Part 4

We cannot make these experiments upon dead bodies which we rarely have in the hospitals till fifteen hours or more after death; but by killing dogs by hunger, which, when long continued, becomes a real disease that lasts in these animals eight, ten and even twelve days, I have seen the contractility entirely extinguished at the moment of death. Dogs have been often brought to me affected with different diseases, especially three years since when there was a kind of epidemic among these animals; now by opening them at the instant of death, by killing them even some time before and thus producing a sudden death wholly different from that which happens in the sound state in which all the parts are uninjured in their functions and consequently in their vital forces, I have always seen a constant absence of contractility, or at least so greatly weakened that it appeared to be nothing.

Many physiologists have spoken of a general convulsion which comes on in the organic muscles at the instant of death, of a rising of the heart, the stomach, the intestines, &c. This excess of action is sometimes real in sudden deaths, in those especially that we produce for our experiments; it is very rare in deaths preceded by a long disease in which the patient is extinguished, as it were, insensibly, and passes gradually from life to death. It is a fault common to almost all authors, to generalize too much the facts observed under certain circumstances. Many false consequences are the results of it.

_Sympathies._

No organ receives more easily the influence of others, than the organic muscles; all however are not equally susceptible of it. The heart occupies the first rank in this respect; then comes the stomach, then the intestines, and finally the bladder. It is in this order that we shall now examine this influence.

It is a remarkable phenomenon, that every kind of affection in any 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.