We have but few data concerning the animal properties of the
absorbents. Sensibility of relation does not appear to exist in them;
it is difficult to ascertain this by experiments. When we puncture
a lacteal when it is full of chyle, a lymphatic filled with serum
on the surface of the liver, or even the thoracic duct, the animal
gives no indication of pain. But what inference can be drawn under
circumstances, in which the abdomen being opened, the numerous painful
sensations would render nothing, comparatively, the slight sensation
which the puncture produced, admitting that it existed? No experiment,
I believe, has yet been attempted to ascertain if irritation carried to
the interior of these vessels produces a sensible effect. Probably the
same result would be obtained by fine injections used for this purpose,
as has been for the veins, considering the analogy of structure and the
continuity of the peculiar membrane of both systems.
There are circumstances however in which the absorbents have a very
acute sensibility, viz. when they are inflamed. It is a very frequent
phenomenon in diseases, that there is a very evident swelling and
redness, along the course of the sub-cutaneous absorbents in the lower
extremities, giving considerable pain to the patient, terminating
at the inguinal glands, or even extending beyond. In wounds with a
poisoned instrument, in the acute pains of a whitlow, &c. a very
painful sensation is often felt the whole length of the absorbents of
the superior extremities.
The lymphatic glands do not appear to enjoy, in a natural state, animal
sensibility, when they are irritated in different ways, which can
easily be done. But inflammation may develop it in these glands as in
the absorbents, by raising to a high degree their organic sensibility.
Thus the pain is very acute, when after a puncture made by an infected
instrument, after a sprain, &c. these glands swell. We know the extreme
suffering that arises from those in the axilla, when they swell and
suppuration succeeds. Shall I speak of the pains experienced from the
mesenteric glands when cancerous? Who is ignorant of those which buboes
occasion, &c.?
As to animal contractility, it is entirely wanting in the absorbents
and their glands.
The organic properties exhibit in the absorbent system, the following
arrangement. Sensible contractility has been allowed them by Haller.
It is founded upon this, that the lymphatics easily empty themselves
of the chyle that passes through them, and upon this also, that
by touching them with sulphuric acid, they crisp immediately. But
sulphuric acid, like all the concentrated acids and caloric, produces
the same effect upon all animal substances, even after death; it is the
horny hardening. When the absorbents, particularly the thoracic duct
are touched with the point of a scalpel, no contraction follows. If
they are capable of contracting upon themselves, it appears that it is
when they cease to be distended, and not when they are irritated; and
that it is consequently by their contractility of texture. The sensible
organic contractility is then at least doubtful in them, if it exists
it is very obscure and at most to be compared to that of the dartos
muscle.
The organic sensibility and the insensible organic contractility are
evidently found in the absorbents. It is by these properties that
they perform their functions, that fluids are absorbed by them, that
they circulate in their branches, &c. &c. These two properties are
remarkable in them in this, that they continue some time after death.
A fluid injected when the animal is still warm, is absorbed, either
on the serous or mucous surfaces. It is less easy in the cellular
texture. We can prolong a little this absorbent power, by supporting
the heat artificially by a bath. This has in general less efficacy than
I thought for a long time. Various recent experiments have convinced
me of this. This arises no doubt from the fact, that it is the vital
heat and not an artificial one, which is necessary to the exercise of
this function, or rather vital heat and absorption are two effects of
a common cause, viz. organic properties. As long as these properties
remain in the solids, they retain caloric and absorb. But the moment
they are gone, the heat goes and at the same time absorption ceases. It
would be useless to expose to caloric, solids that life had entirely
abandoned; they would become warm; but they could exhibit no vital
phenomenon. In the same way it would be useless to keep up the heat
of an animal recently killed, by making an artificial one succeed the
natural. It is organic sensibility and insensible contractility, that
must be prevented from escaping to prolong absorption. If artificial
heat keeps up this function, it is only by first keeping up these
properties. We cannot calculate upon absorption when the animal is
cold, though Mascagni and many others have said otherwise. I have in
vain attempted to keep it in action then; generally I have not observed
it above two hours after death. The organic sensibility is in relation
with many fluids in the absorbent system, and it is in this that it
differs from the other systems, the glandular, for example, which is
never in relation but with one particular fluid, and which rejects all
the others in a natural state. Water and other mild fluids can easily
be absorbed, though very different from the lymph. In the natural
state, the thoracic duct alternately admits chyle and lymph.
_Character of the Vital Properties._
From what has been said, it is evident that the organic properties
perform the principal part in the peculiar life of the absorbent
system. These properties are much more conspicuous there than in the
venous system; at least they are much more capable of being raised.
In fact there are ten inflammations of the absorbents for one of the
veins. This disposition to inflame from the least virus that passes
through their tubes, from pains, though not severe, that are felt at
their extremity, particularly characterizes these vessels. It is rare
that there is found in the course of a vein, those swellings, pains
and inflammations so frequent in the course of the absorbents. This
difference proves a diversity of structure in the peculiar membrane,
notwithstanding its continuity with that of the veins. In fact at the
period when experiments were made upon the transfusion of medicines
into them, authors have not related any case of venous inflammation
from the contact of foreign substances upon the membrane of the veins;
whilst practice frequently presents us this fact in the absorbents.
The lymphatic glands especially have a great tendency to inflammatory
swellings, when deleterious substances that are absorbed come in
contact with them. In the first periods these substances confine their
effects to the first glands they meet; thus the absorption of the
venereal virus hardly extends beyond the glands of the groin; thus
the axillaries alone swell when a puncture is made with an infected
instrument, &c.; the glands that follow, remain untouched.
Though much disposed to inflame, the lymphatic glands exhibit however
more slowness in this affection, than many other animal textures,
the cellular and cutaneous, for example. We know that phlegmon and
erysipelas go through their periods quicker, than the inflammations
of the inguinal, axillary glands, &c. The pain of which these
inflamed glands are the seat differs also much from that of these two
affections; it is more dull, obscure, &c. The pus is more slow in
forming; it resembles considerably cellular pus; it differs much from
that of erysipelas. There are few textures in the economy that are more
disposed than this to hardening after inflammation. For one single time
that the skin become scirrhous after erysipelas, the lymphatic glands
become so twenty. This is truly one of their distinctive characters.
The absorbents often exhibit to a certain degree, like their glands,
a character of slowness in the phenomena over which their organic
properties preside. For example, when concerned in a wound, they
contract, crisp up and close more slowly than the sanguineous
capillaries, that are then also concerned; hence the flow of serum
that continues for some minutes after that of blood has ceased.
This phenomenon is constant in small wounds. If the absorbents and
the capillaries had the same degree of insensible contractility, it
certainly would not take place.
Here then are new proofs of the principles of which we have every
instant occasion to present the consequences in this work; viz. that
the vitality peculiar to each system, the particular degree of vital
forces that characterize them, imprint upon all its affections a
peculiar tinge and aspect, if I may so express myself, unknown to all
the other systems.
_Differences of the Vital Properties in the Absorbent Vessels and their
Glands._
Though we have considered at the same time the vital properties in the
glands and in the absorbents, though anatomy shows the first to be an
assemblage of folds and vascular windings, yet it cannot be denied that
they have a peculiar kind of vitality, by which they are distinguished
from the absorbents that come to them. It is this peculiar kind that
exposes them to certain diseases of which the absorbents are not the
seat, at least not in so evident a manner. The scrophulous virus seems
more especially to attack them. They are particularly affected in
tabes mesenterica, strumous diseases, &c. In the innumerable swellings
of which they are the seat in consequence of organic diseases, the
absorbents do not appear at the same time altered in their texture. It
seems even that in a very great number of cases, the numerous folds
that these vessels form in the glands, do not partake of their organic
injury; they, in fact, transmit the lymph as usual. Nothing is more
common than to see abdominal and thoracic enlargements of these glands
in children, without producing serous effusions, even at the most
advanced periods. In opening the bodies of small subjects, I have often
been astonished at this phenomenon. The lymphatic vessels are not even
more dilated, at least we do not find them easier in children affected
with tabes mesenterica, than in others. We can hardly ever discover
them at this age to inject.
_Sympathies._
The absorbent system is much disposed to receive the sympathetic
influence of the other organs. This disposition relates, 1st, to the
glands; 2d, to the vessels themselves.
One of the phenomena which the examination of dead bodies perhaps
most often exhibits, is the swelling of the lymphatic glands from
the organic affections of the principal viscera. We observe this
phenomenon, 1st, in the neck from the affections of the thyroid gland
and sometimes of the larynx, in the jugular glands; 2d, on the
chest from cancer in the breast, in the axillary and often in the
mammary glands, from every kind of phthisis in those that surround
the bronchiæ, very rarely if ever from diseases of the heart, whether
aneurism, ossification or diseases of the valves; 3d, in the abdomen,
from cancerous diseases of the stomach, especially of the pylorus,
and most of those in which the texture of the liver is altered, in
the numerous glands that accompany the biliary vessels and those
surrounding the pancreas; from schirrus of the intestines, from their
cancers, which are in general rather rare, in the mesenteric glands;
from the affections of the womb, the rectum, and the bladder, in
the glands of the pelvis; from schirrus of the testicles, diseases
of the urethra, in the inguinal and lumbar glands, &c.; 4th, on the
superior extremities from punctures, bites and most of the inflammatory
affections in the axillary glands; 5th, on the inferior extremities
from many affections in the inguinal glands.
These swellings of the lymphatic glands are of the same nature as the
affection that produces them; if that is acute they are so, if chronic
they pursue the same course. The swelling of the glands in the axilla
is acute, if it is the consequence of a prick of the finger, of a
whitlow, &c. and chronic, if it arises from cancer.
I am far from considering all these different swellings as the result
of a sympathetic influence exerted upon the gland. No doubt the
conveyance of absorbed matter produces the effect, as happens when
there is some virus, punctures with poisoned instruments, &c. producing
the swelling. But sometimes also sympathy alone is the cause. When by
the acute pain that a whitlow, a splinter under the nail or a bruise of
the finger occasion, the axillary glands swell; when the same glands
swell from the effect of a blister applied to the arm or fore-arm, &c.;
when this phenomenon happens in the inguinal glands from a blister
on the thigh or the leg, of which I have seen many cases, &c. &c.
there is certainly no matter conveyed to the gland; it is an effect of
sympathy.
Most surgeons believe that every cancer in the breast, with swelled
glands, requires their extirpation. I believe that in some cases they
may become cancerous, but I doubt if this happens in the greatest
number. 1st. In old ulcerated cancers of the breast, they continue most
often swelled during the whole of life, without suppurating. 2d. After
operations, in which some deep seated ones have been left, we rarely
see them become cancerous. When the cancer is reproduced, it is the
wound that opens again. 3d. I have many times compared the texture of
a gland of the axilla enlarged by a cancer of the breast, with that of
the bronchial glands enlarged in phthisis, with that of the sub-hepatic
glands swollen from steatomatous tumours, hydatids of the liver, &c.
and I could discover no difference. 4th. Finally, all those who open
many dead bodies may be convinced that almost all the organic diseases
of the viscera which have many glands around them, are accompanied with
their enlargement, whatever may be the nature of those diseases. This
phenomenon struck me so much, that at one time attributed the effusions
which terminate almost all these organic diseases, to the difficulty
the lymph experiences in passing through these glands. But the
absence of these swellings in the diseases of the heart attended with
dropsy, the frequent absence of swelling of the superior extremities
when the axillary glands were enlarged, the tumefaction of the lower
parts, the glands of the superior being alone swelled, and many other
similar proofs, which made me consider the serous effusions that take
place then, as passive exhalations, analogous to those that produce
hemorrhages, did not permit me to adopt this first opinion.
It is essential to distinguish the swellings of the lymphatic glands by
the influence of the diseases of the neighbouring viscera, from those
which arise from tabes mesenterica and other analogous, scrophulous
diseases. 1st. In the latter case, the texture of the gland is always
primarily affected; it is only secondarily in the other. 2d. The one
from scrophulous affections appears exclusively in childhood; the other
at all ages. 3d. Finally, a gland swollen from the affection of another
organ, most frequently preserves a texture, and colour analogous to its
natural state. It is only in the last periods that the texture becomes
sometimes hard, like cartilage, and even suppurates; but it is not
with the same phenomena as the texture of the mesenteric and bronchial
glands swollen by scrophula. The appearance and structure are wholly
different. This last exhibits in this case a white substance which is
found in small quantity in the first periods; so that when we cut the
gland, we easily distinguish this substance from the texture of the
gland that remains, where it still exists, with its natural colour and
arrangement. In the latter periods, this white matter has encroached
upon the whole gland, the texture of which has disappeared. However in
phthisis, and sometimes, though more rarely, in cancers, the swelled
glands exhibit in consequence an analogous appearance; but in all the
other cases it is different.
We know that nature often chooses these glands in important fevers, as
the place of the crisis. They are the seat of what are very improperly
called parotid tumours, in adynamic fevers.
The absorbents are, like their glands, influenced by the affections
of the neighbouring organs. I am well persuaded that the different
alterations which the absorption of chyle undergoes, the absorption
of the aqueous part of the bile and the urine, and the derangement
of those of the serous surfaces in many diseases, are effects purely
sympathetic. But it is not very easy to distinguish when they are
not so. There are certainly sympathetic absorptions, as there are
sympathetic exhalations and secretions.
On the other hand, the absorbent system being affected, the other
organs very often experience sympathetic influences. In tabes
mesenterica, and in the enlargement of the bronchial glands that
correspond with it, there are many symptoms that evidently arise from
the sympathetic relations that connect these glands to the other
organs. It is not my province to point out these symptoms.
As to the influence of the diseases of the absorbents upon the other
organs, we know but little of it. When their course is inflamed from a
puncture, from a wound with an instrument having on it some virus, &c.
there are often vomitings, diarrhœa, &c.