486

gans of the body, undergoes a gradualabsorption and decay when it is renderedincapable of executing its function. Incases of internal inflammation, producedby penetrating wounds of the eye, atro-phia is a frequent occurrence. When thisatrophia commences, you may feel the

globe soft and flaccid, and when the lidsare closed you may observe a depressioninstead of the ordinary convexity. The

eye will continue to shrink up until itcomes to almost the size of a large pea,or bean, and in the centre of this struc-ture you may perceive a small spot of thecornea remaining, and somewhat of theappearance of an iris. It may be con-sidered to be the favourable terminationof a case of internal inHammation ; of sncha case, I mean, in which the functions ofthe internal part of the organ have beendestroyed,becausethe patient is no longerliable to the risk of staphyloma, or pro.trusion of the globe, to cause irritationor relapses of a dangerous inflammatoryprocess. The state of atrophia is, in itself,remediless ; I have never seen a case inwhich, by any method, the progiess ofthe affection eould be put a stop to.

LECTURESON THE

THEORY AND PRACTICE OF PHYSIC,

BY DR. CLUTTERBUCK.

Theatre, General Dispensary, Aldersgate-street.

LECTURE XXXII.

Diseases of the Absorbing System.Gentlemen,THE food having undergone the neces-

sary changes in the organs of digestion,by which it is converted into a I’niJk-likeflnid’termed chyle, we have next to tracethe route of this from the alimentarycanal into the left subclavian vein, inorder to be mixed with the general massof blood, The lacteal vessels, opening Ievery where on the internal surface ofthe small intestines, are the immediatechannels through which the chyle entersthe general system. Now as these ves-sels make a part only of the generalapparatus by which foreign matters areintroduced into the body,and as this orderof parts are peculiar in their structure aswell as in their office, the diseases towhich they are liable cannot be suffi-cieutly understood, without brietfy ad-

verting to the physiology of these parbaltogether.The absorbing system, then, consists of

a set of vessels, the principal trunks ofwhich enter the great veins near to the

heart. From these trunks, the absorbentsramify throughout the body, in company,for the most part, with the blood vessels.They are, however, much le.s conspicuousthan these, partly on account of theirminuteness and transparency, and partlyfrom the colourless nature of the fluidthey mostly convey. The absorbing systemis commonly divided into two branches;.the one opening, as before observed, up-on the internal surface of the alimentarycanal, for the purpose of absorbing or

taking up the nutritious and digestedparts of the food in the form of cliyle, andwhich, from the white colour of this fluid,are termed the lacteal absorbents; theother branch, the lymphatic absorbQuts, isdistributed every where throughout thebody, opening on every surface, and iutoevery cavity and interstice, ready to takein such matters as are presented to themThe fluid absorbed by the latter beingcolourless like water, they have beentermed lymphatics accordingly, and some-times interstitial absorbents ; though thisterm, of course, does not apply to thosewhich open into the greater cavities, orupon the external and other surfaces ofthe body. These two branches, however,of the absorbing system, discharge them-selves into one common trunk, the thora-cic duct, as it is called, placed along thefront of the spine, and are in all essen-tial respects the same. The absorbentsresemble veins more than arteries, the

fluid they convey moving, like the venousblood, from the extreme branches to.

wards the trunks ; while, like veins, theyare also furnished in various parts withvalves that open towards the heart, so asto prevent a retrograde course oftheflnid,when they are subjected to mechanicalpressure of any kind.The function performed by this order

of vessels, is sufficiently ascertained.-They are in fact the principal, if not theonly channels, by which foreign mattersmake their way into the system. Theyalso serve to take up the lymph or fluidthat is constantly escaping from the ex.haling extremities of the arterial system,into the different cavities and intersticesof the body.The manner in which they accomplish

their purpose, is however a matter ofdispute among physiologists; some ofwhom consider them as mere pa6,iivetubes of conveyance, while others, withmore probability, imagine them to heendued with an active or muscular power,

487

by the exertion of which they drink npor absorb the fluids or other matters pre-

’

sentedto them; and, by the same power,convey them onwards into the generalcircnlation. It is true that all this can-not be made a matter of demonstration,on account of the tenuity and transpa-

, rency of those vessels ; but so many phe-nomenaconcur in proof of it, and whichcannot, as I think, be otherwise account-ed for, that I shall consider the point assufficiently established, without leadingyon into further controversy. I shallonly add, that the extremities or months,as they are aptly termed, of these vessels,not only evince an active power, but evenan elective one; for, while they greedilyimbibe some things, they as pertinaciorrslyreject others; a proof this of a high stateof organisation.The absorbents, both lacteals and lym-

phatics, in their course, enter what, (fromtheir rounded form,) are termed glands;those belonging to the lacteals being si-tuated between the laminae of the mesen-tery, and thence called the mesenteric

glands; the others, the lymphatic glands,these being found in various parts in thecourse of the lymphatic vessels, but mostconspicuously in the groin, arm-pits, sidesof the neck, and under the lower jaw.For the particular situation of others, Imust refer yon to your anatomy. Thestrncture of these glands is every wherethe same. They are in a considerabledegree vascular, and possessed of a mo-derate share only of sensibility and irri-tability. Their function is nnknown,though it is probable they effect some ini-portant change in the fluid that passesthrough them.The disordered states to which this

system of parts is liable, are but super-ficially known, and have been alreadyreferred to in a general way in our formertectnres: so that I have not much to addto the subject.A vitiated or imperfect quality of the

chyle itself, may be supposed occasionallyto exist; for these would seem to be ne-cessary consequences of either the use ofimproper food, or of an imperfect diges-tion. And if the chyle were really ineither of these states, it must follow thatthe nutrition of the body would be im-perfectly performed, and the generalhealth suffer in consequence, and thatperhaps in a variety of ways. But allthis is merely matter of inference, notrestin- upon any actual observation, andtherefore not applicable to practice. AllI can say to you practically upon thispoint is, that when the general health isobiiously impaired, and we find reasonta believe, either that errors in diet exist,

or that the digestive function is imper-fectly performed, our endeavours shouldbe directed to the correction of these, bymeans adapted to the particular occasion.The absorbents themselves, either

lacteals or lymphatics, may be supposedto be too active on some occasions;and on others, the reverse. Nor is thereany difficulty in concluding them to beaffected with paralysis, or total want ofpower to act. Their action too, like thatof the blood-vessels and other parts, in-stead of being simply increased, or simplydiminished, may be perverted, so as to

give rise to material alterations of thestate of the body altogether. It may notbe useless to direct your attention to the

probable consequences of such disorderedstates of action in the absorbent vessels,although as I have just hinted to you,our knowledge of the subject is by nomeans very precise or satisfactory.Too great activity of the lacteal vessels

would probably call for a larger or morefrequent supply of nutriment, and thusperhaps lead to a phlethoric state of thesystem. A similar state of the interstitialabsorbents would give rise to emaciationor general wasting of the body, not of thefluids merely, but of the solids also ; for itcannot be doubted that the absorbentshave the power of removing the hardestparts of the body, though we may be un-ahle to detect the exact manner of theiracting.Such an occurrence is in fact observed

to, take place in febrile disorders in gene-ral, but most strikingly in what iscalled hectic fever, produced by pul-monary consumption. A large and con-tinned use of mercury is another pow-erful exciting canse of action to the ab-sorbents ; and induces, in consequence, aremarkable degree of emaciation.

, I know of no reason for believing thatsuch general wasting of the body, occa-sioned by excess of action in the ab-

sorbent vessels, is ever a primary disease,although you will find it so laid down innosological writings, under the names ofatrophy and marasmus, which are thereclassed among original and independentdiseases. Being, however, merely se-

condary states, the result of previouslocal disease, the treatment is to be di-rected first and chiefly to the primary af-fection, whatever this may be. But asthe local disease does not always admitof remedy, (as is generally the case in

pulmonary consumption, at least whenfar advanced,) it is still an object of im-portance in practice to diminish, as far aspossible, the excess of action in the ab-sorbents upon which the emaciation prin-cipally depends. This state of the ab.

488

sorbents being generally accompanied Iwith increased arterial action, requiresthe use of remedies of a sedative or

antiphlogistic nature, such its small andrepeated bleedings, and the digitalis; to

which, I think, might be occasionally ad-ded the super-acetate of lead, though this onother accountsis liable to serious objections.The interstitial absorbents of particular

parts may be excited to increased actionin a variety of ways, the effects dependingupon the nature and violence of the meansused. Heat, pressure, aad friction in dif-ferent degrees, may be particularlymentioned here, as means by which notonly effused fluids, but the solids also maybe removed, and the bulk of parts di-minished.On the other hand, want of activity in

the lacteal vessels, and still more a

paralytic state of these vpssels, (if in.deed such a state ever exists,) must ne-cessarily impede the supply of the body,however ample the supply of food, orhowever perfect the performance of theother parts of the digestive function.But such states we in reality know littleof, though it is not difficnlt to conceivethem to exist. Inactivity of the l,1Jm-phatic absorbents is probably no unfre-quent occurrence, and may be the causeof some dropsical accumulations, both inthe cavities and interstices of the body.It is not however easy to distinguishdropsies of this kind from snch as areoccasioned by increased exhalation, whichis undoubtedly a mnch more frequentcause of dropsy. That the lymphaticvessels may be paralyzed, and so renderedunable to perform their office, seems tobe clearly ascertained in the case ofhemiphlegia, many instauces of which areaccompanied with an anasarcous state ofthe paralytic limbs.Want of action in the lymphatic ves-

sels in general, would be remedied, to acertain extent, by heat, and fi’iction, andstimulant drugs of various kinds ; but inthe use of such means, you are not to for-get that no new power of action is givento those vessels; it is merely calling intogreater action that power which alreadyexists, and which is liable to be exhaustedby the over-exertion. Thus, though a tem-porary effect is produced of the kind youwish, it may be far from permanent,while a state of still greater weaknessmay be thus produced; so that you mayend wors than you began. This exhaust-

ing effect of stimulant or exciting meansof cure, is very apt to be overlooked inpractice, and is therefore well deservingof your attention.A perverted or unnatural action of the

absorbent vessels, is a state sufficiently

easy to conceive, altlongh we have littldistinct knowledge on the subject. Sucha state, however, would assist in explain-ing a variety of mal-conforinalioni, whicha reference to the blood-vessels alone, asthe constructive part of the machinery ofthe body, could scarcely render intelli.gihle. It is plain that the figure of thebody, both ax a whole and in its separateparts, must depend in a great degreeupnn the absorbents, and oot upon theblood vessels exclusively. This you willfind very well illustrated by Mr. JohnHunter, in his Treatise o2,t the Blood, whowas accustomed to call the absorbentsthe modellers, and the blood vessels thebuilders of the machine.The absorbents, in common with all ani-

mated structures, are liable to inflamma-tion, which may either impede or disordertheir function, as I have already ex-

plained to you.The glands belonging to the absorbent

system, namely, the mesenteric and lym-phatic glands, are freqnently the subjectsof disease, and that sometimes of consi-derable importance. The only morbidstate of these glands that wehaveanydistinct knowledge of, appears to be iii-flammation in different degrees. This,however, is commonly of a chronic andindolent kind, and by no means easy ofremoval. When the glands of the mesen-tery pretty generally are in this state,(a frequent occurrence in children,) theswelling which they undergo in conse-quence, and which is easily ascertained

by the enlarged and hardened state ofthe abdomen, not only disturbs the regu-lar actions of the alimentary canal alto-gether, but appears to intercept, by pres-sure, the passage of the chyle in its course;by which the supply of the body is in agreat degree prevented. Hence we findthat, although food is taken voraciously,and in large quantity, in many cases, thebody wastes and becomes emaciated inthe highest degree. A similar affectionof the lymphatic glands in other parts,though not productive of such serious

consequences, may yet, by interruptingthe passage of the lymph, become a causeof that bloated state of the face, whichoften attends the swelling of the sub-

maxillary glands: and the same with reogard to other parts.That peculiar state of disease termed

struma or scrofula, is generally consi-dered as an affection of the lymphatic orabsorbent system, for no reason that I canperceive, except that the glands of thissystem most frequently participate in thedisease. This, however, appears to meto be much too limited a view of thesubject ; for though it may be true that

489

the glands are more frequently affectedthan other parts, they are by no means ex-clusively so; and, in some instances, notat all Scrofula, in fact, is so peculiarin its characters, and in its treatmentand so nnlike in these respects to com-

mon maladies, as to jtistity our classingit among specific diseases, with which,therefore, it will hereafter be considered.Common inflammation of the absorbent

glands, calls only for common means ofcure. These structures, however, are

natnrally indolent and inactive, and henceare but rarely the subjects of acute in-flammation; and as such glandular affec-tions are most frequently met with inpersons of no great general strength, itis seldom that remedies of a very activekind are required, or are even admissible.In relaxed habits, where the solids ap-pear to want firmness, and where thepulse is soft and weak, experience provesthat tonic, and even moderately stimu- ilant remedies, (such as the ammonia insmall doses, together with the cold bath,)are the most successful means of cure.In siieli cases, also, a solid, animal, andeven savoury diet, is to be preferred, sofar, at least, as the appetite calls for.The prejodice so generally entertainedagainst salt and salted provisions, as

tending to create humours, as the expres-sion is, is entirely without foundation ;while the practice to which such a notionleads, namely, the frequent use ot pur-gatives, for carrying off the supposed illhumours, is not only unnecessary, but in-jllrions. This applies particularly to thecase of delicate children, to whom themost drastic purges, such as senna, scam-mony, and calomel, are often unsparinglyprescribed, in order to bring down thebig and hard bellies, so frequently metwithin them. This practice is founded inthe mistake of supposing, that the swell-ing lepends wholly upon a loaded stateof bowels, and which it requires purga-tives, therefore, to subdue. A dose ofcalomel and scammouy, or jalap, is ac-cordingly administered; bad stools areprorured, and the distention is somewhatlessened. This is an encouragement topursue the practice from day to day, inthe expectation that the foul matter willbe at last all carried off, and the swellingof the belly reduced. But neither theone nor the othtr in general happens.The practitioner is defeated in his pur-pose, and the child suffers extremely,both under the operation of such irritat-ing medicines, and in his general healthafterwards,Now there is no difficulty in understand-

ing all this, if you but reflect a little.The first cause of all the mischief, is the

swelled state of the mesenteric glands.This, partly by sympathy, and partly bymechanical pressure, impedes the regularaction of the intestines, and occasionssome degree of costiveness, by which theswelling is further augmented. The

swelling of the glands is the result of in-flammation, though slight in degree, andindolent in its nature. By the use ofdrastic purgatives, the parts are furtherirritated ; and the inflammation, and con-sequent swelling, are increased. Theunnatural and offensive state of the eva-cuations, is generally produced by themedicine itself ; for in the healthiestchildren, the stools will assume this cha-racter from the use of calomel and scam-moity. It is true, that by the operationof the purgative, the intestines are emp-tied of their contents, and the bulk issomewhat lessened; but the increasedexertion of one day is followed by a stateof inaction for two or three days after-wards, and a fresh accumulation ensues.So that nothing is gained in this tespect,while the general health is injured by theviolent operation of the medicines, and thedisorder excited in the organs of nutritionaltogether.

In treating such cases, you should bearin mind that the foundation of the dis-ease is inflammation, but that of an indo-lent kind, and taking place generally inweak and delicate habits. All the rest is

secondary, and of inferior moment. Youshould consider, therefore, what is the

proper treatment of inflammation, undersuch circumstances. In general, it willbe unnecessary to draw blood; thoughwhere much of a febrile state is present,with a tolerable share of strength, eventhis may be required to a timited extent.Stimulating the skin of the abdomen byammonia, or the tartarised antimony, isoften useful. Where no febrile symp-toms are present, the infusion of gentian,with a few grains of the carbonate of am-monia, will keep up a regular action of thealimentary canal, and render purgativesunnecessary. At all events, none butthose of a mild description should beused, and that not too frequently.

I might next treat, gentleman, of thediseases of the organs of respiration, forthese must act upon the chyle, in order to

convert it into perfect blood. But as, inorder to reach the organs of respiration,the lungs, the chyle must be first carried to

the heart, along with the venous bloodcoming from every part ot the body, itwill perhaps be most in order, and Ithink most useful also, to treat, in thefirst place, of the sang uiferous system,and its diseases, which, therefore, willmake the subject of our next lecture.