I am far from considering all these different swellings as the result of a sympathetic influence exerted upon the gland. No doubt the conveyance of absorbed matter produces the effect, as happens when there is some virus, punctures with poisoned instruments, &c. producing the swelling. But sometimes also sympathy alone is the cause. When by the acute pain that a whitlow, a splinter under the nail or a bruise of the finger occasion, the axillary glands swell; when the same glands swell from the effect of a blister applied to the arm or fore-arm, &c.; when this phenomenon happens in the inguinal glands from a blister on the thigh or the leg, of which I have seen many cases, &c. &c. there is certainly no matter conveyed to the gland; it is an effect of sympathy.
Most surgeons believe that every cancer in the breast, with swelled glands, requires their extirpation. I believe that in some cases they may become cancerous, but I doubt if this happens in the greatest number. 1st. In old ulcerated cancers of the breast, they continue most often swelled during the whole of life, without suppurating. 2d. After operations, in which some deep seated ones have been left, we rarely see them become cancerous. When the cancer is reproduced, it is the wound that opens again. 3d. I have many times compared the texture of a gland of the axilla enlarged by a cancer of the breast, with that of the bronchial glands enlarged in phthisis, with that of the sub-hepatic glands swollen from steatomatous tumours, hydatids of the liver, &c. and I could discover no difference. 4th. Finally, all those who open many dead bodies may be convinced that almost all the organic diseases of the viscera which have many glands around them, are accompanied with their enlargement, whatever may be the nature of those diseases. This phenomenon struck me so much, that at one time attributed the effusions which terminate almost all these organic diseases, to the difficulty the lymph experiences in passing through these glands. But the absence of these swellings in the diseases of the heart attended with dropsy, the frequent absence of swelling of the superior extremities when the axillary glands were enlarged, the tumefaction of the lower parts, the glands of the superior being alone swelled, and many other similar proofs, which made me consider the serous effusions that take place then, as passive exhalations, analogous to those that produce hemorrhages, did not permit me to adopt this first opinion.
It is essential to distinguish the swellings of the lymphatic glands by the influence of the diseases of the neighbouring viscera, from those which arise from tabes mesenterica and other analogous, scrophulous diseases. 1st. In the latter case, the texture of the gland is always primarily affected; it is only secondarily in the other. 2d. The one from scrophulous affections appears exclusively in childhood; the other at all ages. 3d. Finally, a gland swollen from the affection of another organ, most frequently preserves a texture, and colour analogous to its natural state. It is only in the last periods that the texture becomes sometimes hard, like cartilage, and even suppurates; but it is not with the same phenomena as the texture of the mesenteric and bronchial glands swollen by scrophula. The appearance and structure are wholly different. This last exhibits in this case a white substance which is found in small quantity in the first periods; so that when we cut the gland, we easily distinguish this substance from the texture of the gland that remains, where it still exists, with its natural colour and arrangement. In the latter periods, this white matter has encroached upon the whole gland, the texture of which has disappeared. However in phthisis, and sometimes, though more rarely, in cancers, the swelled glands exhibit in consequence an analogous appearance; but in all the other cases it is different.
We know that nature often chooses these glands in important fevers, as the place of the crisis. They are the seat of what are very improperly called parotid tumours, in adynamic fevers.
The absorbents are, like their glands, influenced by the affections of the neighbouring organs. I am well persuaded that the different alterations which the absorption of chyle undergoes, the absorption of the aqueous part of the bile and the urine, and the derangement of those of the serous surfaces in many diseases, are effects purely sympathetic. But it is not very easy to distinguish when they are not so. There are certainly sympathetic absorptions, as there are sympathetic exhalations and secretions.
On the other hand, the absorbent system being affected, the other organs very often experience sympathetic influences. In tabes mesenterica, and in the enlargement of the bronchial glands that correspond with it, there are many symptoms that evidently arise from the sympathetic relations that connect these glands to the other organs. It is not my province to point out these symptoms.
As to the influence of the diseases of the absorbents upon the other organs, we know but little of it. When their course is inflamed from a puncture, from a wound with an instrument having on it some virus, &c. there are often vomitings, diarrhœa, &c.