degree strong, arising in the economy, alters immediately the motions
of the heart. The least wound, oftentimes the slightest pain are
sufficient to produce derangements in it; now these derangements are
of two kinds; sometimes its action is arrested for a moment; hence
syncopes, a mode of derangement which happens especially in violent
and sudden pains. The vulgar expression which is employed in these
cases, viz. "my heart is failing," is perfectly true. Sometimes, and
this is the most common case, this action is accelerated; hence the
febrile motions so frequent in all the local affections, motions purely
sympathetic and which cease when the affection disappears. In many
local inflammations, the evil is too circumscribed to admit an obstacle
to the course of the blood, an obstacle, which according to Boerhaave,
forces the heart to redouble its action to surmount it; besides when
there is no swelling, but only pain in the part, and the febrile motion
comes on, it is there clearly a sympathetic phenomenon. The increase of
the action of the heart may depend no doubt upon a foreign substance,
which, mixed with the blood, alters and renders it more irritating;
it may be owing to an affection of the substance of the organ which
disposes it to be more irritable; but it is certainly very often
sympathetic, and depends upon that unknown relation which connects all
our organs, upon that consensus which links together all their actions,
and places them in reciprocal dependance.
I shall say as much of the stomach; though its sympathetic reaction may
not be altogether as frequent as that of the heart, yet it becomes very
evident under many circumstances. Most local affections, especially
inflammations are accompanied with sympathetic vomitings. Various
fevers have in their commencement similar vomitings. It is in the
hospitals especially that we frequently observe these phenomena. Many
physicians have not considered these vomitings as merely sympathetic,
but as the index of a bilious affection, founded on this, that bile
is then almost always thrown up. But in all the animals that I have
opened, I have almost always seen the stomach when empty containing a
certain quantity of this fluid which had flowed back from the duodenum;
other authors have also made similar observations; so that it appears
that in the state of vacuity, the existence of bile in the stomach
is a natural phenomenon. Hence it is not astonishing, that in the
commencement of diseases, and even in their course, the stomach being
sympathetically excited and thus becoming the seat of vomiting, more or
less of this fluid should be thrown up. It would be brought up even in
health if vomiting is then excited by an emetic; this is what sometimes
happens in the morning when the stomach is empty, if any cause foreign
to an affection of the liver, as the sight of a disgusting object,
produces vomiting; the bile then comes out like every thing else that
is contained in the stomach. I do not say that oftentimes the liver
being sympathetically excited in the commencement of diseases, does
not furnish more bile, that this superabundant bile flowing into the
stomach, does not make this viscus contract; but certainly this is
not most commonly the case; we vomit bile as we discharge it by the
anus, because it is found in the stomach and intestines, and not
because it is superabundant. If vomiting was a natural function, the
bilious evacuations in this way would be as natural as the greenish
tinge of the excrements, which is always found in a state of health.
We see then, from this, that the bilious vomitings are, in many cases,
purely accessory, and that the essential phenomenon is the sympathetic
contraction of the stomach.
In the case of which I have just spoken there is no gastric difficulty;
the sympathetic alteration of the stomach only extends to the fleshy
fibres. But most frequently this gastric difficulty appears at the
beginning of diseases in which there is local affection; sand-like
substances are vomited up; it is because then the organ essentially
affected, the lungs for example, if it is in a peripneumony, has acted
sympathetically not only on the fleshy fibres, but also upon the mucous
membrane. This excited increases its secretion; hence these sand-like
substances, which are nothing but the mucous juices mixed with the
gastric fluid and with the bile; now the presence of these substances
is often sufficient to make the stomach contract, and produce vomiting
which expels them.
From this it is evident that there can be sympathetic vomitings without
gastric difficulty, and sympathetic gastric difficulty with a vomiting
immediately produced. In the first case the fleshy fibres feel the
sympathetic influence of the affected organ; in the second it is the
mucous membrane. But how, when the lungs, the pleura, the skin,
&c. being affected, does the stomach come into action? I have said
that the word sympathy was only a veil for our ignorance in respect
to the relations of the organs to each other. Vomitings produced by
erysipelas, phlegmon, pleurisy, peripneumony, &c. are then most often
an effect exactly analogous to the increase of the action of the heart,
which produces fever. They resemble the cerebral derangement from
which arises delirium, a derangement which is much more rare, &c. All
these phenomena indicate that the other organs feel by reaction the
state of that which is affected, &c. Physicians who have not viewed
all these phenomena in a great and general manner, have confined their
treatment to too narrow bounds. Much attention was formerly paid to the
sympathetic derangement of the heart, and bleeding was much practised
in the beginning of diseases; for some years past much regard has been
had to the sympathetic derangement of the stomach, and emetics are
frequently given; perhaps before long, more attention will be given to
the weights of the head, pains in that part, watchfulness, drowsiness,
&c. which are very common sympathetic symptoms, and the treatment will
be directed to the brain. In these varieties judicious physicians
will regard all these phenomena in a general manner; they will see in
all a proof of that general agreement which disposes together all the
functions, which connects all and thus connects their derangements;
they will see each organ rise up, as it were against the evil which
is introduced into the economy, and each react in its own way; they
will see these reactions producing effects wholly different, according
to the organ reacting, fever arising from the reaction of the heart,
delirium, drowsiness, watchfulness, convulsions, &c. from that of
the brain, vomiting from that of the stomach, diarrhœa from that of
the intestines, gastric and intestinal derangements, foulness of the
tongue from those of the mucous membranes, overflowings of bile from
that of the liver, &c. Thus in a machine in which the whole is united
and connected together, if one part is deranged all the others are so
also. We should laugh at the mechanist who attempted to mend but one
of these pieces, and neglected to repair the local derangement from
which all those arose which the machine exhibits. Let us not laugh at
the physician who attacks only a single symptom, without combating
the disease, of which he oftentimes knows not the principle, though
he knows that this principle exists; but let us laugh at him, if he
attaches to his treatment an importance which is nothing compared with
that of the disease.
The intestines next to the stomach are the most often sympathetically
affected in diseases. The bladder is the organic muscle that is the
last to feel the influences that go from the diseased organ; this
sometimes however happens. In fevers, we know that retentions of
urine from sympathetic and temporary paralysis, are not very rare;
incontinence of urine is less often seen.
_Character of the Vital Properties._
We see from what has been said, that the vital properties are very
active in the organic muscles, especially as it respects contractility.
These muscles are really during life, in constant action: they receive
with great ease the influence of other organs. Their vital properties
are altered with the greatest promptness, especially that which I have
just pointed out; for the insensible contractility is rarely altered in
them, because it does not perform an essential part. Observe in fact
that the morbid derangements of an organ affect always the predominant
vital force of that organ. Animal contractility is frequently
altered in the preceding system; in this it is the sensible organic
contractility. On the contrary, the insensible being very small,
the phenomena over which it presides remain always nearly the same;
nutrition is always uniform; lesions of the muscular texture are rare;
when they take place, it is rather by communication, as in cancers of
the stomach, in which the disease begins upon the mucous surface, and
in which the fleshy fibres are only consequently affected. The heart
and the womb are the muscles that are the most subject to these morbid
alterations; yet in the first they belong oftener to the internal
membrane than to the fleshy fibres themselves. On the contrary in the
systems in which the sensible organic contractility is incessantly in
action, as in the cutaneous, the serous, &c. in which it presides over
nutrition and exhalation; in the glandular, the mucous, &c. in which
it produces secretion and nutrition, it is this which is especially
altered. From these derangements arise alterations of texture, organic
diseases properly called, which are as common in these systems, as they
are rare in those in which the insensible contractility, is so very
obscure, as to be only at the degree necessary for nutrition.
It is to this that must be referred the infrequency of acute
inflammations of this system. As this affection is frequent in the
cutaneous, the serous, the mucous systems, &c. so this system, whose
functions require but little insensible organic contractility, presents
it rarely. Those who open many dead bodies know, that the texture of
the heart is hardly ever found inflamed. Nothing is more common than
phlegmasia of the external or serous membrane, and of the internal
or mucous membrane of the stomach, the intestines, &c.; but nothing
is more obscure and less frequently seen than that of their fleshy
tunic. In rheumatism, there is sometimes when the pains cease around
the joints, violent cholics, spasmodic vomitings even, indices perhaps
of an acute affection of the fibres of the stomach or intestines; but
we never find marks of these affections; we do not see the muscular
texture exhibiting the bright red of the inflamed mucous, cutaneous
and serous organs; or at least I have never observed it.
Physicians have not paid sufficient attention to the difference of
inflammations according to the difference of systems; but especially
they have not sufficiently observed that this difference accords
perfectly with that of the insensible organic contractility; that
where this vital force is most characterized, inflammations have the
greatest tendency to take place, because it is this which presides
over their formation; because these affections suppose its increase;
as convulsions suppose the increase of animal contractility, as
vomitings, accelerated pulsations of the heart, suppose that of organic
contractility, &c. I cannot repeat it too much, that the most frequent
diseases in each system, put always in action, raise or diminish the
predominant vital force in that system. It is a new pathological view,
that may be fruitful in results.
ARTICLE FOURTH.
PHENOMENA OF THE ACTION OF THE MUSCULAR SYSTEM OF ORGANIC LIFE.
These phenomena are, as in the preceding system, relative to the state
of contraction or to that of relaxation.
I. _Force of the Contractions._
It is never capable of being raised to the point which the force of
the muscles of animal life sometimes attains. Between the strongest
and the weakest pulse, between the feeble jet which precedes some
retentions of urine, and the jet of the most vigorous man, there is
much less difference than between the langour of the voluntary muscles
of some women and the power of those of a maniac, or a man in anger.
The heart and the deltoid muscle are nearly equal in respect to their
fleshy mass; now what would become of the circulation, if the first
sometimes sent the blood with the force which the second uses to raise
the superior extremity? A fit of anger, mania, &c. is sufficient to
produce aneurisms. On the other hand the organic muscles are not
affected with those prostrations of forces so common in the others;
paralysis is foreign to them, because they are not within the cerebral
influence. There is something which answers to convulsions; it is the
irregular agitations which produce so many varieties in the pulse
of acute fevers, agitations which must be distinguished from those
produced by an organic defect of the heart; but these agitations are
wholly different from spasms of the voluntary muscles; there is even no
analogy.
There is not in the force of the contraction of the muscles of which
we are treating, the waste which is so remarkable in that of the other
muscles; the effort is nearly proportionable to the acting cause, and
the distinction of this force into absolute and effective, cannot be
applied here; only there is required more or less contractile energy,
according as the body to be expelled from a hollow muscle, is solid or
fluid. Hence why the great intestines are provided with longitudinal
fibres more characterized than those of the small intestines; why the
rectum especially, in which the excrements have their greatest degree
of solidity, exhibits these fibres in a more evident manner than the
colon or the cæcum, though under a different form; why in diarrhœas the
weakest contraction is sufficient to evacuate the intestines, whilst
the sensible organic contractility of the rectum being insufficient to
void very solid excrements, it is necessary that the abdominal muscle
should aid the expulsion; why when a hard body is introduced into the
stomach, and the gastric juices do not soften it, it remains there a
long time before being expelled, and produces an inconvenient weight,
&c. &c. We know with what rapidity the passage of liquids takes place
from the stomach to the intestines, and how long on the contrary solid
aliments remain in the first.
The force of the organic muscles is incomparably greater in the
phenomena of life than in our experiments. Once laid bare, the heart
communicates only feeble motions, and most often irregular ones. There
is no proportion between the force necessary to produce the jet,
sometimes from seven to eight feet, which the blood exhibits coming
from the open carotid of a dog, and the force of the contractions which
the strongest stimuli produce when applied to the heart extracted from
the body. Nothing equals in our experiments the force of contraction
necessary for vomiting, &c. &c.
Numerous calculations have been made upon the force of contraction,
in the organic muscles as in the preceding, and there has been the
same variety of results. Can we in fact calculate the degrees of a
phenomenon which a thousand causes make vary every instant, not only in
different individuals, but even in the same, which sleep, digestion,
exercise, rest, tranquillity of mind, violence of the passions, day,
night, every thing in a word, incessantly modifies? I do not know that
we digest twice in exactly the same period, if the urine twice remains
the same length of time in the bladder before being discharged, if its
jet is twice exactly equal, &c.
The force of the organic muscles often remains in its ordinary degree,
or is even increased; whilst a general weakness possesses the others.
The force of the pulse, vomiting, diarrhœa, &c. coinciding with a
general prostration of the muscles of animal life, are not rare
phenomena in diseases.
II. _Quickness of the Contractions._
It varies singularly; very rapid in experiments, when death is recent
and the stimuli are very strong, the contractions are in general slower
in the natural state; we might say that it is in the inverse ratio of
the force; often at the instant we open the pericardium, the heart
moves with a rapidity which the eye can hardly follow, especially if we
inject an irritating fluid into this serous sac, a little before laying
the organ bare. The contractions increase much in quickness in certain
diseases; those of the heart, for example, then acquire in the adult
a rapidity often much greater than they have in the first age; this
rapidity is also in this case entirely distinct from the force of its
contractions; it is rare even that these two things are found united at
the highest point. In general when the force of the heart is increased,
there is a little more quickness; but there is very often a diminution
of force with an increase of quickness, or the force remains the same,
the quickness being much increased.
We have seen that the voluntary muscles have in general a degree of
quickness beyond which they cannot go, and that this quickness belongs
to the original constitution. Is not the same phenomenon observed
here? Often in two fevers whose symptoms are the same, whose degree of
intensity seems to be exactly uniform, the pulse is infinitely more
frequent in one individual than in the other. This does not always
denote a difference in the disease, but in the primitive constitution,
an aptitude of one of the two hearts to contract much quicker under the
same stimulant. Who does not know that in experiments, the contractile
rapidity is infinitely variable under the influence of the same causes?
Each organic muscle has its degree of quickness; the heart, the
stomach, the intestines, the bladder, &c. differ remarkably in this
respect.
III. _Duration of the Contractions._
The heart never remains in permanent contraction, as often happens in
the voluntary muscles. Though hunger seems to prove the contrary in the
stomach and the intestines, yet this phenomenon is not contradictory;
in fact, the permanent contraction of the empty gastric viscera is
the result of the contractility of texture. Whenever the sensible
organic contractility is in action, there is alternate contraction and
dilatation; this alternation even characterizes essentially this last
property, and distinguishes it from the animal contractility and from
that of texture, in which the state of contraction is often permanent.
IV. _State of the Muscle in Contraction._
All the phenomena described for the voluntary muscles, are almost
applicable to these, such as the hardening, increase in thickness,
diminution in length, expression of the blood, &c. &c. But there
are some differences between the heart and the gastric muscles, in
respect to the mode of contraction. In fact we see very sensibly in
the first, 1st, contractions of the whole analogous to those of the
voluntary muscles, contractions which take place in the state of
health, which produce the projection of the blood, and which are easily
made in experiments when the animals are still living; 2d, numerous
oscillations which seize upon the fibres, which agitate the whole of
them without producing any sensible effect, without contracting the
cavity, without projecting the blood for example. These oscillations
are observed at the instant of death, when the heart is ceasing to
be contractile; we may then irritate it in vain, there are no more
contractions of it as a whole; though there is a general and very
evident vibration of its fibres, yet its cavity is not contracted; the
blood stagnates in it. The heart perfectly resembles under this double
relation the voluntary muscles; it is agitated as we see these muscles
in the shuddering, that is called horripilatio, as we see it also in
certain sub-cutaneous muscles in some individuals. I have already, for
example, seen many persons affected with an habitual trembling of a
portion of the solæus, a trembling very evident to the eye through the
skin, and which had nothing in common with the contraction necessary to
the extension of the foot.
The involuntary muscles of the abdomen never exhibit this double mode
of contraction. Instead of the quick and sudden motions of the whole
of the muscle, we see but a slow contraction in it, often but slightly
apparent; it is a kind of creeping; there is not even to speak properly
a contraction of the whole, like that of the heart in which all the
fibres of an auricle or ventricle are moved at the same time; here each
fleshy surface appears to act successively. Placed at the origin of
the great vessels, the bladder and the stomach would be incapable of
communicating to the blood those motions by jerks, which the jet of an
artery exhibits at each contraction. On the other hand, at the instant
the motion ends in the stomach, the intestines and the bladder, we
never see in them those oscillations, those vibrations which are almost
constant in the heart and the voluntary muscles, and which we can even
create in them at will.
V. _Motions imparted by the Organic Muscles._
There are hardly ever simple motions in these muscles; the different
interlacing of their fleshy surface allows them to act almost always in
three or four different directions upon the substances they contain.
We can say nothing general upon those motions which compose the
diastole of the heart, the peristaltic motion of the alimentary canal,
the contraction of the bladder, &c. Each muscle has its mechanism
which belongs to the physiological history of the function to which it
contributes.
VI. _Phenomena of the Relaxation of the Organic Muscles._
In the relaxation of the organic muscles, phenomena in general take
place that are opposite to the preceding. It is then useless to
enumerate them; but there is a question here that should be examined,
that of knowing the nature of that state which succeeds contraction and
alternates with it.
In the muscles of animal life, when the contraction ceases, the muscle
does not in general go back itself to the state it was in antecedent
to the contraction, but it is drawn back to it by its antagonist; for
example, when the biceps is contracted to bend the fore-arm and its
contraction ceases, it becomes passive; the triceps putting itself
then in motion, extends it and draws it back to its natural position,
by acting at first on the bones which communicate the motion to this
muscle. Each muscular power of animal life finds then in that which
is opposed to it a cause of return to the state it had left in order
to contract. It is not so in organic life; its muscles, which are all
hollow, have no antagonists. We have considered as such to a certain
extent, the substances contained in the hollow muscles, substances
which oppose the effect of contraction; but incapable most commonly
of reacting after having been compressed, on account of their want of
elasticity, these substances cannot perform the same offices as real
antagonists.
Most physiologists have admitted as a cause of dilatation, the entrance
of new substances, which replace, in the muscular cavities, those
expelled by contraction; thus the entrance of new blood into the
heart, aliments into the different portions of the alimentary canal,
has been considered as proper to dilate these organs; so that according
to this opinion the muscles would be purely passive when they enlarged.
But the following considerations, many of which some authors, Grimaud
in particular, have already stated, do not permit us to consider in
this way the dilatation of the organic muscles, that of the heart in
particular.