Part 1

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 III.

_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 III."

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._

MUSCULAR SYSTEM OF ORGANIC LIFE.

This system is not as abundantly spread out in the economy as the preceding. The whole mass which it forms, compared with the whole of the other, which is more than one third of the body, presents in this respect a very remarkable difference. Its position is also different; it is concentrated, 1st, in the thorax, where the heart and œsophagus belong to it; 2d, in the abdomen where the stomach and intestines are in part formed by it; 3d, in the pelvis where it contributes to form the bladder and even the womb, though this belongs to generation, which is a function distinct from organic life. This system then occupies the middle of the trunk, is foreign to the extremities, and is found far from the action of external bodies, whilst the other superficially situated, forming almost alone the extremities, seems, as we have said, almost as much destined in the trunk to protect the other organs, as to execute the different motions of the animal. The head contains no part of the organic muscular system; this region of the body is wholly devoted to the organs of animal life.

ARTICLE FIRST.

OF THE FORMS OF THE MUSCULAR SYSTEM OF ORGANIC LIFE.

All the muscles of the preceding system take in general a straight direction. These are all on the contrary curved upon themselves; all represent muscular cavities differently turned, sometimes cylindrical as in the intestines, sometimes conical as in the heart, sometimes rounded as in the bladder, and sometimes very irregular as in the stomach. No one is attached to the bones; all are destitute of tendinous fibres. The white fibres arising from the internal surface of the heart, and going to be attached to the valves of its ventricles, have by no means the nature of the tendons. Ebullition does not easily reduce them to gelatine; desiccation does not give them the yellowish appearance of these organs; they resist maceration longer than them.

It is in general a great character that distinguishes the muscular organic system from that of animal life, that it does not arise from, nor terminate in fibrous organs. All the fibres of this last are continuous either with tendons, or aponeuroses or fibrous membranes. Almost all those of the first go on the contrary from the cellular texture, and return to it after having run their course. I at first thought that the dense and compact texture which is between the mucous membrane and the fleshy fibres of the intestines, the bladder, the stomach, &c. was an assemblage and net-work of many small tendons corresponding to these fibres, and interwoven in the form of an aponeurosis; the density of this layer deceived me at first view. Ebullition, maceration, and desiccation have since taught me, that this layer, completely foreign to the fibrous system, should be referred, as Haller has said, to the cellular, which is only more dense and compact there than elsewhere. It is this layer, which I have designated, in the cellular system by the name of the sub-mucous texture. Many fibres of the system of which we are treating appear to form an entire curve, which is not crossed by any cellular intersection; some layers of the heart exhibit this arrangement, which is in general very rare; so that there is almost always an origin and termination of the fibres, upon an organ of a nature different from their own.

We can hardly consider in a general manner the forms of the system of which we are treating; each organ belonging to it is moulded upon the form of the viscus to the formation of which it contributes. In fact, the organic muscles do not exist in distinct fasciculi, like those of animal life; all, except the heart, form but a third, a quarter and often even less in the structure of a viscus.

The greatest number has a thin, flat and membranous form. There are layers more or less broad, and hardly ever distinct fasciculi. Placed at the side of each other, the fibres are rarely one above another; hence it happens that occupying a very great extent, these muscles form however a very small volume. The great gluteus alone would be larger than all the fibres of the stomach, the intestines and the bladder, if they were united like it into a thick and square muscle.

ARTICLE SECOND.

ORGANIZATION OF THE MUSCULAR SYSTEM OF ORGANIC LIFE.

The organization of the involuntary muscles is not as uniform as that of the preceding. In these all is exactly similar excepting the differences of the proportion of the fleshy fibres to the tendinous, of the length of the first, of the prominence of the fasciculi, of their assemblage into flat, long or short muscles; in whatever place we examine them, their varieties are in their forms and not in their texture. Here on the contrary, there is in this texture marked differences; the heart compared with the stomach, the intestines with the bladder are sufficient to convince us of this. It is by virtue of these different textures, that the contractility and sensibility vary as we shall see in each muscle, that the force of the contraction is not the same, and that life is different in each, whilst it is uniform in all those of animal life. We shall now consider in a general manner the organization of the involuntary muscles.

I. _Texture peculiar to the Organization of the Muscular System of Organic Life._

The organic muscular fibre is in general much finer and more delicate than that of the preceding system; it is not brought into as thick fasciculi. Very red in the heart, it is whitish in the gastric and urinary organs. Besides, this colour varies remarkably. I have observed that sometimes maceration renders it of a deep brown in the intestines.

This fibre never has one single direction, like that of the preceding muscles; it is interlaced always, or found in juxta-position in different directions; sometimes it is at a right angle that the fasciculi are cut, as in the longitudinal and circular fibres of the gastric tubes; sometimes it is with angles more or less obtuse or acute, as in the stomach, the bladder, &c. In the heart, this interlacing is such in the ventricles, that it is a true muscular net-work. From these varieties of direction, results an advantage in the motions of these sorts of muscles, which, being all hollow can by contracting diminish according to many diameters the extent of their cavity.

Every organic muscular fibre is in general short; those which, like the longitudinal of the œsophagus, the rectum, &c. appear to run a long course, are not continuous; they arise and terminate at short distances, and thus arise and terminate successively in the same direction or line; no one is comparable to those of the sartorius, the gracilis, &c. as it respects length.

We know the nature of their fibres no better than that of those of animal life; but they appear nearly the same under the action of the different reagents. Desiccation, putrefaction, maceration, ebullition, exhibit in them the same phenomena. I have observed upon the subject of this last, that once boiled, the fibres of both systems are much less alterable by the acids sufficiently weakened. After being some time in the sulphuric, the muriatic and nitric diluted with water, they soften a little, but keep their original form, and do not change into that pulp to which raw fibres are always reduced in the same experiment. The last of these acids turns them yellow as before ebullition.

I have also made an observation as it respects the horny hardening which is produced the instant ebullition commences; it is this, that it is always the same whatever may have been the antecedent dilatation or contraction of the fibres. The stomach which at death was so dilated as to contain many pints of fluid, is reduced to the same size, all other things being equal, as that which is contracted so as to be no larger than the cœcum. Diseases have a little influence on the horny hardening. The heart of a phthisical patient exhibited to me in the same experiment this phenomenon much less evidently, than that of an apoplectic.

The resistance of the organic muscular fibre is in proportion much greater than that of the fibres of the animal muscular system. Whatever may be the distension of the hollow muscles by the fluid which fills them during life, ruptures hardly ever take place in them.

The bladder alone sometimes exhibits this phenomenon, which is however very rare in it. In the great retentions of the urine, in which ruptures take place, it is almost always the urethra that is ruptured, and the bladder remains whole. We meet in practice with a hundred fistulas in the perineum, coming from the membranous portion, to one above the pubis. We find in authors many examples of rupture of the diaphragm; we know of but few of the rupture of the stomach, the intestines and the heart.

II. _Common Parts in the Organization of the Muscular System of Organic Life._

The cellular texture is in general much more rare in the organic muscles than in the others. The fibres of the heart are in juxta-position, rather than united by this texture. It is a little more evident in the gastric and urinary muscles. It is almost wanting in the womb; thus these muscles are not infiltrated, like the preceding, in dropsies; they never exhibit that fatty state of which we have spoken, and which sometimes loads the fibres. I have not observed in these fibres the yellowish tinge which the others often take, especially in the vertebral depressions.

The blood vessels are very numerous in this system; they are found in it even in greater proportion than in the other; more blood consequently penetrates them. This fact is remarkable, especially in the intestines, in which the mesenteric arteries distribute numerous branches, over an extremely delicate fleshy surface. But I would remark that this appearance is to a certain degree deceptive, as many of these vessels only traverse the fleshy surface to go to the mucous membrane. In the ordinary state they give to the gastric viscera a reddish tinge, which I have rendered at will livid and afterwards brought back to its primitive state, by shutting and afterwards opening the stop-cock adapted to the wind pipe, in my experiments upon asphyxia.

The absorbents and exhalants have nothing peculiar in this system.

The nerves come to them from two sources; 1st, from the cerebral system; 2d, from that of the ganglions.

Except in the stomach in which the par vagum is distributed, the nerves of the ganglions predominate everywhere. In the heart, they are the principal; in the intestines, they are the only ones; at the extremity of the rectum and the bladder, their proportion is greater than that of the nerves coming from the spine.

The cerebral nerves intermix with them, in penetrating the organic muscles. The cardiac, solar, hypogastric, plexuses, &c. result from this intermixture which appears to have an influence upon the motions, though we are ignorant of the nature of this influence.

All the nerves of the ganglions which go to the organic muscles, do not appear to be exclusively destined to them. A great number of filaments belong only to the arteries; such is in fact their interlacing, that they form, as we have seen, around these vessels a real nervous membrane, superadded to their own, and exclusively destined to them. I would compare this nervous envelope to the cellular envelope which is also found around the arteries, and which is wholly distinct from the surrounding cellular texture; thus it only has communications with the nerves of the organic muscles, without being distributed to these muscles. Besides as the nerves of the ganglions are always the most numerous and essential in them, and as their tenuity is extreme, the nervous mass destined to each is infinitely inferior to that which is found in the voluntary muscles. The heart and the deltoid muscle compared together, exhibit in this respect a remarkable difference.

ARTICLE THIRD.

PROPERTIES OF THE MUSCULAR SYSTEM OF ORGANIC LIFE.

Under the relation of properties, this system is in part analogous to the preceding, and in part very different from it.

I. _Properties of Texture. Extensibility._

Extensibility is very evident in the organic muscles. The dilatation of the intestines and the stomach by aliments, by the extrication of gas, by the fluids that are found there, that of the bladder by the urine, by injections that are forced in, &c. are essentially owing to this extensibility.

This property is characterized here by two remarkable attributes; 1st, by the rapidity with which it can be put into action; 2d, by the very great extent of which it is susceptible.

The stomach and intestines pass in an instant from complete vacuity to great extension. Artificially distended, the bladder becomes immediately of a size treble, quadruple even of that which is natural to it. It sometimes however resists, but this does not prove its defect of extensibility; it is because the fluid injected irritates it and makes it contract; the organic contractility in exercise, then prevents the development of extensibility, as it sometimes cannot be brought into action by stimulants in a muscle laid bare, because the animal contractility in exercise in the muscle, forms an obstacle to it. The muscles of animal life are never capable of this rapidity in their extensibility, whether because they are intersected by numerous aponeuroses which dilate but slowly, or whether because their layers of fibres are very thick, two circumstances that do not exist in the muscles of organic life. Hence a remarkable phenomenon that I have observed in all cases of tympanites. When we open the abdomen of subjects that have died in this state, without wounding the swelled intestines, these immediately burst out, swell more, and occupy twice as large a space as they were contained in in the abdomen; why? Because the parietes of the abdomen being unable to yield in proportion to the quantity of gas that is developed, this has been compressed in the intestines during life, and expands immediately by its elasticity when the cause of compression ceases. In dropsies in which the distension is slow, the abdominal parietes enlarge much more than in tympanites. The size of the abdomen would be double in this, if the extensibility of the parietes was in proportion to that of the intestines.

As to the extent of the extensibility of the organic muscles, we can form an idea of it by comparing the empty stomach which oftentimes is not larger than the cæcum in its ordinary state, with the stomach containing sometimes five, six and even eight pints of fluid; the bladder contracted and concealed behind the pubis, with the bladder full of urine from suppression, rising sometimes even above the umbilicus; the rectum empty, with the rectum filling a part of the pelvis in old people in whom the excrements have accumulated in it; the intestines contracted with the intestines greatly distended.

It is to the extent of extensibility of the organic muscles and to the limits placed to that of the abdominal parietes, that must be referred a constant phenomenon that is observed in the gastric viscera; viz. that in the natural series of their functions, they are never all distended at the same time; the intestines are filled when the matters contained in the stomach are evacuated; the bladder is not full of urine in the digestive order, until the other hollow organs are empty, &c. In general, that is an unnatural order in which all the organs are distended at once.

There is for the organic muscles a mode of extensibility wholly different from that of which I have just spoken; it is that of the heart in aneurisms, and the womb in pregnancy. The first, for example, acquires a size double, treble even sometimes in its left side, and yet it increases at the same time in thickness. This size is not owing to distension, but to a preternatural growth. The aneurismatic heart is to the ordinary heart, what this is to the heart of the infant; it is nutrition that makes the difference and not distension; for whenever it is owing to this it diminishes in thickness as it increases in extent; there is no addition of substance. Besides the aneurismatic heart has not often the cause that distends it, for commonly in this case the mitral valves allow a free passage to the blood; whilst when they are ossified the left ventricle often remains in a natural state. Moreover, the slow progress of the formation of aneurism proves that it is a preternatural nutrition that has presided over this increase of the heart. You would in vain then empty this organ of the blood it contains, it would not contract and resume its dimensions, as the inflated intestine does which we puncture to allow the air to escape.

In the womb there are two causes of distension; 1st, the sinuses greatly developed; 2d, an addition of substance, a real momentary increase of the fibres of the organ which remains as thick and even more so than in the natural state. At the time of accouchement, the sinuses immediately flatten by the contraction of the fibres; hence the sudden contraction of the organ. But as on the one hand nutrition alone can remove by decomposition the substances added to the fibres to enlarge them, and as on the other, this function is exerted slowly, after the womb has undergone the sudden contraction owing to the flattening of its sinuses, it returns but gradually and at the end of some time to its ordinary size. Extensibility is not then brought into action in the womb filled by the fœtus, and in the aneurismatic heart; these organs really become at that time the seat of a more active nutrition; they grow preternaturally, as they have grown naturally with the other organs; but these do not then experience an analogous phenomenon, they become monstrous in comparison. The womb decreases, because the motion of decomposition naturally predominates over that of composition after accouchement, whilst it was the reverse before this period. The aneurismatic heart remains always so.

These dilatations of the heart should be carefully distinguished from those really produced by extensibility, as in the right auricle and ventricle for example, which are found full of blood at the moment of death, because the lungs which are weakened, not allowing it to pass through them, compel it to flow back to the place from which it came. There are but few hearts which do not exhibit in very various degrees, these dilatations, which we have the power in a living animal of increasing or diminishing at will, according to the kind of death we produce. Two hearts are hardly ever of the same size after death; many varieties are met with, and these depend more or less on the difficulties which the blood experiences in the last moments, in passing through the lungs. Hence why in the diseases of the heart, there is no standard by which we can compare the morbid size, especially if we examine the organ as a whole. In fact the distension of the right side can give it an aneurismatic appearance, and a size even greater than that of some aneurisms. If we examine the left side separately, the error is more easily proved, because this side is subject to less variations. But the principal difference consists in the thickness. The power of contraction appears to increase in proportion to this thickness, which arises from the substance added by nutrition. It is this power which produces the great beating that is felt under the ribs, the strength of the pulse, &c.

_Contractility._

It is in proportion to extensibility. It is often brought into action in the ordinary state. It is in virtue of this property, that the stomach, the bladder, the intestines, &c. contract, and acquire a size so small compared to what they have when they are full. In general, there is no muscle of animal life, which is capable of such extreme contractions as those of organic life.

It should be remarked, however, that life, without having contractility immediately dependant upon it, since the intestines, the stomach, and the bladder contract after death when their distension is removed, modifies it in a very evident manner. The causes even which alter or diminish the vital forces have an influence upon it; hence the following observation that all those accustomed to open dead bodies can make. When the subject has died suddenly, and the stomach is empty, it is much contracted; when, on the contrary, death has been preceded by a long disease which has weakened its forces, the stomach, though empty, remains flaccid, and is found but very little contracted.

We should consider the substances contained in the hollow muscles of organic life, as true antagonists of these muscles; for they have not muscles that act in a direction opposite to theirs. As long as these antagonists distend them, they do not obey their contractility of texture; when they are empty, this is brought into action. It is not, however, upon this property that the mechanism of the expulsion of matters from these organs turns, as aliments from the stomach and intestines, urine from the bladder, blood from the heart, &c. It is the organic contractility that presides over this mechanism. It is difficult to distinguish these properties in exercise. One occasions a slow and gradual contraction, which is without the alternation of relaxation; the other, quick and sudden, consisting in a series of relaxations and contractions, produces the peristaltic motion, those of systole, diastole, &c. It is after the organic contractility has procured the evacuation of the hollow muscles, that the contractility of texture closes them. In death from hemorrhage from a great artery, the left and even the right side of the heart send out all the blood they contain; afterwards empty, they contract powerfully, and the organ is very small. On the contrary, it is very large when much blood remaining in its cavities, distends it, as in asphyxia. These are the two extremes. There are, as I have said, many intermediate states.