Chapter III: Preface: By the Author (2)

2dly. It is necessary in order to resolve the question of the affection of the solids or the fluids in diseases, to distinguish their phenomena into those which are sympathetic, and those that are the product of a direct excitement. Every sympathetic phenomenon has its seat essentially and necessarily inherent in the solids. In fine, the solids alone act upon each other and correspond together by means yet unknown. All sympathetic vomiting, febrile agitation of the heart, exhalation, secretion, and absorption, arise from a change effected, by the influence of a part more or less remote, in the solids of those which are the seats of these phenomena. When cold acts upon the skin covered with sweat, immediately the pleura becomes affected. If cold water is conveyed into the stomach while the body is hot, an effect is oftentimes produced upon a distant organ. This is sympathy, and not the repercussion of the humours. In this work I have cited a great number of examples of sympathy under each system; but in none of them I think is it possible to conceive of an affection of the fluids.

3dly. The division of diseases into organic, or those which alter the texture of the organs, and into those which leave this texture untouched, is still essential here. The first have their seat evidently in the solids.

4thly. The division into acute and chronic, ought not to be neglected in resolving the problem.

5thly. In fine, it would be necessary to make another distinction not less important, viz. that of diseases which are independent of every principle inherent in the economy and of those which proceed from a similar principle, as when the virus of the venereal, the tetters, scrofula or scurvy predominates in the whole system, and alternately attacks the different organs.

How little soever you may examine diseases under different points of view, you will perceive that what is true of one class cannot be so of another. It is evident from this, that it is improper to resolve this question in a general manner, as it has been too often done, and that a theory of diseases founded upon the principle of the affection of the solids or fluids alone, is a pathological absurdity, equal to that in physiology which would place in action the fluids or solids only. I think there are two errors that should be equally feared, that of particularizing and that of generalizing too much. The second leads us to false conclusions as well as the first.

Though the vital properties reside especially in the solids, it is not necessary to consider the fluids as entirely inert. It is undeniable, that those of them which form the composition of the body, increase in vitality as they advance from the aliments of which they are formed, to the solids which they compose. The alimentary mass is less animalized than the chyle, and this is less so than the blood. It would undoubtedly be a subject of very curious research, to determine, how the particles, from being foreign to the vital properties, and enjoying only physical ones, become by degrees possessed of the rudiments of the first. I say the rudiments, for certainly the vital elaboration that the fluids experience in circulating as such in the body, and before they penetrate the solids to become a part of them, is the first degree of their vital properties. In the same manner, if you should inject into this fluid the materials of those that are exhaled or secreted, the exhalant and secretory organs would repulse these materials, if life had not made them undergo a previous elaboration.

It is evidently impossible to say what this vitality of the fluids is; its existence however is not less real, and the chemist who wishes to analyze the fluids, has, like the anatomist who dissects the solids, only the dead body upon which he can operate. You will observe, that when the principle of life has left the fluids, they go immediately into a state of putrefaction, and are decomposed like the solids, deprived of their vital powers. This alone prevents that internal movement, which undoubtedly enters much into the alterations of which the fluids are susceptible. Observe what takes place after a meal; ordinarily a slight increase of the pulse, the effect of the mixture of the nutritive principles with the blood, is the consequence of it. If you have made use of acrid or spicy aliments, to which you are unaccustomed, a general heat, a thousand different sensations of lassitude and heaviness, accompany digestion. Shall I speak of the various kinds of wine, and their effects, even to intoxication? Who has not a hundred times paid dearly for the pleasures of a repast by a general disorder, an universal agitation, a heat in every part during the whole time that the wine circulates with the blood? Who has not observed that one kind of wine produces one effect and another a different? The solids are then without doubt the seat of every thing we experience; but is not the cause of it in the fluids? It is the blood, which carrying with its own particles others that are foreign to it, excites all the organs, and especially the brain, because there is a particular relation between this viscus and spirituous liquors, as there is between cantharides and the bladder, and mercury and the salivary glands. That which I say is so true, that if you infuse wine into the open vein of an animal, you will produce analogous effects. The experiments made upon this subject are so well known that I have not even repeated them.

I will relate a fact here which disproves what has lately been advanced upon the incorruptibility of the blood in diseases. A short time since, in examining a body at the Hôtel Dieu, with Mess. Péborde, l'Herminier, and Bourdet, we found instead of the black abdominal blood, a real grey sanies, which filled all the divisions of the splenic vein, the trunk of the vena porta, and all the hepatic branches, so that by cutting the liver in slices, we could distinguish by the flow of this sanies, all the ramifications of the vena porta from those of the vena cava, which contained ordinary blood. This body was so remarkable for its size, that I do not recollect to have ever seen one equal to it. Certainly this sanies was not the effect of death, and the blood had circulated, if not thus altered, at least very different from its natural state, and really decomposed.

Consider the immense influence of aliments upon health, structure, and even character. Compare the people who live only on milk and vegetables with those who are in the constant use of spirituous liquors. See how alkohol, carried into the new world, has modified the manners and habits of the savages; consider the slow and gradual influence of regimen in chronic diseases, and you will perceive that in health, as in disease, the alteration of the fluids is frequently before that of the solids, which consequently become changed; for it is an inevitable circle. But the alteration of the fluids appears to depend essentially upon the mode of the mixture of parts not animalized with those that are so.

We should have a very inaccurate idea of the mixture with the blood of the foreign substances brought by the way of the intestines, the skin, or the lungs, for the purposes of sanguification, if we compared it to the mixture of inert substances, or chemical combinations. The blood enjoys, if we may so say, the rudiments of organic sensibility; and as the life which it enjoys places it more or less in relation to the fluids that enter it, it is more or less disposed to combine with them and to endow them with the life with which it is animated. Sometimes it repulses for a long time substances that are foreign to it. I am persuaded that a great number of the phenomena that we experience after taking food, especially acrid substances, and spirituous liquors, arises in part from the general disorder that the blood undergoes when its vitality begins to communicate itself to these foreign substances from the kind of struggle which takes place in the vessels, between the living fluid and that which does not live. Thus we see all the solids rise, as it were, against a stimulant they are unaccustomed to. Who knows but that the vitality of the fluids has an influence upon their motions? I think it is very probable. I doubt whether fluids purely inert could, if they were alone in animated vessels, circulate like living fluids. In the same manner, animated fluids could not move themselves, if they were in vessels deprived of life. Life then is equally necessary to one and the other. But these subjects are too obscure to occupy us longer.

V. _Of the properties independent of life._

These are what I call properties of texture. Foreign to inert bodies, inherent in the organs of living bodies, they arise from their texture, from the arrangement of their particles, but not from the life that animates them. Thus death does not destroy them. They remain in the organs when life is gone; that, however, adds much to their energy. Putrefaction and the decomposition of the organs, alone destroy them. The two first of these properties are extensibility and contractility of texture. I have explained these sufficiently in my Treatise on Life. I shall have occasion in this work to explain the influence they have in each system. I shall now speak of a property of which as yet very little has been said; which chemists have proved by their experiments, and which physiologists have confounded often with irritability, but which is as distinct from it as it is from the contractility of texture; I mean the property of being[3] hardened like horn, and contracted by the action of different agents. This will be examined particularly in each system; I shall now describe it in a general manner only.

[3] There are no words in English that correspond exactly to the words _racornir_, and _racornissement_, and I have therefore been compelled to employ the terms, _to harden like horn_, and _horny hardening_, to express the precise meaning. _Tr._

Every organized part, submitted either after death or during life, to the action of fire and of certain concentrated acids, is contracted and wrinkled in different ways, and is affected almost like irritable organs when they are excited. Now this property is to be considered as to the agents which put it in action, as to the organs which are the seat of it, and as to its phenomena.

1st. Fire is the principal agent of this horny hardening. Every living organ, placed upon burning coals, is suddenly raised to the highest degree. 2d. Next to fire, the strongest acids, the sulphuric first, then the nitric, then the muriatic, make the animal fibres contract most suddenly. As they are diluted, they lose this power, and the acids that are naturally very weak have hardly any of it. 3d. Alkohol is much less powerful in producing this effect, though it may be highly concentrated. It contracts, however, the texture of parts, which it condenses and even twists. So that those who preserve anatomical specimens, find it necessary to dilute the alkohol. 4th. The neutral salts, after being moistened by the humidity of animal substances, condense and harden them wonderfully after the lapse of a considerable length of time. 5th. When the air has taken away, by drying, the aqueous particles of the solids, these continuing exposed to its action, contract, wrinkle, and twist in a slow and gradual manner. 6th. The alkalies, however strong they may be employed, do not produce any kind of horny hardening. 7th. Water appears to act in a manner opposite to this horny hardening; it dilates, spreads the organs by maceration, and separates their particles. It is when it is combined with much caloric that it produces horny hardening. This phenomenon takes place at some degrees below boiling, and is very remarkable at that point.

The different agents of which I have just spoken, produce, then, two species of horny hardening: 1st. the first is prompt, sudden, almost like the motion which results from the irritation of a living muscle: 2d. the other slow, gradual, and even insensible. Fire and the strong acids are in a special manner the agents of the first. The action of the neutral salts, of the air, of alkohol, principally produce the second.

These two species differ very much in their results. The state to which the first reduces the organ, is soon changed if the hardening cause continues. 1st. Fire continuing to act upon the solids, reduces them to a hard and coaly mass. 2d. Boiling water, after a length of time, destroys by degrees the hardness the solids had suddenly acquired, by being plunged into it. As the hardness diminishes, the effect of the boiling increases, and it arrives at the greatest extent, when the solid, having lost all consistence, becomes pulpy. 3d. Animal organs that have been acted upon suddenly by the acids, and become consequently hard, soon grow soft and change into a true pulp. This double phenomenon, that is presented on the one hand by boiling, and on the other by the strong acids, has a great analogy, and seems to be derived from the same principle.

The slow and insensible horny hardening, the effect of the contact of neutral salts, such as alum, the muriate of soda, &c. of the air and of alkohol, offers a very different phenomenon from the first. It is not altered by the continued action of the cause that produced it, however long it may be; it does not soften in a slow and insensible manner, as it has hardened, but remains always firm and contracted.

Are these two species only different degrees of the same, or are they derived from separate principles? I know not. I have only observed, that when the living solids have undergone the slow and gradual horny hardening, they are still susceptible of the other. We know that after many years drying, animal textures are hardened, as in a recent state, by the action of fire; I have made the same observation with regard to boiling and the acids. Textures that have been contracted for a long time by alkohol and the neutral salts present the same phenomenon.

All animal textures are susceptible of sudden hardening, except the hair, the epidermis, and the nails; these, if we may so say, exhibit only the rudiments of it. In general the hardening is more sensible, in proportion as the fibrous texture predominates in the organs. Hence the muscles, the tendons, and nerves, are the most susceptible of it. The organs not fibrous, as the glands, show the least degree of it. The slow and insensible horny hardening is almost the same in every part. Both exist in textures deprived of animal contractility, of sensible organic contractility, and of contractility of texture, as well as in those which enjoy them in the highest degree. Thus the tendons, the aponeuroses, the bones, even when their calcareous substance has been removed by acids, may be hardened as well as the muscles and the skin. This single circumstance would suffice to distinguish the contractility arising from hardening from all others, if a variety of differences, which I shall point out hereafter, under the article of the muscles in particular, did not.

When a texture is suddenly hardened, it loses more than half its length, and becomes twisted in various ways. Taken suddenly from the acid or boiling water, it remains hardened; but if it is pulled, it becomes elongated, and then contracts again, when the force applied ceases, so that it has acquired a real elasticity by the process of hardening. This elasticity is remarkable in the tendons, nerves and muscles, which before this are absolutely destitute of it. This elasticity is not an effect of the slow and insensible hardening of alkohol and the neutral salts. By macerating for a length of time the organized textures, they gradually lose the power of contracting suddenly, which does not, however, entirely disappear, until the maceration has reduced the textures to mere pulp.

If the textures are softened by boiling, and stretched out to their original length, after having been hardened, this cannot be produced again by any agent that we may employ.

When the textures are in a state of putrefaction, they no longer possess this kind of contractility.

Slow and insensible hardening cannot take place during life; this is an insurmountable obstacle to it. But that which is sudden may, when its agents have overcome the resistance that vitality offers. Oftentimes we see the skin hardened by burns. When it is stripped of its epidermis, and a very strong acid is poured upon it, the same effect is produced as upon any other organ.

When a part has been hardened upon a living subject, it almost inevitably dies; it cannot be restored to the suppleness that it possessed before; suppuration separates it from the sound parts.

The fluids do not present the phenomenon of hardening, the fibrine only excepted. Separated from the blood, it crisps and contracts.

After what has been said, it is evident that the solids possess the faculty of contracting or shortening. This is brought into action in many different ways. During life it appears, 1st. in the influence of the nerves upon the voluntary muscles; this is animal contractility. 2d. In the involuntary muscles by the action of stimuli; this is sensible organic contractility. 3d. In the muscles, the skin, the cellular texture, the arteries, the veins, &c. from a want of extension. This is the contractility of texture, which is not found, or at least is very obscure, in many of the organs, as the nerves, the fibrous bodies, the cartilages, the bones, &c. 4th. By the action of fire, and the strong acids; this is the contractility of the horny hardening, and is general.

When the muscles are deprived of life, they lose the two first kinds of contractility; but the third remains with them as it does with all the organs that enjoy it. When they are dried or remain in water a little time, they lose that also; but the fourth still continues with them; it is the last that abandons the animal textures; it is perpetuated for a length of years. When I have exposed to the action of fire the cartilaginous parenchyma of bones found in cemeteries, they have become hardened. I am persuaded that this faculty would last for many ages, if we could preserve the organic textures.

Contractility is, then, a common and general property, inherent in all animal textures, but which, according to the manner that it is brought into action, presents essential differences, which divide it into many species, that have no analogy. It would certainly be impossible to avoid distinguishing the difference between the four species I have pointed out, and that insensible contraction, or kind of oscillation, which forms during life the insensible organic contractility, or tonic motions.

Among the causes that bring contractility into action, some belong, then, to life, others are independent of it, and are derived only from organization. All the organs are essentially contractile; but each of the causes which makes them contract acts only upon this or that texture: the horny hardening alone has a general effect.

VI. _Observations upon the organization of animals._

The properties, whose influence we have just analyzed, are not absolutely inherent in the particles of matter that are the seat of them. They disappear when these scattered particles have lost their organic arrangement. It is to this arrangement that they exclusively belong; let us treat of it here in a general way.

All animals are an assemblage of different organs, which, executing each a function, concur in their own manner, to the preservation of the whole. It is several separate machines in a general one, that constitutes the individual. Now these separate machines are themselves formed by many textures of a very different nature, and which really compose the elements of these organs. Chemistry has its simple bodies, which form, by the combinations of which they are susceptible, the compound bodies; such are caloric, light, hydrogen, oxygen, carbon, azote, phosphorus, &c. In the same way anatomy has its simple textures, which, by their combinations four with four, six with six, eight with eight, &c. make the organs. These textures are, 1st. the cellular; 2d. the nervous of animal life; 3d. the nervous of organic life; 4th. the arterial; 5th. the venous; 6th. the texture of the exhalants; 7th. that of the absorbents and their glands; 8th. the osseous; 9th. the medullary; 10th. the cartilaginous; 11th. the fibrous; 12th. the fibro-cartilaginous; 13th. the muscular of animal life; 14th. the muscular of organic life; 15th. the mucous; 16th. the serous; 17th. the synovial; 18th. the glandular; 19th. the dermoid; 20th. the epidermoid; 21st. the pilous.

These are the true organized elements of our bodies. Their nature is constantly the same, wherever they are met with. As in chemistry, the simple bodies do not alter, notwithstanding the different compound ones they form. The organized elements of man form the particular object of this work.

The idea of thus considering abstractedly the different simple textures of our bodies, is not the work of the imagination; it rests upon the most substantial foundation, and I think it will have a powerful influence upon physiology as well as practical medicine. Under whatever point of view we examine them, it will be found that they do not resemble each other; it is nature and not science that has drawn the line of distinction between them.

1st. Their forms are every where different; here they are flat, there round. We see the simple textures arranged as membranes, canals, fibrous fasciæ, &c. No one has the same external character with another, considered as to their attributes of thickness or size. These differences of form, however, can only be accidental, and the same texture is sometimes seen under many different appearances; for example, the nervous appears as a membrane in the retina, and as cords in the nerves. This has nothing to do with their nature; it is then from the organization and the properties, that the principal differences should be drawn.

2dly. There is no analogy in the organization of the simple textures. We shall see that this organization results from parts that are common to all, and from those that are peculiar to each; but the common parts are all differently arranged in each texture. Some unite in abundance the cellular texture, the blood vessels and the nerves; in others, one or two of these three common parts are scarcely evident or entirely wanting. Here there are only the exhalants and absorbents of nutrition; there the vessels are more numerous for other purposes. A capillary net-work, wonderfully multiplied, exists in certain textures, in others this net-work can hardly be demonstrated. As to the peculiar part, which essentially distinguishes the texture, the differences are striking. Colour, thickness, hardness, density, resistance, &c. nothing is similar. Mere inspection is sufficient to show a number of characteristic attributes of each, clearly different from the others. Here is a fibrous arrangement, there a granulated one; here it is lamellated, there circular. Notwithstanding these differences, authors are not agreed as to the limits of the different textures. I have had recourse, in order to leave no doubt upon this point, to the action of different re-agents. I have examined every texture, submitted them to the action of caloric, air, water, the acids, the alkalies, the neutral salts, &c. drying, putrefaction, maceration, boiling, &c. the products of many of these actions have altered in a different manner each kind of texture. Now it will be seen that the results have been almost all different, that in these various changes, each acts in a particular way, each gives results of its own, no one resembling another. There has been considerable inquiry to ascertain whether the arterial coats are fleshy, whether the veins are of an analogous nature, &c. By comparing the results of my experiments upon the different textures, the question is easily resolved. It would seem at first view that all these experiments upon the intimate texture of systems, answer but little purpose; I think however that they have effected an useful object, in fixing with precision the limits of each organized texture; for the nature of these textures being unknown, their difference can be ascertained only by the different results they furnish.

3dly. In giving to each system a different organic arrangement, nature has also endowed them with different properties. You will see in the subsequent part of this work, that what we call _texture_ presents degrees infinitely varying, from the muscles, the skin, the cellular membrane, &c. which enjoy it in the highest degree, to the cartilages, the tendons, the bones, &c. which are almost destitute of it. Shall I speak of the vital properties? See the animal sensibility predominant in the nerves, contractility of the same kind particularly marked in the voluntary muscles, sensible organic contractility, forming the peculiar property of the involuntary, insensible contractility and sensibility of the same nature, which is not separated from it more than from the preceding, characterizing especially the glands, the skin, the serous surfaces, &c. &c. See each of these simple textures combining, in different degrees, more or less of these properties, and consequently living with more or less energy.

There is but little difference arising from the number of vital properties they have in common; when these properties exist in many, they take in each a peculiar and distinctive character. This character is chronic, if I may so express myself, in the bones, the cartilages, the tendons, &c.; it is acute in the muscles, the skin, the glands, &c.

Independently of this general difference, each texture has a particular kind of force, of sensibility, &c. Upon this principle rests the whole theory of secretion, of exhalation, of absorption, and of nutrition. The blood is a common reservoir, from which each texture chooses, that which is adapted to its sensibility, to appropriate and keep it, or afterwards reject it.

Much has been said since the time of Bordeu, of the peculiar life of each organ, which is nothing else than that particular character which distinguishes the combination of the vital properties of one organ, from those of another. Before these properties had been analyzed with exactness and precision, it was clearly impossible to form a correct idea of this peculiar life. From the account I have just given of it, it is evident that the greatest part of the organs being composed of very different simple textures, the idea of a peculiar life can only apply to these simple textures, and not to the organs themselves.

Some examples will render this point of doctrine which is important, more evident. The stomach is composed of the serous, organic muscular, mucous, and of almost all the common textures, as the arterial, the venous, &c. which we can consider separately. Now if you should attempt to describe in a general manner, the peculiar life of the stomach it is evidently impossible that you could give a very precise and exact idea of it. In fact the mucous surface is so different from the serous, and both so different from the muscular, that by associating them together, the whole would be confused. The same is true of the intestines, the bladder, the womb, &c.; if you do not distinguish what belongs to each of the textures that form the compound organs, the term peculiar life will offer nothing but vagueness and uncertainty. This is so true, that oftentimes the same textures alternately belong or are foreign to their organs. The same portion of the peritoneum, for example, enters or does not enter, into the structure of the gastric viscera, according to their fulness or vacuity.

Shall I speak of the pectoral organs? What has the life of the fleshy texture of the heart in common with that of the membrane that surrounds it? Is not the pleura independent of the pulmonary texture? Has this texture nothing in common with the membrane that surrounds the bronchia? Is it not the same with the brain in relation to its membranes, of the different parts of the eye, the ear, &c.?

When we study a function, it is necessary carefully to consider in a general manner, the compound organ that performs it; but when you wish to know the properties and life of this organ, it is absolutely necessary to decompose it. In the same way, if you would have only general notions of anatomy, you can study each organ as a whole; but it is essential to separate the textures, if you have a desire to analyze with accuracy its intimate structure.

VII. _Consequences of the preceding principles relative to diseases._

What I have been saying leads to important consequences, as it respects those acute or chronic diseases that are local; for those, which like most fevers, affect almost simultaneously every part, cannot be much elucidated by the anatomy of systems. The first then will engage our attention.

Since diseases are only alterations of the vital properties, and each texture differs from the others in its properties, it is evident there must be a difference also in the diseases. In every organ then, composed of different textures, one may be diseased, while the others remain sound; now this happens in a great many cases; let us take the principal organs, for example.

1st. Nothing is more rare than affections of the mass of the brain; nothing is more common than inflammation of the tunica arachnoides that covers it. 2d. Oftentimes one membrane of the eye only is affected, the others preserving their ordinary degree of vitality. 3d. In convulsions or paralysis of the muscles of the larynx, the mucous surface is unaffected; and on the other hand the muscles perform their functions as usual in catarrhs of this surface. Both these affections are foreign to the cartilages, and vice versa. 4th. We observe a variety of different alterations in the texture of the pericardium, but hardly ever in that of the heart itself; it remains sound while the other is inflamed. The ossification of the common membrane of the red blood does not extend to the neighbouring textures. 5th. When the membrane of the bronchia is the seat of catarrh, the pleura is hardly affected at all, and reciprocally in pleurisy the first is scarcely ever altered. In peripneumony, when an enormous infiltration in the dead body shows the excessive inflammation that has existed during life in the pulmonary texture, the serous and mucous surfaces often appear not to have been affected. Those who open dead bodies know that they are frequently healthy in incipient phthisis. 6th. We speak of a bad stomach, a weak stomach; this most commonly should be understood as applying to the mucous surface only. Whilst this secretes with difficulty the nutritive juices, without which digestion is impaired, the serous surface exhales as usual its fluid, the muscular coat continues to contract, &c. In ascites, in which the serous surface exhales more lymph than in a natural state, the mucous oftentimes performs its functions perfectly well, &c. 7th. All authors have said much of the inflammation of the stomach, the intestines, the bladder, &c. For myself I believe that this disease rarely ever affects at first the whole of any of these organs, except in the case where poison or some other deleterious substance acts upon them. There are for the mucous surface of the stomach and intestines, acute and chronic catarrhs, for the peritoneum serous inflammations, perhaps even for the layer of organic muscles that separates the two membranes, there is a particular kind of inflammation, though we have as yet hardly any thing certain upon this point; but the stomach, the intestines, and the bladder are not suddenly affected with these three diseases. A diseased texture can affect those near it, but the primitive affection seizes only upon one. I have examined a great number of bodies in which the peritoneum was inflamed either upon the intestines, the stomach, the pelvis, or universally; now very often when this affection is chronic, and almost always when it is acute, the subjacent organs remain sound. I have never seen this membrane exclusively diseased upon one organ, while that of the neighbouring ones remain untouched; its affection is propagated more or less remotely. I know not why authors have hardly ever spoken of its inflammation, and have placed to the account of the subjacent viscera that which most often belongs only to this. There are almost as many cases of peritonitis as of pleurisy, and yet while these last have been particularly noticed the others are almost entirely overlooked. Oftentimes that part of the peritoneum corresponding to an organ, is much inflamed; we see it in the case of the stomach; we observe especially after the suppression of the lochia or the menses, that it is the portion that lines the pelvis that is first affected. But soon the affection becomes more or less general; at least examinations after death prove it satisfactorily. 8th. Certainly the acute or chronic catarrh of the bladder, or womb even, has nothing in common with the inflammation of that portion of the peritoneum corresponding with these organs. 9th. Every one knows that diseases of the periosteum have oftentimes no connexion with the bone, and vice versa, that frequently the marrow is for a long time affected, while both the others remain sound. There is no doubt that the osseous, medullary and fibrous textures have their peculiar affections which we shall not confound with the idea we may form of the diseases of the bones. The same can be said of the intestines, of the stomach, &c. in relation to their mucous, serous, muscular textures, &c. 10th. Though the muscular and tendinous textures are combined in a muscle, their diseases are very different. 11th. You must not think that the synovial is subject to the same diseases as the ligaments that surround it, &c.

I think the more we observe diseases, and the more we examine bodies, the more we shall be convinced of the necessity of considering local diseases, not under the relation of the compound organs, which are rarely ever affected as a whole, but under that of their different textures, which are almost always attacked separately.

When the phenomena of diseases are sympathetic, they follow the same laws as when they arise from a direct affection. Much has been said of the sympathies of the stomach, the intestines, the bladder, the lungs, &c. But it is impossible to form an idea of them, if they are referred to the organ as a whole, separate from its different textures. 1st. When in the stomach, the fleshy fibres contract by the influence of another organ and produce vomiting, they alone receive the influence, which is not extended either to the serous or mucous surfaces; if it were, they would be the seat, the one of exhalation, the other of sympathetic exhalation and secretion. 2d. It is certain that when the action of the liver is sympathetically increased, so that it pours out more bile, the portion of peritoneum that covers it does not throw out more serum, because it is not affected by it. It is the same of the kidney, the pancreas, &c. 3d. For the same reason, the gastric organs upon which the peritoneum is spread, do not partake of the sympathetic influences that it experiences. I shall say as much of the lungs in relation to the pleura, the brain in relation to the tunica arachnoides, the heart to the pericardium, &c. 4th. It is undeniable that in all sympathetic convulsions, the fleshy texture is alone affected, and that the tendinous is not so at all. 5th. What has the fibrous membrane of the testicles in common with the sympathies of its peculiar texture? 6th. No doubt a number of sympathetic pains that we refer to the bones, are seated exclusively in the marrow.

I could cite many other examples to prove, that it is not this or that organ which sympathizes as a whole, but only this or that texture in the organs; besides, this is an immediate consequence of the nature of sympathies. In fact the sympathies are but aberrations of the vital properties; now these properties vary according to each texture; the sympathies of these textures then would do the same.

Observe what takes place in fever, accompanying the different kinds of inflammation. That attending the mucous is slight, that with the serous severe, and that with the cutaneous has the peculiar character of showing itself some days before the eruption, as has been noticed by Pinel. If we attentively observe the fever which attends the inflammations of all the systems, we shall find as many differences, as many peculiar characters, as there are systems. Whence does this arise? From the difference of the relations that unite the heart to each kind of texture; now this difference of relations is the result of the difference of the vital forces peculiar to each.

Observe the itch, herpes, cancer, venereal disease, &c. when they have ceased to be local affections, they spread themselves universally; they alternately attack different textures, according to the relation which they have with the organic sensibility of these textures. But it is almost always separately that they attack them; an organ is never as a whole influenced by them in all its parts. What do I say? If two of these diseases exist at the same time, one seizes upon one texture, the other upon a different one of the same organ. Thus the stomach, the intestines, the lungs, &c. can be attacked by two different diatheses, and each will be independent of the other, because each will be fixed upon a different texture, one upon the mucous, for example, the other upon the serous, &c.

Let us not, however, exaggerate this independence of the textures of the organs in diseases, lest experience should contradict us. We shall see that the cellular system is oftentimes a medium of communication, not only from one texture to another in the same organ, but from one organ to a neighbouring one. Thus in many chronic diseases, all the parts of the same organ are gradually changed, and at the examination of this organ after death, the whole of it appears to have been affected, though one of its textures only was so at first. In the cancer of the breast, you find at first only a small gland that rolls under the finger; finally the glandular, the cellular, and even the cutaneous textures are confounded in one common cancerous mass. Cancer of the stomach, the intestines, the penis, &c. follows the same course. Observe phthisis, exhibiting in the beginning some small tubercles in the pulmonary texture, at length invading oftentimes the pleura, the bronchial membrane, &c. How little soever you may examine bodies with a view to the same chronic disease, and at different periods, you will be convinced of the truth of this assertion, viz. that a texture being at first affected in an organ, communicates its affection gradually to others, and that you will be deceived in judging of the primitive seat of the disease, if you attempt to determine it from the parts found affected at the time of the examination.

In acute diseases, continuity is oftentimes sufficient to explain the different symptoms that appear in textures that are not affected. The peritoneal coat only being inflamed, vomiting is produced. We cough and sometimes expectorate considerably when the pleura alone is diseased. Delirium comes on when the tunica arachnoides is inflamed, though the intellectual functions are not connected with it. Frequently the diseases of the pericardium are sufficient to disturb the motion of the heart, &c. We cannot deny after this, that oftentimes an alteration in one of the textures alone of an organ is sufficient to disturb the functions of all the others; but still it is in one only, that the primitive source of the evil exists.

I now pass to some other considerations relative to the influence of the anatomy of systems in diseases.

Since every organized texture has every where the same arrangement; since, whatever be its situation, it has the same structure and the same properties, it is evident that its diseases must be every where the same. It makes no difference, that the serous texture is connected with the brain by the tunica arachnoides, with the lungs by the pleura, with the heart by the pericardium, with the gastric viscera by the peritoneum, &c. every where it is inflamed in the same manner; every where dropsies take place in the same way; every where it is subject to a species of eruption of little whitish tubercles, like the miliary, of which I believe there has been no description, but which deserves great attention; I have already many times observed this peculiar eruption of the serous texture, which is generally of a chronic character, like most of the cutaneous eruptions; I shall speak of it hereafter. Whatever may be the organ that the mucous texture invests, its affections have in general the same character, excepting the difference only that arises from variety of structure. I will say the same of the fibrous, cartilaginous textures, &c. Mr. Pinel appears to me to have done much for the art, in being the first who arranged inflammations in the order of the systems, and embracing in one general view all those of the same system, whatever may be the organs in which it is found.

There are always two orders of symptoms in inflammations; 1st. those that belong to the nature of the diseased textures; 2d. those which depend upon the affected organ, in which the inflammation exists. For example, the kind of pain, the nature of the accompanying fever, the duration, the termination, &c. are almost always the same, whatever serous surface is affected. But difficulty of breathing, dry cough, &c. prove it to be the pleura; diarrhœa, constipation, vomiting, &c. that it is the peritoneum; injury of the intellectual functions, that it is the tunica arachnoides; irregular pulse, that it is the pericardium, &c. The first belong to the whole class, the second set of symptoms is confined exclusively to this or that particular sort; now the second are, if we may so say, accessory, depending upon the proximity of the affected texture with some other texture. The first are particularly important.

Medicine has yet much to do, in its researches upon the inflammation of the different textures. We are well acquainted with that of the cellular, the cutaneous, the serous, and the mucous; but that of the others is very obscure. It is yet to be ascertained, which is attacked, the fibrous or muscular, in rheumatism. I am inclined to think that it is the first. Almost every thing remains to be known in the cartilaginous, the synovial, the arterial, the venous, &c. as it respects their inflammatory phenomena.

In making these researches, it will be necessary to establish one important distinction; that is, 1st. that certain textures, as the osseous, the muscular of animal life, &c. are precisely the same in all the organs in which they are found, and consequently that their diseases must be the same; 2d. that others, as the cutaneous, the serous, the mucous, &c. experience, according to the organs to which they belong, some variety of structure and vital properties, which necessarily modify the general phenomena of the class of diseases that belong to these textures; 3d. that others, as the glandular, the muscular of organic life, &c. are very different in each organ; and that their general symptoms and class of diseases must consequently differ considerably.

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.

VIII. _Remarks upon the classification of functions._

The plan that I have followed in this work, is not the most favourable to the study of the functions. Many of them, such as digestion, respiration, &c. would find no place here, because they do not belong especially to the simple systems, but to a combination of them, an union of many systems, and even of many organs. Thus what I have said upon the functions, is introduced only incidentally in this work, the particular object of which is the analysis of the different simple systems that form the compound organs. However, as some would wish to connect the different facts of physiology that it contains, with a physiological classification, I will now explain that which I have adopted in my course of lectures.

We know how different the kinds of classification are. The ancient division, into animal, vital, and natural functions, rests upon so weak a foundation, that a methodical superstructure could not be raised upon it. Vicq d'Azyr has substituted one for it which offers hardly any more advantages, as it separates phenomena that are connected, and changes into functions, properties, such as sensibility, irritability, &c. Since this author, others have made divisions which are not more methodical, and are equally removed from the natural arrangement of the phenomena of life.