This system, the name of which I borrow from the fluid that constantly lubricates it, and which is furnished by small glands inherent in its structure, appears everywhere in a membranous form; that of fasciculi is wholly foreign to it. In speaking of the mucous organs we shall designate them almost always under the name of membranes. Their study is a new object of research. Pinel has been among the first, who has perceived the necessity of considering them in a general manner as it respects diseases. I believe that I am the first who has regarded them generally in an anatomical and physiological view. Few systems deserve more attention; upon it take place all the great phenomena of digestion, respiration, secretion, excretion, &c.; it is the seat of many diseases. It should alone, in a nosography in which diseases are distributed by systems, occupy a place equal to that of many.
ARTICLE FIRST.
OF THE DIVISIONS AND FORMS OF THE MUCOUS SYSTEM.
The mucous membranes occupy the interior of the cavities which communicate with the skin by the different openings this covering has on the surface of the body. Their number at first view is very considerable; for the organs in which they are reflected are very numerous. The mouth, the stomach, the intestines, the oesophagus, the bladder, the urethra, the womb, the ureters, all the excretories, &c. &c. derive from these membranes a part of their structure. Yet if we consider that wherever they are continuous, wherever we see them originate, by extending from each other, as they originated in the first instance from the skin, we shall perceive that this number must be wonderfully limited. In fact by thus describing them, not separately in each part, but at the same time in all those upon which they are continued, we see that they are reduced to two general surfaces, of which all the others are portions, and which, on account of the different parts to which they are distributed, can be called, the one gastro-pulmonary, the other genito-urinary. The first is found in the head, the neck and the abdomen. This last cavity and more especially the pelvis, contain the second.
There is also a small insulated mucous surface; it is that which enters by the openings of the nipples and lines the lactiferous tubes. But it is so small that it deserves but little attention; besides, what will be said of the two others will be equally applicable to it. It is then useless to examine it in a general manner.
I. Of the two General Mucous Membranes, the Gastro-Pulmonary and the Genito-Urinary.
The gastro-pulmonary surface penetrates into the interior by the mouth, the nose and the anterior face of the eye. 1st. It lines the first and second of these cavities, extends from the first to the excretory ducts of the parotid and sub-maxillary glands, from the other into all the sinuses, forms the conjunctiva, dips down into the puncta lachrymalia, the nasal duct, the sac of the same name, and is continued into the nose; 2d, it descends into the pharynx, furnishes an elongation to the Eustachian tube, then penetrates the internal ear and lines it, as we shall see; 3d, it dips down into the trachea and is spread upon all the air-tubes; 4th, it penetrates into the oesophagus and the stomach; 5th, it extends to the duodenum where it furnishes two elongations, one destined to the ductus choledochus, to the numerous branches of the hepatic and cystic ducts and the gall-bladder, the other to the pancreatic duct and its different branches; 6th, it is continued into the small and large intestines and finally terminates at the anus where we see it identified with the skin.
The second general mucous membrane, which we have called the genito-urinary, enters in man by the urethra, and thence is spread on the one hand upon the bladder, the ureters, the pelvis of the kidnies, the infundibula, the papillÆ and the capillary tubes which open on their summit; on the other hand it goes into the excretory tubes of the prostate, into the seminal ducts, the vesiculÆ seminales, the vasa deferentia and the branches with numberless windings that produce them.
In woman, this membrane is introduced by the os externum and penetrating on the one hand by the urethra, goes as in man upon the urinary organs; on the other hand, we see it enter the vagina, lining it, the uterus and the fallopian tubes, and afterwards becoming continuous with the peritoneum by the opening of these tubes. It is the only example in the economy, of a communication established between the mucous and serous surfaces.
This manner of describing the course of the mucous surfaces, by saying that they are elongated, dip down, penetrate, &c. from one cavity to another, is no doubt not conformable to the progress of nature, which creates in each organ the membranes belonging to this organ, and does not thus extend them by degrees; but our manner of understanding it is better adapted to this language, the meaning of which the least reflection will show.
In thus referring to two general membranes all the mucous surfaces, I am not only supported by anatomical inspection, but pathological observation has also furnished me with points of demarcation between the two, and points of contact between the different portions of membranes of which each is the assemblage. In the different descriptions of catarrhal epidemics given by authors, we frequently see one of these membranes affected in all parts, the other remaining sound; it is especially not rare to observe a general affection of the first, of that which extends from the mouth, the nose, the surface of the eye, into the alimentary canal and the bronchial vessels. The last epidemic observed at Paris, with which Pinal himself was affected, was of this character; that of 1761, described by Razou, had it also; that of 1752, described in the memoirs of the Society of Edinburgh was remarkable for a similar phenomenon; now, we do not see at that time a corresponding affection in the mucous membrane that is spread upon the urinary organs and upon those of generation. There is then here, 1st, an analogy between the portions of the first, by the uniformity of affection; 2d, a demarcation between the two by the health of the one and the disease of the other.
We see also that the irritation of any one point of one of these membranes, frequently produces a pain in another point of the same membrane, which is not irritated. Thus a calculus in the bladder occasions a pain at the end of the glans penis, the presence of worms in the intestines causes an itching of the nose, &c. &c. Now, in these phenomena purely sympathetic, it is very rare that the partial irritation of one of these two membranes affects with pain one of the parts of the other; there are however examples of it; such is the singular relation that exists, in mucous hemorrhages, between the membrane of the womb and that of the bronchia. If the blood ceases accidentally to flow from one during menstruation, the other frequently exhales it and thus as it were supplies its functions.
We ought then, from inspection and observation, to consider the mucous surface, in general, as formed by two great membranes successively spread upon many organs, having between them no communication except by the skin, which serves them as an intermediate organ, and which, continuing with both, contributes thus with them to form a general membrane everywhere, continuous, covering the animal externally, and extending within upon most of its essential parts. We can conceive that there should exist important relations between the internal and external portion of this single membrane; and that they do will be proved by further researches.
II. Adhering Surface of the Mucous Membranes.
Every mucous membrane exhibits two surfaces, one adhering to the neighbouring organs, the other free, covered with villi, always moistened with a mucous fluid. Each deserves particular attention.
The adhering surface corresponds almost everywhere with the muscles, either of animal or organic life. The mouth, the pharynx, the whole alimentary canal, the bladder, the vagina, the womb, a portion of the urethra, &c. exhibit a muscular layer embracing on the outside their mucous tunic which is within. This arrangement coincides perfectly, in animals with a fleshy membrane, with that of the skin, which moreover approximates very near, as we shall see, the structure of the mucous membranes, and which, as we have seen, is everywhere continuous with them. This arrangement of the mucous membranes occasions them to be agitated by constant motions which favour wonderfully the secretion that takes place in them, the excretion which succeeds it, and the various other functions of which they are the seat. The insertion of this muscular layer exterior to the mucous system, is made, as we have seen, by this dense and compact texture which I have called the sub-mucous. It is from this texture, more compact than the rest of the cellular system, that the mucous surface derives its force. It is from it that the organ which it lines receives its form; it is this which supports and preserves this form; the following experiment proves it. Take a portion of the intestine; remove from any part of it this layer, as well as the serous and the muscular; then inflate it, after having tied it below; the air produces in this place a hernia of the mucous coat. Try afterwards another portion of intestine; deprive this, for a small space, of its mucous membrane and of this also; inflation will produce upon the serous and muscular tunics the same phenomenon that it did in the preceding on the mucous; then it is to this sub-mucous cellular layer that it owes the resistance with which it opposes substances that it contains. The same may be said of the stomach, the bladder, the oesophagus, &c.
III. Free Surface of the Mucous Membranes.
The free surface of the mucous membranes, that which is continually moistened by the fluid from which they borrow their name, exhibits three species of wrinkles or folds.
1st. One inherent in the structure of all the laminÆ of these membranes, is constantly met with, whatever may be their state of dilatation or contraction; such are those of the pylorus and the valve of Bauhin. These folds are formed not only by the mucous membrane, but also by the intermediate tunic of which we have spoken, which here has a remarkable density and thickness, and gives them solidity. The fleshy tunic enters even into their composition, and we see on the exterior, upon the serous surface, a depression that indicates their presence.
2d. Other folds, only formed by the mucous surface, exist also always in a state of vacuity or fulness, less evident however than this; they are owing to the circumstance that the mucous surface is much more extensive than those upon which it is applied, so that it is folded that it may not run a longer course; such are the valvulÆ conniventes of the small intestines, the structure of which we see very well by cutting longitudinally one of these intestines. The edge of the section exhibits the fleshy layer and the serous surface in a straight direction, whilst the mucous layer describes a line resembling a loose thread.
3d. The last species of folds is as it were accidental, and is only observed during the contraction of the organ which is lined by the mucous surface that is the seat of it; such are those of the interior of the stomach, the great intestines, &c. In the greatest number of subjects brought to the dissecting rooms, these folds of which so much has been said as it respects the stomach, cannot be perceived in it, because the subject has died after a disease that has so altered the vital forces, as to prevent all action of this viscus; so that though it is frequently found empty, its fibres are not contracted. In experiments upon living animals, on the contrary, these folds become very evident, and may be demonstrated in this way; make a dog eat or drink copiously, open him an instant after and cut the stomach in the length of its great curvature; no fold is then apparent; but soon the viscus contracts, its edges are turned over and the aliments escape; the whole mucous surface is covered with an infinite number of very prominent ridges, which have as it were the form of cerebral circumvolutions. We obtain the same result by taking out the stomach of an animal recently killed, distending it with air and opening it afterwards, or by cutting it immediately in its state of vacuity and drawing it in opposite directions by its edges; it stretches, its ridges disappear, and if we cease to distend it, they form again immediately in an evident manner. I would observe on the subject of the inflation of the stomach, that by distending it with oxygen, we do not produce by the contact of this gas, greater ridges and consequently a stronger contraction, than by using for the same purpose carbonic acid gas. This experiment furnishes a result very similar to what I have observed in rendering animals emphysematous by different aeriform fluids. It follows from all that we have said upon the folds of the mucous membranes, that in the ordinary contraction of the hollow organs which these membranes line they undergo but a very slight diminution of surface, that they contract scarcely at all, but fold within, so that by dissecting them on an organ in contraction we should have a surface almost equal in extent to that which they exhibit during its dilatation. This assertion, which is true as it respects the stomach, the oesophagus and the great intestines, is not perhaps as entirely so with regard to the bladder, the contraction of which makes the ridges within less evident; but they are not sufficient to destroy the general law. It is also nearly the same with the gall-bladder; yet here we find another cause. The gall-bladder, alternately observed in hunger and during digestion, contains double the bile in the first case that it does in the second, as I have had occasion to see very often indeed, in experiments made for this object or with other views. Now, when the bladder is in part empty, it does not contract upon the bile that remains, with the force of the stomach when it contains but few aliments, or with the power of the bladder when it contains but little urine. It is then flaccid; so that its being distended or not has but a slight influence upon the folds of its mucous membrane.
Besides, in saying that the mucous membranes always exhibit, with some slight difference, the same surface in the extension and contraction of their respective organs, I intend to speak only of the ordinary state of the functions, and not of those enormous dilatations of which we often see the stomach, the bladder, and more rarely the intestines become the seat. Then there is no doubt, a real extension and contraction, which coincide in the membrane with those of the organ.
A remarkable observation which the free surface of the mucous membranes exhibits, and which I have already pointed out, is, that this surface is everywhere in contact with bodies heterogenous to that of the animal, whether these bodies introduced from without to nourish it have not yet been assimilated to its substance, as we see in the alimentary canal and in the wind-pipe; or whether they come from within, as we observe in all the excretory ducts of the glands, which all open into cavities lined by the mucous membranes, and transmit without particles which, after having contributed for some time to the composition of the solids, become heterogeneous to them, and are separated from them by the constant motion of decomposition which takes place in living bodies. Hence we ought to regard the mucous membranes as limits, and barriers, which, placed between our organs and the bodies that are foreign to them, defend them from the mischievous impression of these bodies, and serve consequently within, the same functions which the skin performs without, with respect to the bodies which surround that of the animal, and which tend incessantly to act upon it.
The organization of the mucous system and its vital properties are accommodated to this habitual contact of substances heterogeneous to the living economy. That which is a foreign body to the other systems, the cellular, the muscular, &c. is not so to this. Solid substances, the metals, stones, wood, &c. which introduced into our parts excite in them inevitably suppuration and an antecedent inflammation by their simple contact, pass with impunity over this, provided that their angles and asperities do not tear it; they only augment a little the secretion, as I shall say. We can swallow a ball of lead, of wood, &c. and pass it by the anus without inconvenience. All the irritating fluids without being caustic, that we inject into the great intestines in enemas, or that we swallow, would produce abscesses, &c. if they were forced into the cellular system, &c. Surgeons employ the term foreign bodies in too general a manner; that which is so for one system, is not for another. Foreign is, in this respect, a term of comparison which we should employ only after a knowledge of the peculiar sensibility of each system, and not after that of this property described in a vague manner.
The mucous system not only bears without danger the presence of all bodies that are introduced into the economy, but also when it goes out, it can be exposed with impunity to the contact of external stimuli. Observe what takes place in prolapsus of the womb in which the whole membrane of the vagina sometimes becomes external, in those inversions of the intestinal tubes that take place through preternatural ani, in prolapsus of the rectum, &c.; then the mucous surfaces serve really as integuments; now in these cases the surrounding bodies produce hardly any more pain on them than upon the skin. On the contrary, the instant a serous surface is laid bare, as for example in the operation of hernia, in which the intestine is suffered to come out, on account of an opening unfortunately made by the point of a bistoury, this surface inevitably inflames. All the cellular, muscular, nervous, glandular systems, &c. laid bare, exhibit the same phenomenon. There is no danger in opening the bladder as it respects the contact of the air, whilst there is much in permitting this fluid to penetrate into an articular cavity, a tendinous groove, a serous sac, &c. We know how much in the high operation for the stone, we fear to wound the peritoneum, how uncertain are the results of empyema on account of the contact of the air upon the pleura, &c. The dangers of the action of this fluid upon these surfaces have been perhaps exaggerated, but they are notwithstanding real.
If a fistula extends from the exterior of the abdomen into the intestines, its whole course is lined with callous bodies; these defend the cellular texture and the muscles through which the fistula passes. On the contrary, nothing similar appears upon the intestinal mucous surface, because its organization alone is sufficient to protect it. The urinary, salivary and lacrymal fluids never escape externally by artificial ducts formed in the neighbouring organs, without there are similar callous bodies in the course of these ducts; on the contrary, they pass with impunity over the mucous surfaces. Make in a limb a long and straight opening with a pointed instrument, and fix in it for a time a sound; a callous canal will be produced by it. Let a sound on the contrary remain in the urethra, no alteration of texture will result from it.
Let us conclude from these different considerations, that the mucous system with the cutaneous alone, is organized so as to support the contact of all external bodies, and not to be affected by their presence, or at least experience only an increase of secretion, which is in no ways dangerous. Thus these two systems form two boundaries, the one internal and the other external, between which are placed the organs foreign, by their mode of sensibility and by that of their structure, to the external bodies. To these boundaries the excitement of these bodies is limited; their influence does not go beyond. So long as they do not pass these boundaries, the other organs do not feel them. We might say that the acute sensibility which each of them enjoys, is a kind of sentinel that nature has placed on the confines of the organic domain of the mind, to inform it of whatever can injure it.
ARTICLE SECOND.
ORGANIZATION OF THE MUCOUS SYSTEM.
I. Texture Peculiar to this Organization.
The mucous system presents two things to be considered in its peculiar texture, viz. 1st, a layer more or less thick which constitutes principally this texture, and which by analogy with the cutaneous corion, may be called the mucous corion; 2d, many small elongations which surmount it, and which are called villi or papillÆ. As to the epidermis which covers it, I shall treat of it with the cutaneous epidermis. This texture has nothing similar to the substance that colours the skin, and which is between the papillÆ and epidermis. We know in fact that negroes, as well as whites, have this texture of a bright red, which it derives from its vessels.
Mucous Corion.
This portion of the mucous texture, which is the most important, and which constitutes the thickness, form, and even the nature of it, has a soft and spongy appearance. We might say at first view that it was a consistent pulp, with which the extremely dense cellular texture that is subjacent to it had been covered. This softness is a character which distinguishes it from the cutaneous corion, which moreover has by its intimate nature but little resemblance to it.
The mucous corion is very various as to thickness; it differs in this respect in each organ. That of the gums and the palate is the thickest of all. Then come those of the nasal fossÆ and the stomach, then those of the small intestines and the gall-bladder, then those of the large intestines, of the urinary bladder, the urethra and the other excretories, until it begins at length to become so fine as to appear transparent like a serous surface when it is removed with care. Finally, the finest and most delicate is that of the sinuses of the face and the interior of the ear; the arachnoides is often coarser.
I have called the texture within the ear mucous, though all anatomists call the membrane of the cavities of this organ periosteum. In fact, 1st, we see it evidently continued with the pituitary membrane, by means of the elongation of the Eustachian tube. 2d. We find it constantly moistened by a mucous fluid which this canal serves to convey out, a character foreign to the periosteum, which, like the fibrous membranes, always adheres by both its surfaces. 3d. No fibre can be distinguished in it. 4th. Its fungous appearance, though white and soft, and the ease with which it is torn, are evident attributes of the mucous membranes. Every thing proves that the membrane of the tympanum, that of the meatus, &c. belong to the system of which we are treating. Thus in catarrhs of the pituitary membrane, and of that of the fauces, we most often find that the ear is affected; thus the ear is, like the mucous surfaces, the seat of hemorrhage, thus polypi arise in it, as in the nose and on the surface of the womb. We consider as a sign of deposition of pus in the ear, every purulent discharge coming from that cavity. But how can we conceive of a purulent collection in a part in which there is hardly any cellular texture, in a part wholly osseous? Besides the fibrous system, to which the periosteum of the tympanum belongs, hardly ever suppurates, as we know. Every thing then induces us to believe that these discharges are only the effect of a catarrh of the ear, a catarrh which is sometimes acute and sometimes chronic. I have moreover a recent and decisive fact upon this point; the body of a man subject to these discharges during life exhibited a remarkable thickness and redness of the membrane of the tympanum, but without the least trace of erosion. The ear suppurates like the urethra, the vagina, &c. it is not a new fluid which is formed by suppuration; it is that which naturally comes from the meatus which increases in quantity and comes through a preternatural opening of the membrane of the tympanum.
Diseases make the thickness of all the mucous surfaces vary remarkably. I have seen them many lines thick in the maxillary sinus, and nearly half an inch in the bladder. In great extensions of the mucous sacs, this thickness diminishes very much; it increases in their contractions. The stomach especially exhibits this phenomenon in these two opposite states.
The softness of the mucous corion is also very variable; in the nasal fossÆ, in the stomach and the intestines, it is really a kind of organized velvet. The name of villous membrane is perfectly suited to it. On the contrary, at the origins of the mucous system, as in the mouth, upon the glans penis, at the entrance of the nose, it is a more dense and compact texture, approximating nearer in its nature to the cutaneous corion. I am persuaded that like this it might be tanned and be useful in the arts if it were in larger pieces, whilst I doubt if the action of tanning could produce an analogous phenomenon upon the mucous texture of the deep-seated organs. The softness of this would render it incapable of serving for external integuments. The least cause would be in fact sufficient to break and tear it. Its structure being different from that of the cutaneous corion is the reason that the variolus pustules never appear on it, whilst we often see them on the mucous surfaces near the openings of the skin, especially upon the tongue, the palate and the internal surface of the cheeks.
Exposed to the action of dry air, so that it may come everywhere in contact with it, it becomes dry and very thin, but preserves some resistance. In bladders inflated and dried, in the stomach, the intestines, &c. thus prepared, it is this texture which supports these organs, and which prevents them from becoming flat, though we permit the air to escape; it offers even a resistance, from which arises a kind of crepitation when we wish to bend them in various directions. To be convinced of this, it is only necessary to dry the mucous surface separate from the serous and muscular that correspond with it; these when dried remain pliable like the cellular texture, whilst the first has a kind of rigidity.
In the organs in which the redness of the mucous texture is slight, as in the bladder, the rectum, &c. it becomes transparent by drying. Where it is very red as in the stomach, it takes a deep tinge, which becomes even almost black if there had been an antecedent inflammation in it by which much blood had been accumulated; hence it appears that this fluid is the cause of the colour.
Thus dried the mucous surfaces are smooth; they lose their viscidity at least in appearance; their folds are effaced by adhering to the surface from which they arise; thus the valvulÆ conniventes are marked in a dried intestine, only by a red line, without any apparent prominence. But if we macerate the intestines in this state, the folds form again and become visible.
Exposed to a moist air, or left with other flesh that will not allow it to become dry, the mucous corion putrefies with great ease; the odour that it then sends out is very fetid. I think the reason why the abdomen of dead bodies becomes putrid so soon is in part because it contains substances already in putrefaction, and also because the surfaces, in contact with these substances, and which by their vitality resisted before their action, then readily yield to them. If these substances were contiguous to aponeuroses, putrefaction would be much less rapid. The mucous system when putrid takes a greyish colour; and as the dense, subjacent cellular texture putrefies much less easily, we can then remove from it by the least pressure, the mucous corion, reduced to a putrid pulp, in which every trace of organization has disappeared, and which forms a real pap.
During life, gangrene of the mucous texture takes place in general less frequently than that of the cutaneous. The consequences of catarrh, compared with those of erysipelas may convince us of this; there are however cases in which death appears in this texture, whilst the surrounding ones continue to live, as in gangrenous angina.
Exposed to maceration, the mucous texture yields to it promptly. I think that next to the brain it is altered quickest by the action of water. It is then reduced to a reddish pulp very different from that from putrefaction in the open air. When we put the whole stomach to macerate, this pulp is detached, when the sub-mucous texture and the serous membrane have as yet undergone but little alteration.
Ebullition at first extracts from the mucous texture a greenish scum, very different from that which the muscular and cellular textures give when boiled. This scum which mixed with the whole fluid in the beginning of the boiling, disturbs it and renders it green at first, afterwards rises upon the surface where it has small bubbles of air mixed with its substance; it often even falls to the bottom of the vessel by its weight. Sulphuric acid changes the colour of it to a dull brown.
A short time before the water begins to boil, the mucous texture crisps and acquires the horny hardness like the others, but in a less degree however; hence why it is then wrinkled almost always in different directions. In fact, the sub-mucous texture upon which it is applied, contracting at that time much more than it, it must fold on account of its length; thus during life, when the fleshy coat of the stomach contracts, its mucous surface not contracting in proportion, produces the numerous folds of which we have spoken. The action of a concentrated acid crisping the sub-mucous texture more than the mucous itself, produces an analogous phenomenon. After having been a long time dried, the mucous texture, like however almost all those of the animal economy, does not lose the faculty of acquiring the horny hardness when it is plunged into boiling water; it exhibits this phenomenon, whether we expose it to it dry, or whether we do it after having first softened it in cold water. It is a means by which all the valvulÆ conniventes may be made suddenly to reappear, which had disappeared by drying, and which form again the instant the intestine contracts. This experiment is very curious to witness.
When the ebullition has been a long time continued, the mucous texture turns gradually to a very deep grey, from the white which it had first become. It is not softer than in the natural state, but it breaks much quicker; the following experiment is a proof of it. If we draw the mucous corion, boiled for some time with the subjacent cellular texture, this last resists the most; so that it remains entire, whilst the mucous corion is broken in many places. This never assumes the gelatinous appearance of the cutaneous corion or the fibrous and cartilaginous organs when boiled and of the others which yield much gelatine. However by mixing a solution of tannin with the water in which this system taken from an adult has been boiled, I have seen an evident precipitate.
The action of the acids reduces to a pulp the mucous texture much sooner than most of the others. During life, all the caustics act much more rapidly upon it than upon the cutaneous, of which the thick epidermis is an intermediate organ which checks their tendency of combining with its corion. Thus the instant the nitric acid, a substance which common people almost always choose for their poison, as the practice at the HÔtel Dieu proves, thus the instant I say, that the nitric acid is in contact with the alimentary canal, it disorganizes it, it forms there a whitish eschar, which, when death does not take place immediately, as most often happens, is slowly removed and detached in the form of a membrane. We know that the lips gently rubbed with weakened nitric acid, become the seat of a troublesome itching, whilst that oftentimes though this acid may have acted upon the skin sufficiently to make it yellow, it does not suffer from it.
The softness of the mucous corion makes me presume that it is easily altered by the digestive juices, not that I confide in the experiments of Hunter, who pretended that these juices could act upon the coat that secretes them, but because in general I have observed that the textures like it yield very easily to the action of water in maceration and are also very easily digested. I have not however any experiment upon the subject, and we know that in the animal economy analogy is not always a faithful guide.
All the mucous surfaces, but especially that of the stomach and intestines, have the property of curdling milk, as have many other substances, especially the acids. Is it to this property that must be attributed a phenomenon which is constant during life, viz. the coagulation of milk that enters the stomach for digestion? or is this phenomenon owing to the mixture of this fluid with those which are secreted by the surface of this organ? I think that both these causes contribute to it at the same time; both separate produce in fact this phenomenon. Spallanzani has proved it as it respects the gastric juices. Every body knows that the mucous membrane dried, and consequently deprived of these juices, preserves the property of coagulating milk. Spallanzani has convinced himself that the serous and organic muscular systems of the stomach are destitute of it.
Are aphthÆ an affection of the mucous corion? do they belong to the papillÆ? are they seated in the glands? are they a separate inflammation of these glands, whilst catarrhs are characterized by a general inflammation of a considerable extent of the mucous system? All these questions deserve to be examined. Pinel has perceived the void there is in morbid anatomy upon this point.
Mucous PapillÆ.
The peculiar kind of sensibility which the skin enjoys is attributed principally, as we know, to what is called the papillary body, which commonly is not easy to be demonstrated. The sensibility of the mucous membranes, somewhat analogous to that of the skin, appears to me to have the same kind of organization, which is perceived with infinitely less ease. The papillÆ of this system cannot be called in question at its origin, where it dips into the cavities, in the commencement even of these cavities, as upon the tongue, the palate, the internal part of the alÆ of the nose, upon the glans penis, in the fossa navicularis, within the lips, &c. Inspection is sufficient to demonstrate them there. But it is asked if the papillÆ exist also in the deep-seated parts of this system. Analogy indicates it, since the sensibility is as great there as at their origin, though with varieties that we shall point out; but inspection proves it in a manner not less certain. I think that the villi with which we everywhere see them covered are nothing but these papillÆ.
Very different ideas have been entertained of the nature of these villi; they have been considered in the stomach and the oesophagus as destined to the exhalation of the gastric juice, in the intestines as serving for the absorption of chyle, &c. But, 1st, it is difficult to conceive how an organ everywhere nearly similar, can perform in different parts functions so different; I say nearly similar, for we shall see that these papillÆ exhibit differences of length, size, &c. without having any of texture or structure. 2d. What can be the functions of the villi of the pituitary membrane, of the internal coat of the urethra, the bladder, &c. if they have not relation to the sensibility of these membranes? 3d. The microscopical experiments of Leiberkuhn upon the vesicle of the intestinal villi have been contradicted by those of Hunter, of Cruikshank and especially of Hewson. I am certain that I have never seen any thing similar on the surface of the small intestines, at the time of chylous absorption; and yet it would appear that a thing of inspection could not vary. 4th. It is true that these intestinal villi are everywhere accompanied by a vascular net-work, which gives them a red colour very different from the colour of the cutaneous papillÆ; but the non-appearance of the cutaneous net-work is owing to the pressure of the atmospheric air, and especially to the contraction which it occasions in the small vessels. Observe in fact the foetus as it comes from the womb of its mother; its skin is as red as the mucous membranes, and if its papillÆ were a little longer, it would resemble almost exactly the internal surface of the intestines. Who does not know moreover, that the vascular net-work surrounding the cutaneous papillÆ, is rendered evident by fine injections, so as to change their colour entirely?
That in the stomach this vascular net-work continuous with the exhalants furnishes the gastric juice, and that in the intestines it intermixes with the origin of the absorbents, so that these embrace the villi, we cannot doubt after the experiments and observations of anatomists who have recently engaged themselves in investigating the lymphatic system. But this does not prevent the base of these villi from being nervous, and them from performing upon the mucous membranes the same functions that the papillÆ do upon the cutaneous organ. This manner of regarding them by explaining their existence generally observed upon all the mucous surfaces, appears to me to be much more conformable to the plan of nature, than to suppose them in each place with different and often opposite functions.
Besides it is difficult to decide the question by ocular observation. The delicacy of these elongations conceals their structure, even from our microscopical instruments, agents from which anatomy and physiology do not appear to me to have derived much assistance, because when we see obscurely, each sees in his own way and according to his own wishes. It is then the observation of vital properties that should especially guide us; now, it is evident to judge by them, that the villi have the nature I have attributed to them. The following experiment served to demonstrate to me the influence of the papillary body upon the cutaneous sensibility; it succeeds also upon the mucous membranes. Remove the epidermis in any part and irritate the papillary body with a sharp stilet; the animal is agitated, cries out and gives marks of acute pain. Slide afterwards, through a small opening made in the skin, a pointed stilet into the sub-cutaneous cellular texture, and irritate the internal surface of the corion; the animal remains quiet and makes no noise, unless some nervous filaments accidentally struck make him suffer. Hence it follows very evidently, that it is upon the external surface of the skin that its sensibility resides, that the nerves pass through the corion without contributing to its texture, and that their expansion takes place on the papillary body. It is precisely so with the mucous surfaces. Observe that this circumstance coincides very well with the functions of the two surfaces, which receive by their free portion the action of external bodies, to which they are foreign by their adhering portion.
The papillÆ exhibit very great varieties. On the tongue, in the small intestines, in the stomach and in the gall-bladder, they are remarkable for their length. The oesophagus, the large intestines, the bladder, all the excretory ducts have those that are less evident; these last especially and the urethra in particular, are almost smooth in their whole mucous surface. We can scarcely distinguish the papillÆ in the frontal, sphenoidal, maxillary sinuses, &c.
These small nervous eminences are sufficiently distinct and separate upon the tongue. In the nasal fossÆ, the stomach and the intestines, they are so near together and at the same time so delicate, that the membrane has at first view an uniform and smooth appearance, though it is covered with these elongations. Each papilla is simple; no bifurcation is ever observed at its extremity. All appear to have a pyramidal form, if we can judge at least by those which are the most evident.
Are they susceptible of a species of erection? It has been believed with regard to those of the tongue, which become erect, it is said, to perceive tastes, and with regard to those of the nose, which receive odours more efficaciously in this state of erection, which is in the sensitive phenomena on a small scale, what the erection of the corpora cavernosa is on a large one. I do not believe that any exact experiment can prove this fact. Moreover, it would be necessary then that the intestinal, vesical papillÆ, &c. should be in permanent erection, since they are almost always in contact with foreign substances.
II. Parts common to the Organization of the Mucous System.
Besides the blood vessels, the exhalants and the absorbents which contribute to the structure of this system as to that of all the others, it exhibits also a common organ, which is found almost always separate elsewhere, but which is here especially designed for it. This common organ is of a glandular nature; we shall now examine it.
Of the Mucous Glands and of the Fluids which they secrete.
The mucous glands exist in all the system of this name. Situated beneath the corion or even in its thickness, they pour out incessantly through imperceptible openings a mucilaginous fluid which lubricates its free surface, and which defends it from the impression of the bodies with which it is in contact, and at the same time favours the course of these bodies.
These glands are very apparent in the bronchia, palate, the oesophagus and the intestines, in which they take the names of the anatomists who have accurately described them, and where they make in many places evident projections upon the mucous surface. They are less apparent in the bladder, the womb, the gall-bladder, the vesiculÆ seminales, &c.; but the mucus that moistens them clearly demonstrates their existence. In fact, since on the one hand this fluid is analogous on all the mucous surfaces, and, on the other, in those in which the glands are apparent, it is evidently furnished by them, it must be secreted in the same way in those in which the glands are less evident. The identity of the secreted fluids supposes in fact the identity of the secretory organs. It appears that where these glands are hidden from our view, nature compensates for their delicacy by their number. Besides, there are animals in which, in the intestines especially, they form by their vast number, a kind of new layer, in addition to those of which we have spoken. In man this is remarkable in the palatine arch, in the pillars of the velum, on the internal surface of the lips, the cheeks, &c. &c. There is then this great difference between the mucous and the serous membranes, that the fluid which lubricates one is furnished by secretion, whilst that which moistens the others is from exhalation.
The size of the mucous glands varies; those of the velum of the palate, those of the mouth, &c. are the largest; they become insensible in the greatest number of mucous surfaces. I dissected two subjects that died of a pulmonary catarrh, and in them the glands of the trachea and bronchia, which are, as we know, very apparent, were not enlarged; the membrane alone appeared to be affected. Besides, we do not yet know the injuries of these glands, like those of the analogous organs, which are more apparent from their size. They are in general of a rounded form but with many varieties. No membrane appears to cover them. They have, like the salivary glands and the pancreas, only the cellular texture for an envelope. Their texture is more dense and compact than these last glands; but little cellular texture is found in them; they are soft, vascular, and appear when opened very much like the prostate gland. I cannot say whether nerves penetrate them; analogy indicates it, for all the principal glands receive them.
Mucous Fluids.
We know but little of the composition of the mucous fluids, because in the natural state, it is difficult to collect them, and in the morbid, in which their quantity increases as in catarrhs for example, this composition is probably changed. We know that in general they are unsavoury, insipid, and but slightly soluble in water, in that even which is raised to the highest temperature; they become putrid with difficulty. In fact they remain a long time unchanged in the nose, exposed to the contact of a moist air; in the intestines, they serve, without danger to them, as an envelope for putrid substances, &c.; taken from the body and subjected to different experiments, they give results conformable to these facts. All the acids act upon them and colour them differently; exposed to a dry air, they thicken by evaporation, and are often even reduced to small shining laminÆ. The nasal mucus especially exhibits this phenomenon. Fourcroy has given in detail the analysis of this mucus; he has also given that of the tracheal mucus. But we must not apply rigorously to the analogous fluids our knowledge of the composition of these. It is sufficient in fact to examine a certain number of these fluids, to be convinced that they are not the same in any two places, that more or less thick, more or less uniform, different in their colour, their odour even, &c. they vary in the principles that constitute them, as the membranes which furnish them vary in their structure, in the number and size of their glands, in the thickness of their corion, the form of their papillÆ, the state of their vascular and nervous systems, &c. I am far from being certain that the gastric juice is a mucous juice; it is even probable that exhalation furnishes it, the glands of the stomach throwing out a different fluid by the way of secretion. But this assertion is not accurately demonstrated, and perhaps hereafter it will be proved that this juice, so different from the other mucous juices, is however one of them, and that its properties are distinct only because the structure of the mucous surface of the stomach is not the same as that of the other analogous surfaces.
The functions of the mucous fluids in the animal economy are not ambiguous. The first of these functions is to defend the mucous membranes from the impression of the bodies with which they are in contact, and all which, as we have observed, are heterogeneous to that of the animal. These fluids form upon their respective surfaces a layer which supplies, to a certain extent, by its extreme tenuity, the absence of their epidermis. Thus where this membrane is very apparent, as upon the lips, the glans penis, at the entrance of the nose and in general at all the origins of the mucous system, these fluids are not very abundant. The skin has only an oily layer, infinitely less evident than the mucous of which we are treating, because its epidermis is very distinct.
This use of the mucous fluids explains why they are more abundant where heterogeneous bodies remain some time, as in the bladder, at the extremity of the rectum, &c. than where these bodies are only to pass, as in the ureters, and the excretory ducts generally.
Hence why when the impression of a body would be injurious, these fluids are poured out in greater quantity upon their surfaces. The sound which enters the urethra and remains in it, the instrument that is left in the vagina to compress a polypus, that which remains some time with the same view in the nasal fossÆ, the canal fixed in the lachrymal sac to remove the obstruction, that which is introduced into the oesophagus to assist interrupted deglutition, always produce, upon the portions of the mucous surface that corresponds to them, a more abundant secretion of the fluid which is constantly poured out, a true catarrh. This is one of the principal reasons that renders it difficult to keep elastic sounds in the wind-pipe. The abundance of the mucus that is then secreted, by closing the openings in the instrument, renders frequent introductions necessary, and can even threaten the patient with suffocation, as Desault himself has observed, though however he obtained great advantage from this means, as I have shown in his surgical works. I ought even to say, that since the publication of the Treatise on the Membranes, I attempted to fix a sound in the air tube of a dog, and that the animal died at the end of some time, having the bronchia filled with a frothy fluid which appeared to have suffocated him.
It appears then that every considerable excitement of the mucous surfaces produces a remarkable increase of action. But how can this excitement, which does not take place immediately upon the gland, have so great an influence upon it? for, as we have said, these glands are always under the membrane, and consequently separated by it from the irritating bodies. It appears that it is owing to a general modification of the glandular sensibility, which is capable of being brought into action by any irritation upon the extremity of the excretory ducts, as I shall prove in the glandular system.
It is to the susceptibility that the mucous glands have of feeling the irritation made at the extremity of their ducts, that must be referred the artificial catarrhs with which Vauquelin has been affected by respiring the vapours of the oxy-muriatic acid, the mucous discharge that attends the presence of a polypus, of any tumour in the vagina, of a stone in the bladder, &c. the frequency of fluor albus in women who are immoderate in the use of sexual intercourse, the more abundant discharge of the mucus from the nostrils of those who take snuff, &c. In all these cases, there is evidently excitement at the extremity of the mucous ducts. I refer also to this excitement the mucous discharge that takes place, from stimulating the end of the nipple of a woman who does not give suck, the copious secretions which the presence of an irritating body produces in the intestines, secretions which especially furnish the matter of diarrhoeas, the gastric derangements which succeed an indigestion that has allowed to remain on the mucous surface of the stomach substances not digested and consequently irritating; these derangements are in fact real catarrhs of the membrane of the stomach, catarrhs which most often are not connected with bilious turgescence. I could add many other examples of the mucous secretions increased by an irritation upon the surface of the membranes, at the extremity of the excretory ducts; these will be sufficient to give an idea of the others.
All these excitements produce a kind of inflammation, the peculiarity of which is to contract at first for some time the glandular ducts, and arrest the secretion, which they afterwards excite in great quantity. When the mucous fluids have flowed abundantly for some time, they gradually diminish though the cause continues; thus less mucus is discharged from the urethra in proportion after the sound has remained in it a month, than when first introduced; but almost always as long as the cause continues, the mucous discharge is greater than in a natural state.
Blisters are much employed in medicine on the cutaneous organ, to dispel, according to some, the morbific humour, and overcome, according to others, a natural irritation by an artificial one. Why should we not also in many cases irritate the mucous surfaces? why not act upon the pituitary membrane, upon the glans penis, upon the membrane of the urethra, upon the pharynx, &c. and especially upon the uvula which is so sensible? why, instead of epispastics upon the perineum and sacrum, should we not introduce a sound into the urethra for a paralysis of the bladder? Instead of acting in hemiplegia upon the cutaneous organ, I have already twice employed the following means; I have introduced a sound into the urethra, one in each nasal fossa, and at the same time, a surgeon irritated at intervals the uvula; the patients appeared to be much more excited than by blisters. Very strong purgative enemas and emetics prove the advantage of the excitement of the mucous membranes in this case. Would it not often be better in ophthalmia, to produce an artificial catarrh in the nostril of the diseased side, than to put a blister or seton in the neck? I have once tried it; it did not succeed; but the ophthalmia was of long standing; I propose to repeat these experiments at the HÔtel Dieu upon a great number of patients. I think that we might often in diseases make use of mucous excitements instead of cutaneous, with much more advantage, because in the mucous system the contact of a body is sufficient, and it is not necessary to produce, by removing the epidermis, a kind of ulcer.
The mucous membranes by the continual secretion of which they are the seat, enjoy a principal part in the animal economy. We ought to consider them as one of the great emunctories by which the residue of nutrition constantly escapes, and consequently as one of the principal agents of the habitual decomposition which removes from living bodies the particles that, having for some time contributed to the composition of the solids, are afterwards to become heterogeneous to them. Observe in fact that the mucous fluids do not enter the circulation, but go out of the body; that of the bladder, the ureters and the urethra, with the urine; that of the vesiculÆ seminales and the different ducts with the semen; that of the nostrils by the act of blowing the nose; that of the mouth, in part by evaporation and in part by the anus with the excrements; that of the bronchia, by pulmonary exhalation, which arises principally, as I shall say, from the solution of this mucous fluid in the inspired air; those of the oesophagus, the stomach, the intestines, the gall-bladder, &c. with the excrements, of which they often form in the ordinary state a part almost as considerable as the residue of the aliments, and which they even compose almost entirely in some cases of dysentery and fever, in which the quantity of matter voided is evidently disproportioned to that taken in, &c. Let us observe upon this subject that there are always some errors in the analyses of the fluids in contact with the membranes of which we are speaking, as in that of the urine, the bile, the gastric juices, &c. because it is very difficult and even impossible to separate the mucous fluids from them.
If we recollect what has been previously said upon the extent of the two general mucous surfaces, which is equal and even superior to the extent of the cutaneous organ, and if we afterwards consider that these two great surfaces are constantly throwing out mucous fluids, we shall perceive how important this evacuation must be in the economy, and of what mischief its derangement must become the source. It is undoubtedly to this law of nature which wishes to have every mucous fluid thrown out, that must be attributed, in part in the foetus, the presence of the unctuous fluid of which the gall-bladder is full, the meconium which loads the intestines, &c. fluids which appear to be but a mass of mucous juices, which being unable to pass off, remain until birth, without being absorbed, upon the respective organs on which they have been secreted.
The mucous fluids are not the only ones that are thrown out, and are in this way excrementitious substances to the economy; this is the case with almost all the fluids separated from the mass of blood by secretion; this is evident as it respects the greatest part of the bile; probably the saliva, the pancreatic juice and the tears are also thrown out with the excrements, and their colour alone prevents them from being distinguished like the bile. I do not even know if, by reflecting on many phenomena, we might not attempt to establish as a general principle, that every fluid separated by secretion does not enter the circulation again, that this phenomenon belongs only to the fluids separated by exhalation, as those of the serous cavities, of the articulations, of the cellular texture, of the medullary organ, &c.; that all the fluids are thus either excrementitious or recrementitious, and that no one is excremento recrementitious as the common division implies. The bile in the gall-bladder, the urine in the bladder, the semen in the vesiculÆ seminales, are certainly absorbed; but it is not the fluid itself which re-enters the circulation; it is only its most delicate parts, some of its principles which we do not exactly know, probably the serous and lymphatic part; this does not resemble the absorption of the pleura and other analogous membranes, in which the fluid re-enters the blood as it came out of it.
That which is certain on the subject of the excretion of the secreted fluids is, that I have never been able to produce absorption of the bile by the lymphatics by injecting it into the cellular texture of an animal; it produces there inflammation and afterwards suppuration. We know that urine effused is not absorbed and that it destroys every part it touches, whilst that effusions of lymph and blood are easily discussed. There is as it respects the composition an essential difference between the blood and the secreted fluids. The exhaled fluids on the contrary, as the serum, in this respect resemble it very much.
Another very evident proof that all the mucous fluids are designed to be thrown out, is, that when they have continued for some time in any quantity upon their respective surfaces, they create there a painful sensation of which nature relieves us by various means. Thus the cough, which is the constant result of an accumulation of mucus in the bronchia, serves to expel it; thus vomiting in gastric derangements answers the same purpose as it respects the mucous juices accumulated in the stomach, whose presence produces a weight and even pain, though the membranes be not affected. We cough at will, because it is the diaphragm and intercostals by which this function is performed; we do not seek in medicine for any means to excite it. But as we cannot vomit at will, and as the presence of mucous juices often by fatiguing the stomach, does not irritate it sufficiently to produce a contraction, art has recourse to various emetics. We know what a painful sensation of weight the continuance of mucus accumulated in the frontal, maxillary, sinuses, &c. occasions, when there is a catarrh of a portion of the pituitary membrane. The region of the bladder is for the same reason, in catarrhs of this organ, the seat of a troublesome and even painful sensation.
In general, the sensation which arises from the presence of the mucous juices remaining too long and in too great quantity upon their respective surfaces, varies because, as we shall see, each part of the mucous system has its peculiar mode of sensibility; so that the pain is not the same in each, though produced by the same cause. I would only observe that this sensation does not resemble that which arises from the tearing or the acute irritation of our parts; it is an uneasy, inconvenient sensation, difficult to be borne. Every one knows that which arises from mucus accumulated in the nasal fossÆ, when the nose has not been blown for a long time, that disagreeable one that accompanies gastric derangements, &c. Those who have a weakness of the lachrymal sac in which the tears, on account of this, accumulate during the night, wake up with a sensation of weight, of which they are relieved by evacuating the sac by pressure, if the puncta lachrymalia are open.
Blood Vessels.
The mucous membranes receive a very great number of vessels. The remarkable redness that distinguishes them would be sufficient to prove it, if injections did not demonstrate it; this redness is not everywhere uniform. It is almost nothing in the sinuses of the face, in the internal ear, of which the membranes are rather whitish, and which appear so especially, because their extreme delicacy allows the bone upon which they are applied to be seen very distinctly. In the bladder, in the great intestines, in the excretories, &c. this colour, though still very pale, is a little more evident; it becomes very much so in the stomach, the small intestines, the vagina and in the pituitary and palatine membranes. In the gall-bladder we cannot distinguish it, because the bile always covers the mucous surface in the dead body.
This colour depends upon a very extensive vascular net-work, the branches of which, after having passed through the mucous corion, and ramifying there, divide and spread ad infinitum on its surface, embracing the papillary body and covered only by the epidermis.
It is the superficial position of these vessels and consequently their want of support on one side, that exposes them frequently to ruptures from considerable shocks, as happens on the surface of the bronchia from a severe cough, on that of the ear and the nose from a violent blow on the head. We know that hemorrhage of the mucous system bordering on the brain, is a common accident from concussions and wounds of the head. Hence why the least gravel makes the ureters bleed; why one of the signs of stone in the bladder is the passing of blood; why a blunt sound carefully introduced is so often withdrawn bloody from the urethra; why the least effort made with instruments carried upon polypi, into a fistula lachrymalis or into the nostrils, produces hemorrhage. I have already observed that we must carefully distinguish these hemorrhages from those furnished by the exhalants, and which do not suppose any vascular rupture.
It is also the superficial position of the vessels of the mucous system, which makes its portions visible, as the red edge of the lips, the glans penis, &c. often serve to show us the state of the circulation. Thus in the different species of asphyxia, in submersion, strangulation, &c. these parts are remarkably livid, an effect of the passage of the venous blood, which has undergone no change from the want of respiration, into the extremities of the arterial system.
The long continued exposure of the mucous system to the air, often makes it lose the redness that characterizes it, and it then assumes the appearance of the skin, as has been observed by Sabatier in treating of prolapsus of the womb and vagina, which, from this circumstance, have sometimes so misled some people, as to make them believe it a case of hermaphrodism.
An important question presents itself in the history of the vascular system of the mucous membranes, viz. whether this system admits more or less blood according to different circumstances. As the organs within which these membranes are spread, are almost all susceptible of contraction and dilatation, as we see in the stomach, the intestines, the bladder, &c. it has been thought that during the dilatation, the vessels being more expanded, receive more blood, and that during the contraction on the contrary, being folded up, as it were choaked, they admit but a small quantity of this fluid which then flows into the neighbouring organs. Chaussier has made an application of these principles to the stomach, whose circulation he has considered as being alternately inverse of that of the omentum, which receives during the vacuity of this organ, the blood which this when it is contracted cannot admit. An analogous use has also been attributed to the spleen since the time of Lieutaud. The following is what the inspection of animals opened during abstinence and at different periods of digestion, has shown me upon this point.
1st. During the fulness of the stomach the vessels are more apparent on the exterior of this viscus, than when it is empty. Within, the mucous surface is not more red, sometimes it has appeared to me to be less so. 2d. The omentum, less extended during the fulness of the stomach, exhibits nearly the same number of vessels, as long, but more tortuous, than when it is empty. If they contain less blood, the difference is hardly sensible. I would observe, that in order to distinguish this well, it is necessary to take care that in opening the animal, the blood does not fall on the omentum which presents itself, and thus prevent its state from being ascertained. This is besides a necessary consequence of the arrangement of the vascular system of the stomach. In fact the great stomachic coronary being situated transversely between it and the omentum, and furnishing branches to each, it is evident that when the stomach is lodged between the layers of the omentum by separating these layers, and this by applying itself upon it becomes shorter; it is evident, I say, that the branches which it receives from the coronary cannot be equally applied to it also. In order to do this, it would be necessary that they should go from one to the other without the intermediate trunk that cuts them at right angles; then, in distending, the stomach would separate them as it does the omentum, and would be lodged between them; whereas it pushes them before it with their common trunk, the stomachic coronary, and makes them fold. 3d. I am confident that there is no such constant relation between the size of the spleen and the emptiness or fulness of the stomach, and that these two circumstances coincide necessarily, and that if the first organ increases or diminishes under different circumstances, it is not always precisely the reverse of the stomach. I first made, like Lieutaud, experiments upon dogs to convince myself of it; but the inequality in the size and age of those that were brought to me, making me fear that I should not be able to compare their spleens correctly, I repeated them upon guinea-pigs of the same litter and size, and examined at the same time, some when the stomach was empty and others when it was full. I have almost always found the size of the spleen nearly equal, or at least the difference was not very sensible. Yet in other experiments, I have seen under various circumstances, inequalities in the size of the spleen and especially in the weight of this viscus; but it was indifferently during or after digestion.
It appears from all this, that if during the vacuity of the stomach, there is a reflux of blood towards the omentum and spleen, this reflux is less than it has been commonly said to be. Besides during this state of vacuity, the numerous folds of the mucous membrane of this viscus leaving it, as we have said above, almost as much surface and consequently as many vessels as during fulness, the blood can circulate in it almost as freely. It has no real obstacles but in the tortuous courses, and not in the obstruction, compression and choaking of these vessels by the contraction of the stomach; now this obstacle is easily surmounted, or rather it is not one as I have proved in my Researches upon Death. As to the other hollow organs, it is difficult to examine the circulation of the neighbouring parts during their fulness and vacuity, as the vessels of these are not superficial as in the omentum, and as they themselves are not insulated like the spleen. We can only then, to decide the question, see the state of the mucous membranes on their internal face; now this face has always appeared to me to be as red during the contraction as during the dilatation.
Besides I only give this as a fact without pretending to draw from it any consequence in opposition to the common opinion. It is possible in fact that though the quantity of blood may be nearly always the same, the rapidity of the circulation being increased, more of this fluid may consequently in a given time enter it when it is full; which appears to be necessary to the greater secretion that then takes place of the mucous fluids, a secretion excited by the presence of the substances in contact with the surfaces of the same name. For example, there is no doubt that there is three or even four times as much mucus secreted in the urethra, when a sound fills it, as when it is empty; now the blood must be in proportion.
The remarkable redness of the mucous system, the analogy of respiration in which the blood flows through the mucous surface of the bronchia the well known experiment of a bladder filled with blood and immersed in oxygen, by which means the blood becomes red, have induced a belief that the blood being separated from the atmospheric air only by a thin pellicle or some of the mucous surfaces, as upon the pituitary, the palatine, the glans penis, &c. assumed there a redder colour, either from getting rid of a portion of its carbonic acid gas, or by combining with the oxygen of the air, and that these membranes thus performed functions accessory to those of the lungs. The experiments of Jurine upon the cutaneous organ, experiments adopted by many celebrated philosophers, seem to strengthen this conjecture.
I tried the following experiment to ascertain this fact. I drew through a wound made in the abdomen a portion of intestine which I tied at one point, I afterwards reduced it, keeping out a small portion only which I opened and by which I introduced atmospheric air, which filled the whole portion situated on this side of the ligature. I afterwards tied the intestine below the opening, and reduced the whole of it. At the end of an hour, the animal being opened, I compared the blood of the mesenteric veins which arose from the portion of intestine distended with air, with the blood of the other mesenteric veins arising from the rest of the canal. No difference of colour was manifest; the internal surface of the distended portion of the intestine was not of a more brilliant red. I thought I should obtain a more evident effect, by repeating with oxygen the same experiment upon another animal; but I perceived no greater variety in the colour of the blood. As upon the mucous membranes which are ordinarily in contact with the air, this fluid is constantly changing and is agitated by a perpetual motion, and as in the preceding experiment it remained stagnant, I attempted to produce the same effect in the intestines. I made two openings in the abdomen, and drew out at each a portion of the intestinal canal; having opened these two portions, I fitted to one the tube of a bladder full of oxygen and to the other that of an empty bladder; I afterwards compressed the full bladder, so as to make the oxygen pass into the other, by going through this portion of intestine, left in the abdomen that the heat might support the circulation in it. The oxygen was thus many times sent from one bladder to another, taking its course through the intestine, which, on account of its contractility is more difficult than it at first seems to be. The abdomen being afterwards opened I found no difference between the venous blood returning from this portion of intestine, and that which flowed from the others. The superficial position of the mesenteric veins, covered only by a fine and transparent layer of peritoneum, their size, if the animal be rather large, render this sort of comparison very easy.
I perceive that we cannot infer from what takes place in the intestines, what happens in the pituitary, palatine membrane, &c. because though analogous, the organization may be different. We cannot here as in the intestines examine the venous blood returning from the part; but, 1st, if we consider that in animals who have respired oxygen for some time, we see the palatine and pituitary membranes more red; 2d, if we reflect that the lividity of the different parts of this membrane, in those destroyed by asphyxia by the carbonic acid gas, depends not on the immediate contact of this gas upon the membrane, but upon the passage of venous blood into the arterial system, as my experiments have, I think, demonstrated; 3d, if we remark finally that in these circumstances the contact of the air does not change, after death, the lividity which the venous blood gives to the mucous membranes, although the skin be then much more permeable to every kind of aeriform fluid; we shall see that it is at least necessary to suspend our judgment upon the colouring of the blood in the mucous membranes, until further observations have decided the question.
The following experiment may also throw some light upon the subject. I have inflated the peritoneal cavity of several guinea-pigs with carbonic acid gas, with hydrogen, oxygen and atmospheric air, to see if I could effect through a serous membrane what I could not make succeed in a mucous; I have not, after these experiments, found any difference in the colour of the blood of the abdominal system; it was always the same as in the common guinea-pig which I killed for comparison.
I think however that I have remarked many times, both in frogs and animals with red and warm blood, such as cats and guinea-pigs, that the infiltration of oxygen into the cellular texture gives, at the end of some time, a much brighter colour to the blood, than that which this fluid exhibits in artificial emphysemas produced by carbonic acid gas, hydrogen and atmospheric air, in all which the colour of the blood scarcely differs at all from what is natural. But in other cases oxygen has had no influence upon the colour of the blood; so that notwithstanding having made many experiments upon this point, I am unable to give any general result. It appears that the tonic forces of the cellular texture and of the parietes of the vessels which are spread upon this texture, receive a very variable influence from the contact of the gases, and that according to the nature of this influence, the fibres crisping and contracting more or less, render these parts more or less permeable, either to the aeriform fluids that tend to escape from the blood in order to unite with that of the emphysema, or to this last fluid, if it tends to combine with the blood, which no doubt produces the varieties I have observed.
The red colour of the mucous system is analogous to that of the muscular system. It does not depend essentially on the blood circulating in the small arteries of this system. It arises from the colouring portion of the blood combined with the mucous texture, especially in the deep part of the organs; for at the origin of the mucous surfaces, this colour appears to be principally owing to the blood in circulation; in fact asphyxia does not render so livid the deep mucous surfaces, as it does those which are superficial and in communication with the skin. The black blood arrives immediately to these by the last arteries, and tinges them as we see. In syncope in which the heart being affected no longer sends blood into the arteries, we know that this portion of the mucous system becomes instantly white.
Besides the red colour of the deeper portions, can, like that of the muscles, be removed by repeated washing and frequently changing the water. Yet the water in which they have been washed is not as red as that used for the muscles.
The instant a mucous surface is plunged into boiling water, however red it may be, as that of the intestines and the stomach, it instantly whitens. The action of the nitric, sulphuric and muriatic acids produces in it also a sudden whiteness.
This colour of the mucous surfaces acquires a remarkable intensity in inflammation. The redness becomes then extremely deep on account of the quantity of blood that is accumulated in the capillary system. It is particularly in dysentery that the internal surface of the intestines exhibits this phenomenon in a striking degree. I ought however to observe to those who open dead bodies, that they never should lose sight of the original tinge of the portion of the mucous system they examine, since each of the divisions of this system exhibits in its shades remarkable differences. If the membrane of the bladder, the rectum, &c. is found as red as that of the stomach in its natural state, then pronounce that there had been inflammation; if the redness of the sinuses equals that which is natural to the bladder and the rectum, decide that inflammation had existed in them. There is, as I have said, a scale of colour for the mucous system. It is then essential to have an accurate knowledge of this scale, a type to which we can refer the inflammatory state in the examination of dead bodies.
Exhalants.
Does exhalation take place upon the mucous surfaces? The analogy of the skin seems to indicate it; for it is well proved that the sweat is not a transudation through the inorganic pores of the cutaneous surface, but a real transmission by vessels of a peculiar nature and continuous with the arterial system.
It appears at first that the pulmonary perspiration which takes place upon the mucous surface of the bronchia, which has so much relation with that of the skin, which increases and diminishes according as this diminishes or increases, and the matter of which is probably of the same nature; it appears, I say, that the pulmonary perspiration is made at least in great part by the system of exhalant vessels, and that if the combination of the oxygen of the air with the hydrogen of the blood contributes to produce it, during the act of respiration, it is but in very small quantity, and it is the portion that is purely aqueous. Besides, this last hypothesis of modern chemists, contradictory to the production of all the other fluids thrown out by the mucous surfaces, appears to me ill adapted to explain the formation of this. When the same phenomenon is produced in many places, and the explanation that is given of it is applicable only to one, we should be suspicious of this explanation.
It should be observed in regard to the pulmonary perspiration, that the solution of the mucous fluid which lubricates the bronchia, in the air constantly inspired and expired, furnishes a considerable portion of this vapour which, insensible in summer, is very evident in winter, on account of the condensation of the air. The mucous juices are dissolved like every other fluid; for wherever there is atmospheric air, heat and moisture, there is evaporation. Here this evaporation is even a means which nature employs to rid herself, as I have said, of the mucous juices. If they are too abundant, as in a cold, then the quantity of air which serves as a vehicle to them, not increasing in proportion, it is necessary that there should be another mode of evacuation; this is expectoration which compensates for what the air cannot remove by solution.
The intestinal juice which Haller has especially considered, but which appears to be in much less quantity than he thought it, the oesophagean and gastric juices, particularly this last which has been supposed to be distinct from the mucous juices, are probably deposited by exhalation upon their respective mucous surfaces. But in general it is very difficult to distinguish with precision what belongs in these organs to the exhalant system, from that which is furnished by the system of mucous glands, which, as we have said, are everywhere subjacent to them. Thus we constantly see the mucous fluids of the oesophagus, the stomach and the intestines, mixing with the oesophagean, gastric and intestinal fluids.
As on the one hand the blood vessels ramify almost naked on the mucous surfaces, and as on the other these vessels are always the origin of the exhalants, it is evident, that these have but a short course to run to arrive at their surfaces; they are rather pores than distinct vessels. Hence why no doubt the blood has so great a tendency to escape by the exhalants; why consequently hemorrhages without rupture are so frequent in the mucous system; why this affection can be classed in the diseases of this system, &c. &c. No other, by the arrangement of the arteries, offers to the exhalants so short a course between their origin and termination. Often even, as I have said, we make the blood of these vessels ooze in the dead body through their exhalants.
Absorbents.
The absorption of the mucous membranes is evidently proved, 1st, by those of chyle and of drinks on the intestinal surfaces, of the venereal virus upon the glans penis and the canal of the urethra, of the variolous when the gums are rubbed with it, of the serous portion of the bile, the urine and the semen, when they remain in their respective reservoirs. 2d. When, in the paralysis of the fleshy fibres that terminate the rectum, substances are accumulated at the extremity of this intestine, these substances often become hard, an effect probably of an absorption of the soft parts. 3d. There have been various cases in which the urine has been almost wholly absorbed by the mucous surface of the bladder, where there have been insurmountable obstacles in the urethra. 4th. If we respire, by means of a tube, the air of a large vessel filled with the exhalations of turpentine, so that these vapours can only act upon the mucous surface of the bronchia, the urine has the peculiar odour that always arises from the use of this substance, the exhalations from which have been introduced into the blood by the means of absorption, &c.
Whatever may be the mode of this absorption, it appears that it does not take place in a constant and uninterrupted manner, like those of the serous membranes, in which the exhalant and absorbent systems are in a regular and continual alternation of action. There is scarcely any but the chylous absorption, that of drinks, and that of the aqueous portion of the secreted fluids remaining in a reservoir as they come from their glands, that constantly take place. Nothing is more variable than the other absorptions. Under the same influence, the glans takes up or leaves the venereal virus; the internal surface of the bronchia sometimes admits and sometimes refuses admittance to contagious miasmata. There are more cases of retention in which the urine is not absorbed entirely, than there are where this absorption takes place, &c. &c. The innumerable varieties of the vital forces of the mucous membranes, varieties produced by those of the stimuli with which they are in contact, explain these phenomena. If these forces are raised or diminished a little, the absorption is altered, even that which is natural, as that of the chyle. Take a purgative; it contracts, shuts even the mouth of the absorbents of the intestinal canal; as long as the irritation continues, all the drinks that are taken pass off by the anus; at the end of four or five hours, the absorbents gradually recover their natural tone and absorption recommences. In these cases, the first discharges are only the intestinal matters, the others are the copious drinks that have been taken. There are many diseases in which, the sensibility of the chylous absorbents being too much raised, they are no longer in relation with the aliments, they take up with difficulty the residue of them, &c. Deficiency of action produces the same phenomenon; in absorption in fact it is a middle degree of sensibility of the organ which produces it, a degree below or above which it cannot take place.
All the mucous absorbents appear to go to the thoracic duct.
Nerves.
I would remark that at all the origins of the mucous system, where the animal sensibility is very great and where it places us, like the skin, in relation with external bodies, cerebral nerves are distributed. The pituitary and palatine membranes, the conjunctiva, the mucous surface of the rectum, the glans penis, the prepuce, &c. exhibit this fact very evidently. There are hardly any nervous filaments coming from the ganglions in these different places.
On the contrary, this last species of nerves is the predominant one in the intestines, in all the excretories, in the reservoirs of the secreted fluids, &c. places where the organic sensibility is the most evident.
ARTICLE THIRD.
PROPERTIES OF THE MUCOUS SYSTEM.
I. Properties of Texture.
Extensibility and contractility are much less in this system than they at first appear to be, on account of the numerous folds which it exhibits in the hollow organs during their contraction, folds which are developed only during extension, as we have seen. Yet these two properties become very evident in some cases. The excretories are capable of taking a size much larger than is natural to them. This is seen in the ureters in particular, which are sometimes found as large as an intestine. The ductus choledochus and the pancreatic duct have often also these dilatations. The urethra and the salivary ducts appear to be less extensible than the others. If they have ever so little obstacles from strictures, contractions, &c. they break rather than stretch; hence various urinary and salivary fistulas.
Hence there is, as we see, many varieties in the degrees of the extensibility of the mucous system; it is the same with regard to the contractility of texture. These two properties are besides capable of being put rapidly into action. We know that the stomach, the intestines, the bladder, &c. pass in an instant from a great size to extreme contraction. Their functions even suppose this rapidity, without which they could not be performed. The palatine membrane which lines the cheeks, exhibits the same phenomenon when the mouth is filled with air, aliments, &c. which are afterwards expelled from it.
When the usual fluids cease to pass through the mucous ducts, they remain in permanent contraction; this is what takes place in the intestines below a preternatural anus. I have seen in this case the cÆcum and the rectum reduced to the size of a large quill. Yet there is never then an obliteration of their parietes, on account of the presence of the mucous juices, of which the patient always passes a certain quantity. The urethra, after the operations for stone in which the urine passes for a long time through the wound, and in the great fistulas in the perineum or above the pubis, the salivary ducts in wounds which affect them and through which the whole saliva is discharged, the nasal canal in fistulÆ lachrymales, contract also more or less, but are never obliterated. We know that the vas deferens is often a very long time without having semen pass through it, and yet it remains open. This phenomenon distinguishes the mucous ducts from the arterial, which, when the course of blood is interrupted in them, change into ligaments in which every thing like a canal disappears. We ought not to lose sight of this phenomenon of all the mucous ducts; it proves the incorrectness of the practice of those who, thinking that at the end of some time it is impossible to re-establish, in fistulas, the natural way, think it necessary to make an artificial one.
The mucous tubes are not only not obliterated when they are empty, but when inflamed they do not even contract adhesions of their parietes, as so often happens in the serous cavities, in the cellular texture, &c. Observe how important this fact is to the great functions of life; what would indeed become of these functions, if in catarrhs of the intestines, the bladder, the stomach, the oesophagus, the excretories, &c. these adhesions were as frequent as they are in pleurisy, peritonitis, pericarditis, &c.
II. Vital Properties.
Few systems live in a more active manner than this; few exhibit the vital forces in a higher degree.
Properties of Animal Life.
Constantly in relation, like the integuments, with external bodies, the mucous surfaces have occasion for a sensibility which would enable the mind to perceive these relations, especially at the origin of these surfaces. Thus the animal sensibility is very much developed there. It is even superior in it in many places to that of the cutaneous organ, in which no sensation is as acute as those which take place on the pituitary membrane from odours, upon the palatine from tastes, upon the surface of the vagina, the urethra, the glans penis during coition. But without speaking of these exaggerations of sensibility, if I may so express myself, all the natural phenomena of the mucous surfaces prove this property in an evident manner; it is unnecessary however to pause for these phenomena.
I would only observe that this sensibility, like that of the cutaneous organ, is essentially subjected to the powerful influence of habit, which tending constantly to blunt the acuteness of the sensation of which they are the seat, brings equally to indifference the pain and the pleasure they make us experience, and of which it is the medium, as we know. 1st. I say that habit brings to indifference the painful sensations arising upon the mucous membranes. The presence of a sound in the urethra for the first time, is distressing the first day, painful the second, inconvenient the third, and insensible the fourth. Pessaries introduced into the vagina, bougies into the rectum, tents fixed in the nasal fossÆ, and a canula kept for a length of time in the nasal canal, exhibit in different degrees the same phenomena. It is upon this remark that is founded the possibility of the introduction of sounds into the wind-pipe to aid respiration, and into the oesophagus to produce an artificial deglutition. This law of habit can even transform into a pleasure an impression at first painful; the use of snuff for the pituitary membrane and different aliments for the palatine, furnish well known examples of this. 2d. I say that habit brings to indifference agreeable sensations arising on the mucous surfaces; the perfumer, placed in an odoriferous atmosphere, the cook, whose palate is constantly affected by delicious tastes, do not find in their professions the acute enjoyments they give to others. From habit can even arise the succession from pleasure to painful sensations, as in the preceding case it converts pain to pleasure.
I would however observe that this remarkable influence of habit is only exerted upon sensations produced by simple contact, and not upon those produced by real injuries, as the tearing, the forced stretching, the cutting or pinching of the mucous system; thus it does not mitigate the pains caused in the bladder by pressure and by the tearing a stone occasions, or on the surface of the womb, of the nasal fossÆ, &c. by a polypus, on that of the oesophagus or the wind-pipe by a sharp and uneven body accidentally lodged there, &c. &c.
It is to this power of habit over the sensibility of the mucous system, that must be in part referred the gradual diminution of its functions, which accompanies age. Every thing is stimulant in infancy, every thing is blunted in old age. In one, the very active sensibility of the alimentary, biliary, urinary, salivary surfaces, &c. contributes principally to produce that rapidity with which the digestive and secretory phenomena succeed each other; in the other, this sensibility blunted by habitual contact, connects but slowly the same phenomena.
Is it not from the same cause that arises this remarkable modification of the sensibility of this system, viz. that at its origins, as upon the pituitary, the palatine membranes, the oesophagus, the glans penis, the opening of the rectum, &c. it gives us the sensation of the bodies with which it is in contact, and that it does not give this sensation in the very deep organs which it lines, as in the intestines, the excretories, the gall-bladder, &c.? In the interior of the organs, this contact is always uniform; the bladder only knows the contact of the urine, the gall-bladder that of the bile, the stomach that of the aliments masticated and reduced, whatever may be their diversity, to an uniform, pulpy mass. This uniformity of sensation produces no perception, because in order to perceive, it is necessary to compare, and here the two terms of comparison are wanting. Thus the foetus has no sensation of the waters of the amnios; thus, the air, very irritating to a new born infant, becomes insensible to it. On the contrary, at the beginning of the mucous membranes, the stimulants vary every instant; the mind can then perceive the presence of them, because it can establish approximations between their different modes of action. What I say is so true, that if in the interior of the organs, the mucous membranes are in contact with a foreign body, different from that which they are accustomed to, they transmit the sensation of it to the mind. A catheter in the bladder, sounds introduced into the stomach, &c. are examples of this. Fresh air, in great heat of the atmosphere, suddenly introduced into the trachea, carries an agreeable sensation over the whole surface of the bronchia; but habit soon renders us insensible to it and we cease to have the perception of it. Yet it is to be observed that when the intestines come out in preternatural inversions of the anus, their sensibility never becomes so acute as that of the palatine, pituitary surfaces, &c. &c. The absence of cerebral nerves no doubt has an influence upon this phenomenon.
The sensibility of the mucous system is much raised in inflammations; acute catarrhs are, as we know, very painful. The contact of bodies is then not only felt, but is very disagreeable. I would observe however that the sensibility never rises so high as it does in the inflamed cellular, serous, fibrous systems, &c. A phlegmon, a pleurisy, &c. compared with a catarrh, are sufficient to convince us of this. We may say that the organs least accustomed to feel in the natural state, experience in diseases the most acute sensations.
There is no animal contractility in the mucous system.
Properties of Organic Life.
Organic sensibility and insensible contractility are very evident in the mucous system. They are constantly put in action in it by four different causes; 1st, by the nutrition of this system; 2d, by the absorption that takes place in it, either naturally or accidentally; 3d, by its exhalation; 4th, by the constant secretion of its glands. These two properties are the original causes of all these functions, the increase and diminution of which are truly the indices of the state of these glands. As a thousand causes continually act upon the mucous surfaces, as a thousand different stimuli continually excite them, especially at their origin, this state is incessantly varying like the functions that result from it.
The mucous system differs then from most of the others; 1st, in this, that the organic sensibility and the insensible contractility are habitually more exalted in it, on account of the more numerous functions over which they preside; 2d, in this, that they incessantly vary, on account of the variety of the stimuli. Observe in fact that, in the osseous, fibrous, cartilaginous, muscular, nervous systems, &c. on the one hand, these properties are put in action only by nutrition; and on the other, no stimulant being in contact with these systems, they always remain at the same degree.
Hence it is not astonishing that the diseases which especially put in action the organic sensibility and the insensible contractility of the same species, should be so frequent in the mucous organs. All the catarrhal affections, both acute and chronic, all the hemorrhages, various and numerous tumours, polypi, fungi, &c. all kinds of excoriations, ulcers, &c. of which they are the seat, are derived from the various alterations of which their organic properties are susceptible.
It is also to these alterations that must be attributed a remarkable phenomenon, viz. the innumerable varieties the mucous fluids exhibit in diseases. Take for example those that are thrown off from the internal surface of the bronchia, those that are brought up by expectoration, and which we can examine better than others, because they are mixed with no foreign substance; observe how they differ, in the different affections of the chest; sometimes they have a yellowish and as it were bilious tinge; sometimes they are frothy in the vessel which receives them; sometimes they adhere to it with tenacity, and at others they are easily detached from it. Viscid or liquid, fetid or without odour, grey, white, green or even black in the morning, they have a thousand external appearances which evidently denote differences in their composition, differences which chemists have not yet explained to us. I do not speak of the cases where as in phthisis, hemoptysis, &c. foreign substances are mixed with these mucous juices. Now it is evident that all these varieties depend only upon the varieties of the organic sensibility of the bronchial glands or of the membrane upon which they pour out their fluids. According as the property is differently altered in the mucous system, it is in relation with different substances, admits some and rejects others. The same organ, the same vessels can there, according to the state of the forces that animate them, separate from the mass of blood many different substances, rejecting one to-day and admitting it to-morrow, &c.
Do you wish for other proofs of the innumerable varieties which the different modifications of the organic sensibility of the mucous membranes produce in their functions? Observe the urethra; in the ordinary state it lets the urine pass freely; in the excitement in which its forces are in erection, its sensibility repels it and admits only the semen. Who does not know that in one species of epiphora, the mucous passages for the tears are open, and that the diminution only of their vital forces prevents this fluid from flowing in them? The sensibility of the mucous surfaces is oftentimes so altered that their glands refuse to admit every kind of fluid; this happens in the beginning of some peripneumonies, in which expectoration is entirely suppressed, it is always a serious beginning, and even an indication of death, if the state of the sensibility does not change, unless a relaxation, as it is commonly called, takes place.
In general, I think that there are but few systems which deserve, more than this of which we are treating, to fix the attention of physicians, on account of the innumerable alterations of which it is susceptible, alterations which almost always suppose those of the predominant vital properties of this system, as the alterations of the muscular, nervous systems, &c. most often put in action the properties which more particularly belong to them, viz. animal contractility for one, and the sensibility of the same species for the other.
The sensible organic contractility does not appear to be the attribute of the mucous system; yet there is often in it something more than the insensible oscillations which compose the other organic contractility. For example, in the emission of semen, in which there is no agent of impulse at the extremity of the urethra, as in the evacuation of urine, it is very probable that this is spasmodically contracted to produce the jet, oftentimes very strong, which then takes place. The following phenomenon which I have observed in myself appears to belong to the same cause. In gaping, there sometimes escapes from the mouth then wide open, a small jet of fluid, which coming from the lateral parts of this cavity that it passes over, is thrown at some distance; if a surface is then before the mouth, as when we read a book, this fluid is spread in small drops upon this surface; it is the saliva which the excretory duct of Steno throws out with force. Now on the one hand this duct is almost wholly mucous, and on the other it has not at its posterior part a muscular agent of impulse. Perhaps the excretories which pour out their fluids in the deep parts of the organs, exhibit the same phenomenon. We know that the milk is also sometimes subject to a kind of ejection, when it is very abundant, an ejection which supposes a powerful contraction of the lactiferous ducts. In general, these different motions analogous to that of the dartos, of the cellular texture, &c. appear to hold a middle place between those of tone and those of irritability.
Sympathies.
There are few systems that sympathize more frequently with the others than this. Now in its sympathies, it sometimes influences and sometimes is influenced. The first Tissot calls the active mode of sympathy, the second the passive. Let us make use of this classification.
Active Sympathies.
One point of the mucous system being inflamed, irritated or stimulated in any way, all the vital forces can enter separately into action in the other systems.
Sometimes it is the animal contractility that is brought sympathetically into action; thus the diaphragm, the intercostal and abdominal muscles contract to produce sneezing from irritation of the pituitary membrane, or cough from the irritation of the membrane of the bronchia, or from that even of the surface of the stomach, which produces stomachic coughs, which, as we know, have nothing to do with affections of the chest. We know the general spasm that seizes all the muscles the instant a foreign body passes between the mucous edges of the epiglottis. Stones of the bladder and the urethra, by making the cremaster contract sympathetically, produce retraction of the testicle. Physicians might, I think, profit by the knowledge of these mucous sympathies. In apoplexy, in which the bronchia is sometimes filled with mucus that the patient cannot evacuate, the action of ammonia upon the pituitary membrane produces the double effect, 1st, of stimulating the brain as blisters do; 2d, of freeing, by the cough it occasions, the surface of the bronchia, which being obstructed, is an obstacle to the passage of the air.
Sometimes it is the animal sensibility that is put into action by an affection of the mucous surfaces. The stone, that irritates that of the bladder, causes an itching at the end of the glans penis. That of the intestines being irritated by worms, an inconvenient itching is felt at the end of the nose. Whytt has seen a foreign body introduced into the ear, affect painfully the whole corresponding side of the head; an ulcer of the bladder, produce every time the patient passed water, a pain on the superior part of the thigh, &c. &c.
The sensible organic contractility is often sympathetically excited by the affections of the mucous system. I might at first refer to this subject what I have observed respecting the organic muscles, almost all of which move from an excitement of a contiguous mucous surface; but that is a natural phenomenon; there are many others that are preternatural. A stone that irritates the internal surface of the pelvis of the kidney produces vomiting, which is, as we know, produced any time at will by an irritation of the uvula. The instant the semen passes the urethra in coition, the action of the heart is commonly accelerated. Tissot speaks of a stone which, being entangled in the duct of Warton, produced a sympathetic discharge from the bowels. I saw at the HÔtel Dieu two women, who, whenever they menstruated, and the mucous surface of the womb was consequently in activity, could retain the urine but a short time in the bladder, which contracted involuntarily to expel it the moment it entered it. At ordinary times, there was nothing peculiar in the evacuation of this fluid.
As to the sympathies of insensible contractility and of organic sensibility, they take place when a mucous surface being irritated towards the extremity of an excretory duct, the gland of this duct is brought into action, when, for example, the saliva flows in greater abundance by the action of sialagogues upon the extremity of the Stenonian duct. Whenever there is a gastric derangement and the mucous surface of the stomach consequently suffers, the surface of the tongue is sympathetically affected; the glands situated under this surface increase their action and hence that white mucous coat, that is commonly called a foul tongue, which is a real sympathetic catarrh, but which can however exist idiopathically. Here also is to be referred the remarkable influence of the mucous system upon the cutaneous; thus during digestion, in which the mucous juices pour out abundantly from all sides into the stomach and the intestines, and in which the mucous membranes of the gastric viscera are consequently in great action, the fluid of insensible transpiration is lessened remarkably, according to the observation of Sanctorius; it is in very small quantity three hours after the meal, so that the action of the cutaneous organ is evidently less energetic. Thus during sleep, in which all the internal functions become more evident and are exerted to their utmost, and in which the sensibility of the mucous membranes is consequently strongly developed, the skin seems to be struck with a species of atony; it becomes cold more easily, it allows less substances to escape from it, &c. To these sympathies also can be referred many phenomena of hemorrhages. We know with what facility the mucous surface ceasing, from any accidental cause, to throw out blood, as happens so often on that of the womb, another is immediately affected and discharges this fluid; hence hemorrhages from the nose, the stomach, the chest, &c. from the suppression of those of the uterus, &c.
Passive Sympathies.
In many cases, the other systems being irritated, the animal sensibility of this is brought into action. Among the numerous examples of this fact, the following is a remarkable one. In many diseases in which organs foreign to the mucous system are affected, we experience a sensation of burning heat in the mouth, the stomach, the intestines, &c. and yet the mucous surface, the seat of this sensation, does not disengage more caloric than usual; we may be convinced of this by placing the fingers in the mouth. This sensation is of the same nature as that which we refer to the glans penis when there is a stone in the bladder, as that which is experienced at the end of the nose from worms in the intestines, &c. There is no material cause of pain, and yet there is suffering. Thus in intermittent fevers we experience a cutaneous shivering, though the skin may be as warm as usual; I would observe in respect to this, that the mucous membranes are hardly ever the seat of an analogous sensation of sympathetic cold, but it is almost always a sensation of heat that the aberrations of the vital forces produce in them. Whence arises this difference between them and the cutaneous organs? I know not. I attribute also to a sympathy of animal sensibility the great thirst which takes place in all the severe affections of any part. In all great wounds, after severe operations, in experiments on living animals, &c. we observe this thirst which depends upon a sympathetic affection of the whole mucous surface that extends into the mouth, the stomach and the oesophagus.
Animal contractility cannot be put sympathetically into action in the mucous system, since it does not exist in it.
The same is true of the sensible organic contractility. It is possible that sometimes the kind of motion we have noticed, and which resembles this property, may be sympathetically excited; I know no example of it.
The insensible organic contractility is here very frequently in sympathetic activity. It is the skin especially which exercises by means of this property, a great influence upon the mucous system. 1st. In hemorrhages of the mucous surface of the womb, the nostrils, &c. a cold body applied to the skin in the neighbourhood, contracts this surface and stops the blood. 2d. Who does not know that the production of most catarrhs is often the sudden consequence of the action of cold on the cutaneous organ? 3d. In various affections of the mucous membranes, baths which relax and expand the skin, frequently produce happy effects. 4th. When the temperature of the atmosphere benumbs the cutaneous tone, that of the mucous system receives a remarkable increase of energy. Hence why in winter and in cold climates, in which the functions of the skin are very much diminished, all those of this system increase in proportion. Hence the more evident pulmonary exhalation, the more abundant internal secretions, a more active digestion, more quickly performed and consequently an appetite more easily excited. 5th. When on the contrary the heat of the climate and the season relax and expand the cutaneous surface, the mucous surface is in proportion contracted; in summer, at noon, &c. there is a diminution of the secretions, of that of the urine especially, a slowness in the digestive phenomena from a defect in the action of the stomach and intestines, an appetite slow to return, &c. 6th. In various general affections of the skin, certain portions of the mucous membranes are almost always affected. In scarlet fever, the throat most usually suffers sympathetically. This phenomenon is very common in small pox. 7th. In the latter periods of organic affections of the viscera, as in phthisis, diseases of the heart, enlargements of the liver, cancers of the womb, &c. the mucous membranes are affected like the serous surfaces. The kind of atony in which they then are, produces a more copious flow of mucous juices in them which are altered, become more fluid, &c.; hence the diarrhoeas that are called colliquative, which are then to the mucous surfaces, what dropsies are to the serous ones; 8th. It is also to this atony that must be attributed the pectoral hemorrhages which so frequently take place in the last periods of organic diseases, in those of the heart especially. During the short time that I have been at the HÔtel Dieu, there has already died more than twenty patients whom I have opened, of these affections almost forgotten by all practitioners before the time of Corvisart; I have only observed four examples in which passive hemorrhage of the lungs was not the precursor of death.
Character of the Vital Properties.
From what we have thus far said, it is evident that the mucous system is one of those of the whole economy, in which life is the most active. Always in contact with substances that stimulate and irritate it, it is as it were like the skin, in continual action. Yet the life is not the same in all its parts; it undergoes in each remarkable modifications, which no doubt depend on those we have pointed out in the organization of this system, in the nature of its corion, in the arrangement of its papillÆ, in the distribution of its vessels and its nerves, in that of its glands, &c.; for as we have seen, none of these essential bases of the mucous system is everywhere arranged in the same manner. There is an organization common to the system, and one peculiar to each of its divisions. It is the same in regard to its life; there is a life common to the system, and as many peculiar ones as there are parts to which it is extended. We know how much the animal sensibility of the pituitary membrane differs from that of the palatine, how powerfully the membrane of the glans penis and the urethra is stimulated by the passage of the semen which makes no impression upon any other mucous surface. The same is true in regard to the organic sensibility and the contractility of the same species. Each mucous surface, in relation with the fluid it is accustomed to, would bear the others with difficulty. The urine would be a stimulant for the stomach and the gastric juice for the bladder; the bile that remains in the gall-bladder would produce a catarrh upon the membrane of the nose, in the vesiculÆ seminales, &c.
From these varieties in the vital forces of each division of the mucous system, it is not astonishing that the diseases of this system should also be very variable. Each has a general character, but this is modified in each mucous surface. There is an order of symptoms common to all catarrhs; but each has its peculiar signs, each has its different products. The fluid from a pulmonary catarrh does not resemble that from a nasal one; that coming from a urethral, vesical catarrh, &c. is wholly different from that from an intestinal one. These fluids exhibit in their morbid changes the same differences that we have pointed out in their natural composition, differences which are derived like them, from the different vitality of each portion of the mucous system.
It is to these varieties of life and the vital forces that must be referred also those of the sympathies. Each portion of this system has a peculiar sympathetic action upon the other organs. The pituitary alone being irritated produces sneezing. You would excite in vain the extremity of the glans penis, the rectum, &c. you would never produce vomiting as you do by stimulating the uvula.
An important remark should here be made in regard to the stomach. We know that there is no organ which performs a more important part in the sympathies than this. The least affection of this important viscus, the least gastric derangement, spread over the whole animal economy a painful influence; all the other parts feel it. I do not believe even that there is any uneasiness more fatiguing and general than that which we then experience in certain cases. The general weakness which takes place in hunger almost instantaneously, is sympathetic; the alteration of nutrition has not had time to produce it. The same is true with regard to the sudden increase of the forces which results from the contact of the aliments upon the mucous surface of this viscus, an increase which cannot be attributed to the passage of the chyle into the blood, which has not yet had time to take place.
I think the stomach owes this important part in the sympathies principally to its mucous surface. In fact, 1st, its serous surface has no connexion with it, since it is there of the same nature as in all the rest of the peritoneum, besides in what is called inflammation of the abdomen, and in which this serous surface is especially affected, we do not observe such numerous sympathetic relations. 2d. The fleshy coat appears to be the same as that of the whole intestinal canal; why then should it have different influences? 3d. As it respects blood-vessels and nerves of the ganglions, the stomach is nearly organized like the rest of the alimentary tube. 4th. It has besides the par vagum; but is this nerve alone capable of producing such numerous phenomena? It can contribute to them; but certainly the peculiar modifications which it experiences in the mucous surface, the peculiar nature of this membrane contribute also much to it. No membrane is organized like that of the stomach. Though we do not see perfectly at first view its organic differences, reflection is sufficient to convince us of them; thus on the one hand no one separates so great a quantity of fluid, and on the other none furnishes one of a nature analogous to that of the gastric juice.
ARTICLE FOURTH.
DEVELOPMENT OF THE MUCOUS SYSTEM.
I. State of the Mucous System in the First Age.
The development of the mucous system follows in general the laws of that of the organs to which it belongs. Early in the gastric apparatus, later in the pulmonary and that of generation, it seems in its growth rather to obey the impulse it receives, than to give one to what surrounds it, an arrangement common to almost all the systems which contribute to form the different apparatus. Observe in fact that there is always in the growth certain parts to which all the others refer; thus in the cerebral apparatus, the early size of the brain produces that of the bones of the cranium, of the dura-mater, the pia-mater, the arachnoides and the vessels; thus it is on account of the spinal marrow, that the vertebral canal is so evident in the foetus; thus all the serous surfaces have a growth in proportion to that of their respective organs, &c. &c. I would remark however that the early growth of the systems which are only to follow that of the parts to which they are destined, is only in the dimensions of length, breadth, &c. The thickness most commonly does not correspond with these dimensions. Thus the bones of the cranium though broader in proportion than those of the pelvis in the foetus, are not thicker. The extent of the dura-mater is in proportion greater than that of the albuginea which belongs to the same system; but the organization is no further advanced.
In the foetus, the delicacy of the mucous texture is extreme, the papillÆ are hardly perceptible. But by carrying the hand over a mucous surface, we feel there an extremely delicate velvet and such as is not equalled by the finest velvet. The redness of this system is not then as evident, because no doubt less blood penetrates it, as the various functions which are afterwards to take place upon these surfaces, as digestion, the excretions, respiration, &c. are but feeble or entirely wanting. At this age, the quantity of blood seems to be in an inverse ratio in the skin and in these surfaces. The mucous red is then like the muscular, of a very deep tinge, often even livid, on account of the nature of the blood circulating in the arteries. Then the adhesions of the mucous texture to the subjacent cellular are less; those especially of this last with the surrounding parts are very slight; thus it is very easy to draw out whole the internal portion of the intestines of the foetus, from the external covering that contains it, so as to see two cylindrical canals, one of which is muscular and serous, the other cellular and mucous. The stretching destroys in this experiment all the valvulÆ conniventes, and the small intestines are as smooth on the interior as the large, in the canal artificially extracted. If we subject this canal to ebullition, much more scum arises from it than in the adult; this scum is white and never green. The crisping that takes place a little before the first boiling, diminishes more in proportion the length of the canal, and consequently appears to be stronger.
At birth, when respiration and digestion suddenly commence, the secretions increase, the mucous system acquires a remarkable degree of activity. It is instantly excited powerfully by the many new substances with which it is in contact. It is by it and by the cutaneous system that bodies foreign to ours then immediately stimulate it, and so much the more efficaciously, as the double surface which receives the excitement is not accustomed to it. Then the red blood which penetrates the mucous system, gives it an increase of energy and sensibility, which renders it still more proper to receive impressions. Thus the mucous juices which till then stagnated upon their respective surfaces, without fatiguing and irritating them, are suddenly for them, on account of their increase of sensibility, stimulants which excite them, and force the subjacent muscles to contract. Then the urine becomes for the bladder a cause that promotes the contraction of it. A few instants after birth, all the openings in which the mucous membranes begin, open and permit to escape the meconium, the urine and all the mucous juices. This internal and general shock that empties all the mucous cavities, renders them fit to become the seat of the great functions which are soon to take place in them.
When all the internal functions are in activity, the mucous surfaces experience no more sudden changes, analogous to that of which I have spoken. They grow like the other viscera in a slow and insensible manner; they preserve for a long time their original softness, which is remarkable, especially in the nose, the stomach, &c. and which during lactation, is not adapted in the infant, to the solid substances with which the adult is nourished. Is this softness the cause of the mucous affections which are in general so common at that age? We know that then the mucous juices abound; the pituitary membrane is more moist; the stomach and intestines are frequently affected with a species of catarrh which is the cause of the looseness that we have so often to combat in infancy. The membrane of the bronchia is also frequently diseased. The two extreme ages of life resemble each other by the abundance of the mucous juices secreted upon their respective mucous surfaces.
In youth the mucous system is in very powerful action. The active hemorrhages of this system are very frequent at this age; those of the nose, the bronchia and even the stomach often take place; those of the portions of this system, subjacent to the diaphragm, are then less common. Observe that in man, hemorrhages of the gastro-pulmonary surface are infinitely more frequent than those of the genito-urinary surface, which on the contrary, are much more numerous in woman in whom one of them is natural to a part of this surface, viz. menstruation.
At the period of puberty, the development of the genital parts in both sexes, gives much activity to a part of the genito-urinary surface; then menstruation begins upon that of the womb; then the sensibility of the urethra is raised in order to feel acutely the passage of the semen. Observe that this increase of energy is not attended with a weakness of the other parts, as happens in many cases; on the contrary, all the systems, all the apparatus seem to borrow, from the force which the genital parts acquire, an increase of action.
II. State of the Mucous System in the subsequent Ages.
In the years which succeed youth, the mucous system continues to grow, thicken and become firmer. Its vital energy seems still to predominate for some time, in the superior surfaces, as in the pituitary, the membrane of the bronchia, &c.; thus the affections of these parts are more frequent until the thirtieth year. But as we advance in age, the abdominal mucous surfaces appear to predominate over the others, as in general all the organs of this region do.
Besides, a thousand causes in the course of life, make the state of the mucous system vary. We do not find it in two subjects, with the same shade of colour, with the same density, with the same external appearance. By taking any surface upon many subjects, that of the stomach, for example, we easily see these differences, with which we must be struck if we have opened dead bodies but ever so little.
The redness of the mucous texture is very bright until the thirtieth year; after that, it begins to alter. This texture becomes more and more pale in old age; the blood enters it but in small quantity; it acquires more consistence and density. The fingers carried over it no longer perceive that softness, that velvet so remarkable in the first age. Its forces, which grow languid, render difficult, in the excretories, the exit of the fluids which pass through these tubes to be thrown out. Yet the mucous glands still secrete their fluids in very great abundance. Often even these fluids increase in proportion which constitutes the catarrhal affections, so common in old age. But these affections then have the same character as the functions of the whole system; secretion takes place slowly; the disease is always chronic; most often it terminates only with life.
The mucous absorption is, at this age, slow and difficult, like all the others; the various contagions are taken much less easily, either by the respiratory surfaces, or by the contact of contagious miasmata upon the neighbouring surfaces of the skin. The chyle slowly absorbed, makes the digestive periods longer.
