6. The puncta lacrymalia, with the lacrymal sack and nasal duct, compose a complete gland, and much resemble the intestinal ca.n.a.l: the puncta lacrymalia are absorbent mouths, that take up the tears from the eye, when they have done their office there, and convey them into the nostrils; but when the nasal duct is obstructed, and the lacrymal sack distended with its fluid, on pressure with the finger the mouths of this gland (puncta lacrymalia) will readily disgorge the fluid, they had previously absorbed, back into the eye.
7. As the capillary vessels receive blood from the arteries, and separating the mucus, or perspirable matter from it, convey the remainder back by the veins; these capillary vessels are a set of glands, in every respect similar to the secretory vessels of the liver, or other large congeries of glands. The beginnings of these capillary vessels have frequent anastomoses into each other, in which circ.u.mstance they are resembled by the lacteals; and like the mouths or beginnings of other glands, they are a set of absorbent vessels, which drink up the blood which is brought to them by the arteries, as the chyle is drank up by the lacteals: for the circulation of the blood through the capillaries is proved to be independent of arterial impulse; since in the blush of shame, and in partial inflammations, their action is increased, without any increase of the motion of the heart.
8. Yet not only the mouths, or beginnings of these anastomosing capillaries are frequently seen by microscopes, to regurgitate some particles of blood, during the struggles of the animal; but retrograde motion of the blood, in the veins of those animals, from the very heart of the extremity of the limbs, is observable, by intervals, during the distresses of the dying creature. Haller, Elem. Physiol. t. i. p. 216. Now, as the veins have perhaps all of them a valve somewhere between their extremities and the heart, here is ocular demonstration of the fluids in this diseased condition of the animal, repa.s.sing through venous valves: and it is hence highly probable, from the strictest a.n.a.logy, that if the course of the fluids, in the lymphatic vessels, could be subjected to microscopic observation, they would also, in the diseased state of the animal, be seen to repa.s.s the valves, and the mouths of those vessels, which had previously absorbed them, or promoted their progression.
III. _Communication from the Alimentary Ca.n.a.l to the Bladder, by means of the Absorbent Vessels._
Many medical philosophers, both ancient and modern, have suspected that there was a nearer communication between the stomach and the urinary bladder, than that of the circulation: they were led into this opinion from the great expedition with which cold water, when drank to excess, pa.s.ses off by the bladder; and from the similarity of the urine, when produced in this hasty manner, with the material that was drank.
The former of these circ.u.mstances happens perpetually to those who drink abundance of cold water, when they are much heated by exercise, and to many at the beginning of intoxication.
Of the latter, many instances are recorded by Etmuller, t. xi. p. 716.
where simple water, wine, and wine with sugar, and emulsions, were returned by urine unchanged.
There are other experiments, that seem to demonstrate the existence of another pa.s.sage to the bladder, besides that through the kidneys. Thus Dr.
Kratzenstein put ligatures on the ureters of a dog, and then emptied the bladder by a catheter; yet in a little time the dog drank greedily, and made a quant.i.ty of water, (Disputat. Morbor. Halleri. t. iv. p. 63.) A similar experiment is related in the Philosophical Transactions, with the same event, (No. 65, 67, for the year 1670.)
Add to this, that in some morbid cases the urine has continued to pa.s.s, after the suppuration or total destruction of the kidneys; of which many instances are referred to in the Elem. Physiol. t. vii. p. 379. of Dr.
Haller.
From all which it must be concluded, that some fluids have pa.s.sed from the stomach or abdomen, without having gone through the sanguiferous circulation: and as the bladder is supplied with many lymphatics, as described by Dr. Watson, in the Philos. Trans. v. 59. p. 392. and as no other vessels open into it besides these and the ureters, it seems evident, that the unnatural urine, produced as above described, when the ureters were tied, or the kidneys obliterated, was carried into the bladder by the retrograde motions of the urinary branch of the lymphatic system.
The more certainly to ascertain the existence of another communication between the stomach and bladder, besides that of the circulation, the following experiment was made, to which I must beg your patient attention:--A friend of mine (June 14, 1772) on drinking repeatedly of cold small punch, till he began to be intoxicated, made a quant.i.ty of colourless urine. He then drank about two drams of nitre dissolved in some of the punch, and eat about twenty stalks of boiled asparagus: on continuing to drink more of the punch, the next urine that he made was quite clear, and without smell; but in a little time another quant.i.ty was made, which was not quite so colourless, and had a strong smell of the asparagus: he then lost about four ounces of blood from the arm.
The smell of asparagus was not at all perceptible in the blood, neither when fresh taken, nor the next morning, as myself and two others accurately attended to; yet this smell was strongly perceived in the urine, which was made just before the blood was taken from his arm.
Some bibulous paper, moistened in the serum of this blood, and suffered to dry, shewed no signs of nitre by its manner of burning. But some of the same paper, moistened in the urine, and dried, on being ignited, evidently shewed the presence of nitre. This blood and the urine stood some days exposed to the sun in the open air, till they were evaporated to about a fourth of their original quant.i.ty, and began to stink: the paper, which was then moistened with the concentrated urine, shewed the presence of much nitre by its manner of burning; whilst that moistened with the blood shewed no such appearance at all.
Hence it appears, that certain fluids at the beginning of intoxication, find another pa.s.sage to the bladder besides the long course of the arterial circulation; and as the intestinal absorbents are joined with the urinary lymphatics by frequent anastomoses, as Hewson has demonstrated; and as there is no other road, we may justly conclude, that these fluids pa.s.s into the bladder by the urinary branch of the lymphatics, which has its motions inverted during the diseased state of the animal.
A gentleman, who had been some weeks affected with jaundice, and whose urine was in consequence of a very deep yellow, took some cold small punch, in which was dissolved about a dram of nitre; he then took repeated draughts of the punch, and kept himself in a cool room, till on the approach of slight intoxication he made a large quant.i.ty of water; this water had a slight yellow tinge, as might be expected from a small admixture of bile secreted from the kidneys; but if the whole of it had pa.s.sed through the sanguiferous vessels, which were now replete with bile (his whole skin being as yellow as gold) would not this urine also, as well as that he had made for weeks before, have been of a deep yellow? Paper dipped in this water, and dryed, and ignited, shewed evident marks of the presence of nitre, when the flame was blown out.
IV. _The Phaenomena of the Diabetes explained, and of some Diarrhoeas._
The phenomena of many diseases are only explicable from the retrograde motions of some of the branches of the lymphatic system; as the great and immediate flow of pale urine in the beginning of drunkenness; in hysteric paroxysms; from being exposed to cold air; or to the influence of fear or anxiety.
Before we endeavour to ill.u.s.trate this doctrine, by describing the phaenomena of these diseases, we must premise one circ.u.mstance; that all the branches of the lymphatic system have a certain sympathy with each other, insomuch that when one branch is stimulated into unusual kinds or quant.i.ties of motion, some other branch has its motions either increased, or decreased, or inverted at the same time. This kind of sympathy can only be proved by the concurrent testimony of numerous facts, which will be related in the course of the work. I shall only add here, that it is probable, that this sympathy does not depend on any communication of nervous filaments, but on habit; owing to the various branches of this system having frequently been stimulated into action at the same time.
There are a thousand instances of involuntary motions a.s.sociated in this manner; as in the act of vomiting, while the motions of the stomach and oesophagus are inverted, the pulsations of the arterial system by a certain sympathy become weaker; and when the bowels or kidneys are stimulated by poison, a stone, or inflammation, into more violent action; the stomach and oesophagus by sympathy invert their motions.
1. When any one drinks a moderate quant.i.ty of vinous spirit, the whole system acts with more energy by consent with the stomach and intestines, as is seen from the glow on the skin, and the increase of strength and activity; but when a greater quant.i.ty of this inebriating material is drank, at the same time that the lacteals are excited into greater action to absorb it; it frequently happens, that the urinary branch of absorbents, which is connected with the lacteals by many anastomoses, inverts its motions, and a great quant.i.ty of pale unanimalized urine is discharged. By this wise contrivance too much of an unnecessary fluid is prevented from entering the circulation--This may be called the drunken diabetes, to distinguish it from the other temporary diabetes, which occur in hysteric diseases, and from continued fear or anxiety.
2. If this idle ingurgitation of too much vinous spirit be daily practised, the urinary branch of absorbents at length gains an habit of inverting its motions, whenever the lacteals are much stimulated; and the whole or a great part of the chyle is thus daily carried to the bladder without entering the circulation, and the body becomes emaciated. This is one kind of chronic diabetes, and may be distinguished from the others by the taste and appearance of the urine; which is sweet, and the colour of whey, and may be termed the chyliferous diabetes.
3. Many children have a similar deposition of chyle in their urine, from the irritation of worms in their intestines, which stimulating the mouths of the lacteals into unnatural action, the urinary branch of the absorbents becomes inverted, and carries part of the chyle to the bladder: part of the chyle also has been carried to the iliac and lumbar glands, of which instances are recorded by Haller, t. vii. 225. and which can be explained on no other theory: but the dissections of the lymphatic system of the human body, which have yet been published, are not sufficiently extensive for our purpose; yet if we may reason from comparative anatomy, this translation of chyle to the bladder is much ill.u.s.trated by the account given of this system of vessels in a turtle, by Mr. Hewson, who observed, "That the lacteals near the root of the mesentery anastomose, so as to form a net-work, from which several large branches go into some considerable lymphatics lying near the spine; and which can be traced almost to the a.n.u.s, and particularly to the kidneys." Philos. Trans. v. 59. p.
199--Enquiries, p. 74.
4. At the same time that the urinary branch of absorbents, in the beginning of diabetes, is excited into inverted action, the cellular branch is excited by the sympathy above mentioned, into more energetic action; and the fat, that was before deposited, is reabsorbed and thrown into the blood vessels; where it floats, and was mistaken for chyle, till the late experiments of the ingenious Mr. Hewson demonstrated it to be fat.
This appearance of what was mistaken for chyle in the blood, which was drawn from these patients, and the obstructed liver, which very frequently accompanies this disease, seems to have led Dr. Mead to suspect the diabetes was owing to a defect of sanguification; and that the schirrosity of the liver was the original cause of it: but as the schirrhus of the liver is most frequently owing to the same causes, that produce the diabetes and dropsies; namely, the great use of fermented liquors; there is no wonder they should exist together, without being the consequence of each other.
5. If the cutaneous branch of absorbents gains a habit of being excited into stronger action, and imbibes greater quant.i.ties of moisture from the atmosphere, at the same time that the urinary branch has its motions inverted, another kind of diabetes is formed, which may be termed the aqueous diabetes. In this diabetes the cutaneous absorbents frequently imbibe an amazing quant.i.ty of atmospheric moisture; insomuch that there are authentic histories, where many gallons a day, for many weeks together, above the quant.i.ty that has been drank, have been discharged by urine.
Dr. Keil, in his Medicina Statica, found that he gained eighteen ounces from the moist air of one night; and Dr. Percival affirms, that one of his hands imbibed, after being well chafed, near an ounce and half of water, in a quarter of an hour. (Transact. of the College, London, vol. ii. p. 102.) Home"s Medic. Facts, p. 2. sect. 3.
The pale urine in hysterical women, or which is produced by fear or anxiety, is a temporary complaint of this kind; and it would in reality be the same disease, if it was confirmed by habit.
6. The purging stools, and pale urine, occasioned by exposing the naked body to cold air, or sprinkling it with cold water, originate from a similar cause; for the mouths of the cutaneous lymphatics being suddenly exposed to cold become torpid, and cease, or nearly cease, to act; whilst, by the sympathy above described, not only the lymphatics of the bladder and intestines cease also to absorb the more aqueous and saline part of the fluids secreted into them; but it is probable that these lymphatics invert their motions, and return the fluids, which were previously absorbed, into the intestines and bladder. At the very instant that the body is exposed naked to the cold air, an unusual movement is felt in the bowels; as is experienced by boys going into the cold bath: this could not occur from an obstruction of the perspirable matter, since there is not time, for that to be returned to the bowels by the course of the circulation.
There is also a chronic aqueous diarrhoea, in which the atmospheric moisture, drank up by the cutaneous and pulmonary lymphatics, is poured into the intestines, by the retrograde motions of the lacteals. This disease is most similar to the aqueous diabetes, and is frequently exchanged for it: a distinct instance of this is recorded by Benningerus, Cent. v. Obs. 98. in which an aqueous diarrhoea succeeded an aqueous diabetes, and destroyed the patient. There is a curious example of this, described by Sympson (De Re Medica)--"A young man (says he) was seized with a fever, upon which a diarrhoea came on, with great stupor; and he refused to drink any thing, though he was parched up with excessive heat: the better to supply him with moisture, I directed his feet to be immersed in cold water; immediately I observed a wonderful decrease of water in the vessel, and then an impetuous stream of a fluid, scarcely coloured, was discharged by stool, like a cataract."
7. There is another kind of diarrhoea, which has been called caeliaca; in this disease the chyle, drank up by the lacteals of the small intestines, is probably poured into the large intestines, by the retrograde motions of their lacteals: as in the chyliferous diabetes, the chyle is poured into the bladder, by the retrograde motions of the urinary branch of absorbents.
The chyliferous diabetes, like this chyliferous diarrhoea, produces sudden atrophy; since the nourishment, which ought to supply the hourly waste of the body, is expelled by the bladder, or r.e.c.t.u.m: whilst the aqueous diabetes, and the aqueous diarrhoea produce excessive thirst; because the moisture, which is obtained from the atmosphere, is not conveyed to the thoracic receptacle, as it ought to be, but to the bladder, or lower intestines; whence the chyle, blood, and whole system of glands, are robbed of their proportion of humidity.
8. There is a third species of diabetes, in which the urine is mucilaginous, and appears ropy in pouring it from one vessel into another; and will sometimes coagulate over the fire. This disease appears by intervals, and ceases again, and seems to be occasioned by a previous dropsy in some part of the body. When such a collection is reabsorbed, it is not always returned into the circulation; but the same irritation that stimulates one lymphatic branch to reabsorb the deposited fluid, inverts the urinary branch, and pours it into the bladder. Hence this mucilaginous diabetes is a cure, or the consequence of a cure, of a worse disease, rather than a disease itself.
Dr. Cotunnius gave half an ounce of cream of tartar, every morning, to a patient, who had the anasarca; and he voided a great quant.i.ty of urine; a part of which, put over the fire, coagulated, on the evaporation of half of it, so as to look like the white of an egg. De Ischiade Nervos.
This kind of diabetes frequently precedes a dropsy; and has this remarkable circ.u.mstance attending it, that it generally happens in the night; as during the rec.u.mbent state of the body, the fluid, that was acc.u.mulated in the cellular membrane, or in the lungs, is more readily absorbed, as it is less impeded by its gravity. I have seen more than one instance of this disease. Mr. D. a man in the decline of life, who had long accustomed himself to spirituous liquor, had swelled legs, and other symptoms of approaching anasarca; about once in a week, or ten days, for several months, he was seized, on going to bed, with great general uneasiness, which his attendants resembled to an hysteric fit; and which terminated in a great discharge of viscid urine; his legs became less swelled, and he continued in better health for some days afterwards. I had not the opportunity to try if this urine would coagulate over the fire, when part of it was evaporated, which I imagine would be the criterion of this kind of diabetes; as the mucilaginous fluid deposited in the cells and cysts of the body, which have no communication with the external air, seems to acquire, by stagnation, this property of coagulation by heat, which the secreted mucus of the intestines and bladder do not appear to possess; as I have found by experiment: and if any one should suppose this coagulable urine was separated from the blood by the kidneys, he may recollect, that in the most inflammatory diseases, in which the blood is most replete or most ready to part with the coagulable lymph, none of this appears in the urine.
9. Different kinds of diabetes require different methods of cure. For the first kind, or chyliferous diabetes, after clearing the stomach and intestines, by ipecacuanha and rhubarb, to evacuate any acid material, which may too powerfully stimulate the mouths of the lacteals, repeated and large doses of tincture of cantharides have been much recommended. The specific stimulus of this medicine, on the neck of the bladder, is likely to excite the numerous absorbent vessels, which are spread on that part, into stronger natural actions, and by that means prevent their retrograde ones; till, by persisting in the use of the medicine, their natural habits of motions might again be established. Another indication of cure, requires such medicines, as by lining the intestines with mucilaginous substances, or with such as consist of smooth particles, or which chemically destroy the acrimony of their contents, may prevent the too great action of the intestinal absorbents. For this purpose, I have found the earth precipitated from a solution of alum, by means of fixed alcali, given in the dose of half a dram every six hours, of great advantage, with a few grains of rhubarb, so as to produce a daily evacuation.
The food should consist of materials that have the least stimulus, with calcareous water, as of Bristol and Matlock; that the mouths of the lacteals may be as little stimulated as is necessary for their proper absorption; lest with their greater exertions, should be connected by sympathy, the inverted motions of the urinary lymphatics.
The same method may be employed with equal advantage in the aqueous diabetes, so great is the sympathy between the skin and the stomach. To which, however, some application to the skin might be usefully added; as rubbing the patient all over with oil, to prevent the too great action of the cutaneous absorbents. I knew an experiment of this kind made upon one patient with apparent advantage.
The mucilaginous diabetes will require the same treatment, which is most efficacious in the dropsy, and will be described below. I must add, that the diet and medicines above mentioned, are strongly recommended by various authors, as by Morgan, Willis, Harris, and Etmuller; but more histories of the successful treatment of these diseases are wanting to fully ascertain the most efficacious methods of cure.
In a letter from Mr. Charles Darwin, dated April 24, 1778, Edinburgh, is the subsequent pa.s.sage:--"A man who had long laboured under a diabetes died yesterday in the clinical ward. He had for some time drank four, and pa.s.sed twelve pounds of fluid daily; each pound of urine contained an ounce of sugar. He took, without considerable relief, gum kino, sanguis diaconis melted with alum, tincture of cantharides, isingla.s.s, gum arabic, crabs eyes, spirit of hartshorn, and eat ten or fifteen oysters thrice a day. Dr.
Home, having read my thesis, bled him, and found that neither the fresh blood nor the serum tasted sweet. His body was opened this morning--every viscus appeared in a sound and natural state, except that the left kidney had a very small pelvis, and that there was a considerable enlargement of most of the mesenteric lymphatic glands. I intend to insert this in my thesis, as it coincides with the experiment, where some asparagus was eaten at the beginning of intoxication, and its smell perceived in the urine, though not in the blood."
The following case of chyliferous diabetes is extracted from some letters of Mr. Hughes, to whose unremitted care the infirmary at Stafford for many years was much indebted. Dated October 10, 1778.
Richard Davis, aged 33, a whitesmith by trade, had drank hard by intervals; was much troubled with sweating of his hands, which incommoded him in his occupation, but which ceased on his frequently dipping them in lime. About seven months ago he began to make large quant.i.ties of water; his legs are oedematous, his belly tense, and he complains of a rising in his throat, like the globus hystericus: he eats twice as much as other people, drinks about fourteen pints of small beer a day, besides a pint of ale, some milk-porridge, and a bason of broth, and he makes about eighteen pints of water a day.
He tried alum, dragon"s blood, steel, blue vitriol, and cantharides in large quant.i.ties, and duly repeated, under the care of Dr. Underhill, but without any effect; except that on the day after he omitted the cantharides, he made but twelve pints of water, but on the next day this good effect ceased again.
November 21.--He made eighteen pints of water, and he now, at Dr. Darwin"s request, took a grain of opium every four hours, and five grains of aloes at night; and had a flannel shirt given him.
22.--Made sixteen pints. 23.--Thirteen pints: drinks less.
24.--Increased the opium to a grain and quarter every four hours: he made twelve pints.
25.--Increased the opium to a grain and half: he now makes ten pints; and drinks eight pints in a day.
The opium was gradually increased during the next fortnight, till he took three grains every four hours, but without any further diminution of his water. During the use of the opium he sweat much in the nights, so as to have large drops stand on his face and all over him. The quant.i.ty of opium was then gradually decreased, but not totally omitted, as he continued to take about a grain morning and evening.
January 17.--He makes fourteen pints of water a day. Dr. Underhill now directed him two scruples of common rosin triturated with as much sugar, every six hours; and three grains of opium every night.