Physiological Researches on Life and Death

by Xavier Bichat

[101] When from any cause, the diaphragm cannot contract, the enlargement of the thorax is effected solely by the elevation of the ribs, and as this motion is then very evident, we can then appreciate better the influence the intercostal muscles have in its production in ordinary respiration. Haller, as is well known, supposed that the first rib was almost immoveable, and that the muscles in the first intercostal space, took it as their fixed point to elevate the second. This second rib, in its turn, served as a fixed point to elevate the third, and thus on to the last rib. But if we observe the mechanical phenomena of respiration when the diaphragm does not contract, as is the case in diaphragmatic pleurisy, we see that the first rib is far from being immoveable. Now, we cannot conceive how the intercostals which are attached to its inferior part, can, by contracting, assist in raising it. Besides, in order to elevate the ribs, a very great resistance must be overcome, and the intercostal muscles are too slender to induce us to suppose that they are capable of effecting it. The principal agents of this motion then are the anterior and posterior scaleni, which are distinctly seen to contract in great inspirations, the supra-costales and the muscles of the neck which attach it to the sternum. We ought to add to these a muscle, to which this use has never before been attributed; I mean the diaphragm. This muscle in fact in its contraction tends to become flat, from being concave as it is in inspiration. Now, its middle part in depressing the abdominal viscera experiences a certain resistance, and takes, as it were, from them a fixed point, by means of which it elevates the base of the thorax to which its circumference is attached.

[102] Asphyxia is not always the cause of death in those who are hung, there is sometimes connected with it a more efficient cause, which consists in the compression of the spinal marrow. This was formerly very often observed in those who had been executed, because the executioner in throwing them off gave a rotatory motion to the body which produced the luxation of the first vertebra on the second.

[103] By injecting into the veins different irrespirable gases, Nysten has been able to distinguish the effects which result from the deleterious properties of the gases from those which arise from the alteration of respiration from a want of atmospheric air.

Thus among the elastic fluids which he tried, he found sulphuretted hydrogen, the deutoxide of azote, chlorine and ammoniacal gas eminently deleterious; for introduced in sufficient quantity into the animal economy they uniformly cause death, whilst others, such as oxygen, azote, hydrogen, carburetted hydrogen, carbonic acid, oxide of carbon, and protoxide of azote do not produce death when introduced into the lungs, except by excluding the only mixture, that can support respiration; in no other way do they occasion death, at least in a sudden manner. If however, they are thrown quickly into the blood vessels, they cause death, but it is mechanically and in the same way as atmospheric air would do it. It should also be observed that these different gases do not all act in the same way when they are introduced into the lungs; the gaseous oxide of carbon destroys animals much quicker than azote or the protoxide of azote. They die also quicker in the proto-phosphuretted hydrogen, and even in the carbonic acid gas. There are also in the action of deleterious gases certain anomalies which have not hitherto been explained. Nysten injected, at three injections, into the veins of a dog of middle size thirty centimetres of sulphuretted hydrogen. The animal after the first injection, was agitated, and made powerful inspirations; the second produced convulsive motions and the third apparent death; but the next day he was entirely well. Now a less quantity of sulphuretted hydrogen carried into the organs of respiration and mixed with five or six hundred times its volume of air, would infallibly destroy the animal.

[104] The composition of some of these vapours is better known at the present day; but there are others in which our means of analysis have been unable to detect the deleterious principle; thus in the malaria, which has depopulated the country in the neighbourhood of Rome, our chemists have as yet only found as constant elements, those which enter into the composition of atmospheric air.

[105] It appears from the experiments of M. Desormes that the contact of sulphuretted hydrogen on the skin of an animal is immediately fatal.

[106] We know that fine injections pass from the branches of the pulmonary artery into the divisions of the bronchia; and that even water, when pushed into the trachea, will return, at least a small quantity of it, by the pulmonary veins and arteries.

Bichat thought that the gases absorbed in the lungs must pass through the mucous membrane; but this is not the case unless absorption takes place at the time they are in the bronchia, for the mucous membrane which lines the air-tubes does not extend into each bronchial lobule.

[107] This fact, frequently confirmed in my experiments, is not always the same in man. We often see emphysema produced by violent efforts of respiration, efforts which have forced into the cellular organ the air contained in the lungs. Now, if the passage of the air in the blood preceded or even accompanied its introduction into the neighbouring cells of the bronchia, all these cases of emphysema would be necessarily fatal, and even in a sudden manner, since, from what has been said before, the contact of the air on the brain, to which the circulation would carry it, would inevitably interrupt the functions of this organ.

Yet we see that emphysema is often cured, or does not produce death for a length of time.[108] I saw, at the Hotel Dieu, an air tumour, suddenly appear in the axilla, from the violent efforts of the patient to prevent respiration, whilst Desault reduced an old luxation. In a few days this tumour disappeared without producing any inconvenience. We find, in the Memoirs of the Academy of Surgery and in Treatises on Operations, various examples of emphysema produced by powerful agitations of the thorax, and in consequence of the introduction of a foreign body into the wind-pipe; emphysema, with which the patients have lived many days, and from which even they have recovered.