General Anatomy, Applied to Physiology and Medicine, Vol. 2 (of 3)

by Xavier Bichat

The lymphatic glands especially have a great tendency to inflammatory swellings, when deleterious substances that are absorbed come in contact with them. In the first periods these substances confine their effects to the first glands they meet; thus the absorption of the venereal virus hardly extends beyond the glands of the groin; thus the axillaries alone swell when a puncture is made with an infected instrument, &c.; the glands that follow, remain untouched.

Though much disposed to inflame, the lymphatic glands exhibit however more slowness in this affection, than many other animal textures, the cellular and cutaneous, for example. We know that phlegmon and erysipelas go through their periods quicker, than the inflammations of the inguinal, axillary glands, &c. The pain of which these inflamed glands are the seat differs also much from that of these two affections; it is more dull, obscure, &c. The pus is more slow in forming; it resembles considerably cellular pus; it differs much from that of erysipelas. There are few textures in the economy that are more disposed than this to hardening after inflammation. For one single time that the skin become scirrhous after erysipelas, the lymphatic glands become so twenty. This is truly one of their distinctive characters.

The absorbents often exhibit to a certain degree, like their glands, a character of slowness in the phenomena over which their organic properties preside. For example, when concerned in a wound, they contract, crisp up and close more slowly than the sanguineous capillaries, that are then also concerned; hence the flow of serum that continues for some minutes after that of blood has ceased. This phenomenon is constant in small wounds. If the absorbents and the capillaries had the same degree of insensible contractility, it certainly would not take place.

Here then are new proofs of the principles of which we have every instant occasion to present the consequences in this work; viz. that the vitality peculiar to each system, the particular degree of vital forces that characterize them, imprint upon all its affections a peculiar tinge and aspect, if I may so express myself, unknown to all the other systems.

Differences of the Vital Properties in the Absorbent Vessels and their Glands.

Though we have considered at the same time the vital properties in the glands and in the absorbents, though anatomy shows the first to be an assemblage of folds and vascular windings, yet it cannot be denied that they have a peculiar kind of vitality, by which they are distinguished from the absorbents that come to them. It is this peculiar kind that exposes them to certain diseases of which the absorbents are not the seat, at least not in so evident a manner. The scrophulous virus seems more especially to attack them. They are particularly affected in tabes mesenterica, strumous diseases, &c. In the innumerable swellings of which they are the seat in consequence of organic diseases, the absorbents do not appear at the same time altered in their texture. It seems even that in a very great number of cases, the numerous folds that these vessels form in the glands, do not partake of their organic injury; they, in fact, transmit the lymph as usual. Nothing is more common than to see abdominal and thoracic enlargements of these glands in children, without producing serous effusions, even at the most advanced periods. In opening the bodies of small subjects, I have often been astonished at this phenomenon. The lymphatic vessels are not even more dilated, at least we do not find them easier in children affected with tabes mesenterica, than in others. We can hardly ever discover them at this age to inject.

Sympathies.

The absorbent system is much disposed to receive the sympathetic influence of the other organs. This disposition relates, 1st, to the glands; 2d, to the vessels themselves.

One of the phenomena which the examination of dead bodies perhaps most often exhibits, is the swelling of the lymphatic glands from the organic affections of the principal viscera. We observe this phenomenon, 1st, in the neck from the affections of the thyroid gland and sometimes of the larynx, in the jugular glands; 2d, on the chest from cancer in the breast, in the axillary and often in the mammary glands, from every kind of phthisis in those that surround the bronchiæ, very rarely if ever from diseases of the heart, whether aneurism, ossification or diseases of the valves; 3d, in the abdomen, from cancerous diseases of the stomach, especially of the pylorus, and most of those in which the texture of the liver is altered, in the numerous glands that accompany the biliary vessels and those surrounding the pancreas; from schirrus of the intestines, from their cancers, which are in general rather rare, in the mesenteric glands; from the affections of the womb, the rectum, and the bladder, in the glands of the pelvis; from schirrus of the testicles, diseases of the urethra, in the inguinal and lumbar glands, &c.; 4th, on the superior extremities from punctures, bites and most of the inflammatory affections in the axillary glands; 5th, on the inferior extremities from many affections in the inguinal glands.

These swellings of the lymphatic glands are of the same nature as the affection that produces them; if that is acute they are so, if chronic they pursue the same course. The swelling of the glands in the axilla is acute, if it is the consequence of a prick of the finger, of a whitlow, &c. and chronic, if it arises from cancer.