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

by Xavier Bichat

Cellular texture exterior to the excretory ducts.

All the excretories, the salivary, urinary, spermatic, hepatic, pancreatic, &c. are evidently surrounded with a layer analogous to the preceding, entirely distinct from the neighbouring texture, and which appears to be inserted in it without partaking of its nature; it is a distinct body, as to its thickness, its form, and its texture. The filaments that compose it, not being separated in their interstices by any fluid, remain in contact with each other; so that the whole really makes a membrane in the form of a canal, which can be easily raised up like that which surrounds the arteries; it is, however, thicker than that of the veins.

Of the cellular system considered in relation to the organs that it surrounds on all sides.

Except the organs of which we have just spoken, all parts of the body are surrounded on every side with a cellular layer more or less abundant, which forms for them, according to the happy expression of Bordeu, a kind of peculiar atmosphere, an atmosphere in the midst of which they are immersed, and which serves to insulate them from the other organs, to interrupt to a certain degree the communications which would unite them in an intimate manner, which would identify, if we may so say, the existence of one with the other, if they were in immediate apposition.

The serous vapour, in which the cellular atmosphere of each organ is constantly immersed, and the fat which floats there in greater or less abundance, powerfully assist in this insulation of vitality; both form for the different organs a line of separation, which, being fluid, enjoys in a much less degree than them the vital forces, which also in this point of view, is not at their level, if I may so express myself, and which is consequently very proper, to interrupt in a certain degree the vital communications that would otherwise exist. The essential difference that there is between the peculiar life of the cellular texture and that of the other organs, renders it also very susceptible of performing alone like a solid, an analogous use independent of the fluids it contains.

It is to this insulation of the vitality of the organs by their surrounding cellular texture, that we can refer in part that of the diseases, which is only an alteration of this vitality. Every day we see an affected part contiguous to a sound one, without communicating to it its disease. A healthy pleura covering the lungs filled with tubercles, or ulcers, in phthisis; an inflamed peritoneum corresponding with the intestines, the stomach, the liver, the spleen, which remain in their natural state; the mucous membranes affected with catarrhs approaching without danger the numerous parts they cover; the sub-cutaneous organs remaining free from the innumerable eruptions of which the skin is the seat; the tunica arachnoides in a state of suppuration enveloping a healthy brain, and a thousand other similar facts; these are the phenomena that the examination of bodies constantly presents. Shall I speak of the different tumours that are formed in the midst of organs, without their perceiving it, of the numerous excrescences that grow by their side without affecting them? Dissect a muscle under a suppurating cutaneous wound, or even a most obstinate ulcer; you will not often find it different from the rest, the skin only has been affected. No doubt the difference of vitality of two neighbouring organs is an essential cause of the insulation of their diseases; but the cellular atmosphere that protects them is also an important one. When an organ sends elongations into another, it communicates to it much more easily its diseases, than if a thick cellular layer separated them; for example, we know that the affections of the periosteum and the bone are soon identified.

Let us not, however, exaggerate this idea, by describing the cellular atmosphere as an insurmountable barrier to diseases. Facts would often contradict us, by showing diseases passing from an organ to the texture that surrounds it, and from this texture to the neighbouring organs; so that we see it at one time an obstacle, and at another the means of their propagation. The atmosphere that is formed is in different cases susceptible of being charged with all the emanations that arise from the organ, or to speak in language more strictly medical and physiological, the vital forces of an organ being altered, those of the surrounding texture are often altered by communication, and gradually those of the different neighbouring organs themselves. This kind of influence that the organs have upon each other, should be carefully distinguished from sympathy, in which, a part being diseased, another part becomes affected without the intermediate ones being deranged in their functions. Here there is constantly in the communication of diseases, the same order as in the position of the organs.

A great number of local affections affords us examples of this dependance, in which an organ and its texture being diseased, the neighbouring organs afterwards become so. In phlegmon, a more or less considerable swelling surrounds the red and inflamed place; rheumatism, which affects the white parts of the wrists and fingers, produces a painful swelling around them; a considerable tumefaction in the neighbourhood of the knee is almost always the result of diseases of the joint, which affect only the ligaments, &c. Many tumours have around them a kind of diseased atmosphere, an atmosphere which extends more or less remotely, which always exists in the cellular texture, and which constantly partakes of the nature of the tumour. If it is acute, as in phlegmon, it is a simple swelling which disappears almost entirely at death; as I have often seen in dead bodies an inflamed part that was very large during life, resume by the loss of the vital forces, nearly its ordinary size. Is the tumour chronic? it is an induration more or less evident that affects, oftentimes to a distance, the neighbourhood of the diseased parts, as we see in most cancers.

This atmosphere of disease is developed not only around the affected organ, but embraces also the neighbouring ones. The inflammations of the pleura spread to the lungs, that of the convex surface of the liver to the diaphragm; pericarditis, by the influence it has on the fleshy fibres of the heart, produces in this organ the irregular motions of an intermittent pulse; peritonitis, which is exclusively confined to the peritoneum, in the beginning, terminates, when it becomes chronic, by affecting the subjacent intestines; it is this which forms chronic enteritis, &c.

It should be remarked, however, that mere contiguity without cellular texture, is often sufficient to communicate disease; for example, a carious tooth affects its neighbour; the inflamed portion of a serous membrane, in contact with healthy ones, soon produces inflammation in them; thus it is, that after inflammation has continued a short time, though the pain has announced only one point to be primarily affected, the whole surface is found attacked.