THE MOTION AND CIRCULATION OF THE BLOOD ARE CONFIRMED FROM THE
PARTICULARS APPARENT IN THE STRUCTURE OF THE HEART, AND FROM THOSE
THINGS WHICH DISSECTION UNFOLDS
I do not find the heart as a distinct and separate part in all animals;
some, indeed, such as the zoophytes, have no heart; this is because
these animals are coldest, of no great bulk, of soft texture or of a
certain uniform sameness or simplicity of structure; among the number
I may instance grubs and earth-worms, and those that are engendered of
putrefaction and do not preserve their species. These have no heart, as
not requiring any impeller of nourishment into the extreme parts; for
they have bodies which are connate and homogeneous, and without limbs;
so that by the contraction and relaxation of the whole body they assume
and expel, move and remove the aliment. Oysters, mussels, sponges, and
the whole genus of zoophytes or plant-animals have no heart; for the
whole body is used as a heart, or the whole animal is a heart. In a
great number of animals, almost the whole tribe of insects, we cannot
see distinctly by reason of the smallness of the body; still in bees,
flies, hornets, and the like, we can perceive something pulsating with
the help of a magnifying glass; in pediculi, also, the same thing
may be seen, and as the body is transparent, the passage of the food
through the intestines, like a black spot or stain, may be perceived by
the aid of the same magnifying glass.
In some of the bloodless[32] and colder animals, further, as in
snails, whelks, shrimps, and shell-fish, there is a part which
pulsates--a kind of vesicle or auricle without a heart--slowly indeed,
and not to be perceived save in the warmer season of the year. In these
creatures this part is so contrived that it shall pulsate, as there is
here a necessity for some impulse to distribute the nutritive fluid,
by reason of the variety of organic parts, or of the density of the
substance; but the pulsations occur unfrequently, and sometimes in
consequence of the cold not at all, an arrangement the best adapted
to them as being of a doubtful nature, so that sometimes they appear
to live, sometimes to die; sometimes they show the vitality of an
animal, sometimes of a vegetable. This seems also to be the case with
the insects which conceal themselves in winter, and lie, as it were,
defunct, or merely manifesting a kind of vegetative existence. But
whether the same thing happens in the case of certain animals that have
red blood, such as frogs, tortoises, serpents, swallows, may be made a
question without any kind of impropriety.
[32] [i.e. Not having red blood.]
In all the larger and warmer, because [red-]blooded animals, there
was need of an impeller of the nutritive fluid, and that perchance
possessing a considerable amount of power. In fishes, serpents,
lizards, tortoises, frogs, and others of the same kind there is a heart
present, furnished with both an auricle and a ventricle, whence it is
perfectly true, as Aristotle has observed,[33] that no [red-]blooded
animal is without a heart, by the impelling power of which the
nutritive fluid is forced, both with greater vigour and rapidity to a
greater distance; it is not merely agitated by an auricle as it is in
lower forms. And then in regard to animals that are yet larger, warmer,
and more perfect, as they abound in blood, which is ever hotter and
more spirituous, and possess bodies of greater size and consistency,
they require a larger, stronger, and more fleshy heart, in order
that the nutritive fluid may be propelled with yet greater force and
celerity. And further, inasmuch as the more perfect animals require a
still more perfect nutrition, and a larger supply of native heat, in
order that the aliment may be thoroughly concocted and acquire the last
degree of perfection, they required both lungs and a second ventricle,
which should force the nutritive fluid through them.
[33] De Part. Animal. lib. iii.
Every animal that has lungs has therefore two ventricles to its heart,
one right, another left; and wherever there is a right, there also is
there a left ventricle; but the contrary of this does not hold good:
where there is a left there is not always a right ventricle. The left
ventricle I call that which is distinct in office, not in place from
the other, that one namely which distributes the blood to the body at
large, not to the lungs only. Hence the left ventricle seems to form
the principal part of the heart; situated in the middle, more strongly
marked, and constructed with greater care, the heart seems formed for
the sake of the left ventricle, and the right but to minister to it;
for the right neither reaches to the apex of the heart, nor is it
nearly of such strength, being three times thinner in its walls, and in
some sort jointed on to the left, (as Aristotle says;) though indeed it
is of greater capacity, inasmuch as it has not only to supply material
to the left ventricle, but likewise to furnish aliment to the lungs.
It is to be observed, however, that all this is otherwise in the
embryo, where there is not such a difference between the two
ventricles; but as in a double nut, they are nearly equal in all
respects, the apex of the right reaching to the apex of the left, so
that the heart presents itself as a sort of double-pointed cone. And
this is so, because in the fœtus, as already said, whilst the blood
is not passing through the lungs from the right to the left cavities
of the heart, but flowing by the foramen ovale and ductus arteriosus,
directly from the vena cava into the aorta, whence it is distributed
to the whole body, both ventricles have in fact the same office to
perform, whence their equality of constitution. It is only when the
lungs come to be used, and it is requisite that the passages indicated
should be blocked up, that the differences in point of strength and
other things between the two ventricles begin to be apparent: in the
altered circumstances the right has only to throw the blood through the
lungs, whilst the left has to impel it through the whole body.
There are further within the heart numerous braces, so to speak,
fleshy columns and fibrous bands, which Aristotle, in his third book
on Respiration, and the Parts of Animals, entitles nerves. These are
variously extended, and are either distinct or contained in grooves
in the walls and partition, where they occasion numerous pits or
depressions. They constitute a kind of small muscles, which are
superadded and supplementary to the heart, assisting it to execute a
more powerful and perfect contraction, and so proving subservient to
the complete expulsion of the blood. They are in some sort like the
elaborate and artful arrangement of ropes in a ship, bracing the heart
on every side as it contracts, and so enabling it more effectually
and forcibly to expel the charge of blood from its ventricles. This
much is plain, at all events, that some animals have them strongly
marked, others have them less so; and, in all that have them, they are
more numerous and stronger in the left than in the right ventricle;
and whilst some have them in the left, there are yet none present
in the right ventricle. In the human subject, again, these fleshy
columns and braces are more numerous in the left than in the right
ventricle, and they are more abundant in the ventricles than in the
auricles; occasionally, indeed, in the auricles there appear to be none
present whatsoever. In large, more muscular and hardier bodies, as of
countrymen, they are numerous; in more slender frames and in females
they are fewer.
In those animals in which the ventricles of the heart are smooth
within, and entirely without fibres or muscular bands, or anything like
foveæ, as in almost all the smaller birds, the partridge and the common
fowl, serpents, frogs, tortoises, and also fishes, for the major part,
there are no chordæ tendineæ, nor bundles of fibres, neither are there
any tricuspid valves in the ventricles.
Some animals have the right ventricle smooth internally, but the left
provided with fibrous bands, such as the goose, swan, and larger birds;
and the reason here is still the same as elsewhere, as the lungs are
spongy, and loose, and soft, no great amount of force is required to
force the blood through them; hence the right ventricle is either
without the bundles in question, or they are fewer and weaker, not
so fleshy or like muscles; those of the left ventricle, however, are
both stronger and more numerous, more fleshy and muscular, because the
left ventricle requires to be stronger, inasmuch as the blood which
it propels has to be driven through the whole body. And this, too, is
the reason why the left ventricle occupies the middle of the heart,
and has parietes three times thicker and stronger than those of the
right. Hence all animals--and among men it is not otherwise--that
are endowed with particularly strong frames, and that have large and
fleshy limbs at a great distance from the heart, have this central
organ of greater thickness, strength, and muscularity. And this is both
obvious and necessary. Those, on the contrary, that are of softer and
more slender make have the heart more flaccid, softer, and internally
either sparely or not at all fibrous. Consider farther the use of
the several valves, which are all so arranged, that the blood once
received into the ventricles of the heart shall never regurgitate,
once forced into the pulmonary artery and aorta shall not flow back
upon the ventricles. When the valves are raised and brought together
they form a three-cornered line, such as is left by the bite of a
leech; and the more they are forced, the more firmly do they oppose
the passage of the blood. The tricuspid valves are placed, like
gate-keepers, at the entrance into the ventricles, from the venæ cavæ
and pulmonary veins; lest the blood when most forcibly impelled should
flow back; and it is for this reason that they are not found in all
animals; neither do they appear to have been constructed with equal
care in all the animals in which they are found; in some they are more
accurately fitted, in others more remissly or carelessly contrived,
and always with a view to their being closed under a greater or a
slighter force of the ventricle. In the left ventricle, therefore,
and in order that the occlusion may be the more perfect against the
greater impulse, there are only two valves, like a mitre, and produced
into an elongated cone, so that they come together and touch to their
middle; a circumstance which perhaps led Aristotle into the error
of supposing this ventricle to be double, the division taking place
transversely. For the same reason, indeed, and that the blood may
not regurgitate upon the pulmonary veins, and thus the force of the
ventricle in propelling the blood through the system at large come to
be neutralized, it is that these mitral valves excel those of the right
ventricle in size and strength, and exactness of closing. Hence, too,
it is essential that there can be no heart without a ventricle, since
this must be the source and storehouse of the blood. The same law does
not hold good in reference to the brain. For almost no genus of birds
has a ventricle in the brain, as is obvious in the goose and swan, the
brains of which nearly equal that of a rabbit in size; now rabbits
have ventricles in the brain, whilst the goose has none. In like
manner, wherever the heart has a single ventricle, there is an auricle
appended, flaccid, membranous, hollow, filled with blood; and where
there are two ventricles, there are likewise two auricles. On the other
hand, however, some animals have an auricle without any ventricle;
or at all events they have a sac analogous to an auricle; or the vein
itself, dilated at a particular part, performs pulsations, as is seen
in hornets, bees, and other insects, which certain experiments of my
own enable me to demonstrate have not only a pulse, but a respiration
in that part which is called the tail, whence it is that this part is
elongated and contracted now more rarely, now more frequently, as the
creature appears to be blown and to require a larger quantity of air.
But of these things, more in our Treatise on Respiration.
It is in like manner evident that the auricles pulsate, contract, as
I have said before, and throw the blood into the ventricles; so that
wherever there is a ventricle an auricle is necessary, not merely
that it may serve, according to the general belief, as a source and
magazine for the blood: for what were the use of its pulsations had it
nothing to do save to contain? No; the auricles are prime movers of the
blood, especially the right auricle, which is “the first to live, the
last to die,” as already said; whence they are subservient to sending
the blood into the ventricle, which, contracting incontinently, more
readily and forcibly expels the blood already in motion; just as the
ball-player can strike the ball more forcibly and further if he takes
it on the rebound than if he simply threw it. Moreover, and contrary
to the general opinion, since neither the heart nor anything else can
dilate or distend itself so as to draw aught into its cavity during the
diastole, unless like a sponge, it has been first compressed, and as it
is returning to its primary condition; but in animals all local motion
proceeds from, and has its original in the contraction of some part: it
is consequently by the contraction of the auricles that the blood is
thrown into the ventricles, as I have already shown, and from thence,
by the contraction of the ventricles, it is propelled and distributed.
Which truth concerning local motions, and how the immediate moving
organ in every motion of an animal primarily endowed with a motive
spirit (as Aristotle has it,[34]) is contractile; and in what way the
word νευ̑ρον is derived from νεύω, nuto, contraho; and how Aristotle
was acquainted with the muscles, and did not unadvisedly refer all
motion in animals to the nerves, or to the contractile element, and
therefore called those little bands in the heart nerves--all this,
if I am permitted to proceed in my purpose of making a particular
demonstration of the organs of motion in animals from observations in
my possession, I trust I shall be able to make sufficiently plain.
[34] In the book, de Spiritu, and elsewhere.
But that we may go on with the subject we have in hand, viz. the use of
the auricles in filling the ventricles: we should expect that the more
dense and compact the heart, the thicker its parietes, the stronger
and more muscular must be the auricle to force and fill it, and _vice
versa_. Now this is actually so: in some the auricle presents itself
as a sanguinolent vesicle, as a thin membrane containing blood, as in
fishes, in which the sac that stands in lieu of the auricle, is of such
delicacy and ample capacity, that it seems to be suspended or to float
above the heart; in those fishes in which the sac is somewhat more
fleshy, as in the carp, barbel, tench, and others, it bears a wonderful
and strong resemblance to the lungs.
In some men of sturdier frame and stouter make, the right auricle is
so strong, and so curiously constructed within of bands and variously
interlacing fibres, that it seems to equal the ventricle of the heart
in other subjects; and I must say that I am astonished to find such
diversity in this particular in different individuals. It is to be
observed, however, that in the fœtus the auricles are out of all
proportion large, which is because they are present before the heart
[the ventricular portion] makes its appearance or suffices for its
office even when it has appeared, and they therefore have, as it were,
the duty of the whole heart committed to them, as has already been
demonstrated. But what I have observed in the formation of the fœtus as
before remarked (and Aristotle had already confirmed all in studying
the incubated egg,) throws the greatest light and likelihood upon the
point. Whilst the fœtus is yet in the guise of a soft worm, or, as is
commonly said, in the milk, there is a mere bloody point or pulsating
vesicle, a portion apparently of the umbilical vein, dilated at its
commencement or base; by and by, when the outline of the fœtus is
distinctly indicated, and it begins to have greater bodily consistence,
the vesicle in question having become more fleshy and stronger, and
changed its position, passes into the auricles, over or upon which
the body of the heart begins to sprout, though as yet it apparently
performs no duty; but when the fœtus is farther advanced, when the
bones can be distinguished from the soft parts, and movements take
place, then it has also a heart internately which pulsates, and, as I
have said, throws blood by either ventricle from the vena cava into the
arteries.
Thus nature, ever perfect and divine, doing nothing in vain, has
neither given a heart where it was not required, nor produced it
before its office had become necessary; but by the same stages in the
development of every animal, passing through the constitutions of all,
as I may say (ovum, worm, fœtus), it acquires perfection in each. These
points will be found elsewhere confirmed by numerous observations on
the formation of the fœtus.
Finally, it was not without good grounds that Hippocrates, in his book,
“De Corde,” intitles it a muscle; as its action is the same, so is its
function, viz. to contract and move something else, in this case, the
charge of blood.
Farther, as in muscles at large, so can we infer the action and use
of the heart from the arrangement of its fibres and its general
structure. All anatomists admit with Galen that the body of the heart
is made up of various courses of fibres running straight, obliquely,
and transversely, with reference to one another; but in a heart which
has been boiled the arrangement of the fibres is seen to be different:
all the fibres in the parietes and septum are circular, as in the
sphincters; those, again, which are in the columnæ extend lengthwise,
and are oblique longitudinally; and so it comes to pass, that when all
the fibres contract simultaneously, the apex of the cone is pulled
towards its base by the columnæ, the walls are drawn circularly
together into a globe, the whole heart in short is contracted, and the
ventricles narrowed; it is therefore impossible not to perceive that,
as the action of the organ is so plainly contraction, its function is
to propel the blood into the arteries.
Nor are we the less to agree with Aristotle in regard to the
sovereignty of the heart; nor are we to inquire whether it receives
sense and motion from the brain? whether blood from the liver? whether
it be the origin of the veins and of the blood? and more of the same
description. They who affirm these propositions against Aristotle,
overlook, or do not rightly understand the principal argument, to the
effect that the heart is the first part which exists, and that it
contains within itself blood, life, sensation, motion, before either
the brain or the liver were in being, or had appeared distinctly, or,
at all events, before they could perform any function. The heart, ready
furnished with its proper organs of motion, like a kind of internal
creature, is of a date anterior to the body: first formed, nature
willed that it should afterwards fashion, nourish, preserve, complete
the entire animal, as its work and dwelling place: the heart, like
the prince in a kingdom, in whose hands lie the chief and highest
authority, rules over all; it is the original and foundation from which
all power is derived, on which all power depends in the animal body.
And many things having reference to the arteries farther illustrate
and confirm this truth. Why does not the arteria venosa pulsate,
seeing that it is numbered among the arteries? Or wherefore is there
a pulse in the vena arteriosa? Because the pulse of the arteries is
derived from the impulse of the blood. Why does an artery differ so
much from a vein in the thickness and strength of its coats? Because
it sustains the shock of the impelling heart and streaming blood.
Hence, as perfect nature does nothing in vain, and suffices under all
circumstances, we find that the nearer the arteries are to the heart,
the more do they differ from the veins in structure; here they are
both stronger and more ligamentous, whilst in extreme parts of the
body, such as the feet and hands, the brain, the mesentery, and the
testicles, the two orders of vessels are so much alike that it is
impossible to distinguish between them with the eye. Now this is for
the following very sufficient reasons: for the more remote vessels are
from the heart, with so much the less force are they impinged upon
by the stroke of the heart, which is broken by the great distance at
which it is given. Add to this, that the impulse of the heart exerted
upon the mass of blood, which must needs fill the trunks and branches
of the arteries, is diverted, divided, as it were, and diminished at
every subdivision; so that the ultimate capillary divisions of the
arteries look like veins, and this not merely in constitution but in
function; for they have either no perceptible pulse, or they rarely
exhibit one, and never save where the heart beats more violently than
wont, or at a part where the minute vessel is more dilated or open than
elsewhere. Hence it happens that at times we are aware of a pulse in
the teeth, in inflammatory tumours, and in the fingers; at another time
we feel nothing of the sort. Hence, too, by this single symptom I have
ascertained for certain that young persons, whose pulses are naturally
rapid, were labouring under fever; in like manner, on compressing the
fingers in youthful and delicate subjects during a feeble paroxysm, I
have readily perceived the pulse there. On the other hand, when the
heart pulsates more languidly, it is often impossible to feel the pulse
not merely in the fingers, but at the wrist, and even at the temple;
this is the case in persons afflicted with lipothymiæ and asphyxia, and
hysterical symptoms, as also in persons of very weak constitution and
in the moribund.
And here surgeons are to be advised that, when the blood escapes with
force in the amputation of limbs, in the removal of tumours, and in
wounds, it constantly comes from an artery; not always per saltum,
however, because the smaller arteries do not pulsate, especially if a
tourniquet has been applied.
And then the reason is the same wherefore the pulmonary artery has
not only the structure of an artery, but wherefore it does not differ
so widely in the thickness of its tunics from the veins as the aorta:
the aorta sustains a more powerful shock from the left ventricle than
the pulmonary artery does from the right; and the tunics of this last
vessel are thinner and softer than those of the aorta in the same
proportion as the walls of the right ventricle of the heart are weaker
and thinner than those of the left ventricle; and in like manner, in
the same degree in which the lungs are softer and laxer in structure
than the flesh and other constituents of the body at large, do the
tunics of the branches of the pulmonary artery differ from the tunics
of the vessels derived from the aorta. And the same proportion in
these several particulars is universally preserved. The more muscular
and powerful men are, the firmer their flesh, the stronger, thicker,
denser, and more fibrous their heart, in the same proportion are the
auricles and arteries in all respects thicker, closer, and stronger.
And again, and on the other hand, in those animals the ventricles of
whose heart are smooth within, without villi or valves, and the walls
of which are thinner, as in fishes, serpents, birds, and very many
genera of animals, in all of them the arteries differ little or nothing
in the thickness of their coats from the veins.
Farther, the reason why the lungs have such ample vessels, both
arteries and veins, (for the capacity of the pulmonary veins exceeds
that of both the crural and jugular vessels,) and why they contain so
large a quantity of blood, as by experience and ocular inspection we
know they do, admonished of the fact indeed by Aristotle, and not led
into error by the appearances found in animals which have been bled
to death,--is, because the blood has its fountain, and storehouse,
and the workshop of its last perfection in the heart and lungs. Why,
in the same way we find in the course of our anatomical dissections
the arteria venosa and left ventricle so full of blood, of the same
black colour and clotted character, too, as that with which the right
ventricle and pulmonary artery are filled, inasmuch as the blood is
incessantly passing from one side of the heart to the other through
the lungs. Wherefore, in fine, the pulmonary artery or vena arteriosa
has the constitution of an artery, and the pulmonary veins or arteriæ
venosæ have the structure of veins; because, in sooth, in function and
constitution, and everything else, the first is an artery, the others
are veins, in opposition to what is commonly believed; and why the
pulmonary artery has so large an orifice, because it transports much
more blood than is requisite for the nutrition of the lungs.
All these appearances, and many others, to be noted in the course of
dissection, if rightly weighed, seem clearly to illustrate and fully
to confirm the truth contended for throughout these pages, and at the
same time to stand in opposition to the vulgar opinion; for it would
be very difficult to explain in any other way to what purpose all is
constructed and arranged as we have seen it to be.
AN ANATOMICAL DISQUISITION
ON THE
CIRCULATION OF THE BLOOD
TO
JOHN RIOLAN, Jun., of Paris
A MOST SKILFUL PHYSICIAN; THE CORYPHÆUS OF ANATOMISTS
REGIUS PROFESSOR OF ANATOMY AND BOTANY IN THE
UNIVERSITY OF PARIS; DEAN OF THE SAME UNIVERSITY
AND FIRST PHYSICIAN TO THE QUEEN
MOTHER OF LOUIS XIII.
BY WILLIAM HARVEY, AN ENGLISHMAN
PROFESSOR OF ANATOMY AND SURGERY IN THE ROYAL COLLEGE
OF PHYSICIANS OF LONDON; AND PRINCIPAL PHYSICIAN TO
HIS MOST SERENE MAJESTY THE KING.
CAMBRIDGE, 1649.
THE FIRST ANATOMICAL DISQUISITION ON THE CIRCULATION OF THE BLOOD,
ADDRESSED TO JO. RIOLAN
Some few months ago there appeared a small anatomical and pathological
work from the pen of the celebrated Riolanus, for which, as sent to
me by the author himself, I return him my grateful thanks.[35] I also
congratulate this author on the highly laudable undertaking in which he
has engaged. To demonstrate the seats of all diseases is a task that
can only be achieved under favour of the highest abilities; for surely
he enters on a difficult province who proposes to bring under the
cognizance of the eyes those diseases which almost escape the keenest
understanding. But such efforts become the prince of anatomists; for
there is no science which does not spring from preexisting knowledge,
and no certain and definite idea which has not derived its origin from
the senses. Induced therefore by the subject itself, and the example
of so distinguished an individual, which makes me think lightly of the
labour, I also intend putting to press my Medical Anatomy, or Anatomy
in its Application to Medicine. Not with the purpose, like Riolanus, of
indicating the seats of diseases from the bodies of healthy subjects,
and discussing the several diseases that make their appearance there,
according to the views which others have entertained of them; but that
I may relate from the many dissections I have made of the bodies of
persons diseased, worn out by serious and strange affections, how and
in what way the internal organs were changed in their situation, size,
structure, figure, consistency, and other sensible qualities, from
their natural forms and appearances, such as they are usually described
by anatomists; and in what various and remarkable ways they were
affected. For even as the dissection of healthy and well-constituted
bodies contributes essentially to the advancement of philosophy and
sound physiology, so does the inspection of diseased and cachectic
subjects powerfully assist philosophical pathology. And, indeed, the
physiological consideration of the things which are according to nature
is to be first undertaken by medical men; since that which is in
conformity with nature is right, and serves as a rule both to itself
and to that which is amiss; by the light it sheds, too, aberrations
and affections against nature are defined; pathology then stands out
more clearly; and from pathology the use and art of healing, as well
as occasions for the discovery of many new remedies, are perceived.
Nor could any one readily imagine how extensively internal organs
are altered in diseases, especially chronic diseases, and what
monstrosities among internal parts these diseases engender. So that I
venture to say, that the examination of a single body of one who has
died of tabes or some other disease of long standing, or poisonous
nature, is of more service to medicine than the dissection of the
bodies of ten men who have been hanged.
[35] Enchiridium Anatomicum et Pathologicum. 12mo, Parisiis, 1648.
I would not have it supposed by this that I in any way disapprove
of the purpose of Riolanus, that learned and skilful anatomist; on
the contrary, I think it deserving of the highest praise, as likely
to be extremely useful to medicine, inasmuch as it illustrates the
physiological branch of this science; but I have thought that it would
scarcely turn out less profitable to the art of healing, did I place
before the eyes of my readers not only the places, but the affections
of these places, illustrating them as I proceed with observations,
and recording the results of my experience derived from my numerous
dissections.
But it is imperative on me first to dispose of those observations
contained in the work referred to, which bear upon the circulation
of the blood as discovered by me, and which seem to require especial
notice at my hands. For the judgment of such a man, who is indeed the
prince and leader of all the anatomists of the present age, in such
a matter, is not to be lightly esteemed, but is rather to be held of
greater weight and authority, either for praise or blame, than the
commendations or censure of all the world besides.
Riolanus, then, admits our motion of the blood in animals,[36] and
falls in with our conclusions in regard to the circulation; yet not
entirely and avowedly; for he says[37] that the blood contained in
the vena portæ does not circulate like that in the vena cava; and
again he states[38] that there is some blood which circulates, and
that the circulatory vessels are the aorta and vena cava; but then he
denies that the continuations of these trunks have any circulation,
“because the blood is effused into all the parts of the second and
third regions, where it remains for purposes of nutrition; nor does
it return to any greater vessels, unless forcibly drawn back when
there is a great lack of blood in the main channels, or driven by a
fit of passion when it flows to the greater circulatory vessels;” and
shortly afterwards: “thus, as the blood of the veins naturally ascends
incessantly or returns to the heart, so the blood of the arteries
descends or departs from the heart; still, if the smaller veins of
the arms and legs be empty, the blood filling the empty channels in
succession, may descend in the veins, as I have clearly shown,” he
says, “against Harvey and Walæus.” And as the authority of Galen and
daily experience confirm the anastomoses of the arteries and veins,
and the necessity of the circulation of the blood, “you perceive,” he
continues, “how the circulation is effected, without any perturbation
or confusion of fluids and the destruction of the ancient system of
medicine.”
[36] Enchiridion, lib. iii, cap. 8.
[37] Ib. lib. ii, cap 21.
[38] Ib. lib. iii, cap. 8.
These words explain the motives by which this illustrious anatomist
was actuated when he was led partly to admit, partly to deny the
circulation of the blood; and why he only ventures on an undecided
and inconclusive opinion of the subject; his fear is lest it destroy
the ancient medicine. Not yielding implicitly to the truth, which it
appears he could not help seeing, but rather guided by caution, he
fears speaking plainly out, lest he offend the ancient physic, or
perhaps seem to retract the physiological doctrines he supports in his
Anthropology. The circulation of the blood does not shake, but much
rather confirms the ancient medicine; though it runs counter to the
physiology of physicians, and their speculations upon natural subjects,
and opposes the anatomical doctrine of the use and action of the heart
and lungs, and rest of the viscera. That this is so shall readily be
made to appear, both from his own words and avowal, and partly also
from what I shall supply; viz. that the whole of the blood, wherever
it be in the living body, moves and changes its place, not merely that
which is in the larger vessels and their continuations, but that also
which is in their minute subdivisions, and which is contained in the
pores or interstices of every part; that it flows from and back to the
heart ceaselessly and without pause, and could not pause for ever so
short a time without detriment, although I admit that occasionally, and
in some places, its motion is quicker or slower.[39]
[39] Vide Chapter III.
In the first place, then, our learned anatomist only denies that the
contents of the branches in continuation of the vena portæ circulate;
but he could neither oppose nor deny this, did he not conceal from
himself the force of his own arguments; for he says in his Third Book,
chap. viii., “If the heart at each pulsation admits a drop of blood
which it throws into the aorta, and in the course of an hour makes
two thousand beats, it is a necessary consequence that the quantity
of blood transmitted must be great.” He is farther forced to admit as
much in reference to the mesentery, when he sees that far more than
single drops of blood are sent into the cœliac and mesenteric arteries
at each pulsation; so that there must either be some outlet for the
fluid, of magnitude commensurate with its quantity, or the branches
of the vena portæ must give way. Nor can the explanation that is had
recourse to with a view of meeting the difficulty, viz. that the blood
of the mesentery ebbs and flows by the same channels, after the manner
of Euripus, be received as either probable or possible. Neither can
the reflux from the mesentery be effected by those passages and that
system of translation, by which he will have it to disgorge itself
into the aorta; this were against the force of the existing current,
and by a contrary motion; nor can anything like pause or alternation
be admitted, where there is very certainly an incessant influx: the
blood sent into the mesentery must as inevitably go elsewhere as that
which is poured into the heart. And this is obvious; were it otherwise,
indeed, everything like a circulation might be overturned upon the same
showing and by the same subterfuge; it might just as well be said that
the blood contained in the left ventricle of the heart is propelled
into the aorta during the systole, and flows back to it during the
diastole, the aorta disgorging itself into the ventricle, precisely as
the ventricle has disgorged itself into the aorta. There would thus be
circulation neither in the heart nor in the mesentery, but an alternate
flux and reflux,--a useless labour, as it seems. If, therefore, and
for the reason assigned and approved by him, a circulation through
the heart be argued for as a thing necessary, the argument has
precisely the same force when applied to the mesentery: if there be no
circulation in the mesentery, neither is there any in the heart; for
both affirmations, this in reference to the heart, that in reference to
the mesentery, merely changing the words, stand or fall together, by
force of the very same arguments.
He says: “The sigmoid valves prevent regurgitation into the heart; but
there are no valves in the mesentery.” To this I reply, that the thing
is not so; for there is a valve in the splenic vein, and sometimes
also in other veins. And besides, valves are not met with universally
in veins; there are few or none in the deep-seated veins of the
extremities, but many in the subcutaneous branches. For where the blood
is flowing naturally from smaller into greater branches, into which
it is disposed to enter, the pressure of the circumjacent muscles is
enough, and more than enough to prevent all retrograde movement, and
it is forced on where the way lies open; in such circumstances, what
use were there for valves? But the quantity of blood that is forced
into the mesentery by each stroke of the heart, may be estimated in
the same way as you estimate the quantity impelled into the hand when
you bind a ligature with medium tightness about the wrist: if in so
many beats the vessels of the hand become distended, and the whole
extremity swells, you will find, that much more than a single drop of
blood has entered with each pulse, and which cannot return, but must
remain to fill the hand and increase its size. But analogy permits us
to say, that the same thing takes place in reference to the mesentery
and its vessels, in an equal degree at least, if not in a greater
degree, seeing that the vessels of the mesentery are considerably
larger than those of the carpus. And if any one will but think on the
difficulty that is experienced with all the aid supplied by compresses,
bandages, and a multiplied apparatus, in restraining the flow of blood
from the smallest artery when wounded, with what force it overcomes
all obstacles and soaks through the whole apparatus, he will scarcely,
I imagine, think it likely that there can be any retrograde motion
against such an impulse and influx of blood, any retrograde force to
meet and overcome a direct force of such power. Turning over these
things in his mind, I say, no one will ever be brought to believe
that the blood from the branches of the vena portæ can possibly make
its way by the same channels against an influx by the artery of such
impetuosity and force, and so unload the mesentery.
Moreover, if the learned anatomist does not think that the blood is
moved and changed by a circular motion, but that the same fluid always
stagnates in the channels of the mesentery, he appears to suppose
that there are two descriptions of blood, serving different uses and
ends; that the blood of the vena portæ, and that of the vena cava are
dissimilar in constitution, seeing that the one requires a circulation
for its preservation, the other requires nothing of the kind; which
neither appears on the face of the thing, nor is its truth demonstrated
by him. Our author then refers to “A fourth order of mesenteric
vessels, the lacteal vessels, discovered by Asellius,”[40] and having
mentioned these, he seems to infer that they extract all the nutriment
from the intestines, and transfer this to the liver, the workshop of
the blood, whence, having been concocted and changed into blood, (so
he says in his third book, chapter the 8th), the blood is transferred
from the liver to the right ventricle of the heart. “Which things
premised,” he continues,[41] “all the difficulties which were formerly
experienced in regard to the distribution of the chyle and blood by the
same channel come to an end; for the lacteal veins carry the chyle to
the liver, and as these canals are distinct, so may they be severally
obstructed.” But truly I would here ask: how this milky fluid can be
poured into and pass through the liver, and how from thence gain the
vena cava and the ventricle of the heart when our author denies that
the blood of the vena portæ passes through the liver, and that so a
circulation is established? I pause for a reply. I would fain know how
such a thing can be shown to be probable; especially when the blood
appears to be both more spirituous or subtile and penetrating than
the chyle or milk contained in these lacteal vessels, and is further
impelled by the pulsations of the arteries that it may find a passage
by other channels.
[40] Enchiridion, lib. ii, cap. 18.
[41] Ibid.
Our learned author mentions a certain tract of his on the Circulation
of the Blood: I wish I could obtain a sight of it; perhaps I might
retract. But had the learned writer been so disposed, I do not see
but that having admitted the circular motion of the blood,[42] all
the difficulties which were formerly felt in connexion with the
distribution of the chyle and the blood by the same channels are
brought to an equally satisfactory solution; so much so indeed that
there would be no necessity for inquiring after or laying down any
separate vessels for the chyle. Even as the umbilical veins absorb the
nutritive juices from the fluids of the egg and transport them for
the nutrition and growth of the chick, in its embryo state, so do the
meseraic veins suck up the chyle from the intestines and transfer it to
the liver; and why should we not maintain that they perform the same
office in the adult? For all the mooted difficulties vanish when we
cease to suppose two contrary motions in the same vessels, and admit
but one and the same continuous motion in the mesenteric vessels from
the intestines to the liver.
[42] Enchiridion, lib. iii, cap. 8: “The blood incessantly and
naturally ascends or flows back to the heart in the veins, as in the
arteries it descends or departs from the heart.”
I shall elsewhere state my views of the lacteal veins when I treat of
the milk found in different parts of new-born animals, especially of
the human subject; for it is met with in the mesentery and all its
glands, in the thymus, in the axillæ, also in the breasts of infants.
This milk the midwifes are in the habit of pressing out, for the
health, as they believe, of the infants. But it has pleased the learned
Riolanus, not only to take away circulation from the blood contained in
the mesentery; he affirms that neither do the vessels in continuation
of the vena cava, nor the arteries, nor any of the parts of the
second and third regions, admit of circulation, so that he entitles
and enumerates as circulating vessels the vena cava and aorta only.
For this he appears to me to give a very indifferent reason:[43] “The
blood,” he says, “effused into all the parts of the second and third
regions, remains there for their nutrition; nor does it return to the
great vessels, unless forcibly drawn back by an extreme dearth of blood
in the great vessels, nor, unless carried by an impulse, does it flow
to the circulatory vessels.”
[43] Enchirid. lib. iii, cap. 8.
That so much of the blood must remain as is appropriated to the
nutrition of the tissues, is matter of necessity; for it cannot nourish
unless it be assimilated and become coherent, and form substance in
lieu of that which is lost; but that the whole of the blood which flows
into a part should there remain, in order that so small a portion
should undergo transformation, is nowise necessary; for no part uses so
much blood for its nutrition as is contained in its arteries, veins,
and interstices. Nor because the blood is continually coming and going
is it necessary to suppose that it leaves nothing for nutriment behind
it. Consequently it is by no means necessary that the whole remain
in order that nutrition be effected. But our learned author, in the
same book, where he affirms so much, appears almost everywhere else to
assert the contrary. In that paragraph especially where he describes
the circulation in the brain, he says: “And the brain by means of
the circulation sends back blood to the heart, and thus refrigerates
the organ.” And in the same way are all the more remote parts said
to refrigerate the heart; thus in fevers, when the præcordia are
scorched and burn with febrile heat, patients baring their limbs and
casting off the bedclothes, seek to cool their heart; and the blood
generally, tempered and cooled down, as our learned author states it to
be with reference to the brain in particular, returns by the veins and
refrigerates the heart. Our author, therefore, appears to insinuate a
certain necessity for a circulation from every part, as well as from
the brain, in opposition to what he had before said in very precise
terms. But then he cautiously and ambiguously asserts, that the
blood does not return from the parts composing the second and third
regions, unless, as he says, it is drawn by force, and through a signal
deficiency of blood in the larger vessels, &c., which is most true if
these words be rightly understood; for by the larger vessels, in which
the deficiency is said to cause the reflux, I think he must be held to
mean the veins not the arteries; for the arteries are never emptied,
save into the veins or interstices of parts, but are incessantly filled
by the strokes of the heart; but in the vena cava and other returning
channels, in which the blood glides rapidly on, hastening to the heart,
there would speedily be a great deficiency of blood did not every part
incessantly restore the blood that is incessantly poured into it. Add
to this, that by the impulse of the blood which is forced with each
stroke into every part of the second and third regions, that which
is contained in the pores or interstices is urged into the smaller
veins, from which it passes into larger vessels, its motion assisted
besides by the motion and pressure of circumjacent parts; for from
every containing thing compressed and constringed, contained matters
are forced out. And thus it is that by the motions of the muscles
and extremities, the blood contained in the minor vessels is forced
onwards and delivered into the larger trunks. But that the blood is
incessantly driven from the arteries into every part of the body,
there gives a pulse and never flows back in these channels, cannot
be doubted, if it be admitted that with each pulse of the heart all
the arteries are simultaneously distended by the blood sent into
them; and as our learned author himself allows that the diastole of
the arteries is occasioned by the systole of the heart, and that the
blood once out of the heart can never get back into the ventricles by
reason of the opposing valves; if I say, our learned author believes
that these things are so, it will be as manifestly true with regard to
the force and impulse by which the blood contained in the vessels is
propelled into every part of every region of the body. For wheresoever
the arteries pulsate, so far must the impulse and influx extend, and
therefore is the impulse felt in every part of each several region;
for there is a pulse everywhere, to the very points of the fingers and
under the nails, nor is there any part of the body where the shooting
pain that accompanies each pulse of the artery, and the effort made to
effect a solution of the continuity is not experienced when it is the
seat of a phlegmon or furuncle.
But, further, that the blood contained in the pores of the living
tissues returns to the heart, is manifest from what we observe in the
hands and feet. For we frequently see the hands and feet, in young
persons especially, during severe weather, become so cold that to the
touch they feel like ice, and they are so benumbed and stiffened that
they seem scarcely to retain a trace of sensibility or to be capable
of any motion; still are they all the while surcharged with blood, and
look red or livid. Yet can the extremities be warmed in no way, save
by circulation; the chilled blood, which has lost its spirit and heat,
being driven out, and fresh, warm, and vivified blood flowing in by
the arteries in its stead, which fresh blood cherishes and warms the
parts, and restores to them sense and motion; nor could the extremities
be restored by the warmth of a fire or other external heat, any more
than those of a dead body could be so recovered: they are only brought
to life again, as it were, by an influx of internal warmth. And this
indeed is the principal use and end of the circulation; it is that
for which the blood is sent on its ceaseless course, and to exert its
influence continually in its circuit, to wit, that all parts dependent
on the primary innate heat may be retained alive, in their state of
vital and vegetative being, and apt to perform their functions; whilst,
to use the language of physiologists, they are sustained and actuated
by the inflowing heat and vital spirits. Thus, by the aid of two
extremes, viz. cold and heat, is the temperature of the animal body
retained at its mean. For as the air inspired tempers the too great
heat of the blood in the lungs and centre of the body, and effects the
expulsion of suffocating fumes, so in its turn does the hot blood,
thrown by the arteries into all parts of the body, cherish and nourish
and keep them in life, defending them from extinction through the power
of external cold.
It would, therefore, be in some sort unfair and extraordinary did
not every particle composing the body enjoy the advantages of the
circulation and transmutation of the blood; the ends for which the
circulation was mainly established by nature would no longer be
effected. To conclude then: you see how circulation may be accomplished
without confusion or admixture of humours, through the whole body, and
each of its individual parts, in the smaller as well as in the larger
vessels; and all as matter of necessity and for the general advantage;
without circulation, indeed, there would be no restoration of chilled
and exhausted parts, no continuance of these in life; since it is
apparent enough that the whole influence of the preservative heat
comes by the arteries, and is the work of the circulation.
It, therefore, appears to me that the learned Riolanus speaks rather
expediently than truly, when in his Enchiridion he denies a circulation
to certain parts; it would seem as though he had wished to please the
mass, and oppose none; to have written with such a bias rather than
rigidly and in behalf of the simple truth. This is also apparent when
he would have the blood to make its way into the left ventricle through
the septum of the heart, by certain invisible and unknown passages,
rather than through those ample and abundantly pervious channels,
the pulmonary vessels, furnished with valves, opposing all reflux
or regurgitation. He informs us that he has elsewhere discussed the
reasons of the impossibility or inconvenience of this: I much desire
to see his disquisition. It would be extraordinary, indeed, were the
aorta and pulmonary artery, with the same dimensions, properties,
and structure, not to have the same functions. But it would be more
wonderful still were the whole tide of the blood to reach the left
ventricle by a set of inscrutable passages of the septum, a tide which,
in quantity, must correspond, first to the influx from the vena cava
into the right side of the heart, and next to the efflux from the left,
both of which require such ample conduits. But our author has adduced
these matters inconsistently, for he has established the lungs as an
emunctory or passage from the heart;[44] and he says: “The lung is
affected by the blood which passes through it, the sordes flowing along
with the blood.” And, again: “The lungs receive injury from distempered
and ill-conditioned viscera; these deliver an impure blood to the
heart, which it cannot correct except by multiplied circulations.” In
the same place, he further proceeds, whilst speaking against Galen of
blood-letting in peri-pneumonia and the communication of the veins:
[44] Lib. iii, cap. 6.
“Were it true that the blood naturally passed from the right ventricle
of the heart to the lungs, that it might be carried into the left
ventricle and from thence into the aorta; and were the circulation of
the blood admitted, who does not see that in affections of the lungs
the blood would flow to them in larger quantity and would oppress them,
unless it were taken away, first, freely, and then in repeated smaller
quantities in order to relieve them, which indeed was the advice of
Hippocrates, who, in affections of the lungs takes away blood from
every part--the head, nose, tongue, arms and feet, in order that its
quantity may be diminished and a diversion effected from the lungs; he
takes away blood till the body is almost bloodless. Now admitting the
circulation, the lungs are most readily depleted by opening a vein;
but rejecting it, I do not see how any revulsion of the blood can be
accomplished by this means; for did it flow back by the pulmonary
artery upon the right ventricle, the sigmoid valves would oppose its
entrance, and any escape from the right ventricle into the vena cava
is prevented by the tricuspid valves. The blood, therefore, is soon
exhausted when a vein is opened in the arm or foot, if we admit the
circulation; and the opinion of Fernelius is at the same time upset by
this admission, viz. that in affections of the lungs it is better to
bleed from the right than the left arm; because the blood cannot flow
backwards into the vena cava unless the two barriers situated in the
heart be first broken down.”
He adds yet further in the same place:[45] “If the circulation of the
blood be admitted, and it be acknowledged that this fluid generally
passes through the lungs, not through the middle partition of the
heart, a double circulation becomes requisite; one effected through the
lungs, in the course of which the blood quitting the right ventricle
of the heart passes through the lungs in order that it may arrive at
the left ventricle; leaving the heart on the one hand, therefore, the
blood speedily returns to it again; another and longer circulation
proceeding from the left ventricle of the heart performs the circuit of
the whole body by the arteries, and by the veins returns to the right
side of the heart.”
[45] Lib. iii, cap. 6.
The learned anatomist might here have added a third and extremely short
circulation, viz. from the left to the right ventricle of the heart,
with that blood which courses through the coronary arteries and veins,
and by their ramifications is distributed to the body, walls, and
septum of the heart.
“He who admits one circulation,” proceeds our author, “cannot repudiate
the other;” and he might, as it appears, have added, “the third.” For
why should the coronary arteries of the heart pulsate, if it were not
to force on the blood by their pulsations? and why should there be
coronary veins, the end and office of all veins being to receive the
blood brought by the arteries, were it not to deliver and discharge the
blood sent into the substance of the heart? In this consideration let
it be remembered that a valve is very commonly found at the orifice of
the coronary vein, as our learned author himself admits,[46] preventing
all ingress, but offering no obstacle to the egress of the blood. It
therefore seems that he cannot do otherwise than admit this third
circulation, who acknowledges a general circulation through the body,
and that the blood also passes through the lungs and the brain.[47]
Nor, indeed, can he deny a similar circulation to every other part of
every other region. The blood flowing in under the influence of the
arterial pulse, and returning by the veins, every particle of the body
has its circulation.
[46] Lib. iii, cap. 9.
[47] Lib. iv, cap. 2.
From the words of our learned writer quoted above, consequently, his
opinion may be gathered both of the general circulation, and then of
the circulation through the lungs and the several parts of the body;
for he who admits the first, manifestly cannot refuse to acknowledge
the others. How indeed could he who has repeatedly asserted a
circulation through the general system and the greater vessels, deny a
circulation in the branches continuous with these vessels, or in the
several parts of the second and third regions? as if all the veins,
and those he calls greater circulatory vessels, were not enumerated
by every anatomist, and by himself, as being within the second region
of the body. Is it possible that there can be a circulation which is
universal, and which yet does not extend through every part? Where
he denies it, then, he does so hesitatingly, and vacillates between
negations, giving us mere words. Where he asserts the circulation, on
the contrary, he speaks out heartily, and gives sufficient reasons,
as becomes a philosopher; and then, when he relies on this opinion
in a particular instance, he delivers himself like an experienced
physician and honest man, and, in opposition to Galen and his favourite
Fernelius, advises blood-letting as the chief remedy in dangerous
diseases of the lungs.
No learned man and Christian, having doubts in such a cause, would have
recommended his experience to posterity, to the imminent risk, and even
loss of human life; neither would he, without very sufficient reasons,
have repudiated the authority of Galen and Fernelius, which has usually
such weight with him. Whatever he has denied in the circulation of the
blood, therefore, whether with reference to the mesentery or any other
part, and with an eye to the lacteal veins or the ancient system of
physic, or any other consideration, must be ascribed to his courtesy
and modesty, and is to be excused.
Thus far, I think, it appears plain enough, from the very words and
arguments of our author, that there is a circulation everywhere; that
the blood, wherever it is, changes its place, and by the veins returns
to the heart; so that our learned author seems to be of the same
opinion as myself. It would therefore be labour in vain, did I here
quote at greater length the various reasons which I have consigned in
my work on the Motion of the Blood, in confirmation of my opinions, and
which are derived from the structure of the vessels, the position of
the valves, and other matters of experience and observation; and this
the more, as I have not yet seen the treatise on the Circulation of the
Blood of the learned writer; nor, indeed, have I yet met with a single
argument of his, or more than his simple negation, which would lead
me to see wherefore he should reject a circulation which he admits as
universal, in certain parts, regions, and vessels.
It is true that by way of subterfuge he has recourse to an anastomosis
of the vessels on the authority of Galen, and the evidence of daily
experience. But so distinguished a personage, an anatomist so expert,
so inquisitive, and careful, should first have shown anastomoses
between the larger arteries and larger veins, and these, both
obvious and ample, having mouths in relation with such a torrent
as is constituted by the whole mass of the blood, and larger than
the capacity of the continuous branches, (from which he takes away
all circulation,) before he had rejected those that are familiarly
known, that are more likely and more open; he ought to have clearly
shown us where these anastomoses are, and how they are fashioned,
whether they be adapted only to permit the access of the blood into
the veins, and not to allow of its regurgitation, in the same way
as we see the ureters connected with the urinary bladder, or in
what other manner things are contrived. But--and here I speak over
boldly perhaps--neither our learned author himself, nor Galen, nor
any experience, has ever succeeded in making such anastomoses as he
imagines, sensible to the eye.
I have myself pursued this subject of the anastomosis with all the
diligence I could command, and have given not a little both of time
and labour to the inquiry; but I have never succeeded in tracing any
connexion between arteries and veins by a direct anastomosis of their
orifices. I would gladly learn of those who give so much to Galen,
how they dare swear to what he says. Neither in the liver, spleen,
lungs, kidneys, nor any other viscus, is such a thing as an anastomosis
to be seen; and by boiling, I have rendered the whole parenchyma of
these organs so friable that it could be shaken like dust from the
fibres, or picked away with a needle, until I could trace the fibres
of every subdivision, and see every capillary filament distinctly. I
can therefore boldly affirm, that there is neither any anastomosis of
the vena portæ with the cava, of the arteries with the veins, or of
the capillary ramifications of the biliary ducts, which can be traced
through the entire liver, with the veins. This alone may be observed in
the recent liver: all the branches of the vena cava ramifying through
the convexity of the liver, have their tunics pierced with an infinity
of minute holes as is a sieve, and are fashioned to receive the blood
in its descent. The branches of the porta are not so constituted, but
simply spread out in subdivisions; and the distribution of these two
vessels is such, that whilst the one runs upon the convexity, the other
proceeds along the concavity of the liver to its outer margin, and all
the while without anastomosing.
In three places only do I find anything that can be held equivalent to
an anastomosis. From the carotids, as they are creeping over the base
of the brain, numerous interlaced fibres arise, which afterwards form
the choroid plexus, and passing through the lateral ventricles, finally
unite and terminate in the third sinus, which performs the office of
a vein. In the spermatic vessels, commonly called vasa præparantia,
certain minute arteries proceeding from the great artery adhere to the
venæ præparantes, which they accompany, and are at length taken in and
included within their coats, in such a way that they seem to have a
common ending, so that where they terminate on the upper portion of
the testis, on that cone-shaped process called the corpus varicosum et
pampiniforme, it is altogether uncertain whether we are to regard their
terminations as veins, or as arteries, or as both. In the same way are
the ultimate ramifications of the arteries which run to the umbilical
vein, lost in the tunics of this vessel.
What doubt can there be, if by such channels the great arteries,
distended by the stream of blood sent into them, are relieved of so
great and obvious a torrent, but that nature would not have denied
distinct and visible passages, vortices, and estuaries, had she
intended to divert the whole current of the blood, and had wished in
this way to deprive the lesser branches and the solid parts of all the
benefit of the influx of that fluid?
Finally, I shall quote this single experiment, which appears to me
sufficient to clear up all doubts about the anastomoses, and their
uses, if any exist, and to set at rest the question of a passage of the
blood from the veins to the arteries, by any special channels, or by
regurgitation.
Having laid open the thorax of an animal, and tied the vena cava
near the heart, so that nothing shall pass from that vessel into its
cavities, and immediately afterwards, having divided the carotid
arteries on both sides, the jugular veins being left untouched; if the
arteries be now perceived to become empty but not the veins, I think
it will be manifest that the blood does nowhere pass from the veins
into the arteries except through the ventricles of the heart. Were
it not so, as observed by Galen, we should see the veins as well as
the arteries emptied in a very short time, by the efflux from their
corresponding arteries.
For what further remains, oh Riolanus! I congratulate both myself
and you: myself, for the opinion with which you have graced my
Circulation; and you, for your learned, polished, and terse production,
than which nothing more elegant can be imagined. For the favour you
have done me in sending me this work, I feel most grateful, and I
would gladly, as in duty bound, proclaim my sense of its merits, but
I confess myself unequal to the task; for I know that the Enchiridion
bearing the name of Riolanus inscribed upon it, has thereby more of
honour conferred upon it than it can derive from any praise of mine,
which nevertheless I would yield without reserve. The famous book will
live for ever; and when marble shall have mouldered, will proclaim to
posterity the glory that belongs to your name. You have most happily
conjoined anatomy with pathology, and have greatly enriched the subject
with a new and most useful osteology. Proceed in your worthy career,
most illustrious Riolanus, and love him who wishes that you may enjoy
both happiness and length of days, and that all your admirable works
may conduce to your eternal fame.
A
SECOND DISQUISITION TO JOHN RIOLAN, JUN.,
IN WHICH
MANY OBJECTIONS
TO THE
CIRCULATION OF THE BLOOD
ARE REFUTED.
A SECOND DISQUISITION TO JOHN RIOLAN
It is now many years, most learned Riolanus, since, with the aid of
the press, I published a portion of my work. But scarce a day, scarce
an hour, has passed since the birth-day of the Circulation of the
blood, that I have not heard something for good or for evil said of
this my discovery. Some abuse it as a feeble infant, and yet unworthy
to have seen the light; others, again, think the bantling deserves
to be cherished and cared for; these oppose it with much ado, those
patronize it with abundant commendation; one party holds that I have
completely demonstrated the circulation of the blood by experiment,
observation, and ocular inspection, against all force and array of
argument; another thinks it scarcely yet sufficiently illustrated--not
yet cleared of all objections. There are some, too, who say that I
have shown a vainglorious love of vivisections, and who scoff at and
deride the introduction of frogs and serpents, flies, and others of the
lower animals upon the scene, as a piece of puerile levity, not even
refraining from opprobrious epithets.
To return evil speaking with evil speaking, however, I hold to be
unworthy in a philosopher and searcher after truth; I believe that I
shall do better and more advisedly if I meet so many indications of
ill breeding with the light of faithful and conclusive observation. It
cannot be helped that dogs bark and vomit their foul stomachs, or that
cynics should be numbered among philosophers; but care can be taken
that they do not bite or inoculate their mad humours, or with their
dogs’ teeth gnaw the bones and foundations of truth.
Detractors, mummers, and writers defiled with abuse, as I resolved with
myself never to read them, satisfied that nothing solid or excellent,
nothing but foul terms, was to be expected from them, so have I held
them still less worthy of an answer. Let them consume on their own ill
nature; they will scarcely find many well-disposed readers, I imagine,
nor does God give that which is most excellent and chiefly to be
desired--wisdom, to the wicked; let them go on railing, I say, until
they are weary, if not ashamed.
If for the sake of studying the meaner animals you should even enter
the bakehouse with Heraclitus, as related in Aristotle, I bid you
approach; for neither are the immortal Gods absent here, and the great
and almighty Father is sometimes most visible in His lesser, and to the
eye least considerable works.[48]
[48] To those who hesitated to visit him in his kiln or bakehouse
(ἱπνω, which some have said should be ἱππω, rendered a dunghill)
Heraclitus addressed the words in the text. Aristotle, who quotes
them, has been defending the study of the lower animals.
In my book on the Motion of the Heart and Blood in Animals, I have
only adduced those facts from among many other observations, by which
either errors were best refuted, or truth was most strongly supported;
I have left many proofs, won by dissection and appreciable to sense,
as redundant and unnecessary; some of these, however, I now supply in
brief terms, for the sake of the studious, and those who have expressed
their desire to have them.
The authority of Galen is of such weight with all, that I have seen
several hesitate greatly with that experiment before them, in which
the artery is tied upon a tube placed within its cavity; and by which
it is proposed to prove that the arterial pulse is produced by a power
communicated from the heart through the coats of the arteries, and not
from the shock of the blood contained within them; and thence, that the
arteries dilate as bellows, are not filled as sacs. This experiment is
spoken of by Vesalius, the celebrated anatomist; but neither Vesalius
nor Galen says that he had tried the experiment, which, however, I
did. Vesalius only prescribes, and Galen advises it, to those anxious
to discover the truth, and for their better assurance, not thinking
of the difficulties that attend its performance, nor of its futility
when done; for indeed, although executed with the greatest skill,
it supplies nothing in support of the opinion which maintains that
the coats of the vessel are the cause of the pulse; it much rather
proclaims that this is owing to the impulse of the blood. For the
moment you have thrown your ligature around the artery upon the reed or
tube, immediately, by the force of the blood thrown in from above, it
is dilated beyond the circle of the tube, by which the flow is impeded,
and the shock is broken; so that the artery which is tied only pulsates
obscurely, being now cut off from the full force of the blood that
flows through it, the shock being reverberated, as it were, from that
part of the vessel which is above the ligature; but if the artery below
the ligature be now divided, the contrary of what has been maintained
will be apparent, from the spurting of the blood impelled through the
tube; just as happens in the cases of aneurism, referred to in my book
on the Motion of the Blood, which arise from an erosion of the coats of
the vessel, and when the blood is contained in a membranous sac, formed
not by the coats of the vessel dilated, but preternaturally produced
from the surrounding tissues and flesh. The arteries beyond an aneurism
of this kind will be felt beating very feebly, whilst in those above
it and in the swelling itself the pulse will be perceived of great
strength and fulness. And here we cannot imagine that the pulsation
and dilatation take place by the coats of the arteries, or any power
communicated to the walls of the sac; they are plainly due to the shock
of the blood.
But that the error of Vesalius, and the inexperience of those who
assert their belief that the part below the tube does not pulsate when
the ligature is tied, may be made the more apparent, I can state, after
having made the trial, that the inferior part will continue to pulsate
if the experiment be properly performed; and whilst they say that when
you have undone the ligature the inferior arteries begin again to
pulsate, I maintain that the part below beats less forcibly when the
ligature is untied than it did when the thread was still tight. But the
effusion of blood from the wound confuses everything, and renders the
whole experiment unsatisfactory and nugatory, so that nothing certain
can be shown, by reason, as I have said, of the hemorrhage. But if, as
I know by experience, you lay bare an artery, and control the divided
portion by the pressure of your fingers, you may try many things at
pleasure by which the truth will be made to appear. In the first place,
you will feel the blood coming down in the artery at each pulsation,
and visibly dilating the vessel. You may also at will suffer the blood
to escape, by relaxing the pressure, and leaving a small outlet; and
you will see that it jets out with each stroke, with each contraction
of the heart, and with each dilatation of the artery, as I have said
in speaking of arteriotomy, and the experiment of perforating the
heart. And if you suffer the efflux to go on uninterruptedly, either
from the simple divided artery or from a tube inserted into it, you
will be able to perceive by the sight, and if you apply your hand, by
the touch likewise, every character of the stroke of the heart in the
jet; the rhythm, order, intermission, force, &c., of its pulsations,
all becoming sensible there, no otherwise than would the jets from a
syringe, pushed in succession and with different degrees of force,
received upon the palm of the hand, be obvious to sight and touch. I
have occasionally observed the jet from a divided carotid artery to be
so forcible, that, when received on the hand, the blood rebounded to
the distance of four or five feet.
But that the question under discussion, viz. that the pulsific power
does not proceed from the heart by the coats of the vessels, may be
set in yet a clearer light, I beg here to refer to a portion of the
descending aorta, about a span in length, with its division into the
two crural trunks, which I removed from the body of a nobleman, and
which is converted into a bony tube; by this hollow tube, nevertheless,
did the arterial blood reach the lower extremities of this nobleman
during his life, and cause the arteries in these to beat; and yet the
main trunk was precisely in the same condition as is the artery in the
experiment of Galen, when it is tied upon a hollow tube; where it was
converted into bone it could neither dilate nor contract like bellows,
nor transmit the pulsific power from the heart to the inferior vessels;
it could not convey a force which it was incapable of receiving through
the solid matter of the bone. In spite of all, however, I well remember
to have frequently noted the pulse in the legs and feet of this patient
whilst he lived, for I was myself his most attentive physician, and he
my very particular friend. The arteries in the inferior extremities of
this nobleman must therefore and of necessity have been dilated by the
impulse of the blood like flaccid sacs, and not have expanded in the
manner of bellows through the action of their tunics. It is obvious,
that whether an artery be tied over a hollow tube, or its tunics be
converted into a bony and unyielding canal, the interruption to the
pulsific power in the inferior part of the vessel must be the same.
I have known another instance in which a portion of the aorta near
the heart was found converted into bone, in the body of a nobleman, a
man of great muscular strength. The experiment of Galen, therefore,
or, at all events, a state analogous to it, not effected on purpose
but encountered by accident, makes it sufficiently to appear, that
compression or ligature of the coats of an artery does not interfere
with the pulsative properties of its derivative branches; and indeed,
if the experiment which Galen recommends were properly performed by
any one, its results would be found in opposition to the views which
Vesalius believed they would support.
But we do not therefore deny everything like motion to the tunics of
the arteries; on the contrary, we allow them the same motions which we
concede to the heart, viz. a diastole, and a systole or return from the
distended to the natural state; this much we believe to be effected by
a power inherent in the coats themselves. But it is to be observed,
that they are not both dilated and contracted by the same, but by
different causes and means; as may be observed of the motions of all
parts, and of the ventricle of the heart itself, which is distended by
the auricle, contracted by its own inherent power; so, the arteries are
dilated by the stroke of the heart, but they contract or collapse of
themselves.[49]
[49] Vide Chapter III. of the Disquisition on the Motion of the Heart
and Blood.
You may also perform another experiment at the same time: if you fill
one of two basins of the same size with blood issuing per saltum from
an artery, the other with venous blood from a vein of the same animal,
you will have an opportunity of perceiving by the eye, both immediately
and by and by, when the blood in either vessel has become cold, what
differences there are between them. You will find that it is not as
they believe who fancy that there is one kind of blood in the arteries
and another in the veins, that in the arteries being of a more florid
colour, more frothy, and imbued with an abundance of I know not what
spirits, effervescing and swelling, and occupying a greater space, like
milk or honey set upon the fire. For were the blood which is thrown
from the left ventricle of the heart into the arteries, fermented into
any such frothy and flatulent fluid, so that a drop or two distended
the whole cavity of the aorta; unquestionably, upon the subsidence of
this fermentation, the blood would return to its original quantity of
a few drops; (and this, indeed, is the reason that some assign for the
usually empty state of the arteries in the dead body;) and so should it
be with the arterial blood in the cup, for so it is with boiling milk
and honey when they come to cool. But if in either basin you find blood
nearly of the same colour, not of very different consistency in the
coagulated state, forcing out serum in the same manner, and filling the
cups to the same height when cold that it did when hot, this will be
enough for any one to rest his faith upon, and afford argument enough,
I think, for rejecting the dreams that have been promulgated on the
subject. Sense and reason alike assure us that the blood contained in
the left ventricle is not of a different nature from that in the right.
And then, when we see that the mouth of the pulmonary artery is of the
same size as the aorta, and in other respects equal to that vessel, it
were imperative on us to affirm that the pulmonary artery was distended
by a single drop of spumous blood, as well as the aorta, and so that
the right as well as the left side of the heart was filled with a brisk
or fermenting blood.
The particulars which especially dispose men’s minds to admit diversity
in the arterial and venous blood are three in number: one, because in
arteriotomy the blood that flows is of a more florid hue than that
which escapes from a vein; a second, because in the dissection of dead
bodies the left ventricle of the heart, and the arteries in general,
are mostly found empty; a third, because the arterial blood is believed
to be more spirituous, and being replete with spirit is made to occupy
a much larger space. The causes and reasons, however, wherefore all
these things are so, present themselves to us when we ask after them.
1st. With reference to the colour it is to be observed, that wherever
the blood issues by a very small orifice, it is in some measure
strained, and the thinner and lighter part, which usually swims on
the top and is the most penetrating, is emitted. Thus, in phlebotomy,
when the blood escapes forcibly and to a distance, in a full stream,
and from a large orifice, it is thicker, has more body, and a darker
body; but, if it flows from a small orifice, and only drop by drop,
as it usually does when the bleeding fillet is untied, it is of a
brighter hue; for then it is strained as it were, and the thinner and
more penetrating portion only escapes; in the same way, in the bleeding
from the nose, in that which takes place from a leech-bite, or from
scarifications, or in any other way by diapedesis or transudation, the
blood is always seen to have a brighter cast, because the thickness
and firmness of the coats of the arteries render the outlet or outlets
smaller, and less disposed to yield a ready passage to the outpouring
blood; it happens also that when fat persons are let blood, the orifice
of the vein is apt to be compressed by the subcutaneous fat, by which
the blood is made to appear thinner, more florid, and in some sort
arterious. On the other hand, the blood that flows into a basin from a
large artery freely divided, will look venous. The blood in the lungs
is of a much more florid colour than it is in the arteries, and we know
how it is strained through the pulmonary tissue.
2d. The emptiness of the arteries in the dead body, which probably
misled Erasistratus in supposing that they only contained aereal
spirits, is caused by this, that when respiration ceases the lungs
collapse, and then the passages through them are closed; the heart,
however, continues for a time to contract upon the blood, whence we
find the left auricle more contracted, and the corresponding ventricle,
as well as the arteries at large, appearing empty, simply because there
is no supply of blood flowing round to fill them. In cases, however, in
which the heart has ceased to pulsate and the lungs to afford a passage
to the blood simultaneously, as in those who have died from drowning
or syncope, or who die suddenly, you will find the arteries, as well as
the veins, full of blood.
3d. With reference to the third point, or that of the spirits, it may
be said that, as it is still a question what they are, how extant in
the body, of what consistency, whether separate and distinct from the
blood and solids, or mingled with these,--upon each and all of these
points there are so many and such conflicting opinions, that it is
not wonderful that the spirits, whose nature is thus left so wholly
ambiguous, should serve as the common subterfuge of ignorance. Persons
of limited information, when they are at a loss to assign a cause
for anything, very commonly reply that it is done by the spirits;
and so they bring the spirits into play upon all occasions; even as
indifferent poets are always thrusting the gods upon the stage as a
means of unravelling the plot, and bringing about the catastrophe.
Fernelius, and many others, suppose that there are aereal spirits and
invisible substances. Fernelius proves that there are animal spirits,
by saying that the cells in the brain are apparently unoccupied, and
as nature abhors a vacuum, he concludes that in the living body they
are filled with spirits, just as Erasistratus had held that, because
the arteries were empty of blood, therefore they must be filled with
spirits. But Medical Schools admit three kinds of spirits: the natural
spirits flowing through the veins, the vital spirits through the
arteries, and the animal spirits through the nerves; whence physicians
say, out of Galen, that sometimes the parts of the brain are oppressed
by sympathy, because the faculty with the essence, i.e. the spirit, is
overwhelmed; and sometimes this happens independently of the essence.
Farther, besides the three orders of influxive spirits adverted to, a
like number of implanted or stationary spirits seem to be acknowledged;
but we have found none of all these spirits by dissection, neither
in the veins, nerves, arteries, nor other parts of living animals.
Some speak of corporeal, others of incorporeal spirits; and they who
advocate the corporeal spirits will have the blood, or the thinner
portion of the blood, to be the bond of union with the soul, the spirit
being contained in the blood as the flame is in the smoke of a lamp or
candle, and held admixed by the incessant motion of the fluid; others,
again, distinguish between the spirits and the blood. They who advocate
incorporeal spirits have no ground of experience to stand upon;
their spirits indeed are synonymous with powers or faculties, such
as a concoctive spirit, a chylopoietic spirit, a procreative spirit,
&c.--they admit as many spirits, in short, as there are faculties or
organs.
But then the schoolmen speak of a spirit of fortitude, prudence,
patience, and the other virtues, and also of a most holy spirit of
wisdom, and of every divine gift; and they besides suppose that there
are good and evil spirits that roam about or possess the body, that
assist or cast obstacles in the way. They hold some diseases to be
owing to a Cacodæmon or evil spirit, as there are others that are due
to a cacochemy or defective assimilation.
Although there is nothing more uncertain and questionable, then, than
the doctrine of spirits that is proposed to us, nevertheless physicians
seem for the major part to conclude, with Hippocrates, that our body is
composed or made up of three elements, viz. containing parts, contained
parts, and causes of action, spirits being understood by the latter
term. But if spirits are to be taken as synonymous with causes of
activity, whatever has power in the living body and a faculty of action
must be included under the denomination. It would appear, therefore,
that all spirits were neither aereal substances, nor powers, nor
habits; and that all were not incorporeal.
But keeping in view the points that especially interest us, others,
as leading to tediousness, being left unnoticed, it seems that the
spirits which flow by the veins or the arteries are not distinct
from the blood, any more than the flame of a lamp is distinct from
the inflammable vapour that is on fire; in short, that the blood and
these spirits signify one and the same thing, though different,--like
generous wine and its spirit; for as wine, when it has lost all its
spirit, is no longer wine, but a vapid liquor or vinegar; so blood
without spirit is not blood, but something else--clot or cruor; even
as a hand of stone, or of a dead body, is no hand in the most complete
sense, neither is blood void of the vital principle proper blood; it
is immediately to be held as corrupt when deprived of its spirit. The
spirit therefore which inheres in the arteries, and especially in the
blood which fills them, is to be regarded either as its act or agent,
in the same way as the spirit of wine in wine, and the spirit of aqua
vitæ in brandy, or as a flame kindled in alcohol, which lives and feeds
on, or is nourished by itself. The blood consequently, though richly
imbued with spirits, does not swell, nor ferment, nor rise to a head
through them, so as to require and occupy a larger space,--a fact that
may be ascertained beyond the possibility of question by the two cups
of equal size; it is to be regarded as wine, possessed of a large
amount of spirits, or, in the Hippocratic sense, of signal powers of
acting and effecting.
It is therefore the same blood in the arteries that is found in the
veins, although it may be admitted to be more spirituous, possessed
of higher vital force in the former than in the latter; but it is not
changed into anything more vaporous, or more aereal, as if there were
no spirits but such as are aereal, and no cause of action or activity
that is not of the nature of flatus or wind. But neither the animal,
natural, nor vital spirits which inhere in the solids, such as the
ligaments and nerves (especially if they be of so many different
species), and are contained within the viewless interstices of the
tissues, are to be regarded as so many different aereal forms, or kinds
of vapour.
And here I would gladly be informed by those who admit corporeal
spirits, but of a gaseous or vaporous consistency, in the bodies of
animals, whether or not they have the power of passing hither and
thither, like distinct bodies independently of the blood? Or whether
the spirits follow the blood in its motions, either as integral parts
of the fluid or as indissolubly connected with it, so that they can
neither quit the tissues nor pass hither nor thither without the influx
and reflux, and motion of the blood? For if the spirits exhaling from
the blood, like the vapour of water attenuated by heat, exist in a
state of constant flow and succession as the pabulum of the tissues, it
necessarily follows that they are not distinct from this pabulum, but
are incessantly disappearing; whereby it seems that they can neither
have influx nor reflux, nor passage, nor yet remain at rest without the
influx, the reflux, the passage [or stasis] of the blood, which is the
fluid that serves as their vehicle or pabulum.
And next I desire to know of those who tell us that the spirits are
formed in the heart, being compounded of the vapours or exhalations of
the blood (excited either by the heat of the heart or the concussion)
and the inspired air, whether such spirits are not to be accounted
much colder than the blood, seeing that both the elements of their
composition, namely, air and vapour, are much colder? For the vapour of
boiling water is much more bearable than the water itself; the flame of
a candle is less burning than the red-hot snuff, and burning charcoal
than incandescent iron or brass. Whence it would appear that spirits
of this nature rather receive their heat from the blood, than that
the blood is warmed by these spirits; such spirits are rather to be
regarded as fumes and excrementitious effluvia proceeding from the body
in the manner of odours, than in any way as natural artificers of the
tissues; a conclusion which we are the more disposed to admit, when we
see that they so speedily lose any virtue they may possess, and which
they had derived from the blood as their source,--they are at best of
a very frail and evanescent nature. Whence also it becomes probable
that the expiration of the lungs is a means by which these vapours
being cast off, the blood is fanned and purified; whilst inspiration is
a means by which the blood in its passage between the two ventricles
of the heart is tempered by the cold of the ambient atmosphere, lest,
getting heated, and blown up with a kind of fermentation, like milk or
honey set over the fire, it should so distend the lungs that the animal
got suffocated; somewhat in the same way, perchance, as one labouring
under a severe asthma, which Galen himself seems to refer to its
proper cause when he says it is owing to an obstruction of the smaller
arteries, viz. the vasa venosa et arteriosa. And I have found by
experience that patients affected with asthma might be brought out of
states of very imminent danger by having cupping-glasses applied, and
a plentiful and sudden affusion of cold water [upon the chest]. Thus
much--and perhaps it is more than was necessary--have I said on the
subject of spirits in this place, for I felt it proper to define them,
and to say something of their nature in a physiological disquisition.
I shall only further add, that they who descant on the calidum innatum
or innate heat, as an instrument of nature available for every purpose,
and who speak of the necessity of heat as the cherisher and retainer
in life of the several parts of the body, who at the same time
admit that this heat cannot exist unless connected with something,
and because they find no substance of anything like commensurate
mobility, or which might keep pace with the rapid influx and reflux
of this heat (in affections of the mind especially), take refuge in
spirits as most subtile substances, possessed of the most penetrating
qualities, and highest mobility--these persons see nothing less than
the wonderful and almost divine character of the natural operations
as proceeding from the instrumentality of this common agent, viz. the
calidum innatum; they farther regard these spirits as of a sublime,
lucid, ethereal, celestial, or divine nature, and the bond of the soul;
even as the vulgar and unlettered, when they do not comprehend the
causes of various effects, refer them to the immediate interposition
of the Deity. Whence they declare that the heat perpetually flowing
into the several parts is in virtue of the influx of spirits through
the channels of the arteries; as if the blood could neither move so
swiftly, nor penetrate so intimately, nor cherish so effectually. And
such faith do they put in this opinion, such lengths are they carried
by their belief, that they deny the contents of the arteries to be
blood! And then they proceed with trivial reasonings to maintain that
the arterial blood is of a peculiar kind, or that the arteries are
filled with such aereal spirits, and not with blood; all the while, in
opposition to everything which Galen has advanced against Erasistratus,
both on grounds of experiment and of reason. But that arterial blood
differs in nothing essential from venous blood has been already
sufficiently demonstrated; and our senses likewise assure us that the
blood and spirits do not flow in the arteries separately and disjoined,
but as one body.
We have occasion to observe so often as our hands, feet, or ears
have become stiff and cold, that as they recover again by the warmth
that flows into them, they acquire their natural colour and heat
simultaneously; that the veins which had become small and shrunk, swell
visibly and enlarge, so that when they regain their heat suddenly they
become painful; from which it appears, that that which by its influx
brings heat is the same which causes repletion and colour; now this can
be and is nothing but blood.
When an artery and a vein are divided, any one may clearly see that
the part of the vein towards the heart pours out no blood, whilst that
beyond the wound gives a torrent; the divided artery, on the contrary,
(as in my experiment on the carotids,) pours out a flood of pure blood
from the orifice next the heart, and in jets as if it were forced
from a syringe, whilst from the further orifice of the divided artery
little or no blood escapes. This experiment therefore plainly proves
in what direction the current sets in either order of vessels--towards
the heart in the veins, from the heart in the arteries; it also shows
with what velocity the current moves, not gradually and by drops, but
even with violence. And lest any one, by way of subterfuge, should
take shelter in the notion of invisible spirits, let the orifice of
the divided vessel be plunged under water or oil, when, if there be
any air contained in it, the fact will be proclaimed by a succession
of visible bubbles. Hornets, wasps, and other insects of the same
description plunged in oil, and so suffocated, emit bubbles of air from
their tail whilst they are dying; whence it is not improbable that they
thus respire when alive; for all animals submerged and drowned, when
they finally sink to the bottom and die, emit bubbles of air from the
mouth and lungs. It is also demonstrated by the same experiment, that
the valves of the veins act with such accuracy, that air blown into
them does not penetrate; much less then can blood make its way through
them:--it is certain, I say, that neither sensibly nor insensibly, nor
gradually and drop by drop, can any blood pass from the heart by the
veins.
And that no one may seek shelter in asserting that these things are
so when nature is disturbed and opposed, but not when she is left to
herself and at liberty to act; that the same things do not come to pass
in morbid and unusual states as in the healthy and natural condition;
they are to be met by saying, that if it were so, if it happened
that so much blood was lost from the farther orifice of a divided
vein because nature was disturbed, still that the incision does not
close the nearer orifice, from which nothing either escapes or can be
expressed, whether nature be disturbed or not. Others argue in the
same way, maintaining that, although the blood immediately spurts out
in such profusion with every beat, when an artery is divided near the
heart, it does not therefore follow that the blood is propelled by
the pulse when the heart and artery are entire. It is most probable,
however, that every stroke impels something; and that there would be
no pulse of the container, without an impulse being communicated to
the thing contained, seems certain. Yet some, that they may seize upon
a farther means of defence, and escape the necessity of admitting the
circulation, do not fear to affirm that the arteries in the living
body and in the natural state are already so full of blood, that they
are incapable of receiving another drop; and so also of the ventricles
of the heart. But it is indubitable that, whatever the degree of
distension and the extent of contraction of the heart and arteries,
they are still in a condition to receive an additional quantity of
blood forced into them, and that this is far more than is usually
reckoned in grains or drops, seems also certain. For if the ventricles
become so excessively distended that they will admit no more blood,
the heart ceases to beat, (and we have occasional opportunities of
observing the fact in our vivisections,) and, continuing tense and
resisting, death by asphyxia ensues.
In the work on the Motion of the Heart and Blood, I have already
sufficiently discussed the question as to whether the blood in its
motion was attracted, or impelled, or moved by its own inherent nature.
I have there also spoken at length of the action and office, of the
dilatation and contraction of the heart, and have shown what these
truly are, and how the heart contracts during the diastole of the
arteries; so that I must hold those who take points for dispute from
among them as either not understanding the subject, or as unwilling to
look at things for themselves, and to investigate them with their own
senses.[50]
[50] Vide Chapter XIV.
For my part, I believe that no other kind of attraction can be
demonstrated in the living body save that of the nutriment, which
gradually and incessantly passes on to supply the waste that takes
place in the tissues; in the same way as the oil rises in the wick of
a lamp to be consumed by the flame. Whence I conclude that the primary
and common organ of all sensible attraction and impulsion is of the
nature of sinew (nervus), or fibre, or muscle, and this to the end that
it may be contractile, that contracting it may be shortened, and so
either stretch out, draw towards, or propel. But these topics will be
better discussed elsewhere, when we speak of the organs of motion in
the animal body.
To those who repudiate the circulation because they neither see
the efficient nor final cause of it, and who exclaim, cui bono? I
have yet to reply, having hitherto taken no note of the ground of
objection which they take up. And first I own I am of opinion that our
first duty is to inquire whether the thing be or not, before asking
wherefore it is? for from the facts and circumstances which meet us
in the circulation admitted, established, the ends and objects of its
institution are especially to be sought. Meantime I would only ask,
how many things we admit in physiology, pathology, and therapeutics,
the causes of which are unknown to us? That there are many, no one
doubts--the causes of putrid fevers, of revulsions, of the purgation of
excrementitious matters, among the number.
Whoever, therefore, sets himself in opposition to the circulation,
because, if it be acknowledged, he cannot account for a variety
of medical problems, nor in the treatment of diseases and the
administration of medicines, give satisfactory reasons for the
phenomena that appear; or who will not see that the precepts he has
received from his teachers are false; or who thinks it unseemly to give
up accredited opinions; or who regards it as in some sort criminal
to call in question doctrines that have descended through a long
succession of ages, and carry the authority of the ancients;--to all
of these I reply: that the facts cognizable by the senses wait upon no
opinions, and that the works of nature bow to no antiquity; for indeed
there is nothing either more ancient or of higher authority than nature.
To those who object to the circulation as throwing obstacles in the
way of their explanations of the phenomena that occur in medical
cases (and there are persons who will not be content to take up with
a new system, unless it explains everything, as in astronomy), and
who oppose it with their own erroneous assumptions, such as that,
if it be true, phlebotomy cannot cause revulsion, seeing that the
blood will still continue to be forced into the affected part; that
the passage of excrementitious matters and foul humours through the
heart, that most noble and principal viscus, is to be apprehended;
that an efflux and excretion, occasionally of foul and corrupt blood,
takes place from the same body, from different parts, even from the
same part and at the same time, which, were the blood agitated by a
continuous current, would be shaken and effectually mixed in passing
through the heart, and many points of the like kind admitted in our
medical schools, which are seen to be repugnant to the doctrine of
the circulation,--to them I shall not answer farther here, than that
the circulation is not always the same in every place, and at every
time, but is contingent upon many circumstances: the more rapid or
slower motion of the blood, the strength or weakness of the heart as
the propelling organ, the quantity and quality or constitution of the
blood, the rigidity or laxity of the tissues, and the like. A thicker
blood, of course, moves more slowly through narrower channels; it is
more effectually strained in its passage through the substance of the
liver than through that of the lungs. It has not the same velocity
through flesh and the softer parenchymatous structures and through
sinewy parts of greater compactness and consistency: for the thinner
and purer and more spirituous part permeates more quickly, the thicker
more earthy and indifferently concocted portion moves more slowly, or
is refused admission. The nutritive portion, or ultimate aliment of the
tissues, the dew or cambium, is of a more penetrating nature, inasmuch
as it has to be added everywhere, and to everything that grows and is
nourished in its length and thickness, even to the horns, nails, hair,
and feathers; and then the excrementitious matters have to be secreted
in some places, where they accumulate, and either prove a burthen or
are concocted. But I do not imagine that the excrementitious fluids
or bad humours when once separated, nor the milk, the phlegm, and the
spermatic fluid, nor the ultimate nutritive part, the dew or cambium,
necessarily circulate with the blood: that which nourishes every part
adheres and becomes agglutinated to it. Upon each of these topics and
various others besides, to be discussed and demonstrated in their
several places, viz. in the physiology and other parts of the art of
medicine, as well as of the consequences, advantages or disadvantages
of the circulation of the blood, I do not mean to touch here; it were
fruitless indeed to do so until the circulation has been established
and conceded as a fact. And here the example of astronomy is by no
means to be followed, in which from mere appearances or phenomena that
which is in fact, and the reason wherefore it is so, are investigated.
But as he who inquires into the cause of an eclipse must be placed
beyond the moon if he would ascertain it by sense, and not by reason,
still in reference to things sensible, things that come under the
cognizance of the senses, no more certain demonstration or means of
gaining faith can be adduced than examination by the senses, than
ocular inspection.
There is one remarkable experiment which I would have every one try
who is anxious for truth, and by which it is clearly shown that the
arterial pulse is owing to the impulse of the blood. Let a portion
of the dried intestine of a dog or wolf, or any other animal, such
as we see hung up in the druggists’ shops, be taken and filled with
water, and then secured at both ends like a sausage: by tapping with
the finger at one extremity, you will immediately feel a pulse and
vibration in any other part to which you apply the fingers, as you do
when you feel the pulse at the wrist. In this way, indeed, and also by
means of a distended vein, you may accurately, either in the dead or
living body, imitate and show every variety of the pulse, whether as to
force, frequency, volume, rhythm, &c. Just as in a long bladder full of
fluid, or in an oblong drum, every stroke upon one end is immediately
felt at the other; so also in a dropsy of the belly and in abscesses
under the skin, we are accustomed to distinguish between collections
of fluid and of air, between anasarca and tympanites in particular.
If a slap or push given on one side is clearly felt by a hand placed
on the other side, we judge the case to be tympanites [?]; not, as
falsely asserted, because we hear a sound like that of a drum, and this
produced by flatus, which never happens [?]; but because, as in a drum,
every the slightest tap passes through and produces a certain vibration
on the opposite side; for it indicates that there is a serous and
ichorous substance present, of such a consistency as urine, and not any
sluggish or viscid matter as in anasarca, which when struck retains the
impress of the blow or pressure, and does not transmit the impulse.
Having brought forward this experiment I may observe, that a most
formidable objection to the circulation of the blood rises out of it,
which, however, has neither been observed nor adduced by any one who
has written against me. When we see by the experiment just described,
that the systole and diastole of the pulse can be accurately imitated
without any escape of fluid, it is obvious that the same thing may
take place in the arteries from the stroke of the heart, without the
necessity for a circulation, but like Euripus, with a mere motion of
the blood alternately backwards and forwards. But we have already
satisfactorily replied to this difficulty; and now we venture to say
that the thing could not be so in the arteries of a living animal;
to be assured of this it is enough to see that the right auricle is
incessantly injecting the right ventricle of the heart with blood, the
return of which is effectually prevented by the tricuspid valves; the
left auricle in like manner filling the left ventricle, the return
of the blood there being opposed by the mitral valves; and then the
ventricles in their turn are propelling the blood into either great
artery, the reflux in each being prevented by the sigmoid valves in
its orifice. Either, consequently, the blood must move on incessantly
through the lungs, and in like manner within the arteries of the body,
or stagnating and pent up, it must rupture the containing vessels,
or choke the heart by over distension, as I have shown it to do in
the vivisection of a snake, described in my book on the Motion of the
Blood. To resolve this doubt I shall relate two experiments among many
others, the first of which, indeed, I have already adduced, and which
show with singular clearness that the blood flows incessantly and with
great force and in ample abundance in the veins towards the heart. The
internal jugular vein of a live fallow deer having been exposed, (many
of the nobility and his most serene majesty the king, my master, being
present,) was divided; but a few drops of blood were observed to escape
from the lower orifice rising up from under the clavicle; whilst from
the superior orifice of the vein and coming down from the head, a
round torrent of blood gushed forth. You may observe the same fact any
day in practising phlebotomy: if with a finger you compress the vein a
little below the orifice, the flow of blood is immediately arrested;
but the pressure being removed, forthwith the flow returns as before.
From any long vein of the forearm get rid of the blood as much as
possible by holding the hand aloft and pressing the blood towards the
trunk, you will perceive the vein collapsed and leaving, as it were,
in a furrow of the skin; but now compress the vein with the point of
a finger, and you will immediately perceive all that part of it which
is towards the hand, to enlarge and to become distended with the blood
that is coming from the hand. How comes it when the breath is held and
the lungs thereby compressed, a large quantity of air having been taken
in, that the vessels of the chest are at the same time obstructed, the
blood driven into the face, and the eyes rendered red and suffused?
Why is it, as Aristotle asks in his problems, that all the actions
are more energetically performed when the breath is held than when
it is given? In like manner, when the frontal and lingual veins are
incised, the blood is made to flow more freely by compressing the neck
and holding the breath. I have several times opened the breast and
pericardium of a man within two hours after his execution by hanging,
and before the colour had totally left the face, and in presence of
many witnesses, have demonstrated the right auricle of the heart and
lungs distended with blood; the auricle in particular of the size
of a large man’s fist, and so full of blood that it looked as if it
would burst. This great distension, however, had disappeared next day,
the body having stiffened and become cold, and the blood having made
its escape through various channels. These and other similar facts,
therefore, make it sufficiently certain that the blood flows through
the whole of the veins of the body towards the base of the heart, and
that unless there was a further passage afforded it, it would be pent
up in these channels, or would oppress and overwhelm the heart; as on
the other hand, did it not flow outwards by the arteries, but was found
regurgitating, it would soon be seen how much it would oppress.
I add another observation. A noble knight, Sir Robert Darcy, an
ancestor of that celebrated physician and most learned man, my very
dear friend Dr. Argent, when he had reached to about the middle period
of life, made frequent complaint of a certain distressing pain in
the chest, especially in the night season; so that dreading at one
time syncope, at another suffocation in his attacks he led an unquiet
and anxious life. He tried many remedies in vain, having had the
advice of almost every medical man. The disease going on from bad
to worse, he by and by became cachectic and dropsical, and finally,
grievously distressed, he died in one of his paroxysms. In the body
of this gentleman, at the inspection of which there were present Dr.
Argent, then president of the College of Physicians, and Dr. Gorge, a
distinguished theologian and preacher, who was pastor of the parish,
we found the wall of the left ventricle of the heart ruptured, having
a rent in it of size sufficient to admit any of my fingers, although
the wall itself appeared sufficiently thick and strong; this laceration
had apparently been caused by an impediment to the passage of the blood
from the left ventricle into the arteries.
I was acquainted with another strong man, who having received an
injury and affront from one more powerful than himself, and upon whom
he could not have his revenge, was so overcome with hatred and spite
and passion, which he yet communicated to no one, that at last he
fell into a strange distemper, suffering from extreme oppression and
pain of the heart and breast, and the prescriptions of none of the
very best physicians proving of any avail, he fell in the course of
a few years into a scorbutic and cachectic state, became tabid and
died. This patient only received some little relief when the whole of
his chest was pummelled or kneaded by a strong man, as a baker kneads
dough. His friends thought him poisoned by some maleficent influence,
or possessed with an evil spirit. His jugular arteries, enlarged to the
size of the thumb, looked like the aorta itself, or they were as large
as the descending aorta; they had pulsated violently, and appeared
like two long aneurisms. These symptoms had led to trying the effects
of arteriotomy in the temples, but with no relief. In the dead body I
found the heart and aorta so much gorged and distended with blood, that
the cavities of the ventricles equalled those of a bullock’s heart in
size. Such is the force of the blood pent up, and such are the effects
of its impulse.
We may therefore conclude, that although there may be impulse without
any exit, as illustrated in the experiment lately spoken of, still
that this could not take place in the vessels of living creatures
without most serious dangers and impediments. From this, however, it
is manifest that the blood in its course does not everywhere pass with
the same celerity, neither with the same force in all places and at all
times, but that it varies greatly according to age, sex, temperament,
habit of body, and other contingent circumstances, external as well
as internal, natural or non-natural. For it does not course through
intricate and obstructed passages with the same readiness that it does
through straight, unimpeded, and pervious channels. Neither does it
run through close, hard, and crowded parts, with the same velocity
as through spongy, soft, and permeable tissues. Neither does it flow
and penetrate with such swiftness when the impulse [of the heart] is
slow and weak, as when this is forcible and frequent, in which case
the blood is driven onwards with vigour and in large quantity. Nor
is the same blood, when it has become more consistent or earthy, so
penetrative as when it is more serous and attenuated or liquid. And
then it seems only reasonable to think that the blood in its circuit
passes more slowly through the kidneys than through the substance of
the heart; more swiftly through the liver than through the kidneys;
through the spleen more quickly than through the lungs, and through
the lungs more speedily than through any of the other viscera or the
muscles, in proportion always to the denseness or sponginess of the
tissue of each.
We may be permitted to take the same view of the influence of age, sex,
temperament, and habit of body, whether this be hard or soft; of that
of the ambient cold which condenses bodies, and makes the veins in the
extremities to shrink and almost to disappear, and deprives the surface
both of colour and heat; and also that of meat and drink which render
the blood more watery, by supplying fresh nutritive matter. From the
veins, therefore, the blood flows more freely in phlebotomy when the
body is warm than when it is cold. We also observe the signal influence
of the affections of the mind when a timid person is bled and happens
to faint: immediately the flow of blood is arrested, a deadly pallor
overspreads the surface, the limbs stiffen, the ears sing, the eyes are
dazzled or blinded, and, as it were, convulsed. But here I come upon
a field where I might roam freely and give myself up to speculation.
And, indeed, such a flood of light and truth breaks in upon me here;
occasion offers of explaining so many problems, of resolving so many
doubts, of discovering the causes of so many slighter and more serious
diseases, and of suggesting remedies for their cure, that the subject
seems almost to demand a separate treatise. And it will be my business
in my “Medical Observations,” to lay before my reader matter upon all
these topics which shall be worthy of the gravest consideration.
And what indeed is more deserving of attention than the fact that in
almost every affection, appetite, hope, or fear, our body suffers,
the countenance changes, and the blood appears to course hither and
thither. In anger the eyes are fiery and the pupils contracted; in
modesty the cheeks are suffused with blushes; in fear, and under a
sense of infamy and of shame, the face is pale, but the ears burn as
if for the evil they heard or were to hear; in lust how quickly is the
member distended with blood and erected! But, above all, and this is
of the highest interest to the medical practitioner,--how speedily is
pain relieved or removed by the detraction of blood, the application
of cupping-glasses, or the compression of the artery which leads to a
part? It sometimes vanishes as if by magic. But these are topics that
I must refer to my “Medical Observations,” where they will be found
exposed at length and explained.
Some weak and inexperienced persons vainly seek by dialectics and
far-fetched arguments, either to upset or establish things that are
only to be founded on anatomical demonstration, and believed on the
evidence of the senses. He who truly desires to be informed of the
question in hand, and whether the facts alleged be sensible, visible,
or not, must be held bound either to look for himself, or to take
on trust the conclusions to which they have come who have looked;
and indeed there is no higher method of attaining to assurance and
certainty. Who would pretend to persuade those who had never tasted
wine that it was a drink much pleasanter to the palate than water? By
what reasoning should we give the blind from birth to know that the sun
was luminous, and far surpassed the stars in brightness? And so it is
with the circulation of the blood, which the world has now had before
it for so many years, illustrated by proofs cognizable by the senses,
and confirmed by various experiments. No one has yet been found to
dispute the sensible facts, the motion, efflux and afflux of the blood,
by like observations based on the evidence of sense, or to oppose
the experiments adduced, by other experiments of the same character;
nay, no one has yet attempted an opposition on the ground of ocular
testimony.
There have not been wanting many who, inexperienced and ignorant of
anatomy, and making no appeal to the senses in their opposition, have,
on the contrary, met it with empty assertions, and mere suppositions,
with assertions derived from the lessons of teachers and captious
cavillings; many, too, have vainly sought refuge in words, and these
not always very nicely chosen, but reproachful and contumelious; which,
however, have no farther effect than to expose their utterer’s vanity
and weakness, and ill breeding and lack of the arguments that are to
be sought in the conclusions of the senses, and false sophistical
reasonings that seem utterly opposed to sense. Even as the waves of
the Sicilian sea, excited by the blast, dash against the rocks around
Charybdis, and then hiss and foam, and are tossed hither and thither;
so do they who reason against the evidence of their senses.
Were nothing to be acknowledged by the senses without evidence
derived from reason, or occasionally even contrary to the previously
received conclusions of reason, there would now be no problem left
for discussion. Had we not our most perfect assurances by the senses,
and were not their perceptions confirmed by reasoning, in the same
way as geometricians proceed with their figures, we should admit no
science of any kind; for it is the business of geometry, from things
sensible, to make rational demonstration of things that are not
sensible; to render credible or certain things abstruse and beyond
sense from things more manifest and better known. Aristotle counsels
us better when, in treating of the generation of bees, he says:[51]
“Faith is to be given to reason, if the matters demonstrated agree
with those that are perceived by the senses; when the things have been
thoroughly scrutinized, then are the senses to be trusted rather than
the reason.” Whence it is our duty to approve or disapprove, to receive
or reject everything only after the most careful examination; but to
examine, to test whether anything have been well or ill advanced, to
ascertain whether some falsehood does not lurk under a proposition, it
is imperative on us to bring it to the proof of sense, and to admit or
reject it on the decision of sense. Whence Plato in his Critias says,
that the explanation of those things is not difficult of which we can
have experience; whilst they are not of apt scientific apprehension who
have no experience.
[51] De Generat. Animal. lib. iii, cap. x.
How difficult is it to teach those who have no experience, the things
of which they have not any knowledge by their senses! And how useless
and intractable, and unimpregnable to true science are such auditors!
They show the judgment of the blind in regard to colours, of the deaf
in reference to concords. Who ever pretended to teach the ebb and flow
of the tide, or from a diagram to demonstrate the measurements of the
angles and the proportions of the sides of a triangle to a blind man,
or to one who had never seen the sea nor a diagram? He who is not
conversant with anatomy, inasmuch as he forms no conception of the
subject from the evidence of his own eyes, is virtually blind to all
that concerns anatomy, and unfit to appreciate what is founded thereon;
he knows nothing of that which occupies the attention of the anatomist,
nor of the principles inherent in the nature of the things which guide
him in his reasonings; facts and inferences as well as their sources
are alike unknown to such a one. But no kind of science can possibly
flow, save from some pre-existing knowledge of more obvious things;
and this is one main reason why our science in regard to the nature
of celestial bodies, is so uncertain and conjectural. I would ask of
those who profess a knowledge of the causes of all things, why the
two eyes keep constantly moving together, up or down, to this side or
to that, and not independently, one looking this way, another that;
why the two auricles of the heart contract simultaneously, and the
like? Are fevers, pestilence, and the wonderful properties of various
medicines to be denied because their causes are unknown? Who can tell
us why the fœtus in utero, breathing no air up to the tenth month of
its existence, is yet not suffocated? Born in the course of the seventh
or eighth month, and having once breathed, it is nevertheless speedily
suffocated if its respiration be interrupted. Why can the fœtus still
contained within the uterus, or enveloped in the membranes, live
without respiration; whilst once exposed to the air, unless it breathes
it inevitably dies?[52]
[52] Vide Chapter VI. of the Disq. on the Motion of the Heart and
Blood.
Observing that many hesitate to acknowledge the circulation, and others
oppose it, because, as I conceive, they have not rightly understood
me, I shall here recapitulate briefly what I have said in my work on
the Motion of the Heart and Blood. The blood contained in the veins,
in its magazine, and where it is collected in largest quantity, viz.
in the vena cava, close to the base of the heart and right auricle,
gradually increasing in temperature by its internal heat, and becoming
attenuated, swells and rises like bodies in a state of fermentation,
whereby the auricle being dilated, and then contracting, in virtue
of its pulsative power, forthwith delivers its charge into the right
ventricle; which being filled, and the systole ensuing, the charge,
hindered from returning into the auricle by the tricuspid valves, is
forced into the pulmonary artery, which stands open to receive it,
and is immediately distended with it. Once in the pulmonary artery,
the blood cannot return, by reason of the sigmoid valves; and then
the lungs, alternately expanded and contracted during inspiration and
expiration, afford it passage by the proper vessels into the pulmonary
veins; from the pulmonary veins, the left auricle, acting equally and
synchronously with the right auricle, delivers the blood into the left
ventricle; which acting harmoniously with the right ventricle, and all
regress being prevented by the mitral valves, the blood is projected
into the aorta, and consequently impelled into all the arteries of
the body. The arteries, filled by this sudden push, as they cannot
discharge themselves so speedily, are distended; they receive a shock,
or undergo their diastole. But as this process goes on incessantly, I
infer that the arteries both of the lungs and of the body at large,
under the influence of such a multitude of strokes of the heart and
injections of blood, would finally become so over-gorged and distended,
that either any further injection must cease, or the vessels would
burst, or the whole blood in the body would accumulate within them,
were there not an exit provided for it.
The same reasoning is applicable to the ventricles of the heart:
distended by the ceaseless action of the auricles, did they not
disburthen themselves by the channels of the arteries, they would by
and by become over-gorged, and be fixed and made incapable of all
motion. Now this, my conclusion, is true and necessary, if my premises
be true; but that these are either true or false, our senses must
inform us, not our reason--ocular inspection, not any process of the
mind.
I maintain further, that the blood in the veins always and everywhere
flows from less to greater branches, and from every part towards
the heart; whence I gather that the whole charge which the arteries
receive, and which is incessantly thrown into them, is delivered to the
veins, and flows back by them to the source whence it came. In this
way, indeed, is the circulation of the blood established: by an efflux
and reflux from and to the heart; the fluid being forcibly projected
into the arterial system, and then absorbed and imbibed from every
part by the veins, it returns through these in a continuous stream.
That all this is so, sense assures us; and necessary inference from the
perceptions of sense takes away all occasion for doubt. Lastly, this is
what I have striven, by my observations and experiments, to illustrate
and make known; I have not endeavoured from causes and probable
principles to demonstrate my propositions, but, as of higher authority,
to establish them by appeals to sense and experiment, after the manner
of anatomists.
And here I would refer to the amount of force, even of violence, which
sight and touch make us aware of in the heart and greater arteries;
and to the systole and diastole constituting the pulse in the large
warm-blooded animals, which I do not say is equal in all the vessels
containing blood, nor in all animals that have blood; but which is of
such a nature and amount in all, that a flow and rapid passage of the
blood through the smaller arteries, the interstices of the tissues, and
the branches of the veins, must of necessity take place; and therefore
there is a circulation.
For neither do the most minute arteries, nor the veins, pulsate; but
the larger arteries and those near the heart pulsate, because they
do not transmit the blood so quickly as they receive it.[53] Having
exposed an artery, and divided it so that the blood shall flow out as
fast and freely as it is received, you will scarcely perceive any pulse
in that vessel; and for the simple reason, that an open passage being
afforded, the blood escapes, merely passing through the vessel, not
distending it. In fishes, serpents, and the colder animals, the heart
beats so slowly and feebly, that a pulse can scarcely be perceived in
the arteries; the blood in them is transmitted gradually. Whence in
them, as also in the smaller branches of the arteries in man, there is
no distinction between the coats of the arteries and veins, because
the arteries have to sustain no shock from the impulse of the blood.
[53] Vide Chapter III, on the Motion of the Heart and Blood.
An artery denuded and divided in the way I have indicated, sustains no
shock, and therefore does not pulsate; whence it clearly appears that
the arteries have no inherent pulsative power, and that neither do
they derive any from the heart; but that they undergo their diastole
solely from the impulse of the blood; for in the full stream, flowing
to a distance, you may see the systole and diastole, all the motions
of the heart--their order, force, rhythm, &c.,[54] as it were in a
mirror, and even perceive them by the touch. Precisely as in the water
that is forced aloft, through a leaden pipe, by working the piston
of a forcing-pump, each stroke of which, though the jet be many feet
distant, is nevertheless distinctly perceptible,--the beginning,
increasing strength, and end of the impulse, as well as its amount,
and the regularity or irregularity with which it is given, being
indicated, the same precisely is the case from the orifice of a divided
artery; whence, as in the instance of the forcing engine quoted, you
will perceive that the efflux is uninterrupted, although the jet is
alternately greater and less. In the arteries, therefore, besides the
concussion or impulse of the blood, the pulse or beat of the artery,
which is not equally exhibited in all, there is a perpetual flow and
motion of the blood, which returns in an unbroken stream to the point
from whence it commenced--the right auricle of the heart.
[54] Vide Chapter III, on the Motion of the Heart and Blood.
All these points you may satisfy yourself upon, by exposing one of the
longer arteries, and having taken it between your finger and thumb,
dividing it on the side remote from the heart. By the greater or less
pressure of your fingers, you can have the vessel pulsating less or
more, or losing the pulse entirely, and recovering it at will. And
as these things proceed thus when the chest is uninjured, so also do
they go on for a short time when the thorax is laid open, and the
lungs having collapsed, all the respiratory motions have ceased; here,
nevertheless, for a little while you may perceive the left auricle
contracting and emptying itself, and becoming whiter; but by and by
growing weaker and weaker, it begins to intermit, as does the left
ventricle also, and then it ceases to beat altogether, and becomes
quiescent. Along with this, and in the same measure, does the stream
of blood from the divided artery grow less and less, the pulse of the
vessel weaker and weaker, until at last, the supply of blood and the
impulse of the left ventricle failing, nothing escapes from it. You
may perform the same experiment, tying the pulmonary veins, and so
taking away the pulse of the left auricle, or relaxing the ligature,
and restoring it at pleasure. In this experiment, too, you will observe
what happens in moribund animals--viz. that the left ventricle first
ceases from pulsation and motion, then the left auricle, next the right
ventricle, finally the right auricle; so that where the vital force and
pulse first begin, there do they also last fail.
All of these particulars having been recognized by the senses, it is
manifest that the blood passes through the lungs, not through the
septum [in its course from the right to the left side of the heart],
and only through them when they are moved in the act of respiration,
not when they are collapsed and quiescent; whence we see the probable
reason wherefore nature has instituted the foramen ovale in the fœtus,
instead of sending the blood by the way of the pulmonary artery into
the left auricle and ventricle, which foramen she closes when the
new-born creature begins to breathe freely. We can also now understand
why, when the vessels of the lungs become congested and oppressed,
and in those who are affected with serious diseases, it should be
so dangerous and fatal a symptom when the respiratory organs become
implicated.
We perceive further, why the blood is so florid in the lungs, which
is, because it is thinner, as having there to undergo filtration.
Still further; from the summary which precedes, and by way of
satisfying those who are importunate in regard to the causes of the
circulation, and incline to regard the power of the heart as competent
to everything--as that it is not only the seat and source of the
pulse which propels the blood, but also, as Aristotle thinks, of the
power which attracts and produces it; moreover, that the spirits are
engendered by the heart, and the influxive vital heat, in virtue of
the innate heat of the heart, as the immediate instrument of the
soul, or common bond and prime organ in the performance of every act
of vitality; in a word, that the motion, perfection, heat, and every
property besides of the blood and spirits are derived from the heart,
as their fountain or original, (a doctrine as old as Aristotle, who
maintained all these qualities to inhere in the blood, as heat inheres
in boiling water or pottage,) and that the heart is the primary cause
of pulsation and life; to those persons, did I speak openly, I should
say that I do not agree with the common opinion; there are numerous
particulars to be noted in the production of the parts of the body
which incline me this way, but which it does not seem expedient to
enter upon here. Before long, perhaps, I shall have occasion to lay
before the world things that are more wonderful than these, and that
are calculated to throw still greater light upon natural philosophy.
Meantime I shall only say, and, without pretending to demonstrate it,
propound--with the good leave of our learned men, and with all respect
for antiquity--that the heart, with the veins and arteries and the
blood they contain, is to be regarded as the beginning and author,
and fountain and original of all things in the body, the primary
cause of life; and this in the same acceptation as the brain with its
nerves, organs of sense and spinal marrow inclusive, is spoken of as
the one and general organ of sensation. But if by the word heart the
mere body of the heart, made up of its auricles and ventricles, be
understood, then I do not believe that the heart is the fashioner of
the blood; neither do I imagine that the blood has powers, properties,
motion, or heat, as the gift of the heart; lastly, neither do I admit
that the cause of the systole and contraction is the same as that of
the diastole or dilatation, whether in the arteries, auricles, or
ventricles; for I hold that that part of the pulse which is designated
the diastole depends on another cause different from the systole, and
that it must always and everywhere precede any systole; I hold that
the innate heat is the first cause of dilatation, and that the primary
dilatation is in the blood itself, after the manner of bodies in a
state of fermentation, gradually attenuated and swelling, and that in
the blood is this finally extinguished; I assent to Aristotle’s example
of gruel or milk upon the fire, to this extent, that the rising and
falling of the blood does not depend upon vapours or exhalations, or
spirits, or anything rising in a vaporous or aëreal shape, nor upon any
external agency, but upon an internal principle under the control of
nature.