HARVEY'S DELINEATION OF THE VENOUS RETURN
It may seem surprising that the discoverer of the venous return
felt the need of a _deus ex machina_ to distend the right auricle.
On reflection, however, ought it to surprise us that, although we
find the muscular power of the heart sufficient to complete the
Harveian circulation, Harvey himself did not, but eked it out with
Aristotelian forces? Vigorous as Harvey was, he could not make
smooth the road which he himself had broken. For instance, he could
not study, like ourselves, the return of the blood to the heart
in the opened chest of an animal anæsthetized and curarized. The
knowledge gained by his own tireless investigations did not suffice
to teach him what we now know, viz.: that the unaided force of the
systole of the left ventricle is sufficient to distend the right
auricle with blood and to charge with blood the right ventricle as
well.
The essence of Harvey's great discovery is his reversal of the
immemorial direction of the venous flow, which he also proved to
be abundant and rapid. But the laws which rule this flow were not,
and could not be, patent to him as to us, owing to the imperfect
physiological knowledge of his day. Hence at times his statements
as to the movement of the blood are conceived in what, to borrow
an architectural phrase, may be called a "transition style." As a
sequel to his doctrine of the cause of the heart-beat let us pass
in review some of these statements; but, first, let us briefly note
a few facts which may help us to realize the imperfect state of the
science of physics in Harvey's day.
Harvey was fourteen years younger than Galileo, who struck crippling
blows at the Aristotelian physics, yet could not explain the common
pump;[250] and Harvey's discovery of the circulation was made
public thirteen years before the momentous work on the movement
of liquids done by Torricelli, who was thirty years younger than
Harvey.[250] Moreover, it was only a year before the publication of
the Exercises to Riolanus in Harvey's old age that Blaise Pascal
supplied the final proof that the mercurial column below the vacuum
of Torricelli's barometer is really sustained by the pressure of the
atmosphere.[250] It was not till one hundred years after the
publication of Harvey's discovery that the Reverend Stephen
Hales published the first comparative manometric measurements of
the blood-pressure in the arteries and the veins of the same living
animal, and stated in his preface that "the animal fluids move by
Hydraulick and Hydrostatical Laws."[251]
Now let us turn to some delineations of the movement of the blood
made by Harvey himself. I have found no evidence that he knew the
venous flow to be promoted by the aspiration of the chest; but he
knew well the effect of the muscular movements of the body upon that
flow. Of course he had a perfect grasp of the fundamental truth that
the main cause of the venous return is the forcible emptying of the
ventricles into the arteries. He says to Riolanus:--
"Among these things should be noted the force and violence and
rapid vehemence which we perceive by touch and sight in the
heart and greater arteries; and the systole and diastole of
the pulse in the larger and warmer animals I do not affirm to
be the same in all the vessels which contain blood, nor in all
blood-containing animals; but to be such and so ample in all
that as a result thereof a streaming and an accelerated course
of the blood through the small arteries, the porosities of
the parts, and the branches of all the veins are necessarily
brought about; and as a result thereof a circulation....[252]
In the case of the arteries, over and above the shock, pulse,
or vibration of the blood (which is not equally perceptible in
all), a continual flow and movement thence take place until the
blood returns to the point whence it started first, namely, the
right auricle."[253]
[Illustration: The Title-page of William Harvey's _Exercitatio
Anatomica de Motu Cordis et Sanguinis in Animalibus_, Frankfort,
1628.]
With the calm quantitative account which a reader of Hales'
"Statical Essays" will find given by that clergyman of his
epoch-making physical experiments upon the blood-pressure, it is
interesting to compare the following vivid qualitative recital of
inferences made from surgical observations by his great predecessor.
Harvey says:--
"Moreover, whoever shall have seen and thought upon the amount
of difficulty and exertion with which the blood is stanched by
compression, ligatures, or various appliances, when it leaps
impetuously out of a petty artery, even the smallest, which
has been cut or torn in two; and shall have seen or thought
upon the amount of force with which the blood, as though thrown
out from a syringe, flings off and drives before it the whole
of the appliances, or traverses them--that man will hardly
believe it probable, I think, that any of the blood can pass
backward against so great an impulse and influx of the entering
blood, unless from a point whence it is driven back with equal
force."[254]
Harvey rightly discountenanced the ancient idea of direct
anastomoses between the mouths of veins and the mouths of
arteries, as opposed to fine and multiplied communications. In
some situations, however, he admitted that ampler communications
exist comparable to such anastomoses; and it throws light upon
his state of mind as to the movement of the blood that, despite
his recognition of the very forcible exit of the blood from the
arteries, he suggested in his old age that in the cases aforesaid
regurgitation from vein to artery is guarded against by a valvular
arrangement, the terminal part of the artery traversing the wall of
the vein obliquely, as the ureter traverses the wall of the bladder
and as the biliary duct traverses the wall of the duodenum.[255]
We should not forget that in his day the capillary vessels, the
existence of the corpuscles, and the chemistry of the blood were
still unknown; so that the passage into the veins of the mysterious
hot vital liquid through the "porosities" of the parts might
naturally present itself to his mind in a way very strange to us. He
tells us this:--
"The blood does not take its course through the looser texture
of flesh and parenchyma in the same way as through the more
compact consistency of tendinous parts. Indeed, the thinner and
purer and more spirituous part passes through more quickly; the
thicker, more earthy, ill-composed[256] part tarries longer and
is rejected."[257]
After more than twenty years of the comment and criticism, called
forth by his treatise of 1628, he said to Riolanus:--
"As to whether the moving blood be attracted, or impelled, or
move itself by virtue of its own intrinsic nature, enough has
been said in my little book on the motion of the heart and
blood."[258]
Yet about two years after the Exercises to Riolanus, Harvey, in
writing a private letter, judged it necessary to accentuate, as
follows, his denial that forces of attraction really play the part
in physiology which the ancients had conceded to them. Speaking of
the impulsion of the blood through the arteries, he says:--
"Indeed, the passage of the blood into the veins is brought
about by that impulsion and not by any dilatation of the veins
whereby, like bellows, they draw in the blood."[259]
But, despite the foregoing utterances and other such, his statements
are sometimes vague and sometimes quite unexpected, regarding the
nature of the movement of the blood in the veins. Indeed, in 1628 he
speaks quite as a disciple of Aristotle. He says regarding the flow
in the arteries:--
"For this distribution and movement of the blood there is need
of impetus and violence and of an impeller such as the heart.
Partly because the blood readily concentrates and gathers
together of itself--toward its seat of origin, as it were,[260]
or as a part to the whole, or as a drop of the water sprinkled
upon a table to the mass thereof--as the blood habitually
and very speedily does from slight causes, from cold, fear,
horror, and other causes of this sort; partly, also, because
the blood is pressed out of the capillary veins into the small
branches and thence into the greater by the movements of the
limbs and the compression of the muscles; the blood is more
disposed and prone to move from the circumference on the center
than the other way, even supposing no valves to be present as
a hindrance. In order, therefore, to relinquish its seat of
origin, and enter constricted and colder places, and move in
opposition to its bent,[261] the blood has need not only of
violence but of an impeller, such as is the heart alone, and
after the fashion described already."[262]
This picture of the blood hesitating to leave its warm cardiac
birthplace for the chill regions of the periphery, but very ready to
return, has a tone far from hydraulic, but may so much the better
prepare us for the view, made public by Harvey in his old age, that
the blood is the primal seat of the soul itself. Except in the light
of the foregoing passage the following words would be quite obscure.
He says that the auricles
"are filled as being the storehouse and reservoir[263] of the
blood, the blood turning of itself and compressed toward the
center by the movement of the veins."[264]
With due allowance for the use of modes of expression no longer
familiar we find Harvey in 1649 handling the venous flow with
no very modern touch, in the following passage--a passage which
also reminds us that not till twelve years later, four years
after Harvey's death, did Malpighi announce his discovery of the
capillary blood-vessels in the lung of the frog.[265] Harvey says to
Riolanus:--
"The arteries are never depleted except into the veins or the
porosities of the parts, but are continually stuffed full by the
pulse of the heart; but in the vena cava and the circulatory
vessels, into which the blood glides at a quick pace and hastens
toward the heart, there would be the greatest scarcity of blood,
did not all the parts incessantly pour out again the blood
poured into them. Add, also, that the impetus of the blood which
is urged and driven at every pulsation into all parts of the
second and third regions, forces the blood contained therein
from the porosities into the little veins and from the branches
into the larger vessels; this being effected also by the motion
and compression of the surrounding parts; for contents are
squeezed out of whatever contains them, when it is compressed
and narrowed. So by the movements of the muscles and limbs the
venous branches which creep on between are pressed upon and
narrowed, and push on the blood from the lesser toward the
greater."[266]
A similar touch of vagueness is perceptible when the venous flow is
dealt with by Harvey in that very same résumé of the circulation
which seats the underlying cause of the pulse in the hot blood
of the vena cava close to the auricle. In that résumé he says to
Riolanus:--
"I assert, further, that the blood in the veins courses always
and everywhere from the lesser into the greater and hastens from
all parts toward the heart; whence I gather that the amount,
continuously sent into the arteries, which the arteries have
received is transferred through the veins, and at length returns
and flows back whence it first was impelled; and that in this
wise the blood is moved in a circle in flux and reflux by the
heart, by an impulsion the impetus of which forces the blood
through all the arterial filaments; and that afterward in a
continuous flow from all parts it goes back through the veins,
one after another, by which it is absorbed, drained away, and
transported."[267]
As to the flow in the lungs Harvey says in the treatise of 1628:--
"It being the will of nature that the blood itself be strained
through the lungs, she was obliged to superadd the right
ventricle, in order that by the beat thereof the blood might be
driven through the lungs themselves, out of the vena cava into
the cavity of the left ventricle."[268]
We have already found Harvey saying to Riolanus, in regard to
the pulmonary transit, that the blood within the branches of the
arterial vein
"cannot now go back in opposition to the sigmoid valve, while
at the same time the lungs are widened and enlarged and then
narrowed, by inspiration and expiration, and with the lungs
their vessels also, and offer to the blood aforesaid a path and
transit into the venous artery."[269]
More than thirty-two years earlier Harvey had written in his
note-book the following words:--
"N.B. The lungs by their movement in subsiding propel blood from
the arterial vein into the venous artery and thence into the
left auricle."[270]
When we review and ponder the foregoing delineations of the
character of the movement of the blood, we may cease to wonder
that Harvey did not recognize the simple hydraulic cause of the
distention of the right auricle and felt obliged to seek a more
recondite explanation thereof, finding this in an Aristotelian
expansion of the hot blood.