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

by Xavier Bichat

After having shown most of the local diseases, as affecting almost always, not an individual organ, but some texture in an organ, it is necessary to show the differences they present according to the textures they affect. As under each system, this subject will be treated more or less fully, I shall only refer to it here.

We shall see, then, that pain is modified differently in each texture, according to the degree of sensibility that it possesses. No one excites the same sensations as the others when it is inflamed. Compare the burning of erisypelas with the throbbing of phlegmon, the pain of rheumatism with that of inflamed lymphatic glands, &c. We shall see also that the sense of heat, developed in each inflamed texture, has a particular character; here it is sharp and biting, there like the feeling produced by fire, &c. There are two general causes that produce a variation in the symptoms of diseases: 1st. the nature of the affected texture; thus, as I have just said, the inflammation of each produces a different kind of suffering. 2d. The nature of the disease; we know that cancer, whatever texture it may affect, has a pain that is peculiar to it; that syphilis and scurvy have also a peculiar character, that is, however, modified in a slight degree in each texture.

The difference of textures not only modifies the symptoms, but affects the duration of them also. Nothing in medicine is more vague, in this point of view, than the terms acute and chronic, in relation to inflammations of the different textures. Most commonly they run their course rapidly in the dermoid, cellular, serous, mucous textures, &c.; on the other hand, they are slow in the bones, the cartilages, and the fibro-cartilages. If we apply this distinction to the same texture, it is very well; thus there are catarrhs, serous and cutaneous inflammations, &c. that are acute and chronic. But if we generalize it, it cannot be understood. A catarrh would be chronic if it lasted two months; but this is the common term of an acute inflammation of the bones; a chronic one continues for a whole year or more. Cutaneous, mucous wounds, &c. last only five or six days if they heal by the first intention; while it requires thirty or forty for a bone, a cartilage, &c. to be cicatrized by the juxta-position of its different parts. A disease cannot be classed, then, by its duration, as an acute or chronic one, except in relation to the same system; when we describe it then in a general way, this distinction becomes void.

Physicians consider abstractedly almost all diseases. When they speak of inflammation they describe the redness, swelling, throbbing and pain, as general attributes, always uniform. If of suppuration, they take for a general standard that of the cellular texture, in phlegmon, without thinking that it is only one of the modifications of suppuration and its product. The same may be said of gangrene, scirrhus, &c. Nothing is more vague and uncertain than the general ideas that are given concerning a disease; they scarcely agree in one or two of the textures.

It is not only the history of diseases that the anatomy of systems will elucidate; it will change in part the method of treating morbid anatomy. Morgagni, to whom we owe so much in this respect, and many others, to whom the art is indebted, have adopted the general arrangement used in descriptions. They have examined the diseases of the head, the chest, the abdomen, and the extremities. In following this method, they can only form to themselves a general idea of the alterations common to all the textures. The ideas are necessarily too much contracted, when there is presented only an insulated part of a system, which is composed of a great many others. If, besides this, you obtain a general knowledge of the affections of each system, you must bear in mind, with regard to each, the general ideas concerning the affections of the parts they compose.

It appears to me to be infinitely more simple to consider at first all the affections common to each system, and then to observe what every organ has peculiar to itself in the part that it occupies.

I divide, then, morbid anatomy into two great parts. The first contains the history of the alterations common to each system, whatever may be the organ in the structure of which it is concerned, or whatever may be the place it occupies. It is necessary to show at first the different alterations of the cellular, arterial, venous, nervous, osseous, muscular, mucous, serous, synovial, glandular, cutaneous textures, &c. to examine the kind of inflammation, suppuration, gangrene, &c. peculiar to each; to speak of the different enlargements of which they are susceptible, the changes in their nature, which they undergo, &c. Some, as the mucous, the cutaneous, the serous, the glandular, &c. afford in this respect an immense field to morbid anatomy. The others, as the fibrous, the nervous, the muscular, &c. are more rarely changed in their texture. We shall see hereafter that nutrition alone is performed in these, and that the others are particularly the seat of exhalation, absorption, secretion, &c. functions which suppose much energy in the insensible contractility and organic sensibility, which are connected with all the alterations of texture.

After having thus pointed out the alterations peculiar to each system, in whatever organ it is found, an examination should be made of the diseases peculiar to each region; as those of the head, the chest, the abdomen, and the extremities, after the common method. Here they may be divided, 1st. into diseases which can especially affect an organ as a whole, and not one of its textures alone, which is very rare. 2d. Into the characters peculiar to each portion of this or that texture; for example in the head, the peculiar symptoms which are seen in diseases of the serous surface of the tunica arachnoides, those in affections of the mucous surface of the pituitary membrane, &c.

This course is incontestably the most natural, though, as in all divisions in which we wish to copy nature, there are many cases which it almost excludes.

It seems to me that we live at a period, when morbid anatomy should take a higher stand. This science is not only that of organic derangements, that take place slowly, as the principles or consequences of chronic diseases, it consists in the examination of all the alterations our organs can undergo, at any period in which we may observe their diseases. With the exception of certain kinds of fevers and nervous affections, every thing in pathology is within the province of this science. How weak appears the reasoning of many great physicians, when we examine it, not in their works, but on the dead body. Medicine was for a long time excluded from the circle of the exact sciences; it will have a right to be associated with them, at least in the diagnostics of diseases, when we shall every where unite to accurate observation, an examination of the changes our organs undergo. This course is beginning to be that of all rational minds; it will without doubt soon be general. What is observation worth, if we are ignorant of the seat of the disease? You may take notes, for twenty years, from morning to night at the bedside of the sick, upon the diseases of the heart, the lungs, the gastric viscera, &c. and all will be to you only a confusion of symptoms, which, not being united in one point, will necessarily present only a train of incoherent phenomena. Open a few bodies, this obscurity will soon disappear, which observation alone would never have been able to have dissipated.