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

by Xavier Bichat

Much has been said since the time of Bordeu, of the peculiar life of each organ, which is nothing else than that particular character which distinguishes the combination of the vital properties of one organ, from those of another. Before these properties had been analyzed with exactness and precision, it was clearly impossible to form a correct idea of this peculiar life. From the account I have just given of it, it is evident that the greatest part of the organs being composed of very different simple textures, the idea of a peculiar life can only apply to these simple textures, and not to the organs themselves.

Some examples will render this point of doctrine which is important, more evident. The stomach is composed of the serous, organic muscular, mucous, and of almost all the common textures, as the arterial, the venous, &c. which we can consider separately. Now if you should attempt to describe in a general manner, the peculiar life of the stomach it is evidently impossible that you could give a very precise and exact idea of it. In fact the mucous surface is so different from the serous, and both so different from the muscular, that by associating them together, the whole would be confused. The same is true of the intestines, the bladder, the womb, &c.; if you do not distinguish what belongs to each of the textures that form the compound organs, the term peculiar life will offer nothing but vagueness and uncertainty. This is so true, that oftentimes the same textures alternately belong or are foreign to their organs. The same portion of the peritoneum, for example, enters or does not enter, into the structure of the gastric viscera, according to their fulness or vacuity.

Shall I speak of the pectoral organs? What has the life of the fleshy texture of the heart in common with that of the membrane that surrounds it? Is not the pleura independent of the pulmonary texture? Has this texture nothing in common with the membrane that surrounds the bronchia? Is it not the same with the brain in relation to its membranes, of the different parts of the eye, the ear, &c.?

When we study a function, it is necessary carefully to consider in a general manner, the compound organ that performs it; but when you wish to know the properties and life of this organ, it is absolutely necessary to decompose it. In the same way, if you would have only general notions of anatomy, you can study each organ as a whole; but it is essential to separate the textures, if you have a desire to analyze with accuracy its intimate structure.

VII. Consequences of the preceding principles relative to diseases.

What I have been saying leads to important consequences, as it respects those acute or chronic diseases that are local; for those, which like most fevers, affect almost simultaneously every part, cannot be much elucidated by the anatomy of systems. The first then will engage our attention.

Since diseases are only alterations of the vital properties, and each texture differs from the others in its properties, it is evident there must be a difference also in the diseases. In every organ then, composed of different textures, one may be diseased, while the others remain sound; now this happens in a great many cases; let us take the principal organs, for example.

1st. Nothing is more rare than affections of the mass of the brain; nothing is more common than inflammation of the tunica arachnoides that covers it. 2d. Oftentimes one membrane of the eye only is affected, the others preserving their ordinary degree of vitality. 3d. In convulsions or paralysis of the muscles of the larynx, the mucous surface is unaffected; and on the other hand the muscles perform their functions as usual in catarrhs of this surface. Both these affections are foreign to the cartilages, and vice versa. 4th. We observe a variety of different alterations in the texture of the pericardium, but hardly ever in that of the heart itself; it remains sound while the other is inflamed. The ossification of the common membrane of the red blood does not extend to the neighbouring textures. 5th. When the membrane of the bronchia is the seat of catarrh, the pleura is hardly affected at all, and reciprocally in pleurisy the first is scarcely ever altered. In peripneumony, when an enormous infiltration in the dead body shows the excessive inflammation that has existed during life in the pulmonary texture, the serous and mucous surfaces often appear not to have been affected. Those who open dead bodies know that they are frequently healthy in incipient phthisis. 6th. We speak of a bad stomach, a weak stomach; this most commonly should be understood as applying to the mucous surface only. Whilst this secretes with difficulty the nutritive juices, without which digestion is impaired, the serous surface exhales as usual its fluid, the muscular coat continues to contract, &c. In ascites, in which the serous surface exhales more lymph than in a natural state, the mucous oftentimes performs its functions perfectly well. &c. 7th. All authors have said much of the inflammation of the stomach, the intestines, the bladder, &c. For myself I believe that this disease rarely ever affects at first the whole of any of these organs, except in the case where poison or some other deleterious substance acts upon them. There are for the mucous surface of the stomach and intestines, acute and chronic catarrhs, for the peritoneum serous inflammations, perhaps even for the layer of organic muscles that separates the two membranes, there is a particular kind of inflammation, though we have as yet hardly any thing certain upon this point; but the stomach, the intestines, and the bladder are not suddenly affected with these three diseases. A diseased texture can affect those near it, but the primitive affection seizes only upon one. I have examined a great number of bodies in which the peritoneum was inflamed either upon the intestines, the stomach, the pelvis, or universally; now very often when this affection is chronic, and almost always when it is acute, the subjacent organs remain sound. I have never seen this membrane exclusively diseased upon one organ, while that of the neighbouring ones remain untouched; its affection is propagated more or less remotely. I know not why authors have hardly ever spoken of its inflammation, and have placed to the account of the subjacent viscera that which most often belongs only to this. There are almost as many cases of peritonitis as of pleurisy, and yet while these last have been particularly noticed the others are almost entirely overlooked. Oftentimes that part of the peritoneum corresponding to an organ, is much inflamed; we see it in the case of the stomach; we observe especially after the suppression of the lochia or the menses, that it is the portion that lines the pelvis that is first affected. But soon the affection becomes more or less general; at least examinations after death prove it satisfactorily. 8th. Certainly the acute or chronic catarrh of the bladder, or womb even, has nothing in common with the inflammation of that portion of the peritoneum corresponding with these organs. 9th. Every one knows that diseases of the periosteum have oftentimes no connexion with the bone, and vice versa, that frequently the marrow is for a long time affected, while both the others remain sound. There is no doubt that the osseous, medullary and fibrous textures have their peculiar affections which we shall not confound with the idea we may form of the diseases of the bones. The same can be said of the intestines, of the stomach, &c. in relation to their mucous, serous, muscular textures, &c. 10th. Though the muscular and tendinous textures are combined in a muscle, their diseases are very different. 11th. You must not think that the synovial is subject to the same diseases as the ligaments that surround it, &c.

I think the more we observe diseases, and the more we examine bodies, the more we shall be convinced of the necessity of considering local diseases, not under the relation of the compound organs, which are rarely ever affected as a whole, but under that of their different textures, which are almost always attacked separately.

When the phenomena of diseases are sympathetic, they follow the same laws as when they arise from a direct affection. Much has been said of the sympathies of the stomach, the intestines, the bladder, the lungs, &c. But it is impossible to form an idea of them, if they are referred to the organ as a whole, separate from its different textures. 1st. When in the stomach, the fleshy fibres contract by the influence of another organ and produce vomiting, they alone receive the influence, which is not extended either to the serous or mucous surfaces; if it were, they would be the seat, the one of exhalation, the other of sympathetic exhalation and secretion. 2d. It is certain that when the action of the liver is sympathetically increased, so that it pours out more bile, the portion of peritoneum that covers it does not throw out more serum, because it is not affected by it. It is the same of the kidney, the pancreas, &c. 3d. For the same reason, the gastric organs upon which the peritoneum is spread, do not partake of the sympathetic influences that it experiences. I shall say as much of the lungs in relation to the pleura, the brain in relation to the tunica arachnoides, the heart to the pericardium, &c. 4th. It is undeniable that in all sympathetic convulsions, the fleshy texture is alone affected, and that the tendinous is not so at all. 5th. What has the fibrous membrane of the testicles in common with the sympathies of its peculiar texture? 6th. No doubt a number of sympathetic pains that we refer to the bones, are seated exclusively in the marrow.