General Anatomy, Applied to Physiology and Medicine, Vol. 2 (of 3)

by Xavier Bichat

The state of the animal muscular system is truly the thermometer of the state of the brain; the degree of its movements indicates the degree of energy of this organ. Those who attend in a lunatic hospital have often occasion to consult this thermometer. At the side of a furious patient, whose muscular power is doubled, or even trebled, you see a man all whose motions languish in a remarkable inertia. A thousand different degrees are observed in these motions; now these degrees do not depend upon the muscles; the most furious madman is often he whose very delicate external forms indicate the weakest muscular constitution; as the most perfect automaton is sometimes he whose muscles are the most powerfully developed. The muscles are to the brain what the arteries are to the heart. The physician learns by these vessels the state of the central organ of circulation which communicates impulse to them; by the muscles of animal life, he learns the state of the central organ of this life. Observe patients in many important fevers; in the morning there is prostration, in the evening you find an extreme agitation in the muscles. Now what is the seat of this revolution? It is not the muscles, but it is the brain. There has been a translation to the head, as it is commonly called.

If from the bed of the sick we go to the laboratory of the physiologist, we shall see experiments in perfect accordance with the preceding observations. The ligature of all the arteries that go to the brain, interrupts immediately the movements of this organ, movements necessary to its action, and produces a sudden cessation of voluntary motion, and afterwards death. By injecting through the carotid and towards the head, ink, solutions of neutral salts, acids, substances whose contact is fatal to cerebral action, I have always seen the animal perish with previous convulsive motions. The injection of water does not produce this effect; it can with impunity to the life of the brain be introduced into the arterial blood, if it is injected moderately; but pushed with force, you will irritate extremely this organ, and in an instant the animal is seized with violent agitations; moderate the force, rest succeeds. I have already related this experiment elsewhere. If we lay bare the cephalic mass, and irritate it with a mechanical or chemical agent, &c. in an instant the animal muscular system is brought into action. It is however to be observed that in these experiments the convexity of the organ appears to be much less connected with the motions, than its base. The irritation confined to the cortical substance, to the superficial layers of the medullary, is almost nothing; it is not till we arrive at the inferior layers, that the convulsions come on. I have wished to try many times to ascertain with precision the place where the irritation becomes a cause of convulsion; but this has always appeared to me very difficult, and the results have been infinitely various. I believe that we can hardly establish any thing more than a general result, viz. that the nearer we approach in the experiments the annular protuberance, and in general the cerebral base, the more apparent are the convulsive phenomena; they are so much the less as we remove from them, they are nothing on the convex surface. Observe that it is on the side of its base, that is to say, on the side of its essential part, that the brain receives the numerous vessels which carry to it excitement and life, whether by the motion which they communicate to it, or by the nature of the red blood which they carry to it, as my experiments published the year passed have, I think, demonstrated.

Add to these experiments those of the artificial commotions. The muscles of the ox vacillate, and are unable to support themselves, the instant the blow is struck. At other times animals expire, their limbs convulsively agitated from a blow given on the occiput; rabbits often exhibit this phenomenon. Pigeons die with convulsive motions of the wings. Irregular agitations arising from an irregular influx of the power of the brain always precede the instant of death, which the commotion has produced.

Let us conclude from all these experiments and the observations that precede them, that the action of the animal muscular system is always essentially connected with the state of the brain, and that when this action is increased or diminished there is almost always an increase or diminution of the cerebral action.

Let us not however exaggerate the relation which connects the muscular to the cerebral phenomena; observation would prove us incorrect. There are various examples of aqueous, sanguineous and even purulent congestions in the brain, without having produced any alteration in muscular motion. Different tumours and defects of conformation have occasioned disturbance of the intellectual functions, without affecting those of the muscles; how many times is the brain disordered in various species of alienations; how many times do the understanding, memory, attention and imagination indicate these derangements by their irregular aberrations, without their being felt by the muscular system. Is there not often an alteration of the external sensation, without an alteration of motion? In general the brain has three great functions. 1st. It receives the impressions from the external senses; it is in this relation the seat of perception. 2d. It is the principle and the centre of the voluntary motions, which are not exerted but by its influence. 3d. The intellectual phenomena are essentially connected with the regularity of its life; it is as it were the seat of them. Now it can be deranged as to one of these functions, and remain sound as to the others; it can be a regular principle of the motions, and an irregular centre of the phenomena of the understanding; not communicating with external objects by the senses, and determining motions, or presiding over intellectual functions, as happens in sleep which is disturbed by dreams, &c.

From what has been said we can understand why acephalous fœtuses cannot live out of the womb of the mother. As animal life is nothing in the fœtus, as respiration does not take place, as the functions are limited to the great circulation, to the secretions, exhalations and nutrition, the acephalous fœtuses can live in the womb of the mother, and acquire a very considerable size; but at birth they cannot breathe, the intercostals and diaphragm being unable to act. The gastric viscera receives no influence from their muscular parietes; all the limbs are immoveable. Animal life, which commences in others at birth, cannot commence in them, because they have not the centre of this life; they have senses, but nothing to receive their impressions; muscles, but nothing to make them move; they can continue to live but a little while in themselves, without beginning to live from without. But as in general it appears that when the infant quits the womb, the red blood becomes necessary to it, that to have this, it must respire, and as this function cannot commence, it loses the internal life which it had in the womb of the mother. There are acephalous fœtuses which have at the origin of the nerves a small medullary swelling; in others the spinal marrow is larger. If these medullary swellings, if the spinal marrow by its peculiar texture, supply the place of the brain, life can continue, and it is in this way that we can explain some examples of acephalous subjects that have lived a certain time. But certainly an acephalous subject organized like ourselves, which has nothing to supply the place of the brain, cannot live. Thus in almost all the examples of these monsters, related by authors, and especially by Haller, the death of the individual took place at its birth.

Animal Contractility considered in the Nerves.

The brain, at a distance from almost all the muscles, communicates with them by the nervous system, and by it transmits to them its influence; now this communication is made in two ways. 1st. There are nerves which go directly from the brain to the muscles of animal life. 2d. The greatest number does not go from this organ itself, but from the spinal marrow. Almost all the muscles of the neck, all those of the chest, the abdomen and the extremities receive theirs from this last source. The spinal marrow is, as it were, a general nerve, of which the others are only divisions and principal branches.

All the lesions of this principal nerve are felt by the muscles that it has under its influence; the compressions that it experiences from a fracture of the vertebræ, from any displacement, from an effusion of blood, serum, pus, &c. in the vertebral canal, the derangements which take place from a violent blow received upon the whole region of the spine, from a fall upon the loins, or on the superior part of the sacrum, are followed by numbness and paralysis of the subjacent muscles. Divide the spinal marrow, by introducing a scalpel into the canal, immediately all motion ceases below the division. If you wish on the contrary to produce convulsions, introduce a stilet into the canal; irritate the marrow with it or by chemical agents placed on it, there will be immediately agitation and convulsion in all the animal and muscular system that is below.

The higher the lesion of the marrow is, the more dangerous is it. In the lumbar region its influence extends only to the inferior extremities, and the muscles of the pelvis; in the back it paralyzes these muscles and those of the abdomen; now as these last contribute indirectly to respiration, this function begins to be embarrassed; if the lesion is above the dorsal region, it becomes still more painful, because the intercostals lose their action; the diaphragm alone then supports the respiratory phenomena, because the phrenic nerve still receives and transmits the cerebral influence. But when the lesion happens above the origin of this nerve, there is no more action of the diaphragm, and no more contraction of the intercostal and abdominal muscles; respiration ceases; from the same cause the circulation is interrupted; the blood being no longer carried to the brain, the action of this organ is annihilated. Hence why the luxations of the first vertebra on the second are suddenly fatal, when the displacement is very great; why judicious surgeons dare not sometimes run the hazard of reduction, when these luxations are partial, for fear of rendering them complete, and of thus seeing the patient, whom they attempted to relieve, perish in their hands; why, when we wish to knock down an animal, the blow should be given on the superior and posterior part of the spine; and why a stilet plunged between the first and second vertebræ immediately destroys life.