THE BLOOD PERCOLATES THE SUBSTANCE OF THE LUNGS FROM THE RIGHT
VENTRICLE OF THE HEART INTO THE PULMONARY VEINS AND LEFT VENTRICLE
That this is possible, and that there is nothing to prevent it from
being so, appears when we reflect on the way in which water percolating
the earth produces springs and rivulets, or when we speculate on
the means by which the sweat passes through the skin, or the urine
through the parenchyma of the kidneys. It is well known that persons
who use the Spa waters, or those of La Madonna, in the territories of
Padua, or others of an acidulous or vitriolated nature, or who simply
swallow drinks by the gallon, pass all off again within an hour or
two by urine. Such a quantity of liquid must take some short time in
the concoction: it must pass through the liver; (it is allowed by all
that the juices of the food we consume pass twice through this organ
in the course of the day;) it must flow through the veins, through the
parenchyma of the kidneys, and through the ureters into the bladder.
To those, therefore, whom I hear denying that the blood, aye the whole
mass of the blood may pass through the substance of the lungs, even as
the nutritive juices percolate the liver, asserting such a proposition
to be impossible, and by no means to be entertained as credible, I
reply, with the poet, that they are of that race of men who, when they
will, assent full readily, and when they will not, by no manner of
means; who, when their assent is wanted, fear, and when it is not, fear
not to give it.
The parenchyma of the liver is extremely dense, so is that of the
kidney; the lungs, again, are of a much looser texture, and if
compared with the kidneys are absolutely spongy. In the liver there
is no forcing, no impelling power; in the lungs the blood is forced
on by the pulse of the right ventricle, the necessary effect of whose
impulse is the distension of the vessels and pores of the lungs. And
then the lungs, in respiration, are perpetually rising and falling;
motions, the effect of which must needs be to open and shut the pores
and vessels, precisely as in the case of a sponge, and of parts having
a spongy structure, when they are alternately compressed and again are
suffered to expand. The liver, on the contrary, remains at rest, and
is never seen to be dilated and constricted. Lastly, if no one denies
the possibility of the whole of the ingested juices passing through
the liver, in man, oxen, and the larger animals generally, in order
to reach the vena cava, and for this reason, that if nourishment is
to go on, these juices must needs get into the veins, and there is no
other way but the one indicated, why should not the same arguments
be held of avail for the passage of the blood in adults through the
lungs? Why not, with Columbus, that skilful and learned anatomist,
maintain and believe the like, from the capacity and structure of the
pulmonary vessels; from the fact of the pulmonary veins and ventricle
corresponding with them, being always found to contain blood, which
must needs have come from the veins, and by no other passage save
through the lungs? Columbus, and we also, from what precedes, from
dissections, and other arguments, conceive the thing to be clear. But
as there are some who admit nothing unless upon authority, let them
learn that the truth I am contending for can be confirmed from Galen’s
own words, namely, that not only may the blood be transmitted from the
pulmonary artery into the pulmonary veins, then into the left ventricle
of the heart, and from thence into the arteries of the body, but that
this is effected by the ceaseless pulsation of the heart and the motion
of the lungs in breathing.
There are, as every one knows, three sigmoid or semilunar valves
situated at the orifice of the pulmonary artery, which effectually
prevent the blood sent into the vessel from returning into the cavity
of the heart. Now Galen, explaining the uses of these valves, and
the necessity for them, employs the following language:[28] “There
is everywhere a mutual anastomosis and inosculation of the arteries
with the veins, and they severally transmit both blood and spirit,
by certain invisible and undoubtedly very narrow passages. Now if
the mouth of the vena arteriosa, or pulmonary artery, had stood in
like manner continually open, and nature had found no contrivance for
closing it when requisite, and opening it again, it would have been
impossible that the blood could ever have passed by the invisible
and delicate mouths, during the contractions of the thorax, into the
arteries; for all things are not alike readily attracted or repelled;
but that which is light is more readily drawn in, the instrument being
dilated, and forced out again when it is contracted, than that which
is heavy; and in like manner is anything drawn more rapidly along an
ample conduit, and again driven forth, than it is through a narrow
tube. But when the thorax is contracted, the pulmonary veins, which
are in the lungs, being driven inwardly, and powerfully compressed on
every side, immediately force out some of the spirit they contain, and
at the same time assume a certain portion of blood by those subtile
mouths; a thing that could never come to pass were the blood at liberty
to flow back into the heart through the great orifice of the pulmonary
artery. But its return through this great opening being prevented,
when it is compressed on every side, a certain portion of it distils
into the pulmonary veins by the minute orifices mentioned.” And
shortly afterwards, in the very next chapter, he says: “The more the
thorax contracts, the more it strives to force out the blood, the more
exactly do these membranes (viz. the sigmoid valves) close up the mouth
of the vessel, and suffer nothing to regurgitate.” The same fact he
has also alluded to in a preceding part of the tenth chapter: “Were
there no valves, a three-fold inconvenience would result, so that the
blood would then perform this lengthened course in vain; it would flow
inwards during the diastoles of the lungs, and fill all their arteries;
but in the systoles, in the manner of the tide, it would ever and anon,
like the Euripus, flow backwards and forwards by the same way, with a
reciprocating motion, which would nowise suit the blood. This, however,
may seem a matter of little moment; but if it meantime appear that the
function of respiration suffer, then I think it would be looked upon as
no trifle, &c.” And, again, and shortly afterwards: “And then a third
inconvenience, by no means to be thought lightly of, would follow, were
the blood moved backwards during the expirations, had not our Maker
instituted those supplementary membranes [the sigmoid valves].” Whence,
in the eleventh chapter, he concludes: “That they have all a common
use, (to wit, the valves,) and that it is to prevent regurgitation or
backward motion; each, however, having a proper function, the one set
drawing matters from the heart, and preventing their return, the other
drawing matters into the heart, and preventing their escape from it.
For nature never intended to distress the heart with needless labour,
neither to bring aught into the organ which it had been better to have
kept away, nor to take from it again aught which it was requisite
should be brought. Since, then, there are four orifices in all, two in
either ventricle, one of these induces, the other educes.” And again
he says: “Farther, since there is one vessel, consisting of a simple
tunic, implanted in the heart, and another, having a double tunic,
extending from it, (Galen is here speaking of the right side of the
heart, but I extend his observations to the left side also,) a kind of
reservoir had to be provided, to which both belonging, the blood should
be drawn in by the one, and sent out by the other.”
[28] De Usu partium, lib. vi. cap. 10.
This argument Galen adduces for the transit of the blood by the right
ventricle from the vena cava into the lungs; but we can use it with
still greater propriety, merely changing the terms, for the passage
of the blood from the veins through the heart into the arteries.
From Galen, however, that great man, that father of physicians, it
clearly appears that the blood passes through the lungs from the
pulmonary artery into the minute branches of the pulmonary veins,
urged to this both by the pulses of the heart and by the motions
of the lungs and thorax; that the heart, moreover, is incessantly
receiving and expelling the blood by and from its ventricles, as from
a magazine or cistern, and for this end is furnished with four sets
of valves, two serving for the induction and two for the eduction of
the blood, lest, like the Euripus, it should be incommodiously sent
hither and thither, or flow back into the cavity which it should
have quitted, or quit the part where its presence was required, and
so the heart be oppressed with labour in vain, and the office of the
lungs be interfered with.[29] Finally, our position that the blood is
continually passing from the right to the left ventricle, from the vena
cava into the aorta, through the porous structure of the lungs, plainly
appears from this, that since the blood is incessantly sent from the
right ventricle into the lungs by the pulmonary artery, and in like
manner is incessantly drawn from the lungs into the left ventricle, as
appears from what precedes and the position of the valves, it cannot
do otherwise than pass through continuously. And then, as the blood
is incessantly flowing into the right ventricle of the heart, and is
continually passed out from the left, as appears in like manner, and as
is obvious both to sense and reason, it is impossible that the blood
can do otherwise than pass continually from the vena cava into the
aorta.
[29] See the Commentary of the learned Hofmann upon the Sixth Book of
Galen, “De Usu partium,” a work which I first saw after I had written
what precedes.
Dissection consequently shows distinctly what takes place [in regard to
the transit of the blood] in the greater number of animals, and indeed
in all, up to the period of their [fœtal] maturity; and that the same
thing occurs in adults is equally certain, both from Galen’s words,
and what has already been said on the subject, only that in the former
the transit is effected by open and obvious passages, in the latter by
the obscure porosities of the lungs and the minute inosculations of
vessels. Whence it appears that, although one ventricle of the heart,
the left to wit, would suffice for the distribution of the blood over
the body, and its eduction from the vena cava, as indeed is done in
those creatures that have no lungs, nature, nevertheless, when she
ordained that the same blood should also percolate the lungs, saw
herself obliged to add another ventricle, the right, the pulse of which
should force the blood from the vena cava through the lungs into the
cavity of the left ventricle. In this way, therefore, it may be said
that the right ventricle is made for the sake of the lungs, and for
the transmission of the blood through them, not for their nutrition;
seeing it were unreasonable to suppose that the lungs required any so
much more copious a supply of nutriment, and that of so much purer and
more spirituous a kind, as coming immediately from the ventricle of the
heart, than either the brain with its peculiarly pure substance, or the
eyes with their lustrous and truly admirable structure, or the flesh of
the heart itself, which is more commodiously nourished by the coronary
artery.