Physiological Researches on Life and Death

by Xavier Bichat

Haller and Lorry have paid much attention to this phenomenon, and have proposed an explanation of it which seems very satisfactory at first view, though it is really imperfect. When the thorax is dilated, say they, it draws the blood from the venæ cavæ, and, by degrees, that of the veins which are near it. The mechanism of this inspiration is very similar to that by which the air is drawn into the trachea. When the thorax contracts, on the contrary, the blood is crowded back in the venæ cavæ by the pressure which is made on all the pectoral organs, vessels, heart and lungs, by the expiratory powers, and by degrees arrives at the veins which terminate in them. Hence the alternation of vacuity and fulness which the jugular veins exhibit.

If we open an artery, and examine with attention the jet of blood, we see that it increases in expiration, and this is especially evident when the animal expires strongly or makes an effort; but as we cannot always produce these efforts at will, or a great inspiration, we can in some measure imitate the phenomenon and produce the contraction of the lungs by compressing with the hands the sides of the thorax; we see then the jet of arterial blood increase or diminish, in proportion to the pressure that is made. If respiration produces this effect on the course of the blood in the arteries, it is natural to think that it can influence the course of the venous blood, not only by means of the veins, as Haller and Lorry thought, but also by means of the arteries. For the purpose of satisfying myself, I made the following experiment, I tied the jugular vein of a dog; the vessel became empty below the ligature, and swelled much above, as uniformly happens. I punctured slightly with a lancet the distended portion, so as to make a very small opening. I obtained in this way a jet of blood, which the ordinary motions of respiration did not modify evidently, but which trebled or quadrupled in size if the animal made any considerable effort.

It might be objected, that the effect of respiration was not transmitted by the arteries to the open vein, but by the veins which were free, and which would have transmitted the blood of the venæ cavæ, towards the tied vein, by means of anastomoses. It is easy to remove this difficulty; in fact, in the dog the internal jugular vein is, as it were, but the appearance of a vein, and the circulation of the head and neck is performed almost entirely by the external jugular veins, which are very large. By tying at the same time these two veins I was sure of preventing, in a very great measure, the reflux which has just been spoken of; but so far from the double ligature diminishing the phenomenon before stated, the jet becomes on the contrary more strictly in relation with the motions of respiration, for it was evidently modified, even by common respiration; which, as we have seen, does not happen in the case of a single ligature. In order to render the thing more evident, I tried it on the crural vein; this vein and all its branches being furnished with valves, which oppose a reflux, if this phenomenon of the increase of the jet appears during expiration, we might be sure that the impulse came from the arteries. This is what I have observed in fact in many experiments. The crural vein being tied and punctured below the ligature, the jet which is formed increases evidently in powerful expirations, in the efforts and the mechanical compressions of the parietes of the thorax with the hands.

We see by this and the preceding experiments, that we cannot adopt without modification the expression of Haller and Lorry relative to the swelling of the veins. This swelling takes place, not only, as they say, by the flowing back of the blood of the venæ cavæ into the branches which open into them mediately or immediately, but also by the entrance into the vein of a greater quantity of blood coming from the arteries.

[80] As in dead bodies the air within and the air without are of the same temperature, the lungs, when they are full of it, do not flatten when the thoracic cavity is opened. There is usually then a space between the parietes and the contained organs; this is not because we die in expiration; for as the lungs empty themselves, the ribs and intercostal muscles rest upon them; it is because the pulmonary air, in cooling occupies less space, and the cells contracting gradually as the cooling takes place, diminish the whole size of the organ. A vacuum is then made between the pectoral and pulmonary portions of the pleura.

It is thus that, under some circumstances, the brain flattening and lessening after death, whilst the cavity of the cranium remains the same, a vacuum is formed between these two parts, which then exhibit an arrangement different from that of the living organs. If the sacs without an opening, as the peritoneum, tunica vaginalis, &c. never resemble, in this respect, the pleura and arachnoides; if their different surfaces are always contiguous after death, it is because the abdominal parietes or the skin of the scrotum, unable to resist the external air, flatten by pressure, and are brought against the internal organs, as the diminution of these tends to form a vacuum.

It is to this vacuum existing in the pleura of dead bodies, that must be referred the following phenomenon, which is always observed when the abdomen is opened and the diaphragm dissected. In fact, as long as no opening is made in this muscle, it remains distended and concave, notwithstanding the weight of pectoral viscera which rest upon it in a perpendicular situation, because the external air, which presses the concavity of it, forces it then into the vacuum in the thorax, which never exists during life. But the instant the air is admitted by a cut of the scalpel, this muscular partition flattens, because the equilibrium is established. If all the air is drawn from the lungs by a syringe, the diaphragmatic arch is still more evident.

There is then this difference between the opening of a dead body and that of a living one, that in the first the lungs are already flattened, and in the second they flatten at the instant of opening. The contraction of the cells, from the condensation of the air by cooling, is an effect of the contractility of texture or from want of extension, which as we have said, continues in a degree with the organs after death.

Besides, if the lungs flattened in the dead body the instant the thorax was opened, it would be owing to the pressure of the external air, a pressure which would expel through the trachea what was contained in these organs. Now if, to prevent the escape of air, you close hermetically the canal by fixing a tube to it the stopper of which is tight, and the thorax is afterwards opened, the lungs still flatten; the air had already gone out of them. Make, on the contrary, the same experiment on a living animal, you will always prevent the flattening of these organs, by preventing the expulsion of the air.

In this point of view Goodwyn has gone on a wrong principle in measuring in a dead body, the quantity of air remaining in the lungs after each expiration. Besides, if you open bodies ever so little, you will hardly find two in which there is the same arrangement in the lungs. The infinitely various manner in which life terminates, by accumulating more or less blood in these organs, by retaining more or less air in them, &c. gives them so variable a size, that no general data can be established respecting them. On the other hand, can we hope to be more successful on the living body? No; for who does not know that digestion, exercise, rest, the passions, tranquillity of mind, sleep, watchfulness, temperament, sex, &c. make an infinite variety in the forces of the lungs, the rapidity with which the blood circulates through them, and the quantity of air that penetrates them? All the calculations on the quantity of this fluid which enters or goes out according to the inspiration or the expiration, appear to me to be physiological errours, inasmuch as they assimilate the nature of vital forces with that of physical forces. They are as useless to science as those which had formerly for their object the muscular force, the velocity of the blood, &c. Besides, observe if their authors agree better among themselves then they used to do on this much agitated point.