of the external membrane of the spleen, the liver and the lungs. Compare these membranes, that are brought to our tables, when boiled with the intermuscular aponeuroses, the tendons, &c. you will see that it is impossible to confound, as has been done, all the white textures together, in regard to their nature.

If we compare the different effects of agents the most known upon the serous system, with those that we have observed upon the cellular system, we shall see that they are entirely the same; that these two systems are consequently analogous, and even identical.

The serous system when it putrefies in the open air does not become green like the skin, but is of a dull and very deep grey. During life, on the contrary, its blackness is very evident in gangrene which is sometimes the result of an acute inflammation, sometimes of those chronic inflammations, attended with many small white tubercles, which are so frequently found upon these membranes. This difference arises from the circumstance, that in the dead body these surfaces are not penetrated with blood at the time they become putrid; whereas they contain much during life, when putrefaction succeeds inflammation which has filled the exhalants with it. Many other facts prove, that the greater the quantity of blood there is in a part when it putrefies, the more livid and black it becomes. In the many dead bodies that I have opened, I have never yet observed gangrene except in the peritoneum. I have never seen it in the pleura, the arachnoides, the pericardium, the tunica vaginalis; it no doubt takes place in them; but I think I have opened dead bodies enough to allow my observation to establish as a general principle; that the peritoneum is more subject to it than all the other analogous organs.

Though the different considerations offered above establish much analogy between the cellular and the serous systems, they exhibit however real differences. First their external appearance is not the same. Then there is something in their intimate nature that we are unacquainted with, and which differs also; for whenever two organs are identical in their nature, they are subject to the same affections; now there is a disease of the serous surfaces that is not seen in the cellular system; it is those slow inflammations of which I spoke just now, a disease which should not be ranked in the class of the phlegmasiæ, and which the production of the small tubercles that attend it, especially characterizes. Authors who have not sufficiently attended to it, have denominated it chronic enteritis in the peritoneum, latent inflammation in the pleura, &c. though however foreign to every subjacent organ, except in the latter periods when it is propagated by the cellular texture, it has its seat exclusively in the serous membranes, and is an affection peculiar to these membranes, as miliary eruptions are to the cutaneous surfaces, as aphthæ to the mucous surfaces, &c. Add to this difference that of the pus which the cellular texture and the serous surfaces secrete; this fluid is not the same in the two systems. The difference of its nature is not known; but its external appearance is by no means the same.

II. Parts common to the Organization of the Serous System. Exhalants.

A very evident exhalation is constantly going on upon the serous surfaces. A particular order of vessels is the agent of this exhalation, the matter of which is the fluid mentioned above. These vessels are very distinctly demonstrated in this system; it is the only one in which the eye of the anatomist can accurately trace them. The following are the means of seeing them; 1st, in a living animal, draw out an intestine from the abdomen; it will have a reddish tinge owing to the vessels under the serous coat, and hardly at all to the vessels in this coat itself. Irritate it, and reduce the intestine after attaching a string to it, as in the operation of hernia where there is gangrene, draw it out again at the end of six and thirty or eight and forty hours; it will exhibit many reddish lines, running over this serous surface, and showing in it plainly the exhalants which were insensible in the natural state, on account of the transparency of their fluids. 2d. Very fine injections cover in an instant all the serous surfaces with an infinite number of lines of the colour of the injected fluid, lines which are evidently exhalants full of this fluid. 3d. In these injections an extremely fine dew is made to ooze out upon the smooth surface of the serous membranes, a dew which takes place without rupture or transudation, and of which the exhalants are the sources. 4th. If a serous surface is laid bare in a living animal, and wiped dry, it is soon after covered with new serum, which the exhalants furnish.

Absorbents.