[Illustration: BICHAT. X
_Published by Richardson & Lord, Boston._]
GENERAL ANATOMY,
APPLIED TO
PHYSIOLOGY AND MEDICINE;
BY XAVIER BICHAT,
PHYSICIAN OF THE GREAT HOSPITAL OF HUMANITY AT PARIS, AND
PROFESSOR OF ANATOMY AND PHYSIOLOGY.
Translated from the French.
BY GEORGE HAYWARD, M.D.
FELLOW OF THE AMERICAN ACADEMY OF ARTS AND SCIENCES,
AND OF THE MASSACHUSETTS MEDICAL SOCIETY.
_IN THREE VOLUMES._
VOLUME I.
_BOSTON_:
PUBLISHED BY RICHARDSON AND LORD.
J. H. A. FROST, PRINTER.
1822.
DISTRICT OF MASSACHUSETTS, _to wit_:
DISTRICT CLERK'S OFFICE.
Be it remembered, that on the seventeenth day of April, A. D. 1822,
in the forty-sixth year of the Independence of the United States of
America, _Richardson & Lord_, of the said District, have deposited
in this office the title of a book, the right whereof they claim as
proprietors, in the words following, _to wit_:
"General Anatomy, applied to Physiology and Medicine; by Xavier Bichat,
Physician of the Great Hospital of Humanity at Paris, and Professor of
Anatomy and Physiology. Translated from the French, by George Hayward,
M. D. Fellow of the American Academy of Arts and Sciences, and of the
Massachusetts Medical Society. In three Volumes. Volume I."
In conformity to the Act of the Congress of the United States,
entitled, "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
entitled, "An Act supplementary to an Act, entitled, 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 extending the Benefits thereof to the Arts of
Designing, Engraving and Etching Historical and other Prints."
JOHN W. DAVIS,
_Clerk of the District of Massachusetts_.
PREFACE BY THE TRANSLATOR.
I commenced the present translation while pursuing the study of
medicine in Paris in the winter of 1813-14. It was then my intention
to have completed and published it immediately upon my return to the
United States; but I learnt in England in the spring following, that
a translation of this work was about to appear from the London press.
This information induced me to abandon my undertaking, but after
waiting more than six years for the appearance of the English edition,
and finding from letters received from London, that there was but
little if any expectation of its being published there at all, I was
led to pursue my original plan and complete the translation which I
now offer to the public. In doing this, I was influenced more by the
intrinsic value of Bichat's work than by any and every other motive. I
was unwilling that so many of my professional brethren should be any
longer denied access to this admirable production, because it was in
a foreign language, and though I could have wished that another had
undertaken the task, yet I was resolved to go through the labour rather
than it should not be performed at all.
Some of the writings of Bichat are so well known and so justly
appreciated in this country, that it is perhaps unnecessary for
me to speak of his merits as an author, or offer an apology for
translating the present work. Every thing which he gave to the public
bore unequivocal proofs of being the production of a mind of the most
original and powerful cast, and it is impossible to estimate what
the influence of his labours might have been upon medical science if
a longer career had been permitted to him. As it was, he accomplished
much, and as his writings are more known, their influence will be more
sensibly felt. His manner of investigating physiological subjects was
characteristic of his strong and original mind, and it is difficult
to determine which is the most admirable, his acute and accurate
reasoning, or his ingenious and well conducted experiments. Nor were
these experiments the result of preconceived opinions, he seems to
have brought his mind perfectly unbiassed to every subject that he
investigated, and to have been guided in every instance by the most
rigorous laws of induction. To these high qualifications he added
great perspicuity in his arrangement, remarkable purity and beauty of
style, and an extensive knowledge of disease, which enabled him to
enrich his work with much valuable practical information. It is not
pretended, but that his experiments upon living animals may have in
some few cases led him to erroneous conclusions, but how numerous were
the instances in which he obtained from them the most satisfactory and
important information. It has, I know, become fashionable of late to
undervalue these experiments, and to deny that any useful application
can be made of them. It is no doubt true, that the sufferings which
animals sometimes undergo in these experiments, are such as to destroy
entirely the order and regularity of all the functions, and of course
to prevent us from determining any thing as to these functions in
health. This probably was the case with some of the experiments of
Magendie on vomiting, and Legallois on the principle of life; but let
us not condemn this mode of investigation because it has been sometimes
injudiciously employed, let us not forget that the argument is wholly
directed against the abuse of it, and that these experiments have
already led to some practical consequences of immense value. Would the
carotid artery have ever been tied in a living human subject, if it had
not been first ascertained that it could be done with safety in animals?
In translating this work, I have studiously endeavoured to give with
precision the meaning of the author, and have, I fear, by this means
frequently employed French idiomatic expressions. From the great
originality of many parts of the General Anatomy, Bichat found it
necessary in some instances to employ new terms, to which there were
no corresponding words in our language; in such cases, I have either
made use of several, or adopted the term, as one or the other seemed
best calculated to render the meaning more clear and exact. A few notes
only have been given, and these for the most part for the purpose of
explaining what was obscure, rather than of controverting any thing
contained in the original. Upon the whole, I trust that this work will
be a valuable acquisition to our stock of medical literature, and I
shall feel as if my labour has not been in vain, if I shall have been
the means of making my countrymen better acquainted with the writings
of its illustrious author.
_Boston, April, 1822._
PREFACE BY THE AUTHOR.
The work which I now offer to the public, will appear to them new,
I trust, in three points of view; 1st, in the _plan_ that has been
adopted; 2d, in most of the _facts_ which it contains; and 3d, in the
_principles_ which constitute its doctrine.
1st. The _plan_ consists in considering separately and presenting with
all their attributes, each of the simple systems, which, by their
different combinations, form our organs. The basis of this plan is
anatomical, but the details that it embraces belong also to medicine
and physiology. It has nothing in common, but the name, with what has
been lately advanced upon the anatomy of systems; my Treatise on the
Membranes alone gives an outline of it.
2d. The _facts_ and observations in this work, in addition to what
is already known, form a very numerous series. I shall not give an
analysis of them; the reader will supply it, how little soever he may
know of works on Anatomy and Physiology. Experiments on living animals,
trials with different reagents on organized textures,[1] dissection,
examinations after death, observations upon man in health and disease,
these are sources whence I have drawn them, and they are the sources
of nature. I have not, however, neglected authors, those especially
who make the science of the animal economy a science of facts and
experiments.
[1] I have in this and every other instance translated the French
word _tissu_ by the English word _texture_. I know many writers have
adopted the French term, but I think it unnecessary, to say the least,
to employ a foreign word, when one of our own language can be used
with quite as much precision. _Tr._
I will make but one remark upon the experiments contained in this work;
amongst them will be found a series upon the simple textures, which
I subjected successively to desiccation, putrefaction, maceration,
ebullition, stewing, and to the action of the acids and the alkalies.
It will be easily seen, that it was not the object of these experiments
to determine the composition, or ascertain the different elements, and
consequently give a chemical analysis of simple textures; for this
purpose they would have been insufficient; but their object was to
establish the distinctive characters of these simple textures, to show
that each has a peculiar organization, as each has a peculiar life, and
to prove by the different results which they gave, that the division
which I have adopted is not speculative, but that it rests upon the
diversity of their intimate structure. The different re-agents, which
I used, were only to assist me where the scalpel was insufficient, and
on this account, therefore, I presume these experiments will have some
influence upon Anatomy.
3d. The general _doctrine_ of this work has not precisely the character
of any of those which have prevailed in medicine. Opposed to that of
Boerhaave, it differs from that of Stahl and those authors who, like
him, refer every thing in the living economy, to a single principle,
purely speculative, ideal, and imaginary, whether designated by the
name of _soul_, _vital principle_, or _archeus_. The general doctrine
of this work consists in analyzing with precision the properties
of living bodies, in showing that every physiological phenomenon
is ultimately referable to these properties considered in their
natural state; that every pathological phenomenon derives from them
augmentation, diminution, or alteration; that every therapeutic
phenomenon has for its principle the restoration of the part to the
natural type, from which it has been changed; in determining with
precision the cases in which each property is brought into action;
in distinguishing accurately in physiology as well as in medicine,
that which is derived from one, and that which flows from others; in
ascertaining by rigorous induction the natural and morbific phenomena
which the animal properties produce, and those which are derived
from the organic; and in pointing out when the animal sensibility
and contractility are brought into action, and when the organic
sensibility and the sensible or insensible contractility. We shall be
easily convinced upon reflection, that we cannot precisely estimate
the immense influence of the vital properties in the physiological
sciences, before we have considered these properties in the point of
view in which I have presented them. It will be said, perhaps, that
this manner of viewing them is still a theory; I will answer, that it
is a theory like that which shows in the physical sciences, gravity,
elasticity, affinity, &c. as the primitive principles of the facts
observed in these sciences. The relation of these properties as causes
to the phenomena as effects, is an axiom so well known in physics,
chemistry, astronomy, &c. at the present day, that it is unnecessary
to repeat it. If this work establishes an analogous axiom in the
physiological sciences, its object will be attained.
GENERAL OBSERVATIONS.
There are in nature two classes of beings, two classes of properties,
and two classes of sciences. The beings are either organic or
inorganic, the properties vital or non-vital, and the sciences
physiological or physical. Animals and vegetables are organic—minerals
are inorganic. Sensibility and contractility are vital properties;
gravity, elasticity, affinity, &c. are non-vital properties. Animal and
vegetable physiology, and medicine form the physiological sciences;
astronomy, physics, chemistry, &c. are the physical sciences. These two
classes of sciences have relation only to different phenomena; there
are two other classes that correspond to these, which relate to the
internal and external forms of bodies and their description. Botany,
anatomy, and zoology, are the sciences of organic bodies; mineralogy,
&c. of the inorganic. The first will occupy us, and we shall fix our
attention especially upon the relations of living bodies with one
another, and their relations with those that do not live.
I. _General remarks upon physiological and physical sciences._
The differences between these sciences are derived essentially from
those existing between the properties that preside over the phenomena,
which are the object of each class of sciences. So immense is the
influence of these properties, that they are the principle of all
phenomena; whether we examine those of astronomy, of hydraulics, of
dynamics, of optics, of acoustics, &c. we shall finally arrive by a
connexion of causes to gravity, to elasticity, &c. as the end of our
researches. So the vital property is the primum mobile to which we must
ascend, whether we consider the phenomena of respiration, of digestion,
of secretion, circulation, inflammation, fevers, &c.—In giving
existence to every body, nature has imprinted upon it a certain number
of properties, that particularly characterize it, and by means of
which it contributes in its own manner, to all the phenomena that are
developed, succeed, and continually connect themselves in the universe.
Cast your eyes upon that which surrounds you; turn them upon objects
the most distant; whether, aided by the telescope, they examine those
that swim in space, or, armed with the microscope, they enter the world
of those, whose minuteness almost evades our view, every where you will
find on one side physical properties, on the other vital properties,
brought into action; every where you will see inert bodies gravitating
upon each other, and reciprocally attracting; living bodies gravitate
also, but above all they feel, and possess a motion which they owe only
to themselves.
These properties are so inherent in bodies, that we cannot conceive of
their existence without them. They constitute their essence and their
attribute. To exist and to enjoy them are two things inseparable.
Suppose that of a sudden they are deprived of them; instantly all the
phenomena of nature cease, and matter alone exists. Chaos was only
matter without properties; to create the universe, God endowed it with
gravity, elasticity, affinity, &c. and to a part he gave sensibility
and contractility.
This mode of considering the vital and physical properties,
sufficiently shews, that we cannot ascend above them in our
explanations, that they afford the principles, and that these
explanations are to be deduced from them as consequences. The physical
sciences, as well as the physiological, then, are composed of two
things; 1st. the study of phenomena, which are effects; 2d. the
research into the connexions that exist between them and the physical
or vital properties, which are the causes.
For a long time these sciences have not been so considered; every fact
that was observed, was made the subject of a particular hypothesis.
Newton was the first to remark, that however variable the physical
phenomena were, they could all be referred to a certain number of
principles. He analyzed these principles and found that attraction
enjoyed the most important place among them. Attracted by each other
and by their sun, the planets describe their eternal courses; attracted
to the centre of our system, the waters, air, stones, &c. move or tend
to move towards it: it is truly a sublime idea, and one that serves as
the basis to all the physical sciences. Let us render homage to Newton;
he was the first who discovered the secret of the Creator, viz. A
simplicity of causes reconciled with a multiplicity of effects.
The epoch of this great man was the most remarkable of human wisdom.
Since that period, we have had principles from which we draw facts as
consequences. This epoch, so advantageous to the physical sciences,
was nothing to the physiological; what do I say? it retarded their
progress. Mankind soon saw nothing but attraction and impulse in the
vital phenomena.
Boerhaave, though brilliant in genius, suffered himself to be dazzled
by a system which misled all the men of learning of his age, and which
made a revolution in the physiological sciences, that may be compared
to that effected in the physical, by the vortices of Descartes. The
plausibility of the theory and the celebrated name of its author, gave
to this revolution an empire, which, though rotten in its foundation,
was not easily overthrown.
Stahl, less brilliant than profound, rich in the means that convince,
though deficient in those that please, formed for the physiological
sciences an epoch more worthy of notice than that of Boerhaave. He
perceived the discordance between the physical laws and the functions
of animals; this was the first step towards the discovery of the vital
laws, but he did not discover them. The soul was to him every thing in
the phenomena of life; it was much to neglect attraction and impulse.
Stahl perceived that these were not true, but the truth escaped him.
Many authors, following his steps, have referred to a single principle,
differently denominated by each, all the vital phenomena. This, called
the vital principle by Barthez, archeus by Van Helmont, &c. is a
speculation that has no more reality than that which would refer to
a single principle all the physical phenomena. Among these we know
that some are derived from gravity, some from elasticity, others from
affinity, &c. The same in the living economy, some are derived from
sensibility, others from contractility.
Unknown to the ancients, the laws of life have begun to be understood
during the last age only. Stahl had already remarked the tonic
motions, but he did not generalize their influence. Haller was engaged
particularly with sensibility and irritability; but in limiting one to
the nervous system, and the other to the muscular, this great man did
not consider them in the correct point of view; he made them almost
insulated properties. Vicq d'Azyr changed them into functions in his
physiological division and ranked them with ossification, digestion,
&c. that is, he confounded the principle with the consequence. Thus you
see, notwithstanding the labours of a crowd of learned men, how much
the physiological sciences still differ from the physical. In these,
the chemist refers all the phenomena that he observes to affinity:
the natural philosopher, in his science, every where sees gravity,
elasticity, &c. In the others, we have not as yet ascended, at least
in a general manner, from the phenomena to the properties from which
they are derived. Digestion, circulation, or the sensations, do not
bring the idea of sensibility or contractility to the mind of the
physiologist, as the movement of a watch proves to the mechanician
that elasticity is the primum mobile of its motion; or as the wheel of
a mill or of any machine, which running water sets in motion, proves
to the natural philosopher that gravity is the cause. To place upon
the same level in this respect these two classes of sciences, it is
evidently necessary to form a just idea of vital properties. If their
limits are not accurately assigned, we cannot with precision analyze
their influence. I shall present here only general considerations on
this point, which has been treated sufficiently in my Researches upon
Life; what I shall add now will be but as a supplement to what has been
explained in that work.
II. _Of vital properties, and their influence upon all the phenomena of
the physiological sciences._
To assign the limits of these properties, we must follow them from
bodies that are hardly developed, to those which are the most perfect.
In the plants that seem to form the transition from vegetables to
animals, you discover only an internal motion that is scarcely real;
their growth is as much by the affinity of particles and consequently
by juxta-position, as by a true nutrition. But in ascending to
vegetables better organized, you see them continually pervaded by
fluids, that circulate in numerous capillary canals, which mount,
descend, and run in a thousand different directions, according to
the state of the forces that regulate them. This continual motion
of fluids is foreign to the physical properties, the vital ones only
direct it. Nature has endowed every portion of a vegetable with a
faculty of feeling the impression of fluids, with which their fibres
are in contact, and of reacting upon them in an insensible manner,
to favour their course. The first of these faculties I call organic
sensibility, the other, insensible organic contractility. This is very
obscure in most vegetables; it is the same in the bones of animals.
These two properties govern not only the vegetable circulations, which
correspond in some measure to the capillary system of animals, but
also the secretion, absorption, and exhalation of vegetables. Remark,
in fine, that these bodies have only functions relative to their
properties; that all the phenomena that animals derive from properties
which they have more than vegetables, as the great circulation and
digestion, for which there must be sensible organic contractility;
as the sensations, for which there must be animal sensibility;
and locomotion, the voice, &c. for which animal contractility is
necessary; remark, I say, that these functions are essentially foreign
to vegetables, since they have not vital properties to place them in
action.
For the same reason the catalogue of their diseases is less extensive.
They have not the class of nervous diseases, in which the animal
sensibility takes so great a part; they have not those of convulsions
or paralysis, which are formed by an augmented or diminished animal
contractility; they have not those of fevers, or gastric diseases,
which evidently arise from a disorder in the sensible organic
contractility. The diseases of vegetables are tumours of various kinds,
increased exhalations, marasmus, &c.; they all indicate a derangement
in the organic sensibility and in the corresponding insensible
contractility.
If we pass from vegetables to animals, we see the lowest of these,
the zoophites, receive into a sac, which is alternately filled and
emptied, the aliments that are to nourish them; we see them begin to
unite sensible organic contractility or irritability to the properties
which they have in common with vegetables, and consequently commence
the performance of different functions, digestion in particular.
Thus far the organized bodies live wholly within themselves; they have
no relation with that which surrounds them; animal life is wanting
in them, or at least if it has commenced in these animo-vegetables,
its rudiments are so obscure that we can hardly discover them. But
this life begins to display itself in the superior classes, in worms,
insects, mollusca, &c. On the one hand, the sensations, and on the
other, locomotion, which is inseparable from them, are more or less
fully developed. Then the vital properties necessary to the exercise of
these new functions, are added to the preceding. Animal sensibility and
contractility, obscure in the lower species, become more perfect, as
we approach quadrupeds, and locomotion and the sensations become also
more extensive. Sensible organic contractility then increases, and in
proportion to that, digestion, circulation of the great vessels, &c.
which are governed by it, receive a development which is constantly
growing more perfect.
If we strictly examine the immense series of living bodies, we shall
see the vital properties gradually augmenting in number and energy,
from the lowest of plants to the first of animals, man; we shall see
the lowest plants obedient to vital and physical properties; all plants
are governed only by these, which, in them, consist of insensible
contractility and organic sensibility; the lowest animals begin to add
sensible organic contractility to these properties, afterwards animal
sensibility and contractility. We know the expression of Linnæus,
which he has used to characterize minerals, vegetables, and animals.
The following would be more correct: 1st. physical properties for
minerals; 2d. physical properties and organic vital properties,
except[2] sensible contractility, for vegetables; 3d. physical
properties, all the organic vital properties, and the animal vital
properties, for animals.
[2] Several plants certainly possess a considerable degree of sensible
organic contractility; the mimosa pudica (sensitive plant) is a
well known example, though there are several others that enjoy this
property to almost as great an extent; particularly the hedysarum
gyrans, the oxalis sensitiva, and the berberis vulgaris. "A very
remarkable degree of irritability, not exceeded by the sensitive
plant, exists in the flowers of the barberry, (berberis vulgaris.)
When these are fully expanded, the stamens are found spread out on
the inside of the corolla. In this situation, if the inside of the
filament be touched with a pin or straw, it instantly contracts and
throws the anther violently against the stigma. This fact, which has
been particularly described by Dr. Smith, in the English barberry,
is not less remarkable and distinct in the American varieties of the
shrub." Bigelow's Florula Bostoniensis. _Tr._
Man and the neighbouring species, which are the particular object of
our researches, enjoy then evidently, all the vital properties, some of
which belong to organic life, the others to animal life. 1st. Organic
sensibility and insensible contractility have all the phenomena of
the capillary circulation, of secretion, of absorption, exhalation,
nutrition, &c. evidently dependant upon them in a state of health.
In treating, therefore, of these functions, we must always ascend to
these properties. In the state of disease, all the phenomena that
suppose a disorder in these functions, are clearly derived from an
injury of these properties. Inflammation, formation of pus, induration,
resolution, hemorrhage, unnatural augmentation or suppression of
secretions; increased exhalation, as in dropsies; diminished, or wholly
wanting, as in adhesions; absorption, disordered in some way or other;
nutrition, altered more or less, or presenting unnatural phenomena,
as in the formation of tumours, cysts, cicatrices, &c.: these are
morbid symptoms, that evidently suppose some injury or disorder in
these two preceding properties. 2d. Sensible organic contractility,
which, like the preceding, is not separated from the sensibility of the
same nature, governs especially in a state of health, the movements
necessary to digestion and the circulation of the great vessels, at
least for the red and black blood of the general system, for the
excretion of urine, &c. In the state of disease, all the phenomena of
vomiting, of diarrhœas, and a great part of those numberless ones of
the pulse, may ultimately be referred to a disorder of the sensible
organic contractility. 3d. All the external sensations, those of
seeing, hearing, smelling, tasting, and feeling, and the internal, as
those of hunger, thirst, &c. are derived in a state of health from
the animal sensibility. In disease, what part does not this property
perform? Pain and its innumerable modifications, itching, smarting,
tickling, the sensation of heaviness, weight, lassitude, throbbing,
pricking, pulling, &c. &c. are not these only different alterations of
animal sensibility? A hundred different words would not express the
diversity of painful sensations that morbid affections bring with them.
4th. Animal contractility is the principle of locomotion and the voice;
convulsions, spasms, palsies, &c. are derived from an augmentation or
diminution of this property. Examine all the physiological and all the
pathological phenomena, and you will see that there is no one which
cannot be ultimately referred to some one of the properties of which
I have just spoken. The undeniable truth of this assertion, brings us
to a conclusion not less certain in the treatment of diseases, viz.
that every curative method should have for its object the restoration
of the altered vital properties to their natural type. Every remedy,
which, in local inflammation, does not diminish the augmented organic
sensibility; which, in œdema and dropsy, does not increase this
weakened property; and which does not reduce animal contractility in
convulsions, and elevate it in paralysis, fails in its object, and is
contraindicated.
To what errors have not mankind been led in the employment and
denomination of medicines? They created deobstruents, when the theory
of obstruction was in fashion, and incisives, when that of the
thickening of the humours prevailed. The expressions of diluents and
attenuants, and the ideas that are attached to them, were common before
this period. When it was necessary to blunt the acrid particles, they
created inviscants, incrassants, &c. Those who saw in diseases only a
relaxation or tension of the fibres, the _laxum_ and _strictum_ as they
called it, employed astringents and relaxants. Refrigerant and heating
remedies were brought into use by those who had a special regard in
diseases to an excess or a deficiency of caloric. The same identical
remedies have been employed under different names according to the
manner in which they were supposed to act. Deobstruent in one case,
relaxant in another, refrigerant in another, the same medicine has been
employed with all these different and opposite views; so true is it
that the mind of man gropes in the dark, when it is guided only by the
wildness of opinion.
There has not been in the materia medica, a general system; this
science has been governed by the different theories that have
successively predominated in medicine; each has, if I may so express
myself, flowed back upon it. Hence the vagueness and uncertainty
that it presents at this day. An incoherent assemblage of incoherent
opinions, it is perhaps of all the physiological sciences, that
which best shows the caprice of the human mind. What do I say? It is
not a science for a methodical mind, it is a shapeless assemblage
of inaccurate ideas, of observations often puerile, of deceptive
remedies, and of formulæ as fantastically conceived as they are
tediously arranged. It has been said that the practice of medicine was
disgusting; I add further, that it is not in some respects the study
of a reasonable man, when its principles are derived from the greatest
part of the works on the materia medica. Take away those medicines, the
effect of which is known only by accurate observation, as evacuants,
diuretics, sialagogues, anti-spasmodics, &c. those consequently that
act upon a particular function; what knowledge have we of the remainder?
It is, without doubt, extremely difficult at present to class remedies
according to their modus operandi; but it is undeniable that all have
for their object, the restoration of the vital forces to the natural
type, from which they have been driven by disease. Since the morbid
phenomena may be considered as different alterations of these forces,
the action of remedies should also be viewed as the means by which
these alterations are to be brought back to the natural type. Upon this
principle, each of the properties has its class of appropriate remedies.
1st. We have seen that there is in inflammations an increase of organic
sensibility and insensible contractility; diminish then this increase
by cataplasms, fomentations, and local baths. In some dropsies, in
white-swellings, &c. there is a diminution of these properties; raise
them by the application of wine and all those substances that are
called tonics. In every species of inflammation, suppuration, tumours
of different kinds, ulcers, obstructions; in every alteration of
secretion, exhalation, or nutrition, the remedies act peculiarly upon
the insensible contractility, to increase, diminish, or alter it in
some way. All those that are called resolvents, tonics, stimulants,
emollients, &c. act upon this property. Observe, that these remedies
are of two kinds: 1st. general; as wine, ferruginous substances,
oftentimes the acids, &c.; these re-animate insensible contractility,
and give tone to the whole system: 2d. particular; thus this property
is separately excited by nitre in the kidnies, mercury in the salivary
glands, &c.
2d. Many remedies act particularly upon the sensible organic
contractility; such are emetics, which produce a contraction of the
stomach; cathartics, and drastics especially, which create a strong
contraction of the intestines. Art does not excite the heart in the
same manner as these viscera; we do not artificially increase its
movements as we do those of the stomach in gastric diseases. It will,
perhaps, hereafter be attempted, especially if it is true that fever
may often be a method of cure, and then it will not, I think, be
difficult to find the means of effecting it. At other times, we have
to diminish sensible organic contractility, and then remedies are
employed that act in a manner opposite to the preceding, as in stopping
vomitings, in diminishing intestinal irritation, &c.
3d. Animal sensibility has also remedies that are peculiar to it.
But they act in two ways—1st. in diminishing pain in the part where
it is seated, as different applications upon tumours, obstructions,
&c.: 2d. in acting upon the brain that perceives the pain; thus all
narcotic preparations, taken internally, remove the sensation of pain,
while the cause still subsists. In cancer of an ulcerated uterus, the
disease continues its progress with activity, but the prudent physician
stupifies the brain so much, that it is incapable of perceiving it. It
is essential to distinguish accurately these two actions of remedies
upon the animal sensibility. They are totally different from each other.
4th. Medicinal substances have also their influence on animal
contractility. Every thing that produces an active excitement on the
external surface of the body, as vesicatories, frictions, smarting,
&c. tends to re-animate in paralysis this benumbed faculty. All those
substances that paralyze the cerebral action, prevent the brain from
governing the muscles of animal life; when these muscles, therefore,
are convulsively agitated, these substances are true anti-spasmodics.
In presenting these observations, I do not mean to offer a new plan
for the materia medica. Medicines are too complicated in their action
to be arranged anew, without more reflection than I profess as yet to
have bestowed on the subject. Moreover, an inconvenience common to
every classification, would here present itself: the same medicine
acts often upon many vital properties. An emetic, while it brings into
action the sensible organic contractility of the stomach, excites the
insensible contractility of the mucous glands, and oftentimes the
animal sensibility of the nervous villi. The same observation may be
made with regard to the stimulants of the bladder, of the intestines,
&c. My only object is to show, that in the action of substances applied
to the body to heal it, as in the phenomena of diseases, every thing
must be referred to the vital properties, and that their augmentation,
diminution, or alteration, are ultimately the invariable object of our
curative method.
Some authors have considered diseases only as increased strength
or weakness, and have consequently divided medicines into tonics
and debilitants. This idea is true in part, but it is false when we
generalize it too much. For every vital force there are means proper
to raise it when too much diminished, and to lessen it when too much
elevated. But tonics and debilitants are certainly not applicable to
every case. You would not weaken animal contractility, augmented in
convulsions, as you would insensible organic contractility increased
in inflammation; neither would you increase them by the same means.
The morbid phenomena that organic contractility and animal sensibility
experience, are not cured by the same method. There are medicines
proper for each vital force. Moreover, it is not only in increase or
diminution that the vital forces err, but they are besides disordered;
the different modifications that insensible contractility and organic
sensibility can undergo, produce in wounds and ulcers a diversity of
suppuration, in glands a diversity of secretion, in exhaling surfaces
a diversity of exhalations, &c. It is necessary, therefore, that
medicines should not only diminish or increase each of the vital
forces, but that they should moreover restore them to the natural
modification from which they have been altered.
What I have just said is particularly applicable to the strictum and
laxum of many authors, who every where see but these two things.
The strictum may be properly applied to inflammation, the laxum to
dropsies, &c.; but what have these two states of the organs in common
with convulsions, with disorder of the intellect, with epilepsy, with
bilious affections, &c.? It is the peculiarity of those who have a
general theory in medicine, to endeavour to bend every phenomenon to
it. The fault of generalizing too much, has been perhaps more injurious
to science, than that of viewing each phenomenon separately.
These observations are, I think, sufficient to show, that every where
in the physiological sciences, in the physiology of vegetables and
of animals, in pathology, in therapeutics, &c. there are vital laws,
that govern the phenomena which are the object of these sciences; and
that there is not one of these phenomena that does not flow from these
essential and fundamental laws, as from its source.
If I should take a survey of all the divisions of physical sciences,
you would see that the physical laws were ultimately the sole principle
of all their phenomena; but this is so well known that it is not
necessary to do it. I will consider an important subject, and one to
which we are naturally led by the preceding observations. I mean, a
parallel between physical and vital phenomena, and consequently between
physical and physiological sciences.
III. _Characteristics of the vital properties, compared with those of
the physical._
When we consider, on one side, the phenomena which are the object
of the physical sciences, and those that are the object of the
physiological, we see how immense is the space that separates their
nature and their essence. But this difference arises from that which
exists between the laws of the one and the other.
Physical laws are constant and invariable; they are subject neither
to augmentation or diminution. A stone does not gravitate towards the
earth with more force at one time than another; in every case marble
has the same elasticity, &c. On the other hand, at every instant,
sensibility and contractility are increased, diminished, or altered;
they are scarcely ever the same.
It follows, therefore, that the physical phenomena are never variable,
that at all periods and under every influence they are the same; they
can, consequently, be foreseen, predicted, and calculated. We calculate
the fall of a heavy body, the motion of the planets, the course of a
river, the ascension of a projectile, &c.: the rule being once found,
it is only necessary to make the application to each particular case.
Thus heavy bodies fall always in a series of odd numbers; attraction is
in the inverse ratio of the square of the distances, &c. On the other
hand all the vital functions are susceptible of numerous variations.
They are frequently out of their natural state; they defy every kind
of calculation, for it would be necessary to have as many rules as
there are different cases. It is impossible to foresee, predict, or
calculate, any thing with regard to their phenomena; we have only
approximations towards them, and even these are often very uncertain.
There are two things in the phenomena of life, 1st. the state of
health; 2d. that of disease; hence there are two distinct sciences;
physiology considers the phenomena of the first state, pathology
those of the second. The history of the phenomena in which the vital
forces have their natural type, leads us to consider as a consequence,
those phenomena that take place when these forces are altered. But in
the physical sciences there is only the first history; the second is
never found. Physiology is to the movements of living bodies, what
astronomy, dynamics, hydraulics, hydrostatics, &c. are to those of
inert ones; but these last have no such correspondent sciences as
pathology. There is nothing in the physical sciences that corresponds
to therapeutics in the physiological. For the same reason, every idea
of medicament is absurd in the physical sciences. The object of a
medicament is the restoration of properties to their natural type; but,
the physical properties, never losing this type, have of course no need
of restoration.
We see then that the peculiar instability of the character of the
vital laws is the source of an immense series of phenomena, which
form a peculiar order of sciences. What would become of the universe,
if the physical laws were subject to the same commotions and the
same variations as the vital? Much has been said of the revolutions
of the globe, of the changes that the earth has undergone, of the
overthrows that ages have gradually brought about, and upon which ages
have accumulated without producing others: but you would see these
overthrows and these general commotions in nature at every instant, if
the physical properties had the same character as the vital.
For the same reason, that the phenomena and laws of the physical
and physiological sciences are unlike, the sciences themselves are
essentially different. The manner of presenting the facts and of
prying into their causes, the experimental art, &c. every thing bears
a different stamp; and it is absurd to confound them. As the physical
sciences were perfected before the physiological, mankind thought
that they could illustrate the latter by connecting them with the
former; but they have confused them; and this was inevitable, for the
application of the physical sciences to physiology, was the explication
of the phenomena of living bodies by the laws of the inert. Here then
is a false principle, and all the consequences drawn from it must be
erroneous. Let us leave to chemistry its affinity, and to physics
its elasticity and gravity, and let us employ in physiology only
sensibility and contractility; I except, however, those cases where the
same organ becomes the seat of vital and physical phenomena, as the
eye and the ear, for example. It is on this account, that the general
character of this work is wholly different from those on physiology,
and even that of the celebrated Haller. The works of Stahl illustrate
well the advantage of neglecting all those pretended accessory aids,
which overthrow the science in attempting to support it. But as this
great physician had not analyzed the vital properties, he could not
present their phenomena in their true point of view. Nothing is more
vague and indefinite than the words, _vitality_, _vital action_, _vital
influx_, &c. when we do not precisely limit their meaning. Suppose
that mankind had created some general and vague words, which were to
correspond to all the non-vital properties, and which gave no precise
or definite ideas; if you were every where to use these terms, if you
did not determine that which belonged to gravity, that which depended
on affinity, and that which was the result of elasticity, you would
never be understood. Let us say as much in regard to the physiological
sciences. The art is much indebted to many physicians of Montpellier
for having deserted the theory of Boerhaave, and having followed in
preference that given by Stahl. But in leaving a bad path, they have
taken another so tortuous, that they will never, I think, find its
termination.
Ordinary minds, in reading, stop at insulated facts that are presented;
they do not embrace, at one view, the principles of the work.
Oftentimes the author himself incautiously follows the impression given
to a science in the age in which he writes. But the man of genius every
where pauses at this impression, which should be henceforth entirely
different in physical and physiological works. It is necessary to use
a different language; for most of the words that are carried from the
physical into the physiological sciences, continually refer to ideas
that have no connexion with them. You see the living solids constantly
undergoing composition and decomposition, every moment taking and
rejecting new substances; on the other hand, inert bodies remain the
same, and keep the same constituent principles, until friction and
other causes destroy them. So in the elements of inert bodies, there is
a constant uniformity, and an invariable identity in their principles,
which is known when they have been once analyzed; whilst the principles
of the living fluids are so continually changing, that it is necessary
that many analyses should be made, under every possible circumstance.
We shall see the glands and exhaling surfaces pour out, according to
the degree of their vital forces, a great variety of modifications
of the same fluid; what do I say? they pour out a variety of fluids
really different; for are not the sweat and the urine poured out under
one circumstance, and the sweat and the urine under another, two
distinct fluids? There are a thousand examples that would incontestably
establish this assertion.
It is the nature of vital properties to exhaust themselves; time wastes
them. Elevated in the commencement of life, they remain stationary
at the adult age, and afterwards are debilitated and become nothing.
Prometheus, it is said, having formed some statues of men, snatched
fire from heaven to animate them. This fire is the emblem of the vital
properties; while it burns, life is supported; when it is extinguished,
it ceases. It is, then, a part of the essence of these properties, to
animate matter for a determinate time only; hence there are necessary
limits to life. On the other hand, the physical properties, constantly
inherent in matter, never abandon it; so that inert bodies have no
limits to their existence, but what accident gives to them.
By nutrition the particles of the matter of inanimate bodies pass into
living bodies, and vice versa; and we can evidently conceive that this
matter has been endowed through an immense series of ages with physical
properties. These properties are given to it at the creation, and will
leave it only when the world shall end. This matter, in passing into
living bodies, in the space that separates these two epochs, a space
that immensity only can bound, this matter, I say, becomes possessed,
at intervals, of vital properties, which are then united to physical
properties. Here, then, is a great difference in matter, with regard to
these two kinds of properties; one it enjoys by intermissions only, the
other it possesses constantly.
I could add many other considerations, that would still further
establish the difference between the physical and vital laws, and
consequently between the physical and vital phenomena, and as a
consequence from these, the difference of the general character and
methods of the physical and physiological sciences. I could show, that
inert bodies are formed at hazard, by juxta-position or a combination
of their particles, while living bodies, on the contrary, exist in
consequence of a certain function, viz. generation; that the first
increase in the same manner as they are formed, by juxta-position or
the combination of new particles; the others by an internal movement
of assimilation, which requires different preliminary functions;
these constantly experiencing composition and decomposition; those
remaining always internally in the same condition, undergo no other
modifications than such as are derived from chance and the physical
laws. The existence of inert bodies ceases as it commenced, by
mechanical laws, by friction, or by new combinations; living bodies
afford in their natural destruction, a phenomenon as uniform as in
their production; they pass suddenly to a new state when life abandons
them, and undergo putrefaction, desiccation, &c. which they did not
before, because the physical properties being restrained by the vital,
could not produce these phenomena; inert bodies, on the other hand,
always preserve the same modifications. Though a stone or a metal, when
broken or dissolved, ceases to exist, their particles will always be
the same. But some authors have already presented a great part of this
parallel; let us content ourselves with drawing from it a consequence
often deduced from other facts, I mean the difference of the laws that
preside over the two classes of functions.
But there is an essential difference between vital and physical
properties; I refer to sympathies.
All inert bodies show no communication in their different parts. Though
the extremity of a stone, or of a metal, may be altered in any way by
chemical dissolution, or by mechanical agents, the other parts are not
affected; it is necessary to touch them by a direct action. On the
contrary, every thing is so connected and tied together in the living
body, that no one part can be disordered in its functions, without
being immediately perceived by the rest. All physicians have known the
singular consent that exists between our different organs, both in a
state of health and disease, but principally in the latter. How easy
would be the study of diseases, if they were stripped of every thing
derived from sympathy! Who does not know that these complaints often
predominate over those that arise from the injury of the diseased
organ? Who does not know that the cause of sleep, of exhalation, of
absorption, of secretion, of vomiting, of diarrhœa, of retention of
urine, of convulsions, &c. is oftentimes very far from the brain, from
the exhalants, from the absorbents, from the glands, from the stomach,
from the intestines, from the bladder, from the voluntary muscles, &c.?
How little soever we reflect on the sympathetic phenomena, it will be
evident that they are only unnatural developments of vital forces which
are called into action in an organ by the influence that it receives
from those that have been directly excited. In this view all the
systems are dependant upon each other. This important point of doctrine
will be treated at so much length, in this work, particularly under the
article on the nervous system that it is useless to insist much upon it
here.
We shall see sympathies call into action always those vital properties
especially that prevail in a system; animal sensibility in the nerves,
contractility of the same kind in the voluntary muscles, insensible
organic contractility in the involuntary, sensible contractility in
the glands, in the serous, mucous, synovial, cutaneous surfaces, &c.
We shall see them assume the character of the vital properties of the
organs in which they are developed, their progress will be chronic in
the bones, cartilages, &c. acute in the muscles, skin, &c. We shall
see them observe in the frequency of their development, the laws of
nutrition and growth, to appear oftener in the nervous and vascular
system of the child, in the pulmonary organs in youth, and in the
abdominal contents in adult age. But let us pass to other subjects.
IV. _Of the vital properties and their phenomena, considered in
relation to the solids and fluids._
Every organized body is composed of fluids and of solids. The first
are, in one point of view, the materials, and in another the residue of
the second. 1st. They are the materials, for from the aliments which
convey through the intestines, the elements of nutrition, even to the
interior of the organs where these elements are deposited, they form
evidently a part of the chyle and the blood. 2d. They are the residue,
for after having remained some time in the organs, these nutritive
particles are taken up, enter again into the blood, and afterwards make
a part of the secreted fluids, and of those that form cutaneous and
mucous exhalations, which are thrown out externally.
There are then fluids for composition and others subservient to
decomposition. The solids are the termination of the first, which come
from without, and the place from which the second are sent back. The
fluids of composition and decomposition are not all insulated; the
chyle, the materials that enter by cutaneous absorption, the principles
that the lungs draw from the air, &c. are especially of the first
kind. The fluids secreted and exhaled upon the mucous and cutaneous
surfaces, appear to be exclusively of the second. But the blood is a
common centre, in which the elements that enter, and those that go out,
circulate together.
This being admitted, let us see what part the fluids and the solids
enjoy in the vital phenomena. This must evidently depend on the
properties they possess; and in reflecting on the vital properties
which we know, it is evident, that every idea of fluidity is foreign
to them, that fluidity cannot be the seat of any contraction nor of
organic and animal sensibility, &c. I will not speak here of the
pretended spontaneous movements of the blood, of the subtle fluids
that it contains, according to some authors, and which can on occasion
expand or contract it; all this is but an assemblage of vague ideas,
that are confirmed by no experiment. Moreover, all the phenomena of
the living economy show us manifestly the fluids in a state almost
passive, and the solids, on the other hand, always essentially
active. It is the solids that every where receive the excitement, and
act in consequence; the fluids are only the excitants. This constant
impression of the second upon the first, constitutes every where
continual sensations that are not referred to the brain, and which are
consequently not perceived; this is organic sensibility, and differs
from the animal in this, that the mind has no consciousness of these
sensations, which do not go beyond the organs in which they take place.
Since, on one side, the vital properties are essentially seated in the
solids, and on the other, the morbid phenomena are but alterations of
these properties, it is evident that these phenomena reside especially
in the solids, and that to a certain limit the fluids are foreign to
them. Every kind of pain, all spasms and irregular movements of the
heart, that constitute the innumerable variations of the pulse, have
their seat in the solids.
Let us not believe, however, that the fluids are nothing in diseases;
they oftentimes carry the fatal principle of them. They possess, then,
in disease, the same place as in the state of health, in which the
solids are the active agents of all the phenomena that we observe, but
their action is inseparable from that of the fluids. That the heart may
contract, that the capillary system may close itself, it is necessary
that fluids should first go there. In proportion as the fluids are
in their natural state, the excitement is natural; but when this is
changed from any cause, as by the introduction of foreign substances,
at that instant they become unnatural excitants; the functions are
disordered, and diseases supervene. You see, then, that the fluids can
oftentimes be the principle of diseases, and the vehicle of morbific
matter. But this subject merits further consideration.
Here we can apply the distinction of fluids into those of composition
and those of decomposition. The first, which enter the system in
various ways, go into the blood, which, on one account, belongs
to them, but on another, to the fluids of decomposition. It is
incontestable, 1st. that the chyle can be loaded with a variety of
foreign substances, and carry into the blood the fatal principles
of disease, as when putrid and badly digested matter, principles of
contagion mixed with our aliment, &c. are found in the primæ viæ.
2d. Is it not established by many proofs, that cutaneous absorption
oftentimes introduces into the blood the causes of disease, and, 3dly.
that substances foreign to the constituent principles of the air,
and adapted to excite disease, may accidentally get into that fluid
through the medium of the lungs? these things we cannot doubt. Here,
then, there are already three ways open to the principles of morbific
matter, as we shall moreover have reason to be convinced in the course
of this work. 4th. There is another accidental one, that arises from
wounds, cuts, bites, lacerations, &c. by means of which destructive
principles are oftentimes conveyed into the animal economy. Under these
four we might produce a variety of cases, in which the fluids are the
first causes of diseases, by conveying their essential principles and
becoming unnatural excitants to the solids, in which they produce
phenomena contrary to the natural order. But it is evident, that it is
those fluids especially destined to the composition of the organs that
thus carry morbific principles; these are especially their vehicle,
and convey the disease. On the other hand, the fluids destined to the
decomposition tend to carry the disease out of the system. We have seen
that these fluids are every where poured upon the mucous and cutaneous
surfaces, either by exhalation or secretion, as the sweat, the urine,
&c.: and it is by these fluids that a crisis is produced. Physicians
have exaggerated to an infinite degree the influence of these morbific
humours, thus driven out; but we cannot doubt that this doctrine
has oftentimes a real foundation. If these fluids are sometimes the
vehicles of disease, it is when they enter unnaturally into the system,
as when the bile passes into the mass of blood, when the absorbed urine
enters this fluid, &c.
After all that has just been said, it is evident, that it is necessary
to distinguish accurately diseases themselves, or rather the whole of
the symptoms that characterize them, according to the principles that
produce or support them. Almost all the symptoms are in the solids,
but the cause can be in them as well as in the fluids. An example
will render this more clear; the heart can contract unnaturally; 1st.
because its organic sensibility is increased whilst the blood itself
remains the same; 2d. because the blood is either augmented, as in
plethora, or altered in its nature, as in putrid fevers, &c. while the
organic sensibility of the heart does not vary. The excitement may
be double, or the organ may be twice as susceptible as common, the
effect is the same; an acceleration of the pulse takes place. The solid
always takes the principal part in the disease; it is always that which
contracts, but in the first case the cause was in the solid, in the
second it was not.
This example gives an idea of what occurs in diseases, in all of which
the solids are especially in action; but the cause of this action,
sometimes exists in them, and sometimes not. It is no doubt essentially
necessary to seek the distinction of these cases. The following
reflections are made with this view. 1st. I distinguish, in the present
question, diseases into two classes; 1st. into those which especially
affect animal life; 2d. into those that particularly disorder organic
life. I say particularly, for such is the connexion of these two lives,
that the one can hardly be altered without the other; thus fevers that
affect organic life, produce cerebral effects that agitate the animal:
thus also primitive cerebral affections influence sympathetically
the circulation, respiration, &c. But certainly we cannot deny, that
there are some affections, whose principal and primitive character is a
disorder of the animal life; such are convulsions, spasms, paralysis,
mania, epilepsy, catalepsy, &c. But it appears that the cause of these
diseases is almost always in the solids, and that the fluids most
commonly are not affected. Therefore you see that crises, in every case
are foreign to these diseases. Hypochondria, hysteria, melancholia,
&c. though they appear to reside more particularly in the solids, can
yet be in a degree dependant on the fluids, as different examples will
prove.
Diseases, on the other hand, that particularly affect organic life,
as fevers, inflammations, &c. may have their principle as well in the
fluids as in the solids. Hence the reason, that these diseases are
subject to crisis, and are cured by evacuants, alteratives, &c.
2dly. It is necessary in order to resolve the question of the affection
of the solids or the fluids in diseases, to distinguish their phenomena
into those which are sympathetic, and those that are the product
of a direct excitement. Every sympathetic phenomenon has its seat
essentially and necessarily inherent in the solids. In fine, the
solids alone act upon each other and correspond together by means yet
unknown. All sympathetic vomiting, febrile agitation of the heart,
exhalation, secretion, and absorption, arise from a change effected,
by the influence of a part more or less remote, in the solids of those
which are the seats of these phenomena. When cold acts upon the skin
covered with sweat, immediately the pleura becomes affected. If cold
water is conveyed into the stomach while the body is hot, an effect is
oftentimes produced upon a distant organ. This is sympathy, and not the
repercussion of the humours. In this work I have cited a great number
of examples of sympathy under each system; but in none of them I think
is it possible to conceive of an affection of the fluids.
3dly. The division of diseases into organic, or those which alter
the texture of the organs, and into those which leave this texture
untouched, is still essential here. The first have their seat evidently
in the solids.
4thly. The division into acute and chronic, ought not to be neglected
in resolving the problem.
5thly. In fine, it would be necessary to make another distinction not
less important, viz. that of diseases which are independent of every
principle inherent in the economy and of those which proceed from a
similar principle, as when the virus of the venereal, the tetters,
scrofula or scurvy predominates in the whole system, and alternately
attacks the different organs.
How little soever you may examine diseases under different points of
view, you will perceive that what is true of one class cannot be so of
another. It is evident from this, that it is improper to resolve this
question in a general manner, as it has been too often done, and that
a theory of diseases founded upon the principle of the affection of
the solids or fluids alone, is a pathological absurdity, equal to that
in physiology which would place in action the fluids or solids only.
I think there are two errors that should be equally feared, that of
particularizing and that of generalizing too much. The second leads us
to false conclusions as well as the first.
Though the vital properties reside especially in the solids, it is not
necessary to consider the fluids as entirely inert. It is undeniable,
that those of them which form the composition of the body, increase
in vitality as they advance from the aliments of which they are
formed, to the solids which they compose. The alimentary mass is less
animalized than the chyle, and this is less so than the blood. It
would undoubtedly be a subject of very curious research, to determine,
how the particles, from being foreign to the vital properties, and
enjoying only physical ones, become by degrees possessed of the
rudiments of the first. I say the rudiments, for certainly the vital
elaboration that the fluids experience in circulating as such in the
body, and before they penetrate the solids to become a part of them, is
the first degree of their vital properties. In the same manner, if you
should inject into this fluid the materials of those that are exhaled
or secreted, the exhalant and secretory organs would repulse these
materials, if life had not made them undergo a previous elaboration.
It is evidently impossible to say what this vitality of the fluids is;
its existence however is not less real, and the chemist who wishes to
analyze the fluids, has, like the anatomist who dissects the solids,
only the dead body upon which he can operate. You will observe, that
when the principle of life has left the fluids, they go immediately
into a state of putrefaction, and are decomposed like the solids,
deprived of their vital powers. This alone prevents that internal
movement, which undoubtedly enters much into the alterations of which
the fluids are susceptible. Observe what takes place after a meal;
ordinarily a slight increase of the pulse, the effect of the mixture
of the nutritive principles with the blood, is the consequence of
it. If you have made use of acrid or spicy aliments, to which you
are unaccustomed, a general heat, a thousand different sensations of
lassitude and heaviness, accompany digestion. Shall I speak of the
various kinds of wine, and their effects, even to intoxication? Who
has not a hundred times paid dearly for the pleasures of a repast
by a general disorder, an universal agitation, a heat in every part
during the whole time that the wine circulates with the blood? Who has
not observed that one kind of wine produces one effect and another a
different? The solids are then without doubt the seat of every thing
we experience; but is not the cause of it in the fluids? It is the
blood, which carrying with its own particles others that are foreign
to it, excites all the organs, and especially the brain, because there
is a particular relation between this viscus and spirituous liquors,
as there is between cantharides and the bladder, and mercury and the
salivary glands. That which I say is so true, that if you infuse wine
into the open vein of an animal, you will produce analogous effects.
The experiments made upon this subject are so well known that I have
not even repeated them.
I will relate a fact here which disproves what has lately been advanced
upon the incorruptibility of the blood in diseases. A short time since,
in examining a body at the Hôtel Dieu, with Mess. Péborde, l'Herminier,
and Bourdet, we found instead of the black abdominal blood, a real grey
sanies, which filled all the divisions of the splenic vein, the trunk
of the vena porta, and all the hepatic branches, so that by cutting the
liver in slices, we could distinguish by the flow of this sanies, all
the ramifications of the vena porta from those of the vena cava, which
contained ordinary blood. This body was so remarkable for its size,
that I do not recollect to have ever seen one equal to it. Certainly
this sanies was not the effect of death, and the blood had circulated,
if not thus altered, at least very different from its natural state,
and really decomposed.
Consider the immense influence of aliments upon health, structure, and
even character. Compare the people who live only on milk and vegetables
with those who are in the constant use of spirituous liquors. See how
alkohol, carried into the new world, has modified the manners and
habits of the savages; consider the slow and gradual influence of
regimen in chronic diseases, and you will perceive that in health, as
in disease, the alteration of the fluids is frequently before that of
the solids, which consequently become changed; for it is an inevitable
circle. But the alteration of the fluids appears to depend essentially
upon the mode of the mixture of parts not animalized with those that
are so.
We should have a very inaccurate idea of the mixture with the blood of
the foreign substances brought by the way of the intestines, the skin,
or the lungs, for the purposes of sanguification, if we compared it to
the mixture of inert substances, or chemical combinations. The blood
enjoys, if we may so say, the rudiments of organic sensibility; and
as the life which it enjoys places it more or less in relation to the
fluids that enter it, it is more or less disposed to combine with them
and to endow them with the life with which it is animated. Sometimes
it repulses for a long time substances that are foreign to it. I am
persuaded that a great number of the phenomena that we experience after
taking food, especially acrid substances, and spirituous liquors,
arises in part from the general disorder that the blood undergoes when
its vitality begins to communicate itself to these foreign substances
from the kind of struggle which takes place in the vessels, between
the living fluid and that which does not live. Thus we see all the
solids rise, as it were, against a stimulant they are unaccustomed to.
Who knows but that the vitality of the fluids has an influence upon
their motions? I think it is very probable. I doubt whether fluids
purely inert could, if they were alone in animated vessels, circulate
like living fluids. In the same manner, animated fluids could not
move themselves, if they were in vessels deprived of life. Life then
is equally necessary to one and the other. But these subjects are too
obscure to occupy us longer.
V. _Of the properties independent of life._
These are what I call properties of texture. Foreign to inert bodies,
inherent in the organs of living bodies, they arise from their texture,
from the arrangement of their particles, but not from the life that
animates them. Thus death does not destroy them. They remain in the
organs when life is gone; that, however, adds much to their energy.
Putrefaction and the decomposition of the organs, alone destroy them.
The two first of these properties are extensibility and contractility
of texture. I have explained these sufficiently in my Treatise on Life.
I shall have occasion in this work to explain the influence they have
in each system. I shall now speak of a property of which as yet very
little has been said; which chemists have proved by their experiments,
and which physiologists have confounded often with irritability,
but which is as distinct from it as it is from the contractility of
texture; I mean the property of being[3] hardened like horn, and
contracted by the action of different agents. This will be examined
particularly in each system; I shall now describe it in a general
manner only.
[3] There are no words in English that correspond exactly to the words
_racornir_, and _racornissement_, and I have therefore been compelled
to employ the terms, _to harden like horn_, and _horny hardening_, to
express the precise meaning. _Tr._
Every organized part, submitted either after death or during life, to
the action of fire and of certain concentrated acids, is contracted
and wrinkled in different ways, and is affected almost like irritable
organs when they are excited. Now this property is to be considered as
to the agents which put it in action, as to the organs which are the
seat of it, and as to its phenomena.
1st. Fire is the principal agent of this horny hardening. Every living
organ, placed upon burning coals, is suddenly raised to the highest
degree. 2d. Next to fire, the strongest acids, the sulphuric first,
then the nitric, then the muriatic, make the animal fibres contract
most suddenly. As they are diluted, they lose this power, and the acids
that are naturally very weak have hardly any of it. 3d. Alkohol is
much less powerful in producing this effect, though it may be highly
concentrated. It contracts, however, the texture of parts, which
it condenses and even twists. So that those who preserve anatomical
specimens, find it necessary to dilute the alkohol. 4th. The neutral
salts, after being moistened by the humidity of animal substances,
condense and harden them wonderfully after the lapse of a considerable
length of time. 5th. When the air has taken away, by drying, the
aqueous particles of the solids, these continuing exposed to its
action, contract, wrinkle, and twist in a slow and gradual manner. 6th.
The alkalies, however strong they may be employed, do not produce any
kind of horny hardening. 7th. Water appears to act in a manner opposite
to this horny hardening; it dilates, spreads the organs by maceration,
and separates their particles. It is when it is combined with much
caloric that it produces horny hardening. This phenomenon takes place
at some degrees below boiling, and is very remarkable at that point.
The different agents of which I have just spoken, produce, then, two
species of horny hardening: 1st. the first is prompt, sudden, almost
like the motion which results from the irritation of a living muscle:
2d. the other slow, gradual, and even insensible. Fire and the strong
acids are in a special manner the agents of the first. The action of
the neutral salts, of the air, of alkohol, principally produce the
second.
These two species differ very much in their results. The state to which
the first reduces the organ, is soon changed if the hardening cause
continues. 1st. Fire continuing to act upon the solids, reduces them
to a hard and coaly mass. 2d. Boiling water, after a length of time,
destroys by degrees the hardness the solids had suddenly acquired,
by being plunged into it. As the hardness diminishes, the effect of
the boiling increases, and it arrives at the greatest extent, when
the solid, having lost all consistence, becomes pulpy. 3d. Animal
organs that have been acted upon suddenly by the acids, and become
consequently hard, soon grow soft and change into a true pulp. This
double phenomenon, that is presented on the one hand by boiling, and
on the other by the strong acids, has a great analogy, and seems to be
derived from the same principle.
The slow and insensible horny hardening, the effect of the contact of
neutral salts, such as alum, the muriate of soda, &c. of the air and of
alkohol, offers a very different phenomenon from the first. It is not
altered by the continued action of the cause that produced it, however
long it may be; it does not soften in a slow and insensible manner, as
it has hardened, but remains always firm and contracted.
Are these two species only different degrees of the same, or are they
derived from separate principles? I know not. I have only observed,
that when the living solids have undergone the slow and gradual horny
hardening, they are still susceptible of the other. We know that after
many years drying, animal textures are hardened, as in a recent state,
by the action of fire; I have made the same observation with regard to
boiling and the acids. Textures that have been contracted for a long
time by alkohol and the neutral salts present the same phenomenon.
All animal textures are susceptible of sudden hardening, except the
hair, the epidermis, and the nails; these, if we may so say, exhibit
only the rudiments of it. In general the hardening is more sensible,
in proportion as the fibrous texture predominates in the organs. Hence
the muscles, the tendons, and nerves, are the most susceptible of it.
The organs not fibrous, as the glands, show the least degree of it. The
slow and insensible horny hardening is almost the same in every part.
Both exist in textures deprived of animal contractility, of sensible
organic contractility, and of contractility of texture, as well as in
those which enjoy them in the highest degree. Thus the tendons, the
aponeuroses, the bones, even when their calcareous substance has been
removed by acids, may be hardened as well as the muscles and the skin.
This single circumstance would suffice to distinguish the contractility
arising from hardening from all others, if a variety of differences,
which I shall point out hereafter, under the article of the muscles in
particular, did not.
When a texture is suddenly hardened, it loses more than half its
length, and becomes twisted in various ways. Taken suddenly from the
acid or boiling water, it remains hardened; but if it is pulled, it
becomes elongated, and then contracts again, when the force applied
ceases, so that it has acquired a real elasticity by the process
of hardening. This elasticity is remarkable in the tendons, nerves
and muscles, which before this are absolutely destitute of it. This
elasticity is not an effect of the slow and insensible hardening of
alkohol and the neutral salts. By macerating for a length of time
the organized textures, they gradually lose the power of contracting
suddenly, which does not, however, entirely disappear, until the
maceration has reduced the textures to mere pulp.
If the textures are softened by boiling, and stretched out to their
original length, after having been hardened, this cannot be produced
again by any agent that we may employ.
When the textures are in a state of putrefaction, they no longer
possess this kind of contractility.
Slow and insensible hardening cannot take place during life; this is an
insurmountable obstacle to it. But that which is sudden may, when its
agents have overcome the resistance that vitality offers. Oftentimes we
see the skin hardened by burns. When it is stripped of its epidermis,
and a very strong acid is poured upon it, the same effect is produced
as upon any other organ.
When a part has been hardened upon a living subject, it almost
inevitably dies; it cannot be restored to the suppleness that it
possessed before; suppuration separates it from the sound parts.
The fluids do not present the phenomenon of hardening, the fibrine only
excepted. Separated from the blood, it crisps and contracts.
After what has been said, it is evident that the solids possess the
faculty of contracting or shortening. This is brought into action in
many different ways. During life it appears, 1st. in the influence of
the nerves upon the voluntary muscles; this is animal contractility.
2d. In the involuntary muscles by the action of stimuli; this is
sensible organic contractility. 3d. In the muscles, the skin, the
cellular texture, the arteries, the veins, &c. from a want of
extension. This is the contractility of texture, which is not found,
or at least is very obscure, in many of the organs, as the nerves,
the fibrous bodies, the cartilages, the bones, &c. 4th. By the action
of fire, and the strong acids; this is the contractility of the horny
hardening, and is general.
When the muscles are deprived of life, they lose the two first kinds of
contractility; but the third remains with them as it does with all the
organs that enjoy it. When they are dried or remain in water a little
time, they lose that also; but the fourth still continues with them;
it is the last that abandons the animal textures; it is perpetuated
for a length of years. When I have exposed to the action of fire the
cartilaginous parenchyma of bones found in cemeteries, they have become
hardened. I am persuaded that this faculty would last for many ages, if
we could preserve the organic textures.
Contractility is, then, a common and general property, inherent in all
animal textures, but which, according to the manner that it is brought
into action, presents essential differences, which divide it into many
species, that have no analogy. It would certainly be impossible to
avoid distinguishing the difference between the four species I have
pointed out, and that insensible contraction, or kind of oscillation,
which forms during life the insensible organic contractility, or tonic
motions.
Among the causes that bring contractility into action, some belong,
then, to life, others are independent of it, and are derived only from
organization. All the organs are essentially contractile; but each
of the causes which makes them contract acts only upon this or that
texture: the horny hardening alone has a general effect.
VI. _Observations upon the organization of animals._
The properties, whose influence we have just analyzed, are not
absolutely inherent in the particles of matter that are the seat of
them. They disappear when these scattered particles have lost their
organic arrangement. It is to this arrangement that they exclusively
belong; let us treat of it here in a general way.
All animals are an assemblage of different organs, which, executing
each a function, concur in their own manner, to the preservation of
the whole. It is several separate machines in a general one, that
constitutes the individual. Now these separate machines are themselves
formed by many textures of a very different nature, and which really
compose the elements of these organs. Chemistry has its simple bodies,
which form, by the combinations of which they are susceptible, the
compound bodies; such are caloric, light, hydrogen, oxygen, carbon,
azote, phosphorus, &c. In the same way anatomy has its simple textures,
which, by their combinations four with four, six with six, eight with
eight, &c. make the organs. These textures are, 1st. the cellular;
2d. the nervous of animal life; 3d. the nervous of organic life; 4th.
the arterial; 5th. the venous; 6th. the texture of the exhalants;
7th. that of the absorbents and their glands; 8th. the osseous; 9th.
the medullary; 10th. the cartilaginous; 11th. the fibrous; 12th.
the fibro-cartilaginous; 13th. the muscular of animal life; 14th.
the muscular of organic life; 15th. the mucous; 16th. the serous;
17th. the synovial; 18th. the glandular; 19th. the dermoid; 20th. the
epidermoid; 21st. the pilous.
These are the true organized elements of our bodies. Their nature is
constantly the same, wherever they are met with. As in chemistry, the
simple bodies do not alter, notwithstanding the different compound ones
they form. The organized elements of man form the particular object of
this work.
The idea of thus considering abstractedly the different simple textures
of our bodies, is not the work of the imagination; it rests upon the
most substantial foundation, and I think it will have a powerful
influence upon physiology as well as practical medicine. Under whatever
point of view we examine them, it will be found that they do not
resemble each other; it is nature and not science that has drawn the
line of distinction between them.
1st. Their forms are every where different; here they are flat, there
round. We see the simple textures arranged as membranes, canals,
fibrous fasciæ, &c. No one has the same external character with
another, considered as to their attributes of thickness or size.
These differences of form, however, can only be accidental, and the
same texture is sometimes seen under many different appearances; for
example, the nervous appears as a membrane in the retina, and as
cords in the nerves. This has nothing to do with their nature; it is
then from the organization and the properties, that the principal
differences should be drawn.
2dly. There is no analogy in the organization of the simple textures.
We shall see that this organization results from parts that are common
to all, and from those that are peculiar to each; but the common parts
are all differently arranged in each texture. Some unite in abundance
the cellular texture, the blood vessels and the nerves; in others, one
or two of these three common parts are scarcely evident or entirely
wanting. Here there are only the exhalants and absorbents of nutrition;
there the vessels are more numerous for other purposes. A capillary
net-work, wonderfully multiplied, exists in certain textures, in
others this net-work can hardly be demonstrated. As to the peculiar
part, which essentially distinguishes the texture, the differences
are striking. Colour, thickness, hardness, density, resistance, &c.
nothing is similar. Mere inspection is sufficient to show a number of
characteristic attributes of each, clearly different from the others.
Here is a fibrous arrangement, there a granulated one; here it is
lamellated, there circular. Notwithstanding these differences, authors
are not agreed as to the limits of the different textures. I have had
recourse, in order to leave no doubt upon this point, to the action of
different re-agents. I have examined every texture, submitted them to
the action of caloric, air, water, the acids, the alkalies, the neutral
salts, &c. drying, putrefaction, maceration, boiling, &c. the products
of many of these actions have altered in a different manner each kind
of texture. Now it will be seen that the results have been almost all
different, that in these various changes, each acts in a particular
way, each gives results of its own, no one resembling another. There
has been considerable inquiry to ascertain whether the arterial coats
are fleshy, whether the veins are of an analogous nature, &c. By
comparing the results of my experiments upon the different textures,
the question is easily resolved. It would seem at first view that all
these experiments upon the intimate texture of systems, answer but
little purpose; I think however that they have effected an useful
object, in fixing with precision the limits of each organized texture;
for the nature of these textures being unknown, their difference can be
ascertained only by the different results they furnish.
3dly. In giving to each system a different organic arrangement, nature
has also endowed them with different properties. You will see in the
subsequent part of this work, that what we call _texture_ presents
degrees infinitely varying, from the muscles, the skin, the cellular
membrane, &c. which enjoy it in the highest degree, to the cartilages,
the tendons, the bones, &c. which are almost destitute of it. Shall I
speak of the vital properties? See the animal sensibility predominant
in the nerves, contractility of the same kind particularly marked in
the voluntary muscles, sensible organic contractility, forming the
peculiar property of the involuntary, insensible contractility and
sensibility of the same nature, which is not separated from it more
than from the preceding, characterizing especially the glands, the
skin, the serous surfaces, &c. &c. See each of these simple textures
combining, in different degrees, more or less of these properties, and
consequently living with more or less energy.
There is but little difference arising from the number of vital
properties they have in common; when these properties exist in many,
they take in each a peculiar and distinctive character. This character
is chronic, if I may so express myself, in the bones, the cartilages,
the tendons, &c.; it is acute in the muscles, the skin, the glands, &c.
Independently of this general difference, each texture has a particular
kind of force, of sensibility, &c. Upon this principle rests the whole
theory of secretion, of exhalation, of absorption, and of nutrition.
The blood is a common reservoir, from which each texture chooses, that
which is adapted to its sensibility, to appropriate and keep it, or
afterwards reject it.
Much has been said since the time of Bordeu, of the peculiar life of
each organ, which is nothing else than that particular character which
distinguishes the combination of the vital properties of one organ,
from those of another. Before these properties had been analyzed with
exactness and precision, it was clearly impossible to form a correct
idea of this peculiar life. From the account I have just given of it,
it is evident that the greatest part of the organs being composed of
very different simple textures, the idea of a peculiar life can only
apply to these simple textures, and not to the organs themselves.
Some examples will render this point of doctrine which is important,
more evident. The stomach is composed of the serous, organic muscular,
mucous, and of almost all the common textures, as the arterial, the
venous, &c. which we can consider separately. Now if you should attempt
to describe in a general manner, the peculiar life of the stomach it is
evidently impossible that you could give a very precise and exact idea
of it. In fact the mucous surface is so different from the serous, and
both so different from the muscular, that by associating them together,
the whole would be confused. The same is true of the intestines, the
bladder, the womb, &c.; if you do not distinguish what belongs to each
of the textures that form the compound organs, the term peculiar life
will offer nothing but vagueness and uncertainty. This is so true, that
oftentimes the same textures alternately belong or are foreign to their
organs. The same portion of the peritoneum, for example, enters or does
not enter, into the structure of the gastric viscera, according to
their fulness or vacuity.
Shall I speak of the pectoral organs? What has the life of the
fleshy texture of the heart in common with that of the membrane that
surrounds it? Is not the pleura independent of the pulmonary texture?
Has this texture nothing in common with the membrane that surrounds
the bronchia? Is it not the same with the brain in relation to its
membranes, of the different parts of the eye, the ear, &c.?
When we study a function, it is necessary carefully to consider in a
general manner, the compound organ that performs it; but when you
wish to know the properties and life of this organ, it is absolutely
necessary to decompose it. In the same way, if you would have only
general notions of anatomy, you can study each organ as a whole; but it
is essential to separate the textures, if you have a desire to analyze
with accuracy its intimate structure.
VII. _Consequences of the preceding principles relative to diseases._
What I have been saying leads to important consequences, as it respects
those acute or chronic diseases that are local; for those, which like
most fevers, affect almost simultaneously every part, cannot be much
elucidated by the anatomy of systems. The first then will engage our
attention.
Since diseases are only alterations of the vital properties, and each
texture differs from the others in its properties, it is evident
there must be a difference also in the diseases. In every organ then,
composed of different textures, one may be diseased, while the others
remain sound; now this happens in a great many cases; let us take the
principal organs, for example.
1st. Nothing is more rare than affections of the mass of the brain;
nothing is more common than inflammation of the tunica arachnoides that
covers it. 2d. Oftentimes one membrane of the eye only is affected,
the others preserving their ordinary degree of vitality. 3d. In
convulsions or paralysis of the muscles of the larynx, the mucous
surface is unaffected; and on the other hand the muscles perform their
functions as usual in catarrhs of this surface. Both these affections
are foreign to the cartilages, and vice versa. 4th. We observe a
variety of different alterations in the texture of the pericardium,
but hardly ever in that of the heart itself; it remains sound while
the other is inflamed. The ossification of the common membrane of the
red blood does not extend to the neighbouring textures. 5th. When the
membrane of the bronchia is the seat of catarrh, the pleura is hardly
affected at all, and reciprocally in pleurisy the first is scarcely
ever altered. In peripneumony, when an enormous infiltration in the
dead body shows the excessive inflammation that has existed during
life in the pulmonary texture, the serous and mucous surfaces often
appear not to have been affected. Those who open dead bodies know that
they are frequently healthy in incipient phthisis. 6th. We speak of a
bad stomach, a weak stomach; this most commonly should be understood
as applying to the mucous surface only. Whilst this secretes with
difficulty the nutritive juices, without which digestion is impaired,
the serous surface exhales as usual its fluid, the muscular coat
continues to contract, &c. In ascites, in which the serous surface
exhales more lymph than in a natural state, the mucous oftentimes
performs its functions perfectly well, &c. 7th. All authors have said
much of the inflammation of the stomach, the intestines, the bladder,
&c. For myself I believe that this disease rarely ever affects at first
the whole of any of these organs, except in the case where poison
or some other deleterious substance acts upon them. There are for
the mucous surface of the stomach and intestines, acute and chronic
catarrhs, for the peritoneum serous inflammations, perhaps even for
the layer of organic muscles that separates the two membranes, there
is a particular kind of inflammation, though we have as yet hardly any
thing certain upon this point; but the stomach, the intestines, and the
bladder are not suddenly affected with these three diseases. A diseased
texture can affect those near it, but the primitive affection seizes
only upon one. I have examined a great number of bodies in which the
peritoneum was inflamed either upon the intestines, the stomach, the
pelvis, or universally; now very often when this affection is chronic,
and almost always when it is acute, the subjacent organs remain sound.
I have never seen this membrane exclusively diseased upon one organ,
while that of the neighbouring ones remain untouched; its affection is
propagated more or less remotely. I know not why authors have hardly
ever spoken of its inflammation, and have placed to the account of
the subjacent viscera that which most often belongs only to this.
There are almost as many cases of peritonitis as of pleurisy, and
yet while these last have been particularly noticed the others are
almost entirely overlooked. Oftentimes that part of the peritoneum
corresponding to an organ, is much inflamed; we see it in the case of
the stomach; we observe especially after the suppression of the lochia
or the menses, that it is the portion that lines the pelvis that is
first affected. But soon the affection becomes more or less general; at
least examinations after death prove it satisfactorily. 8th. Certainly
the acute or chronic catarrh of the bladder, or womb even, has nothing
in common with the inflammation of that portion of the peritoneum
corresponding with these organs. 9th. Every one knows that diseases of
the periosteum have oftentimes no connexion with the bone, and vice
versa, that frequently the marrow is for a long time affected, while
both the others remain sound. There is no doubt that the osseous,
medullary and fibrous textures have their peculiar affections which we
shall not confound with the idea we may form of the diseases of the
bones. The same can be said of the intestines, of the stomach, &c. in
relation to their mucous, serous, muscular textures, &c. 10th. Though
the muscular and tendinous textures are combined in a muscle, their
diseases are very different. 11th. You must not think that the synovial
is subject to the same diseases as the ligaments that surround it, &c.
I think the more we observe diseases, and the more we examine bodies,
the more we shall be convinced of the necessity of considering local
diseases, not under the relation of the compound organs, which are
rarely ever affected as a whole, but under that of their different
textures, which are almost always attacked separately.
When the phenomena of diseases are sympathetic, they follow the same
laws as when they arise from a direct affection. Much has been said of
the sympathies of the stomach, the intestines, the bladder, the lungs,
&c. But it is impossible to form an idea of them, if they are referred
to the organ as a whole, separate from its different textures. 1st.
When in the stomach, the fleshy fibres contract by the influence of
another organ and produce vomiting, they alone receive the influence,
which is not extended either to the serous or mucous surfaces; if it
were, they would be the seat, the one of exhalation, the other of
sympathetic exhalation and secretion. 2d. It is certain that when the
action of the liver is sympathetically increased, so that it pours out
more bile, the portion of peritoneum that covers it does not throw
out more serum, because it is not affected by it. It is the same of
the kidney, the pancreas, &c. 3d. For the same reason, the gastric
organs upon which the peritoneum is spread, do not partake of the
sympathetic influences that it experiences. I shall say as much of the
lungs in relation to the pleura, the brain in relation to the tunica
arachnoides, the heart to the pericardium, &c. 4th. It is undeniable
that in all sympathetic convulsions, the fleshy texture is alone
affected, and that the tendinous is not so at all. 5th. What has the
fibrous membrane of the testicles in common with the sympathies of its
peculiar texture? 6th. No doubt a number of sympathetic pains that we
refer to the bones, are seated exclusively in the marrow.
I could cite many other examples to prove, that it is not this or that
organ which sympathizes as a whole, but only this or that texture in
the organs; besides, this is an immediate consequence of the nature of
sympathies. In fact the sympathies are but aberrations of the vital
properties; now these properties vary according to each texture; the
sympathies of these textures then would do the same.
Observe what takes place in fever, accompanying the different kinds
of inflammation. That attending the mucous is slight, that with the
serous severe, and that with the cutaneous has the peculiar character
of showing itself some days before the eruption, as has been noticed
by Pinel. If we attentively observe the fever which attends the
inflammations of all the systems, we shall find as many differences, as
many peculiar characters, as there are systems. Whence does this arise?
From the difference of the relations that unite the heart to each kind
of texture; now this difference of relations is the result of the
difference of the vital forces peculiar to each.
Observe the itch, herpes, cancer, venereal disease, &c. when they have
ceased to be local affections, they spread themselves universally;
they alternately attack different textures, according to the relation
which they have with the organic sensibility of these textures. But it
is almost always separately that they attack them; an organ is never
as a whole influenced by them in all its parts. What do I say? If two
of these diseases exist at the same time, one seizes upon one texture,
the other upon a different one of the same organ. Thus the stomach, the
intestines, the lungs, &c. can be attacked by two different diatheses,
and each will be independent of the other, because each will be fixed
upon a different texture, one upon the mucous, for example, the other
upon the serous, &c.
Let us not, however, exaggerate this independence of the textures of
the organs in diseases, lest experience should contradict us. We shall
see that the cellular system is oftentimes a medium of communication,
not only from one texture to another in the same organ, but from one
organ to a neighbouring one. Thus in many chronic diseases, all the
parts of the same organ are gradually changed, and at the examination
of this organ after death, the whole of it appears to have been
affected, though one of its textures only was so at first. In the
cancer of the breast, you find at first only a small gland that rolls
under the finger; finally the glandular, the cellular, and even the
cutaneous textures are confounded in one common cancerous mass. Cancer
of the stomach, the intestines, the penis, &c. follows the same course.
Observe phthisis, exhibiting in the beginning some small tubercles in
the pulmonary texture, at length invading oftentimes the pleura, the
bronchial membrane, &c. How little soever you may examine bodies with
a view to the same chronic disease, and at different periods, you will
be convinced of the truth of this assertion, viz. that a texture being
at first affected in an organ, communicates its affection gradually to
others, and that you will be deceived in judging of the primitive seat
of the disease, if you attempt to determine it from the parts found
affected at the time of the examination.
In acute diseases, continuity is oftentimes sufficient to explain the
different symptoms that appear in textures that are not affected. The
peritoneal coat only being inflamed, vomiting is produced. We cough and
sometimes expectorate considerably when the pleura alone is diseased.
Delirium comes on when the tunica arachnoides is inflamed, though
the intellectual functions are not connected with it. Frequently the
diseases of the pericardium are sufficient to disturb the motion of the
heart, &c. We cannot deny after this, that oftentimes an alteration
in one of the textures alone of an organ is sufficient to disturb the
functions of all the others; but still it is in one only, that the
primitive source of the evil exists.
I now pass to some other considerations relative to the influence of
the anatomy of systems in diseases.
Since every organized texture has every where the same arrangement;
since, whatever be its situation, it has the same structure and the
same properties, it is evident that its diseases must be every where
the same. It makes no difference, that the serous texture is connected
with the brain by the tunica arachnoides, with the lungs by the pleura,
with the heart by the pericardium, with the gastric viscera by the
peritoneum, &c. every where it is inflamed in the same manner; every
where dropsies take place in the same way; every where it is subject to
a species of eruption of little whitish tubercles, like the miliary, of
which I believe there has been no description, but which deserves great
attention; I have already many times observed this peculiar eruption
of the serous texture, which is generally of a chronic character,
like most of the cutaneous eruptions; I shall speak of it hereafter.
Whatever may be the organ that the mucous texture invests, its
affections have in general the same character, excepting the difference
only that arises from variety of structure. I will say the same of the
fibrous, cartilaginous textures, &c. Mr. Pinel appears to me to have
done much for the art, in being the first who arranged inflammations in
the order of the systems, and embracing in one general view all those
of the same system, whatever may be the organs in which it is found.
There are always two orders of symptoms in inflammations; 1st. those
that belong to the nature of the diseased textures; 2d. those which
depend upon the affected organ, in which the inflammation exists. For
example, the kind of pain, the nature of the accompanying fever, the
duration, the termination, &c. are almost always the same, whatever
serous surface is affected. But difficulty of breathing, dry cough, &c.
prove it to be the pleura; diarrhœa, constipation, vomiting, &c. that
it is the peritoneum; injury of the intellectual functions, that it is
the tunica arachnoides; irregular pulse, that it is the pericardium,
&c. The first belong to the whole class, the second set of symptoms is
confined exclusively to this or that particular sort; now the second
are, if we may so say, accessory, depending upon the proximity of the
affected texture with some other texture. The first are particularly
important.
Medicine has yet much to do, in its researches upon the inflammation
of the different textures. We are well acquainted with that of the
cellular, the cutaneous, the serous, and the mucous; but that of
the others is very obscure. It is yet to be ascertained, which is
attacked, the fibrous or muscular, in rheumatism. I am inclined to
think that it is the first. Almost every thing remains to be known in
the cartilaginous, the synovial, the arterial, the venous, &c. as it
respects their inflammatory phenomena.
In making these researches, it will be necessary to establish one
important distinction; that is, 1st. that certain textures, as the
osseous, the muscular of animal life, &c. are precisely the same in
all the organs in which they are found, and consequently that their
diseases must be the same; 2d. that others, as the cutaneous, the
serous, the mucous, &c. experience, according to the organs to which
they belong, some variety of structure and vital properties, which
necessarily modify the general phenomena of the class of diseases
that belong to these textures; 3d. that others, as the glandular, the
muscular of organic life, &c. are very different in each organ; and
that their general symptoms and class of diseases must consequently
differ considerably.
After having shown most of the local diseases, as affecting almost
always, not an individual organ, but some texture in an organ, it
is necessary to show the differences they present according to the
textures they affect. As under each system, this subject will be
treated more or less fully, I shall only refer to it here.
We shall see, then, that pain is modified differently in each texture,
according to the degree of sensibility that it possesses. No one
excites the same sensations as the others when it is inflamed. Compare
the burning of erisypelas with the throbbing of phlegmon, the pain
of rheumatism with that of inflamed lymphatic glands, &c. We shall
see also that the sense of heat, developed in each inflamed texture,
has a particular character; here it is sharp and biting, there like
the feeling produced by fire, &c. There are two general causes that
produce a variation in the symptoms of diseases: 1st. the nature of
the affected texture; thus, as I have just said, the inflammation of
each produces a different kind of suffering. 2d. The nature of the
disease; we know that cancer, whatever texture it may affect, has a
pain that is peculiar to it; that syphilis and scurvy have also a
peculiar character, that is, however, modified in a slight degree in
each texture.
The difference of textures not only modifies the symptoms, but affects
the duration of them also. Nothing in medicine is more vague, in
this point of view, than the terms acute and chronic, in relation to
inflammations of the different textures. Most commonly they run their
course rapidly in the dermoid, cellular, serous, mucous textures,
&c.; on the other hand, they are slow in the bones, the cartilages,
and the fibro-cartilages. If we apply this distinction to the same
texture, it is very well; thus there are catarrhs, serous and cutaneous
inflammations, &c. that are acute and chronic. But if we generalize it,
it cannot be understood. A catarrh would be chronic if it lasted two
months; but this is the common term of an acute inflammation of the
bones; a chronic one continues for a whole year or more. Cutaneous,
mucous wounds, &c. last only five or six days if they heal by the first
intention; while it requires thirty or forty for a bone, a cartilage,
&c. to be cicatrized by the juxta-position of its different parts.
A disease cannot be classed, then, by its duration, as an acute or
chronic one, except in relation to the same system; when we describe it
then in a general way, this distinction becomes void.
Physicians consider abstractedly almost all diseases. When they
speak of inflammation they describe the redness, swelling, throbbing
and pain, as general attributes, always uniform. If of suppuration,
they take for a general standard that of the cellular texture, in
phlegmon, without thinking that it is only one of the modifications
of suppuration and its product. The same may be said of gangrene,
scirrhus, &c. Nothing is more vague and uncertain than the general
ideas that are given concerning a disease; they scarcely agree in one
or two of the textures.
It is not only the history of diseases that the anatomy of systems
will elucidate; it will change in part the method of treating morbid
anatomy. Morgagni, to whom we owe so much in this respect, and
many others, to whom the art is indebted, have adopted the general
arrangement used in descriptions. They have examined the diseases of
the head, the chest, the abdomen, and the extremities. In following
this method, they can only form to themselves a general idea of the
alterations common to all the textures. The ideas are necessarily too
much contracted, when there is presented only an insulated part of a
system, which is composed of a great many others. If, besides this, you
obtain a general knowledge of the affections of each system, you must
bear in mind, with regard to each, the general ideas concerning the
affections of the parts they compose.
It appears to me to be infinitely more simple to consider at first all
the affections common to each system, and then to observe what every
organ has peculiar to itself in the part that it occupies.
I divide, then, morbid anatomy into two great parts. The first contains
the history of the alterations common to each system, whatever may be
the organ in the structure of which it is concerned, or whatever may be
the place it occupies. It is necessary to show at first the different
alterations of the cellular, arterial, venous, nervous, osseous,
muscular, mucous, serous, synovial, glandular, cutaneous textures,
&c. to examine the kind of inflammation, suppuration, gangrene, &c.
peculiar to each; to speak of the different enlargements of which they
are susceptible, the changes in their nature, which they undergo,
&c. Some, as the mucous, the cutaneous, the serous, the glandular,
&c. afford in this respect an immense field to morbid anatomy. The
others, as the fibrous, the nervous, the muscular, &c. are more rarely
changed in their texture. We shall see hereafter that nutrition alone
is performed in these, and that the others are particularly the seat
of exhalation, absorption, secretion, &c. functions which suppose much
energy in the insensible contractility and organic sensibility, which
are connected with all the alterations of texture.
After having thus pointed out the alterations peculiar to each system,
in whatever organ it is found, an examination should be made of the
diseases peculiar to each region; as those of the head, the chest, the
abdomen, and the extremities, after the common method. Here they may be
divided, 1st. into diseases which can especially affect an organ as a
whole, and not one of its textures alone, which is very rare. 2d. Into
the characters peculiar to each portion of this or that texture; for
example in the head, the peculiar symptoms which are seen in diseases
of the serous surface of the tunica arachnoides, those in affections of
the mucous surface of the pituitary membrane, &c.
This course is incontestably the most natural, though, as in all
divisions in which we wish to copy nature, there are many cases which
it almost excludes.
It seems to me that we live at a period, when morbid anatomy should
take a higher stand. This science is not only that of organic
derangements, that take place slowly, as the principles or consequences
of chronic diseases, it consists in the examination of all the
alterations our organs can undergo, at any period in which we may
observe their diseases. With the exception of certain kinds of fevers
and nervous affections, every thing in pathology is within the
province of this science. How weak appears the reasoning of many great
physicians, when we examine it, not in their works, but on the dead
body. Medicine was for a long time excluded from the circle of the
exact sciences; it will have a right to be associated with them, at
least in the diagnostics of diseases, when we shall every where unite
to accurate observation, an examination of the changes our organs
undergo. This course is beginning to be that of all rational minds;
it will without doubt soon be general. What is observation worth, if
we are ignorant of the seat of the disease? You may take notes, for
twenty years, from morning to night at the bedside of the sick, upon
the diseases of the heart, the lungs, the gastric viscera, &c. and all
will be to you only a confusion of symptoms, which, not being united
in one point, will necessarily present only a train of incoherent
phenomena. Open a few bodies, this obscurity will soon disappear, which
observation alone would never have been able to have dissipated.
VIII. _Remarks upon the classification of functions._
The plan that I have followed in this work, is not the most favourable
to the study of the functions. Many of them, such as digestion,
respiration, &c. would find no place here, because they do not belong
especially to the simple systems, but to a combination of them, an
union of many systems, and even of many organs. Thus what I have said
upon the functions, is introduced only incidentally in this work, the
particular object of which is the analysis of the different simple
systems that form the compound organs. However, as some would wish to
connect the different facts of physiology that it contains, with a
physiological classification, I will now explain that which I have
adopted in my course of lectures.
We know how different the kinds of classification are. The ancient
division, into animal, vital, and natural functions, rests upon so weak
a foundation, that a methodical superstructure could not be raised
upon it. Vicq d'Azyr has substituted one for it which offers hardly
any more advantages, as it separates phenomena that are connected, and
changes into functions, properties, such as sensibility, irritability,
&c. Since this author, others have made divisions which are not more
methodical, and are equally removed from the natural arrangement of the
phenomena of life.
I have endeavoured, as far as possible, in classing the functions, to
follow the path marked out by nature herself. I have laid, in my work
upon Life and Death, the foundations of this classification, which I
pursued before I published this work. Aristotle, Buffon, &c. have seen
in man two kinds of functions, one which connects him with external
bodies, the other, which serves for his nourishment. Grimaud brought
forward again this idea, which is as great as it is true, in his course
of physiology and in his memoir upon nutrition; but by considering
it in too general a manner, he did not analyze it with sufficient
exactness, he ranked among the external functions, only sensation and
motion, he did not describe the brain as the centre of these functions,
nor place the voice among them, which is however one of the great
means of communication, with the bodies that surround us. He did not
analyze more accurately the internal functions. He did not point out
their connexion in the elaboration of nutritive matter, where each
works in its turn, if I may so express myself; nor show the distinctive
characters, which separate generation from all the other functions
relating to the individual alone. Besides, the distinction of internal
and external functions was only presented as a general sketch in his
Memoir upon Nutrition, and not as a means of classification. He did not
avail himself of it, in the division of the functions, in his lectures,
of which many manuscripts arranged by himself, are to be met with at
the present time; in these he examined, 1st. osteogony, which was
treated at much length; 2d. the action of the muscles; 3d. the action
of the vessels or the circulation; 4th. generation; 5th. the action of
the organs of the senses; 6th. the action of the brain and nerves; 7th.
digestion; 8th. secretion; 9th. respiration, &c. From this it may be
perceived, that Grimaud, like preceding authors, mixed together all the
functions without referring them to certain general heads.
In reflecting upon the division pointed out above, I soon saw that it
was not only one of those general views, one of those great outlines,
that are oftentimes made by men of genius who cultivate physiology,
but that it might become the permanent basis of a methodical
classification. To come at this classification I observed that it was
necessary at first to refer all the functions to two great classes,
one relating to the individual, the other to the species; that these
two classes had nothing in common, but the general connexion that
unites all the phenomena of living bodies; but a variety of distinctive
attributes characterize them, which cannot be separated from them.
These two first classes being rigorously defined, and their limits
established by nature, I sought to discover in each, orders equally
natural; this was easy in the functions relating to the individual.
In fact, this was the place for the general outline of Aristotle and
Buffon; but it was not to be presented in too general a manner; the
nature and connexion of the functions peculiar to each order, were to
be accurately assigned.
I called the order of functions that connects us with external bodies,
animal life, thus indicating that this order belongs alone to animals,
that it is more with them than with vegetables, and that it is the
addition of these functions that particularly distinguishes them
from vegetables. I called organic life, the order that serves for the
constant composition and decomposition of our bodies, because this life
is common to all organized beings, vegetables as well as animals; and
because the only condition of enjoying it is organization; so that it
forms a boundary between organic and inorganic bodies, as animal life
serves to separate the two classes that form the first.
Animal life is composed of the action of the senses which receive
impressions, of the brain which perceives them, reflects, and wills,
of the voluntary muscles and larynx that execute this volition, and of
the nerves which are the agents of transmission. The brain is truly
the central organ of this life. Digestion, circulation, respiration,
exhalation, absorption, secretion, nutrition, calorification, compose
organic life, which has the heart for its principal and central organ.
I place calorification here, because it is evident from what I have
said under the article upon the capillary systems, that it is a
function analogous to secretion, exhalation and nutrition. It is truly
a separation of combined caloric, from the mass of blood. It is, if
the expression is preferred, a secretion or exhalation of that fluid
in every part of the body. I have not even at present given this place
to heat in my physiological classification: but in reflecting upon the
method of its production, it will be seen that it ought to have it.
The two orders of the first class being established, it was easy to
assign those of the second, which are three in number: 1st. functions
belonging to the male; 2d. those belonging to the female; 3d. those
arising from an union of the two sexes and the product of this union;
these are the three orders.
Such is the classification that I made in my Lectures on Physiology;
it has evidently nothing in common with any of those that are found
in physiological works; and if you reflect upon it a little, it
will appear I think infinitely preferable to any of them. Observe in
fine, that each class and each order have general and characteristic
attributes that particularly distinguish them, and which being
applicable to all the functions of that order, mark a difference
between them and all the functions of any other order. I have pointed
out moreover the distinctive attributes of animal and of organic life;
I have shown that the organs of one are symmetrical, those of the other
irregular; that there is a harmony in the functions of the first, a
discordance in those of the second; that one commences sooner and
terminates later, &c.
I have demonstrated, that the cerebral nerves belong especially to
animal life, the nerves of the ganglions to the organic, which appears
to me to be a remarkable difference, and which has induced me to make
two systems of the nerves, that anatomists have united in one. The
first, belonging to animal life, is composed of the cerebral nerves,
the other to organic, is formed of the nerves of the ganglions, or what
is commonly called the great sympathetic.
But it is the vital powers especially that distinguish one life from
another. I have shown that one kind of sensibility and contractility
belongs to animal life, and another to organic. Now as these vital
properties are the principle of the functions, it is evident that the
division of these properties demonstrates that that of the two lives is
not an abstraction, but that it is nature herself that has fixed the
limits, since she has made particular properties for each.
It is impossible to form a precise idea of the vital properties,
without admitting the division I have made. How many disputes there
have been, upon the subject of sensibility! Not one of them would
have taken place, if the attributes of animal life had been properly
distinguished from those of the organic. Certainly no one will
hereafter confound in one view, as frequently has been done, the
faculty that the heart has of being sensible to the entrance of the
blood, without transmitting that impression, and the faculty that the
skin, the other senses, the nerves, &c. have, not only of feeling the
impression of external bodies, but of transmitting it to the brain, so
that the sensation may be perceived.
If you include under one common name of irritability, the motions of
muscles that contract only by stimuli, and those which the cerebral
influence puts in action, it is impossible that you should be
understood.
There has been much discussion during the last age, upon the point,
whether sensibility is the same as contractility, or if these two
properties can be separated. Each of the two opinions seem to have
rested upon an equally solid foundation. But all these disputes
will be done away, by admitting the distinction I have made in the
vital properties. 1st. In animal life, then, it is evident, that
contractility is not a necessary consequence of sensibility; thus
frequently external objects make for a long time an impression upon
us, and yet the voluntary muscles remain unmoved. 2d. On the other
hand, in organic life, these two properties are never separated. In
the involuntary motions of the heart, the stomach, the intestines,
&c. there is first an excitement of the organic sensibility, and
then an action of the sensible organic contractility. In the same
manner, in the motions necessary to secretion, exhalation, &c. when
the organic sensibility has been brought into action, immediately
insensible organic contractility takes place. It is that they may
be studied better, and appreciated more accurately, that in organic
life, I separate these two kinds of contractility from sensibility.
In the natural state they are inseparable. Hence why the passive
sympathies of animal sensibility are very different from those of
animal contractility, and make two distinct classes, whilst the
passive sympathies of organic sensibility can never be separated from
the corresponding contractilities. We suffer by sympathy, and are
sympathetically convulsed in a distinct manner; these two things are
almost always separate. On the contrary, sensation and motion in the
organic sympathies are inseparable.
I could prove by many examples, that all the disputes, and all the
diversities of opinion, upon the subject of the vital properties,
proceed only from this cause, that those which preside over the
functions of one life, have not been distinguished from those which put
into action the functions of the other.
Let us return to my physiological division; I will now give a table
of it, which, presenting it under one point of view, will give a more
precise idea of the classification. This table comprehends, 1st. the
prolegomena of the science; 2d. the exposition of the functions. In the
prolegomena, every thing is referred to two great considerations; on
the one hand to organic texture, described in a general manner, and on
the other to life, considered in relation to its great attributes.
TABLE OF PHYSIOLOGY.
_PROLEGOMENA._
GENERAL OBSERVATIONS ON ORGANIC TEXTURE.
SECTION I.
│1st. Of the organic texture of animals.
│2d. Of simple textures, in general.
│3d. Of organs, in general.
│4th. Of the apparatus, in general.[4]
[4] In a subsequent part of this work, the author defines _appareil_,
which I have translated by the word _apparatus_, to be an assemblage
of many systems. It will be perceived that the English word in this
and some other instances is in the plural number. I should certainly
have preferred some other term more conformable to the idiom of our
own language if I had known any one that would so well have conveyed
the sense of the author. _Tr._