THE THIRD POSITION IS CONFIRMED: AND THE CIRCULATION OF THE BLOOD IS
DEMONSTRATED FROM IT
Thus far have we spoken of the quantity of blood passing through the
heart and the lungs in the centre of the body, and in like manner from
the arteries into the veins in the peripheral parts and the body at
large. We have yet to explain, however, in what manner the blood finds
its way back to the heart from the extremities by the veins, and how
and in what way these are the only vessels that convey the blood from
the external to the central parts; which done, I conceive that the
three fundamental propositions laid down for the circulation of the
blood will be so plain, so well established, so obviously true, that
they may claim general credence. Now the remaining position will be
made sufficiently clear from the valves which are found in the cavities
of the veins themselves, from the uses of these, and from experiments
cognizable by the senses.
The celebrated Hieronymus Fabricius of Aquapendente, a most skilful
anatomist, and venerable old man, or, as the learned Riolan will have
it, Jacobus Silvius, first gave representations of the valves in the
veins, which consist of raised or loose portions of the inner membranes
of these vessels, of extreme delicacy, and a sigmoid or semilunar
shape. They are situated at different distances from one another, and
diversely in different individuals; they are connate at the sides of
the veins; they are directed upwards or towards the trunks of the
veins; the two--for there are for the most part two together--regard
each other, mutually touch, and are so ready to come into contact by
their edges, that if anything attempt to pass from the trunks into the
branches of the veins, or from the greater vessels into the less, they
completely prevent it; they are farther so arranged, that the horns of
those that succeed are opposite the middle of the convexity of those
that precede, and so on alternately.
The discoverer of these valves did not rightly understand their use,
nor have succeeding anatomists added anything to our knowledge: for
their office is by no means explained when we are told that it is to
hinder the blood, by its weight, from all flowing into inferior parts;
for the edges of the valves in the jugular veins hang downwards, and
are so contrived that they prevent the blood from rising upwards; the
valves, in a word, do not invariably look upwards, but always towards
the trunks of the veins, invariably towards the seat of the heart. I,
and indeed others, have sometimes found valves in the emulgent veins,
and in those of the mesentery, the edges of which were directed towards
the vena cava and vena portæ. Let it be added that there are no valves
in the arteries [save at their roots], and that dogs, oxen, &c., have
invariably valves at the divisions of their crural veins, in the veins
that meet towards the top of the os sacrum, and in those branches which
come from the haunches, in which no such effect of gravity from the
erect position was to be apprehended. Neither are there valves in the
jugular veins for the purpose of guarding against apoplexy, as some
have said; because in sleep the head is more apt to be influenced by
the contents of the carotid arteries. Neither are the valves present,
in order that the blood may be retained in the divarications or smaller
trunks and minuter branches, and not be suffered to flow entirely
into the more open and capacious channels; for they occur where there
are no divarications; although it must be owned that they are most
frequent at the points where branches join. Neither do they exist for
the purpose of rendering the current of blood more slow from the centre
of the body; for it seems likely that the blood would be disposed to
flow with sufficient slowness of its own accord, as it would have to
pass from larger into continually smaller vessels, being separated
from the mass and fountain head, and attaining from warmer into colder
places.
But the valves are solely made and instituted lest the blood should
pass from the greater into the lesser veins, and either rupture them
or cause them to become varicose; lest, instead of advancing from the
extreme to the central parts of the body, the blood should rather
proceed along the veins from the centre to the extremities; but the
delicate valves, while they readily open in the right direction,
entirely prevent all such contrary motion, being so situated and
arranged, that if anything escapes, or is less perfectly obstructed
by the cornua of the one above, the fluid passing, as it were, by the
chinks between the cornua, it is immediately received on the convexity
of the one beneath, which is placed transversely with reference to the
former, and so is effectually hindered from getting any farther.
And this I have frequently experienced in my dissections of the veins:
if I attempted to pass a probe from the trunk of the veins into one
of the smaller branches, whatever care I took I found it impossible
to introduce it far any way, by reason of the valves; whilst, on the
contrary, it was most easy to push it along in the opposite direction,
from without inwards, or from the branches towards the trunks and
roots. In many places two valves are so placed and fitted, that when
raised they come exactly together in the middle of the vein, and
are there united by the contact of their margins; and so accurate
is the adaptation, that neither by the eye nor by any other means
of examination can the slightest chink along the line of contact
be perceived. But if the probe be now introduced from the extreme
towards the more central parts, the valves, like the floodgates of
a river, give way, and are most readily pushed aside. The effect of
this arrangement plainly is to prevent all motion of the blood from
the heart and vena cava, whether it be upwards towards the head, or
downwards towards the feet, or to either side towards the arms, not a
drop can pass; all motion of the blood, beginning in the larger and
tending towards the smaller veins, is opposed and resisted by them;
whilst the motion that proceeds from the lesser to end in the larger
branches is favoured, or, at all events, a free and open passage is
left for it.
But that this truth may be made the more apparent, let an arm be
tied up above the elbow as if for phlebotomy (A, A, fig. 1). At
intervals in the course of the veins, especially in labouring people
and those whose veins are large, certain knots or elevations (B, C,
D, E, F) will be perceived, and this not only at the places where a
branch is received (E, F), but also where none enters (C, D): these
knots or risings are all formed by valves, which thus show themselves
externally. And now if you press the blood from the space above one
of the valves, from H to O, (fig. 2,) and keep the point of a
finger upon the vein inferiorly, you will see no influx of blood from
above; the portion of the vein between the point of the finger and the
valve O will be obliterated; yet will the vessel continue sufficiently
distended above that valve (O, G). The blood being thus pressed out,
and the vein emptied, if you now apply a finger of the other hand upon
the distended part of the vein above the valve O, (fig. 3,) and
press downwards, you will find that you cannot force the blood through
or beyond the valve; but the greater effort you use, you will only see
the portion of vein that is between the finger and the valve become
more distended, that portion of the vein which is below the valve
remaining all the while empty (H, O, fig. 3).
It would therefore appear that the function of the valves in the veins
is the same as that of the three sigmoid valves which we find at the
commencement of the aorta and pulmonary artery, viz., to prevent all
reflux of the blood that is passing over them.
Farther, the arm being bound as before, and the veins looking full
and distended, if you press at one part in the course of a vein with
the point of a finger (L, fig. 4), and then with another finger
streak the blood upwards beyond the next valve (N), you will perceive
that this portion of the vein continues empty (L N), and that the
blood cannot retrograde, precisely as we have already seen the case
to be in fig. 2; but the finger first applied (H, fig. 2,
L, fig. 4), being removed, immediately the vein is filled from
below, and the arm becomes as it appears at D C, fig. 1. That the
blood in the veins therefore proceeds from inferior or more remote to
superior parts, and towards the heart, moving in these vessels in this
and not in the contrary direction, appears most obviously. And although
in some places the valves, by not acting with such perfect accuracy,
or where there is but a single valve, do not seem totally to prevent
the passage of the blood from the centre, still the greater number
of them plainly do so; and then, where things appear contrived more
negligently, this is compensated either by the more frequent occurrence
or more perfect action of the succeeding valves or in some other way:
the veins, in short, as they are the free and open conduits of the
blood returning _to_ the heart, so are they effectually prevented from
serving as its channels of distribution _from_ the heart.
[Illustration: Fig. 4.]
[Illustration: Fig. 3.]
[Illustration: Fig. 2.]
[Illustration: Fig. 1.]
But this other circumstance has to be noted: The arm being bound, and
the veins made turgid, and the valves prominent, as before, apply the
thumb or finger over a vein in the situation of one of the valves in
such a way as to compress it, and prevent any blood from passing
upwards from the hand; then, with a finger of the other hand, streak
the blood in the vein upwards till it has passed the next valve above,
(N, fig. 4,) the vessel now remains empty; but the finger at L
being removed for an instant, the vein is immediately filled from
below; apply the finger again, and having in the same manner streaked
the blood upwards, again remove the finger below, and again the vessel
becomes distended as before; and this repeat, say a thousand times, in
a short space of time. And now compute the quantity of blood which you
have thus pressed up beyond the valve, and then multiplying the assumed
quantity by one thousand, you will find that so much blood has passed
through a certain portion of the vessel; and I do now believe that you
will find yourself convinced of the circulation of the blood, and of
its rapid motion. But if in this experiment you say that a violence is
done to nature, I do not doubt but that, if you proceed in the same
way, only taking as great a length of vein as possible, and merely
remark with what rapidity the blood flows upwards, and fills the vessel
from below, you will come to the same conclusion.