Part 19

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._

The second character of the glandular life, is that of being subject to habitual alternations of increase and diminution. Sleep extends especially to the animal functions; they alone are completely suspended in the ordinary state, and it is this which constitutes sleep. But the glands sleep also to a certain extent, though there is never a complete suspension except in diseases. I would compare the sleep of animal life to the intermissions of intermittent fevers in which the apyrexia is complete, and the sleep of the glands to those of remitting fevers in which the paroxysm is only moderated, though it always continues.

The saliva is copiously poured out when aliments enter the mouth, at other times it only moistens this cavity. Whilst the chyme is passing through the duodenum, the pancreas and liver moisten it abundantly; they are also in action during hunger, but in an infinitely less degree. I have convinced myself of this by many experiments upon the comparative state of digestion and hunger; the substance of these experiments I have given elsewhere. We know that it is some time after eating before the kidneys commence their action. The intermissions of the action of the mammæ are almost as real as those of the organs of animal life. Each mucous gland has its time of secretion; it is that in which the surfaces, to which the excretories go, are in contact with any substance that is remaining there, or that is only passing.

The glands then must be considered as continually separating a fluid from the blood, and as being at certain periods in greater activity, and consequently as furnishing more fluids.

This remission of the glands appears to be owing to a cause nearly analogous to that of sleep, which, in animal life, is produced by the weariness the sensitive and locomotive organs experience, after long continued action. The kind of weariness which the glands are capable of experiencing, is not in general attended with a painful sensation, as in animal life; its nature appears to be wholly different. Yet women, after nursing too long, feel a pain in the breast that warns them to leave off. The testicles become the seat of a painful sensation, when the emission of semen has been many times forced.

_Third Character. The Glandular Life is never simultaneously raised in the whole system._

The vital properties of the glands are never simultaneously excited in all. When one is in action, the others are in remission. We might say, that there is but a determinate quantity of life for all, and that one cannot live more without the others living less. To this law is the digestive order accommodated. In the first period the salivary glands furnish at first a great quantity of fluid; in the second, the parietes of the stomach; in the third, in which the chyme passes into the small intestines, the liver and the pancreas are principally in action; in the fourth, it is the mucous glands of the great intestines which especially act; and finally the kidneys enter into a particular action in order to evacuate the residue of the fluids. All the glands cannot act at the same time; it is as in the external motions in which certain muscles always rest whilst the others contract. The most improper time for coition is that of digestion, because we then make the mucous, hepatic, pancreatic secretions, &c. coincide with that of the testicles. In diseases one gland increases its secretion only at the expense of the others. Observation proves this every day.

We might, as I have said, make use of this remark, by producing in various glandular and other affections, artificial catarrhs, a disease which we can always produce on the mucous surfaces by the introduction of a foreign body. I have for some time past made much use of ammonia respired by the nose. Pinel prescribes it before the paroxysms of epilepsy. There are an infinite number of other cases in which it is very efficacious, as in some kinds of cephalalgia, in ataxic fevers, in certain apoplexies, in various comatose affections, &c. A blister does not act till the expiration of some time; it requires four, five, six hours even for it to produce an irritation. Who does not know that oftentimes in diseases in which the forces are much prostrated, it has no action on the cutaneous system? On the contrary, the excitement of the pituitary membrane by ammonia is always sudden on the one hand and always efficacious on the other. Its effect, it is true, is only instantaneous, but this is precisely its advantage; for in many cases a blister is only useful the moment it irritates the skin; hence the use of drying it immediately and reapplying it. The employment of ammonia or of any other strong stimulant upon the pituitary membrane, can be repeated every quarter of an hour, every five or six minutes or even every minute. If habit renders the patient less sensible to its excitement, we can replace it by another irritating substance, whereas we cannot thus change the cutaneous excitement by a blister. What I have said of the pituitary surface is applicable to those of the rectum, the urethra and stomach, on which we can in many cases apply in diseases excitements in a more advantageous manner than is done upon the skin by means of blisters.

Moreover, the character of the glandular life of which we are treating, is only an insulated modification of a character general to all the vital properties, a character which consists in this, that they are weakened in one place when they are raised in another. Hence why the great collections of pus, large tumours and dropsies are always attended with a weakness in the glandular action. It is upon this character that rests the use of vesicatories, setons, moxa, cauteries, &c. which do not act, as has been said, by evacuating the morbific matter, but by making the irritation of the diseased part cease by that which is produced elsewhere.

_Fourth Character. Influence of climate and season on Glandular Life._

Another phenomenon is also derived from the preceding character, and it is one that may be likewise considered as characteristic of the glandular system; viz. that in general it is in greater activity in winter than summer, in cold climates than in warm. In fact, heat which expands the cutaneous system increases the action of it at the expense of that of the glands, and reciprocally cold which contracts it, by preventing the constant exhalation that is going on there, forces the glandular system to supply this action. Hence why the same fluid, introduced into the economy, goes out with the urine in winter and with the sweat in summer; why, if we wish to produce an immediate discharge of urine in summer, it is necessary to suppress the perspiration by the sudden application of cold to the surface of the skin, by descending into a cellar, or some other subterraneous place; so that in summer we can, after digestion, make the product of the fluids pass off with the urine or the sweat, according to the temperature of the atmosphere in which we digest; why teas and diuretics forbid the use of each other, and why a physician who should employ them at the same time would know but little of the laws of our economy; why most of the diseases that are attended with an immoderate discharge of the secreted fluids, are almost always characterized by a diminution of the exhaled fluids; why in some seasons diseases have a greater tendency to be characterized by sweats, and in others by urinary, mucous evacuations, &c. It is to the greater degree of the vital activity of the glandular system in the winter, that must then be referred the frequency of catarrhs, diseases most of which suppose an unnatural increase of its action, the greater facility with which the kidneys are influenced by cantharides, &c. Physicians should have these considerations particularly in view in their treatment. It is necessary to act more upon the glandular system in winter, and the cutaneous in summer, because each system is as much more disposed to answer to the excitements made upon it, as it actually is in greater activity.

_Fifth Character. Influence of Sex upon Glandular Life._

Is the life of the glandular system more active in man than in woman? As it respects the glands destined to digestion, the secretion of the tears, the evacuation of urine, &c. there is but little difference in the two sexes. As to genital glands, man has testicles and the prostate; woman has mammæ, so that in this respect they seem to be equal. Observe however that the influence of the first upon the economy, is much greater than that of the second. It is from the womb that go forth in woman the irradiations which correspond with those which the testicles send to all the other organs.

ARTICLE FOURTH.

DEVELOPMENT OF THE GLANDULAR SYSTEM.

I. _State of this System in the Fœtus._