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PATHOLOGICAL  ANATOMY.
THE LAST COURSE
XATIER  BICHAT,
FROM AN AUTOGRAPHIC MAKUSCHIPT
           P. A. BECLARD;



WITH AN ACCOUNT OF THE LIFE AND LABOURS OF BICHAT,



           By F. G. BOISSEAU,

JIEMHIR OF TITT. ROTAl ACADEMIES OF MEDICINE OF PARIS AKD HADHID,
       O? THE MEDICAL SOCIETY OT EMULATION, 8tC.



       TRANSLATED FROM THE FRENCH

           BY JOSEPH TOGNO,

             STUDENT OT MEDICINE.
•  foil a i
         PHILADELPHIA:

JOHN GKIGG, NO. 9, NORTH FOURTH STREET.


            1827. 
                           Q2








Eastern District of Pennsylvania, to wit:
  Be it remembered, that on the nineteenth day of July, A. D. 1827,
in  the fifty-first year of the Independence of the  United States  of
America, John Grigg, of the said district, has deposited  in  this office
the title of a Book, the right whereof he claims as proprietor, in the
words following, to wit:—
  " Pathological Anatomy.  The last course of Xavier Bichat, from an
Autographical Manuscript of P. A. B^clard; with an account  of the
Life and Labours of Bichat, by F. G. Boisseau, member of the Royal
Academies of Medicine of Paris and Madrid, of the Medical Society of
Emulation, 8cc. Translated from the French by Joseph  Togno, Stu-
dent of Medicine."

   In conformity to the Act  of the Congress of the United States, en-
titled,  " An act for  the encouragement of learning, by securing the
copies of maps, charts and books, to the authors and proprietors of such
copies, during the times therein  mentioned:" and also  to  an act en-
titled, " An act supplementary to an act, entitled, An act for the en-
couragement of learning,  by securing the copies of maps, charts and
books, to the authors and proprietors of such copies, during the times
therein mentioned;  and extending the benefits thereof to the arts  of
designing, engraving, and etching historical and other prints.

                     , , ,                D. CALDWELL,
                     Clerk of the Eastern District of Pennsylvania.

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ADVERTISEMENT
OF THE EDITOR.
   Having become possessor, at the sale of the library of
the late celebrated  professor Beclard, of a manuscript
written in his own hand, of the last course of lectures of
Bichat, the idea of publishing this  work presented itself
to us; but before doing this, we thought it proper to con-
sult with several enlightened Physicians.   They all unani-
mously concurred with  us in saying, that the  smallest
part of the doctrine of a man who has rendered such emi-
nent services to science and humanity should be collected
with religious care; that the public would eagerly seek the
compilation  of  a course of  lectures during the delivery of
which Bichat spent the last hours of so valuable a life; and
of which we regretted very much  that we possessed no
document, and, lastly, that it would be a  supplement full
of interest to all the editions of his works.  These mo-
tives have determined us.
  Doctor Boisseau has politely paid attention to the pub-
lication of this work, and has prefixed a notice of the life
and labours  of the  immortal author  of  the  Anatomie
Ginirale.
                                J. B. BAILLLERE. 
 
A
            SHORT  ACCOUNT

                     OF THE

LIFE  AND LABOURS OF XAVIER  BICHAT,

              BY F. G. BOISSEAU.
  Vicq-D'Azyr was no more; but such men as Chaussier,
Corvisart, Desgenettes, Halle, Pinel, were preparing the
glory of the medical school of Paris, when appeared in the
midst of the disciples  of Desault, one of those superior
minds, born to regenerate science and to perfect human
knowledge.—Bichat, a pupil of Mark-Anthony Petit, flies
to Paris to escape the massacre of Lyons, and immediately
engages the attention of the senior surgeon of the Hotel-
Dieu.  From this moment he resolves to  treat the latter
with the tenderness of a son; he  lends him his pen, as-
sists him in his  operations, and  supplies his  place in nu-
merous  consultations;  in the meantime, he studies the
writings  of the  great masters, he dissects, and  operates
on the dead subject  After the death of Desault, he pub-
lishes the last volume of the Journal de Chirurgie, and
renders a pious homage to the memory of the great sur-
geon who had foreseen  his genius.
  After two years of silence and study, Bichat delivers a
course of lectures on Anatomy, Physiology, the diseases
of the bones and operative surgery.  Having recovered from 
6
NOTICE on BICHAT.
 a violent attack of Haemoptysis, he resumes his dissection*
 and experiments; he publishes the surgical works of De-
 sault, he founds la Societt midicale d'tmulation, and en-
 riches the memoirs of this society with  original  observa-
 tions on the synovial membranes, the relations of the or-
 ganization of the membranes to each other, and the sym-
 metry of the different organs.   In the beginning  of the
 nineteenth  century, Bichat, publishes his Treatise on the
 membranes, the Inquiries on life and death, and his Gene-
 ral Anatomy; he then employs himself in classifying diseases
 in an immutable manner; in order to discover  their nature
 and seat, examines an immense number of subjects, and last-
 ly delivers  lectures on  Pathological Anatomy:—France
 finds in him a Bordeu, a Vicq-D'Azyr, and consoles herself
 in not having given birth to Haller and Morgagni.
  The plans of genius  are  so vast, that  it can, of itself,
 execute them but in part; Bichat aspired to rebuild the
 temple of medical science on the immoveable foundation
 of Physiological and Pathological Anatomy.   But nature
 sometimes seems to take pleasure in putting boundaries to
 theprogress of human intellect,and condemns to apremature
 death the inquisitive minds of those, who follow her steps
 too closely  and with too much ardour, in the  prosecution
 of her wonderful works.   Bichat, only thirty years of age,
exhausted by Watchings,  intellectual' labour, and con-
 tinual attendance  in  the dissecting rooms, died  in the
 commencement of the century which he would have en-
lightened.  Sandifort had said of him: " before six years
shall have passed, he will outstrip our JBoerhaave."
 Corvisart wrote to the first Consul, " Bichat has just died
on a field of battle which numbers more  than one victim:
no man in so short a time has done so much and so well."
  Why weep for great men?  they have lived  sufiiciently
 long, when they have performed enough to render them-
 selves glorious; but we must record their virtues, that they 
NOTICE ON BICHAT.
7
may serve as models, and proclaim their success, to con-
found envy.
  " The  most amiable moral qualities,  said Buisson, en-
hanced in the person of Bichat  the eclat of his merit.   It
was  impossible to find more frankness and candour,  or
one who  would more readily sacrifice his  own  opinions
vhen a solid objection  was presented to him.   Incapable
of anger and impatience, he was as easily accessible in the
moments of his laborious pursuits as during his leisure
hours. His generosity made him always a liberal friend
to those of his pupils, who, far from their families, were ac-
cidentally in want of funds, or  who had not the means to
procure elsewhere the  necessary instruction.  Skilful  in
distinguishing talent, he  encouraged it in every possi-
ble manner as soon as he  discovered  it.   No  one was
more ready to  bestow  confidence  on  those  whom  he
thought  sincerely attached to him. No one could resist his
amiable and prepossessing manners, and a short conversa-
tion  with him was sufficient to give us an insight into  his
character, and to  convince us how far he was from  those
reserved expressions and that affected politeness which so
often makes a show of real sentiment.  All who knew him
were his friends, except those who were  jealous of  his
brilliant talents.  Envy sometimes pursued him, and sought
to destroy his reputation; his enemies considered it a crime
that he  should  be  a  man  of  merit;  but  he contented
himself with despising their vain attacks, and thought
them unworthy of refutation, always ready  to renew with
his detractors, a friendship which they alone had broken."
  Generalization  of  facts is the most fertile work of ge-
nius, and it is that which best characterizes it.  Bichat
has left a great monument of this lind.  Before  his time
the organs of the body were studied separately, in the or-
der  of the functions  or of their situation; he classified the
tissues in his vast mind according to their analogies, and 
s
NOTICE ON DICHAT.
thus realized the great view of Bordeu in the organic de-
partment; in a word, he created general anatomy.
  He wished to do for the functions, that which he had
done for the organs but here (why not confess it?) he paid
a tribute to human weakness.  Instead  of confining him-
self to describing  in a superior manner the known laws
of organic action, he followed Barthez in adopting a vital
principle, and attributed to the tissues properties of which
several were functions, and the others,  doubtful qualities.
But  he founded amongst us  experimental  Physiology,
which Haller had created beyond the Rhine; and it is to
the example which he set by inquiring into the functional
relations of the brain, lungs, and heart, during life and at
the moment of death, that we owe all those  experiments
which have since been made during twenty-five years, on
the respiratory and circulating actions of the organs, the
encephalon, the spinal marrow and nerves.
  The influence of the works of Bichat is not confined to
France; Germany has been influenced by the genius of this
great man, and has followed him in the new routes which
he has discovered  and in those which he  has revived.
Even proud  England follows, although at a distance, the
footsteps of this Frenchman; so that, Brown, Darwin, God-
win, and even Hunter are now forgotten.
  Italy recognises in Bichat the worthy successor of her
innumerable anatomists and physiologists; she consoles her-
self in seeing a Frenchman shine in his turn  on a theatre
on which  so many Italians had rendered themselves illus-
trious; here also Bichat has found disciples worthy of him.
His works translated into Spanish, will make skilful ob-
servers of men in th* peninsula, when this unhappy coun-
try shall enjoy the blessings  of peace, under the auspices
of a government sufficieLtly enlightened not to fear science.
  Bichat's genius shone e>en in descriptive anatomy.  No-
body before  him displayed'^ it so much clearness added
to an extreme conciseness ana  remarkable rapidity: such 
NOTICE ON BICHAT.
9
was the character of his style on whatever subject he wrote.
Inaccuracies  and negligences  have been remarked in his
productions;  in that only we  must not imitate him, but
nevertheless he is, without doubt, the Frenchman"who best
understood the art of writing on Anatomy and Physiology.
His style was animated and brilliant when he had to treat
of the functions and intellectual faculties.  Bichat had not
time to perfect his style, although he has proved that he
could have done so, had he possessed more leisure, and
had he been less occupied with  the advancement of science.
  His most remarkable undertaking was that of attempt-
ing to reform Therapeutics.  The most splendid talent
can not embrace every thing, it was reserved for M.  Ali-
bert to apply physiology to Therapeutics.
  Professor Pinel had the glory of having inspired Bichat
with the idea of the distinction of the tissues; but Bichat
truly made this idea his own in applying it to Physiology.
Had not death snatched  him  from us, there is no doubt
but that he would have applied it still  more extensively to
Pathology; but  our  present generation had no positive
data on  this subject, when the present manuscript, now of-
fered to the public, was submitted to us.
  The attentive  reader will readily perceive that Bichat,
under the name of pathological anatomy, meant to desig-
nate true pathology, that is to say,  the knowledge of mor-
bid phenomena  observed  during life,  and the  organic
alterations  found after death.   He will appreciate how
profound were the views of this man, so dear to our coun-
try; with what ardour he sought truth; with what warmth
he seized the relations of things, from which arose charac-
teristic  differences; with what clearness he  had laid the
plan of  his course of lectures; with what rapidity he de-
scribed  the characters of different diseases; with what can-
dour he avowed the ignorance  under which they laboured,
in his time, on many obscure points of pathology.
  Since a premature  death has snatched from us this great
             2 
10
NMTiru on uiniat.
genius, and has deprived us of the work in which, in timr,
he would  have  committed his pathological views, let us
congratulate ourselves that one of his zealous hearers has
gathered the outlines of his last course, in which his lu-
minous  genius  had shone.  The sketch  of a picture of
Raphael is not without value:  at least we see in it the linea-
ments of the thought of the immortal painter.
  The  reader will peruse in  the present work many ideas
which now have become a kind of public  property, and
the originality of which is given to others—not to Bichat:
and  he must bear  in  mind  that this manuscript  was
written by Beciard in 1S05.
  It is evident by this date, that it was not taken from the
lectures of Bichat by Beciard himself, but by a person, the
correctness and sagacity of  whom were  known  to him,
since he took the trouble to transcribe it.   Perhaps  this
work was compiled  from the notes which were communi-
cated to him.  What convinces me that he  has  copied it
entirely as it  will  be read, is that  we perceive every
where in it the lively and rapid diction of the speaker, the
same familiar phrases often recur, and several  are to be
found in the works of Bichat.  It is well  known that he
wrote with great rapidity, without re-perusing his compo-
sition,  hence the  similarity between  his  speaking  and
writing.
  I made  it a point to respect the text of this manuscript:
I confined myself in correcting the style, which was very
defective, and I preferred to leave in it some  blemishes,
fearing that I might alter the meaning in substituting one
word for another, or in  changing the construction of the
phrases.   In a word, I acted as I would have done had  I
had the honour to  transmit to the public the unpublished
labours of Bichat himself.
  This tradition, however imperfect it may be, of the last
thoughts of a mind so penetrating and so vast, can not fail
to interest the numerous disciples of his cotemporaries 
NOTICE ON BICHAT.
11
and  his own pupils.  It is also a precious document for
the history of the medical art.   None of the errors which
I permitted  to  remain in  this work can be attributed
to Bichat, unless they should be found in his works,  or if
they are not the immediate consequence  of his known
principles.   The greatest  number of them belong to the
time in which he lived.
  I can not  forget to  speak here of  the great loss which
Anatomical  science has experienced in the unexpected
death of Beciard: it is the lives of such men that we must
place in opposition to the detractors of medicine; will they
not be silent at the  sight of so much  science and  devoted-
uess!
Paris, 26th August, 1825. 
 
PATHOLOGICAL  ANATOMY.
LAST COURSE OF BICHAT.
           PRELIMINARY DISCOURSE.

  Medicine  has two general  objects in  view;  first, the
knowledge of diseases, and second, their cure.  Under this
last relation there are few diseases submitted to the empire
of medicine,  and it is only to the former that we refer pa-
thological anatomy.
  Diseases may be divided into two classes: those which af-
fect the general system, and those which attack  only one
organ in particular.  The first do not come under the cog-
nizance of pathological anatomy.  All the diverse kinds of
fevers  produce a general derangement,  although, often-
times no organ be  particularly injured.  The  knowledge
of general diseases  differs essentially from that of organic
diseases:  for  the former, observation is sufficient; in the
latter, on the  contrary, we have besides observation, post-
mortem examination.  This is the reason why the know-
ledge of general diseases is only founded on certain signs
which attach themselves to nothing.  Such is the etiology
of fevers and  of other similar diseases: all the distinctions,
and classifications which have been made according to sea- 
11
PRELIMINARY
DISCOURSE.
sons, humours, &c.  are evidently fallacious.    Their no-
sology presents an extreme difficulty.
  Not so with local  diseases, which may be classified ac-
cording to the character of the lesion of the affected organ.
Their diagnosis is infinitely more easy than the first, since
there existsone more means to discriminate them,post-mor-
tem examination; and it is only since some interest has been
excited in this science, that we may flatter ourselves with hav-
ing made some progress in the knowledge of these diseases.
It is well known  into how many errors we have fallen, so
long as we had confined ourselves to the simple observation
of symptoms.  Let us take for example consumption. It has
been considered as an  essential malady, before we had
recourse to  post-mortem examination; since, it has been
shown that marasmus was only a consecutive symptomatic
malady of the affection of an organ.   Jaundice has been
for a long  time considered by practitioners as an essential
malady; post-mortem  examination has also proved that
this affection, thought primitive, was in reality  only con-
secutive to diverse alterations of the  liver, of which it i&
always  the symptom.  The same has happened with re-
spect to dropsies, which although for a long time consider-
ed as essential affections, have never been other than the
result of some  organic disease.  It is, then, ignorance of
organic affections, resulting from a total neglect of post
mortem examination, which is the cause that has misled
the ancient practitioners on most  diseases; thus, Cullen
and Sauvuges have erred in their classifications.
  It is  true that symptoms are also advantageous  in the ex-
amination  of organic diseases; but for a methodical classifi-
cation we must shun  every  thing which is only accessory;
a nosology founded on the  affections of the organs will ne-
cessarily be invariable. It is also to the want of post-mortem
examination, that we may ascribe the hypothetical reasoning
■*f the ancients on the atrabile, pituita,  &c., imaginary sub- 
PRELIMINARY DISCOURSE.
15
stances that they had never seen, but which they fancied.
The solids have also been the subject  of these erroneous
principles:  every  swelling was called obstruction, and
every obstruction (engorgement)  was a scirrhus.   Phy-
sicians have never followed the natural course which we
indicate; a rapid view of  the progress of  the  science of
medicine will convince us of it.
  We may distinguish two classes of physicians; those who
have only observed, and  those  who to observation have
added  post-mortem  examination.  The former are very
numerous; the latter are confined to a very small number,
and are only to be met with in  the last century.  Hippo-
crates, Celsus, Aretaeus,  and  all the Greek authors, have
been  satisfied with observing the  symptoms;  and conse-
quently most of their diseases are badly described.
  Immediately  after the Greeks, physicians were divided
into two sects:  the empirics, who cured according to ex-
perience, and the dogmatics, who were guided by symp-
toms.  Not  one, among either,  has left a post-mortem ex-
amination.   The same  thing happened  with the Arabs,
who only  imitated  the  Greeks.   Five  or six centuries
elapsed without any improvement in medicine.  At its
revival, the  Greek authors were again commented upon.
Afterwards followed the sect of  the chymists: Paracelsus,
and Van Helmont, explained every thing by the laws of
fermentation.   Sydenham was satisfied  with observing
symptoms.  Then Stahl and Boerhaave appeared.  Their
disciples, and particularly those of Montpellier, in these
last centuries,  very seldom have  had recourse to  post-
mortem examination.  It was not  until about the middle
of the seventeenth century that surgeons made, for the first
time, anatomical examinations.   Physicians  adopted this
method.  Bonnet made a collection of observations, but
replete with erroneous theories.
   Morgagni appeared after him, and truly created patho- 
 IG            POST-MORTEM EXAMINATION.

 logical science, and whilst yet in its infancy, be carried it
 to perfection, and his work on chronic diseases is a chef-
 d'a-wrc.   Several tried to write on the same subject, par-
 ticularly Lieutaud, but all are far inferior to Morgagni.
 Portal and/*/></-</'./ryr have  also shone on this  sub-
ject, and the article in the Encyclopedic does honour to
 the latter.
  This practice, of post-mortem examination, is that which
 is followed, in our days, all over Europe.
                  CHAPTER T.

    Considerations on Post-Mortem Examination.

  Before we establish precepts on the manner of examin-
ing dead bodies, we must consider first the diverse altera-
tions which different diseases produce.   Any one who has
had the opportunity to see only few post-mortem examina-
tions, has observed that the condition of the organs, either
internal or external, varies according to the affection which
has produced death.   We may distinguish  three kinds of
death: sudden death; that which happens in an acute mala-
dy; and, finally, that which follows a chronic disease.
  In sudden death, there is hardly any alteration present,
either in the  internal or external  organs; in the greatest
number of cases the disease is concentrated either in the
brain,  heart,  or lungs:  such as, asphyxia,  syncope, poi
soning, &c.
  The muscles are red, with a texture as firm  as in  a na-
tural state; the skin is hard to the  touch, the eyes  promi-
nent; the mucous surfaces,  and often, even  the  cheeks
retain  a blush;  the  expression  of the  physiognomy re- 
i'OVf-MORTEM EXAMINATION.
17
 mains; in a word, the appearance of all the organs differs
 essentially from what they are in chronic diseases.
   The second kind of death begins to have some influence
 in altering the aspect of the cadaver.  Every acute disease
 always alters more or less perceptibly the parts; there are
 even some, the  effects of which,  on  the corpse, are similar
 to those in the most protracted diseases; all the solids are
 altered, almost  decomposed;  as is the  case in  pestilential
 fever, &c.
   When acute diseases are continued for a long time, then
 the  fat is absorbed,  serosity abounds, and the phenomena
 become, soon after, like those  of chronic diseases.  Never-
 theless, we must observe that the organs most altered, are
 those in which nutrition is most active in an healthy state;
 and  on  the contrary, those which enjoy only an  obscure
 vitality, are the least sensibly injured.  Such are the ten-
 dons and oponeuroses.
  Lastly, the third  kind of death,  produced  by chronic
 diseases, totally changes the  state  of  the organs in  the
 subject.  Their  texture is ordinarily found very much al-
 tered, especially when death has been protracted; they
 have a flaccidity foreign  to the usual state; the  alterations
 affect also  the  tendons  and oponeuroses, which  become
 yellow.
  In general, these are the diverse influences of disease on
 the body, necessary  to be known.   We must  be on our
 guard  not to take for the effect of the disease, what only
 belongs  to that kind of death.  Nevertheless, many have
 fallen into this error; thus, in inflammatory fevers they
 were looking for an engorgement  in the brain, without
 reflecting that it was produced by the state of the lungs at
 the moment of death; if,  for example, the patient had had,
for some time, a difficulty of breathing, and  were they to
 find an  effusion in the brain, they never failed  to  ascribe
the effusion to the disease, although it was entirely foreign
to it.
             3 
18
POST-MORTEM t x A MI NATION
   If the patient dies in a syncope, no traces of blood are
 to be found in the brain.
   The same takes place in all the organs; often the condi-
 tion in which we find them, is only the consequence of the
 state in which the subject was at the time he died.   Some-
 times also, the  disease  may have produced it, but we are
 ignorant of any such circumstance.
   The lividity and flushing of the  face may be numbered
 among these phenomena.   We should also be aware of the
 changes that death produces in the diseased organ: inflam-
 matory tumours, which during life are red and prominent,
 are resolved entirely after death, which is not observed in
 chronic tumours; it is probable that in acute inflammation
 of the internal  organs  the same thing happens,  and we
judge so by analogy.
   In an inflammation of the intestines, the tension of the
 abdomen may be partially produced by the gases, and also by
 the swelling of the neighbouring cellular tissue; and indeed
 it may disappear almost entirely after death.   That which
 causes the resolution of acute tumours, is, that the irritation
 which retains the blood in the part, disappears with life.
 In chronic inflammation, this change does  not take place
 after death, because the blood is then found almost blend-
 ed with the parts.
   In the examination of a corpse we should pay particular
 attention to the essential phenomena, without stopping to
 observe accessory circumstances.
   It is equally advantageous to seek for the connection of
 the phenomena  which have resulted after death, with those
 which have taken place before.
   The manner  to proceed  in autopsic examinations, must
 differ according to the different kinds of diseases we have
 established; commonly it  is prosecuted in an anatomical
 order, but it is not the  best method to give precise ideas
 on the subject; in general diseases,  it is a great deal better 
PATHOLOGICAL ANATOMY.
19
to follow the order of the functions:  in  this manner we
arrive at a knowledge of those which are injured.
   In local diseases the manner of proceeding must be dif-
ferent: we must first examine the affected organ, then the
neighbouring organs which participate in the lesion; and
afterwards  proceed to examine the functions.  The ad-
vantage resulting from  this method is, that we may nar-
rowly sift the maladies which affect every system.  By
this  means, the diseases of two organs utterly different
will  not be confounded,  although  situated in  the  same
cavity.  However, there are some affections which do not
admit this methodical classification: such are scurvy, sy-
philis, &c; but persevering study may enable us hereafter
to find for them a fit  place.


      ?       -----


                  CHAPTER II.

   Order to be followed in Pathological Anatomy.

  We shall divide at first the examination of diseases into
two parts.  In the first,  we shall examine the affection pe-
culiar to each  system individually, and the modification
which general diseases experience in these  same systems.
In the second, we shall  consider these diseases in the di-
verse organs which they occupy;  and in order  to be the
more methodical, we shall  proceed in the order of the
functions.
  Every system has an order of functions which is peculiar
to itself,whatsoever be its situation.   Such is the phlegmon
or inflammation of the cellular tissue: whether it be in the
extremities, or in the trunk of the body, it is always of
the same nature; the pus which it produces is always the 
   20            1'ATHOLOUICAL ANATOMY.
   »ame.   Whatever may be the place in which the serous
   membranes are found, their diseases are analogous;  they
   only are susceptible of adhesion.  The cutaneous system
   is the exclusive seat of certain morbid affections, such as
   tetter,  syphilitic  eruptions, and  inflammatory pustule's.
   This was so obvious in the eyes of practitioners, that they
   had formed a particular class of cutaneous  diseases.  To
   conclude, from all we have said, it is easy to see, that it is
   all important to examine the diseases of the systems singly.
     In considering diseases under the first relation, we shall
   make a continual abstraction of the systems, which, con-
   jointly with the affected one, concur to the formation of an
   organ.  Hence the inference, that every system may be
   affected singly.   Post-mortem  examinations demonstrate
   it to us, since  it shows, that almost  all the  local diseases
   have each their seat only in one particular tissu^kf the at-
   fected organ.                                   ■
     Let us take for example  the lungs.  These organs are
   composed of the pleura, of the parenchymatous structure
   of  the lungs, and of the internal membrane.  In pleurisy,
   the pleura only is inflamed, the pulmonary tissue and the
   mucous  membrane  remain untouched.   In  peripneumo-
yf nia, it is, on the contrary, the parenchymatous structure of
   the lungs, whilst its two membranes are healthy.   In the
   same manner catarrhal cough is exclusively confined to the
    mucous membrane, whilst  the pulmonary tissue and the
    serous membrane are sound and healthy.   We may reason
    in  the same manner in relation to  all the  other organs.
    The affections of a serous  membrane extend throughout
    and are common to  all its parts: and indeed, the ancients
    mistook, in relation to chronic interitis, in considering it as
    entirely located in  the external coat of the intestines; it
    spreads itself always all over the peritoneum.  However,
    at the bed-side of the patient, this manner of considering
     diseases would  seem inconsistent, since, for the supposed
     affection of a single tissue, the whole organ appears to be 
PATHOLOGICAL ANATOMY.
21
affected.   Thus  in  the inflammation of the peritoneum
which covers the stomach, this organ is affected with vomit-
ing.   One  does  not know how to explain so constant a
sympathy; but the affection of one single  tissue  only, is
nevertheless true.
  When we are familiar with diseases, in order to distin-
guish them we must bear in mind  three kinds of symp-
toms.  The first belongs exclusively to the affected organ,
the second depends upon the surrounding organs, and the
third is general.  Thus in pleurisy, the pain in the  side,
which belongs to the  pleura, must be arranged with the
first  class;  the oppression and the difficulty of breathing
which belong to the lungs, are  comprised in the second;
and lastly the state of the pulse, and that of the secretions,
compose the third.
  In chronic diseases,  the principle that we have just laid
down referring  to  the singleness of the affections of the
systems, often is apparently contradicted, since, when  these
diseases are of so  great violence as to cause death,  com-
monly the whole substance of the organ is found  morbid.
But  this general malady  is always owing to a principal af-
fection which has been developed in one of its tissues, and
the state in which the others are found, after death, is only
consecutive.   Thus in cancer, the disease  commences by
a small moveable tumour in the cellular tissue of the breast;
it is soon engorged and adheres; its progress continues; the
muscles ulcerate; finally the surrounding bones grow cari-
ous, and the state exhibited by the injured part towards the
end, is only a consecutive effect of the primitive affection.
This example is  sufficient to  establish the progressive
stages of  every kind of chronic diseases, either  of those
which are seen on  the exterior surface, or of those, the
phenomena of which takes place within.   In cancer of the
stomach, it often happens that the affection extends  itself
lo the whole peritoneum by the medium of the part of this
membrane which immediately covers this organ; some- 
22           ALTERATION* OF THE FLUIDS.

times the liver also in this  case becomes  tuberculous.   It
is an  essential difference between acute and chronic dis-
eases, that the symptoms of the former are only produced
by the sudden affection of a single organic system, whilst
in  the latter they are caused by a slow alteration of the
whole organ.
  All the chronic diseases do not propagate themselves in
an equal  degree.  Cancer is very  susceptible of it, whilst
the arterial ossification never spreads.
                 CHAPTER III.

          Of the Alterations of the  Fluids.

  All that we have heretofore said, refers particularly to
the alterations of the solids; let us treat now of those of the
fluids; which are as frequent as the first, but much less
known.  Every one knows what great importance physi-
cians have ascribed to them. Almost all have made them the
seat of diseases;  but if we compare what they have said of
them, with what examination teaches us, we shall soon see
how illusory was their theory.   In this respect pathologi-
cal anatomy has as yet much to do.  Their different altera-
tions can not be observed with the same precision as in the
solids.   Abandoned  to themselves, the fluids soon expe-
rience new alterations, the same does not happen in organic
affections of the viscera.
  In order to  facilitate the study of the maladies of the
fluids, we "will divide them into two  classes: those which
exist in a normal, and those which are formed in a patho-
logical state.  We shall speak, at first, in a general manner
of the alterations of the fluids which exist  in  a natural 
             ALTERATIONS OK THE FLUIDS.           23

state.  These fluids are of three kinds: the circulating, the
secreted, and the exhaled.


                    ARTICLE I.

     Of the Alterations of the  Circulating fluids.

  The blood undergoes singular and numerous variations
in diseases; they can only be  known by the examination
of the corpse or of the blood after venesection.   Indeed
the quantity of blood is very variable in different  bodies.
In general it is very abundant in persons dead of asphyxia,
and in every kind of death which terminates life instanta-
neously, such as apoplexy &c; in other affections post-mor-
tem examination presents hardly any, such  is the  case in
chronic diseases, which waste the vital forces for a long time,
as phthisis and all those which induce marasmus or drop-
sy;  hence the pulse, in such cases, is very small towards
the end, and the arteries contract  on themselves.  Finally,
there are other  diseases which  hold a  middle course in
this respect.
  The colour of  the blood  differs materially in different
diseases.  In almost all cadavers it is black, in whatsoever
part it is found.
  It is particularly in  its consistency that blood  differs.
Certain diseases change it very much; scurvy, putrid fever,
and asphyxia render it always very fluid.  Other affections
concrete it.   The polypus is nothing more than a  bloody
concretion,  formed in  the  large vessels or in the heart.
The ancient physicians ascribed  much  importance to" it,
and attributed to it many deaths produced by very differ-
ent causes.   Morgagni,  Bonnet,  Lieutaudj Viq-d'Azyr,
relate observations of polypus, in which we perceive that
they entirely mistake in ascribing the death  to a concre-
tion utterly passive in the malady; they had takejj^he effect
for the cause.  In the  examination of almost any subject, 
21
ALTERATIONS OF TUE  FLUID*.
 similar bloody concretions may be seen.   We may distin-
 guish two kinds in the heart.   Sometimes they offer either
 a white or a yellow mass, but without consistency, and we
 meet with them almost always in this manner in subjects
 dead of a slow disease: in sudden death, on the contrary, the
 clotted blood is very hard, affording resistance, as if  it
 were fibrous, and very different from the first.
   It would be necessary to compare  the  phenomena ex-
 hibited in the dead body with the symptoms of the malady;
 but under this relation, we see that medicine has made very
 little progress, and we meet with very few observations
 in which in  this mode  of inquiry physicians  have not
 taken the effect for the  cause.  Indeed, if the symptoms
 were always produced by  this circumstance, they would
 be present in all subjects.   Lately at the Hotel-Dieu there
 was a patient with all the  symptoms of a disease of the
 heart: suffocation, particularly towards the evening, and
 on the  approach of any change in the weather; obstruc-
 tion  in  respiration, smart  pains  in  the  epigastrium, on
 pressure.  The  symptoms had  always  increased  with-
 out paroxysms, which  is  not common  in maladies of
 the heart; at  last the  patient expired on a foggy day, the
 approach of which the augmentation of his pains had pre-
 dicted.  When he was examined, the lungs were found
 very healthy as well as the heart  and  its valves;  but there
 existed  in the  right ventricle a coagulum of blood very
 hard, and adhering very closely to its parietes.  It appears
 that the bloody concretion had apart in this malady.  We
 may easily believe the possibility of the existence of these
 clots during life, from their analogy with those which are
ordinarily contained in aneurismal sacs.
  Nothing as yet, very general, can be said on the changes
of the nature of the blood in diseases; on  this  subject we
are confined to a few facts. All diseases marked by strength,
such as inflammation, present in the blood  which is drawn
 during life, a buffy  fibrous coat, called  pleuritic.   We 
ALTERATIONS OF THE FLUIDS.
25
 know that  physicians who have admitted the thickening
 of the blood, have made use of this coat to explain the di-
 verse phenomena;  but the part they have caused it to act
 is entirely illusory.  It is only formed when the blood is
 out of its vessels.   However, it seems often that  the blood
 participates in the malady without our knowing  precisely
 its mode of influence. In all protracted diseases,  the blood
 loses, in part, its coagulating property and assumes oppo-
 site characters.  In putrid fevers does it putrefy in reality?
 Authors have exaggerated respecting this; but the prostra-
 tion of strength, the facility with which the cadaver putre-
 fies in these diseases, every thing seems to prove that the
 putrefying principle has passed even into the blood.  It is
 also evident that  in  local affections, the  humours  have a
 tendency to putrefy before the death of the solids.  In the
 inflammation which terminates in gangrene, ordinarily the
 fetid smell is exhaled before the solids  are in a state of
 mortification.
  As to the other alterations of the blood, there are many
 which it would be difficult to classify under any general
 heads.  In jaundice the blood takes on a yellowish  colour.
 In general, in all diseases it is the blood which colours the
 lips and cheeks, in a peculiar manner for each  of them,
 and which enables us often to recognise them.
  From all this we must conclude that the fluids almost al-
 ways participate in the diseases of the solids.  The general
 consensus, which  seems to be wanting in certain  cases,
 would suffice to make us  think so.  As to the other cir-
 culating  fluids, they also  most  probably  are altered, but
 we know less about them.
  First, respecting the chyle, observation ascertains no-
 thing; the same thing is the case with regard to the lymph,
 of the alteration of which so  much has been said:  even in
 our days affections entirely different are mistaken for these
diseases.  What kis called lymphatic engorgement of the
articulations is only a disease of the cartilages.
             4 
2G
ALTERATIONS OP TUB FLUIDS.
                    ARTICLE II.

 Of the Alterations of the Exhaled and Secreted Fluids.

  We will not consider here in a very minute manner the
alterations eitlicr of the secreted or the exhaled fluids; but
we will treat of them more particularly in  the  article of
their respective organs.  Nevertheless, the alterations of
the latter may be divided into two sections.  Sometimes
their augmentation has for, cause the malady of  the organ
which  furnishes them, sometimes the affection of other
neighbouring organs.  In the first case they almost always
change  in their  nature; sometimes  they present flakes,
at others it is only a milky serosity.   The same thing
happens with respect to the secreted fluids; thus the affec-
tion of the neighbouring organ determines a more abundant
secretion, and the  direct aflection changes its nature, as
exemplified  in the bile.  Such are the alterations of the
fluids which naturally exist in the animal economy.

                   ARTICLE  III.

   Of the Fluids formed in a  Pathological State.

  We have  already said that there existed other fluids
formed by diseases, such as pus, which is different accord-
ing to the case.  It is  not the same in a catarrh and in a
phlegmon.  There  are  yet others  of different kind in
cysts, hydatids, and wens, the humour of which is always
more or less thick.  We will treat of  them in  the article
concerning each of these affections. 
INFLAMMATION.
27
                 CHAPTER IV.

                  Of Inflammation.

  Inflammation is so common a disease, that it would be
well to give an idea of it before we describe the alterations
of the diverse systems.  All authors, ancient and modern,
have spent much time on the subject of inflammation. We
will not examine the many opinions of every one of them,
on this subject, we will simply speak of that which obser-
vation  shows us.  Before we treat of it, we will briefly
recall to mind the different organizations of different parts
of the  body.  Every system possesses a substance of its
own, surrounded with a general tissue composed of cellu-
lar texture, nerves, blood vessels, &c.  The greatest  num-
ber present, in  a  sensible  manner, arteries and veins,
and an  extremely abundant capillary tissue;  such is the
case with the skin, muscles, &c.  Others, on the contrary,
present no vessels in an appreciable manner,—such are the
bones,  tendons and  aponeuroses.  In  general,  wherever
the capillaries abound, besides nutrition, there is also a
peculiar function which goes on, as in serous membranes,
in which exhalation takes place.   We must not lose  sight
of their peculiarities, for the frequency and  intensity of
inflammation is always in the direct ratio of the number
of the blood vessels.  As to vitality, we know that every
system possesses its own particular mode of existence.
That of the cellular is entirely different from that of the
mucous, which is owing to the diversity in the  vital pro-
perties of each.
  This granted, it is easy to know what we understand by
inflammation.  We  say that a part is inflamed whenever 
2N
INFLAMMATION.
it is red, painful, hot, and tense; but these four symptoms,
although very frequent, nevertheless do not always  exist.
In order to  understand well this disease, it must be first
briefly considered in each system, beginning with its most
simple stage, and ascending to its greatest complications.
If, for example, we take inflammation in the cutaneous sys-
tem, we see that  it  is  capable  of passing through  every
possible stage. The redness caused by a slight irritation,
by the part being too near the fire, is already the rudiment
of inflammation, already  we observe in it a  preliminary
change in the sensibility  of the  part.   It is never till after
this change that the other phenomena manifest themselves.
In bringing  thus together all the inflammations,  in which
the vital forces are  constantly exalted, we are inclined to
draw  the  inference, that the augmentation of  the vital
forces performs an active part in the disease, and, that it
is the cause  of it.   The afflux of the blood is produced by
the augmentation of the  sensibility; the colouring part of
this liquid passes into vessels in which it did not circulate
before.  This phenomenon is apparent in  the  serous
membranes.   When inflammation is greatest, then effusion
seems to take place,  and no longer permits us  to trace the
red vessels,  but presents only irregular spots more or less
large, as we see in the interior of the lungs in  peri-
pneumonia.   If inflammation becomes still more intense,
then there happens another phenomenon, it is heat, which
commonly appears more considerable than it really is,
since  the  thermometer  indicates that it does not surpass
the natural  temperature  by more than two  or three  de-
grees.   The feeling experienced by the patient is also very
strong.  The  disengagement, more or less  abundant, of
caloric, is remarked not only in inflammations, but also in
every part where vital energy has been excited.  It  is  not
our object to explain here this phenomenon.
  If the inflammation increases to a  greater degree, then
to all these  symptoms  are  added  a febrile disturbance, a 
INFLAMMATION.
29
phenomenon which always  succeeds  great  excitations;
sometimes it precedes and at other times follows the in-
flammatory accession.  This fever is entirely different from
idiopathic fevers.   Another symptom which accompanies
inflammation, is swelling, which is more or less considera-
ble, according to the greater or  smaller determination of
blood that produces it.   From this we see that this circum-
stance is only accessory and must always  vary.
  Inflammation varies also according to two principal cir-
cumstances: 1st. according to  the diseases, with which it is
complicated: 2d. according to the system in which it is
located.
  Inflammation often becomes complicated with affections
of a more or less severe nature,  the symptoms of which,
sometimes, are so intense as to conceal the primitive mala-
dy; thus the signs of inflammation may unite themselves
to those of adynamia, as occurs in  many  examples of pu-
trid peripneumonia, and  in puerperal  fevers, which  are
sometimes associated with 'putridity; and in phlegmon,
which is  often succeeded by mortification.  We  might
mention examples  of these complications  in the inflamma-
tion of each system.  It is seldom complicated with ataxia;
nevertheless, we have seen after several  pleurisies a metas-
tasis to the brain occur, but which lasted only a short time.
A complication very common to inflammation is gastric
disturbance; in almost all  the hospitals, there occur very
few inflammations  which are  not accompanied, from the
beginning, with  this affection.   Besides, in gastric diffi-
culties it is very necessary to  distinguish  what belongs to
the liver,  and what to the stomach.   As to the symptoms,
affecting the mucous  membrane, they seldom are asso-
ciated with inflammation.
  The other systems feel more or less the influence of the
local affection.  The organs suffer by it more or less; thus
in peripneumonia,  the increased  action of the heart pro- 
JO
INFLAMMATION.
duces lever; the stomach becomes deranged by sympathy;
very little urine is passed, and the skin becomes dry.   If
in the first outset of severe inflammations we examine the
condition of the organs, it will be found that all arc more
or less injured in their functions.
  Such is inflammation considered under the relation of its
complications.  Now let us see its differences according to
the system which it aflects.  Writers have not had regard
to this distinction; nevertheless, it is an essential one, and
the difference of the inflammation of one system from that
of another, ought never to be overlooked.
  First, all the systems which are very vascular, such  as
the cellular, mucous,  serous, &c. are very subject  to be-
come inflamed.  Those which  present a contrary disposi-
tion; such as the osseous, the cartilaginous, the tendonous,
almost never  become  inflamed.  In  this respect, we see,
therefore, that the organization of the tissues influences the
character of the different symptoms.  The pain caused by
the inflamed cellular tissue no'  wise resembles that of the
skin in this state; the pain then, produced by inflammation,
has a peculiar  mode according to each  system.   Redness
and heat observe, also, this relation; thus the skin becomes
coloured by the least irritation, whilst, on the contrary, a
considerable time is necessary for the surfaces of the  serous
membranes to become reddened.  The immediate  cause
of this redness is obvious in certain systems, but in others,
where we observe no blood vessels, it is difficult to explain  it;
thusweareignorantof the inflammatory condition of theor-
gans having few blood vessels, such as the bones, cartilages,
and tendons.   Heat presents also a different character ac-
cording to the system  inflamed: in erysipelas, it is acrid
and pungent;  in phlegmon it is augmented, but it has the
ordinary type.  Rheumatism offers also another kind of  it.
The above considerations  must be sufficient to prove that
inflammation is not the same in all the systems. 
INFLAMMATION.
31
  Inflammation is susceptible of terminating in three differ-
ent manners:  1st.  naturally or by resolution; 2d. by sup-
pression or discussion; 3d. by suppuration or other malady.
  Inflammation, in its natural stages, terminates in resolu-
tion.  At first it increases  to its maximum, then  it de-
creases  and resolves itself.  These phenomena rest upon,
and have reference to the principal symptoms.  The first
thing which disappears is the fever, then the redness, the
tumour, and finally the pain.
  The period of the resolution of different inflammations,
is very  uncertain and variable, and although the diseases
have a  general type, it is so modified that they all differ
from  each  other.   First, resolution  varies  according  to
the complications, and this renders it more  or less quick
in its progres, it varies also according to the system affect-
ed, because its  organization and vitality differ  from that
of others:  thus  in the system in  which vitality is most
energetic, resolution will be also more prompt, as in the
muscles, skin, &c; on the contrary, in the bones, and car-
tilages,  in which life seems hardly appreciable, inflamma-
tion passes through its different stages very  slowly;  in
other parts it would be chronic, whilst  in the  latter it is
simply  acute.
  This  difference  is not only remarkable in spontaneous
inflammations, but even in those  which produce the solu-
tion of continuity resulting in cicatrization.  We know-
that it takes forty  days for a bone to unite, whilst the skin
cicatrizes in six.  This difference in  the duration  of re-
solution exists even between systems gifted with greater
vitality: thus  the  serous is remarkable for the rapidity  of
its inflammation, whilst in the tissue of the  liver, and  in
 that of the kidneys, inflammation is much more slow.
  The intensity, therefore, of inflammation, corresponds to
the degree of vitality of the different organs.
  We know also  several  other  accessory  causes  which 
32
INFLAMMATION.
 quicken or retard resolution, and these are treatment, tem-
 perature, and temperament.
   The  inflammation which terminates by resolution,  pre-
 sents a very common phenomenon; it is, the augmentation
 of the secretions, which is called crisis; we will not seek
 here the cause of it, we will only say, that sometimes  it is
 a copious sweat, and at others  a  mucous  expectoration,
 &c, according to the part affected.  This excretion is al-
 ways a  favourable  sign, but it is impossible to determine
 its relation with the disease; it is as much unknown as the
 phenomena which precede it.   In  this respect, it must be
 observed that all inflammations do not terminate in this
 manner.  Inflammation seems subordinate to the system
 that it affects.  That of the mucous tissue is easily ascer-
 tained by its  excretion,  but it is impossible  to judge of it,
 in the same manner, with regard to the osseous system.
   Sometimesinflammation is stopped in its progress through
 its natural stages; and this sometimes is an effect of the disease,
 and at others  of a means  employed by art, as in cases of
 burns,treated by discutients. We can not often at once sup-
 press inflammations; besides, in general,this practice is dan-
 gerous.   We know  often how  fatal it is to repel an erysi-
 pelas; and this is the reason why now  they are almost al-
 ways abandoned to their natural course:  the same  is the
 case with phlegmon, &.c.  This phenomenon is  not  pe-
 culiar to inflammations,  for all  maladies, imprudently sup-
pressed are often transferred to another organ, where they
 produce  a more  fatal affection,  and even  death.   What
 dangerous consequences do not happen in interrupting the
 first stages of an intermittent fever, in the repelling of
 small-pox, or of a simple catarrh?  Nevertheless, it is evi-
 dent, that, in those maladies in  which  experience  has
 taught us, that it would  perhaps terminate fatally, if aban-
 doned to nature, we ought in these cases to seek to trans-
 late elsewhere the excitation, as  in peripneumonia by  the
 use of blisters. 
INFLAMMATION.
33
  There are many inflammations which come on spontane-
ously.   There are others the nature of which seems movea-
ble, and which shift alternately from one part to another; such
is acute rheumatism.  This depends also upon the different
systems; thus the cutaneous often presents these metastases,
whilst the osseous never presents  any.  This spontaneous
suppression was known to all the ancient physicians.
  Inflammation terminates also in other diseases, such as
suppuration, and chronic inflammation.  When resolution
does not occur, suppuration almost  always  follows; but it
is impossible to foresee it,  since the inflammatory progress
is the same; besides, the systems are more or less inclined
to this termination.   The cellular, serous, and mucous tis-
sues, are very prone to it; others, on the contrary, never
suppurate,  such are  the tendons and bones, the inflamma-
tion of which is, as  yet, unknown to pathologists.
  Two principal causes singularly modify suppuration;
these are the diverse complications, and the nature of  the
affected system.   Certain  systems, as we have already re-
marked, are very much inclined to suppuration, and in
these,  inflammation makes very rapid  progress; others, on
the contrary, seem very little susceptible of it.
  Even the mode of suppuration differs in each system; in
the mucous, it is only an increased secretion of the glands
subjacent to the membrane.  In  the  serous, on the con-
trary, it is only an  extraordinary exhalation, sometimes
mixed with flakes, without our ever perceiving any erosion
on the surface.  As  to the pulmonary or cellular system, it
is very difficult by mere inspection to determine how sup-
puration goes on.  Almost always the pus is infiltrated in
the lungs.   In the skin, the pus gathers in small abscesses;
in the cellular tissue, it forms a considerable  sac: the se-
rous  tissue  never forms abscesses in its cavities.  Thus we
see, that the nature  of suppuration differs according to the
particular system.   It is not, therefore, a function, as nu-
trition, which every where takes place in the same manner.
            5 
34
INK LAMM \TI0>
  The nature of the pus varies singularly, although we
confound all its different kinds with that which is general-'
ly produced in the cellular tissue; but in no system docs
it appear the same.   At times,  it is a limpid scrosity, at
others, is mixed  with flakes; sometimes it is a false mem-
brane; finally, at others, it presents the consistence of pap
(bouillie).  Hence comes the erroneous idea we form of
sanies.  The pus coming from a certain system, might be
considered  a true sanies, whilst it would  not be thought
so, if it proceeded from another.
  The symptoms which are  produced by the existence of
this fluid are also different.  In the cellular tissue, it is
manifested  by a heaviness and peculiar tension; upon  the
mucous  surfaces it produces an irritation which  urges us
to remove it, as in coryza.  It never remains with impunity
in the bones; it causes in them  a very  peculiar pain and
injuries,  when  it is  not evacuated.   There  are   some
parts where it may remain without producing any great.
inconvenience.   After pleurisy, a person may retain pus
in his thorax, for a longtime, without experiencing  a very
painful feeling.
  Induration has been represented by the ancient authors
as one of the terminations of inflammation; but seldom does
it succeed this malady, and instead of it, we will treat of a
disease much more common in the termination of an acute
inflammation, namely, chronic inflammation; this  termina-
tion is the most frequent after resolution and suppuration,
particularly in the internal organs.
  This is a disease in which the inflamed parts present every
where an aspect nearly alike,—but in which the princi-
pal symptoms such as the pain, and the heat, experience a
sensible diminution.   For the better understanding  of this
termination, we will relate a few examples.
  Sometimes the inflammation  of the  peritoneum  termi-
nates as follows: the inflammatory symptoms diminish, but
the abdomen remain* obstructed, and sensible to pressure; 
INFLAMMATION.                 35
 vomiting occurs from time to time; there is tension and an
 obscure pain.  This is common in peripneumonia.  Inflam-
 mation, after having  run through its stages, towards  the
 end experiences a remission; the symptoms remain little
 appreciable, but the pain in the side continues and hinders
 any considerable motion.   This  disease commonly termi-
 nates in dropsy, or phthisis pulmonalis.  In the  mucous
 system, the chronic inflammatory affections are extremely
 remarkable.  Nothing is more common than to see acute
 rheumatism become chronic.
  There are material differences between these two spe-
 cies of inflammation.  The chronic  one never becomes
 complicated, because its complications being acute  can not
 last  as long as it.  The termination  of the  chronic  in-
 flammations varies also according to the system; in the se-
 rous it ends almost always in  dropsy; in the  lungs, in
 phthisis pulmonalis; in the mucous membranes, by dysen-
 tery.  It is often the case that the patient dies.
  Inflammation may also terminate in other maladies, such
 as steatoma, &c.  But we have not a sufficient number of
 observations on this subject, to justify us in speaking of it.
 In conclusion, the last termination is gangrene.  It also
 presents differences according to the systems affected.  It
 is  never to  be met with  in cartilages, nerves, nor bones;
 other systems are more  prone to it, as the cellular tissue,
 the mucous and serous membranes, and the skin.  This
 termination may be brought about by two different causes;
 1st. by its peculiar nature, 2d. by excess of inflammation.
  Inflammation which bears an adynamic character, often
 ends in gangrene; but this is subordinate to the general or
 local influence of the  complication.  In the second case,
 there is gangrene.  Thus, it is not observed in putrid pe-
ripneumonia, but when it is a local complication, often the
part putrefies, as in anthrax. This complication is extreme-
ly variable  in its intensity.  Sometimes it mortifies sud- 
36         MkEA«LS t'K THE SKllOl* MM'E.M.

denly the  part; at other times  this putrefaction does not
take place.
  Sometimes, when life is too active in the part, gangrene
is also a consequence.   This accident is more to be feared
in the country than in cities.  Besides, we must carefully
distinguish putrefaction from  gangrene, to which antisep-
tics are not opposed.
                  CHAPTER V.

            Diseases of the Serotis  System.

  We have  already remarked that the diverse systems of
the animal economy, in whatever  part they are to be met
with, present always analagous diseases.   Therefore, it is
indifferent with which of the systems we begin.   We will
however select the  one  the affections of which  are most
known.  The serous, glandular, and mucous systems are
those which  present themselves.
  The  serous system is,  as every one knows, composed of
a certain number of membranes which cover the exterior
of several organs.  They form sacs without any  opening,
and offer two surfaces, one  of which is smooth and polish-
ed, and opposes its surface to itself;  and the other adheres
to the  organ which it envelops, and to the neighbouring
parts.  These membranes are especially composed of cellu-
lar tissue, absorbents, and exhalants, and in this respect,
they have the greatest  analogy with the  cellular  tissue,
from which, however, by  their affections, they  are very
distinct.   In a healthy  condition, they do not enjoy ani-
mal  sensibility; in the inflammatory state, it exists in the 
DISEASES OF TUE SEROUS SYSTEM.
37
highest degree.   They follow  in their development the
progress of the organs which they surround.
  The diseases of this system, as those of others, are refer-
able to two general classes: the essential and the sympto-
matic.  The first of the essential affections of this system
is inflammation.

                     ARTICLE I.

    Of the Inflammation of the Serous Membranes.

   Few systems, if we except the mucous and the cellular,
 are oftener inflamed  than  the serous; but all the mem-
 branes which  compose this system are not equally suscepti-
 ble of it; the  following is their order in this respect: 1st.
 the pleura, 2d. the peritoneum, 3d. the pericardium, 4th.
 the tunica vaginalis, and lastly, the least frequent of all, the
 arachnoid.
   Here, the causes of inflammation are extremely varied:
 in general, we  shall never pay  any attention to  remote
 causes;  among the proximate ones  is particularly the sup-
 pression of transpiration; this is especially the case with
 regard  to the pleura and the  peritoneum.   These causes
 act, not on the affected  membrane,  but on the neighbour-
 in^ organs.   WThen the disease is developed, these are the
 characters which distinguish it: at  first it is accompanied
 with  all the  general phenomena;  fever, chills, sweating;
  in general, it is singularly variable.   A very sudden attack
  is manifested by an excessive pain of the part, as we see
  in pleurisy.   In no system  is the pain more keen; the
  stages succeed each other with an astonishing  rapidity; in
  three or four days the disease is determined: moreover, the
  concomitant fever, which is slight in the affections of other
  parts, is here very intense; and the danger is always more
  manifest.  This inflammation influences also the condition 
38         DISEASES OF THE SEHOls HMKM.
of the organs which it covers;  besides, these  symptoms
varv singularly.
  As  to the condition of the surfaces of the inflamed serous
membranes it is difficult to determine during life.   Never-
theless, in the operation of  hernia, and in some experi-
ments ou dogs, the peritoneum has  been observed in a
state of inflammation; it was  then, extremely red.   As to
tumefaction, it is not appreciable, and is only a thickening
of the membrane.  Inflammation  in this system, as in every
other part of the  body, goes through the same series of
stages, if we except adhesion, which exclusively belongs
to it.   This  phenomenon  has without doubt its origin in
the serous membranes, from the suppression,  for a consi-
derable time, of the fluid which was exhaled before, caused by
the inflammation, which  permits the two  surfaces of the
membranes  to contract  adhesions.  This termination  ac-
companies always those  by  resolution.  These adhesions
are of two kinds:  some have  for means of union a  species
of albuminous matter, in the  form of a false membrane; the
adhesions, properly so called, are those in  which the two
membranes seem to blend themselves at their surfaces.
  All serous membranes are  not equally susceptible of this
adhesion. The pleura presents  this phenomenon  in  two
thirds of the cadavers examined in the dissecting  rooms.
Next in order comes the peritoneum, which sometimes ad-
heres to the diaphragm and to the liver, seldom to the in-
testines; then  follows successively, the pericardium, the
tunica vaginalis, and the arachnoid.
  We see by this gradation, that thosewhich are most sus-
ceptible  of  inflammation present, most commonly, adhe-
sions.  These are of four kinds: in the first, the two parts
are so very  intimately united that we cannot distinguish
them.  The pericardium having been  found in this state,
has caused doubts to arise about its existence.  In the se-
cond species,  the  membranes are  united  in a more loose
manner; in the third,  there are a multitude of small fibrous 
DISEASES OF THE SEi'.OUS SYSTEM.
j-j
prolongations, which extend from one surface to the other.
In the fourth, there are  also bands, but larger, flat,  and
disposed in such  a  manner, that one would think them
natural.  Can we  ascertain during life these kinds of ad-
hesions? Writers have described as a sign the constancy
of the pain; but this only indicates  the remainder of in-
flammation, which lasts more or less time.   Besides, this
affection is oftentimes without danger.
  Another mode  of termination of the inflammation of the
serous membranes is suppuration.   Certain signs  make it
known. Whenthe disease passes the sixth or eighth day,and
the patient feels a  local weight, we then presume that suppu-
ration is formed.  It is somewhat rare to find then in the se-
rous membranes only  a pure fluid exhaled; commonly it is
mixed with an albuminous matter, which gives to it the as-
pect of a lactescent serosity; at other times floating flakes,
more or less large, are met with; as in puerperal fever.
Finally, sometimes, in children  who  have  died from in-
flammation of the pleura, we find a matter absolutely analo-
gous to pus.  We find, moreover, but rather seldom, a kind
of  false membrane, produced by an albuminous matter
more concrete than in a  natural  state.  Lastly, the serous
fluid degenerates so much,  at times, that it assumes a bad
colour and smell, as we see, sometimes succeeding inflam-
mation of the lower abdomen.   These diverse fluids may
remain for more cr less time upon their respective surfaces;
sometimes we find thosewhich have existed for more than
six  months.  In the  chronic inflammation of a serous
 membrane, ordinarily the subjacent organ is affected, whilst
 in  the acute it is never so.  Further, the  suppuration  of
 these membranes is  almost always fatal.   Nevertheless,
 resolution sometimes takes place; but it is very seldom.
   Gangrene is another termination still more rare  than the
 others.  The part in which it most frequently occurs, is
 the peritoneum; even on  the examination of the cada- 
 ■!•>         Pisi: \Sf"t OF THE SEROUS SYSTEM.

 vers, this membrane is merely red. Besides, the black colour
 does not always indicate gangrene.


                    ARTICLE II.

 Of Chronic Inflammation of the Serous Membranes.

   Another termination of acute inflammation in the serous
 membranes, is chronic inflammation,  called by  the  an-
 cients induration.   There are few tissues  in which it is
 more common. m It would be difficult to determine by  the
 symptoms, the transition from the acute  to the  chronic,
 because  their remission is  not sufficiently appreciable.
 Such a termination protracts the disease to the fortieth or
 fiftieth  day,  sometimes  even  as long as  three or four
 months.  These epochs are very variable, and hence im-
 possible to be determined precisely.  The chronic inflam-
 mations of the serous membranes do not always  succeed
 acute inflammation; they may be produced by a sudden
 and imprudent discussion, as well as by the affection of a
 neighbouring organ.  We have  seen also one membrane
 communicate its  affection to another, as the peritoneum to
 the pleura.  However, these simultaneous  affections are
 rare in this system, and because the parts which compose
 it, are seldom near  each other.   In the others, on  the con-
 trary, this phenomenon is much  more frequent.  Often a
 catarrh of the  nasal  passages  extends to all the  mucous
 membranes, which by communication, cover the inside of
 the stomach, lungs, &c.
  Moreover, the  effects of these slow inflammations  in the
serous membranes, are, an obscure pain and analogous
symptoms which often  deceive us in  regard to their true
 nature, because formerly physicians attended only to the
dropsy they produced.  There  is always more or  less de-
rangement in the organs which they cover.  A remarkable
effect of these inflammations, is a real dropsy augmented by 
           DISEASES OF THE SEROUS SYSTEM.         41

exhalation.  When these dropsies have reached their last
period,  it is often  difficult to perceive whence they pro
ceed, and to decide whether they are produced by the af-
fection of a neighbouring organ, or by that of the  mem-
brane itself.  We must have recourse to the preceding cir-
cumstances; for, symptomatic dropsy begins very  differ-
ently from the idiopathic.  Besides, as we have already
observed, almost always in that dropsy which depends on
the organs, the cellular tissue is infiltrated,  whilst in the
other, the serosity is confined to the cavity of the  mem-
brane.   It is  the  same thing with  respect to encysted
dropsies.
  The  fluids  produced  by  chronic  inflammation vary
singularly in their  quantity,  consistency and colour; they
are seldom pure,  almost  always  troubled, lactescent,
&c.  A phenomenon also very common to these affections,
is hemorrhage, in which the  blood passes at once without
any change into  serous cavities: we then find them  full of
a reddish serosity, sometimes in so great a quantity, that
the blood seems clear, always fluid, and without any co-
agulation.  How can that be? It is evidently through the
exhalants, for we perceive no erosion of the membrane.
This hemorrhage is then  manifestly passive, and must be
classed with those of the mucous membranes.  We some-
times meet with  these hemorrhages  after acute inflamma-
tions; but writers have not indicated the causes of  them.
  Such  are the principal effects of chronic inflammation
of the serous membranes, which sooner or later destroys
the patient.
  At  the  time of  post-mortem  examination, these  mem-
branes are generally a little swollen, and thickened by two
or three lines.  In such cases the pain will have been
sometimes general  and at others partial,
6 
 42         nHE\«>KS ok THR SF.ROI's sVSTV.M.

                    ARTICLE III.

    Of Miliary Eruptions of the Serous Membranes.

  Serous membranes are also subject to other essential af-
 fections, and which belong exclusively to them.  There is
 first a miliary eruption, resembling itch, which writers have
 not considered in a general manner.  Morgagni speaks of
 a peritoneum  covered  with  these pustules; but he consi-
 dered them to be symptomatic of other diseases.  We often
 meet with them in the dissecting rooms; they are observed
 on all serous membranes, but particularly on the perito-
 neum.   The whole surface of this membrane is then very
 red; and from it  rise  small  tubercules extremely variable
 in their size and figure.  They are found full of a steato-
 matous substance, and they are almost always accompanied
 with dropsy.   Some have taken them for chronic enteritis;
 perhaps it is  only a variety  of inflammation.  Besides, a
 sufficient number of comparisons, as yet, have not been
 made between the observed  symptoms and post-mortem
 appearances.
  A negro affected with a considerable looseness, caused it
 to cease by a repellant  glister.   From that time,  there
 occurred tenesmus, dropsy of the peritoneum, tension of
 the intestines, and violent pain in the abdomen.  Natural
 and regular passages were again re-established.  There was
 no infiltration in  the extremities.  It was attributed to a
ehronic inflammation.  Purgatives and diuretics were ad-
ministered to bring back the former looseness; but the drop-
sy did not diminish, the patient grew weak pretty rapidly.
At the examination of  the corpse, the abdominal organs
 were found healthy, but the peritoneum was found covered
 with miliary eruptions  full of serosity mixed with whitish
flakes.   We are ignorant of the nature of these eruptions
and their cause.  Some physicians have said that itch and
small-pox can be thus repercussed. 
           DISEASES OK THE SEROUS SYSTEM.         43

                   ARTICLE IV.

Of Spots and  Ossification of the Serous  Membranes.

  There exists also  some other affections peculiar to the
serous membranes; but they are very little known.  The
pericardium is sometimes covered with whitish spots on
the cardiac part.  One would be inclined to think that they
are inherent in  the membrane,  but  they may be easily
removed;  moreover, they never  present in  themselves
the symptom of any disease, and they are met with  in
healthy subjects as  well as in  pathological  cases: this af-
fection particularly  belongs to the pericardium.
   Ossification in serous membranes  is a  phenomenon of
very rare  occurrence; besides  there is no pathognomonic
sign which  may indicate it during life.  Sometimes  the
surface of the spleen becomes entirely cartilaginous, but in
this case the peritoneum is nowise interested.
   Writers have also spoken of worms being found in the
interior of these membranes; but they have either imposed
on us, or the cadaverous examination was made after pu-
trefaction had begun; post-mortem examination has shown
nothing like it to the moderns.
   There are some other affections of the serous membranes,
which present  peculiar phenomena,  such was that of the
peritoneum, observed in a man whose primitive malady
was not known, and whose belly, very  tense, presented
on the right side a considerable tumour.   It was taken for
a  steatoma of the liver, and aperient medicines were given.
The patient  died some days after tapping,  to which they
were obliged to resort.  On examination they found the
peritoneum covered with tubercules fall of a gelatinous
substance having the appearance of albumen.   No similar
observation is to be found in any writers. 
44         DISEASES OK THE SERors SV'TEM


                    ARTICLE V.

Of Sympathetic Affections of the Serous Membranes.

  Of these, dropsies are the most common.  They arc of
two species: the one produced  by the affection of the in-
veloped organ, as in hydro sarcocele, ascites, &c. the other
caused by a general affection or an organic  malady which
influences the  whole system, as in phthisis pulmonalis, af-
fections of the liver, matrix and spleen.  We must not
regard these terminations of organic diseases, as exclusive-
ly belonging  to the serous membranes;  they are general,
and  produced  by the weakness of the  whole  economy.
Therefore, not only serous exhalations are passive, but also
mucous secretions which cause the colliquative looseness;
the cutaneous  exhalation, which produces cold sweat; and
the  hemorrhages from the nose, anus, &c. which are the
consequence of that pathological condition.
  Moreover, all the serous membranes are not equally sub-
ject  to these  symptomatic dropsies.  The peritoneum  is
first, then  the pleura, and finally the pericardium, which
are the most common seats of them.  As to the'arachnoid,
it scarcely  ever contains any dropsical effusion,
  In the different acute  inflammations,  the serous mem-
branes are the seat of  a more abundant  exhalation?  We
might draw this inference  from its analogy with the skin;
but nothing is certain on this subject, because we have had,
as yet, very  few cadaverous  examinations to  testify  its
truth. 
DISEASES OF THE SEROUS SYSTEM.
45
                   ARTICLE VI.

           Of the Diseases of the Pleura.

                     OF PLEURISY.

  Whatever be the cause which produces it, inflammation
is the most frequent disease of this membrane.  Perhaps
it is owing to its being  near the lungs, which are always
in contact with the air; perhaps we ought often to attribute
it to a suppressed transpiration.  Whatever be the remote
cause,  it manifests itself by a chill which varies in  its du-
ration; to this  succeeds a vague sensation of heat, a general
lassitude, a keen pain in the  side, which sometimes hap-
pens suddenly, and  at  other times it appears only after
twenty four hours.  In  two or three  days the disease has
acquired its perfect character.  These are the symptoms:
  Those of the pleura  itself are a very acute stinging
pain, which has its  seat sometimes before,  at others be-
hind, but oftener on the  side.  This  pain  augments at
every  strong   inspiration,  which  then produces  cough.
Often  simple  pressure  made with the finger is painful.
Sometimes this latter phenomenon has deceived  physi-
cians, who have mistaken it for a rheumatic pleurisy.  The
patient with difficulty lies on the affected side.
  The lungs soon after feel this affection; a cough more or
less frequent  manifests itself.  A want of  expectoration
has  been given as a  sign of true pleurisy; nevertheless,
often it is humid, especially towards the last days, when
the patient expectorates more or less.  The expectoration is
bloody, but at last it becomes pure.   Respiration  is diffi-
 cult, but very different from that in peripneumonia; for in
the latter, strong  inspiration is possible, although painful.
   As  to general  characters, the redness of the face varies
 singularly.  Sometimes the cheeks are red, at other times
 they will not have changed their colour; in peripneumonia, 
 4fl         DlsKAsL* OF THF. SKHOl> SYsXKM.
 commonly, this redness is very  constant.  The pulse,
 strong and full, is sometimes unequal on the diseased side.
 The primie vise are almost always in a good condition, and
 when gastric  phenomena present  themselves, it is a com-
 plication and  not a symptom.  The state of the secretions
 and exhalations varies singularly; sometimes they diminish
 at the beginning and augment towards the end.   Strength
 is very little impaired.
  From  these symptoms we shall be able to  distinguish
 pleurisv  from  peripneumonia, however  little separated
 and distinct may be the inflammations of the pleura and
 lungs.   In reading what writers have left to us on this sub-
ject, we see that several of them have regarded as a symp-
 tom, what was only the effect of death, that is, the engorge-
 ment of the lungs.   They have not known how to distin-
 guish the very different consistency  which it acquires by
 inflammation, from simple sanguineous infiltration.
  The essential characters which distinguish peripneumo-
 nia from pleurisy are:  in the former, the face  has a con-
 stant redness, sometimes even a livid tint, which is a bad
 omen.   In this affection strong  inspiration is  impossible,
 whilst  in pleurisy it is only very painful.  Exterior pres-
 sure, always  very sensible in the latter,  is scarcely per-
 ceived in the former.   Percussion in peripneumonia gives
 an obscure sound;  the character of the pain  in pleurisy is
 more keen, and in peripneumonia more obtuse.
  There are cases in which these  two diseases complicate
 themselves; then, there result from them, mixed symp-
 toms.
  Inflammation of the pleura terminates as in the other
 serous membranes.  If it is by resolution, it is on the sixth,
 seventh, eighth, or ninth  day; then there happens a dis-
 tinct remission, and more abundant expectoration.  Often
 there occurs a critical evacuation, such as  copious sweats,
 haemorrhage, &c, but above all expectoration.   At other
 times there happens a metastasis;  the pain translates itself 
DISEASES OF THE SEROUS SYSTEM.
47
 to the shoulder or elsewhere, and it is then a rheumatism.
 In general, the greatest number of patients retain a pain,
 more or less obscure, which lasts till the fifteenth or twen-
 tieth day: it is the remainder of inflammation which  dis-
 appears by degrees.  Adhesions are another  frequent ter-
 mination, of which we have already spoken.
  It is almost impossible, at first, to determine if the pleura
 contain pus.  Writers have, nevertheless, given an infinity
 of signs  in regard to this:  first, it is the desire of the pa-
 tient to lie on the affected  side, whilst in the beginning it
 was  precisely the contrary.  Percussion is especially one
 of the best means; it ought  to be tried on all sides.  Ano-
 ther sign of which writers have not spoken, is the pressure
 of the abdomen: whilst pressing upon the epigastric region
 the patient experiences a sensation of suffocation.   When
these three symptoms are present,  we may infer the exist-
ence of an effusion.  There are other signs, such  as start-
ing in sleep; a livid complexion; the noise that the patient
hears; and the dilatation of the affected side  more than of
the other; the fluctuation of a fluid, &c.
  The patient almost always dies in consequence of these
 collections of  pus.   In examining the cadaver, we find a
pus which varies,  as we have already observed; but often
there occur local derangements in the parts.   Sometimes
the affected lung loses much of its size and sinks in water;
sometimes the  heart is  pressed forward, and beats  as in
aneurism; often the hypochondriac region of the  affected
side  projects outwardly.

      OF CHRONIC INFLAMMATION  OF THE PLEURA.

  The chronic inflammations of the pleura are those which
are best known.  Like the acute  inflammations  of this mem-
brane, they are  totally distinct from those of the lungs.
There are,  however, some phenomena which are  com-
mon, such as the cough, but it  presents in both cases dif- 
4fl
DISEASES OF THE SEROUS SYSTEM.
 ferent characters.  In chronic pleurisy, it is not so humid as
 in phthisis; the pain is not susceptible of shifting; there is
 no  momentary heat in the  hands and feet, no nocturnal
 perspiration as in the latter.   There is a difficulty of lying
 on one side, almost always local dropsy, whilst in phthisis
 dropsy is general.
  The pleura, as well  as  the other serous surfaces, may
 also be the seat of miliary eruptions, of which we have al-
ready spoken: they end ordinarily by  a serous  efi'usion
 more  or less troubled.
  The pleura may also contract a chronic inflammation by
the contact of diseased lungs.  It is also the seat of symp-
 tomatic dropsies, more particularly produced by affections
of the lungs and heart.

                   ARTICLE VII.

         Of the Diseases of the Pericardium.

  These affections are less known than those of the pleura,
either because they are very rare, or because the condition
of the part is a hindrance  to the correct understanding of
its diagnostics.
  Inflammation of the pericardium can  not be doubted,
since, after the manifest symptoms of  inflammation, post-
mortem examination has proved its alteration.  However,
it is not  an easy matter to recognise  it, although writers
have given several  means for this purpose; they  are so
vague that one can not rely on them.   Thus they have in-
dicated  the violence of  the fever, the pain behind  the
sternum,  fainting, and irregularity of the pulse.  All these
signs may partially belong  to inflammation of the lungs.
  As to the terminations of pericarditis, they occur in the
same  manner as in all  the other inflamed membranes; at
first by resolution,  often  followed by adhesions,  which 
DISEASES OF THE SEROUS  SYSTEM.
49
vary singularly, and of which we will say nothing more.
Have these adhesions a decisive influence on  the animal
economy?   Is  the heart hindered in its movements?  If
we consult analogy, we shall see that adhesions do  not
impede the action of the lungs.  Nevertheless, certain ob-
servations  would seem to  prove that some  bad  conse-
quences have resulted from it, such as fainting  and irregu-
larity of the pulse, which progressively increasing, have
caused the  death of the patient.  The second termination
of inflammation of the  pericardium, is suppuration; it is to
be found under diverse forms.  It is difficult to know the
epoch of its formation: we can not judge oi its existence
but after it is already considerably advanced.  The signs
presented  by  writers  are, as yet,  very  obscure.   It is
a sensation of  weight,  and  uneasiness in the precordial
region; in regard to the heart, there is intermission and ir-
regularity of the pulse, difficulty of lying horizontally: a
common phenomenon in dropsies of the thorax.  In these
two cases,  the liquid, pushing the organs upward, hinders
free respiration.  General symptoms are those of effusion;
nevertheless, there  is a peculiar criterion, which is pres-
sure of the epigastrium, which we have already advanta-
geously employed.
  As to  the fluid which is found in  the  pericardium, it
varies singularly: sometimes there are false membranes,
which  unite the  two  surfaces, or present  a  smooth or
rough surface on the  side of  the fluid; sometimes the fluid
is  lactescent, with flakes.
  The fluid also is in a greater or smaller quantity, so that
the pericardium is more or less distended.   Sometimes it
determines its  thickness; Friend has seen it one inch
thick, and even four inches.
  Gangrene is of very rare occurrence in the peivcardium»
although some  cases of it are cited by Lieut^d.  There
are also  symptomatic  dropsies caused by *e affection of
the heart; they also often result from a general affection,
            7 
50         DISEASES OF THE SIROIS SYS 11 \i

                  ARTICLE VIII.

           Of Diseases of (he Peritoneum.

  Affections of the peritonaeum are of a very common oc-
currence, and nevertheless writers who have treated of them
have filled  their works with doubts, occasioned probably,
by  neglect  of  post-mortem  examinations.  They  have
spoken of the isolated affection of each part of this mem-
brane, of the mesentery, of the epiploon, &c, whilst in the
greatest number of cases,  the affection  extends over the
whole surface,  a  common  phenomenon to all  the  serous
membranes, as we have already observed.

                   OP PERITONITIS.

  Writers have spoken very little  of the inflammation of
the peritonaeum in general; they have confined themselves
to the insulated affection of the stomach  or  intestines, to
which they have given different names.
   Inflammation of the abdomen, considered in general,
has essentially  its seat in the surface of the peritonaeum.
This extention seems, nevertheless, contrary to a phe-
 nomenon quite common in this disease, which is the local
pain of which the patient complains.  We shall not seek
 to explain  the cause of this phenomenon; we  shall be satis-
 fied to observe that it is analogous to many others in the
 economy;  such as in pleurisy, in which the patient com-
 plains of a pain in the side; in phthisis, in which he feels
 a pain sometimes in the back,  and at others behind the
 sternum.
   Peritonitis is remarkable for the  following characters, of
 which t.he first belongs to the peritonaeum,  the  second to
 the gastric organs, and the last to the whole economy.
   First, as v> the  peritonaum,  when  the disease  has
 reached its maturity, the abdomen becomes very painful,
 particularly on preying upon it; but this pain is very dif- 
DISEASES OF THE SEROUS SYSTEM.
51
ferent from that of acute dysentery.   In  the latter, one
docs not feel  that very distressing pain in the  abdomen;
there is an abundant and  bloody mucous excretion.  In
peritonitis, the patient is always lying on his back; any
other position is painful.  Writers cite some examples of
these diseases,  in which the symptoms have not been ap-
preciable, and  in which, nevertheless, on dissection, all
the evidences of inflammation have been found.   The ten-
sion of the right and left hypocondria, is always more or
less apparent; often distension  (mtteorisme) of the  intes-
tines, is a condition which points out  a very great differ-
ence between peritonitis and dysentery; the subjacent cel-
lular tissue is a little swollen.
  The most  frequent  symptom  which results from  the
sympathy of neighbouring organs,  is vomiting, which is
not produced by sordes, but by an effect purely sympa-
thetic; sometimes  looseness occurs  from the same cause,
as in puerperal fever.
  As to general symptoms, the pulse is feeble,  depressed;
as to the exhalations and secretions, they vary singularly,
and in  this respect we have very few certain characters
given by nosologists who have treated of this malady.
   Besides, this affection may be complicated with  gastric
obstructions, or adynamia; then  the tongue is  somewhat
black; prostration  is extreme, and breath fetid.
   Peritonitis  runs  through its stages with rapidity.  The
termination is here as elsewhere, and resolution, which
is always  desirable,  is  succeeded by adhesions.  These
do not occur  equally  over  every  part; the small in-
testines are seldom the seat of them.  They are common
to the convexity of the liver, spleen, to the first curvature
of the duodenum,  to the arch of the colon, &c.   However,
these adhesions produce no disorder in the function. Some-
times fatal results  have ensued, such as a fold of the intes-
tines adhering to the mesentery and becoming strangulated
by a band. 
'.y
DISK \"»ts OF THE -IMIOVS SVMkM.
  Another  termination is  suppuration; it  always occur*
when the patient dies; but it is impossible to  determine
the period of its formation.  The  nature of the fluid may
present all the varieties, of which we have spoken  in treat-
ing of the suppuration of the serous membranes in  general:
We seldom find in it false  membranes.   As to the termi-
nation in gangrene, of all the serous membranes, the peri-
tonaeum is the most susceptible:  nevertheless it  is  not  a
very common occurrence, the pus is then grayish and very-
fetid.
  Peritonitis often terminates in chronic inflammation; the
symptoms,  instead  of disappearing, only experience a sen-
sible remission: there is vomiting from time to time, the
pain seems  to  remit; at  times the  patient experiences
none. There is commonly  some degree of constipation, in
which this affection is very different from chronic inflam-
mation of the mucous membranes, which produces a con-
tinual looseness.
  The inflammation of the peritonaeum terminates uniform-
ly in dropsy confined  to  this membrane.  The  chronic
looseness also terminates  in an effusion; but it is then  a
general  dropsy. Therefore, we can not, under this rela-
tion, confound the affection of the peritonaeum with that of
the mucous membrane of the intestines.
  Post-mortem  examination, in what is erroneously called
chronic interities, present more or less affused water, con-
taining some albuminous flakes: the small intestines seem
sometimes adherent, but they are  only united by a more
concrete albuminous portion.   The chronic inflammations
of the peritonaeum may also complicate themselves with
miliary tubercles, as those  of the pleura.  They are  some-
times of the size of a walnut.  We must pay particular at-
tention  to distinguish them from  small  steatomae, which
sometimes  develop themselves in  the  mesentery; they
produce no mischief. 
DISEASES OF THE SEROUS SYSTEM.
53
                OF  PUERPERAL FEVER.
   Physicians have considered puerperal fever, a disease so
common to lying-in women, as a general  affection, and
consequently they have classified it according to the differ-
ent characters that it has presented.  We shall regard only,
in its examination, the peculiarities which it presents dur-
ing life, and what we find after death.   If the fever, which
is constant in this case, has been  taken  for the principal
disease, the affection of the peritonaeum may  at least be re-
garded as an essential symptom.
  Puerperal  fever varies in the time of its attack, and in
general, it is from the second to the twelfth day, after ly-
ing-in, that it manifests itself.  This attack is accompanied
with phenomena always variable.   At first,  we have sup-
pression or diminution of the lochia,  often violent colics;
it is then very difficult of distinguishing to what they be-
long.   When once they  are characterized, these  are the
signs.   First, as regards the peritonaeum, there is abdomi-
nal pain, sometimes toward the loins, at others towards the
epigastrium, sometimes in the whole extent of the perito-
nium.   The character of this pain is peculiar to the serous
membranes.  The patient remains lying on her back.   Ne-
vertheless, there is sometimes some remission in the pains,
as we have seen in the article on peritonitis.  On dissec-
tion of the  cadaver, we  find a real affection of the  peri-
tonaeum.
   As to the symptoms resulting  from the  neighbouring
organs, vomiting is almost always  constant; sometimes it
is complicated with foulness of the stomach; at others there
is only a mere hickup.   Some physicians,  deceived by
this symptom, believed that they now saw  in this an af-
fection simply gastric, whilst it is an  effect merely sym-
pathetic.  In many  cases there is a  marked  looseness,
which is a very bad  omen.  At other  times there  is  con-
stipation. Bloating also, often characterizes this inflamma- 
 r» 1          DISEASES OF TIIK SEROUS SYSTEM.
 tion; it appears that  it is owing most frequently, to the
 swelling of the cellular tissues subjacent to the peritonaeum;
 however the flatulent distension (me'tt'orisme) of the intes-
 tines may have some influence in it.
  Besides the general phenomena common  to  inflamma-
 tion of the  peritoneum, these arc some peculiar to puer-
 peral fever: They arc the suppression of the lochia, and
 the sinking  of the breasts, caused by the want of the secre-
 tion of milk.  The state of  the pulse varies.  When the
 affection is simple, it is little characterized; but when the
 disease is complicated, it then assumes characters analogous
 to this  complication.   Respiration is always a little dis-
 turbed:  it is a very common phenomenon in the affections
 of the peritonaeum, that, pressing the  diaphragm upwards
 renders inspiration  painful.   The Accretions and exhala-
 tions vary;  in general, we can not determine the signs
 from them, in every affection.  The prostration of strength
 is  extreme.   Finally there happens, sometimes, cerebral
 delcrium.
  Writers have spoken of a  gastric complication of puer-
 peral fever;  but the symptoms are very difficult to appre-
hend.  It is often accompanied by adynamia; there is then
extreme  prostration, black and fuliginous tongue, breath
fetid.  Fever  from affection of the mucous  membranes,
 seldom unites itself with it.
  The termination of the puerperal fever varies.  Patients
often die after the third  or  fourth day; in general,  they
live even to  the eighth or tenth day.   Death is the most
 common termination  of  this fever, when the symptoms
 are very much aggravated.   When the  lochia yet flow,
 milk continues to be secreted, and the symptoms diminish,
 we may hope  to save the patient. The emollients and
 ipecacuanha, that had been very much extolled, avail very
 little.  Blisters, the object of which is to translate the ir-
 ritation, as the  indication suggests, serve only to render
 the disease chronic. 
           DISEASES OP THE SEROUS SYSTEM.         55

  Post-mortem phenomena are different according to the
period of death.  When it has been sudden, the peritonaeum
is very little  red; nevertheless pain has been excessive,
distension  (met6orisme) very great, which induces  us to
believe that the blood has escaped by the collateral vessels.
On the other hand; we find commonly a  lactescent hu-
mour, or one  containing whitish flakes, of a peculiar na-
ture.   As  to  the  matrix  we  have few observations for
judging of the condition in which it is then found.   It has
been observed, however, that it putrefies much sooner than
in any other  affection.  When the  patient has died after
thirty days illness, then the peritonaeum is  inflamed.
  Some writers have taken for effused milk, the lactescent
serosity that is then found in that membrane; but nothing
is more incorrect than this opinion.
  Termination by resolution is seldom observed.  In well
marked puerperal fevers, divers crises  by which it ter-
minates  have been indicated.  As  to the  nature of this
disease every one now agrees in saying, that it is a local
affection; the fever accompanying it, is only symptomatic.
Sometimes the inflammation  becomes chronic; then the
symptoms of the puerperal fever cease, and every  thing
reassumes the character of acute peritonitis.
  Writers have treated, in  particular, of local affections of
the peritonaeum; but we very seldom meet with  inflamma-
tion of this membrane, when it is otherwise than general-,
although it may begin in a particular place, by virtue of a
primitive affection of the abdominal  organ which it covers.
Nothing is more  common, among writers, than to treat in
particular, of serous inflammation of the  bladder, stomach,
&c.   They have  been the more deceived, as they  have
taken for symptoms, some signs which, although local in
appearance, denote, nevertheless, a general  affection. 
56
DISEASES OF THE SEROUS SYSTEM
OF THE SYMPTOMATIC AFFECTIONS OF THE PERITONEUM-

  Inflammation of the peritonaeum, is often a symptom of
other diseases, as in the  greatest number of essential fe-
vers, in which the abdomen is distended, becomes painful
during two or three days,and then returns to its natural con-
dition.  Perhaps it is by a symptomatic eruption on the sur-
face of the peritonaeum, as happens sometimes to the skin:
that which would induce  us  to believe so, are the frequent
adhesions that we meet within many cadavers.
  The  most common symptomatic disease of the perito-
naeum is ascites; although physicians have regarded, for a
long time as an essential malady.  Sometimes, as we have
already seen, this dropsy succeeds the chronic affection ol
the peritonaeum; but, oftentimes, it is caused by the organic
affection of an  abdominal viscus; it. is frequently produced
by an affection of the liver, often also of the spleen, the
matrix; seldom of the kidneys.
  It may be produced also by the lesion of a viscus situated
out of the  abdomen.  In these  organic  affections, dropsy
is general, whilst in chronic peritonitis, it is confined to
the abdominal  cavity, as we have already said.
  In the first case the liquid, being more or less copious, is
limpid  and transparent; several folds of the  peritonaeum
disappear,  and give to its cavity an extreme  amplitude.
The intestinal  canal remains free and floating without any
apparent adhesion, as in chronic peritonitis.  This quantity
of fluid acts differently on different parts.  On the  side of
the thorax it presses the diaphragm upwards, and hinders
respiration. The skin anteriorly is uniformly tense as a
balloon.   The liver is either flattened or convex, according
as the base of the thorax expands or contracts.
  Although this disease is not an essential one, neverthe-
less there are certain cases in which it develops characters
which are proper to it  In an affection of the liver, as long
as dropsy is not manifested, certain  symptoms are not de- 
DISEASES OF THE SEROUS SYSTEM.
57
veloped; but they are perceived as soon as it begins to ap-
pear.   The condition of the secretions and  exhalations is
especially influenced; then the urine is  in small quantity
and has the lateritous  sediment, the skin is parched, and
scaly,  for want  of  insensible  perspiration.  Nutrition is
badly performed, there results marasmus.   The state of
the pulse belongs always to the affected organ.

                    ARTICLE IX.

          Of Diseases of the  Vaginal  Tunic.

  All writers, who  have spoken much of hydrocele,  have
said very little about inflammation of this  membrane; never-
theless it is real, but less frequent than in the other serous
membranes: its adhesion proves the existence of it.  In the
case of the operation of hydrocele by injection, this adhe-
sion is absolutely analogous to those of the pericardium
and heart.  When this  inflammation becomes chronic, then
hydrocele  occurs.   Miliary eruptions may take place  on
its surface, as has been observed by Morgagni.
  Hydrocele,  properly so called, is always idiopathic, and
the effusion occurs anterior to the testicle, so that, this
organ is behind, and the spermatic vessels within.

                    ARTICLE  X.

            Of Diseases of the Arachnoid.

  The arachnoid is  a membrane essentially serous, and ex-
tremely thin.  Although it seems, in appearance, to differ
very  much from the others, it is like them in all  the at-
tributes which characterize it.

                     OF PHRENSY.

  The most common affections of the arachnoid membrane
are its inflammation. Writers have distinguished two spe-
            8 
 0>         DISEASES OF THE SKROUS SYSTEM.

 cies of this disease: The one, which they have said to be
 superficial, and as it were  erysipelatous;  the other, more
 deep-seated, which has been called phlegmonous.  This
 division can not be admitted, for, of all the different parts
 that the cranium  contains,  the arachnoid only can become
 inflamed; never have we found the substance of the brain
 inflamed; and as to the dura mater, by virtue of its fibrous
 structure, it is not susceptible of it.   Indeed, all post-mor-
 tem examinations prove this, because the situation of the
 purulent serosity is always on the surface of the brain.
   The inflammation of the arachnoid may be produced by
 two kinds of causes: the first comprehends external lesions,
 the second embraces spontaneous affections.
   The external causes which act upon  the cranium, when
 they  determine inflammation of the arachnoid, produce
 the same phenomena as those remarked in  spontaneous
 phlegmasia.  We see,  that, this division can only be es-
 tablished with regard to the cause.  As to  spontaneous
 phrensy, all writers have spoken of it; but they did not
 know its true seat.   In this disease, as in all others of the
 same species, it begins with pain in the part; the intellec-
tual  faculties are  confused, a common  phenomenon in all
 cerebral affections; in this case it is only sympathetic.  This
derangement varies singularly.   In all  cases,  the passions
are exalted, rage  succeeds, there is a continual agitation.
 Some authors have  distinguished superficial inflammation
 from  the deep-seated, by more or less proneness to sleep:
 but post-mortem examination has not justified this opinion.
The termination of phrensy is generally fatal; death follows
 after the third or fourth day; a whitish serous fluid is found
 extravasated in the cavity of the arachnoid, on the surface
 of the brain.   The ventricles seldom participate in the in-
 flammation, although they are interested in the dropsy.
   Resolution  is generally  very  rare; and  where it does
 take place, there seldom result adhesions.  We must not 
DISEASES OF THE SEROUS SYSTEM.          59
 regard as such some prolongations which form a sheath to
 all the vessels which traverse the dura mater and brain.
   Although authors have spoken of gangrene, yet this ter-
 mination never occurs.
   We have known some  cases in which phrensy has  de-
 generated into chronic inflammation; such was that of a
 child in  whom hydrocephalus succeeded after an acute in-
 flammation of the arachnoid.  We find some analogous  ob-
 servations in Morgagni.

                  OF HYDROCEPHALUS.

   Another essential malady  of  the arachnoid is hydroce-
 phalus, or a collection of water in its cavity.  This collec-
 tion can  occur in two different places; in the ventricles, or
 on the surface of the  brain.  The  disease  seems to arise
 from two causes, either from the affection of thf internal
 surface of the membrane, or from a  defect of t*e exhalants
 of this surface, and then no alteration is perceived.   This
 proneness is  common to the vaginal tunic.
   Wherever may be the  seat, and whoever may  be the
 cause; the size of the head is always e>nsiderable, and the
 more so in proportion as the child is  oung. The enormous
 size of the cranium js the first sign^f the disease; common-
 ly derangement of the intellects faculties accompanies it.
 The organic  alterations are dii»rent according to the seat
 of the collection; when it is M the lateral ventricles,  then
 the cerebral substance is passed from below upward, and
 in this case we almost al-ays find the circonvolutions ef-
 faced.
   When the  water is effused on the  surface,  the contrary
 takes place, and the brain  is pressed from  above down-
 ward.  If the bon*s then  separate in the womb, all the
 fluid  runs out am' the  brain  with it; this constitutes the
 acephalus.
   In both of these cases, the vault of the cranium presents
an extraordinary size, whilst  its  base  is not at all dilated; 
60
D1SE.V»LS OF THE sKKOLs blllKM.
the membranes which join the large flat bones elongate and
increase in proportion.
  The fluid in general is pellucid and transparent; it seldom
penetrates into  the vertebral column; the  origin  of the
nerves shuts up the communication.

OF THE SYMPTOMATIC  AFFECTIONS OF THE ARACHNOID.

  The symptomatic affections of this membrane cause it to
differ from those of its own species.  It only becomes the
seat of dropsy, when  a neighbouring organ is affected, such
as a fungus of the dura mater, a proper affection of the sub-
stance of the brain, &c.   In the greatest number of ataxic
fevers, there is  also an effusion; but is  it then the effect or
the cause of the malady?   The latter case seems the  most
probable.  In those affections in which there happens de-
lirium, se\dom is there any effusion, as in puerperal fever.
As to the oJier diseases which determine general dropsy,
they seem no, to influence the arachnoid.

          OF SPItA.-BIFIDA, OR  HYDRO-SPINALIS.
   It is an idiopathic-^ffection of the arachnoid which covers
the vertebral canal,  't is strictly analogous to hydroce-
phalus; but  it has been vrv little observed, in consequence
of the difficulty which aivayS  exists in exposing the ver-
tebral canal.   However, ve know that it consists  in  a
 collection of water which gamers in the cavity of the arach-
 noid; sometimes it is in all then.xtent of the canal, at others
 it is more  partial.  The spinout  apophyses are divided;
 and if we make a puncture the dife.aSe becomes mortal. 
DISEASES OF THE MUCOUS SYSTEM.
61
                  CHAPTER VI.

           Diseases of the Mucous  System.

  The  mucous system is composed of a series of mem-
branes,  which successively develop themselves over the
different hollow organs of the economy.  There are two
principal ones; one which penetrating through the mouth,
eyes and nose, covers the nasal passages, pharynx, broti-
chiae, and all the intestinal canal; the other which, entering
by the canal of the urethra and vagina, lines all the urinary
and genital organs.  These membranes differ from the se-
rous in  their general organization.  They are divided into
two surfaces: one, which lines the internal cavity of the
organ and corresponds to itself, and is continually lubri-
cated, in a natural state, by mucous; the other, external, is
in contact generally with  a  fibrous surface:  sometimes,
however, there is an intervening cellular tissue.  As to
their texture, it has a great resemblance to that of the skin
We find at first a chorion, very thick in some places, and
thin in some others; this chorion is covered with a papillary
body, the seat probably of mucous sensibility.  The epi-
dermis is more or less  apparent, according to the different
parts.  It is very visible on the tongue, whilst it is not to
be perceived in the intestines.
  The mucous membranes may be regarded as the internal
integuments destined to protect the organs against the con-
tact of foreign bodies.   As to their vital properties, they
vary in  different parts.   There is always organic sensibili-
ty and insensible contractility.
  Respecting  their alterations, we shall speak of them at 
 hi         DISEASES OF THE MUCOUS SYSTEM.

 tirst, in general, then in particular, as we have done in re-
 gard to the serous membranes.
   The mucous system, like the serous, is the seat of two
 species of affections.  The first are  primitive; the others
 are produced simultaneously with another affection.


                    ARTICLE I.

      Of Inflammation of the Mucous System.

   The most frequent malady of the mucous system is in-
 flammation.  In whatsoever place the membranes com-
 posing it are met with, they present similar phenomena in
 their phlogosis.  These latter are known by the common
 appellation of catarrhs.  However, this word has been too
 much generalized, in  refering  to  them all the increased
 secretions of the mucous membranes, which sometimes are
 not the consequence of inflammation.
  The distinctive characters of the mucous inflammations,
 first depend on the manner they begin, and  their close
 relation to the different states of the skin.  They are al-
 most always produced by sudden changes of the  atmos-
 phere; hence, colds or catarrhs, coryzac, &c.   This close
 sympathy is equally evident in other mucous affections.
 Indeed, we know that a cold application on the temples
stops a nasal hemorrhage.
  Another  character of the mucous phlegmasia?, is their
 prevailing frequently as epidemic diseases.  A multitude
of authors have spoken of it.  This is particularly the case
 in dysentery.  This character causes these  inflammations
to differ essentially from the serous phlegmasia?, and from
 those of all the other systems.  Indeed no mention has
ever been made of epidemic of phlegmon, erysipelas, &c.
  The pain in these inflammations is generally less intense
than that in all others.  In coryzae, there is only obstruc-
 tion.  Another character is that they are almost always un- 
DISEASES OF THE MUCOUS SYSTEM.
63
 accompanied with that swelling of the neighbouring cellu-
 lar tissue, which  we observe in other phlegmasiae.  In
 dysentery the abdomen is never distended as in enteritis.
 As to redness, it can not be determined, since, in a normal
 state, it varies according to the condition in which the mu-
 cous membranes are found.   However, it seems that this
 redness is always augmented.   One  can judge of it  by
 analogy from the inflammations of the mouth.   Seldom is
 there any concomitant fever; and, should it exist, it is never
 very intense.  Moreover, mucous phlegmasiae can be com-
 plicated with all the maladies of which we have spoken in
 the article of complications  of the diseases of the serous
 membranes.
   These phlegmasiae never  terminate without a more  or
 less abundant secretion of mucous; there never happens
 any adhesion.   Whatever may be the cause of this pheno-
 menon, it establishes a great  difference between the termi-
 nation of these inflammations, and that of the serous mem-
 branes.   The abundant secretion which occurs at the time
 of the resolution may be also determined by an irritation
 without any phlogosis having previously existed, as we see
 by the introduction of a bougie into the urethra.
  The mucous which is so  abundantly secreted towards
 the end of the mucous  inflammations,  varies according to
 the different membranes and  different stages of the disease;
 thus, that  of a blennorrhagia  is not like that in dysentery,
 and the expectoration produced at the beginning of a cold,
is not the  same as that which takes place towards the end.
  Catarrhal inflammations seldom terminate in gangrene,
 if we  except some cases of anginae.
  Chronic inflammation is a termination of a more frequent
 occurrence;  but there are numberless  degrees  from the
 most chronic to the most acute.
  We know not the results of post-mortem examination in
 this disease, for it is seldom mortal; when it has become
 so, by its  complications, a thickening of different degrees 
64
DISEASES OF THE MUCoI'S SYSTEM.
 has been  observed, and some redness.  Sometimes false
 membranes are formed, such that their dense and inorganic
 aspect causes us to mistake  them for a real tunic.  W e
 have examples of poisoning upon record, in which similar
 substances have been thrown out  in smaller  or  larger
 quantity.

                    ARTICLE II.

     Of Hemorrhages oj the Mucous Membranes.

   Another essential affection of the mucous membranes
 consists in hemorrhages, of which we shall speak in this
 place, only so far as they are relative to these membranes.
   All physicians, till now, had considered them in too ab-
 stracted a manner, without observing that,  what is true
 with  regard to hemorrhage of one part, is not so with re-
 spect to that of another.   All the ideas of the mechanicians,
 who  have explained hemorrhages by obstruction,  have
 been  overturned by Stahl, who has considered matter in a
 manner too abstracted and metaphysical.
   We shall classify the hemorrhages of the mucous mem-
 branes according to the parts in which they  occur:  how-
 ever,  they are divided into two distinct classes;  namely,
 those from rupture, and those from exhalation.
  Those of the first species differ entirely from the others.
 They are always in proportion to the  size of the wound,
 and independent of every kind of vital action.   Hemor-
 rhages by exhalation, on the contrary, are  immediately
 subject to its empire. There is another species, almost in-
termediate to the two first ones; namely, hemorrhoids, the
 nature of which is yet very little known, and which can
not be classified in either of these two species.
  Hemorrhages by exhalation may happen wherever ex-
 halants terminate; and indeed they have their seat in mu-
 cous surfaces.   The nasal passages, bronchiae,  stomach, in- 
DISEASES OF THE MUCOUS SYSTEM.
65
testines, bladder, &c, may be the seat of them.  They
sometimes happen also in the serous membranes; for we
sometimes find a bloody serosity in the peritoneal cavity
in certain cadavers.   We meet with them also in the cellu-
lar tissue;  such are those which produce scarbutic spots.
Those of the skin are of a rare occurrence, but not without
example.   Finally, glands have often been observed  to
exhale blood..
   Hemorrhages by exhalation, in the mucous membranes,
as elsewhere, are of two species, passive and active.  They
are active when they are accompanied with  development
of the vital forces; thus they have this character in the na-
sal passages, when we remark a tickling sensation, together
with a slight pain and redness.   At other times they are
utterly passive, as when they are met with at the close of
some organic affection characterized by debility.
   As to the state of the parts, after death, in which hemor-
rhage takes place, it  does not differ from the natural  con-
dition, as it is seen in the matrix, in females dead, soon after
menstruation.
   There are also hemorrhages which depend  upon the dis-
organization of the tissues, as in cancer of the stomach and
matrix; it is not ascertained  whether this happens by ex-
halation or rupture.
  All hemorrhages by exhalation are remarkable from the
influence that they exert on neighbouring organs.   The
same  is the case with regard to  perspiration.  We know
that the application of a cold body to the belly stops the
menses  or  lochiae; all strong passion  produces the same
effect.
  The excitation of the mucous membrane of the stomach
by an emetic, may equally disturb the menses.
9 
6G
DISEASES OF THE MUCOUS SYSTEM.
                   ARTICLE III.

                     Of Aphthae.

  Another  peculiar affection of the mucous membranes
consists in aphthae.  These are ulcerated tubercles which
appear on their surfaces.   They are of two species.   The
first, which are remarked in the mouth, principally on the
sides of the tongue, present themselves under the form of
small round and prominent ulcers, covered with a pellicle
somewhat thick and difficult to detach;  this pellicle has a
strong analogy to those which are formed  on  the amyg-
dalae, in angina tonsillaris.   Sometimes these ulcers are an
inch in diameter; they may be essential or symptomatic.
  The other species of aphthae, or sore mouth, has been
described by  fVagler  and  Rsederer.  These are small tu-
mours provided with excretory ducts, which is the reason
why we should  regard them as small tumified glands.
What is certain is, that we find no where any thing analo-
gous to them.

                   ARTICLE IV.

                     Of Fungi.

  Fungi are a malady proper to the mucous membranes,
and consist in a considerable thickening of their parietes.
They have  much analogy with hypersarcosis of ulcers and
osteosarcoma.  These fungi display themselves in the si-
nuses, mouth, nasal passages and  matrix, when they are
known  under the  name of polypi.  They contain  many
capillaries in their structure, and when they are cut, blood
pours out like a  sheet of water.  This character serves
to distinguish them from  cancer with  which they  have
some analogy, since,  in the latter  the  arteries assume a
caliber two  or three times larger than in their natural state; 
DISEASES OF THE MUCOUS SYSTEM.
67
moreover it is accompanied with  hardness and callosity,
which are never to be met with in fungi.  A very import-
ant work is yet to be accomplished, which shall contain
the exact distinction of these different tumours.
  Another affection of the mucous membranes, consists in
the alteration that they experience when they are exposed
to the contact  of the air, as is observed in the different dis-
placements that they undergo, in prolapsus  of the rec-
tum,  vagina, or artificial anus.
  Next follows corrugation of  the mucous membranes, of
which we  have an example in gonorrhasa, affecting the
membrane of the urethra; and  in the oesophagus and sto-
mach, after being poisoned by nitric acid.
  The mucous membranes also can be the seat of affections
purely symptomatic.   They express in their peculiar man-
ner the affection which is communicated to them by other
organs.  Thus the catarrhs of  the thorax may be symp-
tomatically the effect of disease of the stomach; the mu-
cous hemorrhages, in a multitude of cases, may serve to
denote other affections; aphthae are often smyptomatic, as
in putrid fevers.
  The mucous membranes are also  sometimes  attacked
with general maladies, and such as are common to the
whole system,  as scurvy and venereal.

                   ARTICLE V.

         Of the Diseases of the  Conjunctiva.

  The conjunctiva differs essentially from all the mem-
branes of its own species in its  texture and aspect.
  Its inflammation bears the name of ophthalmia.  The
causes producing it are referrible to two classes, namely:
the external and internal.  In the inflammatory state of the
mucous membranes, there is a greater or less degree of red-
ness, and this is so much the more remarkable, as in their 
68         DISEASES OF THE MUCOUS SYSTEM.

natural state, we perceive no blood vessels.  It is especial-
ly in the part covering the sclerotica, that this colouration
is mostly visible.   There is besides more or less consider-
able swelling, and sometimes it is such  as not  to permit
the eyelids to open.  The inflammatory state of the mem
brane is of longer or shorter duration: nevertheless, we can
not say that the most acute ophthalmia1 protract themselves
more than ordinary mucous inflammations.
  The terminations may happen differently.  They never
occur without an augmented secretion of the fluid which
lubricates the membrane.  Adhesion never  takes place.
The mucous does not proceed from all the surface of the
conjunctiva; it seems to issue from the meibomian  glands,
situated under the eyelids.  It is especially in the external
angle that it is  to be met with, it there  dries, and forms
what is called rheum.   All the symptoms diminish by de-
grees, but redness persists for a long time.
  A termination extremely frequent in this inflammation,
is chronic ophthalmia.   Then there happens a  remission
in the symptoms, but the redness still continues.  Some-
times this state lasts more or less time; it is subjected to all
those influences which can keep up or check  it.
  Whatever may be the cause of this inflammation and of
its  duration, the following is the pathological  condition
determined by it.  The conjunctiva becomes thicker, en-
gorged, and sometimes its density is greater than that of
the eyelids, producing a kind  of inversion of the latter,
which is called ectropium.
   Hemorrhages  of the conjunctiva are very rare: never-
theless, Hallerand Morgagni relate some examples. They
have even pretended that there were some periodical ones,
in cases of suppression of the menses.
   Sometimes fungi are observed; often they  grow sponta-
neously.  At other times they  present themselves in con-
junction with a cancer of the  eye; they assume then a 
           DISEASES OF THE MUCOUS SYSTEM.         69

volume more considerable, and sometimes produce hemor-
rhages.
  As to symptomatic affections, they are frequent  in the
conjunctiva: thus, ophthalmia often denotes a  venereal
virus.
  The affections of the membrane which covers the lachry-
mal bag, may be also referred to those of the eye.   This
membrane may become engorged under different circum-
stances.  Hence the lachrymal tumour, which, however,
may be also produced by many other causes.   Sometimes,
the disease is complicated with caries of the os unguis; but
this accident is less frequent than authors have pretended;
besides, it is possible, that the concomitant caries of the
bones may be attributed to another cause.


                    ARTICLE VI.

        Of Diseases of the Pituitary Membrane.

  This membrane has a peculiar  structure; it is thicker in
certain places than others, which gives to it a resemblance
to that of the digestive system.  It is very vascular, hence
its frequent hemorrhages. It has some maladies which are
essential, and others only symptomatic.
  We  recognise under the appellation of coryza—the  in-
flammation of the pituitary membrane. This affection is ush-
ered in by a more or less lively pain, heaviness in the head,
difficulty in the passage of air, parched nostrils, and sneezing.
The sense of smell is very much altered, often lost.  The
seat of the inflammation is more or less extensive:   Some-
times it is confined to a part of the pituitary membrane; at
other times it occupies the whole of it, and even invades
the neighbouring parts, such as the pharynx and eustachian
tube.  At the commencement of this affection, the secre-
tion of mucous is entirely absent; a very limpid and acrid
water soon appears, that writers very inconsiderately have 
 70         DISEASES OF THE MUCOUS SYSTEM.

 mistaken for tears. This mucous soon acquires consistency,
 then it returns to its natural state, and the disease  termi-
 nates.   It seldom becomes chronic.   Its longest duration
 is from  fifteen to twenty days.
  Ozxna is another malady proper to the pituitary mem-
 brane.   It is a question yet to be decided whether it con-
 sists in an ulcer analogous  to those of the skin, or only an
 inflammation; post-mortem examination has not as yet dis-
 pelled the uncertainty respecting it.   It is probable, how-
 ever, that it is only an inflammation.  At least we some-
times see small ulcers appear in the nasal passages, caused
 by the revulsion of an herpetic affection, &c.
  Hemorrhages often affect the pituitary membrane, which
is a consequence of its vascular  condition.  Sometimes
these hemorrhages happen by a rupture, as  in concussions,
and blows on the nose; but they  are oftener  produced
by  an irritation of the extremities of the vessels.  These
hemorrhages are of a longer or shorter duration, and may
be arrested, as is well known, by plugging.
  Polypi  may also present themselves  on the pituitary
membrane.  Nothing is better known than  their accidents
and treatment; but we are yet unacquainted with their na-
ture.  However, what follows is that which observation
 has  taught us.  Two kinds  of polypi are  distinguished.
The one, vesicular, is characterized by its  whiteness and
softness, by the little pain it gives, and  by the swelling
that it experiences on exposure to moisture.  This species
 is rarely dangerous, and is never productive of hemor-
 rhages.  The other comprehends those which  are called
 hard,  and which present very different characters;  hard-
ness, rapid growth, pain and spontaneous hemorrhages; the
atmosphere has no influence on them. Their progress causes
the  disorganization of the surrounding parts; sometimes
 they warp the bones, at other times they erode them, and
 appear at the vault of the palate, or determine themselves
 to the pharynx: they may cause deafness and epiphora. 
           DISEASES OF THE MUCOUS SYSTEM.         71

  As to the symptomatic affections of the pituitary mem-
brane, they are very few.   Sometimes, though rarely, co-
ryza complicates itself with another disease.  Hemorrhages
especially are thus produced.  All the other maladies are
idiopathic.
  The  sinuses are covered by a membrane very similar
to the  pituitary.   They also may be the seat of various
affections.
  At first, the frontal sinuses may be attacked with co-
ryza; then all the symptoms of inflammation are there de-
veloped.
  The  maxillary sinus is very subject  to ozaena.  Often,
the fluid which is effused in it erodes the membrane, pro-
duces caries of the bone, and causes fistula. Finally, fungi
are often found in this sinus. They produce the same effects
as the effused  fluid-, and moreover, enlarging the cavity,
they produce a deformity more or less obvious.
  Finally, continued from the pituitary membranes, there
exists another prolongation, which lines^the eustachian tube
and extends as far as the tympanum.  This portion is also
susceptible of pathological affections, such as inflammation:
then the cavity of  the tube is almost  obliterated by swel-
ling, the free circulation of the external air, in the internal
ear,  is   intercepted, which causes deafness.  A  kind of
thick residue has  been found on this  membrane, which
probably was only the result of suppuration.


                   ARTICLE VII.

  Maladies of the Mucous Membranes of the Mouth.

  The  internal membrane of the  mouth is almost never
inflamed, and  when that occurs it is most  commonly by
continuity, as in angina tonsillaris, in which it may happen
that the root of the tongue is interested.  In general, this
inflammation  is  the most rare of all those which are re- 
7 J         JlISEAsES OF THE Ml'lOO SVSTEM.

marked on the mucous membranes: and indeed it is never
symptomatic.
  Aphthae  arc a disease very common- in the mouth, and
there is no portion of the mucous system which is more af-
fected by them.  It is especially among children that they
are oftener to be met with.  They are either idiopathic or
sympathetic.   Often the  idiopathic prevail epidemically,
and in this respect they are included in the class of catarrhs.
Their symptoms are, an inflamed tumour, with swelling,
excoriation, hard edges, excretion of little bits of a whitish
membrane, that the patient spits out or passes in the faeces;
sometimes  there is a feverish excitement, dryness,  and
heat in the mouth.
  Hemorrhages of this membrane, generally speaking, are
very rare.  The blood which issues from the mouth, comes
ordinarily from the  nasal  passages or  from  the lungs.  Ne-
vertheless, when there exist fungi in the mouth, there may
happen  hemorrhages; but they are of a peculiar  nature.
Besides these uiugi are  only  consecutive, as  is seen in
carcinoma of the tongue, in which the disease commences
at first in the muscles.
  The portion of the mucous membrane which covers the
tongue is very subject to morbid sympathies. There exists
between it  and the stomach a peculiar relation  which can
not be  compared but to that which takes  place between
the mammae and the matrix, the testicle and the larynx.
And indeed the most  common causes of foulness of the
tongue are  gastric obstructions.   If we examine the con-
sistency of these sordes of the tongue, it is very tenacious,
and although they are carefully scraped, they can not be
entirely removed. It seems that this foulness of the tongue
is produced by the  subjacent glands,  and not by the  sto-
mach, since no appearance of it is to be found in the oeso-
phagus.  There are,  nevertheless, cases in which the state of
the mouth seems to  be an exception to this rule, and to be 
           DISEASES OF THE MUCOUS SYSTEM.         73

influenced by the stomach; it is when the patient  tastes a
peculiar bitter taste which lasts as long as the sordes.
  The effect of this foulness is loss of taste,  that we must
be on  our guard not to mistake for a  want of appetite,
which  proceeds from the  stomach.   The sordes  of the
tongue vary in their colour, which is sometimes white, at
at others gray or black.  These phenomena are often ac-
companied by vomiting, which  is only the effect of the
gastric irritatation.  The tongue may be, in certain mala-
dies, the seat of a contrar)' phenomenon, and become dry
and rough, as we see in inflammatory fevers.  This cha-
racter  is remarkable in adynamic fevers, so that writers
have given it as the first symptom. Sometimes it happens
only after two or three days: then the tongue dries and be-
comes  black.  There are, however, adynamic fevers which
do not present this  phenomenon.  When there exists a
blackish crust, it is  not found only on the tongue, but also
extends to the gums, and even to the lips.   Sometimes it
is of a considerable thickness, and at others it is very light.
When the tongue becomes humid, it is a sign that it is about
to disappear.   What can be the cause of this black crust?
It seems that it is furnished by the glands, as it is  certain
that the dryness proceeds only from the want of mucous.
This phenomenon of adynamic fevers happens at all ages,
but especially with  old persons.
  Sometimes in  small-pox, pustules are observed  on the
tongue and on the internal parts of the cheeks; but it is not
true that any are developed on the intestines,  as authors
have announced.  There may also occur in the mouth mi-
liary eruptions, in the fever of this name.
10 
74         DUEASES OF THE MUCOUS SYSTEM.


                  ARTICLE  VIII.

      Diseases of the Membrane of the Pharynx.

  The pharynx is susceptible of idiopathic and sympto-
matic affections.  Among the first, inflammations holds the
first rank.  They are known under the general name ol
angina.   Two species may be distinguished, in dividing
them  according to the part of the membrane they affect.
The first is Angina Tonsillaris.
  We distinguish two species of angina tonsillaris;  the one
idiopathic, the other symptomatic; accompanied with erup-
tions of scarlatina.  The first is very common; it occurs
after exposure to cold air; then pain in the part is observed,
heat, considerable tumour, and sometimes fever.   In the
mean  while we see a circle, more or less red, and more or
less defined, about the engorgement.  The effect  of this
engorgement is to contract  more or less the lower  part of
the pharynx.  There is little projection forward, but much
inward; the patient can not swallow without pain, because
the tongue, pressing against the palate in deglutation, urges
the amygdalae forward and outward.  The inflammation
extends on the side of the cellular tissue, towards the jaw;
hence, often the impossibility of opening the mouth.  The
swelling within is sometimes such, that it is only sensible
to the sight.  As the patient seldom dies of this malady,
we know very little of  the  pathological condition of the
parts.  Ordinarily resolution takes place; and it is  always
accompanied with a more or less considerable mucous ex-
cretion; sometimes this excretion adheres to the surface of
the glands; at other times it runs down into the  mouth;
then it presents a whitish aspect.
  This angina may be complicated with the fever of  scar-
latina: there is at first soreness of the throat, accompanied
with other symptoms; then the eruption  appears and runs
through its periods, as do all others.  Sometimes  also it 
DISEASES OF THE MUCOUS SYSTEM.
75
 assumes a character of putridity, and then sometimes the
 amygdalae become gangrenous.
   The membrane of the pharynx, and especially that of the
 velum  pendulum palati is very much exposed to ulcers
 produced by the venereal disease. These ulcers no way re-
 semble those aphthae of which we have spoken in the arti-
 cle on the mouth, and they have nothing in common with
 them, in aspect, cause, nor duration.
   Another  affection proper to this  membrane,  and the
 mouth generally, is blisterng, in poisoning with nitric acid;
 there occurs a large crust which comes off in a very short
 time, leaving  the parts bare, and presenting a very red
 colour.


                   ARTICLE IX.

 Diseases of the Membrane of the Larynx and Bronchise.

   The affections of this membrane are, as the others, idio-
 pathic or symptomatic.   The most  common  is  angina,
 which presents a different character according to its seat at
 the base of the glottis or in the larynx.
   The angina of the edges of the glottis was known to the
 ancient authors; they observed that it was mortal after two
 or three days.   Some have called it serous, others suffo-
 cative.  Indeed, in this affection, we find an infiltration or
 considerable engorgement, although whitish, of the cellular
 tissue, which surround the glottis, and  which, as we see,
 produces a sudden suffocation.   There is no other means
 by which to save the patient, but laryngotomy.  Angina
 Laryngea, properly so called, and angina trachealis resem-
 ble each other very much.  Both have some symptoms
 which are common: pain in the  part,  change of the voice,
 fever, painful deglutation and a sensation of burning. Often
the affection is propagated in the  nasal passages. There is at
first, a dryness  in the throat; soon after a mucous, somewhat 
76
DISEASES OF THE MUCOUS SYSTEM.
limpid, is secreted, then that which is thicker succeeds, and
the malady ceases at the end of seven or eight days.
  This affection  may terminate in gangrene, of which no
part  of the mucous system is  more susceptible.  Rarely
does it complicate itself with cutaneous  eruptions.
  Croup is also a malady peculiar to the membrane of the
larynx.   It differs from angina in its nature and progress.
Commonly it attacks children. It is not generally epidemic.
Its approach is announced by variable phenomena, as in
all maladies.  Sometimes this affection appears after a sup-
pressed evacuation; soon after, pain of the larynx, difficulty
in breathing, hoarse voice, aggravation of the symptoms,
pungent  heat, extreme agitation; the child puts his hand
to the throat, the difficulty of breathing increases, the coun-
tenance becomes louring, soon after there  is more or less
drowsiness.  The disease seldom terminates by resolution;
ordinarily the sensation of suffocation goes on increasing,
and finally the patient dies.   It is astonishing how  rapid
the symptoms are, a circumstance which may be attributed
to the tender age.  Cadaverous autopsia shows flakes,  as
in phthisis pulmonalis.  Besides the trachea and the bron-
chia? are  a little red and swollen.   As to general  changes
the same phenomena take place, as in those persons who
die with  asphyxia.
  The right portion of the heart is engorged, as well as the
brain; the visage is red, and we almost always find in the
larynx a  false membrane, which extends more or less into
the trachea. The thickness of this is variable; as to its na-
ture, it has never been fully examined. It is not the inflam-
mation, but its effects which cause death, for the thicken-
ing of the membrane shuts up the whole passage and ex-
cludes the air.  It is practiced to excite vomiting,  in order
to produce a general irritation which may encourage cough-
ing.   We must  observe on  this occasion  that  we seldom
cough after vomiting, and it would be  better to excite the
cough in another manner.  However,  laryngotomy is the 
DISEASES OF THE MUCOUS SYSTEM.
77
most efficacious means.  Sometimes the inflammation  of
the membrane of the larynx becomes chronic.   In  other
cases, this condition is produced by other  causes than an
acute inflammation, as by venereal disease.  Whatever may .
be the cause, these are the characters of the disease: at first,
painful  sensation in the larynx; small but continual  sputa,
of a grayish colour, that the patient says he discharges
from  the larynx; habitual cough; little alteration in the
voice; at last the  symptoms augment; they are singularly
influenced  by cold and heat.  As to the  precise seat  of
the disease, it would be very difficult to determine; never-
theless it seems to reside in the mucuous membrane.
  At other times, this  affection  terminates by  laryngeal
phthisis.  Then the symptoms continually increase.   The
voice presents a peculiar phenomenon of extinction;  there
is a sensation of pain in the lower part of  the the larynx,
especially when it is elevated by the finger from the ver-
tebral column; the voice is more altered; finally in the last
periods,  it is  very low; the deglutition becomes very diffi-
cult, especially  when the glottis is affected.   Almost al-
ways this malady complicates itself with phthisis pulmona-
lis.  Is it, as authors have said, because  the pus  falls into
the bronchia??  we know  nothing about it; but the fact is
quite common.   Hence, extreme marasmus;  towards the
end, disturbed digestion, choking, and purulent expectora-
tion. All these  general phenomena are related  to the conse-
cutive affection of the lungs.  The following is what post-
mortem  examination shows  us.  The larynx is  observed
to be diseased in several places, and most frequently  at the
height of the arytenoid cartilages.   Its mucous membrane
is ulcerated;  we  see some pus which seems  to  originate
from a deeper situation.   The affection may also be  found
behind the epiglottis, or towards the trachea; but it is al-
most never situated on  the  side of the thyroid  cartilage.
Writers  have spoken of small osseous splinters which were
expectorated  by the patient.   They can be only portions 
 7S         DISEASES OF THE MUCOUS SYSTEM.

 of the arytenoid cartilages uncovered.  It  seems evident
 that it is through the mucous membrane that the disease
 begins; what seems to confirm it, is, that the voice remains
 for a long time uninterrupted, therefore, we may conclude
 that the cartilages are not  as yet attacked.
   The internal membrane of the bronchia? may become the
 seat of diverse affections, less frequent however than those
 of the larynx.
   Pulmonary catarrh is the most common, and that which
 writers have best  observed.   It  is produced, as all  the
 others are, by a  sudden action of cold on the skin.   The
 phenomena which characterize it, present  some  singular
 varieties, according to its seat. Indeed, it may extend into
 the trachea, or be continued into the lungs.  The attack is
 manifested generally by a  pain and a pricking sensation in
 the trachea, which  produces a dry cough.  Sometimes the
 pain extends  to all the  thorax; often it is confined to one
 side; nevertheless the patient can lie on either side.—Op-
 pression augments, with continual cough,  expectoration,
 difficult and always painful, in proportion to the increased
 sensibility of the bronchia?; by degrees the symptoms dimin-
 ish, pain subsides, expectoration becomes more copious and
 easy, the sputa are  more viscous, finally the disease termi-
 nates in a complete resolution.  As to the general phenomena
 which accompany it, they  are to be met with in other dis-
 eases. Thus sometimes we observe at the same time a gas-
 tric  obstruction, and all the  symptoms  which character-
 ize it;  then the cough  is sometimes accompanied with
 vomiting.  If the catarrh be at all violent, we remark a fe-
 brile commotion, which we call catarrhal fever.  As to the
condition of the secretions and excretions, it varies indefi-
 nitely.
  At other times the acute catarrh of the lungs ends in a
 chronic one. Before we speak of the latter,  we shall say a
few words  first of  the suffocative catarrh.  It *is not of
a nature different from common catarrh, but varies from it 
          *  DISEASES OF THE MUCOUS SYSTEM.         7.f>
 only, in the great swelling of the internal membrane of the
 trachea or bronchia?; hence its suffocative character, which
 causes the patient to die of asphyxia.  This catarrh is ush-
 ered in by symptoms more violent than the preceding one,
 respiration very difficult, extensive and hurried dilatation of
 the  thorax.  Sometimes the air is expired with a hissing
 noise; at other times respiration is stertorous, and the pa-
 tient can  not  speak.  On the  last days, we  hear, in the
 trachea a peculiar  noise produced by  the action of the
 air on the swollen membrane.   The  symptoms go on al-
 ways increasing,  finally the patient dies, and presents all
 the phenomena of asphyxia.  This catarrh is only mortal
 by its suffocative  effects and not in its own nature.
   Chronic catarrh of  the lungs is sometimes  produced, as
 we have already observed, by an acute phlegmasia. Often
 it is  also the result of other causes.  Cough then lasts more
 or less time; it is more or less violent; expectoration is not
 abundant; respiration is  disturbed by any violent motion,
 as happens  with  all,  affections  of the  thorax.  The pa-
 tient may lie on either side, and  the functions  are executed
 as commonly.  This kind of catarrh, with old  men, ends
 only with life.  Among persons of middle age it may pro-
 duce phthisis, and patients treat it as a neglected cold.
 Sometimes it  leads to  haemoptysis.   Few subjects who
have died of this  malady have been examined;  neverthe-
less observation has always shown the tracheal membrane
to be materially thickened, downwards and  towards the
bronchia?.
  Haemoptysis is another affection proper to the mem-
brane of the bronchia?.   Indeed often patients die of these
hemorrhages, without the lungs being engorged, whilst the
bronchia?  are  full of  blood.  Haemoptysis  may be pro-
duced by a rupture of the small vessels of the lungs, as
after violent vociferation.  Most frequently it happens
by exhalation.  It is  almost always  a sign of phthisis.
It is  difficult to determine whether the same cause pro- 
SO         DISEASES OF THE MUCOUS SYSTEM.

duces these two diseases, or whether the former engenders
the latter.  Sometimes haemoptysis is known by general
characters; there is a sensation of tickling in the throat, and
a saltish taste in the  mouth very peculiar;  next follows a
very slight cough,  with  bloody expectoration,  at  times
red, at others  black, according as the blood has stopped
flowing or not in the bronchia?; sometimes this fluid is ex-
pectorated pure, and then expectoration is very easy; at
other times there are sputa mixed and striated with blood,
and which are detached with more difficulty.
  As to the other diseases of the mucous membranes, they
are seldom met with in the bronchiae; we never see there
any aphthae; fungi are very rare, as well as  cancer.


                    ARTICLE X.

Symptomatic Affections of the  Pulmonary  Mucous
                     Membrane.

  These  affections are very common, and it is important
not to confound them with the idiopathic.  Pulmonary
catarrhs are sometimes simply symptomatic, in pleurisy
and peripneumonia, in which the mucous membrane is not
directly affected.  Nevertheless, there is an abundant mu-
cous excretion in these two cases.  The same is the case in
gastric fever.   Many essential fevers are also determined in
this manner.   Chronic diseases of other parts equally in-
duce, in the mucous membranes of the lungs, sympathetic
affections of the same nature; thus, in the diseases of the
heart,  we  often see bloody expectorations.  The  same
thing happens  in phthisis. 
DISEASES OF THE MUCOUS SYSTEM.
81
                   ARTICLE XI.

             Diseases of the  Oesophagus.
  The oesophagus presents two maladies.  It is seldom the
seat of catarrhal affections  or of hemorrhage.  Sometimes
aphtha? present themselves here, after poisoning with nitric
acid.  Sometimes it becomes corrugated, which is an ef-
fect of inflammation, or of the action of the venereal virus.


                   ARTICLE XII.
Diseases of  the  Mucous Membrane of the  Stomach.
  There are few mucous membranes oftener affected than
that of the stomach.  The continual state of excitation, in
which the organ that it lines exists, is  the cause of its fre-
quent diseases; and by virtue  of this  physiological  law,
that, organs the most active, are also  the most subject to
disease.
  The most common affection of the mucous membrane of
the stomach is its  catarrh, known under the vulgar  name
of gastric obstruction,   (d'embarras gastrique.)  This
catarrh may be essential; but it is oftener symptomatic.
  The symptoms in the beginning are loss of appetite,
general lassitude; soon after a sensation of pain or of weight
in the epigastric region, the sensation of which is by the
patient referred to the ensiform cartilage.   The tongue is
almost always in a peculiar state.  The gastric pain often
causes nausea, and even vomiting.   As to general symp-
toms, they consist especially in a peculiar head-ache extend-
ing over the orbits of the eyes.  It seems  that this  pain
has its seat in the  brain.  There is a sudden  prostration of
strength, an effect of the close  sympathy which exists be-
tween the stomach and all  the animal economy.
  Different writers  entertain dissimilar opinions as to the
            11 
82
DISEASES OF THE MUCOUS SYSTEM.
 seat of this malady.  Some have asserted that it depend-
 ed  primitively upon  an alteration of the liver, and they
 have drawn this conclusion because the patient passes some-
 times a great quantity of bile, there is a bitter taste in  the
 mouth, &c.  All these symptoms do not prove that there is
 an  affection of the liver;  for,  in a healthy state,  the sto-
 mach contains more or less bile.  The pain is never refer
 red by the patient to  the region of the liver.  Moreover,
 when  this last  organ is diseased,  we do  not observe so
 great a number of sympathetic phenomena as in the  case
 of which we speak.
  This disease is only a true catarrh of the stomach, which,
 indeed, does not follow the ordinary progress of the others,
 but is of the same nature.  There is an abundant secretion
 of mucous,  which overloading the stomach, excites it to
 rise in order to relieve itself, which occurs by a law com-
 mon to all  the  mucous surfaces.  The fluids which are
 passed, are always  mucous; but they may be mixed with
 some other substance, such as air; oftener bile.  Authors
 who have only paid  attention to  the substances  thrown
 up  in  vomiting, distinguish several  kinds of bile.  It is
 certain that it  varies only in  colour because  it comes
 immediatel)r from  the  liver,  or because  it flows from
 the gall bladder.  The ancients recognised also atrabile or
 black bile, produced,  without  doubt, from the bile of the
 gall bladder; or by coagulated blood, that the patient throws
 up sometimes in cancer of  the stomach.  The gastric ob-
 struction generally is terminated by spontaneous or ex-
cited vomiting.  The appetite returns, and the  patient
gets well.
  Very often  gastric obstruction is  only  sympathetic.
There  is no organ so susceptible as the stomach of partici-
pating  in the affections of other parts.  We must pay par-
ticular  attention  to  distinguish this obstruction  from the
diseased conditions of the stomach which  arc determined
by a nervous affection, as in hysteria.  Oftentimes, iuflam- 
             DISEASES OF THE MUCOUS SYSTEM.
  mations of the organs are complicated with gastric obstruc-
  tion, which is sometimes so ^characterized, that there are
  evidently two diseases.  At other times, its symptoms are
  less intense.
    We know very little of the chronic catarrhs of the sto-
  mach.  We observe anorexia, and all the other symptoms
  of gastric obstruction, during a longer or shorter space of
  time.   Is this state owing to a chronic catarrh of the sto-
  mach, or to another condition of the mucous membrane?
  we know nothing about it.
    Vomiting  of blood is another malady of the  stomach,
•  in which its internal surface does not change in  its condi-
  tion.   It often  happens after a  compression  or exterior
  contusion  over the epigastric region. The most common
  cause in women, is the suppression of the menses.
    One of the  phenomena of the vomiting of blood is a salt-
  ish taste which  remains in the  mouth, analogous to that
  tasted  by  the patient in  haemoptysis.  Another peculiar
  character  is,  that the mucous membrane of the stomach
  tolerates a greater quantity  of blood than catarrhal mucous:
  Hence the reason why less effort is  needful in vomiting.
    We sometimes observe  also  vomiting of black sub-
  stances, (or black vomit.)  It is not known whence these
  substances come.  The  ancients  called  them  atrabile.
  The moderns have abandoned  this opinion,  and believe
  that blood only is passed in melaena.   Nevertheless, the
  former had perhaps better observed; for, generally, the af-
  fection succeeds to slow and sad passions.   There is a pain
  in the region of the stomach and liver, and deep  melancho-
  ly, as in all organic maladies.  The matter passed presents
  very little analogy  to blood, as well in its colour as in its
  consistence.  Every thing induces us to believe,  on the
  contrary, that  it is bile.   Vomiting of black matter,  or
  black vomit, often  returns.  There is generally a concomi-
  tant affection of a  neighbouring  organ.  The patient at
  last dies. 
64         DISEASES OF THE MUCOUs S\ STEM.

  We then find in the stomach a certain quantity of black-
ish  matter similar  to that vomited.  The mucous mem-
brane is in its normal state.  The adjacent vessels gorged
with blood,  but this  depends upon the kind of death.  As
to the liver,  it is almost always affected.  The gall bladder
is often full  of blackish matter.   The spleen also is  often
in a pathological condition.
  Must cancer of  the stomach be considered among the
affections of the mucous membrane? It matters not, since
we  are ignorant in  what manner it begins.  What is cer-
tain, is that the serous tunic is  never interested but to-
wards  the end.  The mucous coat is not always so from
the beginning.  Sometimes, it may be regarded as the pri-
mitive seat  of the  affection.  Cancer ordinarily  succeeds
to exterior  contusions, violent emetics, sad passions, &c.
Be  this as it may, the symptoms that it presents  differ
according to the time  in  which it is  examined.  In  the
beginning, there is a general pain in the abdomen; ano-
rexia and  other symptoms of gastric  obstruction, so that
we know not which is the affection that is going to appear;
vomiting is  more or less frequent. At a more advanced
epoch,  it is more frequent, and accompanied  by a painful
sensation at the epigastric region, with or without appre-
ciable tumour in that part.   Sometimes, vomiting happens
immediately after the patient has taken food; at other times
it occurs only long after, which might deceive us and cause
us to mistake  it for another malady, if the other charac-
ters did not enable us to distinguish it.  Blood is vomited
at different  intervals more or less remote, and  this vomit-
ing is often  the forerunner of the affection.  It is the more
frequent as  the pylorus is the more narrow. However, the
disease is extremely easy to recognise.
  As to the sympathetic disturbances of the other func-
tions, at first there is troubled digestion.  The pulse  as-
sumes different states, sometimes strong, sometimes feeble
&c.  The secretions and exhalations vary also singularly: 
DISEASES OF THE MUCOUS SYSTEM.         85
but the most constant sympathetic alteration is want of
nutrition, the absortion of chyle not taking place. Besides,
there is prostration of strength, and even symptoms of ex-
haustion, as in all the other organic maladies.  At last the
patient dies.  Age influences very much the rapidity of the
progress of the disease.   Thus a  young person perishes
much sooner than an old  one.
  Post-mortem examination may present the  disease in
three different states, and having its seat in three diverse
places.  It may exist at  the pyloric extremity, which is
the most common; on the surface of the stomach, or at the
cardiac  extremity, which happens the least  frequently of
all.
  In the beginning we see a projection,  more or less  pro-
minent, about the pylorus.   Sometimes the mucous mem-
brane is already interested; but oftener it is untouched,
and the disease has begun in the layer of the subjacent cel-
lular tissue, so that it  is impossible to determine in which of
these tissues the disease uniformly originates.   The pylo-
rus is more or less corrugated. No gland  as yet is diseased,
nor any neighbouring organ affected.  In the second stage
the disease has made some progress.  Then the adjacent
glands begin to be engorged, between the  liver and the
stomach, from which results an irregular mass.   There is
more or less serosity effused in the peritoneum.  In the
third stage, the coats of the stomach are all invaded, and the
glands begin  to ulcerate.   An ichorous  matter is formed;
often there is a rupture in the stomach, and the neighbour-
ing organs are attacked.  The patient may die in either of
these three conditions.  In the last,  we remark a pheno-
menon entirely foreign to the other organic  diseases; it is
the friability of the  bones.  The last  moments  of the pa-
tient are often  accompanied with an inflammatory state of
the peritoneum, with general distension and effusion of
ichorous matter in its cavity.
   The other  affections of the stomach are those which are 
86
DISEASES VF THi: MITOT'S SYSTEM.
 experienced in poisoning from  nitric  acid.  They differ
 according to the more or less violent action of the caustic.
 When this action is moderate, it  results only in the forma-
 tion of a false membrane; in the second case, there is a real
 shrivelling (racorrisscmen/) of the stomach. When it has
 once acquired this latter condition, the organ can not re-
 sume its primitive sensibility, and it preserves this dispo-
 sition till death, which soon comes on.  We observe then
frequent vomiting, and symptoms analogous  to  those of
cancer.
                    ARTICLE XIII.

   Diseases of the Mucous Membrane of the Intestines.

   These diseases are very common.   Some are chronic and
 others acute, but we have not yet been able to distinguish
 those belonging to the duodenum from those of the colon.
 Ue shall, then, consider them in a general manner.
   The catarrh of the intestines is ranked as to its fre-
 quency, next in order to that of the stomach.  It presents
 an astonishing  variety in its intensity, which  variety is a
 character common to  all  catarrhs.  The lightest species is
 a slight diarrhaea, lasting only a [ow .lays, with moderate
 pain  and no tenesmus: soon subsides without any incon-
 venience.  We excite  an artificial catarrh with purgatives.
 When this malady has  more defined and intense symptoms,
 it is then distinguished by the appellation of dysentery.

                    OF DYsENTERT.

  This disease presents  itself under an infinity of forms,
being susceptible of complication with a great  number of
d.seases.  One of its characters is its liability of becoming
epidemic.  Whatever may be  it, cause, the following are
the symptoms:  At first, griping pains; colic,  more or less
violent; weight, commotion in the large intestines; consti- 
DISEASES OF THE MUCOUS SYSTEM.
87
pation during the first days; tenesmus produced by the ir-
ritability of the intestines, and which is so much the more
intense as these last are  the more empty.   This tenesmus
indicates that the affection belongs exclusively to the mu-
cous membrane, for it does not exist in those of the other
tissues.  There are often sensations of heat in the rectum.
In the succeeding day, the symptoms augment; the griping
is more violent.   This sensation, sometimes difficult to ex-
press,  has nevertheless, nothing in common with the in-
flammatory pain.   Stools begin to pass the third or fourth
day; more or less blood  is passed, together with faeces  and
mucous,  according to the individual constitution.  How-
ever, we  must not regard this character as  an essential  one
in dysenteries. The stools and pains increase till  the eighth
or tenth day, varying according to circumstances.  Pres-
sure is very little  painful; the abdomen is not tense as in
serous inflammation, and the patient may lie  on either
side.   Finally, the symptoms diminish by degrees; grip-
ing recurs at longer  intervals, the fasces,  are more abun-
dant, and loaded with blood; and  the  malady terminates
in ordinary diarrhasa. Such is the termination most favour-
able.   As to concomitant symptoms; the  mouth is bitter;
there is fever, which varies singularly.   Sometimes  the
disease takes the character of another affection, such as that
of adynamia, ataxia, &c.  We should never much regard
the fever when it is simply concomitant.
  Post-mortem examination has shown different alterations
of the mucous membrane, such as redness more or less visi-
ble, swelling, sometimes small ulcers, which are common
when the disease  becomes chronic.  A character peculiar
to dysentery is, dejection by  the anus of membranes of
right sizes and of different  degrees of thickness,  which
sometimes  present the  shape of the intestines:  this is  the
cause why the ancients thought that we passed portions of
intestines.  It is incontestable that they are not portions
of the intestines, but false membranes formed by the same 
?S         DISEASES OF THE MUCOUS SYSTEM.

process as those that we find in the stomach after poison-
ing with nitric acid.
  Acute dysentery does not always- terminate as favourably
as we have supposed.  Sometimes it becomes chronic: then
there is a remission of all the acute symptoms; but a loose-
ness still continues, and lasts for a longer or shorter dura-  ,
tion.  At other times  chronic looseness occurs spontane-
ously, with a moderate pain; which very often is entirely
absent; but fa?ces are frequently passed; sometimes mucous,
at others  simply  water; commonly a  disturbance of  the
other functions; prostration of strength; dryness of the skin;
urine scanty; marasmus.   The patient at last dies.  These
affections are very common in  hospitals.
  Catarrh of the intestines is essential in all  the cases of
which we have spoken; but at other times it is purely sym-
pathetic, as in ataxic and  adynamic fevers, in which  the
disease runs through its periods as usual.
  There are diseases which  impart  to the internal mem-
brane of the intestines an aspect like that which it presents
in chronic catarrhs: They are prolapsus of the rectum, and
volvulus.  Children are often exposed to these diseases.
The internal membrane frequently becomes thickened and
red; generally all the engorgements of the mucous mem-
brane of the intestines present this phenomenon.   The in-
ternal membrane may also be the seat of scirrhous tuber-
cles; they are often found in the small intestines, after
chronic dysenteries.
   A patient, after having drunk much whilst in a great heat,
was attacked with a violent colic, which disappeared, but
returned  eight days afterwards, with all the  symptoms of
dysentery; two days afterwards every thing disappeared,
.except the looseness.  A  month afterwards  he  presented
himself at the Hotel Dieu.  The  pains, which had left
 him, soon returned in a-i iolent manner: he complained es-
 pecially of pain in the right hypochondrium and about the
 region of the bladder. This disease  was taken for a chronic 
DISEASES OF THE MUCOUS SYSTEM.
89
dysentery.  The patient fell  into an extreme marasmus.
During the last two days a peritonitis happened which car-
ried him off.   On the examination of the body, the abdo-
men was found inflamed, an  ichorous matter was effused,
grayish  spots appeared on the small intestines, and at small
distances little scirrhous tubercles were seen, ulcerated on
the side of the intestines, which formed a hard projection
outward; moreover,  several parts of the colon were  con-
tracted.
  In certain cases of the same kind, there happen eruptions
on the surface of the  intestines.
  The intestine may be also covered with aphthae, which
do not differ from those of the other mucous surfaces.
  Cancer oj the intestines is particularly manifested  in
the large intestines; it is more rare than that of the stomach.
It seldom embraces all the portion of the intestine that it af-
fects, this is the reason why there is no ring formed as at
the pylorus.  The morbid part loses all its extensibility.
Whatever may be its seat, this cancer presents the same
disposition as in the  stomach.   At first there  is no altera-
tion in the fibrous  and serous membranes, but when the
disease has made some progress, they all reciprocally affect
each other; the veins  become varicose, sometimes there
happens a rupture of the  intestines, and the aliments are
emptied into the cavity of theperitonaeum; there is a steady
pain in the part, bloody stools, habitual diarrhoea, vomiting
by  antiperistaltic motion.
  At the extremity  of the rectum, cancers present some
peculiarities: they are known  under the  name of scirrhi.
Although often different  tumours are  confounded under
this appellation, such as hardened hemorrhoids, the sympr
toms of cancer are  easy to be distinguished.  Often scirrhi
arc produced by  the  venereal virus. -^Whatever be the
cause, they commence by a weight and  violent tenesmus;
dejections become  more and more difficult; and  they are
bloody, which is produced by a slight lesion  of the intes-
             Vi 
90
DISEASES OF THE MITOI.'S iVSTEM.
tine?.   These hemorrhages characterize cancers of all the
mucous membranes.  The difficulty of passing stools  in-
creases; the faeces are moulded to the shape of the tumour;
finally it is almost impossible to pass them.   Besides these
symptoms, we may ascertain the existence of the disease by
the touch, in carrying the finger  into the  rectum, and
vagina.—These affections yield sometimes to suitable pres-
sure;  the patient often dies.  Dissection  shows, in the
beginning of the disease, that the internal membrane is not
affected, and that the subjacent tunics  present then a con-
siderable volume. As the disease advances, they unite and
form a mass which  ascends considerably.  The intestinal
parietes are thickened by the spreading of the disease, the
surrounding cellular tissue and neighbouring organs, such
as the bladder and the matrix, affect each other: there re-
sults from it a shapeless and ulcerated mass,  in which every
part is confounded.
  Hemorrhage of the mucous membrane of the intestines
is seldom observed, and when it occurs it is generally symp-
tomatic, as in dysentery.  Nevertheless, it sometimes  re-
sults, with women, from suppression of the menses; in this
case, the mucous membrane is untouched.
  Dilatation of the intestines may depend upon the faecal
matter reascending, a condition very common in the rectum;
with old  men,  produced by feebleness of this intestine.
The continual absorption which is going  on renders the
dejections still harder.
  Accumulation of air may also  distend the intestines: it
is then called tympanites.   All  writers have spoken of it
without well understanding this disease.  They have di-
vided it into different species, the seat of which they some-
times placed in  the surrounding cellular tissue of the intes-
tines, sometime* in the cavity of the peritoneum, finally,
sometimes in the intestines.   The latter species only exist.
In tympanites, we have two  things to consider, first the
cause which produces the gas, then that which  keeps it in 
DISEASES OF THE MUCOUS SYSTEM.
91
the intestines.  As to the firstcause, it is produced by the
aliments disengaging more or less air, which escapes com-
monly by the anus.  The nature of these gases varies, but
their  base  is sulphuretted hydrogen.  The cause which
withholds them,  seems to be the atony of the muscular
fibres which have been overdistended.  What is very sin-
gular, is, that digestion may, for a certain time, be per-
formed without this collection of gas escaping.
  The contraction of the intestines, a contrary phenomenon
to the preceding, is remarked under  three circumstances:
it is observed at the end of long abstinence; it may be
the effect of a particular disease; but oftener it is produced
by the unnatural state of the anus, in which case dejections
are passed without being well elaborated.   The intestines
may assume a very small  caliber, without  ever being ob-
literated.
   The second mucous membrane  enters  into the genital
organs, whence it goes, in both sexes, to line the bladder
and surrounding  parts, besides the vagina  and uterus in
females.  Its affections are the more frequent as we ob-
serve it nearer to its entrance.

                  ARTICLE XIV.

Diseases of the Mucous Membrane  of the Glans Penis.

   Catarrh is the most common affection of this membrane.
It may be of two species.   Often  it  is only an excitation
of the glands subjacent to the corona, round the glans, pro-
duced either by the want  of cleanliness, or by other cause;
frequently this catarrh is accompanied by no inflammation.
 At other  times it is the result of a venereal cause, which
acts on the glans, as it does  on  the urethra.   Then, it is
more  intense than in the first case, and  runs  through its
stages as a gonorrhaea, which it entirely resembles.
   Phimosis often happens from the engorgement of the 
92
DISEASES OK THE MLVOU» SYsTEM.
glans, which may be produced, as we know, by a simple
exterior cause, or by a venereal taint.  This disease, by the
contraction of the prepuce, renders it impossible to uncover
the glans.   Sometimes it is a vice  of conformation.   Most
frequently it depends upon  inflammation  of the mucous
membrane of the prepuce, which in this manner loses its
extensibility.  Sometimes this is owing to some venereal
callosity in the cellular tissue, where it is  the result of a
general leucophlegmatic habit.
  Paraphimosis presents a condition entirely analogous
to the preceding one, but is a converse  effect.  It consists
in the difficulty,  and even the impossibility of covering the
glans with  the prepuce, which makes a kind of ligature
behind the corona.  This disease may sometimes proceed
from an unnatural contraction of the prepuce;  sometimes
it is  owing to the swelling of the latter, or the glans  being
covered with chancres.   It is sometimes immediately fol-
lowed by an acute inflammation of the parts, and gangrene
may be the consequence, if we should not have recourse
to an operation.
   Ulcers are also a disease proper to this membrane.  They
may or may not be venereal.  The latter  is often the re-
sult  of too great  friction, or whatsoever cause which pro-
duces on the glans a kind of excoriation entirely analogous
to that of the skin when the epidermis is removed.  As
to venereal ulcers or chancres, they may  present them-
selves under two different aspects. Some are coincident
with a  gonorrhaea and absorb the virus that it  produces;
in this case, they never present any callosities.  Others
are  determined  by  a  pre-existing venereal cause;  they
present  callosities,  hard edges,  and an  unhealthy and
abundant suppuration. 
DISEASES OF THE MUCOUS SYSTEM.
S3
                   ARTICLE XV.

 Diseases of the Mucous Membrane of the  Urethra.

  Catarrh is the principal  disease  of  this membrane.
Every mucous discharge through the urethra is called go-
norrhaea  or blennorrhagia. Sometimes gonorrhaea  is en-
tirely free from venereal virus.   As  to the gonorrhaea,
which has for its cause the latter, its symptoms are so well
known, that we shall here only occupy ourselves with the
anatomical inspection.  The ancients believed that the
semen only was discharged in a  gonorrhaea, the seat of
which was located in the testicles; others have supposed it
to be in  the prostate gland.  Since, it has been observed
that, in gonorrhaea, the  canal only was painful,  and espe-
cially in its anterior  portion.   Morgagni, who  first occu-
pied himself with these researches, placed the seat of the
disease  in the small follicles which are  met with  in the
canal, and which are only the orifices of the excretory ca-
nals of the glands which pour out their fluids in these
places.   It is not in these follicles, but in the glands them-
selves that the gonorrhaea is located.  According to recent
observations, the anterior part of the canal has  been seen
inflamed.  If  we examine the phenomena of gonorrhaea,
we find them in  every respect similar to those of other
kinds of catarrh.  At first there  is local pain, a moderate
excretion of a serous fluid, soon after a more abundant and
thicker discharge, which evidently proves that the mucous
membrane only is affected.  Often the disease  is sponta-
neously cured, at other times it carries with it dangerous
consequences.  The discharge  of gonorrhaea varies singu-
larly, not only in relation to that produced by the catarrh
of other membranes, but also in relation to the different
periods of this affection.   Sometimes the termination is in
reality a chronic  disease, and  the discharge  lasts during
four or five months or even more; persons seldom die from 
 91         DISEASES OF THE MUCOUS SVsTEM.

 it, but often it is succeeded  by a stricture of the urethra.
 At other times we are ignorant of the true cause of this
 latter effect. The  ancients  attributed  it to some fungus
 fleshy  growth in the urethra, an  idea derived from  the
 supposition that gonorrhaea  depended  upon the  suppura-
 tion  of small ulcers which exist in the  canal.   They have
 also  said that it proceeded from cicatrices or bands; indeed
 we often meet with such; but it is not  the most  common
 case.  Sometimes  there are small tumours which are de-
 veloped in the cellular tissue, and  project into the canal,
 diminishing its diameter; very often also the urethra, con-
 tracts of its own accord, a phenomenon analogous to that
 of the stricture of the oesophagus and of the stomach.  Ac-
 cidents happen succeeding these strictures: thus we  ob-
serve urinary fistulae  to follow, which open in  different
 parts.
  Gonorrhaea, is almost always an essential affection; there
 seldom happens any sympathy between the other mem-
branes and the urethra, the  cause of which is,  that the
 genital parts almost never participate in the affections of
 the economy.
  Haemorrhages of the urethra are of rare  occurrence.
There are some which are accidental, but the essential are
very uncommon.  In  this case, how shall we distinguish
 them from the discharge of blood with  urine?  It suffices
 to press the posterior extremity of the urethra, and if the
 blood runs in spite of this compression, then we conclude
 that  it is only from the canal.
   Cancers of the penis seldom begin in the membrane of
 the urethra.  Whatever may be their primitive seat, this
 membrane is by degrees attacked.  The neighbouring parts
 affect each other, and sometimes the disease is spread even
 to the pubes; then an  operation becomes  useless, and the
 patient dies in horrible torments.  In this case, the pros-
 tate  is engorged, and it bears the same relation to  the can-
 cer of the penis that the axillary glands  bear to that of the 
DISEASES OF THE MUCOUS SYSTEM.
95
mammae.  In an advanced state of the disease, the parts are
entirely changed in their nature, and brought back to the
consistence that we  observe  in all cancers,  a  condition
which  must form  an exception to the rules already laid
down in the preliminaries of this work.

                  ARTICLE  XVI.

 Diseases of the Mucous  Membrane of the Vagina.

  Gonorrhaea, with females, has its seat in the vagina, and
sometimes also at the orifice of the urethra: hence the prick-
ing sensation they feel on the evacuation of urine.   The
catarrh, among them, may be produced by other causes
besides venereal affections; it  is  then called fluor albus or
leucorrhxa.  Sometimes the disease is very light,  and en-
tirely analogous to a  slight coryza.  Often also  it  is more
intense, but then it is almost always venereal.  The affec-
tion does not extend  to the matrix, and is arrested at the
orifice of the vagina.   This gonorrhaea with females is ab-
solutely the same with that of men, with the exception of
its termination, which often is in leucorrhaea.  However,
we ought to  refer the chronic  catarrhs of the vagina to
two causes.   First, fluor albus is occasioned by a local af-
fection, as an  immoderate coition, suppression of the men-
ses, &c.; at other times it is only symptomatic.  One would
then be inclined to ascribe them to the general constitution
of the person,  whose countenance expresses weakness:
There is pale complexion, fair hair, and extreme  indif-
ference to venereal pleasures, &c.
  These affections, as well as gonorrhaea, depend only upon
an augmented secretion of the mucous membrane; they are
always without pain.  The fluids which  are produced by
them vary  in their nature and quality; sometimes they are
so abundant that the patient is obliged to take some precau-
tions, as at the  time  of menstrual discharges.   Before the 
 LT»,         DISEASES OF THE MUCOUS SYSTEM.

 age  of puberty, leucorrhaea is of rare occurrence; neverthe-
 less it is sometimes seen.


                  ARTICLE XVII.

   Diseases of the Mucous Membrane of the Matrix.

   Haemorrhages of the mucous membrane of the matrix
 are  very frequent; the most common is known under the-
 name of menstruation.  It is,  as we  know, a natural dis-
 charge, which begins with women at the age of puberty,
 and  ends at  that of  forty or fifty years.  The seat of this
 discharge is not in the vagina, but in the uterus: dissection
 and  experience prove it. If we take the uterus of a woman,
 dead at  the epoch of menstruation, and macerate  it for
 twenty-four hours, on pressing it, blood issues, without,
 in any way, disorganizing the mucous membrane. This ex-
 periment has not the same result on the vagina. The menses
 do not flow by erosion, as it had been supposed, but by a
 simple exhalation, which varies in its quantity as well as in
 its duration. It is not uncommon with girls to see this dis-
 charge preceded by a slight whitish flux.  Since the menses
 have their seat in the matrix, it is evident that they must
 indicate in  their  alterations the diverse affections of this
 organ: it is, indeed/what observation proves.  Besides, all
the passions of the soul, all the general modifications of
the body, act on them in a marked manner.   The vagina
 is  not subject to these influences, and this circumstance es-
tablishes again the seat of the menses in the uterus. More-
over, uterine haemorrhages are produced by a multitude of
causes that  we shall not examine at this time.
   Cancer is another disease of  the matrix which changes
all its tissues, and sooner or later leads to the tomb.  This
affection  is  very common, especially in large cities. It may
affect the body or the neck of the uterus, seldom if ever
the vagina.   It is not a disease of young persons.  It is 
           DISEASES OF THE MUCOUS SYSTEM.          97

observed  commonly after the age of final menstruation;
nevertheless, these  are cancers  which appear before this
epoch.  The causes of cancer of the uterus are very dif-
ferent: immoderate venereal pleasures, repercussion of the
menses, itch, ring-worms, &c. Whatever may be the cause,
it is ushered in by an irregularity in menstruation,  which
increases, stops, or changes in its periods: there are cases,
nevertheless, in which they are  not altered, this is parti-
cularly the case when the disease has its seat in  the neck
of the matrix.  There is pain, more or less violent, in the
region of the uterus;  at first, it  is only a weight, then a
bearing-down sensation in the lombar region and  at the
upper part of the thighs.   The belly is insensible to pres-
sure.  The general  state of the system is very little alter-
ed; nevertheless there is sometimes anorexia and vomiting.
If we examine women at this time,  when the disease is in
the neck, we shall  find it hard and scirrhous.  We must
take care not to confound this  condition  with  that pre-
sented by the os tinea? with women who have borne seve-
ral  children.   Have  scirrhosities their  seat in the  mu-
cous membrane or  elsewhere? it is difficult to determine.
When the disease appears before the final  cessation of men-
struation, it seems  to languish  till  that period; then  it
makes rapid  progress—the  symptoms of which we have
spoken supervene,—and  there is very violent pain in the
region of  the uterus, which sometimes tolerates pressure.
The pain in the thighs extends even to the  knees; it never
spreads  any further.  The discharge is more or less con-
siderable; at first it is blood, and sometimes it is a true flour
albus.   These fluids soon alter, and assume a peculiar cha-
racter; they alternate,  in their-flux, with blood. The touch
teaches, at this  time, that the disease is considerably aug-
mented. The patient dies before the disease has run through
its stages.  We find divers  alterations in the cadaver; if
the disease exist in the neck, there is a very considerable
             13 
Oh         DIsEA-T s OF Till MUCOUS SYSTEM.

swelling, and  an  enlarged  ring (bourrelet) analngous to
that found round the pylorus in similar cases.   Generally,
women  do not die at this first period.   It is oftener  the
middle period which proves fatal.
  At this time, the pain is more intense, with very keen
heat and slight inflammation of the vagina; urine is passed
accompanied with pain; the discharge still continues, either
red, or at other times an ichorous fluid, but always very
fetid.   The glands of the groin seldom become enlarged;
but rather those of the  mesentery, and especially those of
the hypogastrium.  The functions soon feel this local af-
fection,  digestion is imperfect; anorexia,  diarrhaea, maras-
mus, small  pulse, dry skin, no perspiration, infiltration in
the feet, and  even sometimes  leucophlemasia.   The skin
of the face assumes a  peculiar character; the complexion i9
leaden.   Women generally die at this period.   There is
not as yet any general disorganization.
  In the last  stage, the symptoms are yet  more intense:
diarrhaea, marasmus, &c.  On dissection, we find general
disorganization of the body of the matrix, in which  the va-
gina participates.  Consequently, at its upper part,  the tis-
sue of the organ easily tears.  The bladder and rectum ad-
here to the diseased parts. There often happens a crevice in
these organs.  All the glands of the mesentery are  enlarg-
ed.  Often to  these cancers other affections are added; the
engorgement of the glands is the most frequent; we often
meet also  with steatomatous tumours in  the peritoneum.
There are alterations which happen just before death; thus,
we often find a chronic  inflammation of the peritoneum, as
we have seen in the article on cancer  of the  stomach.
It is the property of these can|ers to extend from tissue to
tissue, whilst a multitude of other affections preserve their
primitive seat.
  We shall not speak here of polypi of  the matrix, since
they are not proper to the mucous membranes which  line
this organ. 
            DISEASES of Tit:: MUCOUS SYSTEM.         99

   Fungi, on the contrary, particularly belong to it.  They
 must not be considered as cancers.   Sometimes, they pre-
 sent themselves on the os tinea?; and at others in the bot-
 tom of the  uterus.  Women always experience more or
 less abundant  discharges; the tumour enlarges, and soon
 fills up the cavity of the uterus. These fungi are analogous
 to  the hypersarcosis of ulcers, but they are softer, and
 bleed  more  easily.  The vessels which penetrate them are
 always capillary.  The pain is not the same  as in cancer.
 Often, parts of different sizes fall loose between the libiae; the
 fungus is soon  reproduced with rapidity,  and the disease
 ends in marasmus.
  There are other affections of the uterus on which much
 has been written, but which are rarely met with: such is
 dropsy.   It can exist in two ways; a kind of bag may be
 formed between the mucous membrane and the other tunics,
 containing  more or less serosity; at other times we find
 hydatids, small cysts, containing an albuminous fluid, and
 which appear spontaneously.  It is believed that they are
 produced by worms;* we  shall speak of them more par-
 ticularly in  the article on the liver.
  The same is the case with tympanites of the matrix.
 This organ maybe more or less distended by the air, which
 probably  has  found its  way through the vagina; for,  it is
 difficult believing it to be generated there.


                 'ARTICLE  XVIII.

   Diseases  of the Mucous Membrane of the Bladder.

  Catarrh may affect this membrane.   It may be slight,
 and be only occasioned by feeble irritation, such as that
 produced  by the presence of a  sound or bougie; it disap-
 pears as soon as the cause ceases to act.
  •  Dr.  Baillie is rather inclined to believe that they are animalcules,
like those found in the liver and brain of sheep. TniMi. 
 100       DIStAsKSOF THE i'ELI.Ui.m; l I-.ni k.

   Does there exist in the bladder an acute mtarrh which
 corresponds to that of the thorax?  This  question is not
 as yet settled,  although analogy seems to indicate the  af-
 firmative. We have not yet sufficiently exact observations
 either on the progress or symptoms of this malady.   This
 is not the case with respect to chronic catarrhs,  which su-
 pervene ordinarily in old men; then, there is discharged
 together with urine an  abundant mucous, which is depo-
 sited in the bottom of the vessel.  These catarrhal affection*
 last more or less time, and commonly with old people they
 only terminate with life. The mucous membrane is found
 thicker, but not disorganized.
   Ulcers of the  bladder are equally accompanied with mu-
 cous excretion;  but there is at the same time some particu-
lar phenomena: such as pain,  difficulty in passing urine,
often  evacuation of blood.  On dissection, we find all the
 surface of the bladder hard, thick, strewed with blackish
spots, and the disease  is  always confined to the  mucous
 membranes.
  The bladder is sometimes the seat of other, but not im-
portant affections; such as the swelling of  the neck of the
bladder, which hinders the passage of urine, and soon dis-
appears.
                 CHAPTER VII.

           Diseases of the  Cellular '/'issue.

  The cellular tissue, as we know, fills up every interstice
between  the  organs, which  it envelops, and  of  which it
penetrates  the  substance.  It is particularly  in the inter-
stices of parts that we consider it, under the relation of the
diseases that  it may experience.  These diseases may be 
          DISEASES OF THE CELLULAR TISSUE-       101

classified under three heads: some, idiopathic, arise there
spontaneously, and run through all their periods, as phlegm-
on; some others depend  only upon the continuity of this
tissue with some primitively diseased structure, as cancer;
finally others, are purely symptomatic, as leucophlegma-
sia, which is produced by an organic derangement.  This
distinction  is real: and may be recognised even at the bed
side of the patient.
  We shall first treat of the essential diseases.
  Phlegmon, which is the  inflammation proper to this tis-
sue, presents itself under a different aspect from the inflam-
mation of all other parts.   Its causes  may be  internal  or
external.  When they are  very feeble, the  characters of
its attack are not marked.   When it is more intense, there
happens a chill, heat and pain in the part; in two or three
days it assumes a peculiar kind of pulsation; sometimes we
do not recognise this last by the touch, and sometimes it
is induced by the greater action of the subjacent arteries,
at  the same  time there supervenes a  swelling the more
marked as the crisis of  the malady approaches.  This tu-
mefaction must be considered under two relations: at its
middle part it is red,  and this is induced by inflammation
properly so  called; at the circumference, the engorgement
is much less inflammatory;  it is rather indurated.  The tu-
mour goes on progressively increasing. Let it be observed
that there is no  tissue susceptible of swelling, if we except
the cellular tissue. Other characters distinguish its inflam-
mation, such as pulsation and heat. Redness does not disap-
pear under  the finger,  as  in erysipelatous inflammation.
As to general symptoms they are common to  all inflam-
mations, and are signs of secondary consideration.  There
are often some  gastric symptoms and a fever more or less
violent.  As to what regards exhalations and secretions,
they vary singularly, as well as the strength.  The dura-
tion of these phenomena is extremely uncertain; it depends,
as we know, upon the condition of the patient, his tempera- 
 102       DISEASES  OF THE CKLLI'LAH TISSI'K.

ment, and the degree of intensity of the disease; neverthe-
less it seldom exceeds the seventh or eighth day.  There oc
cur few autopsic examinations of phlegmon in this first con-
dition, in which we find a considerable diminution of the
tumour; the swelling at first disappears, and the phlegmon,
properly so  called, sinks the more in proportion as it was
more acute;  sometimes it assumes a livid colour; few blood
vessels are observed, and the blood is evidently extravasated
in the cellular tissue.  After the sixth day, or even later, the
phlegmon terminates; sometimes it is by resolution, oftener
by suppuration, the character which  distinguishes it from
the other phlegmasia?.   Resolution  is indicated by  the
cessation of symptoms, of pain, &c; the skin becomes yel-
low, especially at the circumference,  and by degrees it re-
sumes its natural type, but commonly the epidermis ex-
foliates.
  Suppuration is announced by very  peculiar phenomena;
the pain changes in  its nature, and  from  poignant  it be-
comes tensive; the tumour presents in the centre a projec-
tion more red, the skin becomes thiner, and a fluctuation is
felt.  It opens commonly outwards if we permit nature to
take its own course, and pus is inclined to  seek its way to
the exterior  rather than into the cavities. When  we exam-
ine an abscess, we see this appear under two different con-
ditions.   The greatest number of exterior abscesses have
their pus in  a mass, and  enclosed in one centre intersected
by bridles.   As to those which are contained in  the inter-
stices of deep seated muscles, pus is there commonly infil-
trated in the cells of the surrounding cellular tissue.
  How is pus produced? This  production in the cellular
tissue is a character which distinguishes it essentially from
that of the serous or  mucous membranes, which is  only
effected by the augmentation of the exhaled fluids; on the
contrary, pus, properly so called, differs very much  from
the fluid which moistens the cells of the cellular tissue.  It
is evidently  formed by exhalation and not  by rupture, as 
           IiISEAfrES OF THE CELLULAR TISSUE,       103

 has  been supposed; and this  we prove by the analogy of
 the different membranes.   Besides, after obstinate suppu-
 ration, we do not remark any  erosion in the abscess which
 has discharged it.   But how comes it to pass that the mi-
 nute vessels which  brought the blood for the nutrition of
 the part,  now discharge a  purulent fluid?—We know no-
 thing about it; all we know is, that  there exists manifest-
 ly in them a cnrmge of sensibility.
   Pus is  a  viscous, whitish fluid, slightly adhesive, ino-
 dorous, when it is of a healthy nature, but may vary infi-
 nitely.
   Chronic inflammation  is  another mode of termination of
 phlegmon.   It often succeeds abscesses; resolution can not
 be entirely induced, the  parts harden, cicatrization can
 not be formed, and  there remains a fistula.
  The last termination of phlegmon  is gangrene.  It may
 depend upon  the  intensity of the inflammation, but it is
 often occasioned also by a deleterious cause which mingles
 with the primitive disease; it is then  called carbuncle. We
 distinguish two kinds; the symptomatic, (of which we shall
 not speak here)  and the idiopathic.   The essential carbun-
 cle is an extended tumour,  seated in  the subcutaneous cel-
 lular  tissue.  Its colour is a livid brown.  This tumour,
 harder than the usual phlegmon, is often accompanied with
 a lymphatic thickening (empdtement.) S»on after  there
 rise small phlyctaenae, on its surface; they discharge serosi-
 ty, and the skin is observed to be gangrenous; the eschar is
 formed, a reddish circle circumscribes it, finally it falls off,
 the sanies runs for some time, and the ulcer at last assumes
 a better aspect.  The pain  in this carbuncle presents a pe-
 culiar character of heat The strength is always prostrated;
 besides the  disease undergoes singular modifications, ac-
 cording to the prevailing epidemic.
  The cellular tissue, in diverse parts of the body, presents
differences in its affections according  to the parts which
may  be the subject of our examination. 
      101       DISEASES OF THE CELLULAR TISSUE.
        The subcutaneous is more exposed to diseases, being the
      nearest  to the external  surface.  All causes  proceeding
      from without act on it.  That of the head is oftener affect-
'     ed on the face than on the cranium.   Whatever may be the
      seat, the subcutaneous phlegmon always presents analagous
      and distinctive characters; at first, it is always circumscrib-
      ed;  the skin  is red, the only membrane which is thus in-
      flamed  conjointly; which is evidently indflrced by its or-
      ganization: its internal surface is composed of areolae, which
      embrace apart of the cellular tissue; this last is infiltrated
      in leucophlegmasia,and is detached after maceration. From
      this association of the skin, there results an erysipelatous
      phlegmon.   When resolution occurs, it also takes place in
      this part; suppuration disorganizes and pierces it: the same
      thing happens in gangrene.
        Furuncle  is a species of inflammation which belongs as
      much to the cellular  tissue as  to the skin;  its causes are
      sometimes exterior,  as uncleanliness;  sometimes  interior,
      and then it  is induced by a peculiar disposition.
        In the  first case, the furuncle is generally  single and
      more or less  voluminous; in the second  case,  there exist
      alwavs  a great many.  Kvery part of  the body is suscep-
      tible of being attacked by it,  if we except the cranium, the
      soles of the feet and the palm of the hands.  It begins by
      a redness less lively than that of the phlegmon:  the tumour
      advances,  and is less rapid in its progress than that of or-
      dinary  inflammation.  Within the  space of  eight or  ten
      days, the summit becoming excoriated, there comes out
      from it a  cellular flake  called (bourbillon;) then the tu-
      mour softens and advances toward a cure.  The pus is
      not  healthy, and the surrounding parts are  more or less
      swollen.   There is no danger  of any fatal consequences;
      sometimes there  is a slight fever; but, if there  is a predis-
      position, it may happen that these accidents may  be more
      intense.  Anatomical  inspection proves that  the  seat  of
      the  disease is in the cellular tissue and in the skin, that the 
DISEASES OF THE CELLULAR TISSUE.
105
first is destroyed  in the part for some distance, and  the
skin pierced like a sieve.  There is a total difference be-
tween this inflammation and the phlegmon: here pus is real-
ly infiltrated, and there is no remainder of the disease on
the skin after the cure, whilst, in the phlegmon, there al-
vvavs  remains a cicatrization.
  There  exists cellular tissue under  the mucous  mem-
branes, as well as under the skin;  but it is less  abundant
and closer; also it is seldom  the seat of phlegmons, which
we only observe near the  rectum.  Besides, this tissue is
never fatty nor infiltrated.
  As  to the subserous tissue, it is looser and more volumi-
nous,  as about the peritoneum and  the pleura; this  is the
reason why it is often the  seat of abscesses; but the serous
membranes suffer very differently from the skin, and in-
stead  of being corroded, they become hard by the contact
of the pus:  by this means they prevent it from being dis-
charged into their cavities, an accident of very rare occur-
rence.  Nevertheless we  must remark that these serous
membranes have a great analogy to the cellular tissue;
which is here, however, differently organized.
  The sub-vascular tissue  never becomes inflamed; its or-
ganization  is different from that which it possesses in other
parts; it also never contains  any serosity nor fat, and even
if it happened that the  abscess should penetrate into it, the
external  tunic of the vessels would thicken, as is the case
with the serous membranes.
  Often  also phlegmon has its seat  in the interstices be-
tween the organs, and the  pus which is  there  formed is
called Jusees.  All the intervals  between the organs are
not equally subject to it; it may supervene on the face,
neck, abdomen, and the  extremities, but it is especially
before the vertebral column that we observe it.  These ab-
scesses, either indolent or acute, dissolve by degrees, and
reappear in another part, more or less remote: they are call-
ed abscesses by congestion.
             14 
106       [UPASES OF THE CELLULAR TISSUE.
  Thecellular tissue acts the mostimportant part in wounds;
we shall speak of it only relatively to the organic  pheno-
mena which are occasioned in it.   Considered in this light,
wounds are divided into those which heal by the first  in-
tention, and those which are cured by suppuration.   In the
first case, there is inflammation of the cellular tissue of the
lips of the wound, brought in contact, whence result ad-
hesion and continuity of the parts, which before were  di-
vided.   We can  not explain this phenomenon;  all  we
know is, that it is very analogous to the adhesions that  we
observe to succeed the inflammations of the serous mem-
branes.  The skin retains for a long time the mark which
is indicated by a linear cicatrix.
  The wound which does not heal by the first intention,
requires more or less time to run through its stages, and it
has then, all the appearance of there being a waste of sub-
stance.  Nevertheless, whatever may be the mode of divi-
sion, there happens a series of phenomena before the cica-
trix is closed:  there is at first a  swelling of the edges, and
after some time the bottom of the wound becomes red. This
redness goes on increasing.  After the bloody discharge
stops, then succeeds a serous pus, which is soon substituted
by another of a more healthy nature.   It is the good or
bad quality of this humour to which is owing the healthy
or disagreeable aspect of the ulcer.  The progress of  the
cicatrix is also influenced by the  remedies employed.   By
degrees the edges are depressed  and draw near the centre;
we see granulations grow out from the bottom, soon unite,
and form a kind of fleshy membrane covering the denuded
cellular tissue.  These granulations are evidently of a cel-
lular nature, for  their growth  is easier in  proportion as
there exists more cellular  tissue; moreover they are al-
ways of the same nature in whatsoever place we observe
them.
  Several authors have believed that they were only the
expansion of the vascular  tissue; but  they are not in  the 
           DISEASES OF THE CELLULAR TISSUE.       107

 least formed  by vessels.  They are covered by a mem-
 brane, and in the interstices of the cellular tissue, are filled
 with a whitish substance, the nature of which  is yet un-
 known.   As  we have  already  observed, the sooner the
 granulations appear the more speedily is the cicatrix form-
 ed.   A pellicle which arises from the edges extends over
 the surface of these granulations, and covers all the wound.
 This substance is not the true cicatrix; it only  serves  to
 protect its formation, so that, when this operation of na-
 ture is accomplished, it falls off in scales.  Then the sub-
 stance which  is to occupy the place  of the skin appears; it
 is at first red and very sensitive; it soon whitens, and often
 becomes harder than the skin itself.  Its thickness is in  an
 inverse ratio to its extent of surface, and dependent on the
 laxity of the parts where it is observed.   On the scrotum,
 it is much thicker than on  the cranium.  This cicatrix has
 nothing in common with the skin; its nature is totally dif-
 ferent,   It is nothing  else  than thickened and  organized
 cellular tissue. Generally it adheres to the subjacent parts.
 It is very sensitive to the  variations of the atmosphere,
 which renders it more or less painful.
   Ulcers affect particularly the  cellular tissue,  whatever
 may  be  the  organs they  interest.  They often succeed
 wounds.   If,  after a wound has run through its ordinary
 stages, suppuration  is kept  up  by any  cause whatsoever,
 this wound assumes then the appellation of ulcer.  Exte-
 rior ulcers may affect diverse parts.  Some are purely cu-
 taneous,  such as  the scabby ulcer (ulcere dartreux),  or
 those which  supervene  after a  blister.   At other times
 they have their seat immediately in the cellular tissue, such
 are those which  succeed the phlegmon, furuncle, or car-
 buncle.   All these ulcers are the  consequence of the chro-
 nic phlegmasia of the cellular tissue.   There are  others
 which interest the muscles, aponeuroses, and of  which we
 do not yet fully understand the alterations in these diseases.
The  vitality of each organ exerts an important  influence 
10^
DISEASES OF THE CELLULAR
I ISHUK
on the condition of these ulcers.   Ver\  often, these latter
interest several  tissues at the same time; but the cellular
tissue always acts the most essential part, since it is the
most abundant, and is that which produces pus.
  In simple ulcers, in general, the edges of the skin arc a
little  swollen; all the cellular tissue is denuded and then
covered with granulations; suppuration, more or less copi-
ous, is a true exhalation.  As to the subjacent parts, they
are commonly untouched.
  Ulcers may  present several  complications.  They arc
often  covered with a  great quantity of fungous excrescen-
ces; which  are always accompanied with paleness, indicat-
ing the bad condition of the wound.
  Callosities are also a very frequent complication; all the
organs are  susceptible of it.   At  first, it is only a more  or
less intense engorgement, but which continually increases,
so  that, at  last, the cellular tissue assumes a steatomatous
consistence.  Besides, these callosities are in  thcirjiature
entirely unknown.  They may assume very different cha-
racters.  In a simple  ulcer, they  commonly make no pro-
gress; but  when it is  malignant,  they enlarge very much.
The skin often participates in this complication.
  The fistulous condition is a complication of ulcers, which
only  consists in a peculiar mode of conformation, which
requires for them a peculiar treatment.   Fistulae are gene-
rally kept  up by a discharge of pus or any other fluid what-
ever.  In  certain cases they exist without  any known
cause.  Whatsoever  be their  source, they have nothing
uniform in their conformation.   The fistulous canal is  or-
dinarily a  little inflamed and callous.
   Varix is also a complication of ulcers; it is extremely
 frequent with  individuals of a weak and  plethoric habit;
 there supervenes an  edematous swelling, which disappears
 by the use of a bandage.
   Leucophlegmasia is another affection of the  cellular tis-
 sue,  almost always symptomatic.   Nevertheless there  are 
           DISEASES OF THE CELLULAR TISSUE.       109

some which are essential, that are always local.  Thus do
we see  sometimes an oedema of the eyelids more or less
considerable.   It is  especially in the parts in which the
cellular tissue  is most  loose, and in those which are the
lowest,  that dropsy occurs; such are the scrotum and the
inferior extremities.   However, in this disease, the tissue
is not in the  least altered, and  its cells are only dilated.
The fluid effused is transparent, and is easily coagulated by
the action of acids; in a  word, it is the same as that which
we find every where exhaled.
  Fat may be  abundant or may be wanting.   In the first
case,  there is  an  appearance of plumpness.  When this
embonpoint is  not very considerable, far from constituting
a disease, it is on the contrary a sign of health. Sometimes
the fat accumulates in so  great a quantity that, indeed, it
produces a true pathological condition; but still there ex-
ists this difference between this latter state and anasarca,
that excessive fatness does not kill the patient; but denotes
only feebleness, little activity when in motion, and some-
times exhaustion, as  we observe in eunuchs. This embon-
point is  developed when favoured by certain circumstances;
it is often observed to occur from the age of forty to fifty,
and also, generally in those persons who lead a sedentary
life, and who are fond of good  living.   The abdomen is
particularly the seat of this accumulation of fat, which oc-
curs sometimes in its cavity, and sometimes on its parietes.
This condition  has never been observed to coincide with
an organic affection.  The other parts of the body, besides
the abdomen, may also become loaded  with fat, such as
the neck, throax, and extremities.
  Sometimes fat disappears from the economy.   A mode-
rate leanness never constitutes a morbid condition. Never-
theless,  if it coincide with a state of feebleness, then it is
ordinarily the symptom of an organic disorder, especially
in the lungs.  This leanness may also supervene upon sad
passions; but does it then depend on an immediate affection 
 110       DISEASES OF THi: CELLULAR TISSUE.

 of the cellular tissue? It is more probable that it succeeds
 some organic alteration.  Violent exercise,«hangc of air,
 want of nourishment, are so many causes which  produce
 leanness.   Sometimes  leucophlcgmasia  is added  to the
 emaciation.
  Encysted tumours have  also their seat in  the cellular
 tissue.  Two kinds are distinguished; wens and cvsts pro-
 perly so called.  There are two species of wens, some arc
 meliceritious and some atheromatous.  Wens may  appear
 in every part of the body. Some are observed on the neck,
 cranium, back, and face.  They are always  rooted in the
 subcutaneous cellular tissue, and generally the skin which
 covers them is untouched.   Several  may exist  in the same
 part;  they  may be either insolated  or united; they vary
 in their form and volume.   Dissection shows us that they
 are a  kind of bag without any opening,  which contains a
 fluid; the external surface of this bag is united to the con-
tiguous cellular tissue; the internal smooth and polished,
corresponds to the contained fluid.   These bags vary in
thickness, so that the cysts of which the  fluid  is the least
liquid, are those of which the parietes are the  least thick.
Sometimes there are bands within these bags, and at others
there  are none.   As to the fluid, it varies singularly; some-
times it resembles honey, and at others curd. It seems that
these  varieties  are purely accidental.   Its colour is no less
variable.  Moreover, whatever may be its colour and con-
sistence, albumine seems to be the base of it.
  Physiologists have tried to explain the formation of
 cysts.  It seems that the membrane of these  bags  has a
very  great analogy with that of a cicatrix, that it  is pro-
duced by the  formation of granulations,  and not  by the
 flattening of the  cells, as it was supposed by the ancients,
 which would be contrary to all the laws of the economy.
  There are also some cysts, properly so  called, in which
 is found a serosity almost limpid.  These  tumours are en-
 tirely analogous to the preceding.  Some  are found in the 
          DISEASES OF THE CELLULAR TISSUE.        1 1 1

abdomen and in other parts;  but it is especially along the
spermatic cord  that they  are to  be  met with:  the  fluid
which they contain is seldom altered.
  The cysts of the ovary do not belong in reality to the
cellular tissue; but we shall  speak of them here because
they have a great analogy to those  of this tissue.
  A great many subjects present some remains of this drop-
sy, which depends almost always on some alteration in men-
struation, either if it appears at the final cessation of men-
struation or before this epoch. Whatever may be the cause,
this disease can not be recognised  in the beginning.  The
patient experiences a weight in the  part, but it is not a well
defined pain.  The disease carries  along with it  very few
general alterations;  when it begins to be well characterized,
there  are some signs which enable us. to detect it, for ex-
ample the size of the abdomen.  But with this chiracter
alone, we may confound the dropsy of the ovary with as-
cites.    In order to distinguish these two diseases, we must
have  recourse to the symptoms which have preceded.  In
ascites, there will have been a preceding malady; in drop-
sy of the ovary, there will have been only a derangement
in the menses.  In this latter case, the tumour is from the
beginning circumscribed; in the former the whole abdomen
is tumefied at the same time.
  In  the dropsy of the ovary, there is no infiltration of the
lower extremities; the disease is very slow in its progress,
for, some have been observed to have existed during eight
or ten years.   But from this enormous distension results
at last a derangement of the functions; digestion is impair-*
ed, and the pulse is feeble, as in all dropsies.  Urine  is, of
all the secretions, that which presents the greatest varieties;
sometimes it is abundant,  at others it is  suppressed, and
according to these two conditions,  dropsy increases or di-
minishes.  The skin is parched, pulmonary exhalation al-
most absent, and leanness extreme.  Dissection shows the
ovary to be enormously dilated;  in its internal surface 
1 1U       DI-EASI> (  r THE CELLl'LAn TISSUE.

there is a kind of false membrane formed.   Sometimes its
cavitv is divided into two.   The fluid which it contains is
always altered;  it presents  different colours and different
degrees of density.
  Steatoma is  also a tumour which is developed in the
cellular tissue, and which is surrounded by a membrane,
being only less sensitive than that which forms cysts.  This
membrane sends off into the interior, prolongations which
constitute the cells and contain  the  fluid.  This latter is
denser and more solid  than in meliceritious tumours; it has
a yellowish tint, and contains a great quantity of albuminc.
This  kind of tumour  may supervene in all parts of the
body, but especially under the skin.   They  are recognised
by a very peculiar hardness; if they are incised, nothing is
discharged. They are often observed on the head, neck, and
trunk; we find them also in the cavities, that of the cranium
excepted, where the want of cellular tissue renders the ex-
istence of those diseases of which it is the scat, impossible.
The same is not the case with the thorax; since it presents
much more cellular tissue,  and  consequently some  stea-
toma? are ncre developed; these tumours cause then pecu-
liar consequences, according to the organ with which they
are in contact: it is impossible to detect their existence,
and we can  only suspect them.   In the abdomen,  they
often supervene in the mesentery, and are the cause of vio-
lent abdominal  pains;  at last, they form such a projection
that they can be perceived by the touch.  At first there is
no disturbance in the digestion, but at last, marasmus super-
venes and carries off the patient. Steatomae  may also be
found in the pelvis.  Some are also seen on the members.
These tumours are nearly  similar wherever they are ob-
served; they nevertheless  vary  in size.  Those we find
under the skin may be very small; but, in the cavities they
acquire an enormous  size: there are  then no pathological
signs to detect  them,  if  we except  their hardness to the 
           DISEASES OF THE CELLULAR TISSUE.       113

 touch, and the alteration of the organs that they encumber
 by their volume.
   Lipoma  (fatty tumour) is nearly similar to the preced-
 ing one, which always occurs in the subcutaneous cellular
 tissue.   This tumour is  more  or less  voluminous, and
 often presents a pedicle.  It is formed by a concretion of
 fat, sometimes altered in its nature.
        •
                     ARTICLE  I.

 Of Affections from  Contiguity of the Cellular Tissue.

   There is no system which  feels  more  promptly the in-
 fluence of the diseased organs than the cellular tissue.  This
 sympathy seems to depend upon its mode of disposition in
 the general structure of the organs  of which it is the basis.
 Thus when an organ  is affected, the cellular tissue which
 composes it soon becomes so too, and,  according to the
 law already established, that, diseases may be propagated
 in tissues of a similar nature, the neighbouring cellular
 tissue is soon equally  affected.  Thus in phlegmon, all the
 surrounding parts experience a more or less considerable
 swelling; in erysipelas, the same phenomenon takes place.
 In fractures, contusions, &c, we observe a swelling of the
 surrounding parts, which, without  doubt, differs from in-
 flammation;  it is not  an oedema, for, in pressing  with the
 finger, the impression does not last  any time; besides there
 is a peculiar sensibility which does not  exist in this last
 disease.  It is not an  emphysema since  crepitation is not
 felt, and that, besides, emphysema only supervenes after the
 rupture of an organ which  contains  air.  It seems that this
 phenomenon is owing only to a peculiar excitation of the
 cellular tissue.
  It is especially the subcutaneous cellujar tissue which is
engorged in phlegmon, erysipelas, and gout.  The same is
the case with that which surrounds the  serous membranes;
            15 
  1 14       nsf \?FS OF THE CELLU! AR TMtl/f.

  thus in enteritis, the distension  of the abdomen is owin^
  to the  swelling  of its cellular t:ssue.  No oppreriabh:
  swelling is observed to accompany the inflammation of the
  mucous membranes, which is owing, without clout t, to the
  density of the cellular tissue which  is in contact with them.
   This  tendency of the cellular  tissue to participate and
 receive  morbid impressions, may cause the translation of
 an affection from one organ to another.  Thus, tflfe inflam-
 mation of the pleura may be communicated to the lungs,
 and, whenever an organ participates in the affection  of
 neighbouring structures, it is always through  the cellu-
 lar tissue  that it receircs i/s impressions.  After death,
 the swelling which accompanied the inflammation disap-
 pears almost entirely.  When  an affection is chronic, the
 cellular tissue is  more  or less  affected, as is observed  in
 cancers and old ulcers.
   Another  phenomenon  from  contiguity of the celluhir
 tissue, is lcucophlegmasia, which  sometimes is symptoma-
 tic, but which often is affected also by the contiguity of the
 diseased organs.   Thus we  sometimes see  local infiltra-
 tions about old ulcers.  However, the malady is the same
 as in sympathetic infiltration; the cause only differs.
   Emphysema may be numbered  among its maladies;  it
 never occurs but in the parts  immediately surrounding the
 thorax, and  in some  cases of gangrene.   Ii is  ascribed to
 three circumstances:  first, to violent movements of the chest
 and  lungs in uttering vehement  cries,  because if then  it
 happens  that one of  the cells  of the bronchia? is ruptured,
 and that  the air which escapes from it,  follows the course
 of the  axillary vessels, it  extends to the neck or on  the
 lateral  parts of the thorax; 2d, to  fractures of the ribs;
and, 3d, to deep incised  wounds of the chest.  When em-
physema is  only local, it is soon  dispersed  by the use of
resolvent compress; but, when it is gonera), death is in-
evitable. 
DISEASES OF THE CELLULAR TISSUE.
115
                     ARTICLE II.

 Of the Sympathetic Affections of the Cellular Tissue.

   (Edema is one of the most frequent affections of the cel-
 lular tissue in acute fevers, and even in intermittent fevers
 whenever they are a little protracted. Then a slight oedema
 is observed  in  the legs, more considerable towards the
 evening, and disappearing during the  night.  In organic
 diseases, this phenomenon is very common.  The affections
 of  the liver, of  the spleen, and particularly of the  lungs,
 cause a leucophlegmasia which ordinarily begins by an in-
 filtration of the legs, and which is often complicated with
 dropsies of  the serous membranes.
  Emaciation is also a symptomatic phenomenon of the
 cellular tissue, for, it  only supervenes  on the occasion of
 some primitive affection.  It is  not the  consequence of
 certain  organic  maladies, such as those of the heart, and
 brain; but those  of the lungs and several others always pro-
 duce it.
  Hemorrhages at the cellular tissue are also to be ranked     •
 in the same  class.  There are some, indeed, which are ac-
 cidental, such as those  which  are  consecutive to contu-
 sions; then they are induced  by a rupture, and the  blood
 effused is soon absorbed.  There are some which  are spon-
 taneous; these rarely occur but in scurvy, a disease which
 affects the whole economy in general. The external exami-
 nation of scorbutic persons presents spots of two  kinds:
 sometimes they are very large and occupy a part of the ex-
 tremities; at others they are merely petechia?.  We ordi-
 narily find these two species isolated; the thighs,  the legs,
 the nates and the arms are the seat of them, but seldom the
trunk, and never the face.  Whatever be the cause of this
phenomenon, on dissection  we find spots {plaques)  de-
pending upon an extravasation of blood in the cellular tis-
sue.   As  to petechia?, they are perceived at the points 
116
:«! ASKS OF THF. LUM.v
where the hairs issue; often bloody infiltration happens in
the very muscles themselves, and then it is not perceived
on the exterior.   It is very probable that these scorbutic
hemorrhages are induced by exhalation.
  Finally, the cellular tissue,  in many diseases, assumes a
peculiar flaccidity and laxity.  This is what we observe in
old age; we  observe  it also in  adults, after acute diseases,
in which the soft parts are flabby, and do not resume their
tone  but  after a perfect recovery.  This  flaccidity has a
very  peculiar effect on the face;  it is that which confounds
the expression of the countenance.
                CHAPTER VIII.

                Pulmonary Diseases.

  The lungs have not as yet been considered  by us as a
simple tissue, because they are an organ; nevertheless, in
pathology, we must regard them as such, although, there
does not exist in any part of the body any thing analogous
to them.   They differ especially from other organs in their
diseases.   Their inflammation, for example, has nothing
in common with that of others: the progress of it is more
rapid; the pus has a very peculiar  nature and odour.  Tu-
bercles exclusively belong to  this organ,* as well as calcu-
lous concretions.   The diseases of the lungs are extremely
common, which results without doubt from the close rela-
tions of this organ with  exterior bodies.  We shall first
speak of its essential affections, and then of its sympathies.
  • The similar small tumours which  occur in the liver, spleen, peri-
toneum, and even in the heart, are by Laennec and others denomi-
nated tubercles.   Thass. 
DISEASES OF THE LUNGS.
117
                    ARTICLE I.

             Inflammation of the Lungs.

  Peripneumonia is the principal of the affections of the
lungs.   This inflammation is more frequent than that of
the pleura, it commonly  depends upon a sudden change
from heat to cold.  Whatever may be its cause, the follow-
ing are its phenomena: its attack begins with chills, fever,
pain in the side, more or less intense.  Sometimes  it is
ushered in with heat; in certain cases, the fever precedes for
two or three days; the pain in the side augments;  in three
or four days it has reached its highest  degree.  When in
that condition, the patient experiences a violent pain in the
chest, sometimes in both sides, and at  others in one side
only, accordingly as both lungs or one only is affected. Of-
ten he refers this pain to no particular part. The sensation
is not as in pleurisy lancinating, but an oppression which
exhausts very much; sometimes,  also, the  pain  is local.
Respiration is oppressed,  but otherwise than in pleurisy.
Short inspirations are not painful.  To this  suffocation is
added a cough more or less violent and frequent: on the
first day it is dry; but after three or four days the expec-
toration begins; sometimes the sputa are white, sometimes
they are bloody; sometimes  they are of a  rusty  yellow,
this colour does not indicate gastric disturbance.  Expec-
toration varies also according to the time at which  it is
examined.
  During the  intensity of pleurisy, the patient can  only
lie  on  the side which  is not  diseased;  in peripneumonia,
the situation makes no difference; exterior pressure is not
painful. As to percussion,  its  results vary according to the
state of the malady; in the beginning the sound is clear,
towards the end it is dull.   When the two diseases unite,
there happen  common phenomena, which  it is of very 
US
DISEASES OF THE LUNGS.
 little consequence for us to discriminate for the sake of the
 treatment, since it is nearly always the same.
   As to the general phenomena, the condition of the diges-
 tive organs varies singularly.  Commonly there is gastric
 disturbance, some diarrha?a, at other times constipation;
 there is always a concomitant fever; the pulse has nothing
 determinate.   The same thing is true as to the state of the
 secretions and exhalations. The urine at the beginning is
 generally lateritious.   Nutrition is not altered, since the
 disease is very acute.  The cerebral functions are ordina-
 rily unimpaired; nevertheless, there is  some delirium. The
 strength is generally diminished; sometimes debility in-
 creases, and then the disease assumes a character of adyna-
 mia, which is often more marked than the primitive dis-
 ease.
   The most common termination of peripneumonia is reso-
 lution.  The disease lasts till from the eighth to the tenth
 day; then gastric disturbance ceases with the cough, and the
 sputa resume their natural state.   This termination is not
 ordinarily marked by any crisis,  such as a sweat  or a he-
 morrhage; only the blood disappears from  the sputa, which
 are often very abundant for some days.
   Another termination is suppuration.  All  writers have
 spoken of it,  and have designated it  under the name of
vomica.  One would be  induced to think, to hear them
 speak,  that it  is very common; but it is very seldom ob-
 served. Indeed, we remark, sometimes, purulent specks in
 the lungs, but too inconsiderable to be regarded as absce ses.
There  is another mode of suppuration more proper to the
 lungs,  it is the infiltration of their tissue  by a serous and
 whitish substance which gives to it a fleshy aspect resem-
 bling the substance of the liver, and indeed they are then
said to be hepatized (hepatisL)   The following signs are
those which would induce us to suspect its existence during
life, towards the ninth or tenth day; there is no remission;
the sputa are of the  same nature; breathing is every day 
DISEASES OF THE LUNGS.
119
more difficult,especially when the patient has drunk some-
thing; he finds some difficulty in lying on the diseased side:
percussion becomes more dull; prostration increases; there is
almost always a florid redness on the cheeks, which is or-
dinarily a positive sign of affections of the lungs.  The symp-
toms continue to increase, and sometimes the patient dies
suddenly. This termination is frequent in peripneumonia,
complicated with  adynamia or ataxia;  in  the bilious and
simple form it is something less frequent. It is remarkable
that in the complication of adynamia, the patient never dies
from the latter, but always from the affection of the lungs,
and commonly after the four or five first days of the com-
plication.   However, in these terminations the  lungs are
found thickened, weighing three or four times more than
when in a healthy state.  There is no organ susceptible of
acquiring an augmentation of weight so quickly.  This fa-
cility of being engorged,  is to be ascribed to the extensi-
bility of the lungs,  as it  is also observed in cases of  as-
phyxia, with this  difference, that in the latter, this organ
does not sink in water, whilst, when converted into a sub-
stance like liver, (carnifle,) it may even  carry to the bot-
tom, along with itself, light substances.   In this case, one
would be  induced to say that it is not the fluid which is  in-
creased, but the solid parts: nevertheless we may convince
ourselves of the contrary by macerating a part of the hepa-
tized lung. If, some time afterwards, it is compressed, it re-
sumes its normal state, by  discharging the pus that it con-
tained.  This disposition  sometimes exists in one of the
lungs, and at others in both, lastly in  one portion only,
and when this occurs it is in the superior  part.   Thus en-
gorged, the lungs lose their extensibility; they tear  with
great facility, and have no  elasticity. With regard to their
blood vessels, they assume the appearance of those of the
liver; we find their orifices wide open when cut transverse-
ly.  As to the condition of the exterior parts, the pleura
is almost always healthy; but sometimes it is inflamed, and 
120
DISEASES OF THE LVNC.S.
presents even a slight serous effusion. The state of the cir-
culation often depends upon the kind of death: commonly
the arteries are empty.
  The termination by gangrene is very rare, even in com-
plications of adynamia: one of a more common occurrence,
is chronic inflammation.  There is,  indeed, then, a remis-
sion;  but all  the  symptoms are kept up.  A sensation of
suffocation is experienced, common  also to the diseases  of
the heart. When it is not succeeded by phthisis pulmona-
lis, and this is seldom the case, the patient dies somewhere
about the fortieth or fiftieth day.  Boerhaave has well de-
scribed slow peripneumonia,  which,  indeed, sometimes
follows the acute; but which also may be independent, and
dshers in phthisis.


                    ARTICLE II.

                     Of Phthisis.

  Phthisis, an organic malady of the  lungs,  presents,  in
the beginning, an infinite variety, which is to be attribut-
ed to the varied progress which each affection of this or-
gan makes, and to the diversity in the causes which give
rise to it.  Towards the end, on the contrary,  all cases  of
phthisis present the same symptoms, and require then,
a similar treatment.
  The greatest number of authors have arranged these dis-
eases in three classes: the first includes the beginning, the
second presents the  most intense symptoms, and finally,
the third is the last epoch.
  In the first stage,  it is impossible to consider in general
the symptoms of phthisis, since it may be the consequence
of an infinity  of diseases; consequently we shall be obliged
to treat it  separately.  As to the second and third stages,
we shall speak of them in general.
  The causes which produce the first stage of phthisis, al- 
DISEASES OF THE LUNGS.
121
though very numerous, may be reduced to a certain num-
ber of heads, as, an hereditary disposition, an acute affec-
tion of the lungs,  the suppression of an evacuation,  any
virus whatsoever, &c.
  Hereditary phthisis does not depend, as the ancients sup-
posed, on a virus transmitted with the  semen,  which  is
only developed at a certain epoch; it must evidently be as-
cribed, as well as all other  analogous diseases, to a peculiar
conformation, proper to certain families.  These differen-
ces influence as much the external conformation  as the
structure of the organ, so.that we might say, respecting
this, that every family has  its temperament, which predis-
poses it to a certain malady, that we then call hereditary.
  The conformation  which  predisposes to phthisis,  is
a feeble constitution; the skin is remarkably fine and clear;
the face and especially the  cheeks are more or less  suffus-
ed with a blush; the chest is very  little developed, very
narrow, especially at the  upper  part,  and consequently,
the shoulders and clavicles  are approximated io each other.
The inferior part often participates also in this constriction;
the formation of the sternum is also materially influenced.
This conformation,  nevertheless, does not always induce
phthisis, whilst  we meet  with well formed persons at-
tacked by it; there is no doubt that, in spite of the favoura-
ble exterior appearance, there exists with these last  a  pre-
disposing cause seated in the lungs.  The  phthisis  which
follows catarrhs and peripneumoniae, occurs at all ages; and
is seldom to be met with after the age of twenty-five or
thirty years, an epoch at which  nutrition is particularly
directed to the thorax.  When it has for cause an heredi-
tary disposition, phthisis is almost always tubercular.  We
mean by  tubercles those granulations which grow by de-     »
grees, suppurate, and,  by  their collection, form vomicae.
This  affection exclusively  belongs  to  the  lungs: miliary
eruptions have nothing in common with this latter affec-
tion.  Authors have pretended that its seat was in the lyra-
             16 
122
DISEASES OF THE LU-^GS.
phatic glands, but we have no reason to  believe it.  He-
sides, it is very doubtful whether such glands exist in the
parenchymatous structure of the lungs, for wherever they
exist, they become swollen in phlegmasiae, and become ap-
parent, when before they were invisible; now, we do not
observe any thing like them in the  inflammation  of the
lungs.  The neighbouring glands  are indeed swollen  in
phthisis, but this  phenomenon is not peculiar to this  dis-
ease.  These kinds of tubercles, more or less numerous,
begin in the superior part; when they have become small
abscesses, then others appear in the inferior portion, which
also begin to suppurate whenever the vomica  is formed  in
the parts above: the pus discharged is contained in a kind
of cyst.  When the affection appears, pain supervenes, the
least exertion puts one out of breath,  and produces  cough;
this latter continues always dry; it  increases, general ema-
ciation makes rapid progress; the cheeks are warm, as well
as the palms of  the hands and the soles of the feet.  We
may then be certain that there exist tubercles  in the lungs.
Sometimes the patient dies in this stage, but it is rather sel-
dom; this often occurs in the second  or third  stages.
  Pleurisies, and oftener peripneumoniae, produce phthisis.
Then it goes through its course as commonly, and ends  in
the symptoms of phthisis, which  progresses by degrees;
at last the patient sinks.  Certain catarrhs  may also pro-
duce it, and this termination  is pretty  common  with old
persons.   At first, the disease becomes chronic, the cough
continues, and at last phthisis appears. Haemoptysis, in the
greatest number of cases, terminates in the same manner,
and this termination is itself often only consecutive to ano-
ther affection. The inspiring of certain acrid and irritating
vapours has been considered capable of producing this ma-
lady, but  this is seldom remarked.  Another cause consists
in the suppression of certain evacuations,  the  discussion of
certain voluminous tumour, the cure of an inveterate ulcer,
the repercussion of certain  cutaneous diseases,  as ring- 
DISEASES OF THE LUNGS.
123
 worms, itch, the suppression of quartan fever on its first at-
 tack.   Finally, phthisis is sometimes complicated with a
 scrofulous or venereal taint.  Being produced by so many
 different causes, it must consequently vary in its mode of
 beginning; but when it has reached its second stage, then all
 the variations are confounded and have similar symptoms,
 and phthisis follows always the same course; it matters not
 what may have been the primitive cause.  In the second
 stage of the disease, the pain in the chest begins to be sensi-
 ble; sometimes it is fixed at one point, at others it  is irregu-
 lar, sometimes  it exists in the lumbar region, at others
 about the epigastrium, and, what is worthy of remark, it is
 never felt in the part in suppuration. This pain has a very
 peculiar character; it has not the keenness of that of cancer,
 nor the character of tension of inflammation: it is a peculiar
 tickling.  There are patients who, during the affection, do
 not experience this pain, although all the other signs are
 present.  It  may experience a  remission;  sometimes it
 ceases during fifteen days or three weeks, and then returns
 with  more intensity.
   Respiration is always more or less impaired.  When the
 patient  is motionless, then  it is easy; but the least agitation,
 the least emotion of the mind, the very action of eating,
 suffices  to excite suffocation, which  obliges the patient to
 remain  at rest.  This strangling  sensation is a symptom
 common also to the diseases of the heart; but there are cer-
tain characters by  which it may be easily distinguished in
 both cases.
   In phthisis it does not attack by fits, as in the diseases of
the heart, in which it is especially manifest in the evening.
At this time there is an exacerbation of symptoms in
 phthisis, but it is not so considerable; moreover, it seldom
 happens that when the patient is quiet, there supervenes an
extraordinary suffocation, which is, on  the contrary, pecu-
 liar to the diseases of the heart. In this latter affection, dur-
ing the  paroxysm, there are palpitations, the lips and nose 
124
DISEASES OF THE LUNOS.
are livid, and the whole  face is  somewhat swollen.  In
phthisis, on the contrary,  at the time of the  attack, the
cheeks  are particularly flushed.   There is always more
cough than in the diseases of the heart,  in  which it is
generally absent.   It is very important to distinguish this
symptom of stiangling, for it is essential and characteristic;
it is the  more felt as the  disease  is the  more advanced.
Cough is also a s)'mptom  belonging to the affected organ;
sometimes  it is dry; at others it is humid;  it increases es-
pecially  by night,  during the  exacerbation of the hectic
fever, as well as after meals.  This cough varies singular-
ly; sometimes it  is intermittent, and  appears  on  certain
days and at certain times of the day.
  The expectoration  of consumptive persons  sometimes
consists of pus,  commonly it is  very difficult to decide
whether the sputa  contain any, for, they  are very often
very analogous to those which  are expectorated towards
the termination of peripneumonia or  in catarrhs of the
thorax; but this sign is little important, for, the aggregate
of the others characterizes the disease  sufficiently.  How-
ever, the pus which is  discharged presents an infinite va-
riety: often the sputa contain  none, sometimes they are
partially mixed, and at others the pus is expectorated pure.
Dehaen believed that pus  was  formed  without ulceration
and was  discharged by  exhalation, but this opinion evi-
dently is contrary to all physiological  ideas.  The  patient
may spit clots  of blood of more or less consistence:  indeed
we find this kind of concretion in  vomicae.  At other times
the sputa are black or green; they seldom contain earthy
concretions: nevertheless,  writers have spoken  of this phe-
nomenon,  and  have formed a variety of phthisis from it,
which they have called calculous; but it is a different mala-
dy, as we shall see. Sometimes the sputa contain membra-
nous substances; are they  portions of the lungs? If we con-
fide in autopsic examination, this is possible. Often the pa-
tient discharges together with the pus, blood. Haemoptysis 
DISEASES OF THE LUNGS.
125
almost always precedes phthisis.  Towards the conclusion
there is sometimes a passive exhalation  on the mucous
membrane.   The voice in this second stage,  is altered; it
becomes hoarse, although there is no affection of  the la-
rynx.   Is this phenomenon  produced by the distribution
of the eighth pair of nerves? We know nothing about it.
Percussion is a very feeble  auxiliary  in phthisis.
  As to the symptomatic affections, digestion  is more or
less impaired; often there is  vomiting after a violent fit of
coughing, and Morton believed that this symptom charac-
terized  particularly this disease; it often occurs after eat-
ing.   Towards the end, a diarrhaea comes on, the chyle is
no longer elaborated nor absorbed; the diarrhaea increases,
and it marks the last moments of  the patient.  In phthisis,
there is a peculiar concomitant fever, called  hectic,  and
that certain writers have considered, but incorrectly, as es-
sential; it is, without doubt,  because like some of  the es-
sential fevers, it experiences remissions.  In  the evening
there is almost always an exacerbation;  at  first a slight
chill, fever, then sweats more or  less abundant, which are
confined to the chest, face and neck.  These sweats are evi-
dently marks of debility; they  occur particularly in the
morning.  The pulse has on  this  occasion a very peculiar
character; it is small, frequent and hard. The irregularities
in the temperature of the body are very remarkable; heat
is particularly felt at the soles of  the feet, in  the palms of
the hands and  on the cheeks.  As to the secretions, they
all vary.  There is first a serous  infiltration of the  thighs,
then of the legs; we seldom have  a general leucophlegma-
sia, it being prevented, without doubt, by the copious per-
spirations that occur at that time.  Nutrition is singularly
altered.  Of all the organic diseases, phthisis is that which
produces  the most frightful  marasmus.  As to external
functions, they are very little altered; the intellectual fa-
culties preserve their integrity to the last.  The functions
of generation  are  singularly  excited, and even   to the 
I2fi
DISEASES OF THE LUNOV
hut  moment the consumptive  person feels an irresistible
proneness to venereal pleasures.   Finally, towards the last
stage, the symptoms are at the highest degree of intensity;
purulent sputa are often  mixed with blood; diarrhaea su-
pervenes; the  extremities are very ccdematous.  Patients
die at different periods: sometimes they perish when tu-
bercles are forming; at others they reach the second stage;
finally, they are always certain to  die in the third.  Some-
times a few days before death, the fades hippocraticu is
marked in  the countenance, and the agony is  long: some-
times, on the contrary, death is sudden, and happens whilst
speaking or eating.
  The autopsic'examination of this disease is common, but
it has been so only within these few years, for, hitherto the
foolish prejudice, that phthisis was catching, deterred phy-
sicians from examining the corpse.
  The lungs of all consumptive  persons present the same
appearance, whatever may have been the cause of the dis-
ease.  They are found more or less interspersed with puru-
lent gatherings (foyers purulents) that  we call vomicae,
and which  we observe  particularly in the superior parts.
The  shape  of these  vomica? is very irregular and variable.
In the beginning the abscesses are small; but they increase
in  the same ratio with the disease.  In certain cases, they
are so numerous, that the lungs seem to be only an areolar
tissue which contains them.   These  vomicae  are crossed
by a great  many bands.  In the neighbouring parts,  we
find more or less induration, which was equally destined
to  go through the process of suppuration.   As to  the fluid
of abscesses, there are cases in which we never meet with
any, and where, as  we have already said, it has been reab-
sorbed.   Very often we find it in great quantity, but not
sufficiently so to distend its parietes, which remain always
flaccid.   This pus varies in its colour and consistence; it
never contains any blood.
  The pleura presents a very variable condition: in certain 
DISEASES OF THE LUNGS.
127
cases it does not adhere, but most frequently it adheres, es-
pecially above and  behind, sometimes  even throughout.
This condition is often produced by a disease additional to
phthisis.  The glands neighbouring to the lungs are more
or less engorged; but this phenomenon is not peculiar to
phthisis, and is observed in all  organic diseases, if we ex-
cept those of the heart.   There  is very little alteration in
the digestive organs; the heart is contracted upon itself,
and, as well  as the  arteries, contains little blood; but this
condition varies and may depend on the kind of death. As
to the secreting organs, they are commonly in their natural
state; nevertheless  the  liver is  sometimes loaded with a
considerable  quantity of fat, which some have wished to
ascribe to a relation of this organ with the lungs; but ex-
amples of fat liver  are seen in other affections, and espe-
cially in those of children, in whom certainly it is not the
effect of phthisis.   In the cellular tissue there is more or
less infiltration; the fat has not only disappeared, but even
the nutrition of the organs is altered; they are flaccid, and
reduced  to a smaller size than common.


                    ARTICLE III.

                      Of Calculi.

   Calculi are also  an affection  of the  lungs.  Morgagni
was the first who wrote concerning them.  They are found
ordinarily towards the upper extremity inclosed in a pecu-
liar cyst. It is impossible to distinguish  their  symptoms
from those of phthisis: some have been found in a healthy
lung, and from which the patient felt no inconvenience.
   The  lungs  presents  also hydatid.  They form a  cyst
more or less considerable, as in vomicae,  with this differ-
ence that they only contain water.  This disease is of
rare occurrence; we have no certain data to distinguish it
   Steatoma;  may also develop themselves in the lungs; 
i:>
DISEASES OF THE LUNGS.
they are then irregularly diffused in its tissue; they present
the consistence of a fatty substance, and it is impossible to
foresee their existence.  Such are the essential diseases of
the lungs.
  Now let us examine  its sympathetic affections.   Al-
though the lungs are an organ essential to life, nevertheless
they are not so  often influenced by diseases as other  im-
portant organs: such as the heart, which by the least sym-
pathetic excitation produces  fever;  the stomach, which
causes gastric disturbances, &c. The lungs, on the contrary,
seldom produce disturbance in  respiration by their sym-
pathetic affections; nevertheless, when they  are very in-
tense, this  sometimes happens.   It is especially then that
the cough supervenes:  it is observed in certain gastric ob-
structions, in the affections of the liver, of the kidneys, &c.
Writers have quoted some similar cases which yielded to
the use of the means employed  against the direct  course
of the disease.   The affection of almost every organ sur-
rounding  the lungs, presents us  with this sympathetic
cough.  It is also observed in certain fevers  which affect
the whole economy; in the beginning of putrid fevers, the
cough  is a phenomenon purely analogous to the vomiting
which is then  remarked.  Not only the  cough is  sympa-
thetic, but also the difficulty of breathing in certain cases,
as in particular idiopathic fevers.  At first we should be in-
clined to believe that the lung3 begin to be obstructed; but
all fears are dissipated  by the cessation of the  pain.   The
same is the case with respect to the pains of the chest in
the beginning of these fevers.
  There are other considerations relative  to the diverse al-
terations that the lungs  experience at the time  of death.
We seldom find them, at this time, alike in all  individuals.
These alterations are evidently connected with the essen-
tial function of the lungs, as the  centre of the circulation,
which is always more or less obstructed at the moment of
death.  There are, on  the contrary, diseases which, from 
DISEASES OF THE LUNGS.             129
 their nature, on dissection, present us the lungs empty of
 blood:  such are  hemorrhages, very  sudden death, and
 syncope.

                    ARTICLE IV.

                      Asphyxia.

  Asphyxix may be referred to the chapter on the diseases
 of the lungs.   We divide  them into two general  classes:
 1st, those caused by simple deprivation of air which takes
 place in a vacuum, by strangulation, by submersion, &c.
 And 2d, thosewhich are produced by deleterious gases,as
 azote, hydrogen, exhalations from privies, as well as the
 vapour of charcoal.
  Drowning presents the following phenomena: the lungs
are more or less gorged with blood; the bronchia? contain
 ordinarily a little water; we meet at the same time with a
 great deal of mucus; we also sometimes find foreign bodies,
 such as gravel.  The heart is very much dilated on the
 right side; the veins are gorged  with a quantity of blood,
 which we find also abundant in the arteries; the heat dis-
appears suddenly,  which  distinguishes this kind of as-
phyxia from all others. In general, the difference in the
cooling of diverse  cadavers is always to be ascribed to the
kind of death, and consequently we should be on  our
guard never to  decide  too hastily on the  period at which
 the patient has expired.   As to the state of the capillary
system in drowning; on the external surface it is very much
loaded with blood, particularly on the superior parts which
are quite  black, whilst the inferior  extremities are  very
little coloured.  This  condition, especially  of the  face,
agrees very well with the  facility with which these same
little vessels retain the  red blood whilst alive. The brain
presents also  vessels very  much engorged; as to its  sub-
stance, it is in its ordinary condition. 
130             I I-F.AsES OF THE LUNG*.

  Strangulation presents nearly the same disposition.  Ne-
vertheless the lungs are less engorged  because the air has
been suddenly stopped, but the veins and the arteries are
full; there is often erection of the penis,  without our know-
ing why.
  In asphyxia produced by charcoal, the lungs are more
or less engorged.  1 f the death has been slow, t hey are very
much so; and if  it is sudden, very little.   The heart and
blood vessels  are very full.  At  the same time that it is
abundant, the  blood is always  liquid.   Heat is preserved
for a long time in this kind of asphyxia;  but the fluidity
of the blood is kept up long after the heat has escaped.  The
limbs may be bent with  the greatest facility, which is not
the case with the other kinds of deaths, in which state much
strength is required to bend them.  The superior parts are
somewhat livid; there is a peculiar vivacity of the eyes.
  As to the other kinds  of asphyxia produced by deleteri-
ous gases, death in  them is so  sudden,  that the lungs are
very little engorged with blood: only few autopsic exami-
nations  have been  as yet  made relative  to this kind  of
death. 
DISEASES OF THE GLANDS.
131
                 CHAPTER  IX.

               Diseases of the  Glands.

  The glandular system does not present, as do the pre-
ceding ones,  many general characters.   The parts which
compose it have very few qualities in common;  the nature
and affection  of every gland are almost peculiar to  each
one.  Consequently it is impossible to treat of the affec-
tions of these parts in a general manner.  We shall speak
of them successively, following the anatomical order.


                    ARTICLE I.

      Of the Diseases  oj the Lacrymal Gland.

  The lacrymal gland is the first which presents itself in
the  head: it is perhaps the one in which organic affections
are  most seldom met with; most authors have  never spo-
ken of them.   Guerin quotes only some examples of scir-
rhus of this gland, an affection which sometimes renders  it
necessary to extract it.   This gland  is very seldom injured,
and consequently the tears are seldom altered, whilst in
the  diseases of the other glands  the secreted fluids often
participate more or less in the affection of the organ.   In
lacrymal tumours, the muddy appearance of the liquid  is
owing only to the admixture of the tears with  the mucus
furnished by the canal which contains it. 
*
132            DISEASES OT THE GLANDS.


                    ARTICLE  II.

         Of Diseases of the Salivary  Glands.

  Next in order come the salivary glands: they are divided
into three species, the parotid, the maxillary and the sub-
lingual glands; they have a similar organization.   In gene-
ral they are very little susceptible of organic affections; ne-
vertheless they sometimes occur.
  The parotid  experiences  some  essential maladies, and
some  others which are symptomatic.  Tumours  of the
parotid (ornilloes) which are very common, seldom reach
the suppuratory stage.   They are especially  observed in
children.  Is their  seat in the very parenchymatous tex-
ture of the gland, or in the surrounding tissue? The enor-
mous  extent of the swelling,  in certain cases, induces us to
believe the latter; perhaps the tissue of  the gland partici-
pates  in it also.  When there happens an abscess, the pus
is simply phlegmonous, and  penetrates sometimes even to
the gland, but its  principal  seat is in the anterior  part.
Sometimes the parotid is nowise interested, as in abscesses
situated in the arm-pit, the glands of these parts arc not al-
ways affected.
  Its  symptomatic affections are better known.   Parotites
arc swellings of this region which supervene in  adynamic
fevers.  These swellings have evidently two different seats:
first, they often occur in the lymphatic  glands, which are
very  numerous in this part.   It is easy  to distinguish this
ease:  the glands are hard, moveable, roll under the finger,
and preserve even in their swollen condition their primi-
tive form; they sometimes acquire a considerable volume;
they  seldom present purulent abscesses.  In the second
case,  it is the tissue subjacent to the gland  which is en-
gorged; the gland  indeed participates partially in the af-
fection, but it is not the principal  seat.  The chronic af-
fections  of the parotid are of rare  occurrence; it becomes 
•'
DISEASES OF THE GLANDS.
133
scirrhus, and then it is resolved with great difficulty.  Its
excretory duct may present a fistula, which may also have
its seat in the gland itself.  When an abscess has denuded
the interior of the parotid, the  saliva  which it contains
oozes out, arrests the cicatrization of the  abscess, forms cal-
losities, and induces  a fistula in the stenonian duct.  It is
perhaps the presence of a foreign  body,  a sore, &c, which
occasions the fistula.   These orifices discharge more or less
saliva; there are some which discharge it only after being
compressed.  There are several methods of curing them.
  The sublingual glands are also  the seat of symptomatic
and idiopathic affections, but of more rare occurrence than
those of the parotid.   We ought always to distinguish the
swelling of these glands from  those of the neighbouring
lymphatic  engorgements.  Their symptomatic inflamma-
tion seldom occurs. The duct of Wharton or the Rivinian
ducts present a  peculiar disease  called ranula;—it is a
collection of saliva produced by the stricture of this canal.
This obstruction is the same as that which induces the la-
crymal tumour: the cause may be a swelling at the orifice,
an aptha or a pustule of small-pox. To cure the disease, the
tumour is opened, and there issues from it a fluid of the con-
sistence of  the white of an egg, and fetid smell.  A fistula
is produced, whence the saliva is fteely discharged. Seldom
does the disease persist; it is common to have a relapse.


                   ARTICLE III.

                Diseases of the  Liver.

  No organ is more frequently affected than the  liveT:
sometimes  its diseases are in common  with others, and
sometimes  they are proper to itself. We shall first speak
of its idiopathic diseases, and then of  its symptomatic af-
fections.
  Inflammation is its most frequent affection, but mo9<j 
  134            DISEASES OF THE GLANDS.

  frequently it is not acute. The ancients divided it into ery-
  sipelatous and phlegmonous; but this difference  has  no
  foundation, since we understand by these two appellations
  the inflammation of the skin and that of the cellular tissue.
  Every opgan, as we have already observed, differs in its
  inflammation as it differs in its structure.
    To form a correct idea of hepatitis, we must bring to mind
  the situation of the liver.   We know that it is not covered
  by any membrane belonging to  it, but that it  is almost
  completely invested by the peritoneum, and that its poste-
  rior part  is  closely connected with  the diaphragm. We
  know that the peritoneum may be  affected all  over and
  about it, without the liver participating in its inflammation,
  as in peritonitis and puerperal fever.   Therefore we must
  only understand by hepatitis the  exclusive inflammation
  of the liver,  which may be, indeed, complicated with that
  of the peritoneum, as  peripneumonia is complicated with
  pleurisy.   The inflammation may  occur in different parts
  of the liver.  Whatever may be its seat, it has certain gen
  eral characters which  render it different from the  other
  phlegmons: at first there  is more or  less pain in the right
  hypochondrium, often also in the epigastric region, and
  sometimes in the left hypocondrium.  This pain has not,
  in general, the keenness of that of peripneumonia; the epi-
  gastrium  is more or less painful underpressure; the patient
  can lie down, only with  difficulty,  on the right side; di-
  gestion is sometimes disturbed according as the superior or
  inferior part is affected.—Jaundice can not be considered
  as a constant sign of hepatitis, since it may supervene in an
  infinity of other cases.  Such are the symptoms common
  to the whole organ. There are some others which  depend
  upon the particular part inflamed.  If it is on the convexity,
  there is hiccup,  corresponding inflammation  of the con-
  tiguous part of the diaphragm, and sometimes of the pleu-
i ra, so that an affection of the chest supervenes, and conse-
  quently it is difficult to distinguish the two diseases.  If the 
DISEASES OF THE GLANDS.
135
seat is in the concavity, then there are no pectoral symp-
toms, but more frequently vomiting, and a greater disten-
sion in the right hypocondriac region.
  The symptomatic phenomena are diarrhaea or constipa-
tion. The pulse is small, and frequent; the fever is subject
to an exacerbation, especially towards the  evening; the
condition of the secretions and exhalations varies.
  As  to the termination, it occurs on the  twelfth or  four-
teenth day; it may occur still later: we have no very pre-
cise observations on this subject.  Resolution is manifest
by the remission of the symptoms; there supervenes  often
a disturbance in the secretions, which indicates the crisis;
and which is especially apparent in the urine.
  Suppuration in the liver is not unfrequent; it occurs dif-
ferently, according to the seat of the inflammation. When
the abscess is in the concavity, some authors  have asserted
that the pus conveyed  in the biliary ducts might fall into
the duodenum; but this very favourable termination sel-
dom happens.  When  the abscess is in the convexity, ad-
hesion of the diaphragm supervenes, as well  as the pleura,
which is perforated, and the pus flows in the chest, whence
it is discharged by expectoration.   Authors have related
several instances of this result; but when the abscess  is in
the middle of the viscus, the pus does not  find  so favoura-
ble an issue, is discharged into the abdomen, and the patient
dies.  Nothing is more common than  these abscesses in
injuries  of the head.  The signs of this termination are lit-
tle known.  The abscesses which constitute these purulent
collections,  (foyers) are callous at  their, circumference;
they are crossed by vessels which form kinds of bands;
there are never an)' cysts as in hydatids.  Gangrene of
the liver, although of a more rare-occurrence than suppu-
ration, nevertheless happens sometimes.
  Chronic inflammation is  very difficult to distinguish.
Authors have mistaken  for it a great many  different dis- 
136
DISEASES OF THE GLANDS.
eases, that they have named under  the  vague appellation
of obstructions.
  The organic diseases of the liver are numerous.  In or-
der to simplify them, we shall classify them under differ-
ent heads: first, those which are attributed to the increase or
diminution of the liver, steatoma?, hydatids, granulations,
the fatty state, and lastly certain affections much more se-
rious.
  The extraordinary size  of the liver,  without any visi-
ble cause to produce it, varies; sometimes it is  thrice or
four times larger  than in its natural state.  This enlarge-
ment differs very much from that of the lungs in certain
cadavers, in which it is only enlarged because it is engorg-
ed with blood; but in the liver, it is by the addition of real
substance.  We do not know the concomitant affection of
this disposition, and we do not know to what we should
ascribe it.
  The diminution of volume is also observed in the liver
without any organic affection.   It sometimes accompanies
an ascetic dropsy, which compressing this viscus towards
the diaphragm, flattens it very considerably: a condition
which we also often observe in the  lungs in  cases of hy-
drothorax.  It has been supposed, but without foundation,
that there existed subjects  in whom the liver was almost
totally wanting.
  Steatomse are whitish tumours that  we meet with  in
many parts of the body, such as the cellular tissue, &c.
They assume in the liver a very peculiar aspect; they may
occur in  any part of the organ, except in the gall bladder
and its ducts, in which none are ever found.  Their num-
ber is variable.  Sometimes they take almost entire posses-
sion of the substance of the  liver; they are at first not very
voluminous, however, they soon augment  considerably.
The tissue of the liver is nowise altered,  and secretes, as in
its normal state, the bile, which does not experience any
alteration in its course.   We are ignorant of the nature of 
DISEASES OF THE GLANDS.
137
these alterations.  The steatoma? are  never surrounded
with  cysts.  The interior presents a lardy, striated and
hard  substance; but without any vascular  plexus.  Some-
times these tumours are formed in the adjacent parts of the
liver: this malady does not then exclusively belong to the
tissue of the lungs. Can we distinguish these tumours in the
patient whilst living?  This is difficult, for nothing is more
vague than the  signs given by authors on what  they have
included under the names of  Obstruction;  nevertheless,
there is more or less pain  in the region of the diseased or-
gan,  and  this  latter projects outwardly more or  less.
Sometimes this projection occurs rather in the epigastri-
um, but we can seldom employ this as a guide, for ordina-
rily there exists at the same time an ascites. We must cause
the patient to lie  on  the back or  on the left side; then to
take a deep inspiration so  that the liver may protrude; but
the strong  and  simultaneous contraction of the abdominal
muscles renders  this means less efficacious  than it would
appear at the first glance.            m
   Granulations of the liver are often found with  dropsi-
cal subjects, or those  extremely emaciated,  but in whom
there exists no  apparent disorganization.   When this vis-
cus is divided,  we find an  infinity of granulations near each
other, which  give to  it the appearance of granite.  This
state is never complicated  with the extraordinary volume
of the liver; on  the contrary, it diminishes and doubles its
density  as well  as its  tenacity; it loses then its elasticity,
and breaks rather than stretch.  What is the nature of these
granulations? We know not;  sometimes they are gray, at
others they are  reddish, and sometimes they seem colour-
ed by bile; we are equally ignorant in regard to the signs
which denote their existence in a patient.
   Fatty Liver  is  a condition  of the organ very common,
particularly with children: it is then remarkable for its yel-
lowish colour.  Sometimes the size never changes, and at
others it augments. The exterior is untouched and smooth;
            18 
13S
DISEASES OF THE GI.ANDs.
it has a peculiar  lubricity  to the touch; we very seldom
meet with any blood.   We can not doubt that it is adeps
which is infiltrated in the substance of the liver.  This af-
fection is easily proved.  Fat is not here as in the cellular
tissue, deposited in cells, but it seems as if it were effused.
Is this disease symptomatic or idiopathic?  we can not de-
cide; all we know about it is, that sometimes it coincides
with phthisis or  other  similar  organic affections.   Most
frequently it  is met with in young  subjects,  which, how-
ever, are in other respects perfectly healthy.   It has been
observed also, that it exists in  an inverse ratio to the quan-
tity of adeps on the exterior surface of the body, and that
subjects whose livers are very fat are commonly very thin.
  Hydatids are also another affection of the liver. We find
them, too, in  many other parts.   They arc small  bladders
full of water,  more or  less large, collected always  in a com-
mon cyst.  This cyst occupies almost always the concavity
of the organ; it has an irregular form; its  internal surface
is rough and  presents sometimes small  points of ossifica-
tion.  It has  no extensibility, it breaks  on the opening of
the subject.   It presents a very peculiar elasticity.  When
we open this bag, there issue from it a great  many little
balls insolated from  each other, and not  adhering to  the
common cyst: they escape  in greater or smaller quantity
at the instant of the opening.  There may be as many as
a hundred,  and then they are smaller.   These bladders
must be considered with  reference  to their  membranes
and to the liquids which they contain.  There exist  two
kinds of membranes:  the one thin and transparent, through
which we may see its contained liquid; the other opaque
and thicker.   Sometimes these two kinds of membranes
exist in the  same hydatid.  What is the nature of these
membranes?   Hitherto  they were supposed to be an ex-
pansion of lymphatic vessels, but it is asserted in our day
that they are real worms, whose structure, indeed, imper-
fect in man, is more obvious in certain animals, such as the 
      4


               DISEASES OF THE GLANDS.            139

 sheep and the ox.   This opinion seems the better founded,
 since these vesicular balls  are entirely free from the sur-
 rounding parts: their nature deserves further research.
 These bladders contain a fluid which is more or less copi-
 ous, sometimes clear and at others muddy; one thing wor-
 thy of notice is, that we find some extremely full and others
 empty.  The fluid they contain is not albumine.  We are
 ignorant of the cause which induces  hydatids.   We are
 also  ignorant of the signs of their formation; these signs
 must necessarily be common to many other diseases.  Be-
 sides, there is almost always leucophlegmasia.  This affec-
 tion is beyond the power of the healing art.


                   ARTICLE VI.

                Diseases of the Liver.

  The affections of the gall-bladder are of a different na-
 ture.  We shall treat  of them, beginning with retention
 of the bile.   Although this affection be more unfrequent
 than  the retention  of  urine, nevertheless we observe it
 pretty frequently.   It  may be ascribed to three kinds of
 causes:  to the swelling of the parts neighbouring to  the
ductus communis choledochus; to that of the internal mem-
brane of this duct; or, lastly, to concretions.
  The first cause is very common.  The pancreas is sub-
ject to become hard and scirrhus, which produces a com-
pression of the ductus  communis choledochus, that causes
the bile to flow back into the gall-bladder and liver.  This
same condition may be determined by the sub-hepatic
glands: this happens pretty often in cancer of the stomach.
We  must observe  that the phenomena are  different,  ac-
cording to the part which is compressed by the obstacle.
If it be the ductus communis, the bile flows back even into
the tissue of the liver and gall-bladder; if it be the cystic
duct,  the repulsion is  only in this latter.  The  greatest 
140
DISEASES OF THE GLANDS.
number of chronic cases of jaundice, which arc of five or
six months standing, are produced by the compression of
the ductus communis.
  As to the engorgement of the mucous membrane of these
ducts, it is not as yet sufficiently understood, and we shall
say nothing about it.
  Stones in  the gall bladder are very frequent, and  the
number there met with is very variable.  Their colour is
sometimes yellow, at others black; their shape is  mostly
conical or pyramidal.  These calculi have a peculiar com-
position, and differ  from  the urinary in their  chemical
analyses.  They may be found in two different conditions:
sometimes they are accompanied with more or less bile,
sometimes (and then they are very voluminous) they are
closely invested by the membrane of the bladder, and they
are  in a manner  impacted together.  Calculi sometimes
obstruct  the biliary duct,  if they are not  too large;  then
the phenomena that they produce are different according
to the part where they stop.  When  it is in the cystic
duct, they produce  the engorgement of the gall-bladder;
if it be in the ductus communis, they produce also the bilia-
ry infiltration  of  the  substance  of the  liver.  Sometimes
we meet with these stones in the substance of the latter,
but it is rather uncommon.
  It is very difficult  to detect the existence of these calculi
in the living subject, whatever authors  may say; we could
at the best but suppose them, from  certain general signs.
When jaundice supervenes without any  apparent cause,
and there is a  pain in  the region of the liver, then  we may
believe it to be caused by  a calculus.
  Jaundice is never an essential malady  of the liver, but
always the symptom of another affection;  it consists in the
effusion  of bile in different parts of the body,  and is not
confined to the skin,  as it was  supposed by the ancients.
Jaundice may be induced  by different causes, which  may
be included under  certain heads.  The first are the spas- 
DISEASES OF THE GLANDS.
141
 modic affections of the liver  in sad passions, such as anger
 and fright.  In a multitude of other affections of the mind,
 it is impossible  to determine how this happens; but the
 sudden sensation which is produced by the moral affection,
 in the region of the liver, does not permit us to doubt that
 jaundice  is induced by the  alteration  of this organ: this
 cause is the most frequent.   Emetics or violent purgatives
 may also produce it.  It supervenes also  pretty often  in
 nervous affections;  in this case the liver  seems not to be
 altered in its substance.
   Another series of causes of jaundice are the affections of
 the  liver, such as its inflammation; but it is not an invaria-
 ble  consequence.   There are others, which do not attack
 the  liver, acting only on the biliary ducts; such  are all
 those which may produce the retention of bile, for exam-
 ple, the  engorgement of the pancreas.  These causes dif-
 fer  from the  preceding one, inasmuch as,  in the first, the
 bile is pumped back again before entering the biliary ducts,
 whilst in this last case it is only so, after flowing back from
 these same canals.   The  sympathetic influence that other
 diseases have on the liver may determine jaundice, as is
 observed in certain bilious dispositions, in which the eyes
 are  yellow; in certain fevers, in which there is a general
 yellowish tinge; and in certain cases of poisoning, in which
 the result of the general disorder extends also to the 1-ver.
   Causes altogether different determine the icterus of in-
 fants, a very frequent affection.  Several modes of explain-
 ing it have been admitted: some have supposed it to arise
 from the presence of meconium in the larger intestines;
^others have ascribed it to drinks that  were given too early
 to children; but very often this icterus is not influenced by
 these causes; it is  rather to  be ascribed  to the general
 changes which then happen. Nevertheless, which ever may
 be the cause, this disease is always the same; it begins  by
 a retention of urine, which always  presents the same phe-
 nomena, whatever may be its origin. 
142
DISEASES OF THE I'. LANDS.
  These are the phenomena of jaundice.   It is incontesta-
ble that its proximate cause is the reabsorption of bile,
which is carried into the different organs, even when its
ducts are free; by this means, it does not fall into the duo-
denum; and  indeed  the faeces are pale, discoloured, some-
times whitish,  and very consistent.  None of  the  parts
coloured by the bile in jaundice are diseased.   There is
no tissue which is not touched by this yellowish  tinge; the
cellular tissue, the muscles, the nerves, the bones, even the
substance of the brain, the cartilages, tendons, and general-
ly all the white parts present a tinge more or less  charac-
terized, which is, without doubt, to be ascribed to the con-
trast of these two colours.  Liquids also are influenced by
the bile; the blood assumes  a greenish tinge; as  to the se-
creted fluids their colour varies.   Saliva does not change,
but the urine acquires a very deep yellow colour.
  Since the causes of jaundice are so different,  the treat-
ment must vary also,  because it is  subordinate to  these
causes.  This disease is either acute or chronic, as the af-
fection  on  which it depends  is  of the one or  the  other
character.
  The symptomatic affections of the liver are very  com-
mon and numerous.  Whatever may be the functions of
this organ in the economy, which without doubt are very
important, although we are ignorant of a great number of
them, it is united by sympathetic  relations with all the
other organs; the brain especially is never injured, without
this  organ experiencing a sympathetic reaction.  Every
kind  of hypothesis  has been exhausted to  explain this
sympathy but they are insufficient.   Most fevers induce a
gastric  affection in which the liver acts an essential  part;
for example, in vomiting of blackish substances, in which
we can not doubt that bile is more abundantly secreted. In
chronic affections, the same influence is remarked: the di-
verse colours of the bile indicate it sufficiently.  It is some-
times  black, at others yellow, white, thick, presenting 
DISEASES OF THE GLANDS.           143
solid concretions; and then viscous, ropy like the white of
an egg, and sometimes limpid as water.  These differences
help to explain the different colours of the faeces.
  At the instant of death, the liver experiences certain al-
terations necessary to be  known, on dissection: in as-
phyxia,  it may  be  considerably  engorged with  blood,
which happens also in all the other diseases, in which, as
in this latter, there is a great flux of blood to the right side
of the heart.   The liver is then not swollen as the lungs,
and  does not  acquire a greater volume; but when cut, it
discharges a great quantity of blood.


                   ARTICLE VII.

               Diseases of the Kidneys.

  The kidneys are double organs, situated on each side, in
the abdomen, on the lateral parts of the vertebral column.
They  are the organ which secretes urine.   On the upper
extremity of each kidney is situated  the capsula renalis,
a gland,  bigger in children  than in adults, and which for
this reason, is little exposed to the diverse affections that
we meet with in others,  by this  physiological  law, that
the parts most nourished and the functions of which are
the most important, are also most frequently and  most
seriously affected.
  As to the affections of the kidneys, they may  be either
idiopathic  or symptomatic.  One of  the former, is  their
inflammation, known under the  name of  nephritis.  It
may be  itself idiopathic or symptomatic, which is  often
very difficult to distinguish.  In all cases,  there is a  very
violent pain in the lumbar region.   This pain differs  from
lumbago  inasmuch as it is not increased  by the touch,
never changes its place, and is not superficial; besides, the
urine  is  more or less  troubled, a character which may be
of  some service to distinguish a  phlegmon seated in the 
1 14
DISEASES OF THE GLANDS.
cellular tissue of the renal regions. Often one kidney alone
being affected there results from it but very little incon-
venience.  If  suppression of urine supervenes, then wc
may be sure of the existence of nephritis.
  As to the general signs, they are often very much mul-
tiplied, but do  not aid the knowledge of the disease.  Thus
as to digestion: more or less thirst; often vomiting; at other
times diarrhaea; then again constipation; small and feeble
pulse, varying according to circumstances.
  Another nephritis, accompanied by more certain signs,
is that produced  by calculi.  Often these  foreign bodies
cause no  pain;  often also they cause  an extreme irritation,
a very violent  pain in the renal region, which does not in-
crease  under pressure; and there follows suppression  of
urine when the two kidneys are affected.  Often there oc-
curs retraction of the testicle  on the affected side.   The
pain changes  its place as the stone does;  often also the
urine is bloody.  The preceding phenomena may also lead
us to suppose  the disease, if the patient  has previously
passed gravel,  and if there exists an  hereditary predisposi-
tion in his family.   As to the general symptoms, they are
the same as in  the first kind of nephritis.
  These affections produced by calculi are not always posi-
tively inflammatory: sometimes they are colics of a longer
or shorter  duration,  which cease  and  then return.  This
shade of affection produced by calculi is the most frequent.
  The stones formed in the kidneys present an infinity of
forms, and are various in  number.   Sometimes they are
so numerous and so small  that they resemble sand; at
others there is one alone which is as big as a pigeon's egg
and fills the whole pelvis where it is developed.  Common-
ly unequal and rough, they are- sometimes polished and
smooth: their weight varies also; sometimes the surround-
ing parts preserve a smooth surface, at others there occur
fungi.
  Sometimes the calculi drop into the urethra, where they 
                 Disr.ASES OF TDK C LANDS.            1 15

  seldom occupy the middle  part; then the canal is dilated
  and accommodates itself to the volume of the calculus:
  none are more dilatable than it.
    Nephrites, idiopathic, and calculous, terminate in differ-
  ent ways.  Ordinarily the disease is suspected by a more
  abundant secretion of urine:  this seldom happens when
  calculi are present, they often determine, on the contrary',
  the suppuration of the kidneys, a condition which we must
  be aware to distinguish from that in which  mucosities are
  sometimes discharged  along with the urine.   Sometimes
  the pus is discharged through an abscess which is formed
  on the lateral parts.  At first there supervenes an adhesion
  by inflammation, then  the pus spreads, gathers in an  ab-
  scess under the skin, which ulcerates,  and permits, at last,
  the purulent matter to escape.   Sometimes calculi are dis-
  charged in this manner; their extraction induces sometimes
  the entire cure of "the disease when they are the cause of
  it: often there remains  a  fistulous opening.   Gangrene of
  the kidneys is of very rare occurrence; Chopart alone has
 spoken of it: its chronic inflammation is very common.
   Hydatids are a pretty frequent disease of the kidneys;
 they are of two kinds which we must distinguish; the one,
 called serous cysts, and which happen on the surface; they
 are more or less large, differing in their number, and com-
 posed  of a  membrane full of yellowish serosities, which
 sinks a little into the  surface of the kidneys.  The other
 kind is a true  hydatid, which is to be found every  where,
 as well as in the kidneys;  and is observed in their inte-
 rior.  We  have no means by which we may distinguish it,
 except when some are passed in the urine.
  As to the other affections of the kidneys, such as worms,
 &c, the  ancient authors alone have spoken of them; au-
 topsic examination has never verified them to the moderns.
  The kidneys maybe also in a very peculiar state of flac-
cidity; they are at the same time increased in volume: the
arteries are contracted as in dropsy.
            19 
146            DISEASES OF THE GLANDS.

  There exist also some other alteratioos of the kidneys.
Thus, Morgagni speaks of  a kidney, the surface of which
was cartilaginous; Lieutaudhas seen three kidneys petrifi-
ed; but these phenomena are not regarded as diseases.
  The symptomatic diseases of the kidneys are very nu-
merous; indeed, few organs are more  influenced, in their
substance  or in the fluid they secrete.
  We can not deny that the diverse conditions of the kid-
neys in the subject, are caused by the influence of dis-
eases on this organ, since in a healthy stale the same or-
gans are always of a uniform appearance.
  The alteration  of the urine  is indubitable in almost all
these affections.  We may  classify the causes of this phe-
nomenon under different heads.
  The first comprehends those affections which act on the
urinary  organs, and they are not at all symptomatic.
  The second includes those which are induced by the state
of the other secretions; for  example, the urine diminishes
commonly in  proportion to the augmented secretion, or
more considerable exhalation of any other fluid.
  The third embraces those which are simply sympathetic;
for example, on the attack of putrid fevers, in the accession
of intermittent fevers,  the  urine is loaded with lateritous
sediment.   The attack of all the phlegmasia? present in
general the same phenomenon; in a word,all diseases cause
the urine to vary, in its quantity as well as in its nature.
  The urine  is often an  excretion that nature selects to
bring about the crisis of the disease, according to the sys-
tems of ancient physicians, who invented this doctrine of
crisis.   We shall not examine here  if it  be  correct, we
shall say only, that there are many diseases which termi-
nate without it.  However, in the conclusion of diseases,
the urine acts always the most important part. 
DISEASES OF THE GLANDS.
147
                  ARTICLE VIII.

           Diseases of the Prostate Gland.

  The prostate is, as we know, situated at the neck of the
bladder; it pours into  the  urethra  a  liquid, of the use of
which we are as yet ignorant.  The affections of this gland
seldom supervene before  the age  of puberty, but at this
time they are very frequent.  These  affections of the pros-
tate were never well known till now.  The ancients sup-
posed the  seat of gonorrhaea to be in this  gland, because
they  had  neglected  post-mortem examinations, which
would have set them right.  It may be the seat of inflam-
mation, suppuration, of scirrhus, engorgement, varices, or
calculi.
  Inflammation supervenes after a contusion, a fall on the
perineum,  or any other  cause; it  is manifested  by heat,
weight in the perineum, a deep and dull pain  on  the ante-
rior part of the rectum, difficulty of passing urine, tenes-
mus,  a sensation of obstruction on  the anterior part of the
rectum: on the introduction of the  finger into  this latter, a
tumour is felt,  painful to  the touch.   Petit believed that
the faeces were moulded on the anterior part,  to its form.
This  inflammation advances always very slowly; the one
which disappears soonest is that which supervenes after
the operation of lithotomy.  When the resolution is going
on, the symptoms diminish, the urine flows with  more
freedom, tenesmus is not so frequent, and the  pain attend-
ing on alvine evacuations is not so great.
  Often the prostate suppurates; then the symptoms  yield
but in part; there is always a difficulty in urinating and in
passing faeces.   Pus does  not destroy the substance of  the
gland, but is infiltrated as in parotitis; sometimes it  accu-
mulates and forms an abscess, which, projecting above  the
level of the skin of the perineum, erodes it, and discharges
exteriorly; sometimes  it opens in  the urethra.  Desault 
h a
Ills i: ASKS OF III I. <> I. A NDS.
has seen a similar ease which supervened when he was at-
tempting to sound the patient.  Gangrene is of very rare
occurrence in the prostate: Chopart quotes an example of it.
  Induration, on the contrary, is  very common  to this
gland after venereal diseases: this induration is with gnat
difficulty remarked  on the  exterior; it is not  felt on the
perineum;  it  is necessary to introduce the finger into the
rectum.  When the engorgement is considerable, it is easy
to discriminate; but when it is small, often we do not sus-
pect it.   This engorgement presents itself under two dif-
ferent conditions; sometimes it is  enlarged without disor-
ganization, at others it is a true scirrhosity: however, we
seldom see cancer supervene in it.  We also observe cer-
tain fistula?, often caused  by lithotomy.
  Varices are a very rare disease of the prostate; the oc-
currence of them has been very much exaggerated; indeed, •
there are some induced in the neighbourhood of this gland;
but this  accident is common  to  the  whole pelvis.  We
never observe any in its  tissue.


                    ARTICLE IX.

               Diseases of the Testicle.

  The testicle, like the prostate, is exempt from  maladies
before the  age of puberty.   At this time it acquires a de-
gree of life more considerable; it becomes at the same time
much more exposed to affections.  Its  position  is not al-
ways the same; when the subject  is very young, it is yet
at the ring; by degrees it descends into the lower part of the
scrotum.  Sometimes it remains  in the  middle, which is
not very uncommon.  The testicle is subject to several
diseases.                       «
  The disease to which it is most exposed, is inflamma-
tion.  It may result from  many  causes, pressure, irrita-
tion,  and venereal causes.  These are its phenomena:  :\\ 
DISEASES OF THE GLANDS.
149
first there is an augmentation of volume, an essential differ-
ence from the inflammation of the liver, renes, &c.  This
phenomenon is not produced by the surrounding cellular
tissue, but by the tissue  of the  organ itself.  There is,
however, some flaccidity,  a very acute pain, and on pres-
sure, it is extremely painful.   This pain extends even to
the loins, which gives to it a great resemblance to  the
pains experienced  in the  affections of the matrix.   The
surrounding organs, all more or less experience a degree
of inflammation; not only the tunica vaginalis is interested,
but also the skin of the scrotum  is evolved and swollen.
When the  disease is light, the fever is not very intense;
but if it increases, so does the fever in the same proportion.
It is seldom complicated with  other  affections, such as
gastric disturbance.  This inflammation sometimes is so
very slight that it hardly deserves this  appellation, as that
which supervenes after the operation  for  hydrocele.  A
slight contusion may produce the swelling  of the testicle,
which remains painful for seven or eight days, and  then
resumes its natural state.   However, this inflammation or-
dinarily comes to  a crisis very slowly, and not till  the
twelfth or eighteenth day.  Resolution is often obtained,
especially when the  inflammation is produced by a repel-
led gonorrhaea.  Sometimes there occurs an  abscess, which
we must take  care to distinguish from hydrocele of the
tunica vaginalis.  Gangrene seldom  occurs; induration is
the most common termination, the testicle remains always
swollen.  We can  not then say that it is a chronic inflam-
mation, since it remains in this condition during the whole
life without any inconvenience; but when, after inflamma-
tion, it is hard and scirrhus, a sarcocele may supervene.
   Sarcoce.le is not always produced by inflammation; most
frequently it has a  different cause, such  as a  blow, a bruise^
&c.  At first the swelling is not painful, it soon becomes
more sensitive, and at last the disease is characterized. Or-
dinarily many varicose veins are observed.   The organiza- 
150           DISEASES OF THE GLANDS.

tion is already changed, all the small ducts have contract-
ed adhesions between themselves.  The patient still ne-
glects to wear a suspensory bag.
  In the second stage, the volume and the hardness consi-
derably increase.   It is this peculiar hardness which gives
to it weight and causes us to distinguish it from hydrocele.
The pain, which becomes lancinating, sometimes is propa-
gated even to  the loins and superior part of the  thigh.
Often the spermatic cord, at this  time,  already shares in
this affection.  The lymphatic glands  participate also in
the engorgement.  Even the mesenteric glands may be in-
terested.  Then the substance of the  testicle is entirely
changed.   It is a fatty,  shapeless, dense,  and  consistent
mass; the vessels  are very  much  enlarged.  The  tunica
vaginalis is sometimes found adhering, sometimes infil-
trated, or in its natural condition.
  Finally in the last stage, we have an  abscess full of pus,
which is always accompanied  by very  violent pains; it
opens on the external surface, and there results from it an
ulcer, which presents all the phenomena of cancer;  exces-
sive pain of the  abdomen, marasmus, slow  fever, pain,
and brittleness  of the bones, &c.
  As to the other affections of the testicle, they are very
rare.  The Spermatocele is nothing else than the too great
accumulation of semen in the seminiferous ducts of this
organ, and is almost never observed.
  Varicocele is not, properly speaking,  a  disease of  the
testicle.  It is remarked  most frequently along the sper-
matic cord.
  There are also certain affections of so  little consequence,
that we can not describe them in particular, such  as the
ossification, which we meet with in sarcoceles.
  As to the symptomatic phenomena, they are of very
rare occurrence. 
DISEASES OF THE GLANDS.
151
                    ARTICLE X.

               Diseases of the Mammae.

   The mamma? in their diseases follow the same order as
 the genital organs; they are very little subject to any dis-
 ease before the age of puberty, and almost never experi-
 ence any sympathetic affection.
   Inflammation of the mammae is generally of very rare
 occurrence, except at the  time of lactation, but at that
 period they are very susceptible of it.   It follows the same
 stages as in simple phlegmon; the least cold, the slightest
 contusion produces it; the milk becomes serous, its secre-
 tion ceases, and the bosom swells.  Often the disease is
 confined to the twelve  or fifteen days immediately after
 delivery.  The mamma? often become very hard, which is
 produced by the stagnation of the milk in its ducts. When
this engorgement  does resolve itself, pain follows, and
 sometimes inflammation: there is no redness,  because the
 affection is deep seated, but there is a pungent heat, and a
 sensation of throbbing.  As to general  symptoms, there is
 always concomitant fever.  Sometimes there is gastric dis-
turbance, which is especially observed in hospitals.  Often-
times resolution terminates the disease, but often also sup-
puration supervenes.  This  collection (depot)  is then im-
properly called lacteous (laiteux).  When it is superficial,
 it  turns into  an abscess as  in phlegmon, but when it is
 deep seated, fluctuation is not felt till late, the pus is dif-
fused and is discharged by seven or eight orifices.   When
 we open these collections we see that the cellular tissue is
alone  the  seat of them.  The gland is not affected, it is
 only a little red.  This state of suppuration is purely analo-
 gous to that of the parotids.   Gangrene is very rare.   In-
duration supervenes oftener, and this exposes the patient
to  cancer. 
15-J
DISEASES OF THE GLANDS.
   Cancer of the mammae may be induced by many other
 causes besides the  induration produced by their inflamma-
 tion.  The suppression of the menses, a blow, &c, may be
 the cause of the development of a little gland, at first move-
 able under the finger, afterwards enlarging and constituting
 the rudiment of cancer.   Whatever may be its cause, the
 following are its progressive stages.
   In the first  stage the patient neglects  a small tumour,
 which,  at first  indolent,  becomes by degrees painful.
 Shooting pains are felt from time to time, the general way
 in which cancers begin.
   The suppression of the menses, or the repetition  of a
 blow, often determines the second stage.  The gland en-
 larges, the breast is generally affected, having a knotty
 unequal  surface, sensible to the eye and touch.   This en-
 gorgement,  although  moveable,  is very  hard, the whole
 substance of the breast is tumefied, and varices supervene.
 The pains increase and become  less  intermittent.   The
 neighbouring organs begin to participate in the disease.
 The cellular tissue becomes engorged, forms adhesions,
 and  causes the inequalities to disappear; the neighbouring
 glands,particularly the axillary, become swollen. Is this en-
 largement a presage of cancer, or is it only a mere symptom
of cancer already existing?  It seems that most frequently
this phenomenon is only symptomatic  in these glands.
  In the third stage of cancer, there supervenes an inflam-
mation which produces an  abscess, the  edges of which are
inverted.  There occur fungous growths; from which there
is discharged a fetid and corrosive ichor.  All the parts are
disorganized; reabsorption  takes place, slow fever super-
venes, the patient is emaciated: at this  time, the operation
would be useless, 
DISEASES OF THE GLANDS.
153
                    ARTICLE XI.

                Diseases  of the Spleen.

  The thyroid gland and spleen arc as little known under
their physiological  relation, as under that of pathological
anatomy.  The ancients have associated the diseases of the
spleen with those of the liver; but we have not a sufficient
number of observations on its affections to affirm or con-
trovert this opinion.
  Inflammation of the spleen is of rare occurrence. Sau-
vages and other nosologists, who have never made an au-
topsic  examination, have  given many signs by which to
detect  it, but nothing is more uncertain.  The lively pain
felt in  the left hypochondrium, may often have its seat in
many other places besides the spleen.   The positive signs
which  we fix upon  in organic diseases, almost all relate to
the lesion  of  the functions of the affected  organs: then,
since we are ignorant of the use of the spleen, we can not
recognise any signs which positively indicate its affection.
Autopsic examination does not enable us to discover any
trace of the acute diseases of this organ.  Suppuration sel-
dom occurs here.   The portion of the peritoneum which
covers  the spleen, is,  on the  contrary, very subject to in-
flammation. We judge of it, by the  frequency of adhe-
sions met with in these parts.
  An  affection of the spleen, pretty  well known, is  the
tumefaction which may succeed  to  certain intermittent
fevers, especially those which have a  quartan type.  We
can not ascribe this accident to the abuse of cinchona, for
it has been observed to supervene  in  cases in which this
remedy had not been exhibited.  We are seldom able to
discriminate the swelling of the spleen, at its beginning.
Its size is not appreciable,  the weight in the part is almost
insensible; but after  a certain time these signs become more
            20 
151
DlsKAsKS OF THE (il.ANDV
observable.  The tumour is very visible, and mam Test to
the touch.  The pain is more intense.  In order to ascer-
tain these symptoms, we  must cause the patient to assume
a suitable attitude.   In  time, there supervene divers other
symptoms, such as anorexia, marasmus,  slow fever, and
commonly dropsy.   Nevertheless, some have been  ob-
served to persist without  this fatal termination.
  Autopsic examination  presents the spleen moro or less
voluminous; some have been observed as large as the liver.
It preserves nearly its primitive shape.  The tissue is a
little more dense and hepatized, the blood vessels are con-
siderably enlarged; they remain dilated when they arc cut
transversely.
  As to the affections of the spleen, with regard to vomit-
ing blood, and melancholy, they are mere visionary things.
  The spleen has sometimes been found cartilaginous and
osseous.  Haller relates some cases.
  We can not doubt that  many diseases have an influence
on the spleen; to convince ourselves, it is only necessary to
compare the spleens found in healthy animals, with those
that we daily meet with  in cadavers: it will be seen that
in the latter, most frequently, the spleen presents material
differences.  Sometimes  it is shrunk; at others it is infil-
trated with an ichor, similar to the sediment of wine.  In
most  epidemic diseases,  we frequently find  the  spleen
tumefied, brown, blackish, and flaccid.


                   ARTICLE  XII.

           Diseases of  the Thyroid Gland.

   The thyroid gland, the use of which is not known,  dif-
fers from other glands in its  diseases.  It is seldom  the
seat of inflammation.   It is most frequently the seat of en-
gorgements; sometimes  the patient experiences  so very
violent pains, that an operation is indispensable. 
         DISEASES OF THE CUTANEOUS SYSTEM.       155

  Its most common disease is goitre or bronchocele; some-
times it is hereditary, and at others endemic; lastly, some-
times it occurs spontaneously.   Women and young per-
sons are more subject to it than adults and old men.  Its
size is variable; some have been  observed to descend as
low down even as  the breast.  The surrounding organs
are seldom affected.  The cellular tissue nowhere adheres
to it. No disturbance occurs in the economy.  Its texture
sometimes presents calcareous granulations in the interior
of the engorgement.  Sometimes there is an infiltration of
a yellowish fluid.   We are ignorant of the cause of the re-
lation which  exists between the swelling of the thyroid,
and the state of the intellectual faculties  in Cretins.
                  CHAPTER  X.

          Diseases of the Cutaneous  System.
   The diseases of this system are very  frequent, which is
to be attributed, without doubt, to its being more exposed
to the action of exterior bodies.  We  shall divide them
into two classes, the idiopathic and symptomatic.  There
are some diseases which seem to hold a middle course be-
tween these, as the pustules of miliary fevers.

                    ARTICLE I.

                   Of Erysipelas.          *

  The inflammation of the skin  known under the  name of
erysipelas may occur every where,  but particularly on the
face and arms.   Sometimes it is produced by external, and
at others by internal causes.  Any active  application, any 
156      DISEASES OF THE CUTANKOUs sYSTKM.

.considerable heat, the action of rubefacients, exposure to
the violent rays of the sun. &.c, may be the external causes.
The internal ones are  also very numerous;  for example,
after certain diseases, and at the crises of some others; as,
in adynamic or ataxic fever, erysipelas is only symptomatic.
It may, nevertheless, be idiopathic, produced by an inter-.
nal cause.  However,  it presents very great varieties in
its intensity.   There is an infinity of degrees between sim-
ple redness, produced by being too  near the  fire, and the
most intense erysipelas.   The skin, of all the systems, is
the most susceptible of being suffused, because of the multi-
tude of small blood vessels which every where penetrate
it.  The muscular and cellular systems redden more slowly.
  Almost always, essential  erysipelas  a little intense, is
preceded and accompanied by a febrile disturbance. These
are the symptoms: redness more or less lively and  more
or less extended; sometimes there is mingled with it a pe-
culiar  yellowish tint.   This colour is confined to the sur-
face of the skin; the chorion is commonly healthy and un-
touched. The redness disappears under the finger. There
is a moderate  tension, but superficial.  When erysipelas
is complicated with phlegrnon, the tension is more or less
considerable.  The  pain  has a peculiar  character, it is a
sensation of an acute burning, depending upon a peculiar
mode of sensibility in the skin.  This itching pain has been
supposed by the ancients to be produced by bile.   The
skin is commonly dry; sometimes it is covered with phlyc-
taenae, which contain a serosity more  or less acrid;  they
open  and desquamation  supervenes.   The organs  adja-
cent to the skin may be  affected, the cellular tissue  also
becomes affected, and then there occurs a phlegmonous
erysipelas:  sometimes, instead of becoming inflamed, this
tissue  becomes o?dematous.  The former injurious practice
of puncturing  the feet in  very much advanced leucophleg-
masiae, often caused erysipelas to terminate in gangrene.
   General symptoms are pretty numerous: when the dis- 
         DISEASES OF THE CUTANEOUS SYSTEM.      157

ease is slight, they are very little appreciable; but if it be
intense, then there are  gastric symptoms which proceed
sometimes  from  the  liver, at others from  the  stomach,
such as diarrhaea and vomiting; there exists  also  a con-
comitant fever, as in  a multitude of phlegmasiae.  Some-
times they assume a troublesome character, such as adyna-
mia or ataxia.  As to the secretions and exhalations,  they
vary singularly; the vital forces are more or less altered.
  The termination may be brought about in several differ-
ent manners; the mildest, is that which consists in a gradual
disappearance  of the  symptoms; then there  is desquama-
tion.   Phlyctaena? often supervene, as we have ahjeady ob-
served; but they do  not resolve the disease, which runs
through all its stages.  At other times the termination is
in oedema.
  Another kind of termination is the translation from one
place to another, as in rheumatism.  This species is called
moveable (ambulante); sometimes it is translated to the
interior,  especially if discutients  have been used; and in
this  case,  diseases more serious  than the  erysipelas it-
self  may supervene.  Most frequently suppuration is  in-
duced;  then erysipelas  is complicated  with phlegmon.
Lastly, sometimes  gangrene is  remarked by the lividity
of the skin, the diminution  of  heat and finally the gan-
grenous eschar.
  Erysipelas differs  according  to the different parts in
which it is manifested.   On the head it is often owing to
an exposure to a hot sun, and  is the more dangerous in
proportion  as cerebral  symptoms are  manifested.  The
face is the part where erysipelas  is most frequently pre-
sent, which, without doubt, is to be attributed  to the pecu-
liar organization of the skin of this region, and to the great
liability, that, the small vessels have to admit blood,  as we
observe in  various emotions of  the mind.   On the trunk,
erysipelas  assumes a peculiar condition;  it is then  known 
 1 5S      D1SI' \si:s OF THE <U 1AM HUS SYSTEM.

 under the  name of znna-  or  herpes:  it successhcly goes
 round the body, so that it  only heals in one place t<» break
 out in another.


                    ARTICLE II.

                        Burns.

  Burns of the skin arc  affections produced only by an
 external cause; they seldom  extend beyond this system.
 Burns vary according to the intensity  of  the heat.  A
 moderate degree will  augment  perspiration  and produce
 favourable effects; but a higher degree of caloric affects the
 vital forces of the part, and  even goes so far as to disor-
 ganize it.  If placed too near the fire, there  supervenes a
 redness very analogous to that  of erysipelas, which lasts
 more or less time.   Heat, under this  relation, at a certain
 degree may be considered as  a rubefacient; when it is of a
 higher degree, we have, besides redness, phlyctaenae.  At
 this  time there is not as  yet any disorganization of the
 part; it is a simple excitation  of the vital forces: burns pro-
 duced by liquids have ordinarily this effect.
  The accident which, in its intensity,comes next to phlyc-
taenae,  is the horny-hardening of a part (racornissernenl).
This phenomenon is independent of every vital property,
since the same thing happens  after death; in this case there
 is only a more intimate connection of the parts, but not yet
any disorganization. Finally, when the  action of caloric
has been still more intense, the skin assumes a blackish as-
pect and becomes a  true slough.  There succeeds to these
effects of caloric phenomena which, in the first stages of the
burn, resemble very much the  progress of an erysipelas, and
which depend upon the  peculiar mode of sensibility in
the skin, as we have already said  in  the article on this
malady.  When disorganization is total, inflammation su- 
         DISEASES OF THE CUTANEOUS SYSTEM.       159

pcrvcnes in the surrounding parts, there occurs phlegmon,
the eschar is circumscribed and falls off.
  Several general symptoms are manifest during the burn.
There is often gastric disturbance, a burning thirst, a more
or less violent concomitant fever, which is always in pro-
portion to the intensity of the disease: we seldom remark
symptoms of ataxia.
  The action of cold on the body is nearly the same as that
of caloric, when it is carried to a certain degree.  Its first
action is to stimulate, as does  caloric in its first mode of
action; with this  difference, that in this case there never
happen any phlyctaenae on the red parts.  When cold is
very  intense, there is numbness; it becomes  debilitating,
the complexion of the skin is blueish, livid, and at last
mortifies throughout.  It is not uncommon to see, in north-
ern regions, the extremities become mortified by excess
of cold, especially in old people; in this case, not only the
skin dies; but even all the subjacent parts:  therefore,  heat
and cold act on the skin nearly alike.


                    ARTICLE III.

                    Of the Measles.

   The measles consist in a greater or less  number of red
points or spots, which occur on the skin, commonly in
children. Sometimes this disease is epidemic.  They have
several stages: the attack, the eruption, its maturity and
decline.  They are  always ushered in by a few days of
fever, and this is called the attack.  It has this diflerence
with  catarrh, that the concomitant fever never precedes the
latter.  This condition in measles, warns the physician as
to  the  disease which may be  expected to succeed.  Then
also there often appear gastric symptoms, such as vomiting,
diarrhaea, sometimes, though rarely, nervous affections: the
febrile symptoms last more or less time.  At last the erup- 
 160      DISEASES OF THE CUTANEOUS SYSTEM.
 tion appears; it is almost always preceded by the fever we
 have just spoken of.  Generally they begin on the face:
 sometimes there are spots of a greater or less extent, which
 covers the whole surface of the body: there arc  often pete-
 chia?.  The skin is seldom swollen; the redness progres-
 sively increases during three or four days; pressure causes
 it to disappear.   It terminates in a disquamation, which
 happens  not till three or  four days  after the redness has
 disappeared.
  When the disease is badly treated, it may terminate in
 a repercussion, being translated to the interior, and to more
 vital parts, producing  dangerous results: the intensity of
 the disease is always in proportion to that of the eruption.
 Often  the mucous  membranes are also  affected at their
 origins, as we observe it in the pituitary membrane, mouth,
 urethra, and anus.
  Autopsic  examination shows us, in this  disease, an ex-
 travasation of blood in the most superficial parts of the skin.


                    ARTICLE IV.

                     Small-Pox.

  Small-pox is a  contagious disease, and is often  epidemic.
 Generally all persons are attacked with it; and most of them
 are exempt from it for the remaining part of their lives.
  Small-pox is divided into two classes,  namely: the be-
 nign or distinct, and the confluent.   They are both  of the
 same nature, and vary only in their degree of  intensity,
 and  infllhe different complications of which  the  confluent
 is susceptible, and from which the other is exempt.
  The attack of small-pox manifests itself in two or three
 days; it is then followed by the eruption; afterwards des-
 quamation, and finally convalescence.  At the time of the
 attack, there is a fever which presents nothing of the cha-
racter of an intermittent; sometimes there is exacerbation 
          DISEASES OF THE CUTANEOUS SYSTEM.       161

 in the evening, and  at others there is  none;  a burning
 thirst, gastric symptoms, and ordinarily a general disturb-
 ance  in  the  secretions.  In certain  cases there are cere-
 bral symptoms, coma or delirium, epilepsy, general de-
 bility and anxiety.  It is  only after  the  eruption has oc-
 curred that we may properly and with certainty determine
 the prognosis of the disease.   The pustules appear on the
 third or fourth day;  they commonly begin at first on the
 face; and this eruption diminishes the general disturbance.
 The pustules are  at  first reddish, pointed, separated by
 wide intervals, which redden  by degrees, a characteristic
 difference from measles, which redden suddenly over the
 whole surface at once. The pustules increase during three
 or four days; then, they are more or less large and round-
 ed; there occurs a swelling more or less considerable in the
 cellular tissue, and especially on the face.  By this means
 the eyelids are shut; febrile disturbance, which at first had
 yielded, then returns; pustules are observed in the mouth
 and nose, but no further inward.   Authors have supposed,
 but very erroneously, that pustules were also developed
 in the intestines.  Autopsic  examination has never con-
 firmed us in this opinion, which is derived, without doubt,
from analogy.
  In distinct small-pox the pustules are round  and full;
 it is a bad omen when they are flat and flabby.   The most
healthy contain a whitish fluid,  sometimes transparent;
 they are unhealthy when they have a blackish  or bloody
 aspect: the pustules dry up  in the order of their erup-
 tion, the symptoms progressively diminishing, the scabs
 fall, and convalescence begins.  There remain for a long
time some red spots, the cicatrices are more or less deep ac-
 cording to the size of the pustules; sometimes there occur
 fissures, which causing the pus to communicate from one
pustule to another, form  what are called coutures.  The
chorion in small-pox remains  always unaffected.
  A fatal termination of small-pox is the repercussion to
            21 
 10*       DI*E\sks ov •1'Mi: cI'TANKOUs M'sTF.M.

 the  interior,  producing different  diseases according  to
 the organ to which it is translated.   Sometimes it is com-
plicated with ataxia or adynamia. It is not uncommon for
phthisis to result from the repercussion of small-pox.


                     ARTICLE V.

                    Of Scarlatina.

  Scarlatina has  been  differently considered by different
 authors.  Some have regarded it as an essential fever, others
as symptomatic of angina.  It is difficult to reconcile these
diverse opinions.  It  is  true that the eruption of scarlatina
 is only secondary, and may sometimes be complicated with
fevers of a particular character.  There are  some  other
cases when it is evidently a simple cutaneous affection, ac-
companied with symptomatic fever; scarlatina must then
be classed with the eruptions of the skin.   Commonly, a
sore throat more or less intense, is added to the eruption.
The relation which exists  between  angina and all  erup-
tions, of measles as well as scarlatina, is very remarkable.
  Further, if scarlatina  is complicated with  fever or angi-
na, it is always accompanied by certain phenomena: ordi-
narily there are gastric symptoms, vomiting; the condition
of the secretions is variable; we seldom meet with cerebral
symptoms.  The disease is ushered in by petechia? similar
to those of measles.   In scarlatina, the spots are red, flat.
and  large; they give  almost to  the whole skin a purple
tint; in measles, we observe between the  spots angular in-
 tervals, and a colour  resembling claret, which is not ob-
 served in  scarlatina.  These  spots disappear  under the
 pressure of the finger,  as in erysipelas;  but in  scarlatina
 there is no tension, and the redness is not so perceptible.
 There is no prickling heat; in  the termination  there never
 supervene any phlyctaenae.  Hence it is difficult to deter-
 mine to what cause we must refer scarlatina, and to decide 
          DISEASES OF THE CUTANEOUS SYSTEM.       163

 if it be an essential or if it be only a symptomatic disease.
 Dissection points out no difference between it and measles,
 and we only distinguish it from this malady  by its con-
 comitant phenomena.


                    ARTICLE VI.

                Of Tetter:—or Herpes.

   Tetter is a disease proper to the  skin.  It is ordinarily
 confined to this system, if we except the corroding Herpes,
 which sometimes interests the subjacent parts.  Four spe-
 cies of tetter have been distinguished: the herpes farinosus,
pustulosus, miliaris, and exedens.   These four species do
 not differ in their nature. The individuals most subject to
 ring-worms are those who  are said to have an acrimony
 in the blood.  They have often pimples on the*face; with
 these persons the functions  are always more  or less dis-
 turbed.
   Farinaceous herpes occurs equally' on every part of the
 body; but it is especially on the face, and more particularly
 near the roots of the hairs. When we observe them, some-
 times  we see the  part  at first red, at  others  it is not
 so; soon after small and burning pimples present them-
 selves,  smaller than those of itch.   The fluid  which they
contain soon dries  up;  the subjacent epidermis exfoliates
 and forms what we know under the name of farinaceous
 tetter.  Respecting the  other inflammations,  tetter  is al-
ways chronic.  Often in this species there is no concomi-
tant redness.  The seat of  it is immediately under the
epidermis. The least application of fatty substances causes
it to disappear.
  As to the herpes pustulosus,  it is not so well  known.
Several authors have referred it to the herpes, of which we
have spoken in  the  article on erysipelas.  There super-
vene, at first, isolated pustules; but which  soon unite and 
164
DISEASES OF THE CUTANEOUS
SYSTEM.
form  large sores,  which dry up and fall off by desqua-
mation.
  The miliary tetter has much analogy with this species.
They are often remarked on the posterior part of the neck.
  The last kind of tetter, and  which differs essentially
from the others, is the herpes exedens.   It may have its
seat in the whole tissue of the skin;  it begins at first by
small isolated ulcers which unite, and become by degrees
exasperated.  It discharges a sanious fluid.  After corrod-
ing the whole skin, it spreads over the surrounding parts;
the subjacent organs are in some degree  withered.   The
whole economy feels this  disorganization.  There  super-
vene general symptoms. In the other tetter, they are only
manifest when there is repercussion.


          .         ARTICLE  VII.

                    Tinea Capitis.

  Scald-head, although a  disease of the skin, exclusively
belongs to the scalp.   Many maladies have been included
in this class which have not the least resemblance  to it.
Thus the milky  scabs, which have been confounded with
it, are entirely foreign to it; they disappear sooner.   The
scabs which it forms are less dry. Such are also the ulcers
produced by vermin. They present the same phenomenon
as the milky scabs; there comes out from them  a pus which
soon dries up on exposure to the air.  These slight dis-
eases produced by lice, deserve at times some attention.  It
has been  observed that when these insects are destroyed
too suddenly,  the  patient is exposed to dangerous conse-
quences, such as violent head-aches.  Finally, farinaceous
herpes may also manifest  itself on the scalp:  we have al-
ready spoken of it.
  Tinea capitis, properly so called, has been divided into
;wo classes: the one which is ulcerated and the other which 
         DISEASES OF THE CUTANEOUS SYSTEM.      165

is not so.   This is its progress.  It is observed always to
appear on the scalp,  at the roots of the hairs.   Sometimes
it is ushered in by small pimples similar to those of tetter;
at others it terminates  in  small ulcers, from which is dis-
charged a copious liquid. Soon after a crust more or less dry
is formed over them which has the appearance of a general
scab: at other times,  isolated scabs are formed, they readi-
ly fall  off,  but are renewed with  the same facility.  The
ulcers produced by scald-head  have  been  imperfectly un-
derstood.  Some have placed their seat in the bulbs of the
hairs; but erroneously so. Autopsic examination shows
us that they are situated on the surface of the chorion, and
that they seldom extend  any further. Sometimes scald-
head ceases all at once, at others  it is indefinitely prolonged,
until an efficacious means is used to remove it.  Often there
exists a general diatheses of this affection; if it is repercus-
sed, it may produce fatal results in the interior;


                  ARTICLE VIII.

                      Of the Itch.
  The  itch is an affection of the whole integuments, never-
theless, it is  seldom seen  on  the face.  It occurs  particu-
larly on the trunk and on the extremities.   It may happen
by infection or spontaneously.  Whatever may be its cause,
it is always manifested by small  pustules, especially be-
tween the fingers, and generally on all the joints.  These
small pustules contain a whitish  ichor; they are pointed and
very easily distinguished  from  the other cutaneous erup-
tions.  The affection is entirely confined to the skin.  Cer-
tain modern authors  have asserted that these  pustules de-
pend upon the development of  animalculi; but it does not
appear that their production is always owing to this cause.
Indeed, we see them appear and disappear with the great-
est  facility.   Whenever the patient  gets warm, they are 
 166       DISEASES OK THE CUTANEOUS SYSTKM.

 very numerous, and but few  when the weather  is cold.
 The repercussion of itch may also produce fatal effects in tin-
 interior.   These small pimples produce a peculiar itching
 different  from that of others; sometimes they become ex-
 coriated.   There supervenes a scab, which falls off by des-
 quamation.
   Leprosy was a very common disease with the ancients.
 It now occurs so seldom that we  can not describe it.


                    ARTICLE  IX.

          Symptomatic Affections of the Skin.

   These affections are very frequent in  most diseases, whe-
 ther acute or chronic.  They may be divided into  three
 classes.  The first are those which consist in spots more or
 less considerable, as observed in  miliary fever, scarlatina,
 &c; finally, the last consists in the different alterations of
 the functions  of the skin.
   Eruptions in the different fevers do not possess the cha
 racter of erysipelas.  There is no tension, nor  lively  pain;
 there is never a termination by suppuration, often there is
 no desquamation, because  there  is  no swelling.  These
 eruptions appear differently: sometimes they are epidemic;
 they  sometimes happen  spontaneously 111 gastric and  in-
 flammatory fevers.  Divers authors have  believed  these
 eruptions to be characteristic of the disease; but they  do
 not induce any modification of  the fever, and  we can not
 consider them as dangerous.  They have evidently  their
 seat in the cellular tissue, subjacent to the epidermis.  Most
 of these eruptions coincide  indifferently with  fatal or be-
 nign diseases.   There is a peculiar one, called by authors
febris rubra  or scarlatina, which must always be con-
 sidered  a fatal symptom,  because it is complicated  with
 adynamic or ataxic fever.  There happen sometimes analo- 
         DISEASES OF THE CUTANEOUS SYSTEM.      167

gous eruptions, after the patient has eaten certain kinds of
fish; such as lobsters, limpets, &c.
  The other class of eruptions  include petechiae.   They
are of several  species; the most common are those which
accompany adynamic fevers.  They must not be consider-
ed  as a symptom of this disease, and they should not in-
duce the physician to make  any change in the treatment.
Autopsic examination proves that their seat is in the cuta-
neous capillary tissue.
  Besides the adynamic petechia?, there occur  also some
which authors had  employed in order to characterize the
fevers with which they are  complicated, and which they
termed scarlatina urticata (ortiies.)  But it  is certain that
these petechiae  may supervene in fevers of different, na-
tures.  Miliary pustules are similarly circumstanced.
  We distinguish two  kinds of miliary eruption, the red
and the white.  The eruption commonly appears on the
fourth or fifth day; it is often  complicated with an adynamic
fever.  It ordinarily ends in desquamation.  The red spe-
cies is of rare occurrence.  The white is the most frequent.
We often see it to  coincide with an inflammatory  fever;
on the redness  which at first occurs, rise small scattered
pustules:  these  small  pimples  fall off by desquamation.
Their seat is also in  the capillary system.
   There also may occur on the skin, small vesicles, which
are always a bad omen, inasmuch as they characterize and
complicate themselves with  a fever of a grave type.
   The sympathetic alteration of the exhalation of the skin,
takes place in almost all diseases.   It then varies very sin-
gularly,  in quantity as well as in its nature. Sometimes
these disturbances of exhalation are merely symptomatic,
at others they are critical.
   The sensations of chills and heat are phenomena which
are especially referrible to the skin, and not to internal or-
gans. It is necessary to distinguish sympathy of heat from
sympathetic heat.   In fevers in which the patient believes 
 16S      DISEAsKS OF THE CUTANEOUS SYSTV.M.

 himself to he burning with heat, and nevertheless preserves
 his natural  temperature, there is  a sympathy of  heat.
 Sympathetic heat, on  the contrary, is  when  an  organ is
 heated in consequence of an affection located in another
 part, or of a passion of the mind.
  Among the chronic  diseases  of the skin, wc first name
 venereal affections.   They denote that the disease is then
 general.  Sometimes it makes its appearance in local red
 spots; they have different degrees of hardness, especially
 on the edges.  We know that the venereal virus most fre-
 quently affects the lymphatic glands, or the mucous mem-
 branes.   Sometimes  there occur also condyloma*, which
always  denote a local  disease,  whilst the  spots announce
a general affection.  These affections are always chronic:
we must take care to distinguish them  from those erup-
tions which sometimes are observed on the face, and often
depend upon an herpetic  taint.  Scurvy may also produce
phenomena  nearly similar, and exhibits what are called
scorbutic spots.  In this case, the tissue of the  skin is un-
touched and only presents extravasated blood.
  In most chronic diseases, the  secretions  and  exhalations
of the skin are deranged.   Thus in exterior suppurations,
the skin is dry, there is a slight chill at night, pulse small
and tense, and there is  perspiration at night.
  As to the condition of the skin after death, it varies sin-
gularly: in certain fits  of apoplexy in which  the  face is
purple, this colour disappears very slowly for want of to-
 nicity of the  small vessels.   It  is the same thing with all
the other acute inflammations. As to the chronio one, they
 scarcely disappear; the blood is then almost combined with
the parts. 
DISEASES OF THE MUSCLES OF ORGANIC LIFE.   169
                 CHAPTER XI.

      Diseases of the Muscles  of Organic Life.

  The muscular system is naturally divided into two prin-
cipal parts: the one comprehends the organic muscles, the
other the muscles of locomotion.  These two classes, so
distinct in physiology, in the relation of their vital proper-
ties, are also distinct in  pathology, in regard to their af-
fections.
  The organic muscular system,  is capable of being affect-
ed with a great many diseases from the varieties of its
structure.   The uniformity of the other, on the contrary,
renders all diseases common, and susceptible of suddenly
passing from one  part to another, as rheumatism; every
fibrous part of the viscera being isolated, has its peculiar
disease.  Thus the inflammation of the intestines is not the
same as that of the heart or matrix.   We shall treat first
of the diseases of the heart.

                    ARTICLE I.

                Diseases oj  the Heart.

  The heart is composed of three parts: of its external
membrane, which belongs to the pericardium; its muscu-
lar tissue; and finally its  internal membrane, which  is de-
rived from  the vessels.  We must only treat here of the
fleshy substance of the heart.  Its diseases have been dis-
tinguished into acute  and chronic.  The ancient physicians
understood them but imperfectly.  Corvisart has recently
explained them much more completely.  The heart  is
            22 
 170   DT"<K \M» OF THE Ml'SCLKS OF ORC \NIC  LIFE.
 without doubt susceptible of acute inflammation as are the
 other muscles; but we must submit this disease to further
 observation, since the signs already given are very con-
 fused; that which  proves that it is  of rare occurrence, is,
 that few traces are met with in autopsic examinations. The
 same  is the case with the suppuration of the heart.  With
 respect to the alterations of the fibrous parts of this viscus,
 in their vital properties, its contractibility, sometimes ex-
 periences  interruptions, and  this is what constitutes syn-
 cope.   This case is of more rare occurrence  than that in
 which these same vital properties  are exalted.  We can
 not doubt that in most  fevers the heart is affected in its
 vital  forces, which  are  increased in  energy.   We  must
 take care  to distinguish the pulse in the organic affections
 of the heart, from the one produced by fever in certain
 cases, for  we should be  often liable to pronounce an un-
 favourable prognosis.  In fevers, when the  pulse is inter-
 mittent, it is a bad presage, whilst when there is an affec-
 tion of the heart, this  intermittent pulse  is kept  up for a
 long time without any bad consequence.  In  intermittent
fevers, a full pulse is a sign of plethora.  On the contrary,
in certain aneurisms of  the heart, the pulse presents the
same  fulness.   When  dropsy supervenes on a, disease of
 the heart,  the pulse often has very great force.   It is there-
 fore the alteration of the heart that essentially  produces
 fever,  which afterwards becomes  complicated,  and thus
 assumes different characters.
  Palpitation is another acute affection of the heart, which
 consists in throbbing, more  or less distinct, and more or
 less persistent.  These palpitations may sometimes be  as-
 cribed to  a redundancy of  blood in the organ, as occurs in
 running; at others to an  excitation of the vital forces, as in
 emotions  of the  mind.  In  most affections in which the
 luno-s become obstructed, the blood not being able  to cir-
 culate, there results more or less violent  palpitation on
 the rio-ht  side.  There is another cause of  palpitation till 
DISEASES OF THE MUSCLES OF ORGANIC LIFE.
now unknown, it is asthma, which although its seat is in
the lungs, is, nevertheless, seldom remarked without pal-
pitation.  This throbbing is accompanied with difficulty
of breathing, oppression, &c.  This condition often erro-
neously leads the physician into the belief that it is a dis-
ease of the heart.                    •
  Palpitations commonly are ascribed to the organic con-
dition of the parietes of this viscus, which may ossify or
become more dilated, constituting two  classes of diseases.
We shall first speak of the latter.
  The size of the heart in the subject may vary according
to the  kind of death.  There  are cases in which the right
side is very much contracted, as in death from hemorrhage.
In persons decapitated, we find the heart extremely small;
and the same thing is observed in syncope.   In phthisis,
it also  diminishes, because  there is less  blood than com-
monly.
  In persons, on the contrary, dead from  asphyxia, the
size of the heart augments singularly; the same is the case
in apoplexy: in these cases we find that the heart is twice
as large as in cases of hemorrhage.  These  kinds of acci-
dental dilatations especially occur in the right side; the
attenuation of the parietes which then occurs, diminishes
also the thickness of the fleshy columns. In aneurism, on
the contrary, the columns assume a greater volume...
  Aneurism of the heart may be formed in  the right side,
which contains black blood, or in the left side which con-
tains red blood: the latter side is the one mostly affected;
it especially occurs in adults, and ordinarily its cause is
mental excitement.  There may also exist other causes;
one which  is somewhat probable, is the ossification of the
arteries surrounding the heart, which in this manner ob-
struct the circulation of the blood.  Pathological anatomy-
furnishes us with many examples; thus the  ossification of
the arch of the aorta often induces aneurismal dilatation of
the left side of the heart.  Whatever may be, however, the 
 172   DISEASES OF THE MUSCLES OF ORGANIC LIFE.

 causes of aneurism, the following are its phenomena: they
 are either essential or symptomatic.
  Throbbings in the region of the heart are not always a
 certain sign of aneurism; they are sometimes produced by
the accumulation of fluids or by other causes.  Generally,
 in aneurism, a thaobbing more or less strong is felt in the
regions of the chest, and so much the  more lively as the
patient is the more emaciated.  Sometimes it extends even
to the ensiform cartilage.   Certain authors, in this  case,
have imagined that the dilatation was seated in the trunk*
of the coeliac artery; but it is too deeply situated; then, on
the contrary, we may be certain that there exists an aneu-
rism of the heart.   In very lean persons, sometimes we
feel the pulsation more or less distinct on the right  side.
Sometimes the throbbings are continued; at others there are
paroxysms, and they occur commonly in the evening; then
the symptoms increase, and the patient is on the point of
being suffocated. This condition is superadded to a peculiar
disposition of the pulse, which varies singularly.   Some-
times it is very full and strong; the throbbings are tumul-
tuous; at others it is very small,  feeble  and concentrated.
These varieties may be observed in the course  of the  same
disease.   Ordinarily in simple aneurisms, the pulse is not
intermittent,  it becomes so after  the  ossification of the
valves.  A pain is manifested in the diseases of the heart,
 as in all organic affections; this sensation of very great lo-
cal pain is referred by the patient to the ensiform cartilage.
 Sometimes there is obstruction in the whole chest; on per-
 cussion the right side is duller than the other.   This sign
 is less sure in  these affections  than  in effusions.  As to
 abdominal pressure it  may sometimes  be employed  with
 advantage,  and at others with no good  result.  When the
 heart is voluminous, then it is painful,  and  there is a sen-
 sation of faintness.   The same thing happens when there
 is an effusion in the peritoneum; but when there is only an
 ossification it does not  avail.  The sensation of suffocation 
      DISEASES OF THE MUSCLES OF ORGANIC LIFE.   173

is a symptom common to the disease of the heart and lungs,
provided they be somewhat of a grave nature: we can not
doubt, that when the volume of the organ of circulation is
uncommonly large, that it causes suffocation by compress-
ing the lungs.  We remark that the patient is better dur-
ing the day time, and that the symptoms increase in the
evening.   It is very essential to discriminate between the
suffocation caused  by the heart and that produced by the
lungs.  The  position of the patient, with an affection  of
the heart, is a characteristic sign; he can not lie down hori-
zontally, and in order to breathe with ease, he is obliged
to sit  up.  In this situation, the heart does not press  so
much on the lungs.  There is more or less violent cough,
sometimes dry, at others accompanied with more or less
abundant sputa.  All these signs collectively give a correct
understanding of the disease.   Sometimes they persist, at
others there is a paroxysm, especially in the evening, some-
times they appear but once in twp or three  days.
  As to the symptoms of the surrounding organs, the peri-
cardium  is sometimes full  of liquid; but not so often,  in
proportion, as the peritoneum is, in the diseases of the ab-
domen.   The appetite is irregular; the face is swollen and
becomes pale; the state of the secretions is variable. Some-
times there is leucophlegmasia, as happens in many organic
affections.  The duration of this aneurism is  sometimes
for three or four months; it  may  last from three to four
years.  This disease is evidently chronic:  it is  the only
one of its kind which does  not induce a disorganization  in
the parietes of the organ.   Five or six days before death,
there is a general  alteration in the expression of the coun-
tenance, the patient expectorates pure blood or blood mix-
ed with mucus.  Autopsic examination shows the lungs to
be sound, or only adherent, the size of the heart is more
or  less large; it is generally the left side which is diseased.
There is often an affection of the aorta; the parietes com-
monly increase in thickness; the fleshy columns are very 
 171   DISEASES OF THE MUSCLES OF ORGANIC LIFE.

 large; sometimes  the auricle is a little dilated;  the  lung*
 are more or less engorged; the gastric organs are in their
 natural state.   The right side is sometimes also the seat
 of  aneurisms; but, then,  its parietes seldom  increase  in
 thickness.
  We have spoken of the  sympathetic affections of the
 heart in the article on fever.


                    ARTICLE II.

       Diseases of the Digestive Muscular Tissue.

  After the fleshy tissue of the heart, come next in order
 the muscular tissues of the oesophagus, stomach, intestines,
 bladder, and matrix.  Generally they are very little expos-
 ed to organic affections.  Dilatation never occurs in them.
 Cancers and different engorgements may affect them, but
 it is only by contiguity* This is not the case with acute
 affections: often vomiting of the stomach is determined by
 the spasmodic  action of the muscular fibres.  The same
 thing takes place  in the iliac passion.  The  affection  is
 then foreign to the organization  and resides only in the
 symptomatic or essential lesion of the vital forces in these
 tissues.  Vomiting may depend on the affection of the
 mucous membrane; often  the organ which induces it, is
 very distant. Symptomatic diarrhoea is very common.  The
 same is the case with respect to the bladder.
  The muscular tissues of organic life  have  nothing in
 common with the muscles of animal life; they are not sub-
ject to convulsions.  Nevertheless, there is a kind of cholic
 in which the muscular tissue of the intestines seems para-
 lysed;  it  is  the painters' cholic, in which there is  such
 obstinate constipation.   In certain hemiplegia?, in which
 the intestines of the affected  side participate in the para-
 lysis, the bladder is subject to some spasmodic affections. 
      DISEASES OF THE MUSCLES OF ORGANIC LIFE.   175


                   ARTICLE III.

            Diseases of the Uterine  Tissue.

  The tissue of the matrix is the seat of numerous lesions;
although much has been written concerning them, still they
are very little known.  The detection of its inflammation,
as that of  the heart, is attended  with great difficulty; al-
though we can not doubt its existence, we want, never-
theless, signs to recognise it. In post-mortem examination
we find only feeble traces of redness.  Although authors
have spoken of suppuration in the tissue of the matrix, ne-
vertheless, we seldom observe any remains of it.  In puer-
peral fever,  we always find this tissue healthy.   As to the
induration of the matrix it is somewhat rare and does not al-
ways induce a diseased state: It is found in this state in very
healthy subjects.  The cause of sterility was but incorrect-
ly ascribed to this condition.   In cancer this induration is
only  by contiguity.
   The polypi of the matrix are of two  species: some are
produced in the mucous membrane, and may be consider-
ed as fungi, which may fall off in parts, others  have  their
seat in the tissue itself. They are like  sarcomatous tumours;
they seldom appear before the age of puberty; they are
more  or  less hard and numerous, formed in  concentric
layers, and sometimes presenting in the interior a cellular
structure.  Their size varies and depends on their number.
Sometimes  they are developed on the side of the cavity of
the matrix, at others on its exterior.  In the first case the
mucous membrane covers them without being affected; at
other times the polypus occupies simply the thickness of the
parietes of the  matrix where it is formed.   From this dis-
position we see how often the ligature must be an ineffec-
 tual remedy.  The signs of polypi of the matrix are either
 general or  particular;—at  first there is a dull pain in the 
 176   DISEASES OF TI1K Ml'M'I.KS OF OIK; \MC LIFE.

region of the matrix, which extends to the lumbar regions;
sometimes there occurs a disturbance of the menses, and
fluor albus supervenes.  This affection of the mucous mem-
brane, with regard to polypi of the matrix, is produced by
the same law by which the spitting of blood is caused in
the affections of the lungs.  From  time to time there is
sympathetic vomiting; the pulse  is in  its  ordinary state;
there is  seldom any  febrile  disturbance;  no sweats nor
faintings, and generally there is no symptom of any other
organic affection.
  As to the  particular signs, when* the polypus  is situated
within the uterus, then it either remains in the  matrix,
or it enters the vagina, or finally protrudes from it.
  In the first case it is difficult to recognise  it.  When it
is in the vagina, we may ascertain it by means of the touch.
There sometimes happen  hemorrhages.  The tumour is
rounded or unequal in its different parts. It might be con-
founded with prolapsus uteri, or with the inversion of this
organ.  In the former case the difference is sensible to
the touch: the os tinea? keeps always its ordinary situation.
The inversion happens only  at the time of child-birth;
moreover, it is often  of itself, a  consequence of  the de-
velopment of polypi.  Sometimes these  polypi  fall off
spontaneously, being cut away by the os  tincae, or by a
ligature  being thrown  around them.  Wrhen they project
out, the mucous membrane which covers them assumes an
aspect similar to the skin.  When the tumour  grows  to-
wards and within the cavity of the abdomen, then it is dif-
ficult to recognise its existence: it is almost impossible to
determine if it be a dropsy of the  ovary, or a collection of
hydatids.  As to  the signs drawn from the lesions of the
functions, nothing positive can be determined from them.
Ordinarily there  occurs towards the end a general leuco-
phlegmasia.
  The"elongation of the neck of  the matrix, is also a dis-
ease of its fleshy texture, it may be  spontaneous, and may 
       DISEASES OF THE MUSCLES OF ANIMAL LIFE.   1 77

be sometimes produced by the displacement of this viscus.
The matrix may also experience a retroversion, an acci-
denrwhich  occurs in the first months of pregnancy, and
from which  result retention of urine and constipation.
  The inversion of the matrix happens only during par-
turition; often for want of skill in the midwife who is too
hasty in detaching the placenta.   The symptomatic affec-
tions of the fleshy tissue of the matrix are very rare, when
not pregnant.  This viscus has almost no relation at all with
the other organs.  Often at the time of gestation, unknown
and purely sympathetic causes may produce abortion.
                 CHAPTER XII.

       Diseases of the Muscles of Animal Life.
   The system of the muscles of animal life is oftener de-
 ranged in its ultimate structure than that of organic  life.
 First, there are many patients in whom it is merely  pas-
 sive:  such are convulsions and paralyses, the cause of which
 is in  the nerves.   We shall treat here only of the affec-
 tions  proper to the muscular system.
   Rheumatism is as yet almost entirely unknown with
 respect to its nature and the  changes which occur in the
 muscles affected by it.  This inflammation is very different
 from  that of the cellular tissue and skin, in which we may
 observe what kinds of phenomena occur in them.   We
 know not which is the special seat of it; we can hardly be-
lieve  that the muscles and tendons, considering their differ-
ent structure, should both  be the seat of rheumatism.  It
seems to shift alternately from the one to the other: the dif-
ficulty lies in knowing if the disease be truly in the muscu-
            23 
ITS   DISEASES OE THE MUSCLES OF ANIMAL LIFE.
lar or tendinous  fibre:  it is an object of research of great
importance.   Rheumatism is evidently observed in the
parts in which there are many fleshy fibres, as in the pec-
toralis  major, lumbar regions, &c.   In these divers  parts
there exist some tendinous fibres.  Post-mortem examina-
tion teaches  us nothing on this subject: Indeed we  must
suspend as yet our judgment.
  There is no doubt  but rheumatism is sometimes seated
in the fibrous tissue,  as  when for example, it fixes itself on
the articulations, in which certainly there are no muscles,
as in the wrist, foot,  &c.  Then post-mortem examination
shows  no lesion in the fibrous parts; we find commonly
the capsules and synovial membranes infiltrated  with, and
containing  mofe synovial fluid than common.   It seems
that this more abundant exhalation of the synovial mem-
branes is purely sympathetic, and the principal affection is
in the tendons.  It is therefore certain that, in several  cases
the seat of rheumatism  is exclusively in the fibrous sys-
tem; perhaps it has its  seat in both  systems at  the  same
time, as we remark a venereal taint affecting simultaneously
the bones and the mucous membranes.  Whatever may be
the seat of rheumatism, these are its phenomena.  Gene-
rally it  is produced by the transition from a warm to a cold
and  humid  temperature.  The suppression of different
evacuations  may also produce it.   We only  consider here
acute rheumatism.   It has its seat more particularly in the
muscles of the lumbar region, and it is there termed  lum-
bago;  in the superior parts of the back, sometimes at the
root of the  neck,  at others  in the  chest.   We must not
confound, like Stoll, the pain of pleurisy with that of rheu-
matism; it is always fixed in the former, but in the latter
it shifts with the greatest facility.   If a blister removes it,
then we may conclude  that the irritation is  seated in the
muscles.
  The abdominal muscles are seldom affected with  rheu-
matism.  The parts most exposed  are the  articulations, 
       DISEASES OF THE MUSCLES OF ANIMAL LIFE.   179

 and especially the  more  important  ones.   The  pain  is
 very moveable, and particularly at night, when it shifts  in
 an instant from  one part to another.   Sometimes two  or
 three parts are affected at the same instant.  The diaphragm
 is seldom attacked by it; when that happens hiccup super-
 venes.
   The disease is ushered in by spontaneous lassitude, dull
 pains, dejection, chills, general uneasiness; soon after the
 pain becomes stronger and more determined; a sensation
 of tearing is experienced in the affected articulations, the
 part is very sensitive to the touch, and sometimes the very
 weight of the cover is intolerable; muscular contraction  is
 very difficult; hence, almost complete  aphonia, when, the
 disease  is in the larynx; the  adjacent parts are  more or
 less distended, the redness is  more or less lively.  These
 pains are often fixed, when they occupy the muscles.
   The general symptoms are often those of gastric disturb-
 ance.  There is always a concomitant fever with exacerba-
 tion in the evening.   Perspiration deserves particular at-
 tention; commonly it appears in this disease, but it is not
 symptomatic.  There is  rarely  any complication  with
 adynamia or ataxia.
   The termination gf rheumatism, as  to  its duration,  is
 very variable; it is, mostly, according to its intensity. Often
 this acute affection lasts during twenty or  thirty days;
 whatever may be its duration, it may terminate by resolu-
 tion.  The part then presents a remission of all  the symp-
 toms, without being reproduced elsewhere, although the
 resolution be complete.
  Nevertheless, the disease may again return in one or two
 years under a chronic or acute form, suppuration may also
 supervene; but the observations which have been made at-
 testing it are so imperfect, that we are as yet ignorant how
 it  is produced.  The degree of its  intensity is rarely so
high as to terminate by death; and when it occurs, it is 
 ISO   DISEASES OF THE Mfsi'LKS OF ANIMAL LIFE.

 owing, mostly, to an affection with which rheumatism is
 complicated; such as adynamia or ataxia.
  A much more common termination is its passage  to the
 chronic type, as we  observe  in all the other  phlegmasia-.
 Chronic rheumatism occurs- pretty often without any pre-
 vious acute affection; it is known  under the  vulgar name
 of fraicheurs.  It materially differs  from the acute, first
 as to its seat.  The acute attacks particularly the articula-
 tions; the chronic is  especially seated  in the muscles; pain
 is very little felt on pressure; in  the  other case the  sensi-
 bility is extreme.  There is no tension in the chronic, in
 the acute  it is considerable.  In  the former, there is no
 concomitant fever; in the latter there  is always some. Gas-
 tric disturbance, sweats, frequently accompany the  acute,
 which are seldom met with in the chronic.  The acute fol-
 lows the continued, the chronic the intermittent type; the
 latter disappears  and  returns with  the changes of the
 weather: we must be able, from this, to distinguish  easily
 these two species.
  Sometimes the pain is fixed  by election in a  part, at
 others it is moveable; in both cases post-mortem examina-
tion teaches us nothing respecting the organic lesion.   The
intervals of the attacks are of longeron* shorter duration,
sometimes they last a month, at others only fifteen  days.
If this affection lasts  several years, it is to be  feared that
the patient will have it for the remainder of his life. Either
when the periods become nearer each other, or happen at
greater  intervals, we may succeed in removing the  local
pain by blisters or by some rubefacient.   When the pain
 has lasted  for a long time in a part, it induces a sensible
 degree of feebleness.
  Rheumatism may be complicated with  some other affec-
tion, and amongst others gout, with which  it has  great
affinity;  nevertheless,  there  are remarkable differences
 which distinguish them.  As to the causes, gout is the re-
sult of good  living, whilst  rheumatism is induced  by the 
      DISEASES OF THE MUSCLES OF ANIMAL LIFE.    181

vicissitudes of the  atmosphere.  The first is hereditary,
but the second is not; the former affects especially the small
articulations, the latter is seated in  the fibrous tissue or in
the muscles.   When it is a rheumatism of long standing,
it lasts  during life.  Gout experiences long remissions;
when the attack is dissipated, the urine deposites concre-
tions.
  Rheumatism may also coincide with scurvy or syphilis;
but this complication is easy to be recognised.
  A dangerous change, which occurs in rheumatism, is its
translation to parts that  are  not commonly subject  to  it.
Metastases, although more rare than in gout, are neverthe-
less observed; the pain in the articulation  ceases,  and the
lesion of the  organ  to  which  the metastasis has taken
place, manifests itself.   In this case the action of a  rube-
facient is very efficacious, because it induces the translation
of the irritation to the surface.
  The muscles of animal life present also certain pheno-
mena; such as the partial  increase of certain parts in irre-
gular nutrition, and caused by the greater exercise of these
parts.  Sometimes  there  is atrophy, produced  cither by
the ligature of an artery, or the cutting of a -nerve, or by
a paralysis; then  it is only appreciable after three or four
years. Finally, at other times, it occurs after chronic rheu-
matic affections; the member is sometimes of a remarkable
paleness, at others yellow. The blood-vessels are evident-
ly contracted, and this relation of  the vessels to the state
of the part is constant as to its increase or diminution: the
same thing is not the case with the  nerves.
  Lassitude is a pain produced  by too long continued con-
traction  of the muscles.   It is sometimes symptomatic.
Symptomatic affections of muscles are still less understood
than the essential: it seldom happens that an acute malady
is not complicated  with them.   These affections are con-
fined to preliminary lassitude: they are never observed in
the conclusion of diseases.  These pulling pains (tiraille- 
 182       DISEASES OF THE ARTEKI.1L SYSTEM.

 ments) are also observed in the mucous, inflammatory, and
 hectic fevers: no notice must be taken of these phenomena
 with respect to the treatment.  The greatest degree of las-
situde of the muscles is in adynamic fever, in which they
 are affected with  such a debility that they can  not any
 longer support the body; hence, faintness, the  supine po-
sition. &c.
                CHAPTER XIII.


          Diseases of the Arterial System.

  The diseases of this  system are very  different  from
those of the veinous, owing to the difference of their struc-
ture.   Indeed nothing  is more different  than aneurism
and varix.
  The diseases of arteries are much less understood than
we should  at first suppose from reading certain authors.
Their inflammation, which ought to be present in all essen-
tial fevers, leaves not the least trace of its existence in the
subject, either within or without the arteries.  Sometimes,
indeed, we find on the internal surface a greater degree of
redness, but this depends on a portion of blood remaining
combined with oxygen.   We have then no data on the in-
flammation of this system.  The same is the case with re-
spect to its suppuration and gangrene; it seems less predis-
posed than the other parts, since, often, this system remains
organized in the middle of a putrefied limb.   We know
nothing about its chronic inflammation, nor on its indura-
tion.   In pathological anatomy we are better informed
with regard to the  diseases of the membranes which line
the arteries; the internal membrane is the essential seat of 
          DISEASES OF THE ARTERIAL SYSTEM.       183

ossification, and this membrane presents this affection in
the heart and arteries.  This  does not take  place in the
veins.   This condition is so common towards the close of
life, that it seems rather a natural phenomenon than a dis-
ease.  And indeed nothing is more common with old peo-
ple than an irregular pulse; with adults, whose circulation
is more prompt, this state of things  can not exist without
great inconvenience.
  The system containing red blood begins at the pulmo-
nary veins.   We have no observations attesting the ossifi-
cation  of these canals.  The heart at its left auricle and
ventricle may present ossifications in the valves. We often
observe ossifications in the mitral valve; it then experi-
ences a real contraction.  Sometimes this ossification be-
gins on the free margin, at others it begins at their inser-
tion:  in this  latter  case the contraction is  not so great.
Sometimes, without being ossified, this valve hardens (ra-
cornit) in such a manner as to permit but little blood to
pass; necessarily  there results from it an irregularity  in
the pulse.   The aortic valves are still oftener ossified; all
three of them are frequently so, either at their base  or
summit.  These ossifications are announced by symptoms
of  aneurism,  which, indeed, sometimes complicates this
affection; there is cough, difficulty of breathing, especially
in the evening, a great irregularity  in the pulse, &c; ne-
vertheless, this inequality is not inherent in  this disposi-
tion.   The internal  membrane of the arteries ossifies very
frequently; indeed this ossification has two degrees: in the
first we feel inequalities and roughness; soon after several
points of ossification are developed in the parts; they spread
by degrees, forming patches, and being united to each other
 by means of a membrane which covers them.  These patch-
es, although very large, are very thin, and permit the ar-
 tery to move yet with facility; sometimes they extend as
 far as the bifurcation of the iliac.  The ossification of the
arteries seldom happens in adults; it is particularly in eld 
 181       DISEASES OF THE ARTERIAL SYSTEM.

 men, in whom every part has a tendency to become harden-
 ed: however, this disposition does not induce any incon-
 venience in them.
  Sometimes the mitral valves become  the  seat of small
 tumours similar to cauliflowers; a case of this kind has been
 related in the Journal dc Medccine.
  We  shall  only speak  here of spontaneous aneurism,
 known under the vulgar name of true aneurism.  In tbis
 disease, there is sometimes a dilatation of  all the artirial
 tunics, at others the two internal are lacerated and the ex-
 ternal alone is dilated.
  When  we examine an aneurism on its first appearance,
 the artery is seen dilated in all its  membranes, although
 some authors have asserted that this order of things could
 not exist  It is true that this entire dilatation can not go
 beyond a certain point, the largest aneurisms, which are
 observed with this condition of the coats, arc those of the
aorta.  Desault has seen at the H&tel-Dicu a man that had
five or six aneurisms in which every membrane was dilat-
ed; in  this case they become necessarily thinner.  As to
the blood which the tumour contains, it is commonly li-
quid, since it disappears by the least pressure; nevertheless,
we can not speak positively concerning it, because we sel-
dom  have an opportunity of seeing similar cases.
  Most commonly, when the tumour has arrived to that size
which no longer permits any dilatation of the two internal
tunics,then they lacerate, and theexternal tissue alone forms'
at this time the tumour.   Without this last coat the blood
would  be  extravasated  in the  interior, and  would cause
death.  On examining such tumours  we find the two inter-
 nal membranes ruptured.  The internal surface of the ex-
 ternal  coat is rough, the adjacent parts  are  more or less
 influenced, the muscles are distended and become flattened:
 the same occurs with the nerves.  The cellular tissue adds
 new layers to the cyst which  it covers, so that this cyst
 becomes thicker as it gets older.  There occurs sometimes 
DISEASES OF THE ARTERIAL SYSTEM.       185
 an oedema of the part; it may become a general  one, as in
 all organic diseases.   As to the contained blood, it always
 presents clots more or less large and hard, according as they
 have been of a longer standing, or are more superficial.—As
 to the aneurisms supposed to be formed by the internal
 membrane through the two other coats, they do not exist.
   The general phenomena vary singularly, according to the
 seat of the disease.  There is always a tumour and more or
 less distinct pulsation. The tumour either enlarges or dis-
 appears, according as it is pressed upon from above or be-
 low.  Sometimes the pain is keen and at others it is not
 felt;  it may experience  intermissions.   The state of the
 pulse is somewhat influenced by it.
   The termination of aneurism commonly brings on death,
 as is the case with all organic diseases, when the situation
 does not permit an  operation.  At the curvature of the
 aorta, this malady is met with very frequently in old people
 who had not given the least suspicion of it during life: we
 observe it also in some adults.   It is impossible  to detect
 the beginning of the  disease; ordinarily  it is on the side of
 the sternum that the  aneurism is manifested. It corrodes
 the sternum, and by degrees appears on the exterior; at
 this time it is impossible to be mistaken, and the tumour
 becomes enormous.   Its termination happens as in every
 other part.  We seldom observe aneurisms in any other
 part of the thoracic  aorta: they are more frequent in  its
 abdominal part.   Some authors have supposed that aneu-
 rism could exist in the coeliac trunk; but it seems rather
 that the disease has its seat in the corresponding part of the
 abdominal aorta.  The symptoms are generally pretty ob-
 scure; we can  only decide from the pulsation and from the
 other general signs; otherwise the termination is the same
as everywhere else.  Aneurism seldom happens in the iliac
and hypogastric arteries: however, it would be impossible
to  determine its existence in these vessels.
  As  to  the aneurisms in the extremities, they present
            24 
ISO        DISEASES OF THE VENOUs SVslEM.

precisely the same condition.   They are somewhat rare in
the superior extremities, if we except  the radial in which
they are sometimes  observed.   In the inferior parts they
are much  more common, and  especially in the  popliteal.
As to the arteries of the leg, none have been observed, at
least not primitive ones.  The anatomical condition of the
tumour is always nearly the same; they have the same ter-
mination,  with this  difference,  that the operation is possi-
ble,  and  that the spontaneous cure happens sometimes
through the collateral arteries, which assume a greater cali-
ber, producing a derivation of blood, which permits the tu-
mour to resolve itself.
   The symptomatic affections of the  arteries are unknown,
and we are ignorant  of the part they act in febrile diseases.
                CHAPTER  XIV.

           Diseases of the  Venous System.

  The venous system is divided into two parts, the gene
ral and the abdominal: their diseases have nothing in com-
mon.  The  vessels which  compose the  general  venous
system, reach the heart through two principal trunks; their
ramifications, which are subdivided in the whole economv,
mostly follow the same distribution as the arteries.  The
loose cellular tissue, with which the veins are formed, ren-
ders them very flexible. Their affections are entirely dif-
ferent from those  of the arteries; their essential maladies
are very little understood.
  We have  no positive sign of the inflammation of the
veins; nevertheless we know that in varices they may
sometimes  become inflamed.  When  they arc  cut into, 
DISEASES OF THE VENOUS SYSTEM.
187
they unite again with great facility, which supposes an in-
flammatory condition; the hemorrhage of the arteries, on
the contrary, is only arrested by their obliteration.  As to
the phenomena through which their inflammation passes
to its termination, we know nothing about them; the same
is the case as to their influence in different disturbance of
the circulation: what is certain, is, that in accesses of fever,
when the disturbance is so  great in the arteries, we per-
ceive no remarkable change in the veins.
  The internal membrane of  these vessels never present
ahy ossification, either in  the veins themselves, or in the
corresponding part of the heart.
  The veins  are  very susceptible of dilatation, resulting
from their structure; the least effort distends them, as we
see by injecting them.  Under this head we must distin-
guish two kinds of dilatations, the  local ones and those
which  are general.   We observe these latter  ones in the
parts which are very much distended, where the blood cir-
culates and remains with  difficulty.   This is observed in
the abdominal parts in ascites, in cancerous tumours of the
breast, &c, and which were formerly known under the
name of varicous veins.
  In varix there is a local  dilatation of the vein, in its cir-
cumference, or in all its portions.   Varices do not  exist
equally in every part of the  body, they are very rare about
the head, either internally or  externally; sometimes they
happen in the neck.   We may meet with a slight venous
dilatation about the pharynx; we never observe any on the
chest.   The same is the case with the superior extremities,
if we except  when compression is made at the  axilla; then
the blood being hindered  in its return, distends  the ves-
sels which contain it.  The vena cava inferior never pre-
sents any varices; \but they are very  common in the sper-
matic vein, which is one*of its branches, both because it is
very long, and because it is hardly surrounded by any solid
parts.  These varices, in the spermatic vein, may be with- 
Iv<        DISEASES OF THE VENOI's SYSTEM.

in or without the abdomen.  The  hypogastric veins arc
also very subject to this accident, because the blood there
circulates against its own  gravitation.  We must pay par-
ticular attention to distinguish varices from  hemorrhoidal
veins.
  The inferior extremities are manifestly the parts most
exposed to varices.  The superficial veins are especially
the most subject to them,  because  the  blood circulates
against its own gravitation, and because also the circulation
here fails of every  auxiliary means.  Old age and a cer-
tain condition produce them also.  These tumours often
complicate ulcers of the legs: pregnant women are subject
to ulcers in these parts; there are  some  who experience
them at every period of pregnancy.
  Varices are very easy to  recognise; they are  blueish,
soft tumours,  increasing and diminishing as we compress
the part above or below it.  We sometimes  find some re-
sembling a string of beads along the course of the veins;
sometimes, as  we have  already observed, varices are ac-
companied  with inflammation; they  may rupture and pro-
duce hemorrhage.  However, in order that this should take
place, the tissue of the veins must change its nature. These
ruptures are pretty frequent. Post-mortem examination
then shows nothing particular in the structure of the ves-
sels.   As to the blood contained  in varices, it is almost al-
ways liquid, and in this it differs from that of aneurism.
  The abdominal  venous system is independent of the
other in its affections, as in  its functions.  Stahl and his
disciples had greatly extended the domain of its functions;
they considered them  as the source of a multitude of evils.
We have very little correct information in relation to these
affections; most of the opinions of Stahl in this respect are
merely hypothetical.   We are ignorant of the mode of in-
flammation and suppuration  of trie vena portarum, as well
as the  manner in which it cicatrizes, since it is never ex-
posed to lesions.   Varice- arc pretty common  in its rami- 
           DISEASES OF THE VEINOUS SYSTEM.        1*9

fications; they are less frequently observed in the abdomi-
nal cavity than in the neighbourhood of the rectum.  These
tumours are known under the name of hemorrhoids.
  Hemorrhoids especially affect the neighbourhood of the
rectum; children and old persons are less exposed to them
than adults, from the  age of five and  twenty to  forty.
They are ascribed to an infinity of causes: thus riding on
horseback; sedentary habits of studious  persons; the pro-
lapsus of the rectum in which the neighbouring veins are
compressed; great straining at stool whilst labouring un-
der constipation; violent purgatives: the compression pro-
duced by the matrix when affected with polypus, or whilst
pregnant;  the  bladder being too much distended; an he-
reditary disposition; peculiar constitution, &c, are so many
causes  which  may produce hemorrhoids.  There is  ano-
ther series of causes, but which are much less certain; these
are the causes produced by the  obstruction of the liver.
Some authors have pretended  that hemorrhoids often re-
sult from this condition, and that reciprocally  leeches ap-
plied  in the neighbourhood of the anus, disengorged the
liver; if this was the case, this engorgement ought to act on
the whole portal system, and we ought to find varices in
the abdomen; but this never happens.  Moreover, in similar
cases, the  blood being pressed back into all the veins, au-
topsic  examination ought  to present them gorged  with
blood, as are both the inferior and superior cava? in ob-
struction of the lungs; but we find nothing in  this  condi-
tion.   It is pretty probable, from this, that the diverse
states of the liver can not influence those of the vena por-
tarum.
   Hemorrhoids have their seat within or without the rec-
tum; when they are within they are seldom an inch from
the opening of the anus.  They are always of the same na-
ture, whatever may be their seat.   These tumours present
two very  different  conditions: in the healthy state  they
seem to be  only varicous veins; but oftener they are ac- 
 190       DISEASES f)F THE V EN "US SYSTEM.

 compaoied with an engorgement more or less considerable
 of the adjacent parts.  The blood, after having ruptured
 the varix, seems to have formed to itself a cyst.   The phe-
 nomena  of hemorrhoids are essential or  symptomatic.
 When they are intense they produce but few phenomena:
 sometimes the tumour is livid, blueish, in the neighbour-
 hood of the rectum; at others it  seems simply red, and
 more deeply situated.  This difference changes nothing in
 their nature; their number and position are variable; some-
 times there are as many as twenty  or thirty conglomerated
 about the rectum, at other times  they are more disseminat-
ed; then there is always more or less tension.  It is not at
 all times the same, but returns by intervals.  The pain is
 in proportion to the tension;  it is  sometimes so keen that
 the patient can not bear it: there is at the same time a sen-
sation of heat  more or less considerable.   When  hemor-
rhoids are within, the difficulty of passing the faeces is ex-
treme; it is less so when they  are without.  The faeces
are then bloody; sometimes the hemorrhoidal flux is in-
dependent of the passage of faeces.  It can not be considered
as an hemorrhage of the mucous membranes; it is evident-
ly the effect of a rupture.
  General symptoms are not appreciable, when the disease
 is not very intense; but,  in the contrary  case, there are
pains  in the lumbar  regions, and vertigo, symptoms not
met with in other hemorrhages:  there is often a  concomi-
tant fever, and difficulty in respiration.
  We do not well understand the condition of these tu-
 mours on dissection; they have not been carefully examin-
ed.  Nevertheless, it seems to be pretty certain that there
 are two species of hemorrhoids: in the first, there is a sim-
 ple dilatation of the  ramifications of the vena portarum;
 this case is not the most frequent; in the second species, it
 seems that there happens a rupture in the venous parietes;
 that the blood  is effused and forms small cysts in the cellu-
 lar tissue.  This we  may readily conceive,  if we tike 
          DISEASES OF THE NERVOUS SYSTEM.       191

notice that inflammation causes the venous parietes to lose
their  extensibility.   Sometimes  these  tumours  present
greater  complications; there may supervene an inflamma-
tion in the neighbouring cellular tissue, abscesses, indura-
tions, &c.  These indurations form scirrhosities and pro-
duce contraction of the rectum.  Another complication is
the serous flux, termed white hemorrhoids;  it is only in
this case, a more abundant secretion of the mucous mem-
brane of the rectum.
                 CHAPTER  XV.


           Diseases of the  Nervous System.

  In anatomy, as in physiology, we recognise two distinct
species of nerves; some come from the brain, and the others
arise from the ganglia.
  The diseases of the nerves of the first species are divid
ed into those which belong to the nerves, and into  those
which appertain  to the brain. It is often difficult to isolate
them because of the  close connection which exists between
these organs.
  The affections of the brain are divided into symptomatic
and essential: the first are very numerous.
  There are many  of its  idiopathic maladies which are
very little known, such as inflammation in wounds of the
head: the cerebral  substance is often interested, without
death supervening; then we have seen the brain to inflame
and suppurate.   It is also susceptible of chronic inflamma-
mation and of every other termination. Superficial inflam-
tions of the  brain are generally very rare; they have often
been confounded with the inflammation of its membranes. 
 1M2        DISEASES OF THE NERVOUS SYSTEM.

 It is true there arc, during the disease, cerebral symptoms;
 but they are purely symptomatic,  as vomiting in perito-
 nitis, &.c.   The spontaneous inflammation of the brain, are
 very little understood.


                    ARTICLE I.

                    Of Apoplexy.

  Apoplexy  is a disease  much better known, and which
belongs exclusively to the brain.  It is not a disease of
young persons, it attacks especially old people in whom
all the parts tend to be paralysed.  The causes which pro-
duce it are a life of luxurious idleness, a plethoric tempera-
ment, high living: it has been also asserted that those who
have a short neck were more exposed to it; but this disposi-
tion does not appear so but because of the volume of the soft
parts of the neck.  Apoplexy seems also to be hereditary:
sometimes  it makes  its attack after violent  passion, such
as anger, or after a copious meal; by  long  application of
the mental faculties;  by suppression  of habitual evacua-
tions; the frequent use of narcotics; it  often occurs even in
a spontaneous manner.  The state of  plethora,  which has
been so often regarded as a predisposing cause, seems to
be an unmeaning word; indeed it is very difficult to deter-
mine the condition in which there is a superfluous quantity
of blood, either by the redness of the  face, which is often
present, even in the state of cacochymy, as we observe it
in phthisis; or by the fulness and frequency of the pulse,
which  may manifest  themselves in  an infinity  of com-
memorative circumstances.   Asphyxia, which also resem-
bles it  in its symptoms, has its essential seat in the lungs.
Drunkenness and narcotism have also relation with this af-
fection.  Catalepsy affects only the muscles of animal life:
during the fit the limbs keep the posture in which they are
placed.  In ataxic fevers they are  also  cerebral pheno- 
DISEASES OF THE NERVOUS SYSTEM.       193
 mena, but no paralysis, irregularity m the heat of the body
 and other symptoms which causes them to be distinguish-
 ed.   Epilepsy is also something like apoplexy.
   It is important  to know whether there  is a real differ-
 ence between an attack of apoplexy and one of  paralysis;
 it seems that there is none.  Paralysis is never  an essen-
 tial  disease,  it is only a symptom of lesion of the  nerves.
 Hemiplegia  is almost always the consequence of apoplexy;
 but  there are muscles, in this case, more or less suscepti-
 ble of being  paralysed. They are especially the muscles of
 the  face and those of the extremities: as to those of the
 trunk, they are little exposed to it. When these hemiplegia?
 are caused by the brain, they happen in different manners.
 Sometimes  there  supervenes first a derangement in the
 senses, a pricking sensation in the limbs;  finally,  a com-
 plete hemiplegia: sonfetimes it occurs suddenly.   When
 the  patient  has returned to his senses, the paralyses still
 remains: these paralyses are only different  degrees of apo-
 plexy. These two diseases reciprocally predispose to each
 other: commonly after  two or three attacks the  patient
 dies.  Apoplexy often occurs  in an unexpected manner,
 sometimes there are warning symptoms preceding  it seve-
 ral days, such as coma, debility in the muscles, pricking
 sensations in the limbs, vertigo, &c; soon after, a manifest
 attack happens.  Few days after, there are  well character-
 ized symptoms, which we may divide into common and
 proper.  As  to the proper  signs, they are observed in the
 functions of  the senses, the cerebral functions, and in the
 motions.  As to what  relates to the  senses, the eyes are
 fixed, the pupil is dilated, all the other senses are blunted;
 nevertheless, the general sense of touch enjoys yet a cer-
 tain degree of sensibility, and stimulants applied to  it, pro-
duce  movements like in a man who starts in his  sleep.
The  intellectual  functions are entirely destroyed;  motion
is more or less impaired.   Commonly there is hemiplegia,
as we have already observed, seldom general paralysis. 
 194       DISEASES OF THE NERVOUS SYSTEM.

   With respect to general symptoms, it is said that the pa-
 tient has a proneness to lie on  the affected side; sometimes
 the pulse is very strong, at others it is not very frequent.
 Ordinarily the face is red and even livid; sometimes this
 colour of the face docs not exist, or is caused by the parti-
 cular kind of death.   Respiration  mostly  is stertorous;
 which, without doubt,  is produced by the paralysis of the
 muscles of the larynx: this condition goes on progressively
 increasing.
  As to the digestion,  there often  occurs gastric disturb-
 ance and vomiting; this symptom disappears on the third
 day; there are often involuntary alvine passages, which
 are always a bad omen.  Exhalations vary singularly; very
 often there is perspiration.  Among the secretions, those
 of the salivary glands are especially affected; the saliva is
 rejected full of air.  As to the heat? no irregularities are
observed as in ataxic fevers, there  is often a complication
 of adynamia.  The duration of the symptoms of apoplexy
varies  singularly; sometimes  they  cease in twenty-four
hours,  most frequently in three or four days: they termi-
nate ordinarily in death or in paralysis.   All the cases are
not equally intense at all times. When the patient escapes
death, there remains commonly a disturbance of the cere-
bral functions; sometimes it is the memory, at others it is
the judgment; sometimes there is a true mania; these le-
sions often affect  the locomotive apparatus  and  produce
paralysis,  as  we  have  already observed: this latter affec-
tion may by degrees disappear. The fits commonly return,
 especially with plethoric persons.
  An Immense  number of subjects  have been opened in
 order to examine the lesion produced by this malady, and
 various alterations of the brain have been found. We must
 take care to separate them from those which do not relate
 to this organ, as the ossification of its meninges and vessels.
 The brain often presents some alterations,  especially in
 those who have  died from apoplexy; but it is pretty  com- 
DISEASES OF THE NERVOUS SYSTEM.
195
 mon also to meet with none. There is not one exterior sign
 which leads us to decide in a precise manner when there
 is an effusion; there is only coma,  stertorous respiration,
 &c, which may induce us to conjecture it.  The effusion
 may take place in different parts: it is seldom found on the
 exterior; it is always in the substance of the  cerebrum,
 cerebellum, or in the pons varolii, that it is most common-
 ly found:  in the brain we observed it about the thalami
 nervorum opticorum.  We should be inclined to think its
 substance lacerated, without perceiving the orifice of any
 vessel,  for capillaries  are  only distributed in  this pard
 Sometimes the effusion is enormous, the convolutions are
 almost all obliterated by pressure.  If blood is met with in
 the ventricles, it is only by a rupture that it has been there
 introduced.  Effusions seldom  occur  in  the (cerebellum,
 and  still more rarely in the medulla oblongata.   It must
 be observed that the nearer the effusion is to the convexi-
 ty, the longer may the patient bear this affection.  He may
 sometimes survive it twenty or thirty days.  The serous
 effusion does not occur in the same manner as the bloody
 one.  It happens always in the ventricles, or on the exte-
 rior of the brain; it is commonly in the pia-mater that it
 is found, and not in the arachnoid when it is on the surface
 of the brain; but when it is in the ventricles, it  is always
 effused by the arachnoid.  Watery collections in the brain
 are sometimes so considerable, that they compress it. They
 are commonly a pure serosity.   It is impossible during life
 to distinguish between serous and sanguine apoplexy, for
 they have common symptoms.   Sometimes we meet with
 both at the same time.   It seems that that which truly in-
 duces apoplexy  is a peculiar condition of the brain, that
 we do not  discern, and to which the serous or bloody col-
 lection is only accessory; for often in these cases no appa-
 rent lesion of  the cerebrum has been detected.  This con-
dition of this organ would be  analogous to that which
produces ataxic fever.  There are indeed other diseases in 
196        DISEASES OF THE NEHVOUs SYSTEM.

which there supervenes an effusion, which still proves that
this phenomena is only a consecutive accident.  We must
not ascribe it as did the ancients, to the action of the heart,
which, by its violence, produces the rupture of the ance-
phalic vessels: if this was the case, the whole face  would
be in the same condition.
                    ARTICLE II.

 ♦                     Of Fungi.

  The other functions of the brain are less understood and
much more rare; and these are first of all fungi.  They
may happen in the brain, cerebellum or pons varolii; some
have been observed on a man who complained, from time
to time,  of an  extreme pain of the right  and posterior
side of the head.  He was attacked  with a hemiplegia of
the left side, and he was taken, to the H&tel-Dieu.  The
disturbance of the intellectual faculties which he had  ex-
perienced had ceased, and the paralysis remained with the
same pain in the head; finally he died leucophlegmatic.  On
dissection, a fungus was found on the anterior part of the
middle lobe of the brain. The whole part was disorganized:
there  was also an affection of the  dura-mater.  A similar
fungus, situated on the posterior part of the brain, has been
observed to produce the same phenomena.
  Ossifications of the pineal gland have been found  in epi-
lepsy; but this malady often exists without presenting this
phenomenon.
  It is very difficult to know the cause and  the seat of all
cephalalgiae, which are symptomatic of a great many  dis-
eases: it is probable that mostly the}' arc not seated in the
brain. In gastric disturbances, it seems that the pain which
the patient feels over and about the superciliary ridge, has
its  seat in the mucous membrane  which lines the  frontal 
          DISEASES OF THE NERVOUS SYSTEM.        19/

sinuses.  As to the seat of megrim, it is impossible to de-
termine.  In certain persons who  have been always com-
plaining, organic alterations have been found.
  The organic affections of the brain are very little known;
there are some  on which we shall not be long detained,
such are hydatids, which sometimes present themselves in
the choroid plexus.  They frequently  are as large as a
pin's head, at other times larger.  We must classify  them
amongst the anomalies of the  brain.  They have  been
found on persons in full health.  The dilatation of  veins
and arteries of the brain have also  been observed, but this
is very rare.


                    ARTICLE III.

                      Of Fatuity.

   Mental alienation is a disease of the brain, which, most
 frequently, leaves no trace of organic affections.   Aliena-
 tions ought to be divided into two classes: those from birth,
 and those which are accidental:  the latter are the most
 common.   Organic alienations  are only to be met with in
 those from  birth.  Indeed, it is probable that the condition
 of the brain induces  in children the modification  of their
 intellectual faculties.   If we observe animals, we see that
 there is a pretty  exact relation  between their intelligence
 and the volume of their brain.
   In the cretins who are idiots from  birth, there is  in the
 cranium a peculiar conformation; the head is flattened trans-
 versely and elongated  superiorly. The defects of organic
 conformation relate, then, either to the osseous case which
 envelops it, or to the brain itself.  Sometimes the bones are
 thicker on one side than on the other, and it is not uncom-
 mon on the  other, to find the two hemispheres unequal,
 which manifestly alters the functions of the cerebral  organ,
 if we admit that it  acts like the  other symmetric organs. 
198      DISEASES OF THE NERVOUS SYSTEM.

All  these different conformations must produce mental
alienation from birth.
  Commonly we find nothing like it in spontaneous aliena-
tion.  The manner in which the disease occurs leaves no
room to believe, that it may be the effect of a chronic cause;
it seems even probable that there  is,  in this  case, no or-
ganic affection.   Indeed, how can we account  for the long
intervals which occur  between the fits? Fatuitous persons
seldom die suddenly from  their disease; commonly there
must occur another affection.   This  may only happen in
certain fits of furious mania which resemble those of ataxic
fevers.                                         •
  Post-mortem examination presents no affection nor ex-
terior phenomenon.  Sometimes there is a very slight efi-
fusion; but it must be symptomatic, as we have seen it to
be in apoplexy.  Ataxic fevers are  very common in fatui-
tous persons.  Often in this case we find some alteration,
which is without doubt produced by the ataxic fever.
  As to the other diseases of the brain, it seems that they
are entirely without any exterior lesion, such  is epilepsy.
Sometimes we find a scirrhus of the brain, or  an engorge-
ment of the dura-mater: the same is the case with catalepsia,
narcotism and hydrocephalus.


                   ARTICLE IV.

      Of Symptomatic Affections of the  Brain.

  After the stomach, heart  and liver, there  is  no organ
more susceptible of sympathetic affections than the brain.
However  little intense the fever may  be, there is then de-
lirium.  This condition is  especially remarkable in ataxic
fever, although  it is classified with the other  essential fe-
vers.   In  a great  number of cases the brain  seems to be
the organ the most particularly affected.   In effect, the
principal phenomena of this disease are all cerebral: som- 
DISEASES OF THE NERVOUS SYSTEM.
199
nolency, which precedes and accompanies it; furious de-
lirium, irregularity of heat, disturbance in the sensations
and motions, &c; often the condition of the pulse is little
disturbed.   The exacerbations in this fever are only indi-
cated by the exaltation of the cerebral symptoms, and not
by those of the circulation.  However, the very sudden
termination of the  disease evidently proves the essential
lesion of so interesting an organ: it would appear, there-
fore, that, in ataxic fever, the brain is the principal seat of
the disease.
   In other  diseases, there are cerebral symptoms of two
species: the head-ache of gastric disturbances seems to have
its seat only in the frontal sinuses,  and not in the cra-
nium.   On the  contrary, in  adynamic  or inflammatory
fevers, there are often real symptoms of ataxia.  These
sympathetic disturbances of the brain are analogous  to all
those which happen in similar  cases in the other organs.
In phlegmasiae, when the concomitant fever is very vio-
lent, there are  also cerebral  symptoms: we observe none
 in chronic diseases.


                     ARTICLE V.

                Diseases of the Nerves.

   Although the diseases of the nerves furnish a vast field
 to pathology, nevertheless, we  can say but very little  of
 them with respect to pathological anatomy, since we do
 not find any mark of organic lesion.
   Authors have comprehended, under the name of nervous
 affections, many  diseases which are  not of this kind, as
 catalepsis, narcotism, &c, which especially affect the brain.
 The nerves in their ordinary condition, are not the seat of
 known affections, nevertheless  it may exist with them; but
 we are ignorant of these modifications.   As to the inflam-
 malion which supervenes after their division, we can not 
 200       DISEASES OF THE NERVOUS SYSTEM.

 now, doubt, that it exists, since it is evident, that the nerves
 cicatrize, either by the immediate reunion of the two ex-
 tremities, or by a kind of  substance which seems inter-
 mediate and analogous to the calosity (cat) which super-
 venes  in fractures.  As to  the induration of nerves, of
 which so much has been said, we do not  discern it.   De-
 sault has seen in a whitlow a degeneration of the nerve in
 the affected finger.
  The nerves are essentially the seat of certain pains more
 or less keen, which writers have made the subject of their
 studies; such are the tic doidoureux of the face, and sciati-
 ca.   Chaussier, in considering these pains in a general man-
 ner, has presented them very advantageously; he has term-
 ed them neuralgias; they  manifest themselves  in diverse
 parts and at different ages, especially in childhood and in
 adults, but seldom in old persons.  These affections are
 characterized by several phenomena; there is an extremely
 keen pain in the whole part traversed by the nerve; it per-
fectly resembles the pain which  results from  a nervous
 branch being  pressed: it is a very disagreeable stinging.
 A character which distinguishes it from that of rheumatism,
is, that it does not present the mobility of that disease; it
may indeed  extend itself as we have already observed, but
it does not change its place.   Besides, it does not produce
swelling, notwithstanding the excessive pains which some-
times necessitate the division of the nerve.  The relief
which  this operation procures is only momentaneous, and
the nerve forming a cicatrice, soon reproduces the same af-
fection.  The nervous pains return by fits; commonly the
patient is subject to them for the remainder of his  life.
Often the causes are hysteric passions, with women whose
nervous system  is very sensitive; exposure to cold air;
dwelling in a damp place, &c  Their seat may be in every
part  of the body, especially  in the head; and particularly
on the face.  Few only are observed in the neck; there are
some which happen in the pelvis, the pain then extends in 
           DISEASES OF THE NERVOUS SYSTEM.       201

 the sciatic nerve, and  follows the course of its branches.
 These, kinds of pains sometimes produce the paralysis of
 the  part which  is affected by them.  Locomotive power
 returns after the fit is over.
   Post-mortem examination teaches us nothing of the na-
 ture of neuralgia?.   Cotugno believed that these pains arose
 from the engorgement of the neurilema.
   Another affection of the nerves  is convulsions, which
 we must  take care to distinguish from those which are
 produced by the brain, although the symptoms  are  the
 same.  We recognise them because in one case the affec-
 tion is local, and general in the other.  For example, let
 us compare epilepsy with  chorea sancti viti; besides, the
 nervous convulsion is continued, whilst those of the brain
 are intermittent.
  Nervous convulsions are manifested in different man-
 ners; sometimes they only  occur when the patient wills to
 move the affected limb, at others they are continual. There
 are individuals in whom we observe a convulsive move-
 ment at the commissures  of the mouth, every time they
 wish  to speak.  Sometimes the muscles of the neck are af-
 fected with  a continual movement, which then is rather
 produced  by atony than by convulsion.   Often there  is
 also lesion in the nerves of sensation, as in those, for exam-
ple, which go to the ear, eyes,  &c.
  Paralysis may also manifest  itself locally, and then it is
 entirely foreign to the brain.   This paralysis may affect
the nerves of motion as well as those of sensation, as we
 observe to be exemplified in gutta serena, and in the  loss
of motion in an isolated limb.  Besides this,  we have no
other knowledge of nervous diseases.
26 
i>02
DISEASES OF THE ADSORBENT SYSTEM
                CHAPTER XVI.

         Diseases of the Absorbent  System.

  Thb absorbent system is composed of lymphatic glands
and vessels  which bear the same  name.  We shall suc-
cessively consider  its maladies in  these two divisions;
those of the glands are better understood than those of the
vessels.

                    ARTICLE I.

         Diseases of the Lymphatic Glands.

  The  affections of the  lymphatic glands, which attack
their tissue, are very common; but this frequency is in an
inverse ratio  to the  age of the person.  They are very
common in children, and very rare with old people, which
is caused, without doubt, by a  greater development than
they have in childhood, and which they lose in a more ad-
vanced age.  The  diseases of  the lymphatic glands  are
either essential or symptomatic.
  The  essential diseases are, first, inflammation, which
often  ends  in induration.  Sometimes this inflammation
occurs  spontaneously, at others it  happens by an exterior
cause.   At others it is produced by a wound which is at a
great  distance,  without  the absorption of  any virus.  It
occurs still more frequently when the instrument is infect-
ed  with some morbific  virus.   Sometimes also it  is the
venereal virus which causes the swelling  and inflamma-
tion; then the absorbents swell with the glands and form
a painful line, at other times the glands only are inflamed. 
DISEASES OF THE ABSORBENT SYSTEM.
203
   Sometimes these slight engorgements  hardly  deserve
 the name of inflammation; the slight swelling and  the mo-
 derate  pain  are  soon  dissipated; but there often  appears
 a swelling which is twice or thrice  its volume.  There is
 always more or less induration; the subjacent skin experi-
 ences nothing during the first days; the pain is not as keen
 as that experienced in phlegmon,  and runs  through its
 inflammatory stages more slowly.   Whenever suppura-
 tion occurs, it is  only after twelve or fifteen days that we
 can feel the fluctuation.  As to the  anatomical  condition,
 we are  not sufficiently  well acquainted with it; the patient
 seldom dies  under these  circumstances; nevertheless, we
 know that there does not exist then any disorganization of
 the glands, which are alone augmented in  volume. Acute
 inflammations occur especially in the glands of  the groins
 and axilla.  We  are entirely ignorant of the inflammation
 of the internal glands.
   The termination of these inflammations may be made by
 suppuration; but it happens later than in  phlegmon; thus
 the ancients had  recommended to open abscesses not with
 a knife, but with caustic.  After more or less  suppuration,
 the wound heals.  On  dissection we find the  gathering in
 the middle of the gland.
   Another very  frequent termination of inflammation of
 the glands is induration; thus,  after a venereal taint, the
 inflammation of a bubo having  run through its periods,
 terminates in a hard, and more or less large tumour. This
 condition of  induration is so common in inflammation of
 the glands, that even during the stage of suppuration there
 is a hard circle immediately surrounding them; but it does
 not predispose to  a cancerous affection. It lasts from five to
 six months, and disappears by degrees. Autopsic examina-
 tion presents no disorganization of  the engorged  glands.
 In every kind of  inflammation of the glands there  is mani-
 fested a slow character in their progress; thus in the scro-
fula, which  attacks particularly the glands of the trunk, 
201      DISEAM.S OF THE ABSORBENT SYSTEM.
in general, the periods are very long.   We do not  know
the nature of a scrofulous habit; even the causes are in part
concealed.   We may divide scrofula according to the part
it affects.   It occurs either in the abdomen, chest or neck,
which affection mostly forms isolated diseases.
   Tabes mesenterica is the  engorgement of the glands of
the abdomen.  It commonly happens in children from their
eighth to their tenth year.   It is manifested by pains, gas-
tric disturbances, and often an habitual diarrhoea.   The
belly is tympanitic; there  is often vomiting. These gastric
phenomena are no indication of the disease; but  there is a
peculiar general  disposition; there is a fine skin,  flacci-
dity, slight oedema, suffusion of the  mucous membrane,
small pulse,  difficulty often in respiring; urine lactescent,
in the first and second stage of the disease; however, there
is debility, feebleness in the motions, and the intellectual
faculties are  very little developed.  But soon we observe
well defined phenomena; the abdomen becomes tympanitic,
which is produced  by the swelling of the glands and by
the  gases.  Sometimes there is a  voracious  appetite, at
others anorexia, pain in the abdomen, and complication of
worms.  The general symptoms are a difficulty in  respi-
ration, which is produced, without doubt, by the consecu-
tive engorgement of the  thoracic glands; and marasmus,
that some writers have given as a characteristic sign.  We
should, at first, be inclined to believe that the non-absorp-
tion of  the chyle is produced by the  engorgement  of the
glands; but it is not until  the last period that this function
is entirely hindered, which must not surprise, since  we
see the lungs, towards the last stage of phthisis, fulfilling
equally well their functions. Finally, strength diminishes,
the tumefaction of the abdomen is enormous, pain  is ex-
cessive, and shifts with the displacement of the mesentery;
diarrhoea is habitual; there is a feeble and contracted pulse.
Towards the end there occurs ascites, or the infiltration of 
DISEASES OF THE ABSORBENT SYSTEM.
205
the lower extremities.  There is no disease which reduces
children to a more frightful marasmus.
  There are few  affections better known by autopsic ex-
amination than this one. The state in which we commonly
find the glands may be referrible to four stages: 1°, simple
swelling of the glands; 2°, transformation of a part of this
gland into a steatomatous substance; 3°, a complete steato-
matous state; 4°,  in the last period, the glands suppurate
and form a sanious fluid.   The  neighbouring  glands are
also engorged; those of the thorax may become equally en-
gorged as those of the abdomen, and may form a disease
entirely  analogous to tabes mesenterica.   Nevertheless,
writers have only spoken of this engorgement as compli-
cating this last disease.  It is certain that it  is sometimes
essential,  and that it constitutes a phthisis  which has not
yet been described, and of which  I am  about  to relate a
case:—
  A child came to the Hotel-Dieu with a slight cough, and
difficulty in respiring. Theredidnotexisteitherascrofulous
habit or a preceding venereal taint. The symptoms were
more intense in the evening, and there was dry cough; and
there happened suffocation every two or three days, which
was renewed every time the patient made any exertion or
ate too much; then respiration was hindered and the chest
painful. One single circumstance could indicate the disease,
it was the engorgement of the glands of the neck. The pulse
was feeble and contracted. These symptoms evidently de-
noted a phthisis, and it was treated accordingly with pectoral
and anolient medicines.  Sometime afterwards, the symp-
toms became more intense,  the  expectoration was mucous
and  not  purulent, the pain in the chest very slight; pres-
 sure obscurely extended in the whole cavity; the compres-
 sion  of the epigastric region produced suffocation.    Diar-
 rhoea; the hands  and feet habitually warm, little passage of
 urine, and  the countenance  completely altered in its ex-
 pression.   The patient died in a frightful marasmus.  On. 
 206      DISEASES OF THE  AHSORHENT SYSTRM.

 dissection, the scat of the disease was found to be in the
 glandsof the lungs, which were steatomatous and very large.
 A great many children present the same disposition as the
 present one, and their phthisis may then be readily classi-
 fied with the diseases of the  lymphatic system.
   Scrophula fugax is an affection  of  the glands of the
 neck: it is pretty frequent, and differs from tabes mesente-
 rica in this respect, that it is slower and never mortal;  it
 either suppurates,  or its swelling is terminated by resolu-
 tion.  The few accidents, that scrophula fugax causes, are
 not to be ascribed  to the nature of the disease, since it is of
 the same as other forms of scrophula; but to the neighbour-
 hood of organs which it can not alter: anatomical inspec-
 tion proves the veracity of this assertion.  This affection
 may be produced by a general right, or  be simply local.
   When the  vice is local, it is observed in the different
 parts of the neck, and particularly in the sub-lingual glands,
 and the salivary glands are  nowise affected.  There may
 be formed a string of engorged glands all along the neck
 over the track of the vessels; sometimes they are observed
 at the occiput.  At first,  it is an indolent engorgement; a
 scirrhous and hard tumour;  the skin is slightly swollen.
 These indurations  remain more or less stationary, some-
times during two  or three years, and without altering in
the least any  function.  Sometimes there is  resolution.
Towards the end  the skin  assumes  a violet  colour, and
 there  occurs an evident flutuation below it These glands
open  spontaneously, and there is  discharged  from them
 a lactescent fluid loaded with whitish flacks.   Sometimes
the flutuation disappears, because the  fluid is reabsorb-
ed.  When the abscess discharges its contents, it remains
 for-a long time fistulous, and cicatrization is only produc-
ed completely by  the adhesion of  the skin to the gland,
 which renders the scar deep and ugly.   Autopsic exami-
 nation of these glands may present, as those of the other
parts, four different conditions. 
          DISEASES OF THE ABSORBENT SYSTEM.       207

  The affections of the lymphatic glands may  therefore
depond upon a local or general vice.   When the affection
is general, it is not confined to the glands, but it acts on all
the systems, in the same manner as the other general affec-
tions, such as the venereal, &c.
  The ossifications of these glands are not a very rare phe-
nomena,  especially in the chest, where they are pretty of-
ten met with on  dissections.   Cancer seldom affects primi-
tively the lymphatic glands, and they are only engorged
consecutively in this malady.
  Symptomatic  affections  are very common in this  sys-
tem,  and are occasioned by the neighbouring  organs.
These glands are also affected in general diseases.   Bubos
are often  a symptom in pestilential diseases. In local phleg-
masia of  the limbs, as in whitlow, it often occurs that the
glands of the axilla are swollen. When there is a blister on
the legs,  those of the groins may also swell.
  Thus the swelling of the lymphatic glands, may be  pro-
duced by the absorption of a virus, by sympathy, &c.


                    ARTICLE II.

          Diseases of the Absorbent Vessels.

  Although  we  know  pretty well the disposition of the
absorbent vessels, nevertheless we are yet ignorant of their
diseases.   It is certain that they absorb the different kinds
of virus; but these  are  not, properly speaking, diseases,
because these kinds of virus act no more on them than on
the other organs.
  The real affections of these vessels are, first, inflamma-
tion, which may occur in two different manners: some-
times they  are  inflamed with the glands, which form a
chain, and is the most common mode of inflammation; at
others these vessels are also engorged, and Mascagni quotes
some  cases of their  inflammation.  When a  person  has 
208      DISEASES OF THE ABSORBENT SYSTEM.

cut himself with an instrument impregnated with Virus,
the glands of the arm and the vessels which have absorbed
this virus are engorged.  It seems then that the inflamma-
tion spreads: the virus is absorbed.   However, we do not
properly understand yet this inflammation, we know Only
that it terminates sooner than those of the  glands.  The
inflammation of the absorbents has seldom been  observed
but in the lower extremities.  Besides, we have no know-
ledge of their induration or gangrene.
  The varicose dilatation of the absorbents is rare.  It is
indeed sometimes observed in the liver, but it is doubtful
whether it be produced by a pathological condition.  As
to hydatids, it is very little probable that they are occasion-
ed by a disease of  the absorbents.   There is a pretty fre-
quent species of dilatation of the  lymphatics, which is
common to the  whole limb.   Sometimes  the branches are
as large  as  the thoracic dudt.  These dilatations, which
produce in certain cases infiltrations, occur on the occasion
of compression and obstruction.
  A great many disputes  have arisen on  the  cases  in
which dropsies are produced  by the want of action in the
absorbents,  or when they are caused  by the exhalants.
There are cases in which it is difficult to decide; neverthe-
less, in compressions, in long standing, when dropsy  hap-
pens, it  is, without doubt, for want  of action in the ab-
sorbents.  Sometimes the absorbents seem to increase their
action.  When we do not suppose the existence of circum-
stances hindering absorption,  it is then very probable that
it is by passive exhalation that dropsy is produced. 
diseases of the fihkous m-iem.
209
                CHAPTER  XVII.

           Diseases of the Fibrous System.

   These diseases are yet very obscure in their diagnosis
 and prognosis.   The idiopathic affections of this tissue are
 very little understood.  It seems that rheumatism, in most
 cases, is only the inflammation of this system.  We do not
 understand its  terminations, such as induration, suppura-
 tion, &c.  Besides, every part which composes the fibrous
 system does not precisely resemble every other in its detail.

                    ARTICLE  I.

             Diseases of the  Dura-mater.

   The dura-mater is a fibrous membrane which covers the
 brain, and plunges into the vertebral canal.  Although the
 contrary is believed,  this membrane is little exposed to
 inflammation; it is communicated mostly from the arach-
 noid, which is  below, for, commonly, we simply observe
 the internal surface which is affected.  Nevertheless, when
 it is cut, it cicatrizes, which proves the necessity of a slight
 inflammation in its tissue.
   The dura-mater presents ossifications and fungi.  The
 first condition  is not rare: all  writers have spoken of it.
 These ossifications precisely resemble those of the arteries;
 they have their seat on the  internal surface of the  mem-
 brane;  they happen on every part, and are more or less
considerable.
  Fungi of the dura-mater  are also very frequent, they
grow without our knowing  their nature.   They present
            v7 
210        DISEASES of the FIBROUS SYSTEM.

themselves variously.  Sometimes they have their seat on
the convexity of the dura-mater.   They may be very nu-
merous: when there is only one, it makes a more  rapid
progress.  The continual throbbing given by the brain to
it, causes it to wear out  the bone of the cranium, and to
make its appearance at last under the pericranium.  At
other times these fungi grow at the  base of the cranium,
produce and develop there very dangerous  consequences,
such as the protrusion of the eye from the orbit; sometimes
they press the brain upwards, and from  this become the
more dangerous.
  We must carefully distinguish  these fungi from the ex-
crescences that the dura-mater sometimes furnishes in the
cicatrization of the operation of trepanning.  It is then a
very natural phenomenon, and which coincides  with those
of the bones and neighbouring skin, which by their con-
tact form a common cicatrice.


                   ARTICLE II.

             Diseases of the Periosteum.

  The periosteum is the second fibrous membrane; it con-
sists  of filaments  crossing each other on the bones, and in-
vesting them.  The periosteum extends even over the car-
tilages, where it  assumes the name of perichondrium.
  Its essential affections are, first, inflammation, and we
  ave said, that inflammation was  very little understood in
the fibrous system in general; nevertheless, there are cases
in which the periosteum seems to be really affected by  it.
Thus in a fall, or after a violent  blow on  a bone  placed
near the exterior, there supervenes a hard tumour, the seat
of which is in the membrane which  covers it.   Often also
the periosteum may form an indolent tumour and without
inflammation.  Most surgeons have been puzzled to dis-
tinguish it from exostosis; but the latter,  is mostly formed 
DISEASES OF THE FIBROUS SYSTEM.
211
 in a slow and chronic manner.  On the contrary, the pe-
 riods of the  periostosis are shorter; in eight or ten  days
 the tumour has acquired a considerable size.  The hard-
 ness indicates also a difference, for it is greater in the tu-
 mour of the bone, than in that of the periosteum.  Most
 frequently these diseases are not to be separated, and when
 exostosis  is  present, the periosteum is also swollen and
 vice versa.  Periostoses commonly affect the bones super-
 ficially, and they terminate in two different manners.  Af-
 ter having remained stationary, they become painful; the
 skin becomes red, ulcerates and discharges an unhealthy
 pus, especially when there is venereal habit.   The disease
 soon resolves itself into an exostosis by the ossification of
 the periosteum.   Finally, periostosis may terminate by
 resolution.
   Another pretty frequent affection, is the ossification of
 the periosteum.  In a natural state, it is not  doubted that
 sometimes the internal  part of this membrane is ossified,
 although this  is  not the manner  in which the bones are
 nourished. In necrosis, the periosteum is only affected
 consecutively, and when necrosis affects the middle  part
 of the bone; then the dead bone is circumscribed, the sub-
jacent part of the periosteum becomes inflamed, then car-
tilaginous, and lastly osseous.  This seldom happens but in
the middle part of the long bones,  where this  necrosis is
the most common.  Autopsic  examination, in this case,
presents the periosteum ossified, forming a bag which in
vests the dead bone free in its interior: the tumour is rough
at the exterior.   The internal periosteum is  reddish, and
sometimes presents fleshy granulations.  The parietes are
generally perforated by small cavities.  The difference of
this  tumour from the spina-ventosa, is first its situation,
then the continuity of the  tumour with the healthy bone
in the latter.
  As to the other affections of the periosteum, its diseases
by contiguity are well known, as in caries of the bones, 
2\i        DISEASES OF THE FIBROUS SYs IE M.

superf.i-ial necrosis, in spina-ventosa, and in osteo-sarcoma:
in all these cases it participates in the condition of the dis-
eased bone.
  As to its symptomatic affections, we are entirely igno-
rant of them; it seems that venereal pains have not their
seat in it, as other kind of pains, such as rheumatism or
spontaneous lassitude.


                    ARTICLE III.

            Diseases of the  Aponeurosis.

  We are entirely ignorant of the affections of the  aponeu-
roses.  Sometimes they compress an abscess, where they
produce a great deal of pain, and then we divide them.   As
to their spontaneous diseases, we do not understand them.


                    ARTICLE IV.

             Diseases  of the Ligaments.

  Ligaments, which form also  a part of the fibrous system,
are a little better understood;  although we have not  seen
their inflammatory state;  nevertheless, we know that it
exists in the articulations manifested by the pain, and es-
pecially in the spraining of a joint.  In effect,  they alone,
in this  case, are  sprained.  When their contusion  has
been material, the parts which surround  the  articulation
swell, as in  gouty rheumatism; if it is still more  intense,
there is fever;  this may even go so far as to  produce te-
tanus.   The condition of the part is not known to us, ex-
cept in the last periods of the disease, which terminates by
a white tumour. 
DISEASES OF THE FIBROUS SYSTEM.
213
                    ARTICLE  V

              Diseases of the  Tendons.

  Tendons are seldom affected by diseases; their inflamma-
tion is very little  understood; that which occurs sponta-
neously is entirely unknown: we observe it only to occur
by contiguity, as in whitlow.  Rheumatism does not affect
them, since in the motion of the articulations, they are not
the tendons which are painful, but the ligaments.   Con-
secutive inflammation of the tendons happens in most ex-
ternal wounds, in which these last are cut.   The ancients
ascribed serious consequences to their division; but it is
rather  to the wound of the nerves that we  must ascribe
them.  When tendons have been divided, the incised parts
sometimes draw near each other and cicatrize, which sup-
poses a real inflammation; but it is always very slow, and
this  reunion  is only effected after that of all  the other
parts.  When they are exposed  to the air,  they mortify
and exfoliate like a bone, which  proves their feeble vital
energy; there are  yet researches  to be made as to their
mode of reuniting.   It is more easily affected  in rupture
than in incised wounds, as we see exemplified in the rup-
ture of the tendo achillis and in that of the patella. 
211
DISEASES OF THE SYNOVIAL SYSTEM.
               CHAPTER  XVIII.

           Diseases of the Synovial System.

  The affections of this system may be considered under
two varieties: 1st, those of the synovial membranes of the
tendons, and 2d, those of the articulations.  First, in  the
synovial membranes of the tendons, we observe inflamma-
tion, dropsy and their withering.
  We observe inflammation in the sheaths of  the liga-
ments of the carpus and fingers, &c, &c.  There is a pana-
ris which is evidently seated in  the sheath of the  common
flexors of  the  hand,  and produces  very serious  conse-
quences; the finger swells without any redness, but with a
keen pain which is felt on the internal part of the finger.
Soon  after pus is collected and  compressed between  the
bone and the synovial membrane.  It seems that it is to
this cause, that we must ascribe  most of the accidents of
this panaris.  On opening its cavity, we find all the surface
of the capsule red and filled by an ichorous and sanious pus.
When  the  disease is  procrastinated, the bone is affected
with caries, the neighbouring articulation is  also  affected;
then the  loss of the finger is the consequence, which  has
caused some physicians to believe that this panaris is a  pe-
culiar disease; but it is a simple inflammation.  Pus seems
to vary a little in this case; it is always sanious and  grayish.
This inflammation may also occur in other capsules besides
those of the fingers: sometimes  they are observed on  the
ligaments of the tarsus or carpus, especially when the pana-
ris has not been opened and the pus has been  permitted to
be diffused. 
DISEASES OF THE SYNOVIAL SYSTEM.
215
  The synovial membranes of the tendons may also be the
seat of dropsy, it is more particularly to be met with in those
membranes which are not covered with fibrous sheaths: it
may happen after gout and contusion. We sometimes find
them on the instep, on the sheath of the common extensors,
on the capsule of the inferior tendon of the patella.  It is
probable that these  collections of synovial fluid are  only
affections produced by contiguity.  It seems that in rheu-
matism, ligaments being affected, the subjacent synovial
membrane  exhales more fluid: the liquid  which is dis-
charged in this  case is gelatinous and reddish.   It was
formerly believed that ganglia were also seated in the ten-
dinous sheaths, which, however, sometimes are  soft and
elongated, and disappear by the use of a pretty strong com-
pression.  There are some of these fluctuating  tumours
which assume a round form, do not disappear on pressure,
and are evidently seated in the cellular tissue subjacent to
the capsule.
  The want of synovial fluid, in the tendinous  synovial
membranes, may be  produced by  a panaris or by too long
continued exercise of the tendons which glide in it; then
there happens a peculiar crepitation and a slight pain.
  The synovial membranes of the articulations are also ex-
posed to many diseases: every time that there occurs any
inflammation, it is accompanied with a very keen pain;
with swelling very sensible to the touch, so that the patient
can not endure the least weight. When the disease is very
violent, there are superadded  general symptoms.  Inflam-
mation may happen in all the articulations,  but especially
in the knee joint, in which we generally observe all the
species of the diseases  of the articulations.  It  ends by
resolution when it is slight; at other times by suppuration,
which is announced by excruciating pains, and which may
terminate even in ataxic symptoms.  We cause all these
symptoms to cease  by evacuating the pus; if it remains
there for any length of time, the bone becomes carious.
t 
21G       DISEASES OF THE SYNOVIAL SYSTEM.
on opening abscesses, we find the synovial membrane very
red on its internal surface.  It seems that the injuries pro-
duced  by pus on this membrane are more sudden than in
the other serous  membranes.   A  sero-purulent effusion
may yet suffer the patient to live for a long time.   Gan-
grene and induration are never met with in the  synovial
system.   A  very frequent termination is chronic inflam-
mation: we can not doubt that it occurs also in the articu-
lations; there is then remission of the symptoms, and the
pain from acute becomes dull.
  The synovial  membranes are torn in some luxations;
then the synovial fluid escapes;  but when the luxation is
reduced a cicatrix is then forming.
  Dropsy of the articulations is a more rare disease than
the perusal  of ancient authors  seems  to indicate.   Or-
dinarily we  observe it in the knee.  It may be produced
by different  causes: first, by chronic inflammation of the
synovial membrane;  by a foreign body which is there de-
veloped; at other times it occurs spontaneously; or finally
by the affections of the neighbouring parts, as in  rheuma-
tism.
  From these considerations we must regard  this disease
as being ordinarily the result of another malady, and not
adopt the  treatment common to all cases.  It is manifested
by a fluctuation, and by a dilatation more or less considera-
ble,  according as the fibrous membrane  is more or less
thick.
  Foreign bodies are pretty often met with in certain ar-
ticulations, especially that of the knee.   Their structure,
volume and  form are variable: sometimes they are osseous;
at others  cartilaginous; they are more or less  numerous;
and incommode more or less, according to the part in which
they are placed.   When they are isolated, it is neverthe-
less probable that they have been produced by the synovial
membrane, otherwise their formation can not  be  account-
ed for. 
DISEASES OF THE CARTILAGINOUS SYSTEM.
217
  The articulations are also subject to anchylosis, which is
only the effect of a primitive  disease.   It may be a true
anchylosis or a false one; i. e., that there may be a reunion
of the extremities which were before  contiguous, or only
impossibility of moving the limb, by some affection of the
cellular tissue, ligament, or neighbouring muscles.
                 CHAPTER  XIX.


         Diseases of the Cartilaginous System.

  Cartilages form a system which is disseminated in al-
most every part of  the body.   They differ according to
the place where they are met with; thus those of the arti-
culations are different from those of the ribs, larynx, &c;
which leads us to suppose that there belong to them differ-
ent  affections.  All  cartilages are remarkable for the ob-
scurity of their vital  properties. We understand but imper-
fectly the inflammation of the articular cartilages; and of all
their diseases, our observation is confined to their swelling
in spontaneous luxation.  This disease occurs ordinarily in
the hip joint, although it does not belong exclusively to this
articulation. Luxation then is not the essential disease, but
the result of the disease of the cartilage. Petit believed that
we ought to ascribe it to the thickening of the synovial fluid,
but post-mortem examinations have corrected this errone-
ous opinion.   Desault had observed that, in the beginning,
the cavity is already almost entirely obliterated by the car-
tilaginous substance which is swollen, whilst the surround-
ing parts are healthy. In a more advanced stage, there oc-
curs an artificial cavity for the head of the displaced bone:
the acetabulum is then lined by an ossified substance.
            28 
 218    DISEASES OF THE C ARTILAOI NOUS SYSTEM.
   Scrofulous taint, and falls, are commonly the predispos-
 ing causes to this malady.  At first  there is pain in the
 articulation; at times  keen, at others dull; difficulty in lo-
 comotion, and especially in performing certain movements
 at a time more or less distant from the attack of the disease;
 sometimes the head of the femur comes out suddenly from
 its cavity; at other  times this dislocation is more  gradual.
 After the luxation there happens  either a lengthening or
 shortening of the thigh, according  as the head of the bone
 is  thrown  above or  below the articulation.   The latter
 case occurs most frequently, and the former is only observ-
 ed when there  is a caries of the inferior part of the aceta-
 bulum.   Very seldom have similar diseases been observed
 in other articulations.
   It is very probable  that, in several  cases the tumours of
 the articulations,  known under the appellation of  white
 swellings, have also their seat in the cartilages. It is very
 difficult to  determine  when  this  is  the case, for they
 may be produced by  an infinity  of causes, which would
"require a peculiar treatment for each one of them.  There
 are cases in  which we know which are the parts primitive-
 ly affected:  for example, in sprains, it is manifest that the
 ligaments are the parts affected.  Sometimes the disease
 begins in the cellular tissue, but this seldom occurs. Should
 the patient  die in this first stage, only one system is then
 found to  be affected, whilst the other part of the articu-
 lation remains untouched; the pain does not yet induce the
 stiffness of the limb.  Sometimes the primitive seat of
 white swellings is in  the bone.  Then, it is sometimes en-
 larged,  and at  others it is in its natural state.   When the
 affection is in  the  cartilage, it may be manifested by the
 same phenomena as  in the articulation of the hip joint.
 Whatever may be the primitive seat, the disease soon ad-
 vances  by contiguity from tissue to tissue, until the disor-
 der extends to  the whole articulation.  A pretty common
 cause of this disease is the suppression of the secretion of 
         DISEASES OF THE MEDULLARY SYSTEM.      219

milk.  Gouty rheumatism, and even gout itself  may also
be numbered amongst its causes.
  As to the other cartilages, their structure exposes them
to very different diseases from those of the articulations.
They are very subject to ossification and caries, as is observ-
ed in the larynx.
  As to other cartilaginous structure, such as those of the
ears, trachea, &c, their diseases are extremely obscure.
                 CHAPTER XX.

          Diseases of the Medullary System.

  The diseases of the medullary system are very common,
though they are very little understood. We can not doubt
in certain cases, that the medullary substance becomes in-
flamed, as in violent and spontaneous pains  manifested in
the middle of the bones.  There often results from it sup-
puration, and then caries of the adjacent parts.  J. L. Petit
relates a case of this nature.  There are some caries in
which it is  probable  that the medullary  system is  essen-
tially affected: it is difficult to recognise them.
  All the authors who have spoken of spina ventosa have
considered  it as a disease of the medulla.  Indeed if we
compare the pains of this disease with the sensibility of
the medullary organ, we shall see the reason of this pro-
bability.
  Spina ventosa is a considerable tumour arising from the
development of the bone and increase of its fleshy granu-
lations.   This disease differs  essentially, according as it
occurs at the extremity or on  the middle of the  bone.
There is a total  difference from these two circumstances.
We do not observe this disease in the short or flat bones, 
220      DISEASES OF THE MEDULLARY SYSTEM.

  When spina ventosa is in the middle of a long bone, tho
pain is, at first, felt in the part, without being increased on
pressure.  There are two well marked stages; the first is
indicated by that spontaneous pain which  is  sometimes
remittent, and continues to last without any external ap-
pearance of disease; in the second  stage, the bone which
was  sound begins to enlarge.  On the  exterior, we feel a
hard tumour; the keen pain goes on progressively increas-
ing; the soft parts inflame, and harden; a fistula soon super-
venes, whence is discharged a  foetid ichor, till the end of
the disease, which brings on death or requires amputation.
  Under the relation in  the condition  of the parts, three
things are to be considered; first,  the medullary substance,
that is found to be converted  into a fungus, permeated by
vessels which easily bleed, as has been observed by Desault;
as to the bone, if it is boiled and exposed, it  presents a
cavity produced by the  destruction of the lanillo?.   The
two surfaces, internal and external, are rough; the parietes
are perforated by several holes which correspond to the
fistula?; the substance of the bone is no longer observed to
be linear. As to the subjacent  parts, we see that they are
converted into a fatty substance with several fistulous pas-
sages.
  Spina ventosa, at the extremities of  bones, is very  dif-
ferent  on autopsic examination, although the  symptoms
are the same.  On the attack there is  a lasting or remit-
tent pain. We observe a tumour, and a fistula.  The prog-
nosis is the same, but post-mortem examination shows the
bone enlarged on all sides; its interior  is full of filaments
and carnosities. The only remedy is amputation. 
DISEASES OF THE OSSEOUS SYSTEM.       221
                CHAPTER  XXI.


           Diseases of the Osseous System.

  The affections of the osseous system are very numerous;
though analogous to those of the other  parts, and the fee-
bleness of its vitality is the only cause which makes a dif-
ference  in its diseases.
  There is  no doubt that inflammation occurs in the
bones. It is observed in fractures for the formation of cal-
lus which is a genuine cicatrix, and only accomplished in
bones after the period of thirty or forty days.  The fleshy
granulations at first grow at the two fractured extremities.
The continual contact in which they are kept, soon induces
the reciprocal adherence of these vegetations.  The calca-
reous phosphate is gradually deposited  by the proper ves-
sels of the bone in the cellular and fleshy texture, which
in this manner assumes an analogous consistence  to that of
the parts it is destined to unite.  Not only is inflammation
observed in the callus, but also  in the exfoliation of the
parts  of  the bones affected by necrosis; and  it  is by an
analogous process that nature throws out the more or less
thick lamella? which have been deprived of life,  either by
a too long exposure to the air, or by any  other cause, &c.
The inflammation  of the subjacent bone  produces the
growth of the fleshy granulation, which  is acquiring vo-
lume, press  on the dead lamella?;  and when many of these
are detached they are called scales; at other times the ex-
foliation  is insensible, which occurs especially when the
lamella? is very thin.  After exfoliation the cicatrix is
formed, which is very sensible,  especially  in superficial 
'■>■■>.>
DISEASES OF THE OSSEOUS SYSTEM.
 bones, as those of the head; and there results the adhesion
 of the bone with the soft parts.
   Caries maintains a chronic state of inflammation in the
 bones, from which is discharged a peculiar sanious fluid,
 that stains the dressings black.  This disease differs essen-
 tially  from necrosis, in which the bone is entirely dead,
 which in caries, on the contrary, the bone is reproduced in
 proportion as it is destroyed.  The seat of caries is more
 especially in the spongy bones, the short ones, and the ex-
 tremities of the long bones; it is occasioned by an infinity
 of causes. ThilWiseased condition of the bones must not be
 confounded with that which is seen in the absorption of the
 sternum, or of any other bone, caused  by  the pressure of
 an aneurism or of a fungus; in which there is then, a loss
 of substance, but  without change of nature.  Sometimes
 the caries is superficial, at others is deeply  situated.   The
 periosteum is always more or  less affected and often indu-
 rated.   The soft parts are infiltrated; sometimes they are
 even changed into a lardacious  substance. There are fistula?
 from which more or less pus is discharged.
   Exostosis is an affection common to all the bones.   Al-
 though authors have considered  it under all its relations,
 nevertheless it is sometimes confounded with other osseous
 tumours, which  arises without doubt from the admission
 of too  many species  in  this disease.   We shall  confine
ourselves to three species, which will be examined separate-
ly; they are the eburneous, or hard (eburnte), the lamellat-
ed (laminae) and the carneous (carnifiS).
  The eburneous exostosis is an osseous tumour, having the
texture of ivory.  Sometimes it is the consequence of a
venereal  taint, at others it is produced by a blow.   It may
present itself in two different manners:  either confined to
a point, or attacking the whole diameter of the bone.   De-
sault had in his possession a specimen of the latter species:
it was  from  a subject, in whom  some bones  of the head
were entirely affected by exostosis.   Generally, exostosis 
           DISEASES OF THE OSSEOUS SYSTEM.        223

is confined to one part of the bone, as it is observed on the
most superficial ones, and  consequently the most exposed
to contusions: such are the bones of  the head, tibia, &c.
Similar tumours  have been  observed to  develop them-
selves  in the interior of the  cranium, without  producing
any lesion in the intellectual functions, because of the slow
mode of development of the exostosis, during which, with-
out doubt, the brain  became  accustomed to this pressure.
They have also occurred in the interior of the pelvis, hin-
dering the birth of the child.   This species of exostosis is
very seldom known  to occur in the short bones.
  The  eburneous tumour is heavier than a portion of bone
of the  same size;  and the  longitudinal direction of the fi-
bres, and  the nourishing blood vessels have disappeared;
this tumour presents a very singular resistance to the saw,
and seems to be  formed by a collection of substance ex-
clusively calcareous.
  As to the adjacent parts they are more or less enlarged;
and, what is very singular, is, that when the  disease em-
braces the bone, the surrounding soft parts  are less affected
than when it occupies only a  single point of its surface.
  We  do not understand the  mechanism of the formation
of these tumours; however,  their progress is very slow,
and resolution or suppuration never occurs in  them.
  Spongy exostosis is better known,and accompanies almost
always caries; and it is met with in every kind of bones,
especially on the extremities of the  long, and within the
short bones. This  enlargement is always consecutive to
a primitive malad)'.   It  is also  observed in the  middle
part of the long bones, as in rachitis, in which the tumours
perceived in the middle of the limbs are only a tumefaction
of the compact tissue, which then become spongy.  This
species presents  an  irregularity in  its structure.   In cer-
tain parts we observe collections of calcareous  substance;
in others we only see  an  areolar tissue.   A  considerable
number of blood vessels  are met with in these tumours, 
2J1         Dl"«E \sks OF THE OSSEOUS SYSTEM.

and  thev are  accompanied  by an ichorous suppuration,
which issues from a greater or smaller number of fistula?.
Spongy exostosis may be considered the first stage of osteo-
sarcoma.
  It  has  been asked if osteo-sarcoma is the cancer of the
bones.  In effect, if we compare  the  excruciating pains
which exist in both diseases, we should be inclined  to be-
lieve them analogous; but if, on the other hand, we examine
them more attentively, we shall find that ostco-sarcoma has
no fungus like cancer; which is observed to be always the
same in all parts, and certainly there exist between cancer
and osteo-sarcoma, differences which do not allow them to
be confounded.  All the bones may become the seat of this
disease, especially the  long ones.  Desault has observed
femurs and ossa innomita attacked  by it.  In its progress,
we remark two well defined periods: the first is distinguish-
ed by pain; difficulty of locomotion; and  lastly engorge-
ment of the part.   In the  second, we are reduced to sim-
ple anatomical inspection; at which time there is great de-
struction of the parts, with fleshy productions, separating,
at intervals, what still remains.  Sometimes  the two ex-
tremities of the bones are unaffected, and the fleshy sub-
stance is permeated by  many blood vessels, which some-
times are simple capillaries, at others present large trunks.
The  adjacent parts are more or less affected; but the  carti-
lages commonly remain sound.  Varicose veins are ob-
served in the neighbourhood; and the soft parts are infil-
trated as in large tumours.
  Fragilitas ossium is rarely an essential malady or oc-
curs  spontaneously; while in cancer, on the contrary, no-
thing is more  frequent.  This extreme brittleness of the
bones may be local or general.   It is only local  when the
bone lies close to a cancerous ulcer, such as the ribs  when
there exists a cancer in the  breast; and  is general  when
the disease has arrived at such a degree, that the cancerous
diathesis is itself become general.  This phenomenon, con- 
            DISEASES OF THE OSSEOUS SYSTEM.        225

 secutive to cancer, does not exclusively belong to it; for it
 is sometimes observed in the ribs after phthisis, or in cases
 of obstruction of the spleen and liver.
   It seems that the proximate cause of this brittleness, is
 the want of gelatinous substance, and not the great quanti-
 ty of calcareous phosphate; for if this was the case, the os-
 seous substance would be only hardened, as in eburneous
 exostosis.   The diminution  of gelatin produces no  differ-
 ence in the shape of the bone, as is observed in those which
 are  burnt.
   Mollities ussium, or softening of the bones, is an oppo-
 site condition to that of their brittleness;  and it seldom
 occurs independently of rachitis.  This appellation of soft-
 ening of the bones, is a vague word, which does not indi-
 cate the disease; indeed, ostea-sarcoma, also,  might be re-
 garded as  the  same affection.  Rachitis is especially con-
 fined to children, but  may, however, appear much later
 than writers  have supposed, as we have  observed in a
 subject fifteen years old.  The vertebra? are particularly
 affected by this disease.   At first, the bones of the  cra-
 nium  increase  either in  extent or volume;  so  that the
 cerebral cavity assumes a greater capacity; however,  this
 development does not affect the bones of the face, and often
 from this disposition  results the precocity of  the intellec-
 tual  faculties.
  As to the vertebral column, it is differently  affected.
 Often  the  spinous  processes are not developed, and  the
 prolongation of the dura-mater is simply  covered by  the
 muscles; but this case is the rarest of all.  Mostly there is
 deformity of the column, which may be curved forwards,
 backwards, or to either side.  The most common deviation
 is backwards, constituting gibbosity; in which the sides
are considerably influenced  by  this unnatural condition.
Often the sternum is deranged in the relation of its consti-
tuent parts; one of which projects forward and produces
another kind of deformity.   When the flexion of the co-
            29 
226        DISEASES OF THE OSSEOUS SYSTEM.

lumn is  lateral, then the sides of the thorax arc singular-
ly distorted, being nearer to the concave, and more remote
from the convex side.  The deformity of the vertebral co-
lumn seldom  extends as far down  as the lumbar region:
when this occurs, the convexity is forwards; and the pelvis
then is very much influenced, and sometimes greatly short-
ened in  its antero-posterior diameter.  Rachitis  seldom
produces any deformity in the bones of the ilium.
  The superior extremities are seldom distorted; but the
inferior are very frequently so.   The legs and thighs are
arched in opposite directions, and  produce  a very great
deformity.  Besides, the extremities of the long bones are
very frequently enlarged and softened, especially when
there occurs a scrofulous diathesis.
  When the disease is cured, the bones acquire more con-
sistence, but never resume  their natural state.   The  ter-
mination is commonly fatal when  it is complicated with
scrofulous or venereal diathesis.
  The persons affected with rachitis have generally charac-
teristic features: such as a peculiar colour of the skin; lively
eyes; a more exquisite sensibility; precocity of mind, lit-
tle muscular energy; and the digestive powers more or less
healthy. 
DISEASES OF THE PILOUS SYSTEM.
227
                CHAPTER XXII.


           Diseases of the Pilous  System.

  The hairs enjoy so obscure a vitality that the greatest
numberoftheiralterationsarenotunderstood.  Thereisonly
Plica Polonica which is susceptible of a particular descrip-
tion. It is not known in France; but is endemic in Poland.
According to the descriptions given of the disease, it is he-
reditary and spontaneous; but not contagious: and is ushered
in by several general  symptoms.  The hairs are matted
and glued into inextricable tangles, grows long and coarse;
they discharge an ichorous fluid  from their extremities,
and bleed when they are cut.   Nevertheless, the subjacent
epidermis is very dry.
  Though the hair has a very feeble vitality, it is influenced
by other diseases; it falls off after a very violent acute affec-
tion, such as an adynamic fever. This  loss of the hair occurs
in two different manners: either the bulb remains, and then
they grow again by degrees; or they fall off, when there is
no hope of their ever growing again, as it is observed in
old people, persons exposed to the sun, and those who are
subject to head-aches.  The hairs  become white by age or
by  violent chagrins.   Whatever  may  be the cause, this
phenomenon is always effected by  the want of nourishing
fluids, which no longer have the  power  to ascend in  the
capillaries.
  Cutting the hairs too soon,  after a severe disease, may
bring on serious  consequences. The same is the case with
the other hairs of the body, the affections of which are  not
understood. 
£~S      DISEASE* OF 'I'll K EIMDEnMOID nvsTKM.
               CHAPTER  XXIII.


         Diseases of the Epidermoid System.

  The epidermis enjoying very littie vitality, must have
very obscure diseases.  They are divided into consecutive
and idiopathic.
  Corns are small tubercles insensible in themselves, but
painful by the compression that they produce on the neigh-
bouring parts.  They are formed by the thickening of the
compressed epidermis.  They generally happen on the feet,
produced by too tight  shoes; and care must be taken to
distinguish them  from warts, which are produced  by the
chorion;  they are organized, and bleed whenever they are
cut too near their base.  They must  also be distinguished
from ognons* which are produced by cartilages.
  The epidermis exfoliates commonly after an affection of
the skin  which it covers;  thus, after erysipelas, small-pox,
phlyctoena?, the membrane is observed to fall off under dif-
ferent shapes.

    • A hard and painful tumour which occurs on the feet.  T.
THE END. 
CONTENTS.
                                                  PAGE
Advertisement of the editor.....3
7 he life and labours of Bichat -----     5
Preliminary Discourse   -    -    -     -    -    -    13
Chap. I.  Consideration on Post-mortem examination    16
Chap. II.  Order to  be  followed  in   Pathological
          Anatomy      ...---    19
Chap. III.  Of the alterations of the fluids     -    -    22
         Art. 1. Of the alterations of the circulating
                 fluids......23
              2. Of the alterations of the exhaled and
                 secreted fluids                     26
              i. Of the fluids formed in a pathologi-
                 cal state.....ib.
Chap. IV.  Of inflammation......27
Chap. V.  Diseases of the. serous system     -    -    36
         Art. 1. Of the inflammation  of the serous
                 membranes                        37
              8. Of chronic inflammation of the se-
                 rous membranes                    40
              3. Of miliary eruptions  of the serous
                 membranes                        42
              4.  Of spots and ossifications of the se-
                  rous membranes                   43
              5.  Of sympathetic affections of the se-
                  rous membranes      ...   44
              6.  Of the diseases of the pleura  -    -   45
                 Of pleurisy.....ib.
                 Of chronic inflammation of the pleura   47
              7. Of the diseases of the pericardium   48
              8. Of the diseases of the peritonaeum   50
                 Of peritonitis     -    -    -    -   ib.
                 Of puerperal fever      -    -    -   53 
*'30
CONTENTS.
                 Of the symptomatic affections of the
                  peritonaeum                        56
          Art. 9. Of diseases of the vaginal tunic     -    57
              10. Of diseases of the arachnoid      -    ib.
                 Of Phrensy.....ib.
                 Of Hydrocephalus                    59
                 Of the symptomatic affections of the
                  arachnoid.....60
                 Of spina bifida    ...     -    ib.
 Chap. VI. Diseases of the mucous system     -     -    61
          Art. 1. Of inflammation of the mucous sys-
                  tem    ......62
              2. Of hemorrhages of the mucous mem-
                  branes      .....64
              3. Of Aphthae.....66
              4. Of Fungi     -----    t"6.
              5. Of the diseases of the conjunctiva  -    67
              6.  Of diseases of the  pituitary mem-
                  brane  ......69
              7. Maladies of the mucous membrane
                  of the mouth    -    -     -    -   71
             8.  Diseases  of the membrane of  the
                  Pharynx    -----   74
             9.  Diseases of the membranes of the
                  larynx and bronchiae                75
              10. Symptomatic affections of the pul-
                  monary mucous membrane  -    -   80
              11. Diseases of the oesophagus   -    -   81
              12. Diseases of the mucous membranes
                  of the stomach  -    -    -    -   81
             13. Diseases of the mucous membranes
                  of the intestines                     86
                Of Dysentery     ....   ibt
             14. Diseases of the mucous membranes
                  of the glans penis     -    -    -   91
             15. Diseases of the mucous membranes
                  of the urethra                      93
             16. Diseases of the mucous membranes
                  of the  vagina                       95
             17. Diseases of the mucous membranes
                  of the matrix                       96
             18. Diseases of the mucous membranes
                  of the bladder                      99
Chap. VII. Diseases of the cellular tissue     -    -   100
         Art. 1. Of affections from contiguity of the
                 cellular tissue   -    -     -    -   113 
CONTENTS.
231
                                                   PACK
          Art. 2.  Of the sympathetic affections of the
                  cellular tissue    -    -    -    -  115
Chap. VIII. Pulmonary diseases    -    -    -    -  116
           Art. 1. Inflammation of the lungs   -    -  117
               2. Of phthisis      -    -    -    -  120
               3. Of calculi.....127
               4. Asphyxia.....129
Chap. IX. Diseases of the glands   ...    -  131
           Art. 1. Of the diseases of  the lachrymal
                   gland.....131
               2. Of the diseases of the salivary glands  132
               3. Diseases of the liver   ...  133
               6.  Ditto.   do.  do.    -    -    -  139
               7. Diseases of the kidneys     -     -  143
               8. Diseases of the prostate gland    -  147
               9. Diseases of the testicles     -     -  148
               10. Diseases of  the mammae    -     -  151
               11. Diseases of  the spleen      -     -  153
               12. Diseases of  the thyroid gland    -  154
Chap. X. Diseases of the cutaneous system    -     -  155
           Art. 1. Of erysipelas    ...     -  ib.
               2. Burns       -  .  -    -    -     -  158
               3. Of the measles   -    -     -     -  159
               4. Small-pox.....160
               5. Of scarlatina    -    -     -     -  162
               6. Of tetter.....163
               7. Tinea capitis    -                 164
               8. Of the itch      -    -     -     -  165
               9. Symptomatic affections of the skin  166
Chap. XI. Diseases of the muscles of organic life    -   169
           Art. 1. Diseases of the heart  -             169
               2. Diseases of the digestive muscular
                   tissue      -    -    .     -     -   174
               3. Diseases of the uterine tissue     -  175
Chap. XII.  Diseases of the muscles of animal life   -   177
       XIII. Diseases of the arterial system    -     -   182
       XIV. Diseases of the venous system    -     -   186
       XV.  Diseases of the nervous system    -     -   191
            Art. 1.  Of apoplexy    -     -     -     -   192
               2.  Of Fungi.....196
               3.  Of Fatuity      .•     -     -     -   197
               4.  Of symptomatic affections of the
                  brain       .....198
               5.  Diseases of the nerves  •    -     -   199 
83*
CONTENTS.
                                                   PAOI
Chap. XVI. Diseases of the absorbent system      -  202
            Art. 1. Diseases of the lymphatic glands   ib.
                2. Diseases of the absorbent vessels  207
Chap. XVII. Diseases of the fibrous  system  -    -  209
            Art. 1. Diseases of the dura-mater     -   ib.
                2. Diseases of the periosteum      -  210
                3. Diseases of the aponeurosis     -  212
                4. Diseases of the ligaments  -    -   ib.
                5. Diseases of the tendons   -    -  213
Chap. XVIII. Diseases of the synovial system      -  214
      XIX.   Diseases of the cartilaginous system -  217
      XX.    Diseases of the medullary system    -  219
      XXI.   Diseases of the osseous system -    -  221
      XXII. Diseases of  the pilous system  -    -  227
      XXIII. Diseases of  the epidermoid system   -  228 
 
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