General Anatomy, Applied to Physiology and Medicine, Vol. 1 (of 3)

by Xavier Bichat

Diseases, on the other hand, that particularly affect organic life, as fevers, inflammations, &c. may have their principle as well in the fluids as in the solids. Hence the reason, that these diseases are subject to crisis, and are cured by evacuants, alteratives, &c.

2dly. It is necessary in order to resolve the question of the affection of the solids or the fluids in diseases, to distinguish their phenomena into those which are sympathetic, and those that are the product of a direct excitement. Every sympathetic phenomenon has its seat essentially and necessarily inherent in the solids. In fine, the solids alone act upon each other and correspond together by means yet unknown. All sympathetic vomiting, febrile agitation of the heart, exhalation, secretion, and absorption, arise from a change effected, by the influence of a part more or less remote, in the solids of those which are the seats of these phenomena. When cold acts upon the skin covered with sweat, immediately the pleura becomes affected. If cold water is conveyed into the stomach while the body is hot, an effect is oftentimes produced upon a distant organ. This is sympathy, and not the repercussion of the humours. In this work I have cited a great number of examples of sympathy under each system; but in none of them I think is it possible to conceive of an affection of the fluids.

3dly. The division of diseases into organic, or those which alter the texture of the organs, and into those which leave this texture untouched, is still essential here. The first have their seat evidently in the solids.

4thly. The division into acute and chronic, ought not to be neglected in resolving the problem.

5thly. In fine, it would be necessary to make another distinction not less important, viz. that of diseases which are independent of every principle inherent in the economy and of those which proceed from a similar principle, as when the virus of the venereal, the tetters, scrofula or scurvy predominates in the whole system, and alternately attacks the different organs.

How little soever you may examine diseases under different points of view, you will perceive that what is true of one class cannot be so of another. It is evident from this, that it is improper to resolve this question in a general manner, as it has been too often done, and that a theory of diseases founded upon the principle of the affection of the solids or fluids alone, is a pathological absurdity, equal to that in physiology which would place in action the fluids or solids only. I think there are two errors that should be equally feared, that of particularizing and that of generalizing too much. The second leads us to false conclusions as well as the first.

Though the vital properties reside especially in the solids, it is not necessary to consider the fluids as entirely inert. It is undeniable, that those of them which form the composition of the body, increase in vitality as they advance from the aliments of which they are formed, to the solids which they compose. The alimentary mass is less animalized than the chyle, and this is less so than the blood. It would undoubtedly be a subject of very curious research, to determine, how the particles, from being foreign to the vital properties, and enjoying only physical ones, become by degrees possessed of the rudiments of the first. I say the rudiments, for certainly the vital elaboration that the fluids experience in circulating as such in the body, and before they penetrate the solids to become a part of them, is the first degree of their vital properties. In the same manner, if you should inject into this fluid the materials of those that are exhaled or secreted, the exhalant and secretory organs would repulse these materials, if life had not made them undergo a previous elaboration.

It is evidently impossible to say what this vitality of the fluids is; its existence however is not less real, and the chemist who wishes to analyze the fluids, has, like the anatomist who dissects the solids, only the dead body upon which he can operate. You will observe, that when the principle of life has left the fluids, they go immediately into a state of putrefaction, and are decomposed like the solids, deprived of their vital powers. This alone prevents that internal movement, which undoubtedly enters much into the alterations of which the fluids are susceptible. Observe what takes place after a meal; ordinarily a slight increase of the pulse, the effect of the mixture of the nutritive principles with the blood, is the consequence of it. If you have made use of acrid or spicy aliments, to which you are unaccustomed, a general heat, a thousand different sensations of lassitude and heaviness, accompany digestion. Shall I speak of the various kinds of wine, and their effects, even to intoxication? Who has not a hundred times paid dearly for the pleasures of a repast by a general disorder, an universal agitation, a heat in every part during the whole time that the wine circulates with the blood? Who has not observed that one kind of wine produces one effect and another a different? The solids are then without doubt the seat of every thing we experience; but is not the cause of it in the fluids? It is the blood, which carrying with its own particles others that are foreign to it, excites all the organs, and especially the brain, because there is a particular relation between this viscus and spirituous liquors, as there is between cantharides and the bladder, and mercury and the salivary glands. That which I say is so true, that if you infuse wine into the open vein of an animal, you will produce analogous effects. The experiments made upon this subject are so well known that I have not even repeated them.

I will relate a fact here which disproves what has lately been advanced upon the incorruptibility of the blood in diseases. A short time since, in examining a body at the Hôtel Dieu, with Mess. Péborde, l'Herminier, and Bourdet, we found instead of the black abdominal blood, a real grey sanies, which filled all the divisions of the splenic vein, the trunk of the vena porta, and all the hepatic branches, so that by cutting the liver in slices, we could distinguish by the flow of this sanies, all the ramifications of the vena porta from those of the vena cava, which contained ordinary blood. This body was so remarkable for its size, that I do not recollect to have ever seen one equal to it. Certainly this sanies was not the effect of death, and the blood had circulated, if not thus altered, at least very different from its natural state, and really decomposed.

Consider the immense influence of aliments upon health, structure, and even character. Compare the people who live only on milk and vegetables with those who are in the constant use of spirituous liquors. See how alkohol, carried into the new world, has modified the manners and habits of the savages; consider the slow and gradual influence of regimen in chronic diseases, and you will perceive that in health, as in disease, the alteration of the fluids is frequently before that of the solids, which consequently become changed; for it is an inevitable circle. But the alteration of the fluids appears to depend essentially upon the mode of the mixture of parts not animalized with those that are so.