Physiological Researches on Life and Death

by Xavier Bichat

FOOTNOTES:

[56] It is not true that a ligature on a nerve produces its effects only on the part to which this nerve is distributed; the brain is also affected; for, without this, how can be explained the pain that is felt, and the excitement, which is often sufficiently powerful to produce convulsions, and sometimes even death.

[57] The facts related here by Bichat are not conformable to those, which, the philosophers and physiologists have observed who have been more particularly engaged with this kind of experiments. Besides the consequences which he has drawn from them are not accurate, and he seems to be ignorant what course the galvanic fluid in this case takes.

[58] If there is always a relation between the vital energy of the brain and its alternate motions, it is because there is a constant relation between these motions and the entrance of the blood into the organ. Thus then, instead of considering this shock as the exciting cause of the brain is it not more natural to see in it only an effect purely accidental of the arrival of the arterial blood, which every thing proves to be the real excitant?

[59] As we know absolutely nothing of the manner in which the intellectual phenomena are produced in the brain, we cannot say whether compression prevents their development by stopping the motions with which the brain is habitually agitated, or by preventing the entrance of the arterial blood, or finally in some other way that we do not suspect.

[60] The organization of these animals differs too much from that of man to enable us to draw conclusions from one to the other, especially in what concerns the functions of the nervous system. There is an experiment of M. Dumeril in which a salamander lived a long time after the amputation of the head, till the formation of a perfect cicatrix in the neck, which intercepted the passage of air to the lungs.

[61] Why are not the cerebral functions disturbed, when water is pushed slowly into the carotids? because there is then mixed with the blood of the artery too small a quantity of water at a time to enable this fluid to have a very evident action on the brain. But if this introduction of water into the mass of blood continues, whatever precaution may be taken, its effects soon show themselves. We have often, in our experiments, introduced a great quantity of water into the veins of an animal, and though much of it passed off by pulmonary transpiration, the arterial blood soon became very aqueous. Now, we have always observed, that in this case, the animals were struck with a kind of stupidity, which evidently indicated a want of action of the brain.

[62] It is not uncommon to see patients, who retain their intellectual faculties perfectly, when the motions of the heart are so feeble, that they certainly cannot produce, in the mass of brain, any sensible jar.

[63] A very considerable quantity of air can be forced into the veins of an animal, without causing its death, provided it be not pushed in suddenly. In all these cases, it is understood, that the quantity that can be thus introduced is in proportion to the size of the animal. I have before me at this moment the details of an experiment that I made on a horse at Alfort with M. Dupui, and in which, before the animal died, I was able, in thirty seven minutes, to inject quickly into the veins forty syringes full of air, and three syringes full into the carotid artery. (The capacity of the syringe was seventeen centilitres.) The animal died three minutes after the last injection. At the examination of the body, we found air in the azygos vein and in the thoracic duct, which contained much lymph, as well as the lymphatic vessels of the internal surface of the lungs. The heart was enormously distended with air mixed with a small quantity of blood.

[64] This is not correct, and death takes place, on the contrary, by the cessation of the motions of the heart. The right ventricle is filled with air; and this air, dilated by heat, so distends it, that it can no longer contract.

[65] The disorders which are produced in this case do not at all resemble those which follow the entrance of air into the veins. If we push towards the brain, by the carotid artery, a small quantity of air, we see almost immediately signs of a strong cerebral congestion, spasmodic stiffness of the muscles, loss of sensibility, and of the action of the senses, and all the phenomena of a real apoplexy. Respiration and the circulation go on some time without any apparent alteration, but finally these two functions become embarrassed and the animal sinks. Every thing leads to the belief, that the alteration in the circulation of the brain depends here on the presence of rarefied air in the ultimate arterial ramifications.

When apoplexy is thus produced by the injection of air, if it be still forced into the artery, it breaks open violently a passage for itself, it tears the small vessels, and spreads in the parenchyma of the brain, which it makes emphysematous and crepitating under the finger. There finally returns a portion of it by the veins, which goes to the right cavities of the heart and which contributes to arrest the circulation.

[66] In the two examinations related by Morgagni, it appears that after a sudden death, there was found in the vessels of the brain an aeriform fluid, to the presence of which, for the want of another material cause, was attributed the death of the individual; but there is no proof that this fluid might not be developed there after death. We shall now relate a more decided case of death occasioned by the presence of air in the blood vessels; but here there is no ground for doubt, because we know the circumstances of the introduction.

A locksmith, twenty three years of age, had had for five years a large tumour on the right shoulder and clavicle. His acute sufferings induced him to enter the hospital to have it removed.

It was necessary in the operation to remove the middle portion of the clavicle. Thus far the success was complete; but little blood was lost, the pulse was good and the breathing easy, when the patient suddenly cried out, My blood is leaving my body! I am dead! And at the same moment he became stiff, lost his consciousness, and was covered with a cold sweat. A singular and rather loud noise was heard in the interior of his chest. The surgeon thought that he had opened the pleura by removing a portion of the clavicle, and thus given access to the air and to the blood to the right side of the thorax. The fingers of an assistant were immediately thrust into the bottom of the wound, with the view of stopping the supposed opening in the pleura, and the surgeon endeavoured to introduce into the thorax the extremity of a sound of gum elastic. When he thought that he had succeeded, he drew with his mouth the air which he supposed to be effused in the pleura. He wished then to proceed to the dressing; and, in order to do this, he substituted, for the fingers of the pupil which were at the bottom of the wound, a sponge covered with wax; but the moment the sponge took the place of the fingers, the same noise that was at first heard and which had ceased in an instant, was renewed with more force than before.

The syncope and cold sweat still continued. Water thrown into his face, made him give some signs of life; but he died a quarter of an hour after the appearance of the accident I have just described, and forty five minutes after the commencement of the operation.

The body was examined the next morning. They expected to find the right pleura open, much blood and air effused into its cavity and the lungs on that side collapsed. Nothing of the kind was found. The pleura was whole and there was no effusion in it. The lungs were as usual; but an opening of half an inch in extent was discovered in the external jugular vein, at the place where this vein opens into the subclavian. The cavities of the heart were large but contained no blood. Bubbles of air were observed in the vessels of the brain; the other vessels were not examined.

This fact was related to me the same day, by a student who was present. It was impossible for me not to refer the death in this instance to the entrance of air into the vessels. The opening in the vein, the noise that was heard, the suddenness of the death, the absence of blood in the cavities of the heart, the presence of air in the vessels of the brain, all sufficiently indicated it. I suspected that the entrance of air had been favoured by the state of tension of the parietes of the vein, or by their morbid alteration, which did not allow them to flatten by atmospheric pressure. I thought that this phenomenon might be produced at will on animals by placing them in the same physical circumstances. I introduced then into the jugular vein of a dog, a sound of gum elastic, and I directed it towards the heart. It was hardly there before I heard the air enter the vein, and the animal fell down in syncope, with the peculiar noise which manifests the presence of air in the heart. I immediately closed the sound to prevent the entrance of more air, and the animal gradually recovered, because the quantity of air introduced had not been in sufficient quantity to produce its death. I then opened the sound, and immediately the air rushed in towards the heart, and its entrance was followed by the same consequences; but, whether from not closing the sound soon enough, or from the entrance of a greater quantity of air, the animal died unexpectedly to me. In opening it, I found all the signs of death from the sudden entrance of air. The right ventricle was distended with air mixed with a little blood.

Sometimes, without any apparent alteration in the texture of the veins, its parietes do not flatten under atmospheric pressure; a simple puncture then is sufficient, as in bleeding, to admit the air into the vessels. Lieutaud relates two cases in which it appears that this took place, and several veterinary surgeons have assured me that they have heard, after bleeding in the jugular vein, a noise which indicates the entrance of air. Usually the quantity introduced is too inconsiderable to produce any evident effects. There has been communicated to me, however, a case observed by Mr. Bouley, the younger a veterinary surgeon in Paris, in which the entrance of air was followed by effects similar to those which we have related.

Mery had long since observed, that, in opening the abdomen of a dog, and puncturing the vena cava above the origin of the emulgents, as the vein become emptied of blood, it filled with air, which went to the right ventricle. Haller also observed that air entered into the veins of frogs and other cold-blooded animals in consequence of a wound of some large vessel. He has shown that it was from this source that was derived that which Redi, Caldesi, and Morgagni saw circulating in the vessels of these animals, since it is not observed, when the necessary precautions are taken to prevent its introduction.

Nysten has made a great number of experiments upon the injection of elastic fluids into the veins, and the results which he has obtained accord perfectly with those which we have observed. He is not satisfied with injecting atmospheric air, he has introduced in the same way a great number of other gases. He has remarked, that among the gases not deleterious he can introduce, without causing death, a much greater quantity if these gases are easily dissolved in the blood.

We cannot follow him in the detail of these experiments; we shall only relate a result relative to the colouring of the blood in the lungs. He has observed, that by injecting air into the vein, so slow as not to produce the death of the animal, the colouring of the arterial blood is rendered imperfect. He is satisfied, he says, that it is not owing to the embarrassment of the lungs. The injection of oxygen does not alter this colouring. The injection of azote completely prevents it; that of the oxide of carbon does not produce any change in it. I give these results from his work; I have not had occasion to verify them myself.

[67] When air is introduced into the vena portæ, there is not only no ill effect at the moment of injection, but there usually follows no apparent effect on the animal. It is not the same when air is injected into the veins of the general system, with so much care as not to produce instantaneous death by the dilatation of the heart. The effects do not then appear till a long time after the injection; but they are wholly different from the primary effects which we have described.

These consecutive symptoms from the entrance of air into the veins are, as Nysten has remarked, the result of an obstruction of the lungs produced by the accumulation of air in the last divisions of the pulmonary artery. The embarrassment in respiration often appears at the end of half a day, it becomes greater and greater, the bronchiæ are filled with a viscid fluid; and the animal usually dies on the third or fourth day. On examination of the body, no air is found in the heart or the vessels; but the lungs, instead of being pink-coloured, are greyish, tinged with brown, and loaded with frothy blood and mucus.

Boerhaave thought, that death which follows the injection of air into the veins was always owing, as it is in this case, to the presence of the air, which offers, in the small vessels, a mechanical obstacle to the passage of the venous blood.

[CHAPTER III.]
OF THE INFLUENCE OF THE DEATH OF THE HEART OVER THAT OF THE LUNGS.

The lungs are the seat of two very different sorts of phenomena. The first, which are entirely mechanical, are relative to the rise and fall of the ribs and diaphragm, to the dilatation and contraction of the air vessels, and to the entry and exit of the air, which is the effect of these movements. The second, which are purely chemical, may be referred to the different alterations, which the air and blood experience.

These two sorts of phenomena have a mutual dependence on each other. Without the mechanical, the chemical changes could not be made; without the chemical changes, the blood would cease to become an excitant to the brain, in consequence of which that organ would no longer operate upon the diaphragm or intercostal muscles; the muscles themselves would then become inactive, and the motions of the thorax be annihilated. These phenomena, however, are put an end to in a different manner by the death of the heart, accordingly as it happens on one or the other side.

I. In what manner are the actions of the lungs interrupted, when the black-blooded heart ceases to act?

The heart has certainly no influence over the mechanical functions of the lungs, but it contributes essentially to produce the chemical changes which are made there, by sending thither the fluid which is destined to undergo a change. When its functions then are interrupted as may happen from wounds or be occasioned by ligature, the chemical changes which should be made in the blood, are suddenly suppressed; though the air continue to enter into the lungs, from the dilatation and contraction of the chest.

Meanwhile there arrives nothing at the red-blooded heart, or[68] so little as to be insufficient for the production of the cerebral movements. The functions of the brain are consequently suspended, and of course the movements of the diaphragm and ribs.

II. In what manner are the actions of the lungs interrupted, when those of the red-blooded heart are suspended?

Whenever from wound, ligature, or aneurism, the functions of the red-blooded heart or aorta cease, the functions of the lungs are terminated in the following order:

1st. There is no further impulse made upon the brain. 2dly, No further movement of that organ.[69] 3dly, No further action exercised upon the muscles. 4thly, No further contraction of the intercostals or diaphragm. 5thly, The mechanical functions of the lungs cease. 6thly, Their chemical functions cease.

In the former case, the chemical changes could not be made for want of blood. Here they cannot be made for want of air. Such is the difference in the death of the lungs, in consequence of that of the heart, according as the latter is affected. But as the circulation is very rapid, there cannot be but a very short interval between the interruption of the chemical and the mechanical functions of the lungs.