It is a remarkable phenomenon, that every kind of affection in any degree strong, arising in the economy, alters immediately the motions of the heart. The least wound, oftentimes the slightest pain are sufficient to produce derangements in it; now these derangements are of two kinds; sometimes its action is arrested for a moment; hence syncopes, a mode of derangement which happens especially in violent and sudden pains. The vulgar expression which is employed in these cases, viz. "my heart is failing," is perfectly true. Sometimes, and this is the most common case, this action is accelerated; hence the febrile motions so frequent in all the local affections, motions purely sympathetic and which cease when the affection disappears. In many local inflammations, the evil is too circumscribed to admit an obstacle to the course of the blood, an obstacle, which according to Boerhaave, forces the heart to redouble its action to surmount it; besides when there is no swelling, but only pain in the part, and the febrile motion comes on, it is there clearly a sympathetic phenomenon. The increase of the action of the heart may depend no doubt upon a foreign substance, which, mixed with the blood, alters and renders it more irritating; it may be owing to an affection of the substance of the organ which disposes it to be more irritable; but it is certainly very often sympathetic, and depends upon that unknown relation which connects all our organs, upon that consensus which links together all their actions, and places them in reciprocal dependance.
I shall say as much of the stomach; though its sympathetic reaction may not be altogether as frequent as that of the heart, yet it becomes very evident under many circumstances. Most local affections, especially inflammations are accompanied with sympathetic vomitings. Various fevers have in their commencement similar vomitings. It is in the hospitals especially that we frequently observe these phenomena. Many physicians have not considered these vomitings as merely sympathetic, but as the index of a bilious affection, founded on this, that bile is then almost always thrown up. But in all the animals that I have opened, I have almost always seen the stomach when empty containing a certain quantity of this fluid which had flowed back from the duodenum; other authors have also made similar observations; so that it appears that in the state of vacuity, the existence of bile in the stomach is a natural phenomenon. Hence it is not astonishing, that in the commencement of diseases, and even in their course, the stomach being sympathetically excited and thus becoming the seat of vomiting, more or less of this fluid should be thrown up. It would be brought up even in health if vomiting is then excited by an emetic; this is what sometimes happens in the morning when the stomach is empty, if any cause foreign to an affection of the liver, as the sight of a disgusting object, produces vomiting; the bile then comes out like every thing else that is contained in the stomach. I do not say that oftentimes the liver being sympathetically excited in the commencement of diseases, does not furnish more bile, that this superabundant bile flowing into the stomach, does not make this viscus contract; but certainly this is not most commonly the case; we vomit bile as we discharge it by the anus, because it is found in the stomach and intestines, and not because it is superabundant. If vomiting was a natural function, the bilious evacuations in this way would be as natural as the greenish tinge of the excrements, which is always found in a state of health. We see then, from this, that the bilious vomitings are, in many cases, purely accessory, and that the essential phenomenon is the sympathetic contraction of the stomach.
In the case of which I have just spoken there is no gastric difficulty; the sympathetic alteration of the stomach only extends to the fleshy fibres. But most frequently this gastric difficulty appears at the beginning of diseases in which there is local affection; sand-like substances are vomited up; it is because then the organ essentially affected, the lungs for example, if it is in a peripneumony, has acted sympathetically not only on the fleshy fibres, but also upon the mucous membrane. This excited increases its secretion; hence these sand-like substances, which are nothing but the mucous juices mixed with the gastric fluid and with the bile; now the presence of these substances is often sufficient to make the stomach contract, and produce vomiting which expels them.
From this it is evident that there can be sympathetic vomitings without gastric difficulty, and sympathetic gastric difficulty with a vomiting immediately produced. In the first case the fleshy fibres feel the sympathetic influence of the affected organ; in the second it is the mucous membrane. But how, when the lungs, the pleura, the skin, &c. being affected, does the stomach come into action? I have said that the word sympathy was only a veil for our ignorance in respect to the relations of the organs to each other. Vomitings produced by erysipelas, phlegmon, pleurisy, peripneumony, &c. are then most often an effect exactly analogous to the increase of the action of the heart, which produces fever. They resemble the cerebral derangement from which arises delirium, a derangement which is much more rare, &c. All these phenomena indicate that the other organs feel by reaction the state of that which is affected, &c. Physicians who have not viewed all these phenomena in a great and general manner, have confined their treatment to too narrow bounds. Much attention was formerly paid to the sympathetic derangement of the heart, and bleeding was much practised in the beginning of diseases; for some years past much regard has been had to the sympathetic derangement of the stomach, and emetics are frequently given; perhaps before long, more attention will be given to the weights of the head, pains in that part, watchfulness, drowsiness, &c. which are very common sympathetic symptoms, and the treatment will be directed to the brain. In these varieties judicious physicians will regard all these phenomena in a general manner; they will see in all a proof of that general agreement which disposes together all the functions, which connects all and thus connects their derangements; they will see each organ rise up, as it were against the evil which is introduced into the economy, and each react in its own way; they will see these reactions producing effects wholly different, according to the organ reacting, fever arising from the reaction of the heart, delirium, drowsiness, watchfulness, convulsions, &c. from that of the brain, vomiting from that of the stomach, diarrhœa from that of the intestines, gastric and intestinal derangements, foulness of the tongue from those of the mucous membranes, overflowings of bile from that of the liver, &c. Thus in a machine in which the whole is united and connected together, if one part is deranged all the others are so also. We should laugh at the mechanist who attempted to mend but one of these pieces, and neglected to repair the local derangement from which all those arose which the machine exhibits. Let us not laugh at the physician who attacks only a single symptom, without combating the disease, of which he oftentimes knows not the principle, though he knows that this principle exists; but let us laugh at him, if he attaches to his treatment an importance which is nothing compared with that of the disease.
The intestines next to the stomach are the most often sympathetically affected in diseases. The bladder is the organic muscle that is the last to feel the influences that go from the diseased organ; this sometimes however happens. In fevers, we know that retentions of urine from sympathetic and temporary paralysis, are not very rare; incontinence of urine is less often seen.
Character of the Vital Properties.
We see from what has been said, that the vital properties are very active in the organic muscles, especially as it respects contractility. These muscles are really during life, in constant action: they receive with great ease the influence of other organs. Their vital properties are altered with the greatest promptness, especially that which I have just pointed out; for the insensible contractility is rarely altered in them, because it does not perform an essential part. Observe in fact that the morbid derangements of an organ affect always the predominant vital force of that organ. Animal contractility is frequently altered in the preceding system; in this it is the sensible organic contractility. On the contrary, the insensible being very small, the phenomena over which it presides remain always nearly the same; nutrition is always uniform; lesions of the muscular texture are rare; when they take place, it is rather by communication, as in cancers of the stomach, in which the disease begins upon the mucous surface, and in which the fleshy fibres are only consequently affected. The heart and the womb are the muscles that are the most subject to these morbid alterations; yet in the first they belong oftener to the internal membrane than to the fleshy fibres themselves. On the contrary in the systems in which the sensible organic contractility is incessantly in action, as in the cutaneous, the serous, &c. in which it presides over nutrition and exhalation; in the glandular, the mucous, &c. in which it produces secretion and nutrition, it is this which is especially altered. From these derangements arise alterations of texture, organic diseases properly called, which are as common in these systems, as they are rare in those in which the insensible contractility, is so very obscure, as to be only at the degree necessary for nutrition.
It is to this that must be referred the infrequency of acute inflammations of this system. As this affection is frequent in the cutaneous, the serous, the mucous systems, &c. so this system, whose functions require but little insensible organic contractility, presents it rarely. Those who open many dead bodies know, that the texture of the heart is hardly ever found inflamed. Nothing is more common than phlegmasia of the external or serous membrane, and of the internal or mucous membrane of the stomach, the intestines, &c.; but nothing is more obscure and less frequently seen than that of their fleshy tunic. In rheumatism, there is sometimes when the pains cease around the joints, violent cholics, spasmodic vomitings even, indices perhaps of an acute affection of the fibres of the stomach or intestines; but we never find marks of these affections; we do not see the muscular texture exhibiting the bright red of the inflamed mucous, cutaneous and serous organs; or at least I have never observed it.
Physicians have not paid sufficient attention to the difference of inflammations according to the difference of systems; but especially they have not sufficiently observed that this difference accords perfectly with that of the insensible organic contractility; that where this vital force is most characterized, inflammations have the greatest tendency to take place, because it is this which presides over their formation; because these affections suppose its increase; as convulsions suppose the increase of animal contractility, as vomitings, accelerated pulsations of the heart, suppose that of organic contractility, &c. I cannot repeat it too much, that the most frequent diseases in each system, put always in action, raise or diminish the predominant vital force in that system. It is a new pathological view, that may be fruitful in results.