OF THE SECRETIONS OF SALIVA, AND OF TEARS, AND OF THE LACRYMAL SACK.
I. Secretion of saliva increased by mercury in the blood. 1. By the food in the mouth. Dryness of the mouth not from a deficiency of saliva. 2. By Sensitive ideas. 3. By volition. 4. By distasteful substances. It is secreted in a dilute and saline state. It then becomes more viscid. 5. By ideas of distasteful substances. 6. By nausea. 7. By aversion. 8. By catenation with stimulating substances in the ear. II. 1. Secretion of tears less in sleep. From stimulation of their excretory duct. 2. Lacrymal sack is a gland. 3. Its uses. 4. Tears are secreted, when the nasal duct is stimulated. 5. Or when it is excited by sensation. 6. Or by volition. 7. The lacrymal sack can regurgitate its contents into the eye. 8. More tears are secreted by association with the irritation of the nasal duct of the lacrymal sack, than the puncta lacrymalia can imbibe. Of the gout in the liver and stomach.
I. The salival glands drink up a certain fluid from the circumfluent blood, and pour it into the mouth. They are sometimes stimulated into action by the blood, that surrounds their origin, or by some part of that heterogeneous fluid: for when mercurial salts, or oxydes, are mixed with the blood, they stimulate these glands into unnatural exertions; and then an unusual quantity of saliva is separated.
1. As the saliva secreted by these glands is most wanted during the mastication of our food, it happens, when the terminations of their ducts in the mouth are stimulated into action, the salival glands themselves are brought into increased action at the same time by association, and separate a greater quantity of their juices from the blood; in the same manner as tears are produced in greater abundance during the stimulus of the vapour of onions, or of any other acrid material in the eye.
The saliva is thus naturally poured into the mouth only during the stimulus of our food in mastication; for when there is too great an exhalation of the mucilaginous secretion from the membranes, which line the mouth, or too great an absorption of it, the mouth becomes dry, though there is no deficiency in the quantity of saliva; as in those who sleep with their mouths open, and in some fevers.
2. Though during the mastication of our natural food the salival glands are excited into action by the stimulus on their excretory ducts, and a due quantity of saliva is separated from the blood, and poured into the mouth; yet as this mastication of our food is always attended with a degree of pleasure; and that pleasurable sensation is also connected with our ideas of certain kinds of aliment; it follows, that when these ideas are reproduced, the pleasurable sensation arises along with them, and the salival glands are excited into action, and fill the mouth with saliva from this sensitive association, as is frequently seen in dogs, who slaver at the sight of food.
3. We have also a voluntary power over the action of these salival glands, for we can at any time produce a flow of saliva into our mouth, and spit out, or swallow it at will.
4. If any very acrid material be held in the mouth, as the root of pyrethrum, or the leaves of tobacco, the salival glands are stimulated into stronger action than is natural, and thence secrete a much larger quantity of saliva; which is at the same time more viscid than in its natural state; because the lymphatics, that open their mouths into the ducts of the salival glands, and on the membranes, which line the mouth, are likewise stimulated into stronger action, and absorb the more liquid parts of the saliva with greater avidity; and the remainder is left both in greater quantity and more viscid.
The increased absorption in the mouth by some stimulating substances, which are called astringents, as crab juice, is evident from the instant dryness produced in the mouth by a small quantity of them.
As the extremities of the glands are of exquisite tenuity, as appears by their difficulty of injection, it was necessary for them to secrete their fluids in a very dilute state; and, probably for the purpose of stimulating them into action, a quantity of neutral salt is likewise secreted or formed by the gland. This aqueous and saline part of all secreted fluids is again reabsorbed into the habit. More than half of some secreted fluids is thus imbibed from the reservoirs, into which they are poured; as in the urinary bladder much more than half of what is secreted by the kidneys becomes reabsorbed by the lymphatics, which are thickly dispersed around the neck of the bladder. This seems to be the purpose of the urinary bladders of fish, as otherwise such a receptacle for the urine could have been of no use to an animal immersed in water.
5. The idea of substances disagreeably acrid will also produce a quantity of saliva in the mouth; as when we smell very putrid vapours, we are induced to spit out our saliva, as if something disagreeable was actually upon our palates.
6. When disagreeable food in the stomach produces nausea, a flow of saliva is excited in the mouth by association; as efforts to vomit are frequently produced by disagreeable drugs in the mouth by the same kind of association.
7. A preternatural flow of saliva is likewise sometimes occasioned by a disease of the voluntary power; for if we think about our saliva, and determine not to swallow it, or not to spit it out, an exertion is produced by the will, and more saliva is secreted against our wish; that is, by our aversion, which bears the same analogy to desire, as pain does to pleasure; as they are only modifications of the same disposition of the sensorium. See Class IV. 3. 2. 1.
8. The quantity of saliva may also be increased beyond what is natural, by the catenation of the motions of these glands with other motions, or sensations, as by an extraneous body in the ear; of which I have known an instance; or by the application of stizolobium, siliqua hirsuta, cowhage, to the seat of the parotis, as some writers have affirmed.
II. 1. The lacrymal gland drinks up a certain fluid from the circumfluent blood, and pours it on the ball of the eye, on the upper part of the external corner of the eyelids. Though it may perhaps be stimulated into the performance of its natural action by the blood, which surrounds its origin, or by some part of that heterogeneous fluid; yet as the tears secreted by this gland are more wanted at some times than at others, its secretion is variable, like that of the saliva above mentioned, and is chiefly produced when its excretory duct is stimulated; for in our common sleep there seems to be little or no secretion of tears; though they are occasionally produced by our sensations in dreams.
Thus when any extraneous material on the eye-ball, or the dryness of the external covering of it, or the coldness of the air, or the acrimony of some vapours, as of onions, stimulates the excretory duct of the lacrymal gland, it discharges its contents upon the ball; a quicker secretion takes place in the gland, and abundant tears succeed, to moisten, clean, and lubricate the eye. These by frequent nictitation are diffused over the whole ball, and as the external angle of the eye in winking is closed sooner than the internal angle, the tears are gradually driven forwards, and downwards from the lacrymal gland to the puncta lacrymalia.
2. The lacrymal sack, with its puncta lacrymalia, and its nasal duct, is a complete gland; and is singular in this respect, that it neither derives its fluid from, nor disgorges it into the circulation. The simplicity of the structure of this gland, and both the extremities of it being on the surface of the body, makes it well worthy our minuter observation; as the actions of more intricate and concealed glands may be better understood from their analogy to this.
3. This simple gland consists of two absorbing mouths, a belly, and an excretory duct. As the tears are brought to the internal angle of the eye, these two mouths drink them up, being stimulated into action by this fluid, which they absorb. The belly of the gland, or lacrymal sack, is thus filled, in which the saline part of the tears is absorbed, and when the other end of the gland, or nasal duct, is stimulated by the dryness, or pained by the coldness of the air, or affected by any acrimonious dust or vapour in the nostrils, it is excited into action together with the sack, and the tears are disgorged upon the membrane, which lines the nostrils; where they serve a second purpose to moisten, clean, and lubricate, the organ of smell.
4. When the nasal duct of this gland is stimulated by any very acrid material, as the powder of tobacco, or volatile spirits, it not only disgorges the contents of its belly or receptacle (the lacrymal sack), and absorbs hastily all the fluid, that is ready for it in the corner of the eye; but by the association of its motions with those of the lacrymal gland, it excites that also into increased action, and a large flow of tears is poured into the eye.
5. This nasal duct is likewise excited into strong action by sensitive ideas, as in grief, or joy, and then also by its associations with the lacrymal gland it produces a great flow of tears without any external stimulus; as is more fully explained in Sect. XVI. 8. on Instinct.
6. There are some, famous in the arts of exciting compassion, who are said to have acquired a voluntary power of producing a flow of tears in the eye; which, from what has been said in the section on Instinct above mentioned, I should suspect, is performed by acquiring a voluntary power over the action of this nasal duct.
7. There is another circumstance well worthy our attention, that when by any accident this nasal duct is obstructed, the lacrymal sack, which is the belly or receptacle of this gland, by slight pressure of the finger is enabled to disgorge its contents again into the eye; perhaps the bile in the same manner, when the biliary ducts are obstructed, is returned into the blood by the vessels which secrete it?
8. A very important though minute occurrence must here be observed, that though the lacrymal gland is only excited into action, when we weep at a distressful tale, by its association with this nasal duct, as is more fully explained in Sect. XVI. 8; yet the quantity of tears secreted at once is more than the puncta lacrymalia can readily absorb; which shews that the motions occasioned by associations are frequently more energetic than the original motions, by which they were occasioned. Which we shall have occasion to mention hereafter, to illustrate, why pains frequently exist in a part distant from the cause of them, as in the other end of the urethra, when a stone stimulates the neck of the bladder. And why inflammations frequently arise in parts distant from their cause, as the gutta rosea of drinking people, from an inflamed liver.
The inflammation of a part is generally preceded by a torpor or quiescence of it; if this exists in any large congeries of glands, as in the liver, or any membranous part, as the stomach, pain is produced and chilliness in consequence of the torpor of the vessels. In this situation sometimes an inflammation of the parts succeeds the torpor; at other times a distant more sensible part becomes inflamed; whose actions have previously been associated with it; and the torpor of the first part ceases. This I apprehend happens, when the gout of the foot succeeds a pain of the biliary duct, or of the stomach. Lastly, it sometimes happens, that the pain of torpor exists without any consequent inflammation of the affected part, or of any distant part associated with it, as in the membranes about the temple and eye-brows in hemicrania, and in those pains, which occasion convulsions; if this happens to gouty people, when it affects the liver, I suppose epileptic fits are produced; and, when it affects the stomach, death is the consequence. In these cases the pulse is weak, and the extremities cold, and such medicines as stimulate the quiescent parts into action, or which induce inflammation in them, or in any distant part, which is associated with them, cures the present pain of torpor, and saves the patient.
I have twice seen a gouty inflammation of the liver, attended with jaundice; the patients after a few days were both of them affected with cold fits, like ague-fits, and their feet became affected with gout, and the inflammation of their livers ceased. It is probable, that the uneasy sensations about the stomach, and indigestion, which precedes gouty paroxysms, are generally owing to torpor or slight inflammation of the liver, and biliary ducts; but where great pain with continued sickness, with feeble pulse, and sensation of cold, affect the stomach in patients debilitated by the gout, that it is a torpor of the stomach itself, and destroys the patient from the great connexion of that viscus with the vital organs. See Sect. XXV. 17.
OF THE STOMACH AND INTESTINES.
1. Of swallowing our food. Ruminating animals. 2. Action of the stomach. 3. Action of the intestines. Irritative motions connected with these. 4. Effects of repletion. 5. Stronger action of the stomach and intestines from more stimulating food. 6. Their action inverted by still greater stimuli. Or by disgustful ideas. Or by volition. 7. Other glands strengthen or invert their motions by sympathy. 8. Vomiting performed by intervals. 9. Inversion of the cutaneous absorbents. 10. Increased secretion of bile and pancreatic juice. 11. Inversion of the lacteals. 12. And of the bile-ducts. 13. Case of a cholera. 14. Further account of the inversion of lacteals. 15. Iliac passions. Valve of the colon. 16. Cure of the iliac passion. 17. Pain of gall-stone distinguished from pain of the stomach. Gout of the stomach from torpor, from inflammation. Intermitting pulse owing to indigestion. To overdose of foxglove. Weak pulse from emetics. Death from a blow on the stomach. From gout of the stomach.
1. The throat, stomach, and intestines, may be considered as one great gland; which like the lacrymal sack above mentioned, neither begins nor ends in the circulation. Though the act of masticating our aliment belongs to the sensitive class of motions, for the pleasure of its taste induces the muscles of the jaw into action; yet the deglutition of it when masticated is generally, if not always, an irritative motion, occasioned by the application of the food already masticated to the origin of the pharinx; in the same manner as we often swallow our spittle without attending to it.
The ruminating class of animals have the power to invert the motion of their gullet, and of their first stomach, from the stimulus of this aliment, when it is a little further prepared; as is their daily practice in chewing the cud; and appears to the eye of any one, who attends to them, whilst they are employed in this second mastication of their food.
2. When our natural aliment arrives into the stomach, this organ is simulated into its proper vermicular action; which beginning at the upper orifice of it, and terminating at the lower one, gradually mixes together and pushes forwards the digesting materials into the intestine beneath it.
At the same time the glands, that supply the gastric juices, which are necessary to promote the chemical part of the process of digestion, are stimulated to discharge their contained fluids, and to separate a further supply from the blood-vessels: and the lacteals or lymphatics, which open their mouths into the stomach, are stimulated into action, and take up some part of the digesting materials.
3. The remainder of these digesting materials is carried forwards into the upper intestines, and stimulates them into their peristaltic motion similar to that of the stomach; which continues gradually to mix the changing materials, and pass them along through the valve of the colon to the excretory end of this great gland, the sphincter ani.
The digesting materials produce a flow of bile, and of pancreatic juice, as they pass along the duodenum, by stimulating the excretory ducts of the liver and pancreas, which terminate in that intestine: and other branches of the absorbent or lymphatic system, called lacteals, are excited to drink up, as it passes, those parts of the digesting materials, that are proper for their purpose, by its stimulus on their mouths.
4. When the stomach and intestines are thus filled with their proper food, not only the motions of the gastric glands, the pancreas, liver, and lacteal vessels, are excited into action; but at the same time the whole tribe of irritative motions are exerted with greater energy, a greater degree of warmth, colour, plumpness, and moisture, is given to the skin from the increased action of those glands called capillary vessels; pleasurable sensation is excited, the voluntary motions are less easily exerted, and at length suspended; and sleep succeeds, unless it be prevented by the stimulus of surrounding objects, or by voluntary exertion, or by an acquired habit, which was originally produced by one or other of these circumstances, as is explained in Sect. XXI. on Drunkenness.
At this time also, as the blood-vessels become replete with chyle, more urine is separated into the bladder, and less of it is reabsorbed; more mucus poured into the cellular membranes, and less of it reabsorbed; the pulse becomes fuller, and softer, and in general quicker. The reason why less urine and cellular mucus is absorbed after a full meal with sufficient drink is owing to the blood-vessels being fuller: hence one means to promote absorption is to decrease the resistance by emptying the vessels by venesection. From this decreased absorption the urine becomes pale as well as copious, and the skin appears plump as well as florid.
By daily repetition of these movements they all become connected together, and make a diurnal circle of irritative action, and if one of this chain be disturbed, the whole is liable to be put into disorder. See Sect. XX. on Vertigo.
5. When the stomach and intestines receive a quantity of food, whose stimulus is greater than usual, all their motions, and those of the glands and lymphatics, are stimulated into stronger action than usual, and perform their offices with greater vigour and in less time: such are the effects of certain quantities of spice or of vinous spirit.
6. But if the quantity or duration of these stimuli are still further increased, the stomach and throat are stimulated into a motion, whose direction is contrary to the natural one above described; and they regurgitate the materials, which they contain, instead of carrying them forwards. This retrograde motion of the stomach may be compared to the stretchings of wearied limbs the contrary way, and is well elucidated by the following experiment. Look earnestly for a minute or two on an area an inch square of pink silk, placed in a strong light, the eye becomes fatigued, the colour becomes faint, and at length vanishes, for the fatigued eye can no longer be stimulated into direct motions; then on closing the eye a green spectrum will appear in it, which is a colour directly contrary to pink, and which will appear and disappear repeatedly, like the efforts in vomiting. See Section XXIX. 11.
Hence all those drugs, which by their bitter or astringent stimulus increase the action of the stomach, as camomile and white vitriol, if their quantity is increased above a certain dose become emetics.
These inverted motions of the stomach and throat are generally produced from the stimulus of unnatural food, and are attended with the sensation of nausea or sickness: but as this sensation is again connected with an idea of the distasteful food, which induced it; so an idea of nauseous food will also sometimes excite the action of nausea; and that give rise by association to the inversion of the motions of the stomach and throat. As some, who have had horse-flesh or dogs-flesh given them for beef or mutton, are said to have vomited many hours afterwards, when they have been told of the imposition.
I have been told of a person, who had gained a voluntary command over these inverted motions of the stomach and throat, and supported himself by exhibiting this curiosity to the public. At these exhibitions he swallowed a pint of red rough gooseberries, and a pint of white smooth ones, brought them up in small parcels into his mouth, and restored them separately to the spectators, who called for red or white as they pleased, till the whole were redelivered.
7. At the same time that these motions of the stomach and throat are stimulated into inversion, some of the other irritative motions, that had acquired more immediate connexions with the stomach, as those of the gastric glands, are excited into stronger action by this association; and some other of these motions, which are more easily excited, as those of the gastric lymphatics, are inverted by their association with the retrograde motions of the stomach, and regurgitate their contents, and thus a greater quantity of mucus, and of lymph, or chyle, is poured into the stomach, and thrown up along with its contents.
8. These inversions of the motion of the stomach in vomiting are performed by intervals, for the same reason that many other motions are reciprocally exerted and relaxed; for during the time of exertion the stimulus, or sensation, which caused this exertion, is not perceived; but begins to be perceived again, as soon as the exertion ceases, and is some time in again producing its effect. As explained in Sect. XXXIV. on Volition, where it is shewn, that the contractions of the fibres, and the sensation of pain, which occasioned that exertion, cannot exist at the same time. The exertion ceases from another cause also, which is the exhaustion of the sensorial power of the part, and these two causes frequently operate together.
9. At the times of these inverted efforts of the stomach not only the lymphatics, which open their mouths into the stomach, but those of the skin also, are for a time inverted; for sweats are sometimes pushed out during the efforts of vomiting without an increase of heat.
10. But if by a greater stimulus the motions of the stomach are inverted still more violently or more permanently, the duodenum has its peristaltic motions inverted at the same time by their association with those of the stomach; and the bile and pancreatic juice, which it contains, are by the inverted motions brought up into the stomach, and discharged along with its contents; while a greater quantity of bile and pancreatic juice is poured into this intestine; as the glands, that secrete them, are by their association with the motions of the intestine excited into stronger action than usual.
11. The other intestines are by association excited into more powerful action, while the lymphatics, that open their mouths into them, suffer an inversion of their motions corresponding with the lymphatics of the stomach, and duodenum; which with a part of the abundant secretion of bile is carried downwards, and contributes both to stimulate the bowels, and to increase the quantity of the evacuations. This inversion of the motion of the lymphatics appears from the quantity of chyle, which comes away by stools; which is otherwise absorbed as soon as produced, and by the immense quantity of thin fluid, which is evacuated along with it.
12. But if the stimulus, which inverts the stomach, be still more powerful, or more permanent, it sometimes happens, that the motions of the biliary glands, and of their excretory ducts, are at the same time inverted, and regurgitate their contained bile into the blood-vessels, as appears by the yellow colour of the skin, and of the urine; and it is probable the pancreatic secretion may suffer an inversion at the same time, though we have yet no mark by which this can be ascertained.
13. Mr. —— eat two putrid pigeons out of a cold pigeon-pye, and drank about a pint of beer and ale along with them, and immediately rode about five miles. He was then seized with vomiting, which was after a few periods succeeded by purging; these continued alternately for two hours; and the purging continued by intervals for six or eight hours longer. During this time he could not force himself to drink more than one pint in the whole; this great inability to drink was owing to the nausea, or inverted motions of the stomach, which the voluntary exertion of swallowing could seldom and with difficulty overcome; yet he discharged in the whole at least six quarts; whence came this quantity of liquid? First, the contents of the stomach were emitted, then of the duodenum, gall-bladder, and pancreas, by vomiting. After this the contents of the lower bowels, then the chyle, that was in the lacteal vessels, and in the receptacle of chyle, was regurgitated into the intestines by a retrograde motion of these vessels. And afterwards the mucus deposited in the cellular membrane, and on the surface of all the other membranes, seems to have been absorbed; and with the fluid absorbed from the air to have been carried up their respective lymphatic branches by the increased energy of their natural motions, and down the visceral lymphatics, or lacteals, by the inversion of their motions.
14. It may be difficult to invent experiments to demonstrate the truth of this inversion of some branches of the absorbent system, and increased absorption of others, but the analogy of these vessels to the intestinal canal, and the symptoms of many diseases, render this opinion more probable than many other received opinions of the animal œconomy.
In the above instance, after the yellow excrement was voided, the fluid ceased to have any smell, and appeared like curdled milk, and then a thinner fluid, and some mucus, were evacuated; did not these seem to partake of the chyle, of the mucous fluid from all the cells of the body, and lastly, of the atmospheric moisture? All these facts may be easily observed by any one, who takes a brisk purge.
15. Where the stimulus on the stomach, or on some other part of the intestinal canal, is still more permanent, not only the lacteal vessels, but the whole canal itself, becomes inverted from its associations: this is the iliac passion, in which all the fluids mentioned above are thrown up by the mouth. At this time the valve in the colon, from the inverted motions of that bowel, and the inverted action of this living valve, does not prevent the regurgitation of its contents.
The structure of this valve may be represented by a flexile leathern pipe standing up from the bottom of a vessel of water: its sides collapse by the pressure of the ambient fluid, as a small part of that fluid passes through it; but if it has a living power, and by its inverted action keeps itself open, it becomes like a rigid pipe, and will admit the whole liquid to pass. See Sect. XXIX. 2. 5.
In this case the patient is averse to drink, from the constant inversion of the motions of the stomach, and yet many quarts are daily ejected from the stomach, which at length smell of excrement, and at last seem to be only a thin mucilaginous or aqueous liquor.
From whence is it possible, that this great quantity of fluid for many successive days can be supplied, after the cells of the body have given up their fluids, but from the atmosphere? When the cutaneous branch of absorbents acts with unnatural strength, it is probable the intestinal branch has its motions inverted, and thus a fluid is supplied without entering the arterial system. Could oiling or painting the skin give a check to this disease?
So when the stomach has its motions inverted, the lymphatics of the stomach, which are most strictly associated with it, invert their motions at the same time. But the more distant branches of lymphatics, which are less strictly associated with it, act with increased energy; as the cutaneous lymphatics in the cholera, or iliac passion, above described. And other irritative motions become decreased, as the pulsations of the arteries, from the extra-derivation or exhaustion of the sensorial power.
Sometimes when stronger vomiting takes place the more distant branches of the lymphatic system invert their motions with those of the stomach, and loose stools are produced, and cold sweats.
So when the lacteals have their motions inverted, as during the operation of strong purges, the urinary and cutaneous absorbents have their motions increased to supply the want of fluid in the blood, as in great thirst; but after a meal with sufficient potation the urine is pale, that is, the urinary absorbents act weakly, no supply of water being wanted for the blood. And when the intestinal absorbents act too violently, as when too great quantities of fluid have been drank, the urinary absorbents invert their motions to carry off the superfluity, which is a new circumstance of association, and a temporary diabetes supervenes.
16. I have had the opportunity of seeing four patients in the iliac passion, where the ejected material smelled and looked like excrement. Two of these were so exhausted at the time I saw them, that more blood could not be taken from them, and as their pain had ceased, and they continued to vomit up every thing which they drank, I suspected that a mortification of the bowel had already taken place, and as they were both women advanced in life, and a mortification is produced with less preceding pain in old and weak people, these both died. The other two, who were both young men, had still pain and strength sufficient for further venesection, and they neither of them had any appearance of hernia, both recovered by repeated bleeding, and a scruple of calomel given to one, and half a dram to the other, in very small pills: the usual means of clysters, and purges joined with opiates, had been in vain attempted. I have thought an ounce or two of crude mercury in less violent diseases of this kind has been of use, by contributing to restore its natural motion to some part of the intestinal canal, either by its weight or stimulus; and that hence the whole tube recovered its usual associations of progressive peristaltic motion. I have in three cases seen crude mercury given in small doses, as one or two ounces twice a day, have great effect in stopping pertinacious vomitings.
17. Besides the affections above described, the stomach is liable, like many other membranes of the body, to torpor without consequent inflammation: as happens to the membranes about the head in some cases of hemicrania, or in general head-ach. This torpor of the stomach is attended with indigestion, and consequent flatulency, and with pain, which is usually called the cramp of the stomach, and is relievable by aromatics, essential oils, alcohol, or opium.
The intrusion of a gall-stone into the common bile-duct from the gall-bladder is sometimes mistaken for a pain of the stomach, as neither of them are attended with fever; but in the passage of a gall-stone, the pain is confined to a less space, which is exactly where the common bile-duct enters the duodenum, as explained in Section XXX. 1. 3. Whereas in this gastrodynia the pain is diffused over the whole stomach; and, like other diseases from torpor, the pulse is weaker, and the extremities colder, and the general debility greater, than in the passage of a gall-stone; for in the former the debility is the consequence of the pain, in the latter it is the cause of it.
Though the first fits of the gout, I believe, commence with a torpor of the liver; and the ball of the toe becomes inflamed instead of the membranes of the liver in consequence of this torpor, as a coryza or catarrh frequently succeeds a long exposure of the feet to cold, as in snow, or on a moist brick-floor; yet in old or exhausted constitutions, which have been long habituated to its attacks, it sometimes commences with a torpor of the stomach, and is transferable to every membrane of the body. When the gout begins with torpor of the stomach, a painful sensation of cold occurs, which the patient compares to ice, with weak pulse, cold extremities, and sickness; this in its slighter degree is relievable by spice, wine, or opium; in its greater degree it is succeeded by sudden death, which is owing to the sympathy of the stomach with the heart, as explained below.
If the stomach becomes inflamed in consequence of this gouty torpor of it, or in consequence of its sympathy with some other part, the danger is less. A sickness and vomiting continues many days, or even weeks, the stomach rejecting every thing stimulant, even opium or alcohol, together with much viscid mucus; till the inflammation at length ceases, as happens when other membranes, as those of the joints, are the seat of gouty inflammation; as observed in Sect. XXIV. 2. 8.
The sympathy, or association of motions, between those of the stomach and those of the heart, are evinced in many diseases. First, many people are occasionally affected with an intermission of their pulse for a few days, which then ceases again. In this case there is a stop of the motion of the heart, and at the same time a tendency to eructation from the stomach. As soon as the patient feels a tendency to the intermission of the motion of his heart, if he voluntarily brings up wind from his stomach, the stop of the heart does not occur. From hence I conclude that the stop of digestion is the primary disease; and that air is instantly generated from the aliment, which begins to ferment, if the digestive process is impeded for a moment, (see Sect. XXIII. 4.); and that the stop of the heart is in consequence of the association of the motions of these viscera, as explained in Sect. XXXV. 1. 4.; but if the little air, which is instantly generated during the temporary torpor of the stomach, be evacuated, the digestion recommences, and the temporary torpor of the heart does not follow. One patient, whom I lately saw, and who had been five or six days much troubled with this intermission of a pulsation of his heart, and who had hemicrania with some fever, was immediately relieved from them all by losing ten ounces of blood, which had what is termed an inflammatory crust on it.
Another instance of this association between the motions of the stomach and heart is evinced by the exhibition of an over dose of foxglove, which induces an incessant vomiting, which is attended with very slow, and sometimes intermitting pulse.—Which continues in spite of the exhibition of wine and opium for two or three days. To the same association must be ascribed the weak pulse, which constantly attends the exhibition of emetics during their operation. And also the sudden deaths, which have been occasioned in boxing by a blow on the stomach; and lastly, the sudden death of those, who have been long debilitated by the gout, from the torpor of the stomach. See Sect. XXXV. 1. 4.
OF THE CAPILLARY GLANDS AND MEMBRANES.
I. 1. The capillary vessels are glands. 2. Their excretory ducts. Experiments on the mucus of the intestines, abdomen, cellular membrane, and on the humours of the eye. 3. Scurf on the head, cough, catarrh, diarrhœa, gonorrhœa. 4. Rheumatism. Gout. Leprosy. II. 1. The most minute membranes are unorganized. 2. Larger membranes are composed of the ducts of the capillaries, and the mouths of the absorbents. 3. Mucilaginous fluid is secreted on their surfaces. III. Three kinds of rheumatism.
I. 1. The capillary-vessels are like all the other glands except the absorbent system, inasmuch as they receive blood from the arteries, separate a fluid from it, and return the remainder by the veins.
2. This series of glands is of the most extensive use, as their excretory ducts open on the whole external skin forming its perspirative pores, and on the internal surfaces of every cavity of the body. Their secretion on the skin is termed insensible perspiration, which in health is in part reabsorbed by the mouths of the lymphatics, and in part evaporated in the air; the secretion on the membranes, which line the larger cavities of the body, which have external openings, as the mouth and intestinal canal, is termed mucus, but is not however coagulable by heat; and the secretion on the membranes of those cavities of the body, which have no external openings, is called lymph or water, as in the cavities of the cellular membrane, and of the abdomen; this lymph however is coagulable by the heat of boiling water. Some mucus nearly as viscid as the white of egg, which was discharged by stool, did not coagulate, though I evaporated it to one fourth of the quantity, nor did the aqueous and vitreous humours of a sheep's eye coagulate by the like experiment: but the serosity from an anasarcous leg, and that from the abdomen of a dropsical person, and the crystalline humour of a sheep's eye, coagulated in the same heat.
3. When any of these capillary glands are stimulated into greater irritative actions, than is natural, they secrete a more copious material; and as the mouths of the absorbent system, which open in their vicinity, are at the same time stimulated into greater action, the thinner and more saline part of the secreted fluid is taken up again; and the remainder is not only more copious but also more viscid than natural. This is more or less troublesome or noxious according to the importance of the functions of the part affected: on the skin and bronchiæ, where this secretion ought naturally to evaporate, it becomes so viscid as to adhere to the membrane; on the tongue it forms a pellicle, which can with difficulty be scraped off; produces the scurf on the heads of many people; and the mucus, which is spit up by others in coughing. On the nostrils and fauces, when the secretion of these capillary glands is increased, it is termed simple catarrh; when in the intestines, a mucous diarrhœa; and in the urethra, or vagina, it has the name of gonorrhœa, or fluor albus.
4. When these capillary glands become inflamed, a still more viscid or even cretaceous humour is produced upon the surfaces of the membranes, which is the cause or the effect of rheumatism, gout, leprosy, and of hard tumours of the legs, which are generally termed scorbutic; all which will be treated of hereafter.
II. 1. The whole surface of the body, with all its cavities and contents, are covered with membrane. It lines every vessel, forms every cell, and binds together all the muscular and perhaps the osseous fibres of the body; and is itself therefore probably a simpler substance than those fibres. And as the containing vessels of the body from the largest to the least are thus lined and connected with membranes, it follows that these membranes themselves consisted of unorganized materials.
For however small we may conceive the diameters of the minutest vessels of the body, which escape our eyes and glasses, yet these vessels must consist of coats or sides, which are made up of an unorganized material, and which are probably produced from a gluten, which hardens after its production, like the silk or web of caterpillars and spiders. Of this material consist the membranes, which line the shells of eggs, and the shell itself, both which are unorganized, and are formed from mucus, which hardens after it is formed, either by the absorption of its more fluid part, or by its uniting with some part of the atmosphere. Such is also the production of the shells of snails, and of shell-fish, and I suppose of the enamel of the teeth.
2. But though the membranes, that compose the sides of the most minute vessels, are in truth unorganized materials, yet the larger membranes, which are perceptible to the eye, seem to be composed of an intertexture of the mouths of the absorbent system, and of the excretory ducts of the capillaries, with their concomitant arteries, veins, and nerves: and from this construction it is evident, that these membranes must possess great irritability to peculiar stimuli, though they are incapable of any motions, that are visible to the naked eye: and daily experience shews us, that in their inflamed state they have the greatest sensibility to pain, as in the pleurisy and paronychia.
3. On all these membranes a mucilaginous or aqueous fluid is secreted, which moistens and lubricates their surfaces, as was explained in Section XXIII. 2. Some have doubted, whether this mucus is separated from the blood by an appropriated set of glands, or exudes through the membranes, or is an abrasion or destruction of the surface of the membrane itself, which is continually repaired on the other side of it, but the great analogy between the capillary vessels, and the other glands, countenances the former opinion; and evinces, that these capillaries are the glands, that secrete it; to which we must add, that the blood in passing these capillary vessels undergoes a change in its colour from florid to purple, and gives out a quantity of heat; from whence, as in other glands, we must conclude that something is secreted from it.
III. The seat of rheumatism is in the membranes, or upon them; but there are three very distinct diseases, which commonly are confounded under this name. First, when a membrane becomes affected with torpor, or inactivity of the vessels which compose it, pain and coldness succeed, as in the hemicrania, and other head-achs, which are generally termed nervous rheumatism; they exist whether the part be at rest or in motion, and are generally attended with other marks of debility.
Another rheumatism is said to exist, when inflammation and swelling, as well as pain, affect some of the membranes of the joints, as of the ancles, wrists, knees, elbows, and sometimes of the ribs. This is accompanied with fever, is analogous to pleurisy and other inflammations, and is termed the acute rheumatism.
A third disease is called chronic rheumatism, which is distinguished from that first mentioned, as in this the pain only affects the patient during the motion of the part, and from the second kind of rheumatism above described, as it is not attended with quick pulse or inflammation. It is generally believed to succeed the acute rheumatism of the same part, and that some coagulable lymph, or cretaceous, or calculous material, has been left on the membrane; which gives pain, when the muscles move over it, as some extraneous body would do, which was too insoluble to be absorbed. Hence there is an analogy between this chronic rheumatism and the diseases which produce gravel or gout-stones; and it may perhaps receive relief from the same remedies, such as aerated sal soda.