General Anatomy, Applied to Physiology and Medicine, Vol. 3 (of 3)
Part 2
The contractility of texture is, in the system of which we are treating, in proportion to the number of fleshy fibres. Thus, all things being equal, the rectum, when empty, contracts upon itself with much more force than the other large intestines; the contraction of the ventricles is much greater than that of the auricles, and that of the œsophagus is much greater than that of the duodenum, &c. &c.
II. _Vital Properties._
They are almost in an inverse order of those of the preceding system.
_Properties of Animal Life. Sensibility._
The animal sensibility is slight in the organic muscles. We know the observation related by Harvey upon a caries of the sternum that laid bare the heart; they irritated, without its being felt by the patient, this organ, which only contracted under the stimulant. Remove the peritoneum behind the bladder of a living dog, and irritate the subjacent muscular layer, the animal gives but few marks of pain. It is difficult to make these experiments upon the intestines and the stomach; their muscular coat is so delicate that we cannot act upon it without at the same time stimulating the subjacent nerves.
It appears that the organic muscles are much less susceptible of the feeling of lassitude, of which the preceding become the seat after great exercise. I do not know however if in those to which many cerebral nerves go, it does not take place; for example, when the stomach has been for a long time contracted, it is probable that the lassitude of its fibres, produces in part the painful sensation that we then have, and which we call hunger, a sensation that should be distinguished from the general affection that succeeds it, and which becomes truly a disease, when abstinence has been too much prolonged. We know that substances not nutritive then appease this sensation without remedying the disease, when the stomach is filled with them. I refer to the same kind of sensibility the anxiety and distress which patients experience, in whom we keep the bladder in permanent contraction by an open sound in the urethra, which transmits the urine as fast as it falls from the ureters. This sensation does not resemble that of hunger, because the sensibility of the bladder and that of the stomach being different, their modifications cannot be the same. Thus each of these two sensations is different from that of which the muscles of animal life, for a long time contracted, become the seat. I do not believe that the sensation of hunger belongs solely to the cause I have pointed out, and which others have not spoken of; but it cannot be denied that it has much part in it. Who knows if, after a fever in which the action of the heart has been for a long time accelerated, the weakness of the pulse which accompanies convalescence, is not a sign of the lassitude in which its fleshy fibres are, on account of the antecedent motion? We know the painful sensation of fatigue which the stomach experiences after the contractions of vomiting.
_Contractility._
The animal contractility is foreign to the muscles of organic life. To be convinced of this, we must recollect that on the one hand this contractility always supposes the influence of the brain and the nerves, to bring in play the action of the muscle, and that on the other, the brain, in order to exert this influence, must be excited by the will, by stimulants or by sympathies. Now none of these causes acting upon the brain, the organic muscles cannot contract.
Every body knows that these muscles are essentially involuntary. If some men have had the faculty of arresting the motions of the heart, it is not upon this organ that the brain has acted; the action of the diaphragm and the intercostals has first been suspended; respiration has ceased for a time; then consequently the circulation.
If we irritate the brain with a scalpel or any other stimulant, the muscles of animal life become convulsed; they are paralyzed if we compress this organ. Those of organic life, on the contrary preserve in both cases their natural degree of motion. The heart still continues to beat, the intestines and stomach move some time after the cerebral mass and spinal marrow have been taken away. Who does not know that the circulation goes on very well in acephalous fœtuses; that after the blow that has knocked down an animal, and rendered his whole voluntary muscular system immoveable, the heart is still for a long time agitated, the bladder rejects the urine, the rectum expels the excrements, &c. the stomach even sometimes vomits up aliments? Opium, which benumbs the whole animal life, because it acts especially upon the brain which is the centre of it, which paralyzes all the voluntary muscles, leaves the others unaffected in their contractions. Intoxication produced by wine exhibits the same phenomenon. A man staggers after drinking; his limbs refuse to carry him, and yet his heart beats with force; his stomach often heaves and rejects the surplus fluids it contains. All narcotic substances also produce this effect.
If from experiments we pass to observations on the sick, we see that all cerebral affections are foreign to the organic muscular system. Wounds of the head with depression, fungi of the brain, effusions of blood, pus and serum, apoplexy, &c. affect exclusively the voluntary muscles, the action of which they increase, weaken or destroy. In the midst of this general derangement of animal life, the organic remains unaffected. The paroxysm of mania and malignant fever likewise proves this fact. Who does not know that in this last the pulse is oftentimes scarcely altered, that sometimes even it is slower?
Frequently in diseases of the head, there are spasmodic vomitings; the action of the heart is accelerated in cerebral inflammations, &c. But these are sympathetic phenomena which happen in the organic muscles, as they do in all the other systems; they may not appear nor be developed; a thousand irregularities are observed in their progress. Whereas the contraction of the muscles of animal life by affections of the brain is a constant, invariable phenomenon, which nothing disturbs, and the development of which nothing prevents, because the means of communication are always the same between the affected organ and the one that moves.
If in the examination of the phenomena relative to the cerebral influence upon the organic muscles, we follow an inverse order, that is to say, that in the affections of these muscles we examine the state of the brain, we observe the same independence; consider most vomitings, the irregular motions of the intestines which take place in diarrhœas, those especially which form the iliac passion, &c.; observe the heart in the agitations of fevers, in the irregular palpitations of which it becomes frequently the seat, &c.; in these derangements of the organic muscles, you will very seldom find signs of lesions of the cerebral organ; it is calm, while every thing is disordered in organic life. Cullen thought that in syncope the action of the brain ceased first, and that that of the heart was afterwards consequently suspended. It is precisely the reverse in the greatest number of cases. The heart, at first affected, ceases to act; now its action being essential to that of the brain, whether from the motion it communicates to it, or from the red blood it sends, the functions of this last are suddenly suspended and the whole animal life ceases. This is remarkable especially in the syncopes that arise from the passions, in those from hemorrhages, polypi, great evacuations, &c. I refer upon this subject to my Treatise upon Life and Death.
If from the influence of the brain we pass to that of the nerves, we find new proofs of the absence of animal contractility in the organic muscles. The most of these muscles receive, as we have seen, two species of nerves, the one cerebral, the other from the ganglions.
The heart, the stomach, the rectum and the bladder are evidently entered by the first species of nerves; now by cutting, or irritating in any way the cardiac filaments of the par vagum, the heart experiences no alteration from it; its motion is neither retarded, nor accelerated. The division of both branches of the par vagum is fatal, it is true, but not until after some days; and I doubt whether it is by the heart that death commences in this case. The principal phenomena consequent upon this division show a great embarrassment in the lungs, a great difficulty of breathing; the circulation appears to be troubled only in consequence.
The same nerves going to the stomach, the same experiment serves to prove the cerebral influence upon this viscus. Now the division of that of one side is usually nothing upon it; that of both soon produces a remarkable derangement in it. But this derangement is wholly different from that which follows the section of the nerve of a muscle of animal life, which becomes suddenly immoveable, whilst that on the contrary the stomach not communicating with the brain except by the par vagum, seems to acquire in an instant an increase of power; it contracts and hence the spasmodic vomitings that are almost always observed during the two or three days that the animal survives the experiment, vomitings that I have constantly noticed in dogs, and which Haller and Cruikshank had before observed. It appears then from this, that though the brain has a real influence upon the stomach, this influence is of a nature wholly different from that which it exerts upon the voluntary muscles. I would observe however that the irritation of one branch of the par vagum, or of both, makes the stomach immediately contract, as happens in a voluntary muscle when we irritate its nerve. It is necessary, in order to make this experiment, to open the abdomen of a living animal, and afterwards to irritate the eighth pair in the region of the neck, so as to have in sight the organ that we make contract.
The bladder and the rectum appear to approximate the voluntary muscles, in their relation with the brain, more than the stomach and the heart. We know that falls on the sacrum, from which arises a shock of the inferior part of the spinal marrow, produce retention of urine; that they strike, as it were, this organ with the same paralysis as the inferior extremities, which then also cease to move. Yet as the bladder is very powerfully assisted in its functions by the abdominal muscles, by the levator ani and other voluntary muscles which surround it, the immobility of these muscles contributes much to the inability to evacuate the urine. That which makes me think so, is that, 1st, the irritation of the spinal marrow towards its inferior part which puts in motion all the voluntary muscles of the inferior extremities and of the pelvis, does not produce any effect upon this part. I have convinced myself of this fact many times upon dogs and guinea-pigs. 2d. By irritating the nerves coming from the sacral foramina and going to the bladder, nerves that it is often very difficult to find, on account of the blood in an animal recently killed, I have seen this muscle remain immoveable. On the contrary all these nerves having been cut, the injection of a fluid slightly stimulant makes it contract with force. 3d. In experiments upon living animals, as in surgical operations, the violence of the pain which sometimes produces spasmodic contractions of all the muscles of animal life, frequently occasions an involuntary discharge of urine. Now in these cases it is not the bladder that is convulsed; for if in an experiment this phenomenon takes place, open the abdominal parietes, in an instant the flow of urine ceases, because on the one hand the muscles of these parietes cannot act upon the intestines and press them against the bladder, and because on the other the levator ani which contracts and raises this organ, has no resisting point against which it can compress it above. Observe in fact that in strong jets of urine, the bladder is placed between two opposite efforts, one superior, which is the gastric viscera pressed by the diaphragm and the abdominal muscles, the other inferior, which is especially the levator ani which acts by contracting from below above, whilst the opposite effort acts from above below; now these two efforts are evidently under the cerebral influence. I have very frequently had occasion to observe the bladder full of urine in a living animal whose abdomen was opened; I have never seen it contract with sufficient violence to expel the fluid.
I do not deny but that the bladder, by the nerves it receives from the sacral plexuses, is to a certain extent a voluntary muscle; but I say that it is principally by forces accessory to its own and necessary to its functions, that it is subjected to the will; that the animal contractility is much greater in its functions than the sensible organic contractility. How then is the urine retained in this organ, or expelled from its cavity at will? In this way; when the urine falls into the bladder, and is there on the one hand but a short time, and on the other only in small quantity, it is not then an irritant sufficiently powerful to produce the exercise of the sensible organic contractility. The effort which the bladder makes is so small, that it cannot overcome the resistance of the urethra, which being shut by the contractility of texture, must be dilated by the impulse communicated to the urine. In order to void this fluid, there must then be added to the contraction of the bladder that of the surrounding voluntary muscles; now the least effort of these muscles is sufficient to overcome the resistance of the urethra. But if the urine is in great quantity in the bladder, and it has acquired by remaining in it a long time that deep colour which indicates the concentration of its principles, then the irritation that it produces on the organ brings powerfully into action the sensible organic contractility; the bladder contracts, and in spite of the animal, there is an evacuation of urine.
In the rectum, in which the excrements have not a long canal, but only a simple opening to pass, this is furnished with a sphincter which is wanting in the urethra. This sphincter habitually closed must be dilated by the impulse communicated to the excrements. When they are in the rectum a short time and in small quantity, the sensible organic contractility is not brought into action with sufficient power to expel them; it requires the action of the neighbouring voluntary muscles. If this action is not determined by the influx from the brain, the excrements remain in the intestines; hence how, for some time, we retain them at will. But as they increase in quantity, and become more acrid by remaining and consequently more irritating, then the sensible organic contractility strongly brought into action, empties the intestine involuntarily. If the sphincter, which is voluntary, is paralyzed, there will be incontinence, because no resistance is opposed to the tendency of the rectum to contract, a tendency which though feeble as long as it is but partly filled, is however always real.
From what we have said, it appears evidently that the bladder and rectum, though receiving cerebral nerves, are yet less influenced by the brain than it at first view appears, and that there is evidently between them and the voluntary muscles a very great difference. They are not mixt, as it is called; they approach the organic muscles infinitely nearer than the others; I doubt even whether if no accessory power acted with and compressed them, the mind could by the nerves which come from the sacral plexuses, make them contract at will. I have never seen an animal void his excrements when the abdomen was open.
Let us conclude from all that has been thus far said, that the cerebral nerves which go to the organic muscles have upon them an influence which by no means resembles that of the cerebral nerves going to the muscles of animal life. I am ignorant moreover of the nature of this influence.
All the organic muscles receive nerves from the ganglions, both the preceding ones which are also penetrated by the cerebral nerves, and the small intestines, and the cœcum, colour, &c. which are exclusively pervaded by them. Now by cutting, tying or irritating in any manner these nerves, by stimulating the ganglions from which they go, by destroying or burning them with a concentrated acid or alkali, the muscle remains in its natural state; its contractions are neither accelerated nor retarded.
I have not been contented with ordinary agents in convincing myself of the deficiency of real action of the nerves upon the organic muscles; a fact, which all good physiologists have always admitted, notwithstanding the opinions hazarded by some physicians who apply the vague term of nervous influence to organs which are not susceptible of it.
I have then employed galvanism, and I am convinced that it has very little, almost no power, in putting into action muscular contractions in organic life, whilst it is the most powerful agent in animal life. I shall not here relate my experiments upon this subject; they will be read in my Researches upon Death.
We can conclude from all that precedes, that the cerebral and nervous influence upon the organic muscles is not known to us; that it does not act as upon the voluntary muscles. It is however real to a certain extent, since it is necessary that the nerves which enter into the composition of these muscles should be of some use; but we are ignorant of this use.
_Organic Properties._
The organic sensibility is strongly characterized in the muscles of which we are treating. Before the sensible organic contractility is developed in them, it is necessary that this should be put in action. But as these two properties are not separated, as in their exercise they always succeed each other, what we are going to say of sensible organic contractility will apply also to the sensibility of the same nature.
Insensible organic contractility or tone, exists in the muscular system, to a degree necessary for its nutrition; but it does not exhibit in it any thing peculiar.
It is the sensible organic contractility that is the predominant property in this system, all the functions of which rest almost entirely upon this contractility, as all the functions of the preceding muscular system are derived as it were from the animal contractility. We shall now examine more in detail this essential property, with regard to which physiology owes so much to the illustrious Haller. We can consider it in three relations; 1st, in the stimuli; 2d, in the organs; 3d, in the action of the first upon the second.
_Of the Sensible Organic Contractility considered in relation to Stimuli._
Stimuli are natural or artificial. The action of the first is continual during life; upon them turn in part the organic phenomena; they place in action the muscles, which without them would be immoveable; they are as it were to these organs what pendulums are to our machines; they give the impulse. The second can hardly have effect until after death, or in our experiments.
_Natural Stimuli._
These stimuli are blood for the heart, urine for the bladder, aliments and excrements for the gastric organs. Every organic muscle has a body, which, habitually in contact with it, supports its motions, as every animal muscle habitually in relation with the brain, borrows from it its power of motion. The natural stimuli support the organs at the same degree of mobility while they remain the same. All things being equal on the part of the organs, the pulse does not vary, the digestive periods continue for the same length of time, the intervals between the excretion of urine are equal, whilst the blood, the chyle or the urine exhibit no differences. But as these substances experience an infinite number of varieties, the organs preserving the same degree of sensibility, have yet frequent changes in their motion.
At the instant chyle enters the blood during digestion, the pulse changes, because the heart is differently irritated. We observe the same phenomenon under different circumstances; 1st, in re-absorptions in which pus goes into the mass of blood; 2d, in the injection of different fluids in the veins, injections that were so frequently made in the last age, at the period of experiments upon transfusion, and which I have also had occasion to make with other views which I shall mention; 3d, in inflammatory diseases in which the blood takes a peculiar character that is yet but little known, and which occasions the formation of the pleuritic buff; 4th, in various other affections, in which the nature of this fluid is remarkably altered; 5th, in the passage of the red blood into the system with black blood. I have observed that in putting a curved tube into the carotid of one side and the jugular of the opposite of a large dog, so that one forces blood into the other, the passage of the red blood into the veins is not fatal like that of the black blood into the arteries; but there is almost always at first an acceleration of the motions of the heart.
The influence of the degeneracy of the fluids in diseases has no doubt been exaggerated; too frequent a source of morbid derangements has been placed in this portion of the economy. But it cannot be denied, that according to the different alterations that the fluids exhibit, they may be capable of exciting differently the solids that contain them. We know that in the same individual, and with the same mass of aliments, digestion varies from one day to another in the duration of its periods; that some aliments prolong and others accelerate it; that some remain very long in the stomach, as it is said, and others as it were only pass through it. Now in all these cases the organ remains the same, the fluid only varies. According as the kidney secretes urine more or less acrid and consequently more or less irritating, the bladder retains it for a longer or shorter time. Such is oftentimes its stimulating qualities, that the moment it comes into this organ it is involuntarily rejected. Shall I speak of emetics and evacuants by the intestinal canal, the effects of which are so variable? We know that the words drastic, purgative, laxative, &c. indicate the different degrees of the stimulating qualities which certain substances introduced into the alimentary canal exhibit, degrees which are to be considered abstractedly from those of the sensibility of the organs; this in fact can be such, that a laxative may produce greater effects than a drastic purge.