Part 8

Let us consider neither the growth nor nutrition in an uniform manner; each system is developed and increases in its own way; all are never found at the same periods of this function. Why? because nutrition, like all the other acts over which life presides, is essentially dependant on the vital forces, and these forces vary in each system.

The growth of the involuntary muscular system is not uniform in all the organs which compose it. Each increases more or less, or is differently developed; one often predominates over the others in an evident manner; a bladder with strong, fleshy fibres, with columns as they are called, is often found in a subject with a debilitated stomach, with small intestines, &c.; reciprocally, the stomach, the heart, &c. have often an insulated predominance.

III. State of the Organic Muscular System after Growth.

It is from the twenty-fourth to the twenty-sixth year, that the organic muscles are completely developed. Then the thorax and the abdomen which contain them have their greatest capacity. These muscles are then as they are to remain through life; they have a density much greater than in youth; their power is increased and their colour is deeper. In general this is subject in the heart to frequent varieties, which coincide very nearly with the varieties of the preceding system. Acute and chronic diseases have nearly the same influence upon it. It is equally the index of the sanguineous, lymphatic temperaments, &c. by the different tinge it assumes. The colour of the gastric, intestinal and vesical fibres varies less; their whiteness, more uniform, is rarely influenced by diseases.

We cannot increase, by constant exercise, the nutrition of the organic muscles. Aliments taken beyond measure, making the stomach frequently contract, weaken it instead of developing its fibres more, as happens from constant exercise given to a superior or inferior extremity. The bladder incessantly in action in some cases of incontinence, is thus gradually weakened and loses its energy. We might say that these two systems were in this respect in an inverse order.

It appears that the nutrition of the organic muscles, like that of the others, is subject to frequent variations; that at some periods they are more developed and less so at others. Diseases have a great influence upon this phenomenon, which proves, like the softening of the bones and their return to the natural state, the constant composition and decomposition of which these organs are the seat. We find in the dissecting rooms many differences in different subjects, as it respects the colour, density and cohesion of the muscles. Now what many exhibit then at once, the same individual often experiences successively; the same man no doubt has, according to the different influences to which he is exposed, his heart red, dense, large and well nourished at one period of life, and feeble, pale and small at another; for the internal organs experience the same alterations as the exterior. Now we know that the external appearance often changes during life.

IV. State of the Organic Muscular System in Old Age.

As we advance in age, the muscular system of which we are treating becomes weak like all the others; yet its action is more durable; it survives, if we may so say, that of the other. When the old man, almost immoveable, crawls about but slowly and with pain, his pulse, digestion, &c. have vigour still. This difference of the two systems is so much the more remarkable, as the time of activity of the second is almost by half less than that of the first; sleep cuts off in fact almost half of the duration of the voluntary motions, whilst it leaves the involuntary wholly untouched. This phenomenon of the organic muscles as it were surviving the voluntary in the last periods of life, is derived on a great scale from the same principle from which arises on a small one the lassitude which follows the contraction in an insulated motion. A less durable motion is necessary to fatigue the voluntary muscles, than to fatigue the involuntary; the stomach empty remains for a long time contracted upon itself without producing any painful sensation, whilst if we hold a body strongly grasped between our fingers for a quarter of an hour, all the flexors are soon painfully affected. After a convulsion of half an hour, in which all the locomotive muscles have been stiff, the whole body is broken, as it is called; it cannot admit of any motion; whilst after a paroxysm of fever of six or eight hours in which the pulse has been violently agitated, the heart often preserves the natural type of its contractions; it requires repeated paroxysms to weaken it. All these phenomena of the two muscular systems evidently prove that that of animal life is fatigued much the soonest; it is this which occasions its intermission. Is it then astonishing that, although less often in exercise than the other, it exhausts sooner the quantum of force nature has given to it? is it astonishing that the other survives the longest? Life is a great exercise which gradually wears up the organs in motion, and which requires their rest; this rest is death; now each moveable organ arrives at it sooner or later, according to the different degree of the forces which it has to expend, and according to its greater or less disposition to be wearied by this great exercise.

Yet the organic muscles are gradually weakened. The pulse becomes slower, digestion is longer in old age; the bladder and rectum first cease to act; then the intestines remain inactive; the stomach and especially the heart die the last.

A long time before death, the muscular cohesion is weakened in this system as in the preceding; the fleshy texture becomes flaccid; the parietes of the heart support themselves in youth; they flatten in old age. The gastric system of a young animal suddenly killed during hunger is firm, dense and contracted upon itself; in an old one, under the same circumstance, it is but little contracted; the stomach and intestines remain much more dilated; they are loose and soft; it is the same phenomenon as in the preceding muscles, which vacillate under the skin, from want of cohesion. The bladder remains constantly large, though empty.

MUCOUS SYSTEM.

This system, the name of which I borrow from the fluid that constantly lubricates it, and which is furnished by small glands inherent in its structure, appears everywhere in a membranous form; that of fasciculi is wholly foreign to it. In speaking of the mucous organs we shall designate them almost always under the name of membranes. Their study is a new object of research. Pinel has been among the first, who has perceived the necessity of considering them in a general manner as it respects diseases. I believe that I am the first who has regarded them generally in an anatomical and physiological view. Few systems deserve more attention; upon it take place all the great phenomena of digestion, respiration, secretion, excretion, &c.; it is the seat of many diseases. It should alone, in a nosography in which diseases are distributed by systems, occupy a place equal to that of many.

ARTICLE FIRST.

OF THE DIVISIONS AND FORMS OF THE MUCOUS SYSTEM.

The mucous membranes occupy the interior of the cavities which communicate with the skin by the different openings this covering has on the surface of the body. Their number at first view is very considerable; for the organs in which they are reflected are very numerous. The mouth, the stomach, the intestines, the œsophagus, the bladder, the urethra, the womb, the ureters, all the excretories, &c. &c. derive from these membranes a part of their structure. Yet if we consider that wherever they are continuous, wherever we see them originate, by extending from each other, as they originated in the first instance from the skin, we shall perceive that this number must be wonderfully limited. In fact by thus describing them, not separately in each part, but at the same time in all those upon which they are continued, we see that they are reduced to two general surfaces, of which all the others are portions, and which, on account of the different parts to which they are distributed, can be called, the one gastro-pulmonary, the other genito-urinary. The first is found in the head, the neck and the abdomen. This last cavity and more especially the pelvis, contain the second.

There is also a small insulated mucous surface; it is that which enters by the openings of the nipples and lines the lactiferous tubes. But it is so small that it deserves but little attention; besides, what will be said of the two others will be equally applicable to it. It is then useless to examine it in a general manner.

I. Of the two General Mucous Membranes, the Gastro-Pulmonary and the Genito-Urinary.

The gastro-pulmonary surface penetrates into the interior by the mouth, the nose and the anterior face of the eye. 1st. It lines the first and second of these cavities, extends from the first to the excretory ducts of the parotid and sub-maxillary glands, from the other into all the sinuses, forms the conjunctiva, dips down into the puncta lachrymalia, the nasal duct, the sac of the same name, and is continued into the nose; 2d, it descends into the pharynx, furnishes an elongation to the Eustachian tube, then penetrates the internal ear and lines it, as we shall see; 3d, it dips down into the trachea and is spread upon all the air-tubes; 4th, it penetrates into the œsophagus and the stomach; 5th, it extends to the duodenum where it furnishes two elongations, one destined to the ductus choledochus, to the numerous branches of the hepatic and cystic ducts and the gall-bladder, the other to the pancreatic duct and its different branches; 6th, it is continued into the small and large intestines and finally terminates at the anus where we see it identified with the skin.

The second general mucous membrane, which we have called the genito-urinary, enters in man by the urethra, and thence is spread on the one hand upon the bladder, the ureters, the pelvis of the kidnies, the infundibula, the papillæ and the capillary tubes which open on their summit; on the other hand it goes into the excretory tubes of the prostate, into the seminal ducts, the vesiculæ seminales, the vasa deferentia and the branches with numberless windings that produce them.

In woman, this membrane is introduced by the os externum and penetrating on the one hand by the urethra, goes as in man upon the urinary organs; on the other hand, we see it enter the vagina, lining it, the uterus and the fallopian tubes, and afterwards becoming continuous with the peritoneum by the opening of these tubes. It is the only example in the economy, of a communication established between the mucous and serous surfaces.

This manner of describing the course of the mucous surfaces, by saying that they are elongated, dip down, penetrate, &c. from one cavity to another, is no doubt not conformable to the progress of nature, which creates in each organ the membranes belonging to this organ, and does not thus extend them by degrees; but our manner of understanding it is better adapted to this language, the meaning of which the least reflection will show.

In thus referring to two general membranes all the mucous surfaces, I am not only supported by anatomical inspection, but pathological observation has also furnished me with points of demarcation between the two, and points of contact between the different portions of membranes of which each is the assemblage. In the different descriptions of catarrhal epidemics given by authors, we frequently see one of these membranes affected in all parts, the other remaining sound; it is especially not rare to observe a general affection of the first, of that which extends from the mouth, the nose, the surface of the eye, into the alimentary canal and the bronchial vessels. The last epidemic observed at Paris, with which Pinal himself was affected, was of this character; that of 1761, described by Razou, had it also; that of 1752, described in the memoirs of the Society of Edinburgh was remarkable for a similar phenomenon; now, we do not see at that time a corresponding affection in the mucous membrane that is spread upon the urinary organs and upon those of generation. There is then here, 1st, an analogy between the portions of the first, by the uniformity of affection; 2d, a demarcation between the two by the health of the one and the disease of the other.

We see also that the irritation of any one point of one of these membranes, frequently produces a pain in another point of the same membrane, which is not irritated. Thus a calculus in the bladder occasions a pain at the end of the glans penis, the presence of worms in the intestines causes an itching of the nose, &c. &c. Now, in these phenomena purely sympathetic, it is very rare that the partial irritation of one of these two membranes affects with pain one of the parts of the other; there are however examples of it; such is the singular relation that exists, in mucous hemorrhages, between the membrane of the womb and that of the bronchia. If the blood ceases accidentally to flow from one during menstruation, the other frequently exhales it and thus as it were supplies its functions.

We ought then, from inspection and observation, to consider the mucous surface, in general, as formed by two great membranes successively spread upon many organs, having between them no communication except by the skin, which serves them as an intermediate organ, and which, continuing with both, contributes thus with them to form a general membrane everywhere, continuous, covering the animal externally, and extending within upon most of its essential parts. We can conceive that there should exist important relations between the internal and external portion of this single membrane; and that they do will be proved by further researches.

II. Adhering Surface of the Mucous Membranes.

Every mucous membrane exhibits two surfaces, one adhering to the neighbouring organs, the other free, covered with villi, always moistened with a mucous fluid. Each deserves particular attention.

The adhering surface corresponds almost everywhere with the muscles, either of animal or organic life. The mouth, the pharynx, the whole alimentary canal, the bladder, the vagina, the womb, a portion of the urethra, &c. exhibit a muscular layer embracing on the outside their mucous tunic which is within. This arrangement coincides perfectly, in animals with a fleshy membrane, with that of the skin, which moreover approximates very near, as we shall see, the structure of the mucous membranes, and which, as we have seen, is everywhere continuous with them. This arrangement of the mucous membranes occasions them to be agitated by constant motions which favour wonderfully the secretion that takes place in them, the excretion which succeeds it, and the various other functions of which they are the seat. The insertion of this muscular layer exterior to the mucous system, is made, as we have seen, by this dense and compact texture which I have called the sub-mucous. It is from this texture, more compact than the rest of the cellular system, that the mucous surface derives its force. It is from it that the organ which it lines receives its form; it is this which supports and preserves this form; the following experiment proves it. Take a portion of the intestine; remove from any part of it this layer, as well as the serous and the muscular; then inflate it, after having tied it below; the air produces in this place a hernia of the mucous coat. Try afterwards another portion of intestine; deprive this, for a small space, of its mucous membrane and of this also; inflation will produce upon the serous and muscular tunics the same phenomenon that it did in the preceding on the mucous; then it is to this sub-mucous cellular layer that it owes the resistance with which it opposes substances that it contains. The same may be said of the stomach, the bladder, the œsophagus, &c.

III. Free Surface of the Mucous Membranes.