General Anatomy, Applied to Physiology and Medicine, Vol. 2 (of 3)Bichat, Xavier
Science
General Anatomy, Applied to Physiology and Medicine, Vol. 2 (of 3)
Bichat, Xavier
Human anatomy; Human physiology
1st. Whenever a tight ligature applied to a limb makes the lower part
swell, whenever too long standing, a perpendicular position of the
superior extremities, &c. produce the same effect, it is to be presumed
that the effusion depends upon the compression of the lymphatics, and
takes place then like venous dilatations in similar circumstances,
because the lymph finds it difficult to circulate. Here then is a case
in which the exhalants have nothing to do with the dropsy, which takes
place because the absorbents do not take up what the exhalants furnish.
If other causes, as a bruise, a wound, &c. diminish the activity of
the part, the absorbents directly weakened, are not able to take up
their fluids. So if their weakness is sympathetic, that is to say, if
it arises from the injury of another viscus, the same phenomenon will
be the result of it. In all these cases we find the absorbents much
dilated in the dead body: often they are even full of fluids.
2d. But in the organic affections to which dropsy succeeds, the
exhalants certainly in the greatest number of cases, pour out more
fluids than usual. The pleura is filled in phthisis, the skin is
then covered with night sweats, blood is raised, &c. These are the
exhalations which I have called passive. They are so abundant on the
serous surfaces, that if a puncture is made, the peritoneum often fills
again with such rapidity, that as much water is collected in a day,
as there would be in a month, if the exhalation was natural. I do not
say that the absorbents are not also affected in these cases; but the
principal cause of the dropsical effusions is certainly then in the
increased action of the exhalants. I could cite other examples, but
this is sufficient. Four years since I was engaged upon the absorbents;
I observed then that these vessels are not always very evident in
dropsical patients, notwithstanding what has been said by many authors,
and that very often we see them more easily in very thin subjects. I
had not then thought of this difference of dropsies; but in working
again upon this system for my Descriptive Anatomy, I think of comparing
the cases in which it is dilated and those in which it is not, with the
cause of the death.
III. _Termination of the Absorbents._
All the known absorbents unite into two principal trunks. One of
these, which is the thoracic duct, receives all those from the lower
extremities, abdomen, the greater part of the thorax, and those of the
left side of the superior parts. The other is formed by the union of
the absorbents of the right side of the superior parts, as well of the
head, as the extremities, and of some of those of the thorax. These
two principal trunks go into the vena cava superior; around them, many
smaller branches also terminate there.
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