those of the liver to the reflux that takes place in the last moments
in which the black blood is obstructed in the lungs. Yet it however
takes place, and we see very great varieties in the quantity of blood
in the great renal vessels, a quantity independent of that which is
constantly found in the organ, and which, as I have said, is very
considerable. Now the size of the kidney hardly corresponds to these
varieties, because its extensibility is almost nothing.
As to the glands situated at the two extremities, as on the one
hand the testicles, and on the other the salivary glands, we hardly
observe in them the sanguineous stagnation, because the reflux is not
sufficiently evident. We cannot then, in this way, judge but by analogy
of their extensibility and contractility.
Yet the engorgements of the testicles, consequent upon gonorrhœa,
and the various swellings of the parotid glands prove that these
properties exist to a certain extent. Are the liver, the kidneys and
other internal glands subject to those acute swellings that are often
seen in the sub-cutaneous ones? It is very probable; perhaps even
physicians have not paid sufficient regard to the accessory symptoms
which may arise for a moment from the pressure of these swelled organs
on the neighbouring parts. Besides, this swelling and the contraction
that follows it, may take place especially in the cellular texture of
the gland, and consequently suppose less extensibility of the glandular
texture than they at first seem to.
II. _Vital Properties. Properties of Animal Life._
The animal contractility is evidently nothing in the glandular texture.
Does the sensibility of the same kind exist in it? The following facts
are connected with this. 1st. A compression of the parotid is to a
certain degree painful. I have even been obliged, in a particular case,
to give up the method of compression that Desault had advised for a
salivary fistula, on account of the pain the patient experienced; but
the numerous nerves which traverse this gland may be the cause of these
pains. 2d. We know that the instant the lithotome cuts the prostate,
or the stone and forceps pass over it, the patient suffers very much.
3d. Stones lodged in the kidneys occasion horrible pains. 4th. Any
considerable pressure of the testicle is very painful.
On the other hand we can cut the texture of the liver and the animal
will give no signs of pain. Haller, after many experiments, ranked the
glands among the insensible parts. What is to be concluded from this?
That the animal sensibility, modified in a thousand ways, appears
to exist in many organs in which certain agents cannot put it in
action, and in which others develop it remarkably. We know that the
various morbid alterations render it very evident in the glands. The
inflammatory pain of these organs has even a peculiar character; it
is obtuse and dull in the greatest number of cases. There is never
experienced in them the acute sensation which characterises cellular
inflammation, or the sharp and biting pain of which the skin is so
often the seat.
_Properties of Organic Life._
Of the properties of organic life, the sensible contractility is
wanting in the glandular system. But the two other properties are
developed in it to the highest degree. They are in constant activity;
secretion, excretion and nutrition keep them in incessant action there.
It is by its organic sensibility that the gland distinguishes, in the
mass of blood, the materials which are proper for its secretion. It is
by its insensible contractility, or its tonic forces, that it contracts
to throw out those which are foreign to this secretion. The first is on
a small scale in each gland, what the animal sensibility of the tongue
and the nostrils is on a large one, which allows only aliments suitable
for the stomach to be introduced into its cavity; the other does
insensibly, what is effected in so evident a manner by the glottis,
when it rises up convulsively against a foreign body that attempts to
enter it. The blood contains the materials of all the secretions, of
the nutrition of all the organs, and of all the exhalations. Each gland
draws from this common reservoir what is necessary to its secretion, as
each organ does what is proper for its nutrition, and as each serous
surface does what is suitable for its exhalation. Now it is by its
organic sensibility that each living part of the body distinguishes
what its functions require.
When the fluids enter the small vessels of the gland, this sensibility
is the sentinel that gives notice of it, and the insensible
contractility is the agent which opens or closes the gates of the
organ, according to the principles that are presented. This comparison,
if I may be allowed the use of it, gives an idea of what then takes
place. Every glandular action turns then especially upon these two
properties, and as this action is almost permanent, they are then
constantly in exercise.
From this it is evident, that all the glandular diseases ought to
suppose a derangement in these properties; for, as we have often seen,
they are the predominant properties of an organ, those, the exercise
of which constitutes its peculiar life, which especially determine its
diseases, by their alteration. This is in fact what observation shows
us. Here we see these properties increased or diminished, sometimes
produce an increase of secretion, as in diabetes, mercurial salivation,
immoderate flow of bile, &c.; sometimes a diminution, a suspension
even of this function, as in acute diseases in which all the ducts are
closed as it were in a moment, as in the suppression of urine, dryness
of the mouth, &c. It is the alteration in the nature of the glandular
sensibility that puts it in relation with fluids foreign to the glands
in a natural state; hence the innumerable varieties of the secreted
fluids especially in diseases. I have spoken of these varieties as
it regards the mucous fluids. The liver and the kidneys particularly
do not experience less numerous ones. The taste, the colour, the
consistence and odour of cystic bile appear in a thousand different
states in dead bodies. Who is ignorant of the innumerable alterations
of which the urine is susceptible? The saliva is less variable; but in
diseases how different is it from its natural state. It is sufficient
to have noticed for some time the various evacuations in diseases, to
see of how many modifications they are capable. Nothing less resembles
the urine and bile, than the fluids sometimes thrown out by the bladder
and the liver; whence do these varieties arise? From this, that
the variable organic sensibility places the organ in relation with
substances to which it was foreign in a natural state; and from this,
that the insensible contractility allows substances to enter the organ
which it before excluded. The same gland without changing its texture,
by a modification only of its vital forces, can then be a source of an
infinite variety of different fluids; I believe even that the kidney,
by taking a sensibility analogous to that of the liver, may secrete
bile. Why may it not secrete it, if it can secrete other fluids so
different from its own?
In health, each gland has a mode of sensibility nearly uniform, a mode
which changes but little; thus each secreted fluid has an appearance,
a consistence and a nature always nearly the same. But in diseases,
a thousand causes change this mode at every instant. An hysterical
paroxysm strikes the kidneys; in an instant they repulse all the
principles that colour the urine, and this comes out limpid; the
paroxysm passes off, the organ resumes its ordinary sensibility, and
the urine returns to its usual state. The influence of the epileptic
paroxysm extends to the sensibility of the salivary glands; in a
moment, a thick, copious and frothy saliva, wholly different from the
natural, comes from the mouth; after the paroxysm, the sympathetic
storm is calmed in the gland, and the saliva returns to its ordinary
state. If I may be allowed the comparison, the glands are in diseases
like the atmosphere in the equinoxes. At these periods, the winds which
succeed each other and incessantly change, often make rain, hail and
snow succeed each other in a very short time; so the forces of the
glandular life, constantly variable in diseases, make the different
products of secretion vary with rapidity.
It is not only to secretion that the various alterations of the organic
sensibility and the insensible contractility of the glands extend;
these alterations when long continued, have an influence also upon
their nutrition; they disturb the course of it; hence the changes of
texture, the tumours of different kinds, the organic diseases, &c.
that are so frequent in the glandular system, a system which presents
the greatest field for morbid anatomy. The great number of organic
diseases which it exhibits, in our dissecting rooms, compared with most
of the other systems, is very striking. The glandular, the cutaneous,
the mucous, the serous, the cellular systems, &c. hold the first rank
in this respect. Observe also that it is in them that the organic
sensibility and the insensible contractility are raised to the highest
degree, because they are the only ones in which these properties are
brought into action not only by nutrition, but also by various other
functions that are going on in the insensible capillary system, viz. by
exhalation, absorption and secretion.
_Sympathies._
Few systems are more frequently the seat of sympathies than this. In
examining them I shall adopt the same order as in the preceding system.
_Passive Sympathies._
The glandular texture is affected with extreme ease by all the others.
This constitutes its passive sympathies. They take place, 1st, in a
natural state; 2d, in diseases.
I say first that there are certain cases in the natural state, in which
the other organs being excited, the glandular is brought into action.
This is especially remarkable in the mucous system. We have seen that
almost all the excretory ducts terminate upon the mucous surfaces.
Now when one of these surfaces is irritated in the neighbourhood of
an excretory duct, the gland of this duct increases its action. 1st.
The presence of aliments in the mouth produces an abundant flow of
saliva. 2d. A sound in the bladder, irritating the ureters or their
neighbourhood, increases the flow of urine. 3d. The irritation of the
glans penis and the extremity of the urethra in coition, produces a
kind of spasm in the testicle from which arises a copious secretion
of the seminal fluid. 4th. Every irritating fluid applied either to
the conjunctiva, or the pituitary membrane occasions a more or less
considerable flow of tears. 5th. By making experiments upon the state
of the gastric viscera during digestion and during hunger, I have
observed that as long as the aliments are only in the stomach, the flow
of bile is inconsiderable, but that this flow increases when they pass
into the duodenum, so that much of it is then found in the intestines.
During hunger, the gall-bladder is much distended; but little bile
flows from it. At the end or even during digestion, it contains but
half as much bile. Yet it might be emptied much more easily during
abstinence, as the fluid which is then found in it is of a deep green,
very bitter, very acrid and consequently very irritating. On the
contrary, during or immediately after digestion, it is much milder,
of a bright yellow and less irritating. There must then be another
stimulus for it during digestion; this stimulus is the food that is
passing by the extremity of the ductus choledochus. I have pointed
out in a long note in my Treatise on the Membranes, the course of the
cystic and hepatic bile.
Let us conclude from these numerous considerations, that one of the
principal means which nature employs to increase the action of the
glands, and to produce that of the excretory ducts is the sympathetic
irritation of the extremity of these ducts or of the neighbourhood of
the point of the mucous surface where they come out. It is to this also
that must be referred the various catarrhs produced by an irritating
body remaining upon one of these surfaces. The infant in sucking and
irritating the nipple, produces a secretion of milk at the same time
that he draws it out. In a morbid state the glands are also very
frequently the seat of passive sympathies. It is almost always then the
organic sensibility and the insensible contractility that are brought
into action in them. It is rare, that the animal sensibility, excited
by sympathies, occasions pains in the glands.
We have said that the varieties the glands exhibit in diseases are
innumerable, either as it respects the quantity or the quality of the
fluids they secrete. Now all these varieties are especially owing to
sympathetic influence. Observe the salivary glands moistening the mouth
or leaving it dry, filling it with a viscid or limpid fluid, frothy
or thin, the mucous glands of the tongue furnishing sometimes a thick
whitish substance, and sometimes a black crust. Physicians consider the
state of the tongue as a constant index of that of the stomach; this
is most often true. Nature has established such a sympathetic relation
between these two parts, that when the mucous surface of the stomach
is disordered, and is the seat of that kind of catarrh which is called
derangement, fulness of the stomach, &c. that of the tongue is also
affected and furnishes more mucous juices, which alter and destroy the
appetite, and thus prevent the taking of aliments which the stomach
could not digest, and which often even it would not bear. The tongue
is then, as in a state of health, a kind of sentinel placed over the
stomach, to refuse that which would injure, and to admit that which is
suitable for it. This is no doubt the cause of this singular influence
which the stomach exerts upon it in diseases. But let us also remark
that sometimes the tongue is foul, when the stomach is in the ordinary
state. This phenomenon is frequent in hospitals; it happens to me very
often. And vice versa, nausea, &c. sometimes takes place without a
catarrh of the tongue.
Shall I speak of the innumerable influences that the liver, the kidney
and the pancreas receive? When an organ is diseased in the animal
economy, these immediately perceive it; their secretion is increased,
diminished or altered, and oftentimes even the sympathetic affection
does not extend to these functions, but produces inflammation,
suppuration, &c. We know that abscesses are formed in the liver from
wounds in the head, &c. Shall I speak of the innumerable varieties of
the flowing of tears in acute diseases, in inflammatory and malignant
fevers, &c.? Who does not know that the eye is then more or less moist,
that it is often constantly weeping? Now whence arise these varieties?
from the sympathetic influence which the lachrymal gland receives. The
disease itself is often foreign to it; but the unknown consensus which
connects the glands with the diseased parts, makes them then enter into
action. We weep from a variety of passions, from grief especially; how
does this happen? Because the influence of the passion is first carried
to the epigastric region, as the violent sensation experienced there,
proves; and the affected organ reacts upon the lachrymal gland. We weep
in the same way as we sweat from fear, or spit copiously in anger, a
phenomenon which the vulgar express by these words, _foaming with rage_.
The testicles and the prostate are much less often sympathetically
influenced in diseases than the other glands. Whilst every thing is
disturbed in the glandular system, they most frequently remain calm
and tranquil. Why? because they are insulated by their functions from
the other glands. The salivary glands, the pancreas, the kidneys,
the liver and almost all the mucous glands contribute to one common
object, viz. digestion. This object is connected with the existence of
most of the other organs. When these are diseased, it is not wonderful
that the glands feel it. On the contrary, the testicles, destined only
to the purpose of generation, entering later into action and ceasing
to act sooner than the other glands, having great intermissions in
their action, cannot in their affections be thus connected with the
diseases of the other organs. Sometimes however they are. We know that
some affections of the lungs dispose to venereal pleasures; that in a
natural state, a lively excitement of certain parts of the skin, of
that of the glutæi muscles especially brings into activity the whole
genital system, &c. &c.
We know the remarkable sympathy that renders the mammæ dependant upon
the womb. It is well known, that they swell a little every month,
at the beginning of menstruation; that cancers are often formed in
them at the cessation of this natural discharge; that the voluptuous
sensation of coition sometimes extends even to them, &c. All physicians
have observed this sympathetic relation which appears to be of a
peculiar kind and to depend upon the analogy of the functions of the
sympathizing organs.
After severe acute diseases, especially idiopathic fevers, the
glandular action is oftentimes much increased; there are great
evacuations; these are the crises; it is, according to the opinions of
most, the morbific humour that is expelled. This is a phenomenon that
should be examined, and which certainly in many cases does not depend,
as I shall prove, on the cause to which it has been attributed.
Though I consider many of the secretory derangements in diseases as
sympathetic, I am far from thinking that all are so. Certainly in
many cases, there is a general affection of the whole system, an
affection in which the glands, like all the other parts, participate;
this is what takes place in idiopathic fevers. But when one system is
especially affected, as the cutaneous in the small pox, the measles,
scarlatina, &c. the serous in pleurisy, peritonitis, &c. the cellular
in phlegmon, the nervous in convulsions, &c. I call the derangement
which the others experience sympathetic, and which does not depend upon
an injury of their texture.
Other ideas may be attached to the word sympathies, but these are
what I have connected with it in diseases. The word is of but little
consequence, provided what it expresses is understood.
_Active Sympathies._
These sympathies are less frequent than the preceding. In the diseases
of the glandular system, we see however examples of them. The history
of inflammations of the kidneys, the salivary glands, the liver, &c.
shows us many phenomena arising sympathetically in the other systems
on account of the diseases of this. I do not speak of the derangement
of digestion and the circulation, functions which, naturally connected
with the secretions, are inevitably deranged when these are; I speak of
the organs, which having no direct relation with the diseased glands,
are yet affected, as we see in convulsions, spasms, wandering or fixed
pains in different places, sweats, &c.
The testicles in health exert a remarkable influence upon the organs
of the voice. We know that it becomes more harsh the moment they enter
into action, and that it changes when they are removed by castration;
this phenomenon is constant and invariable. Barthez believed that it
arose from the ordinary sympathetic phenomena; in fact, it appears
to be but a particular modification of that general influence which
the testicles exert on all the vital forces, which are uniformly
debilitated or strengthened, according as their action is feeble or
strong. Yet some organs are more disposed than others to feel these
affections. The pectoral mucous system is an example of this. Passive
hemorrhage of this system is frequently the consequence of excessive
excretion of semen; phthisis even is often the fatal effect of it.
_Characters of the Vital Properties. First Character. Life peculiar to
each Gland._
The glandular life, the result of the preceding forces considered in
exercise, is not uniform in the whole system, no doubt because its
texture differs in each gland, and because to each texture is given a
peculiar modification of vitality. Many phenomena result from these
differences which have been well observed by Bordeu.
1st. Each gland has certain substances with which it is exclusively in
relation in the natural state. Hence why the salivary glands do not
secrete bile, and the liver allows the materials of urine to pass in
its vessels without separating them; from this results the diversity
of secretions. Hence also why cantharides affect exclusively the
kidneys; why mercury acts especially upon the salivary glands; why
certain substances affect the testicles in a peculiar manner, increase
their secretion and even promote the excretion of the semen; why some
aliments give more milk than others. I am persuaded that certain
substances act upon the mucous glands and dispose them to a greater
secretion.
2d. Each gland has its peculiar mode of sympathies. We have seen that
the testicles sympathize especially with the pectoral organs, and the
liver with the brain. The kidneys, when affected with acute pain,
have an influence peculiarly on the stomach, and occasion vomiting.
The mammæ and the womb are directly and particularly connected in
sympathies.
3d. The inflammation of each gland has a particular character. That of
the kidneys does not resemble that of the liver, the testicles, &c. The
prostate gland when inflamed produces symptoms wholly different from
those of the testicles, &c. I do not speak of the differences resulting
from the diversity of the fluids, but only of those which arise from
the difference of texture.
4th. Each gland has its peculiar diseases, or such at least to which
it is disposed more than the others. Hydatids are very often found
near the convexity of the liver; they are never seen in the salivary
glands or the testicles. Though the parotid glands are as much exposed
to the action of external bodies as the testicles, there are twenty
sarcoceles to one scirrhus of these glands. The liver alone exhibits
that peculiar state that is called fatty; no gland is more frequently
the seat of steatomatous tumours. Physicians who have opened but few
bodies, employ the vague and insignificant word _obstruction_, &c. for
every kind of glandular swelling. But observe that most commonly these
swellings have nothing in common among them but the increase in size;
their nature is wholly different, and yet observe how ignorant many are
in medicine; they perceive by the touch that there is a hardness of the
liver, and immediately aperients, the acetate of potash, &c. are the
common means which they oppose to hydatids, to steatomatous tumours, to
scirrhi with granulations like marble, to fatty livers and to a hundred
different alterations from which the increase of size may arise, as
if it was this increase and not the kind of tumour that produced it,
which they had to combat. Give then also aperients when the liver
displaced by hydrothorax projects unnaturally, and you will act almost
as rationally.
5th. Each gland exhibits peculiar modifications in those evacuations
that are called critical, of which it is sometimes the seat after long
diseases, &c. &c.
6th. It is also to the difference of vitality of the different parts of
the glandular system, that must be referred the following phenomenon;
certain glands enter suddenly into action, either from a direct
irritation, or a sympathetic excitement, as the lachrymal for example,
which from a state of remission passes suddenly from the influence
of the passions, to that of copious secretion. On the contrary, it
requires some time to excite the other glands, as for example the
kidneys, pancreas, &c. which cannot suddenly pour out their fluids,
whatever may be the excitement they experience. The same stimulus
applied to the conjunctiva, produces a flow of tears, and at the same
time increases the action of the Meibomian glands; but the first effect
takes place before the other. The same stimuli applied to the mucous
surfaces can never produce a catarrhal discharge till the expiration of
some time.
_Second Character. Remission of the Glandular Life._