┌1st. Of the vital properties.
│ ┌Animal properties ┌Sensibility.
│ │ │Contractility.
│2d. Division of the vital │
│ properties │Organic ┌Sensibility.
│ └ properties │Sensible and insensible
│ └ contractility.
│3d. Characters of the vital properties. ┌Habit.
│ │Sex.
│4th. Of the causes which modify the │Climate.
│ vital properties │Seasons.
│ └Age, &c.
│
│5th. Of the peculiar differences of the vital ┌Of that which is called
│ properties, in each simple texture, in each └ individual life.
│ individual
│ ┌Of temperament.
│6th. Of the general differences of the vital │Of the passions.
│ properties in different individuals └Of the character.
│
│7th. Sympathies of vital properties. ┌Animal sympathies ┌Of sensibility.
│ │ └Of contractility.
└8th. Division of sympathies │ ┌Of sensible
└Organic sympathies │ contractility.
│Of insensible
└ contractility.
OF THE FUNCTIONS.
FIRST CLASS.—FUNCTIONS RELATIVE TO THE INDIVIDUAL.
ORDER FIRST.—_Functions of Animal Life._
GENUS I. _Sensations._
┌1st. Of the general sensations, or feeling, ┌external.
│ └internal.
│ ┌Hearing.
│ │Seeing.
│2d. Of particular sensations │Smelling.
│ │Tasting
│ └Feeling.
└3d. Of pleasure and of pain.
GENUS II. _Cerebral Functions._
┌Of perception.
┌1st. Relative to sensation │Of imagination.
│ └Of memory.
│ ┌Of attention.
│ │Of the ideas.
│2d. Relative to the understanding │Of the judgment.
│ └Of the reasoning faculty, &c.
│
│ ┌Of the will, ┌the ┌Of the
│3d. Relative to motion │which is │ judgment. │ opposition
│ └determined by │the │ of these two
│ └ passions. └ causes.
│
└4th. Connexion of the cerebral functions with life ┌Of concussion.
└Of apoplexy, &c.
GENUS III. _Locomotion._
┌on the feet Standing.
┌ │on the knees.
│1st. Of the immoveable attitudes │on the pelvis.
│ │on the head, &c. &c.
│ └—Prostration.
│
│ ┌ ┌ Prepulsion.
│ │ │ Repulsion.
│ │Of the superior │ Diduction.
│ │ extremities. │ Pressure.
│ │ └ Elevation, &c.
│ │ ┌Walking.
└2d. Motion │Of the inferior │Running.
│ extremities. └Leaping.
│Of the trunk. Support, raising weights.
│Of the whole body. Swimming.
│ ┌1st. Gestures of the face.
│Of gesture considered │2d. Gestures of the head in
│ as an auxiliary │ general.
└ to the voice. │3d. Gestures of the superior
└ extremities.
GENUS IV. _Voice._
┌1st. Of the voice of brutes Dumbness.
│2d. Of speech. ┌Of stuttering.
│ └Of lisping, &c.
│
│3d. Of singing ┌true.
│ └false.
└4th. Of declamation.
GENUS V. _Nervous transmission._
┌1st. Transmission to the brain of sensations ┌general.
│ └particular.
│2d. Transmission of motion ┌to the locomotive organs.
│ └to the vocal organs.
└3d. Mode of transmission.
OF THE INTERMISSION OF THE FUNCTIONS OF ANIMAL LIFE.
_Sleep._
┌partial ┌of the senses.
┌ 1st. natural. │ │of the brain ... Of sympathetic sleep.
│ │ └of the muscles.
│ └general.
│ 2d. unnatural.
└ 3d. Dreams and somnambulism.
ORDER SECOND.—_Functions of organic life._
GENUS I. _Digestion._
┌1st. Of hunger and thirst.
│2d. Of aliments.
│3d. Of taking of aliments ┌solid.
│ └fluid.
│4th. Of mastication, of lubricating with saliva and deglutition.
│ ┌in the œsophagus. Action of the liquor of the
│ │ œsophagus.
│5th. Alteration of │in the stomach. Action of the gastric liquor.
│ the alimentary mass. │in the small ┌Action of the bile.
│ └ intestines │Action of the pancreatic liquor.
│ └Action of the intestinal liquor.
│
│6th. Separation of the substances that are nutritive from those
│ that are not.
│ ┌the lacteals.
│7th. Absorption of the nutritive substance; │the mesenteric glands,
│ course of the chyle in │the thoracic duct.
│ └the blood vessels.
│8th. Excretion of the non-nutritive ┌Of the peristaltic motion.
│ substance │Of the fecal matter.
│ └Of the intestinal gas.
│ ┌the pharynx and œsophagus.
│ │the stomach.
└9th. Of vomiting, as it has its seat in │the small intestines.
│the large intestines.
└—Sympathetic vomiting.
GENUS II. _Respiration._
┌1st. Of the air.
│2d. Mechanical phenomena ┌Inspiration.
│ └Expiration.
│3d. Chemical Phenomena relative ┌to the air.
│ └to the blood.
└4th. Connexion of respiration with life. Of asphyxia, &c.
GENUS III. _Circulation._
┌Circulation of red blood.
│Circulation of black blood.
┌1st. general │Action of the heart.
│ │Action of the arteries.
│ │Action of the veins.
│ │Connexion of the circulation with life.
│ └ Of syncope, &c.
│2d. abdominal.
│ ┌phenomena of the motion of the blood.
│ ┌general └change of red to black.
└3d. capillary │ ┌its relation with the general.
└pulmonary └change of black to red blood.
GENUS IV. _Exhalations._
┌of their agents.
┌1st. in general │of their phenomena.
│ │of their alterations.
│ └—Sympathetic exhalations.
│ ┌serous.
│ │cellular ┌of fat.
│ │ └of serum.
│2d. in particular. │synovial ┌in the grooves of the tendons.
└ Exhalations │ └in the articulations.
│ ┌in the middle of the long bones.
└medullary │in the extremities of the long bones,
└ in the short and flat ones.
GENUS V. _Absorptions._
┌Of their agents.
┌1st. in general │Of their phenomena.
│ │Of their alterations.
│ └—Sympathetic absorptions.
│ ┌serous.
│ │cellular ┌ of fat.
│2d. in particular. │ └ of serum.
└ Absorptions │synovial ┌ in the grooves of the tendons.
│ └ in the articulations.
│ ┌ in the middle of the long bones.
└medullary │ in the extremities of the long bones,
└ in the short and flat ones.
GENUS VI. _Secretions._
┌Of their agents.
┌1st. in general │Of their phenomena.
│ │Of their alterations.
│ └—Sympathetic secretions.
│ ┌lachrymal.
│ │salivary and pancreatic.
│ │hepatic.
└2d. in particular. Secretions │renal.
│mucous.
└sebaceous.
GENUS VII. _Nutrition._
┌1st. Of the double nutritive motion.
│ ┌Nutritive matter, ┌ the chyle.
│2d. Composition of organs │ considered in ...│ the blood.
│ └—Assimilation. └ the organs themselves.
│
│3d. Decomposition of organs.
│4th. Causes that modify nutrition.
│ ┌infancy Of increase in height.
│5th. Of nutrition considered in │youth Of increase in thickness.
│ │adult age.
│ └old age Decrease.
└ 6th. Of natural death.
GENUS VIII. _Calorification._
┌1st. Phenomena of animal heat.
│ ┌respiration.
│ 2d. Entrance of caloric by │digestion.
│ └absorption.
│ 3d. Its latent state in the blood.
│ 4th. Its disengagement in the capillary system.
│ 5th. Its exit from the body.
└ 6th. Of the sympathies of heat, and of sympathetic heat.
SECOND CLASS.—FUNCTIONS RELATIVE TO THE SPECIES.
A COMPARISON OF THE TWO SEXES. HERMAPHRODISM.
ORDER FIRST.—_Functions peculiar to the male. Phenomena of puberty in
man._
GENUS I. _Production of the semen._
┌1st. Secretion in the testicle.
│2d. Residence in the vesiculæ.
│3d. Excretion Of erection and its phenomena.
│4th. Of the semen.
└5th. Of eunuchs.
ORDER SECOND.—_Functions peculiar to the female. Phenomena of puberty
in woman._
GENUS I. _Menstruation._
┌1st. Of its seat.
│2d. Of its periodical return.
│3d. Of its alterations.
└4th. Of its cessation.
GENUS II. _Production of milk._
┌Difference of this secretion from others.
┌1st. Secretion in the breast └Relation between the breast and womb.
│
│ ┌spontaneous.
│2d. Excretion └by suckling.
└3d. Of the milk.
GENUS III. _Of the fluids of women proper for generation._
┌What these fluids are.
└What is their influence.
ORDER THIRD.—_Functions relative to the union of the sexes, and the
product of this union._
GENUS I. _Generation._
┌1st. Sexual intercourse.
│ ┌Its phenomena ┌in the womb.
└2d. Conception │ └in the tubes and ovaries.
└Hypotheses.
GENUS II. _Gestation, relative_
┌1st. to the mother ┌General state of her functions.
│ └State of the womb.
│ ┌Of its animal life; it is almost nothing.
│ │Of its organic life ┌Functions that it wants.
└ 2d. to the fœtus │ └Activity of assimilation.
└Of monsters.
GENUS III. _Parturition and subsequent phenomena_
┌1st. Causes and mechanism of parturition.
│2d. Of the lochia.
│ ┌Development of its animal life.
└3d. Phenomena of the new born infant └Functions added to its organic.
This is a sketch of the general plan that I have adopted in my
lectures. Those who have attended them, will find here some changes in
one part, and additions in another. But they can easily arrange under
it all the facts that are contained in this work, if they wish to refer
them to a physiological classification, instead of distributing them
according to the anatomical order in which I present them here.
Though a line of demarcation separates each order of functions, it is
not necessary, however, to take, in too exact a sense, the divisions
pointed out above. Each order is connected with the others, more or
less intimately. For example, in the first class, when one order
ceases, another is soon annihilated. It is thus that I have shewn
elsewhere that the heart, which is the principal agent of organic
life, being interrupted, the brain, which is the central organ of
animal life, is immediately stopt for the want of excitement, and the
functions over which it presides are destroyed. It is thus also, as I
have shown, that the brain, having under its immediate superintendence,
respiration, by the means of the diaphragm and intercostals, which
receive the cerebral nerves, has the circulation directly under its
control, and thus the whole of organic life, which ceases when its
action is interrupted. It is on this account that I have considered
respiration as the link that connects animal with organic life, and
have proved that a fœtus without a brain, or without something to
supply its place, cannot live out of the womb of its mother. Every
thing is connected, every thing is united in the animal economy. We
live without and within in a distinct manner, but one life cannot
be preserved as a whole, independent of the other. Thus, though the
functions should be studied abstractedly, we should always have in view
their connexion, when we consider the whole of them as simultaneously
in operation.
It will be seen that in the Descriptive Anatomy, I have adopted a
classification analogous to that of physiology. The one differs,
however, a little from the other, because the same organs often serve
for many functions, and especially because certain functions, such as
exhalation, nutrition, calorification, have not, to speak correctly,
any distinct and determinate organs.
GENERAL ANATOMY.
SYSTEMS
COMMON TO ALL THE APPARATUS.
GENERAL OBSERVATIONS.
The organized systems of the living economy may be divided into two
great classes. One, generally distributed and every where present,
concurs not only in the formation of all the apparatus, but even
in that of the other systems, and offers to every organized part a
common and uniform base; this includes the cellular, arterial, venous,
exhalant, absorbent, and nervous systems. The other, on the contrary,
placed in certain determinate apparatus, foreign to the rest of
the economy, has a less general and oftentimes an almost insulated
existence; this embraces the osseous, cartilaginous, fibrous, muscular,
mucous, serous systems, &c. &c.
The first part of this work will be devoted to the examination of the
general systems, of the generative systems, if I may so express myself,
systems which are not however of such importance that all the organized
parts are necessarily provided with these six. In fine, in some there
are neither arteries nor veins; in others nerves; in some but little
cellular texture; but they concur to form the greatest number, and some
are always found where others are wanting. Thus in the tendons, in
the cartilages, &c. which are deprived of blood, there are exhalants,
absorbents, &c.
In general, it appears that the exhalant and absorbent systems are
the most universally diffused. Nutrition supposes this; in fact this
function is the result of a double movement; one of composition, which
brings to the organs, the other of decomposition, that carries from
them the nutritive matter; now the exhalants are the agents of the
first movement, and the absorbents of the second. As every organ is
nourished, and as the mechanism of nutrition is uniform, it follows
that these two systems belong to all the organs. After them the
cellular system is the most generally found. Where there are no blood
vessels, it is sometimes met with, and it always exists where these
vessels are. Next to this, the arteries and veins are spread to the
greatest number of parts. Oftentimes no nerve is discoverable, where
they penetrate, as in the aponeuroses, the fibrous membranes, &c. &c.
The nervous is of all the generative systems, that which is found by
dissection in the smallest number of parts. The serous membranes, the
whole fibrous system, the cartilaginous, the fibro-cartilaginous, the
osseous, &c. appear to be deprived of it.
Particularly destined to form a part of the structure of other organs,
the generative systems perform the same office for one another; thus
the cellular texture enters into the composition of the nerves, and
the arteries and veins; and the arteries and veins are ramified in the
cellular texture, &c. It is a general intermixture of one with the
other.
It may be imagined, from what has now been said, that the generative
systems, considered under the relation of organs, forming a common
and uniform base for all, ought to be sooner developed than others;
and this, observation proves. While there is hardly an outline of
the others in the first months of the fœtus, these predominate in a
remarkable manner. The nerves, and their centre, which is the brain,
the arteries, the veins and their central organ, which is the heart,
the cellular texture, the exhalants and the absorbents, exhibit this
phenomenon in a striking degree. Mere inspection suffices to prove this
in the nervous, arterial, venous and cellular systems; in the other two
it is proved by the wonderful activity of absorption and exhalation, at
this period of life.
From what has just been said of the general systems of the economy,
it is easy to perceive that they perform the most important part of
nutrition. They form the nutritive parenchyma of each organ; now I call
the nutritive parenchyma, the cellular, vascular and nervous outline
of that organ. It is in this outline that the nutritive matter is
deposited. This matter being different for each organ, establishes a
difference between them. For the bones, it is phosphate of lime and
gelatine; it is gelatine alone for the cartilages, tendons, &c.; fibrin
for the muscles, albumen for certain other organs; so that if the
nutritive parenchyma of a bone was filled with fibrin, it would be a
muscle in the form of a bone, and vice versa, a muscle would become a
bone with a muscular form, if its parenchyma was filled up with earthy
and gelatinous substances. We should know the nature of all the living
parts, if their nutritive substances were known to us; but the most
of them are unknown, it is chemistry that must enlighten us upon this
subject. All the organs resemble each other in their parenchyma, or at
least have a great analogy. If it were possible to remove, from all
the nutritive matter and leave this parenchyma untouched, we should
see only among them, varieties of form, of size, of deposition of
cellular layers, of vascular or nervous branches, but not of nature and
composition.
In the first period after conception, the mucous mass that represents
the fœtus, appears to be only a compound of the general systems.
Each organ has as yet only its nutritive parenchyma, the parenchyma
upon which nature has imprinted the form of the organ, that is to
be developed there. In proportion as this outline is increased, the
nutritive substances penetrate it, and then each organ, which until
that time had been like the rest in its nature, and forming with them a
homogeneous mass, begins to be distinct, and have a separate existence;
each one draws from the blood the substance that is proper for it. This
addition gives the attributes of thickness, of density, and of nature;
but the increase of parenchyma, the augmentation of its dimensions are
always antecedent to this. Whilst all inorganic bodies increase by the
addition of particles, there is here at first an expansive force, from
which length and breadth arise, afterwards substances are exhaled into
the parenchyma, which lengthen and widen it.
By what mechanism is it, that each organ draws the materials of its
nutrition from the blood, the common source? This depends entirely upon
the organic sensibility peculiar to each, which places it in relation
to this or that substance and not to another, and which makes it
appropriate it to itself, is penetrated by it, and suffers it to enter
its vessels on all sides while it draws back and contracts, to prevent
what is foreign to it, from being introduced into its texture.
After this substance has continued for some time to form the organ,
it then becomes foreign to it and heterogeneous; by remaining longer
it would be injurious; it is absorbed and thrown out by the different
emunctories; a new substance of the same kind, which is brought by
exhalation, takes its place. Each organ is then constantly in a
state of composition and decomposition; but this composition and
decomposition vary in their proportion. The predominance of the first
over the second, constitutes growth. Their equilibrium establishes the
stationary state of the body, which is the case with the adult. When
the activity of the second is greater than that of the first, then
decrease and decrepitude follow.
Such is, in short, the manner in which the general theory of nutrition
should be considered, a theory which I shall explain at length in my
physiology, and upon which I will now offer a few words, to show that
it is not a system formed by accident, but that it rests upon the laws
of the economy, and upon its organic phenomena. Now I think that this
assertion will be demonstrated, if I prove, 1st. the uniformity of the
parenchyma of nutrition; 2d. the variety of the nutritive substances;
3d. the faculty which the parenchyma of nutrition has of appropriating
to itself, according to the quantity of its organic sensibility, this
or that nutritive substance, to the exclusion of others, of afterwards
throwing out this substance, and of taking new. These are in fact the
fundamental principles of this theory.
I say in the first place, that the parenchyma of nutrition is the same
for all the organs, and that it is an assemblage of red vessels, of
exhalants, of absorbents, of cellular texture, and of nerves; these are
the proofs. 1st. These different organs are met with in all the others,
as I have observed before, anatomy shows them every where, between each
fibre, each layer, each point, if I may so say; they are truly the
common organs. 2d. When we take away from the organs their different
nutritive substances, for example, from the bones the phosphate of
lime by acid, and the gelatine by boiling, there is a residue which
is evidently cellular and vascular. 3d. There is no doubt but that
the mechanism of the union of divided parts is the same as that of
their natural nutrition. Now in the healing of wounds, the parenchyma
of nutrition is first developed, and is every where the same; every
where fleshy points appear, which are cellular and vascular, which
have the same appearance and same character, whether they arise from
a bone or a cartilage, a muscle, the skin, a ligament, &c. All wounds,
in healing, like the organs, resemble each other in their parenchyma;
they differ also like the organs, in the nutritive substance that is
afterwards deposited in its texture, substances which vary according
to the part where the wound happens to be; thus the deposit of the
phosphate of lime gives to the callus a different character from that
of muscular wounds, which are united by the exhalation of fibrin in
the fleshy points that first arise upon the divided surfaces, &c.
4th. The mucous substance which forms the body of the embryo, appears
to be nothing but cellular or mucous texture, as Bordeu calls it,
which is abundantly supplied with vessels and nerves. In fact, when
the organs are developed in this mucous substance, it may be seen in
their interstices for a certain length of time, and exhibits there
the same appearance as the body of the embryo in the first periods;
gradually this substance becomes condensed, is filled with cells,
and assumes the form of cellular texture; whence it may be presumed,
that in this mucous state of the embryo, there is only the nutritive
parenchyma of the organs; and as the parenchyma is the same in all, it
is evident that the mass of the embryo must be homogeneous. Nutrition
commences, and then each organ appropriates to itself the substance
which is proper for it; after this it ceases to be homogeneous. From
these considerations, it becomes easy to admit the uniformity of the
parenchyma of nutrition, and its cellular, vascular and, in certain
cases, nervous texture.
I am aware, that by admitting this common parenchyma of nutrition, it
becomes necessary that it should be nourished itself, and consequently
that we must go farther back; but in physiology, the art of finding the
truth consists, in searching for it in secondary causes; here facts and
experiments enlighten our way, beyond that, imagination only is our
guide.
After having demonstrated that the organs resemble each other in a
common parenchyma of nutrition, it is unnecessary to prove that they
differ by the substances that are deposited there. Animal chemistry has
within a few years past so much elucidated this point, that it is not
worth while to waste time in refuting what has been written upon the
identity of the nutritive juice.
In fine, it is easy to conceive, how each parenchyma of nutrition
appropriates to itself according to the quantity of organic sensibility
it enjoys, the nutritive substances that are proper for it, and which
are brought to it by the circulation. It is not a phenomenon peculiar
to nutrition; it is observable in all the acts of the organic economy.
Thus the secretions take place only in consequence of the determined
quantity of this sensibility, which, placing each gland in relation
with the fluid that it should separate, makes it receive this fluid,
and reject the others; thus the red part of the blood does not
ordinarily pass into the exhalants, because the serous part is alone
in relation with their organic sensibility; thus the substances that
pass the intestines, do not stop in the biliary or pancreatic ducts,
although their diameter is sufficient to admit them; thus cantharides
are exclusively in relation with the sensibility of the kidneys,
mercury with that of the salivary organs, &c. &c.
We see from this, that the mechanism by which the parenchymas of
nutrition appropriate to themselves nutritive substances, is not an
insulated phenomenon, but a consequence of a general law of organic
sensibility. But why has this property as many degrees as there are
organs in the economy? Why do these degrees establish relations so
different between the organs and the substances that are foreign to
them? Let us stop here; let us be contented with proving this fact by
a great number of examples, without trying to discover the cause. We
could offer nothing but conjectures upon this subject.
These few notions upon the nutritive phenomena, though indirectly
connected with the subject of this volume, are not misplaced here;
because in these phenomena, the generative systems upon which we
are going to treat, perform the greatest part, and because we shall
frequently have occasion to refer to them in the examination of the
development of the organs, the development that authors have only
vaguely examined, upon which the most exact and the most judicious of
all physiologists, Haller, has only slightly glanced, but which however
ought to receive the particular attention of physicians, of those
especially who wish to consider diseases under the essential relation
of the influence that age has upon them.
CELLULAR SYSTEM.
This system, which many know still, under the name of the cribriform
body, the mucous texture, &c. is an assemblage of filaments, and of
white soft layers, intermixed and interwoven in different ways, leaving
between them spaces communicating together, more or less irregular, and
which serve as a reservoir for the fat and serum. Placed around the
organs, the different parts of this system act at the same time as a
bond to connect, and as an intermediate body to separate them. Carried
into the interior of these same organs, they essentially contribute to
their structure.
The great extent of this system, which, though every where spread, is
every where continuous, the number of organs it surrounds, and the
multiplied relations it presents, do not allow me to describe it, as
has been done, in one point of view; in order to give a complete view,
it is necessary to separate the different points in which it may be
examined.
I shall then at first consider abstractedly the general system, as
represented by the continuity of all its parts, in order to consider it
in relation to the organs that it surrounds, or to whose composition it
concurs. I shall examine it afterwards independently of these organs,
as it is spread everywhere in the spaces between them. In fine, its
organization, its properties, its relations with other systems, and its
development will be the object of my researches.
ARTICLE FIRST.
OF THE CELLULAR SYSTEM CONSIDERED IN RELATION TO THE OTHER ORGANS.
The cellular system, considered in an insulated manner, and in relation
to each organ of the animal economy, can be described in two secondary
relations. 1st. It forms for each organ a covering, a boundary which is
exterior to it. 2d. It enters essentially into the structure of each,
and forms one of the essential bases of this structure.
1st. _Of the cellular system upon the exterior of each organ._
The different conformation of the different organs, establishes two
very distinct modifications in the relations of the cellular texture,
that is exterior to them. In one case in fact, it is contiguous only
to one of their surfaces, in the other it envelopes them entirely. The
first arrangement takes place, when these organs have one side free,
and the other attached, as for example, the skin. The second, which is
the most general, is observed, when an organ is attached every where to
those in the vicinity of it. Let us describe separately each of these
two arrangements.
_Of the cellular system which adheres only to one side of the organs._
There are three membranous organs which are free on one side, and
clothed on the other by the cellular texture; these are the skin,
and the serous and mucous membranes. We can also consider here, that
which covers the exterior of the arteries, the veins, the absorbents
and the excretories, which are destitute of it in their interior. As
this texture enters also into the structure of these vessels, most
authors have examined it, in treating of them. It appears to me more
convenient to present under one point of view all the parts of the
cellular system.
_Sub-cutaneous cellular texture._
Besides the chorion, into which, as we shall see, a great quantity of
cellular texture enters, and which anatomists consider as formed by
a particular condensation of this texture, the skin, everywhere that
we examine it, presents a subjacent cellular layer, the quantity and
density of which vary in the different parts of the body.
Upon the greatest part of the median line, this texture appears more
compact, and more adherent to the skin than in many other places. We
may be convinced of this, by dissecting upon the middle of the nose,
of the lips, of the sternum, upon the linea alba of the abdomen, upon
the range of the vertebral and sacral spinous processes, upon the
posterior cervical ligament, &c. From this adhesion arises a sort of
division of the two great halves of the sub-cutaneous cellular texture;
a division that I have sometimes made very evident in my experiments
upon emphysema. The air being driven with moderate force under the
integuments of one side of the body, diffuses itself gradually, and
is stopped in many instances at the median line, so that one side is
puffed up and the other exhibits the ordinary state of the cells. It
is oftentimes necessary to increase the force very much, in order to
overcome the resistance and render the emphysema general. However, we
cannot always produce this phenomenon, and sometimes the air spreads
immediately every where; this takes place especially if it is forced
in about the neck, for the sub-cutaneous texture is as loose there in
front, upon the median line, as it is upon the sides.
It is only from the circumstance, that the sub-cutaneous texture
immediately under the median line, is somewhat more compact than
elsewhere, that we can say with Bordeu, that this texture divides
the body perpendicularly into two equal parts. No where, but under
the skin, do we see any trace of this separation. Besides, I have
demonstrated in one of my works, that the division of the body into two
symmetrical parts, is a general attribute of the organs of animal life,
an attribute which distinguishes them from those of the internal life,
which seem to be characterized by their irregularity; it is under this
relation, and not under that of Bordeu, which is contrary to anatomical
facts, that the median line should be described.
In the other parts of the body, the sub-cutaneous cellular texture
varies considerably. 1st. The density of this texture is remarkable in
the hairy scalp, which is with difficulty separated on that account
from the aponeuroses and subjacent muscles. Those who have often
examined patients who have died of apoplexy, know that sometimes
their heads and necks are emphysematous; I have already seen four.
Now whilst considerable air is found in the face, little or none is
met with under the hairy scalp. 2d. In the face, the sub-cutaneous
texture is remarkably loose, it is very abundant there. 3d. Upon the
trunk this laxity is also very evident; it accommodates itself to the
motions which the great and broad muscles perform there. 4th. Upon the
extremities, the sub-cutaneous cellular texture, situated between the
aponeuroses and the skin, offers almost every where an equal degree
of relaxation. It is only upon the palm of the hand and the sole of
the foot that, its texture becoming more compact, the adhesion of
the aponeuroses to the skin is more evident, an arrangement that is
favourable to the use of these two parts, which are designed to adapt
themselves to the forms of external bodies, to grasp and hold them. It
is to this compact texture, that must be referred the difficulty that
exists of making these parts subject to dropsical effusions. Long after
every other part of the sub-cutaneous texture is infiltrated, this
preserves its ordinary state. I have seen two patients affected with
elephantiasis, where every part of the skin and subjacent texture of
the lower extremities was enormously swelled, except the sole of the
foot. The contrast of this part, remaining in its natural state, with
the top of the foot, which was raised to an enormous swelling, gave
that peculiar appearance that all authors have noticed. At the place
of the annular ligaments, the sub-cutaneous cellular texture is very
compact, and the adhesion of the skin, is also very evident; hence
those contractions that are seen in the limbs of infants at the place
of the ligaments, the fat penetrating but very little into the cells,
that are very closely drawn together.
The sub-cutaneous cellular texture has several different uses. It
furnishes the skin with the great mobility it enjoys, a mobility that
is particularly observable in the great motions of the trunk and
extremities, in the collisions it experiences with external bodies, in
the different tumours that get to a great size, as in sarcocele, which
is often covered at the expense of a part of the integuments of the
penis, the abdomen and the thigh, which are stretched and have a real
locomotion.
It is to this texture also, that the organs subjacent to the skin owe
in part the facility with which they move in the great contractions of
which they are susceptible. The fat contained in great quantity in its
cells, contributes to protect the subjacent parts from the impression
of the external air. We know, that in general this fluid is more
abundant there in winter than in summer, that it is found in a very
considerable proportion under the skin of animals that inhabit cold
countries, that in consequence of the emaciation that follows great
diseases, the impression of the external air is often very sensible, &c.
The serum appears to be in the sub-cutaneous texture, considerably
more than in other parts; it has a greater tendency to accumulate
there, no doubt on account of its laxity. If we compare the quantity
of fluid which enters this texture in a dropsical limb, with that
which occupies the intervals between the muscles and the interstices
of the fibres of the different subjacent organs, we shall see that it
exceeds it considerably, and that the size of the limb is in proportion
much more increased by the dilatation of the portion of sub-cutaneous
cellular texture, than by that of the portions situated deeper. To be
convinced of this, place at the side of a healthy, lower limb, stripped
of its integuments and subjacent texture, a dropsical limb prepared
in the same manner, and consequently having like the other, only its
aponeurotic covering, you will see that the difference is not very
great.
_Sub-mucous cellular texture._
The mucous membranes have the same relations with the cellular texture,
that the skin has, of which they are a continuation, and with which,
as we shall see, they have a great analogy in their structure. There
is then a sub-mucous, as well as a sub-cutaneous texture. But there is
between them, this essential difference, that the texture of the first
is infinitely more compact and condensed than that of the other, and
consequently that the adhesion of the mucous system to the neighbouring
parts is much greater, than that of the cutaneous system. It is to this
difference that may be referred, 1st. the difficulty of dissecting
the mucous membranes and of separating them from the subjacent parts.
2d. The impossibility that I have always found in many successive
experiments, of producing an artificial emphysema in the sub-mucous
texture, whilst I have done it almost every where else, by blowing in
air. 3d. The uniform absence of this fluid in this texture, even when
the natural emphysemas are the most generally spread. 4th. The equally
uniform absence of serum in the sub-mucous cells, in the most general
leucophlegmasia; a phenomenon essential to the functions of the hollow
organs, which would soon be obliterated, if the sub-mucous texture
swelled as much in dropsy as the sub-cutaneous.
Is it to the difference of texture of these two portions of the general
cellular system, that must be referred the much greater frequency of
phlegmonous inflammation in the second than in the first, or is it
that this is less exposed to the exciting causes derived from external
bodies? Both circumstances may have an effect. I believe much more
readily in the first, as the throat, in which is seated, especially
around the amygdalæ, the most lax of all the parts of the sub-mucous
texture, is the most frequent seat of phlegmonous inflammation.
Besides, it is the firm and compact structure of the sub-mucous
texture, which makes it fit to serve as a point of insertion and
termination to that number of fleshy fibres that compose the muscular
membranes of the stomach, the intestines, the bladder, &c. and thus to
fulfil the uses that the tendons have in relation to the muscles of
animal life.
_Sub-serous cellular texture._
There is under almost all the parts of the serous system, as under the
two preceding ones, a cellular layer, which is in general very abundant
and very loose, as we may be convinced by examining it around the
peritoneum, the pleura, the tunica vaginalis, the pericardium, &c. This
quantity of cellular texture is particularly destined to accommodate
the different changes these membranes experience, in dilatation,
in contraction, and in a species of locomotion, of which they are
susceptible under many circumstances. We shall see the peritoneum, for
example, belong at one time to the omentum, at another to the stomach,
according as this last is in a state of fulness or vacuity; now for
these removals, it was necessary that there should be a great degree
of laxity in the surrounding texture. It is to this, that we must
attribute the ease with which the sub-serous texture is penetrated
with water in dropsies, and with air in emphysema. Next to the
sub-cutaneous texture, no part is more disposed to these infiltrations.
There are, however, some places, where the serous membranes adhere in
a very intimate manner to the neighbouring parts. The pericardium in
its two layers, the synovial glands with the cartilages and fibrous
capsules, the tunica arachnoides with the dura mater, offer examples of
this arrangement, which constitutes, when it is with a fibrous membrane
that it makes the adhesion, the sero-fibrous membranes.
_Cellular texture exterior to the arteries._
There is around each artery an extremely compact, condensed, and
resisting layer, which at first sight appears to be a peculiar
membrane, but which evidently belongs to the cellular system. It has
the greatest analogy with that which is under the mucous membranes. It
is never the seat of serous infiltrations. Fat never accumulates there,
and it is never attacked with inflammation. It arises in an insensible
manner from the neighbouring cellular texture, which is gradually
condensed, and intermixed in such a manner, that we can detach it as
a whole, so that it will represent a kind of canal corresponding with
that of the artery which it surrounds and supports. Are the arterial
fibres inserted in this compact texture, as the muscular fibres of the
stomach and intestines are, in the sub-mucous texture? I do not think
they are; for if it was the case, we could not so easily remove the
cellular cylinder that surrounds the arteries; the arterial fibres seem
to be whole circles, and consequently not to have, like the muscular,
two inserted extremities. However, some of these fibres constantly
adhere to the deepest cellular layer, when we remove it; we distinguish
them by their direction and yellowish colour.
_Cellular texture exterior to the veins._
The veins have an external covering analogous to that of the arteries,
but it is in general less thick and compact. It cannot be taken out in
an entire cylinder as easily as that of the arteries. Moreover, it does
not contain fat, and but little serum, and is not subject to dropsical
effusions, but uniformly preserves in all affections its original
state. When we raise by layers this texture which is on the outside of
the coats of the veins, we easily perceive that it is dryer than in
any other part; and I have often been tempted to believe, that it does
not, like that of the arteries, the excretories, and mucous surfaces,
exhale an albuminous fluid which lubricates the other parts of the
cellular system. We shall see that its organization, which is entirely
different, forms an exception in this system.
In examining the cellular cylinder of the veins and arteries,
especially that of the first, it is essential not to confound it with
their filaments, and the numerous nervous branches which come from the
ganglions, and form a very thick net-work around them. The cellular
texture is whiter, the nerves more greyish; this becomes very apparent
after a few days maceration.
I do not speak of the texture external to the absorbents; without doubt
they have one like the veins, but so delicate are these vessels, that
we can say nothing of them founded upon experiment and dissection.
_Cellular texture exterior to the excretory ducts._
All the excretories, the salivary, urinary, spermatic, hepatic,
pancreatic, &c. are evidently surrounded with a layer analogous to the
preceding, entirely distinct from the neighbouring texture, and which
appears to be inserted in it without partaking of its nature; it is
a distinct body, as to its thickness, its form, and its texture. The
filaments that compose it, not being separated in their interstices by
any fluid, remain in contact with each other; so that the whole really
makes a membrane in the form of a canal, which can be easily raised up
like that which surrounds the arteries; it is, however, thicker than
that of the veins.
_Of the cellular system considered in relation to the organs that it
surrounds on all sides._
Except the organs of which we have just spoken, all parts of the
body are surrounded on every side with a cellular layer more or less
abundant, which forms for them, according to the happy expression of
Bordeu, a kind of peculiar atmosphere, an atmosphere in the midst of
which they are immersed, and which serves to insulate them from the
other organs, to interrupt to a certain degree the communications which
would unite them in an intimate manner, which would identify, if we may
so say, the existence of one with the other, if they were in immediate
apposition.
The serous vapour, in which the cellular atmosphere of each organ is
constantly immersed, and the fat which floats there in greater or less
abundance, powerfully assist in this insulation of vitality; both form
for the different organs a line of separation, which, being fluid,
enjoys in a much less degree than them the vital forces, which also in
this point of view, is not at their level, if I may so express myself,
and which is consequently very proper, to interrupt in a certain degree
the vital communications that would otherwise exist. The essential
difference that there is between the peculiar life of the cellular
texture and that of the other organs, renders it also very susceptible
of performing alone like a solid, an analogous use independent of the
fluids it contains.
It is to this insulation of the vitality of the organs by their
surrounding cellular texture, that we can refer in part that of
the diseases, which is only an alteration of this vitality. Every
day we see an affected part contiguous to a sound one, without
communicating to it its disease. A healthy pleura covering the lungs
filled with tubercles, or ulcers, in phthisis; an inflamed peritoneum
corresponding with the intestines, the stomach, the liver, the spleen,
which remain in their natural state; the mucous membranes affected
with catarrhs approaching without danger the numerous parts they
cover; the sub-cutaneous organs remaining free from the innumerable
eruptions of which the skin is the seat; the tunica arachnoides in a
state of suppuration enveloping a healthy brain, and a thousand other
similar facts; these are the phenomena that the examination of bodies
constantly presents. Shall I speak of the different tumours that are
formed in the midst of organs, without their perceiving it, of the
numerous excrescences that grow by their side without affecting them?
Dissect a muscle under a suppurating cutaneous wound, or even a most
obstinate ulcer; you will not often find it different from the rest,
the skin only has been affected. No doubt the difference of vitality
of two neighbouring organs is an essential cause of the insulation
of their diseases; but the cellular atmosphere that protects them is
also an important one. When an organ sends elongations into another,
it communicates to it much more easily its diseases, than if a thick
cellular layer separated them; for example, we know that the affections
of the periosteum and the bone are soon identified.
Let us not, however, exaggerate this idea, by describing the cellular
atmosphere as an insurmountable barrier to diseases. Facts would often
contradict us, by showing diseases passing from an organ to the texture
that surrounds it, and from this texture to the neighbouring organs;
so that we see it at one time an obstacle, and at another the means
of their propagation. The atmosphere that is formed is in different
cases susceptible of being charged with all the emanations that arise
from the organ, or to speak in language more strictly medical and
physiological, the vital forces of an organ being altered, those of the
surrounding texture are often altered by communication, and gradually
those of the different neighbouring organs themselves. This kind of
influence that the organs have upon each other, should be carefully
distinguished from sympathy, in which, a part being diseased, another
part becomes affected without the intermediate ones being deranged
in their functions. Here there is constantly in the communication of
diseases, the same order as in the position of the organs.
A great number of local affections affords us examples of this
dependance, in which an organ and its texture being diseased, the
neighbouring organs afterwards become so. In phlegmon, a more or less
considerable swelling surrounds the red and inflamed place; rheumatism,
which affects the white parts of the wrists and fingers, produces
a painful swelling around them; a considerable tumefaction in the
neighbourhood of the knee is almost always the result of diseases of
the joint, which affect only the ligaments, &c. Many tumours have
around them a kind of diseased atmosphere, an atmosphere which extends
more or less remotely, which always exists in the cellular texture,
and which constantly partakes of the nature of the tumour. If it is
acute, as in phlegmon, it is a simple swelling which disappears almost
entirely at death; as I have often seen in dead bodies an inflamed
part that was very large during life, resume by the loss of the vital
forces, nearly its ordinary size. Is the tumour chronic? it is an
induration more or less evident that affects, oftentimes to a distance,
the neighbourhood of the diseased parts, as we see in most cancers.
This atmosphere of disease is developed not only around the affected
organ, but embraces also the neighbouring ones. The inflammations
of the pleura spread to the lungs, that of the convex surface of
the liver to the diaphragm; pericarditis, by the influence it has on
the fleshy fibres of the heart, produces in this organ the irregular
motions of an intermittent pulse; peritonitis, which is exclusively
confined to the peritoneum, in the beginning, terminates, when it
becomes chronic, by affecting the subjacent intestines; it is this
which forms chronic enteritis, &c.
It should be remarked, however, that mere contiguity without cellular
texture, is often sufficient to communicate disease; for example, a
carious tooth affects its neighbour; the inflamed portion of a serous
membrane, in contact with healthy ones, soon produces inflammation in
them; thus it is, that after inflammation has continued a short time,
though the pain has announced only one point to be primarily affected,
the whole surface is found attacked.
I am convinced that disease is not the only thing, that the cellular
atmosphere of the organs serves to propagate, but it is also the means
of communicating medicinal effects. Why is a blister often useless that
is applied to a remote part in rheumatism, whilst one placed upon the
skin that covers the muscle or the fibrous organ that is the seat of
the disease, frequently produces a sudden effect? Why has a cataplasm
applied to the scrotum oftentimes an influence upon a diseased
testicle, though between the cutaneous organ and this gland there is
no relation of vitality? Why do several other medicines applied also
to the skin, produce an action upon the subjacent parts? The cellular
texture is certainly the means of communication, as in the different
applications made to the mucous membranes. A gargle is advantageous
in inflammations of the tonsils; an emollient enema diminishes that
of the peritoneum, &c.: now these means are not applied directly to
the affected organ; their effects are transmitted by the sub-mucous
texture. However, the advantages of these applications have been much
exaggerated, both when applied to the cutaneous and mucous surfaces,
with a view of acting upon organs of different vitality, and which are
subjacent to these surfaces. Practice too often proves that they may
be excited, and irritated in a certain manner, without the contiguous
organ being affected, because their life and that of the organ has no
resemblance or correspondence, the one is indifferent to the affections
of the other, though the parts are contiguous. Who does not know, how
little effect emollients, discutients, &c. have, upon tumours of the
breast, of the glands of the groin, axilla, &c.? and that they are
as often cured without our applications as they are with? Formerly,
when a tumour appeared projecting under the skin, if it was seated in
the abdominal viscera, and consequently separated from the cutaneous
organ, by many others of a different and even opposite vitality, they
covered it with a poultice. All modern surgeons admit the inutility
of applications made in this way, and now confine them to the most
sub-cutaneous organs. Perhaps hereafter we shall be sufficiently
acquainted with the degree of vitality of each organ, to know when
the cellular texture can be the means of communication of medicinal
effects, between two contiguous organs, with different structure and
properties, and when it is a barrier which stops the communication of
these effects. At present we go almost always groping in the dark.
Frequently a cutaneous application acts by sympathy upon very distant
organs, whilst it has no effect upon neighbouring ones, with which it
has no relation; for example, a bath will check a spasmodic vomiting,
while it will have no sensible effect in diminishing pain which has its
immediate seat in the sub-cutaneous organs.
In general, the vital forces of any organized part are particularly
altered, and consequently its injuries are produced in three ways;
1st. by a direct irritation, as when the conjunctiva is inflamed,
from fresh air, or that filled with irritating exhalations; 2d. by
sympathy, as when one eye being affected, the other becomes so without
any apparent cause; 3d. by cellular communication, as when a bone being
carious, the skin that covers it becomes discoloured, livid and swelled.
Why is the cellular texture, in some cases, the means that nature uses
to defend organs from the influence of that which is diseased, while in
others it serves to propagate morbid affections? Let us limit ourselves
upon this point to the exposition of facts; the research into the
cause, would only be conjecture.
The cellular atmosphere of each organ has relation not only to the
immediate phenomena of its vitality, but also to the different
movements that the organ executes; as this is more abundant, these
movements are more extended. This observation is made, in comparing
that which is in considerable quantities around the heart, the
great arterial trunks, the eye, the womb, the bladder, the great
articulations, as the axilla, the groin, &c. with that which is on the
outside of the tendons, the aponeuroses, the bones, &c. and of which
there is in general only a very small quantity. The extension and
contraction of which its cells are susceptible, make them very proper
to accommodate the great movements of the organs, those especially of
dilatation and contraction, which moreover are favoured by the fluids
that it contains. The organs, upon the external surface of which but
little cellular texture is found, and which, however, perform many
movements, as the stomach, the intestines, the brain, &c. have, to
supply its place, the serous membranes that cover them. These membranes
and the cellular texture are in fact the two great means, and the only
ones, by which nature has facilitated the movements of these organs.
There are many organized parts with obscure motions, but which are
however surrounded with a quantity of cellular texture; the kidnies are
a remarkable example of this. The testicle and its membranes are also
surrounded with a great quantity of this texture; so is the thyroid
gland; the pancreas and salivary glands find it a thick partition
which separates them from the neighbouring organs. In general, almost
all the immoveable parts, which are not of much importance, and which
are not separated from others by serous surfaces, as are almost all
the thoracic and abdominal viscera, are every where surrounded by an
abundant cellular texture.
II. _Of the internal cellular system of each organ._
The cellular texture, after having covered the organs, enters every
where into their intimate structure; it forms one of their principal
elements. In an apparatus, which is an assemblage of many systems,
each of these systems is united to the others by it; thus in the
stomach, the intestines, the bladder, &c. different layers which belong
to it separate the serous, muscular and mucous membranes of these
different hollow organs. In the lungs, between the serous surface
and the pulmonary parenchyma, between this and the divisions of the
bronchia, between them and their mucous surfaces, it offers a variety
of elongations more or less compact.
In the organized systems, the cellular texture at first accompanies
and surrounds, in their whole course, the vascular and nervous
branches which enter into their composition; then it unites together
the different homogeneous parts of each of them. Each fasciculus of a
muscle, every muscular fibre, every nervous filament, every portion of
aponeurosis and ligament, every glandular particle, &c. are surrounded
with a sheath, a particular cellular layer, which in relation to its
parts, is destined to the same uses that the greater covering of which
we have just spoken, performs for the whole organ. Thus the life of
each fibre is insulated by this layer, which, like that of the whole
organ, forms around it a kind of atmosphere, destined to defend and
protect it, but which can, however, like the general layer, and even
more than that, because the parts are nearer to each other, be the
means of the communication of diseases from one fibre to another. The
motion of each of these fibres is peculiarly favoured by the cellular
texture; thus the organs, which, like the muscles, have a very apparent
motion in each of their parts taken separately, are capable by means
of it of a much greater internal contraction, than those which, like
the tendons, the ligaments, and the glands, have no sensible motion but
that which is communicated to them.
The internal cellular texture of each organ has but little of the vital
character which distinguishes that organ; it preserves almost all
its general properties; it is, in the structure of different parts,
the medium which unites without resembling them. We see that it is
insensible in the nerves, without contractility in the muscles, or
powers of secretion in the glands. It is often affected without the
participation of the organ. In many organic affections of the liver,
we meet with steatomatous tumours, which give this organ a raised and
uneven form, and which, occupying only the cellular texture, leave
untouched the glandular texture, which secretes as usual the bile,
which undergoes no alteration in its course. It is remarkable, that
these tumours, oftentimes of enormous size, should exist without
injuring the secretion of bile. They may be compared with those
not less remarkable in the lungs in phthisis, in which, however,
respiration is performed almost the same as in health.
There are many organs, in which the cellular texture is hardly
apparent, because their structure is so compact; some authors have
even denied the existence of it in them. But in many of these organs,
maceration, by filling in an insensible manner the fibres with water,
parts them by degrees, and makes apparent the cellular texture which
separates them, as we see especially in the tendons, in the fibrous
membranes, &c. Ebullition, which takes from some their nutritive
substance, for example gelatine, leaves a membranous residue which
is evidently cellular. In all, even the bones and cartilages, the
production of fleshy points, or granulations, which, as we shall see,
are essentially of a cellular nature, proves the existence of this
internal texture, of which they are only the elongations. The same may
be said of the bones becoming soft, and fleshy, and of fungous tumours
of the other systems, diseases in which this texture becomes very
apparent, because the organ loses by them its compact structure, and
takes one that is more loose and spongy, and which exposes that which
is placed in the interstices of the fibres.
ARTICLE SECOND.
OF THE CELLULAR SYSTEM, CONSIDERED INDEPENDENTLY OF THE ORGANS.
After having considered the cellular system in relation to the organs,
let us consider it separate from all the parts that it covers and
penetrates, in order to represent it as a body continued on all sides,
found every where in the interstices of the organs and being analogous
in this point of view to almost all the other primitive systems. Let us
trace it in the head, the trunk, and extremities.
I. _Of the cellular system of the head._
The cranium and face differ extremely as it respects the cellular
texture; it is found in very small quantity in the first, and in great
abundance in the second.
_Cellular texture of the cranium._
The interior of the cranium has but very little cellular texture; it
is even apparently destitute of it. If, however, we raise the tunica
arachnoides, where the vessels enter and where the nerves go out, we
shall find a small quantity, which is remarkable for its delicacy and
transparency. The pia mater is principally formed by this texture, and
the texture of this membrane appears to be continued with that of the
brain; this, however, is extremely hard to be demonstrated; it is not
proved by maceration, and it is scarcely seen except in fungous tumours.
The communications of the cellular texture of the interior of the
cranium are very numerous.
1st. In front it enters the orbit by the optic foramen and the
sphenoidal fissure; hence the redness and heat of the eye in
paraphrenitis,[5] the influence of which is propagated by these
communications, as well as by the continuity of membranes. It enters
the nostrils by the foramina in the cribriform plate; to this perhaps
we may attribute the weight, and pain of the head in coryza.
[5] The word paraphrenitis is meant probably to designate the
inflammation of the meninges of the brain, though this term is not
usually employed by English writers; but the word used by the author
might be translated inflammation of the diaphragm, which certainly is
not his meaning. _Tr._
2d. Below, the numerous foramina of the base of the skull effect
communications between the face and the cerebral cellular texture, and
between it and the top of the pharynx, the zygomatic furrow, &c. In
many cases in which angina is attended with pain, and heaviness in the
head, vertigo, &c. I am convinced that it is in a great measure owing
to these communications, though oftentimes it may be wholly sympathetic.
3d. Above and behind, the cerebral texture is continued with that
of the corresponding parts of the head, by the numerous but small
openings in the sutures; it accompanies the vessels that go from the
dura-mater to the pericranium, and it becomes probably sometimes the
means of communication, that is so frequently observed between these
two membranes, when one is inflamed; hence the sudden affection that
frequently takes place of the dura mater, tunica arachnoides, &c. from
a stroke of the sun upon the integuments of the cranium, &c.
The cellular texture, though more abundant on the outside of the
cranium, is not found in great quantity there, no doubt because the
muscles are so few and thin. Its communications with the face are
evident, especially upon the forehead; as a consequence of erisypelas
of the cranium, nothing is more common than to see the eye-lids
receive the pus that is formed, and which often accumulates in these
moveable veils, so as to occasion considerable deposits. It is by
these communications also that serum is deposited there, and blood
extravasated. Behind and upon the sides, the communications of the
cellular texture of the cranium are also very evident.
_Cellular texture of the face._
It is very abundant in every part. The orbits are filled with it;
the excavation of the cheeks, that is bounded by the buccinator and
masseter muscles, the zygomatic and malar bones, contain much of it:
all the neighbouring parts of the tongue are furnished with it. The
nasal cavities only and their sinuses, which a mucous surface covers,
that is almost immediately attached to the bone, have but a small
quantity of it.
The facial cellular texture contributes to the beauty and harmony of
the countenance, the features of which, examined closely, show that
the muscles draw in an unpleasant manner across the skin, when there
is no fat, and consequently that there is too great a depression. In
an opposite state, there is a kind of bloating that is disagreeable;
a middle state is the most favourable to the beauty of the face.
This texture is almost wholly disconnected with expression, which is
effected by the muscles. Thus the different passions are delineated
with nearly the same features upon a fat and a lean face. Only these
features are less marked in the first than the second, because in the
last more wrinkles are formed than in the other, by the contraction of
the same muscles.
The cellular texture is in greater or less quantity in the face in
different people. Every one knows that some are always thin in this
part, who are fat in the rest of the body. From the dissection of the
bodies of such persons, I have found that it arises from the small
quantity of cellular texture it contains in proportion to the other
parts. In other individuals, there is an opposite state, a fulness
of the face with a lean body, a striking contrast, and which arises
without doubt from a cause opposite to the first.
It is to the greater proportion of cellular texture, much more than to
the development of the muscles, that must be attributed the evident
thickness of certain parts of the face, in different species of the
human race, that, for example, of the lips and the alæ of the nose in
negroes, &c. From the same cause arises the variety in thickness in the
great and small labia pudendi.
The principal communications of the facial cellular texture are made
with the neck by the sub-cutaneous portion of this texture, by that
which accompanies the vessels, and particularly in the triangular space
at the superior part of which is situated the parotid gland. Thus, from
deposits made upon the lateral parts of the face, effusions of pus take
place that often extend to the neck. In emphysema, the air of which
comes from the chest, after the neck is swelled, the air passes to the
face principally by the sides. There are still great communications of
cellular texture between the neck and the face, by the spaces between
the muscles that are attached to the base of the tongue.
II. _Cellular system of the trunk._
It varies in its proportions, as we examine the regions of the spine,
the neck, the chest, the abdomen, and pelvis.
_Vertebral cellular texture._
I so call the cellular texture which is found in the neighbourhood of
the spine, and in the vertebral canal.
In the cavity of this canal, there is but very little of it. Between
the tunica arachnoides and the medulla oblongata, between the nervous
elongations that go from the last, and the sheaths of the arachnoides
that accompany them, we see some filaments that follow the course of
the vessels, and contribute to the formation of the pia mater. There
is none of this texture between the arachnoides and dura mater. Below
this, between it and the vertebral canal, in the places where it does
not adhere, there is more of it, especially below, where it is very
loose, and always covered with a fluid that is often reddish.
On the outside of the spine, we see, behind, many muscles and but
little cellular texture in proportion; thus, depositions in this part
are much more rare and much less liable to spread than elsewhere, a
circumstance which arises also from this, that the muscles being very
compact in the vertebral canals, keep in a state of depression the
cellular texture that separates them.
This texture is on the contrary very abundant along the whole course
of the anterior part of the spine, in the neck, where it accompanies
the carotids, in the thorax and abdomen, where it follows the course of
the aorta, the great trunks which go from it, the vena cava, azygos,
&c. There is no part of the animal economy, more frequently exposed to
different collections of pus, than this. Nothing is more common than
to see depositions that are formed at the anterior part of the thorax
and abdomen, projecting at the groin by a channel which we discover
by the examination of bodies. It is principally by these cellular
communications, and by those which are beneath the integuments, that
the superior parts correspond with the inferior, and vice versa.
_Cervical cellular texture._
The neck, which is very muscular, has much cellular texture,
besides that which belongs to the vertebral column. It is
especially in the lateral parts, where the lymphatic glands are
situated, that this texture is remarkable. In the space between the
sterno-cleido-mastoideus and trapezius muscles, where the brachial
nerves arise, and where the vessels pass that go from the thorax, there
is a great quantity of it. It communicates with that of the thorax, by
the large opening that is found at the superior part of this cavity;
hence it happens, that when the cells of the lungs are ruptured, the
escaped air occupies first the chest and then the neck, and hence also
the facility with which we produce the same phenomenon by forcing air
beneath the pleura of a dead body, &c.
The cellular texture of the neck communicates also with that of the
superior extremities above and below the clavicle. Hence why the neck
and consequently the chest, are filled with air, water, and other
fluids that are forced into the sub-cutaneous and intermuscular texture
of these extremities.
_Pectoral cellular texture._
In the pectoral cavity, it is upon the median line that the cellular
texture is especially found; it is abundant in the space formed by the
duplicature of the mediastinum; the neighbourhood of the pericardium
is supplied with it, particularly around the great vessels, which it
accompanies a short distance; the rest of the thorax, occupied by the
lungs, contains much less of it.
The pectoral texture communicates with the abdominal, 1st. by the
different openings of the diaphragm, by that of the aorta, and
particularly of the œsophagus; that of the vena cava being too closely
united to that vessel, to permit these communications easily; 2d. by
the opening of the diaphragmatic fibres, especially by the triangular
space, through which those pass that are attached to the ensiform
cartilage; hence the passage of the deposits from the thorax to the
abdomen. Desault mentions a purulent collection, first formed in
the neck, and which by the anterior mediastinum, became prominent
just above the abdomen. Hence the facility with which the pleura
particularly on the right side receives the influence of diseases
of the peritoneum, when this is diseased on the convex surface of
the liver which always keeps its place, whilst by the motions of the
stomach and the spleen, that which covers those two viscera, which are
constantly changing their situation, has a much less decided influence
upon the left pleura.
The cellular communications of the chest take place also from the
interior to the exterior, by the interstices between the intercostal
muscles, but they are not very evident, as these interstices are very
small; thus the diseases of the breast have rarely any influence out
of this cavity; this happens however when in dropsies and chronic
inflammations of the pleura, the pectoral integuments have an adhesion
to the diseased side.
The exterior cellular texture of the chest, is very abundant above; it
there surrounds the breasts and contributes in part to those rounded
forms that delight us in women, and those prominent ones which we
admire in a well formed man. We see it in great quantities under the
pectoral muscles; below it diminishes in a very evident manner.
_Abdominal cellular texture._
The abdomen contains, in proportion a little more cellular texture
than the thorax. In the interior of this cavity, this texture is
found collected in the places where the great arteries and veins
enter the gastric organs, as in the fissure of the liver, the
mesentery, &c. It is not abundant between the peritoneum and the
anterior and lateral parietes of the abdomen, but it is so on the
posterior part of this membrane, particularly about the kidnies.
This interior texture communicates at first with that of the pelvis,
all around the peritoneum, then with that of the lower extremities,
by different openings, by the inguinal ring and especially by the
crural arch. The first of these openings establishes also a cellular
correspondence between the abdomen and genital organs, particularly
in man. We can easily prove these communications by injecting a
fluid into the abdominal cellular texture of a dead body. This fluid
goes spontaneously to the inferior extremities, whilst it requires a
long continued force to drive it to the superior. All practitioners
know, that there is hardly any case of ascites, in which the lower
extremities are not swelled, while the superior are unaltered. It is
then with the abdominal cellular texture, that that of the inferior
extremities has a particular relation, as it is with the pectoral that
that of the superior corresponds, as has been observed by Bordeu and
Portal. It is to be remarked however, that the first are affected much
more easily in the diseases of the abdomen, than the second are in
those of the chest.
_Cellular texture of the pelvis._
There are but few parts in which the cellular texture is more abundant
than in the pelvis. Around the bladder, rectum and womb there is
a great quantity of it, it is found no where more abundantly. This
appears to me to be the cause of it; that, as these three organs are
subject to great dilatation, and as the osseous parietes of the pelvis
cannot yield to these dilatations, like the abdominal parietes, it
is necessary that something should so act, that in whatever state
the preceding organs may be, the cavity of the pelvis should be
always filled. If the motions of the brain alternately increased and
diminished the size of this organ, the bony cavity of the cranium would
have been lined without doubt with cellular texture.
Besides we know the effect of this large quantity of cellular texture
in the pelvis, in deposits which take place in the neighbourhood of the
anus, in infiltrations of urine which accompany ruptures of the urethra
and bladder. The facility with which pus and urine spread themselves in
this part and the mischief they occasion, are well known.
This texture communicates with that of the inferior extremities by
the ischiatic notch, by the arch of the pubis, &c. Different authors
mention, that effusions of pus and urinous infiltrations extend
downwards by these communications. We can fill the pelvis with air, by
blowing this fluid into the inferior extremities, especially in their
intermuscular texture.
The exterior of the cavity of the pelvis has also much cellular
texture, less however behind than upon the sides, but in front around
the genital organs of man as well as woman, there are large masses,
particularly upon the great labia and the dartos.
III. _Of the cellular system of the extremities._
In the superior and inferior extremities, the quantity of cellular
texture decreases from the superior to the inferior part. Around the
two superior articulations, it is very abundant. The hollow of the
axilla, in which the head of the humerus is situated, and which
is spacious, is almost entirely filled with it. The groin has also
considerable, though less than the axilla. The arm and the thigh have
between their muscles large interstices that are cellular. At the elbow
there is a smaller proportion than at the ham, whose deep cavity has a
considerable quantity; an arrangement that is consequently the reverse
of that of the axilla compared with that of the groin.
In the fore arm and leg, the muscles approach each other in a sensible
manner; their cellular layers are much more compact, the whole cellular
system is less abundant.
Towards the inferior part of these two portions of the limbs, where
almost every thing on the hand and foot are tendinous and fibrous,
the cellular texture diminishes still more, and becomes in proportion
to the motions, hardly sensible. However, the foot, especially on the
sole, contains much more than the palm of the hand, where we see but
little.
This successive decrease of the cellular texture of the limbs is
adapted to the uses of their different parts. In fact the extent of
motion that exists above, requires in the muscles a laxity which they
borrow from the quantity of cellular texture that surrounds them.
Below, the multiplicity and at the same time the limited extent of
the motions of the hand and the foot, of the hand especially which is
destined to adapt itself to the form of external bodies, require in the
organs of these two parts a close juxta-position, for which they are
indebted to the small quantity of cellular texture that exists there.
ARTICLE THIRD.
OF THE FORMS OF THE CELLULAR SYSTEM, AND THE FLUIDS IT CONTAINS.
I. _Of the cells._
The general conformation of the cellular texture is not the same every
where. The interstices or cells between the different layers, are
more or less wide; their size is remarkable upon the eyelids and the
scrotum, and in general where there is no fat, or where it is in small
quantity. Moreover the capacity of the cells is extremely variable;
nothing definite can be determined upon this point, as they are capable
of contraction and expansion. When fat and serum fill them, they are
double, triple or even quadruple what they are when they are empty.
It is the variation in the size of the cells of the system of which
we speak, which constitutes all the difference of the general size of
the body in corpulency or emaciation; in each state the size of every
nervous, tendinous fibre, &c. remains nearly the same, and the cellular
system only varies. There is the same variety in leucophlegmasia
compared with the ordinary state of the body.
The figure of the cells is so variable, that we cannot describe them
in a general manner. Round, quadrangular, hexagonal, oval, are found
mixed together. The best way to see these, is to freeze an infiltrated
limb; numerous little icicles are then formed, and show by their form,
that of the cells which they filled. Artificial emphysema is also a
good way; I have often determined by it in our slaughter houses where
they blow meats, the forms of the cells. The injection of melted
gelatine may also be employed; but the results are less certain,
because in going from one cell to another, it breaks the texture; and
moreover after it is hardened, it is difficult to separate each portion
contained in each cell.
All the cells communicate; so that the cellular texture is really
permeable throughout the whole extent of the body, from the feet to
the head. This permeability is proved, 1st. by emphysema spontaneously
produced; 2d. by that which is artificially produced in a living
animal, by blowing air under any portion of the cutaneous organ, an
operation which affects neither the life or health of the animal,
though oftentimes the whole of the body is bloated. We know that
some beggars make use of these means without danger, for the purpose
of exciting compassion. 3d. If one or two punctures are made in a
dropsical limb, it is sometimes wholly emptied in this way. 4th.
Oftentimes this happens from ruptures taking place spontaneously in
limbs of this kind. 5th. Pressure made upon them, makes the fluid
ascend or descend, according to the part upon which it is made. 6th. A
rupture of the bladder or the urethra produces an urinous infiltration,
which sometimes extends even to the sides of the chest. 7th. The
injection of any fluid into the cellular texture of a dead body,
produces an artificial leucophlegmasia.
The permeability of the cellular texture has been much exaggerated,
or rather it has been presented under a point of view different from
that in which it is shown by nature. It is thus that many physicians,
thinking that it could be pervaded indifferently by all the fluids
of the animal economy, have believed that these fluids formed there,
currents in different directions more or less irregular. Thus the sweat
has been considered as the transmission by the skin of the albuminous
fluid of the cellular texture, which, according to some moderns, is
drawn out with the caloric that is constantly disengaged. They have
thought, also, that the permeability of this texture would explain the
rapid passage of drinks to the bladder. They have explained by it too,
the promptness with which sweat is produced by warm liquors, &c.
All these theories, that examination never proves, are repugnant to the
known laws of our economy, laws which show us the fluids constantly
circulating in the vessels, in consequence of the vital forces, of
organic sensibility and contractility which they possess, and not
as being extravasated to move irregularly in the cellular texture.
Moreover, I have never found any portion of drink in the cellular
texture of animals immediately after they have taken it. I have tried
many of these experiments upon dogs, after having deprived them for
some time of drink, that they might drink the more. The cellular
texture in the neighbourhood of the stomach and intestines, that
especially which, placed behind the mesentery, communicates with the
pelvis where the bladder is situated, having been attentively examined,
did not appear to me to contain any fluid; it was analogous to that of
the other parts of the body. Besides, as we shall see hereafter, these
phenomena can be explained in a very natural manner.
The cellular texture is permeable, then, only to fat and lymph; and
yet it appears that but little use is made in an ordinary state of
this permeability by these two fluids, which remain in their cells,
until absorption takes them up. We do not see them pass from one to
another; they are stagnant, if we may so say. It is only in serous
infiltrations, in effusions of pus, in one word, in a morbid state,
that the cellular permeability becomes apparent. We can only consider,
then, the cellular texture as the reservoir, in which are formed the
serum and the fat. After death the cellular texture is every where
penetrated by fluids, which pass not only across the communicating
openings of its cells, but also through the pores which it has, like
all the solids; hence the infiltration of the integuments of the back,
in dead bodies that have been laid upon it for a length of time; hence
also the passage of the bile through the texture, which separates the
gall bladder from the duodenum, and by which means this intestine is
discoloured, &c. &c. But these phenomena have nothing in common with
those that take place in the living body.
II. _Of the serum of the cellular membrane._
The first of the two cellular fluids appears to be the same as that
which is elsewhere furnished by the exhalants and taken up by the
absorbents. The first deposit it in the organs, the second carry it
from them. Thus when we expose to the air condensed by cold any part of
the cellular texture of an animal recently killed and still preserving
its heat, we see a vapour arise which results from the solution of
the serum in this air, a vapour perfectly analogous to a cloud that
transpiration and respiration produce in winter, or even to that which
arises from any aqueous fluid, exposed hot, with a large surface to the
action of fresh air. When the atmosphere is warm the solution takes
place in the same way, but as the vapour is not condensed, there is no
apparent cloud.
The cellular serum varies in quantity in the different regions. Where
there is no fat, as in the scrotum, the eye-lids, the prepuce, &c.
it appears to be a little more abundant than elsewhere. We see also
that these parts are much more disposed to different infiltrations.
In this respect, the scrotum holds the first rank; then come the
eye-lids, afterwards the prepuce, &c. Observe upon this subject, that
the cellular texture exterior to the mucous surfaces, the arteries, the
veins, and excretories, a texture which by the absence of fat resembles
the ordinary, differs from it, however, in this, that serum is never
effused in it.
We cannot judge of the quantity of cellular serum by observations
made upon the dead body, in which the laxity of the parts permits
a transudation of the fluids from all the vessels that pass through
the cellular texture, and which then enter the cells. To estimate
accurately the cellular moisture, I made an animal first emphysematous
below the skin; I made a large incision into this; little blood only
escaped, because the swelling separated the vessels from the course of
the knife. By these means, the cellular texture being laid open, I have
often been convinced that there was much less serum in this texture
than we commonly suppose. I have not observed, that during digestion,
after sleep, and whilst much sweat is exhaled by the cutaneous organ,
three circumstances under which I have repeated these experiments, that
the cellular serum is increased or diminished in a sensible manner.
This fact coincides with what I have stated in my Treatise on the
Membranes, upon the fluid that lubricates the serous surfaces, and the
proportion of which is almost always nearly equal.
We know that in leucophlegmasia, the quantity of cellular serum is much
increased; that it disappears in inflammation, &c.
The nature of this fluid appears to be essentially albuminous;
experiments made upon that of leucophlegmasia show that there is
albumen in it; but has not disease then altered its nature? To be
satisfied in this respect, I first made a dead animal emphysematous,
for the purpose of distending the cells, and to make the alkohol,
which I afterwards injected by a syringe, enter them more easily. Some
minutes after, the skin having been removed, the subjacent texture
presented here and there different whitish flakes. By immersing in
diluted nitric acid the cellular portion of the scrotum of a sound
body that is dead, or which is better, a portion taken directly from a
living animal, we can observe the same thing. It appears, then, that
in health as well as disease, the albumen is one of the essential
principles of the fluid of the cellular texture. I have taken much of
this texture from the scrotum of many bodies, so as to have it separate
from the fat, and I have made it boil in about the same time as nearly
the same quantity of tendinous substance; at the moment of ebullition,
much whitish froth rises upon the water, but little appears in that
which contains the tendons.
Is the nature of the cellular fluid the same as that of the lymph that
circulates in the absorbents? It cannot be doubted but that these
vessels take off this fluid in the cells; it is possible that it is
mixed with other substances, those especially that come from nutrition,
which alter its nature. Chemical analysis is defective upon this point.
III. _Of the cellular fat._
The fat is the second of the fluids for which the cellular texture
serves as a reservoir.
_Natural proportions of the fat._
Very abundant under the skin, around the serous surfaces, the organs
of great motions, &c.; it is wanting, as we have said, upon the penis,
the prepuce, the scrotum, &c. under the mucous surfaces, around the
arteries, the veins, &c. Examined in the interior of the organized
systems, the fat varies in quantity. There is none between the
interstices of the arterial and venous coats. The lymphatic glands do
not appear to contain any. The brain and spinal marrow are destitute of
it. It is always found in the intervals of the nervous fibres; it is
not often very evident; but in dissecting them, an unctuous substance
escapes, which is constant, and which it undoubtedly furnishes. For the
most part, it is in considerable quantity in the muscles, especially
those of animal life; very little of it is seen in those of organic.
In the bones, where there is none, its place is supplied by medullary
substance; the cartilages, the fibrous bodies, the fibro-cartilages,
are almost entirely destitute of it. The glandular system sometimes has
it, as we see it in the parotids, around the pelvis of the kidnies; in
other places, as in the liver, the prostate, &c. there is no trace of
it. The serous and cutaneous systems are never fatty, although much fat
surrounds them. It is the same of the mucous; the epidermis and the
hair never have any of this fluid.
From this we perceive that the interior of the organized systems
contain in general but very little fat. The different apparatus have
but a small proportion between their various parts. It is thus that
between the coats of the stomach, the intestines, the bladder, &c.
between the periosteum and the bone, between that and the cartilage,
between the muscle and the tendon, &c. this fluid is almost always
wanting.
It follows from this that it is principally in the interstices, which
the different apparatus leave between them, that fat accumulates in
cellular reservoirs. Now by examining the different regions, in this
point of view, we see, 1st. that upon the head, the cranium and face
have an inverse arrangement; that it is very abundant in the second,
and wanting in the first, especially in the interior; 2d. that the
neck contains a considerable proportion; 3d. that in the thorax we
see very little around the lungs, but much about the heart; that upon
the exterior of this cavity, the superior part has a considerable
quantity around the breasts; 4th. that in the abdomen, it particularly
abounds in the posterior part in the neighbourhood of the kidnies,
the mesentery, and omentum; 5th. that in the pelvis, there is much
of it near the bladder and rectum; 6th. that upon the extremities it
is found, like the cellular texture, more abundant above and in the
vicinity of the great articulations, &c.
We observe in infancy, that the quantity of fat is in proportion much
more considerable under the skin, than any where else, especially that
in the abdomen the cellular viscera, the omentum in particular contains
but very little at this age. I have established this fact in a great
many instances. There are only some flakes of fat around the kidney,
frequently these are scarcely visible. All the rest of the abdominal
cavity is destitute of it. The pectoral cavity contains scarcely any
more, and always much less in proportion than in after life. I have
observed also that the intermuscular texture is almost every where
deprived of it. We may say, then, that all this fluid is concentrated
under the skin, at least while the fœtus is in good health. Does this
superabundance of sub-cutaneous fat perform any important office? has
it any connexion with the great size of the liver at that period?
I know not: it is a phenomenon that should fix the attention of
physiologists, especially when it is compared with the absence of fat
in almost all the parts where it is afterwards accumulated.
Towards adult age, the abdominal fat is in much greater proportion
than the sub-cutaneous. The exterior swelling is as rare towards the
fortieth year, as it is common about the fourth and fifth, a period
at which all the muscular forms are concealed by the superabundance
of fat, and the body is remarkably rounded. Is there any connexion
between the large quantity of abdominal fat at the adult period, and
the frequency of diseases of which this region is then the seat?
However, the proportions of fat for the different ages are not always
the same; there are some exceptions.
In old age almost all the fat is dissolved and disappears; the body is
wrinkled, hardened, and becomes thin.
_Unnatural proportions of fat._
Oftentimes the fat accumulates in very great quantity in the cellular
texture. I will not cite examples of those enormous collections, of
which different authors have given a number of cases; this would be
superfluous. I shall only observe, that this state of great corpulency,
far from being a sign of health, indicates almost always a weakness
of the absorbents which are destined to take off the fat, and has,
in this point of view, much greater analogy to serous infiltrations
than we commonly think. Different facts establish this assertion. 1st.
Every kind of unnatural corpulency is accompanied with a debility
of the muscular power, with a state of lassitude and languor of the
individual who is the subject of it. 2d. In a man in whom strength and
activity predominate, we do not see this fatty enlargement that hides
the prominences of the muscles; these are distinctly marked. It is
necessary to distinguish carefully the size of the body which arises
from cellular fat, from that which is the consequence of the proper
development and nutrition of the organs. 3d. Oftentimes the causes
which evidently weaken the powers of life, produce a considerable
quantity of fat; such as inactivity, rest, great and long continued
hemorrhage, convalescence from certain acute diseases, in which the
powers still languish, though fat abounds. 4th. A fatty state of the
muscles is a state of evident weakness in them. 5th. I have been
sometimes convinced, in examining atrophous limbs, that the small size
which they retain is owing in part to the fat, which is in proportion
almost equal to that of sound limbs, whilst all the other parts, the
muscles in particular, are contracted and hardened. 6th. Castration,
which takes from the vital powers a part of their activity, from
nutrition a part of its energy, is very often marked by excessive
corpulency. 7th. On the other hand, as a certain degree of development
of the vital powers is necessary for generation, individuals who are
too fat, in whom this degree is wanting, are in general not fitted for
this function. In woman, this fact is remarkable, it is not less so
in man. In other animals we make the same observation. As fowls are
fattened for the table, they cease to lay eggs. Most domestic animals
are governed by the same law. We should say that there is a constant
relation between the secretion of semen and the exhalation of fat, and
that these two fluids are in an inverse ratio to each other.
We may conclude from these facts, that if the moderate exhalation of
fat indicates strength, its superabundance is almost always a sign of
weakness, and that there is in this point of view a kind of connexion
between fatty and serous infiltrations, as I have mentioned before.
It should be observed, however, that leucophlegmasia almost always
arises from an organic disease of some of the viscera, particularly
the heart, the lungs, the liver, the womb, and the spleen; hence it is
usually incurable, and death is the consequence of the organic disease.
On the other hand, an organic disease rarely accompanies corpulency,
which does not prevent a long life. If leucophlegmasia arose only
from cellular weakness, I am persuaded that it would not disturb the
regularity of the functions.
Great fatty collections are oftentimes an effect almost instantaneous
of certain circumstances, for example, of atmospheric influence. It
is thus that in twenty-four hours, a fog fattens thrushes, ortolans,
red-throats, &c. so that they are unable to escape the sportsman. This
phenomenon, which is very frequent in autumn, is never so striking in
the human species.
The diminution of the fat is as frequent as its increase, and it may be
said that there are more cases of extreme emaciation than of remarkable
corpulency. The causes which diminish this fluid are these: 1st. long
abstinence; the necessary fasting and sleep of dormant animals, furnish
us with an example of this; so that in this point of view, fat is the
nourishment which is reserved for the time when the ordinary kind is
taken away; 2d. every organic disease, continued for a long time, as
phthisis, cancer of the pylorus and womb, disorders of the liver,
of the heart, &c.; those who are in the habit of examining bodies
can judge by the external appearance, without knowing the previous
disease, whether the organization of an essential part is changed. In
general, in organic affections, there is not only emaciation, but also
an alteration in the nutrition of the organs; they are more slender
than usual. On the other hand, after an acute fever that has lasted
only a few days, emaciation only is observed; nutrition, a function
that is deranged as it is exercised, that is to say, slowly, is not
yet sensibly affected. There is in this respect a great difference
between two bodies equally emaciated; it is sufficient, in most cases,
to dissect a limb of each, without seeing the internal viscera, to
determine if death has been the gradual effect of an organic disease,
or the sudden result of a bilious or putrid fever, &c. To the causes
already pointed out, we must add, 3d. every considerable purulent
collection, especially if it depends upon a chronic affection; 4th.
leucophlegmasia, though we must not believe that fat and serum mutually
exclude each other, since we often observe much sub-cutaneous fat in
dropsical subjects; 5th. all melancholy affections of the mind which
have an influence especially upon the internal life, and which affect
the organs of it more particularly than those of external life; 6th.
long-continued efforts of the mind, which in a particular manner affect
the brain, consequently the first effect is upon animal life, though
I have observed that an injury of the functions of this life has less
effect upon corpulency than that of the functions of the other; 7th.
all evacuations unnaturally increased, as those of the bile, the
urine, the saliva, &c.; too frequent emissions of semen, &c. catarrhs,
those especially that are seated on large surfaces, as the pulmonary,
intestinal, &c.; 8th. long heat of summer, compared with the cold of
winter, which is in general favourable to an increase of fat; 9th.
running, hard labour, fatigue of every kind; 10th. long diseases,
those especially where it is necessary to use only weak aliments,
and not being able to continue even these for a long time; 11th.
long-continued watchfulness; long sleep producing a contrary effect,
that of increasing the fat; 12th. the immoderate use of spirituous
liquors, &c. &c.; 13th. the use of acrid and spicy aliments, of those
which have opposite properties to the farinaceous, &c. &c.
I do not cite a great number of the causes of emaciation; after these
it will be easily perceived what are omitted. I would only remark,
that almost all may be referred to two principles, viz. 1st. a general
weakness of the powers, a weakness that acts upon the cellular system,
as upon all the others, and produces there this phenomenon; 2d. a
partial weakness of this system, a weakness arising from the affection
of some other organ, whose action seems to increase at the expense of
that of the cellular texture.
_Different states of the fat._
The fat is almost always solid and coagulated in dead bodies, but in
the living it approaches nearer a liquid state, at least in certain
parts, as around the heart, the great vessels, &c. Under the skin it
has uniformly more consistence. In many experiments, where I have
had occasion to open living animals with red and warm blood, I have
never found it exactly flowing as it is when it is melted, though
many authors have pretended that it is so, an opinion founded upon
the belief that the vital heat would keep it melted. Undoubtedly a
degree of heat equal to that of our bodies, acting upon fat out of the
body, would make it much more fluid than it is in the living subject.
Besides, we know that the temperature is nearly uniform, and that the
degrees of the consistence of fat vary remarkably. There is a great
difference between that of the omentum, which is among the most fluid
of the economy, and that of the neighbourhood of the kidnies, the skin,
which is much firmer. Many animals with red and cold blood have liquid
fat.
In general, it appears that the nature and state of this fluid are
not the same in all the regions; that the fat of the abdomen, thorax
and brain differs from each other, though there is no precise rule
concerning these differences.
In young animals the fat is white and very consistent after death. It
is this consistence that gives to the external covering of the human
fœtus, a remarkable firmness and condensation, whilst in the adult
the skin of a dead body is flaccid and loose, yields to the least
communicated motion on account of the state of the sub-cutaneous fat.
This fat in the fœtus is formed into little globules more or less
rounded, which give the whole a granulated appearance. Oftentimes it
even forms considerable masses; for example there is almost always at
this period, between the buccinator, the masseter and the integuments,
a ball of fat, which is separate from the surrounding fat, and can be
taken out whole. It contributes very much to the remarkable prominence
the cheeks have at this period of life.
Fat becomes yellow as we advance in years, and acquires a peculiar
smell and taste. In comparing that of veal with that of beef, we
readily perceive the difference on our tables. In the dissecting room,
this difference is not less remarkable between a subject of ten years
and one of sixty.
Instead of fat, we often find around the heart of dropsical and
phthisical patients, and of all those who have died of a disease, in
which there has been a constant and protracted weakness, a yellowish
substance, transparent and fluid, having a gelatinous appearance,
and which however, approaches near the character of albumen. This
substance also occupies in similar cases other parts; but it is less
frequent there. It appears to be gelatinous rather than oily.
_Exhalation of fat._
Different hypotheses have been proposed concerning the manner in which
fat is separated from the blood. Malphigi spoke of glands and excretory
ducts, which no anatomist since his time has seen and which no one
believes in at present. Haller supposed that the fat was completely
formed in the arterial system, that it circulated with the blood
and floated on its surface on account of its specific levity. This
circulating fat then, according to him, escaped through the pores of
the arteries, and oozed from all parts into the neighbouring cellular
texture. This opinion supposes two things; 1st. the existence of fat
ready formed in the arterial system, an existence that is proved
by no positive fact, of which I never could convince myself by the
examination of red blood as it comes out of the vessels, for if it did
exist there would be numerous little drops floating on its surface
at the moment it was drawn. In my experiments upon the colouring of
the blood, I have frequently established this; I have observed it
also in examining the blood of maniacs upon whom arteriotomy has been
performed at the Hôtel Dieu. 2d. The opinion of Haller is founded upon
a transudation truly mechanical, a transudation that easily takes
place in dead bodies, but never in living. In fact, if we lay bare
an artery of a living animal, separate it entirely from every thing
else, and examine it ever so long, we shall discover no oozing of fat
through its coats, though the blood circulates in it as usual. There
is an infinity of arteries, spread in the cellular texture, through
which fat never transudes, as we see in the scrotum, the eyelids, &c.;
now in these places the arteries are organized as elsewhere, and they
ought therefore to have the fat ready formed in the blood that they
circulate; then, according to Haller, fat would be deposited there.
Besides, we shall see under the article upon exhalations, that this
transudation through the pores of the arteries, whatever fluid is
supposed to be transuded is evidently repugnant to the laws of the
animal economy. I refer then to this article, to establish the fallacy
of Haller's opinion; under that article we shall see also, that the fat
is separated by an exhalation analogous to that of all other exhaled
fluids, that is to say, by the vessels of a particular order, which are
intermediate between the extremities of the arteries and the cellular
texture. Some authors have thought that they saw the vessels that carry
the fat, and have designated them under the name of adipose; but it
appears, that like the other exhalants, they are invisible and can
only be proved by a train of reasoning, which however, satisfactorily
establishes their existence. We can apply to the exhalants of fat, what
will be said upon the exhalant system in general.
I will not treat of the chemical nature of fat, of the acid it
contains, of the particular alterations it undergoes under different
circumstances, that for example, that it experiences when animal
substances that contain it, such as the skin, the muscles, &c. are for
a long time macerated in water. This would lead me into details foreign
to this work. Besides, I could add nothing to what modern chemists have
said upon this subject.
I will terminate this article with an important remark; it is this,
that in those parts which nature has deprived of fat, it would have
injured their functions. The penis increased in size by it, would not
have had a proper relation to the vagina. The eyelids loaded with
fat could scarcely be raised. Accumulated in the sub-mucous texture,
it would have contracted the cavity of the organs which the mucous
surfaces line. Spread in that which surrounds the arteries, the veins
and the excretories, it would have obstructed the caliber of these
vessels; and here observe, that its uniform absence in the sub-arterial
texture is a proof against the opinion of Haller upon its transudation.
Accumulated in the cerebral cavity, it would have compressed the brain
on account of the resistance of the bony parietes of the cranium, &c.
which do not yield like those of the abdomen, when the gastric viscera
are loaded with fat. In the thorax, the diaphragm can descend, and the
lungs can without danger occupy less space when there is considerable
fat exhaled in the mediastinum. This remark, applicable also to the
serum, explains an important phenomenon in diseases, viz. that a
very small quantity of fluid poured out upon the tunica arachnoides
can disturb the functions of the brain, whilst a great effusion is
unattended with danger in the abdomen or the thorax.
ARTICLE FOURTH.
ORGANIZATION OF THE CELLULAR SYSTEM.
The cellular system, like almost all the others, is composed of a
peculiar texture and of common parts.
I. _Of the texture peculiar to the organization of the cellular system._
Much has been written upon the nature of this texture; Bordeu has
given some vague ideas upon it, but no experiments. Fontana has made
researches which lead but to few results, upon its intimate structure
and upon the tortuous cylinders of which, according to him, it is
an assemblage. Let us throw aside all hypotheses that examination
does not support; let us follow nature in the phenomena of structure
that she shows us, and not in those she wishes to conceal. In thus
considering the cellular texture, we see that it is very different from
a species of glue, with which some have wished to compare it. It is
an assemblage of many whitish filaments, crossing very often certain
kinds of delicate layers, which form cells with these filaments. To see
this organization well, a piece of the cellular portion of the scrotum
should be taken, which has no fat, and whose texture is consequently
not concealed by this fluid; this portion being stretched into a
kind of membrane, is seen very distinctly. Then there may be plainly
distinguished, 1st. a transparent net-work, arranged in layers, which
makes the foundation, if we may so say, and the tenuity of which is
such, that it has been aptly compared by a physiologist, to the soap
bubbles that are thrown into the air with a pipe. It is impossible
to distinguish, by the naked eye, any fibre in the texture of these
layers; every thing is there uniform. 2d. They are very evidently
crossed by numerous filaments, which running in all directions, are
interwoven in every way, all of which touch, when the cellular texture
is pressed together, but when stretched out, there can be seen between
them the layers of which I have just spoken. The more it is extended,
the larger consequently the membrane becomes, the interstices between
the filaments are greater, and the intermediate layers are also more
apparent.
What is the nature of these filaments? I presume that some are
absorbents, others exhalants, and that many are formed in the places
where the layers unite together for the formation of the cells. As the
thickness arising from this union is greater, they are distinguished
by more evident lines upon the cellular texture stretched into a
membrane. What induces me to believe this, is, that when, instead of
examining the cellular texture upon a portion taken from the scrotum,
and stretched as I have described, it is observed in an artificial
emphysema, as in that of the slaughter-houses for example, then there
is seen upon the covering of each cell, only the non-filamentous layers
of which I have spoken, without any of those filaments that were seen
crossing it in the other method.
These layers have not the same thickness in all cases; quite dense when
the cellular texture is contracted, they become, when it is distended
with air or any other means, so fine and attenuated, that the mind
cannot conceive that there is any thing organized in them. Their
organization is real, however, though some have doubted it. What in
fact is a texture that is nourished, inflames and suppurates, which is
the seat of very distinct vital functions, and which evidently lives,
if it is not an organic texture? All these vague ideas of concrete
juices, of inorganic glue, of hardened juice, that have been applied to
the cellular texture, have no solid foundation, and rest neither upon
experiment or observation, and ought to be banished from a science in
which imagination is nothing, and facts every thing.
The cellular texture has essential differences of organization;
everywhere where fat or serum is accumulated, there are real cells
which have little sacs communicating with each other, which form
reservoirs, the sides of which are composed of the transparent and
non-filamentous layers of which we have spoken; it is in these sacs
that the serous and fatty depositions take place. On the other hand,
in the sub-mucous texture, in that which forms the external membrane
of arteries, veins, and excretories, there are none of these sacs, no
cells, properly speaking, and no layers to form them. When we carefully
raise this texture, and lift it from the surface upon which it is
applied, and draw it a little so as to show its structure, we shall
see very distinctly numerous filaments interwoven every way, forming
a true net-work, meshes, if I may so express myself, but not sacs and
cavities. The air distends this net-work when it is driven forcibly
into the neighbouring texture; but as soon as an opening is made near
it, it escapes, and the texture sinks down; when accumulated in the
ordinary texture, the sub-cutaneous, intermuscular, &c. it remains in
the cells, notwithstanding they have been in part opened, without doubt
because the communicating openings are very small. This fact is evident
in markets, where we see the cellular texture blown up, around the
meats that are stripped of their skin.
It appears that the filaments that are interwoven in every way, and
which form about the vessels and under the mucous surfaces, a cellular
net-work, are really of the same nature as those spread in different
directions in the membranous layers which make the cells, only they are
nearer together, and are by themselves.
After what I have said, it is evident that there are two things in the
common cellular texture; 1st. a number of fine, transparent layers,
found everywhere where the texture is loose, capable of yielding
suddenly to different distensions, and of retaining the fluids its
cells contain, &c.: 2d. filaments intermixed with these layers wherever
they are, and existing alone in certain places. These layers and
cellular filaments have a remarkable tendency to absorb atmospheric
moisture. We observe it in dissecting rooms, where a subject dry and
easy to dissect in the morning, is often much infiltrated by evening,
if the weather has been damp; now this infiltration takes place in the
cellular system, which is a real hygrometer.
_Composition of the cellular texture._
Chemists have placed this texture in the general class of white organs,
among those which furnish a great quantity of gelatine. It has this in
fact, and we obtain by a solution of tannin a remarkable precipitate
from the water in which this texture has been boiled, without any
foreign organs except the vessels that run through it, as, for example,
that of the scrotum. I have made this experiment. But, however,
different re-agents act very differently upon this texture, as they do
upon the fibrous, cutaneous, cartilaginous textures, &c.