to-day without emotion. In it he sets forth the mystery that has
surrounded the subject of the motion and function of the heart, as well
as the attendant difficulties of the subject, speaking of his own early
despair that he would ever be able to clear up the subject. He even
said that at one time he found the matter so beset with difficulties
that he was inclined to agree with Fracastorius "that the movements of
the heart and their purpose could be comprehended by God alone." Only
later was this despair dispelled by a suggestion when, as he says: "I
began to think whether there might not be a movement in a circle" when
thus the truth dawned fully upon him.
We shall have to speak later of the opposition provoked by the
appearance of this work and its almost general rejection. It is
perhaps, however, but just to those who disputed Harvey's discoveries
to recall that no complete and actual demonstration of the actual
circulation was possible at that time, nor for many years after, and
until the introduction of the microscope, the common magnifying glass
of that day being the only lens in use. It remained for Malpighi to
demonstrate the blood actually in circulation in the lung of a frog
some three or four years after Harvey's death, in 1657. But Harvey
lived long enough to see his views gain general acceptance, and
though at first, and as the result of the opposition provoked by his
publication, his practice fell off mightily, he later regained his
professional position and rose to the highest eminence, being elected
in 1654 to the Presidency of the College of Physicians. To this
institution he proved a great benefactor, making considerable additions
to the building after its destruction in The Great Fire of 1666 and
its subsequent restoration. He also left a certain sum of money as a
foundation for an annual oration, to be delivered in commemoration
of those who had been great benefactors of the College. This oration
is still regularly delivered on St. Luke's Day, i. e., the 18th of
October, and is ordinarily known as the Harveian oration. In these
orations more or less reference to Harvey's work and influence is
always made.
This great man passed away on the 3d of June, 1657, within ten months
of his eightieth birthday, thus affording a brilliant exception to the
list of men who have rendered great service to the world and not lived
long enough to see it appreciated.
As one reads Harvey's own words, the wonder ever grows that it should
have remained for him, after the lapse of so many centuries, to not
only call attention to what had been said by Galen but apparently
forgotten by his successors, namely, that "the arteries contained blood
and nothing but blood, and, consequently, neither spirits nor air,
as may be readily gathered from experiments and reasonings," which
he elsewhere furnishes. He furthermore shows how Galen demonstrated
this by applying two ligatures upon an exposed artery at some distance
from each other, and then opening the vessel itself in which nothing
but blood could be found. He calls attention also to the result of
ligation of one of the large vessels of an extremity, the inevitable
result being just what we to-day know it must be, and the procedure
terminating with gangrene of the limb.
Not long before Harvey's own publication, Fabricius, he of
Aquapendente, had published a work on respiration, stating that, as
the pulsation of the heart and arteries was insufficient for the
ventilation and refrigeration of the blood, therefore were the lungs
fashioned to surround the heart. Harvey showed how the arterial pulse
and respiration could not serve the same ends, combating the view
generally held, that if the arteries were filled with air, a larger
quantity of air penetrating when the pulse is large and full, it
must come to pass that if one plunge into a bath of water or of oil
when the pulse is strong and full it should forthwith become either
smaller or much slower, since the surrounding fluid would render it
either difficult or impossible for air to penetrate. He also called
attention to the inconsistencies between this view and the arrangement
of the prenatal circulation; also to the fact that marine animals,
living in the depths of the sea, could under no circumstances take
in or emit air by the movements of their arteries and beneath the
infinite mass of waters, inasmuch as "to say that they absorb the air
that is present in the water and emit their fumes into this medium,
were to utter something very like a figment;" furthermore "when the
windpipe is divided, air enters and returns through the wound by two
opposite movements, but when an artery is divided blood escapes in one
continuous stream and no air passes."
Discussing further the views which he stigmatized as so incongruous
and mutually subversive that every one of them is justly brought
under suspicion, he reverts again to the statements of Galen, calling
attention to the fact that from a single divided artery the whole of
the blood of the body may be withdrawn in the course of half an hour
or less, and to the inevitable consequences of such an act; also that
when an artery is opened the blood is emptied with force and in jets,
and that the impulse corresponds with that of the heart; again that in
an aneurism the pulsation is the same as in other arteries, appealing
for corroboration in this matter to the recent statements of Riolan,
who later became his avowed enemy. Harvey also called attention to the
fact that while ordinarily there was a seemingly fixed relation between
respiration and pulse-rate, this might vary very much under certain
circumstances, showing that respiration and circulation were two
totally different processes. Harvey utilized also the results of his
researches in comparative anatomy and physiology, for early in his work
he called attention to the fact that every animal which is unfurnished
with lungs lacks a right ventricle.
In his Proemium he then proceeds to ask certain very pertinent
questions which can only be briefly summarized in this place. He asks:
First, why, inasmuch as the structure of both ventricles is practically
identical, it should be imagined that their uses are different, and
why, if tricuspid valves are placed at the entrance into the right
ventricle and prove obstacles to the return of blood into vena cava,
and if similar valves are situated at the commencement of the pulmonary
artery, preventing return of blood into the ventricle, then why, when
similar valves are found in connection with the other side of the
heart, should we deny that they are there for the same purpose of
prevention "here the egress" and "there the regurgitation of the blood?"
Secondly, he asks why, in view of the similarity of these structures,
it should be said that things are arranged in the left ventricle for
the egress and regress of spirits, and in the right ventricle for those
of blood?
Thirdly, he enquires why, when one notes the resemblance between the
passages and vessels connected with the opposite sides of the heart,
one should regard one side as destined to a private purpose, namely,
that of nourishing the lungs, the other to a more public function?
Furthermore, he enquires, since the lungs are so near, and in continual
movement, and the vessels supplying them of such dimensions, what can
be the use of the pulse of the right ventricle, which he had often
observed in the course of his experiments? He sums up his inability
to accept the explanations previously offered with a phrase which
reads rather strangely, even in original Latin: "Deus bone! Quomodo
tricuspides impediunt aëris egressum, non sanguinis." i. e., "Good God!
how should the mitral valves prevent the regurgitation of air and not
of blood?"
He then takes up the views of those who have believed that the blood
oozed through the septum of the heart from the right to the left side
by certain secret pores, and to them he replied "By Hercules, no such
pores can be demonstrated, nor, in fact, do any such exist." Again,
"Besides, if the blood could permeate the substance of the septum,
or could be emptied from the ventricles, what use were there for the
coronary artery and vein, branches of which proceed to the septum
itself, to supply it with nourishment?"
Further on in the treatise Harvey sets forth his motives for writing,
stating how greatly unsettled had become his mind in that he did not
know what he himself should conclude nor what to believe from others.
He says: "I was not surprised that Laurentius should have written that
the movements of the heart were as perplexing as the flux and reflux
of Euripus had appeared to Aristotle." He apologizes for the crime,
as some of his friends considered it, that he should dare to depart
from the precepts and opinions of all anatomists. He acknowledged
that he took the step all the more willingly, seeing that Fabricius,
who had accurately and learnedly delineated almost every one of the
several parts of animals in a special work, had left the heart entirely
untouched.
Passing more directly to the actual work of the heart, he shows that
not only are the ventricles contracted by virtue of the muscular
structure of their own walls, but further that those fibers or bands,
styled "Nerves" by Aristotle, that are so conspicuous in the ventricles
of larger animals when they contract simultaneously, by an admirable
adjustment, help to draw together all the internal surfaces as if
with cords, thus expelling the charge of contained blood with force.
Later on he says that if the pulmonary artery be opened, blood will
be seen spurting forth from it, just as when any other artery is
punctured, and that the same result follows division of the vessel
which in fishes leads from the heart. He furnishes a very happy simile
to prove that the pulses of the arteries are due to the impulses of
the left ventricle by showing how, when one blows into a glove all of
its fingers will be found to have become distended at one and the same
time. He quotes Aristotle, who made no distinction between veins and
arteries, but said that the blood of all animals palpitates within
their vessels and by the pulse is sent everywhere simultaneously, all
of this depending upon the heart.
It is in Chapter Five of the treatise that he gives, probably for the
first time, an accurate published account of just what transpires with
one complete cycle of cardiac activity. The passage need not be quoted
here, but deserves to be read by everyone interested in the subject,
as who should not be? One sentence, however, is worth quotation or,
at least, a summary, as follows: "But if the divine Galen will here
allow, as in other places he does, that all the arteries of the body
arise from the great artery, and that this takes its origin from the
heart; that all the vessels naturally contain and carry blood; that the
three semilunar valves situated at the orifice of the aorta prevent the
return of the blood into the heart, and that they were here for some
important purpose,--I do not see how he can deny that the great artery
is the very vessel to carry the blood, when it has attained its highest
triumph of perfection, from the heart for distribution to all parts of
the body."
His Chapter Six deals with the course by which blood is carried from
the right into the left ventricle, and here one must admire the large
number of experimental demonstrations which Harvey had undertaken upon
all classes of animals, for he speaks even of that which occurs in
small insects, whose circulation he had studied so far as he could with
the simple lens. Furthermore he described the prenatal circulation,
omitting practically nothing of that which is taught to-day, showing
that in embryos, while the lungs are yet in a state of inaction, both
ventricles of the heart are employed, as if they were but one, for
the transmission of blood. In concluding this chapter he again states
briefly the course of the blood, and promises to show, first, that this
may be so and, then, to prove that it really is so.
His Chapter Seven is devoted to showing how the blood passes through
the substance of the lungs from the right ventricle and then on into
the pulmonary vein and left ventricle. He alludes to the multitude of
doubters as belonging, as the poet had said, to that race of men who,
when they will, assent full readily, and when they will not, by no
matter of means; who, when their assent is wanted, fear, and when it is
not, fear not to give it. A little later on he says: "As there are some
who admit nothing unless upon authority, let them learn that the truth
I am contending for can be confirmed from Galen's own words, namely,
that not only may the blood be transmitted from the pulmonary artery
into the pulmonary veins and then into the left ventricle of the heart,
but that this is effected by the ceaseless pulsation of the heart and
the movements of the lungs in breathing." He then shows how Galen
explained the uses of the valves and the necessity for their existence,
as well as the universal mutual anastomosis of the arteries with the
veins, and that the heart is incessantly receiving and expelling blood
by and from its ventricles, for which purpose it is furnished with four
sets of valves, two for escape and two for inlet and their regulation.
Harvey then noted a well-known clinical fact, that the more frequent
or forcible the pulsations, the more speedily might the body be
deprived of its blood during hemorrhage, and that it thus happens that
in fainting fits and the like, when the heart beats more languidly,
hemorrhages are diminished and arrested. The balance of the book is
practically devoted to further demonstration and corroboration of
statements already made. A study of this work of Harvey's illustrates
how much respect even he and his contemporaries still showed for the
authority of Galen. It shows still further how nearly Galen came
to the actual truth concerning the circulation. Had the latter not
adopted too many of the notions of his predecessors concerning the
nature of the soul (Anima) and the spirits (Pneuma) of man, he might
himself have anticipated Harvey by a thousand years, and by such
announcement of a great truth have set forward physiology by an equal
period. Independent and original as Harvey showed himself, he seems to
have failed to get away from the notion of the vapors and spiritual
nature of the blood which he had inherited from the writings of Galen
and many others. Nevertheless he also alludes to this same blood as
alimentive and nutritive. We must not forget, however, that this was
years before Priestly's discovery of oxygen and that Harvey had, like
others, no notion of the actual purpose of the lungs, believing that
the purification and revivification of the blood was the office of the
heart itself.
Along with its other intrinsic merits Harvey's book possesses a clear
and logical arrangement, the author first disposing of the errors of
antiquity, describing next the behavior of the heart in the living
animal, showing its automatic pumplike structure, its alternate
contractions and the other phenomena already alluded to, thus piling
up facts one upon another in a manner which proved quite irresistible.
The only thing that he missed was the ultimate connection between the
veins and the arteries, i. e., the capillaries, which it remained for
Malpighi to discover with the then new and novel microscope, which he
did about 1657, showing the movement of the blood cells in the small
vessels, and confirming the reality of that ultimate communication
which had been held to exist. Malpighi discovered the blood corpuscles
in 1665, but it remained for Leeuwenhoek, of Delft, in 1690, by using
an improved instrument to demonstrate to all observers the actual
movements of the circulating blood in the living animal. One historian
has said that with Harvey's overthrow of the old teachings regarding
the importance of the liver and of the spirits in the heart "fell the
four fundamental humors and qualities" while Daremberg exclaims: "As
in one of the days of the creation, chaos disappeared and light was
separated from darkness."
It remains now only to briefly consider how Harvey's great discovery
was received. To quote the words of one writer: "So much care and
circumspection in search for truth, so much modesty and firmness in
its demonstration, so much clearness and method in the development of
his ideas, should have prepossessed everyone in favor of the theory
of Harvey; on the contrary, it caused a general stupefaction in the
medical world and gave rise to great opposition."
During the quarter of a century which elapsed after Harvey's
announcement there probably was not an anatomist nor physiologist
of any prominence who did not take active part in the controversy
engendered by it; even the philosopher Descartes was one of the first
adherents of the doctrine of the circulation, which he corroborated by
experiments of his own.
Two years after the appearance of Harvey's book appeared an attack,
composed in fourteen days by one Primerose, a man of Scotch descent,
born and educated in France, but practising at Hull, in which he
pronounced the impossibilities of surpassing the ancients or improving
on the work of Riolan, who already had written in opposition to Harvey,
and who was the only one to whom the latter vouchsafed an answer. It
was Riolan who procured a decree of the Faculty of Paris prohibiting
the teaching of Harvey's doctrine. It was this same Riolan who combated
with equal violence and obstinacy the other great discovery of the age,
namely,--the circulation of the lymph.
One of the earliest and fiercest adversaries of Harvey's theory was
Plempius, of Louvaine, who, however, gave way to the force of argument
and who finally publicly and voluntarily passed over to the ranks of
its defenders in 1652, becoming one of Harvey's most enthusiastic
advocates.
Harvey's conduct through the controversy was always of the most
dignified character; in fact, he rarely ventured to reply in any
way to his adversaries, believing in the ultimate triumph of the
truths which he had enunciated. His only noteworthy reply was one
addressed to Riolan, then Professor in the Paris Faculty and one of
the greatest anatomists of his age, to whose opinion great value was
always attached. Even in debating or arguing against him, Harvey always
spoke of him with great deference, calling him repeatedly The Prince of
Science. Riolan was, however, never converted, though whether he held
to his previous position from obstinacy, from excess of respect for the
ancients, or from envy and jealousy of his contemporary, is not known.
Another peculiar spectacle was afforded by one Parisunus, who died in
1643, a physician in Venice, who, like Harvey, had been a pupil of
Fabricius of Aquapendente, who had been stigmatized by Riolan as an
ignoramus in anatomy, but who joined with others in declaring that he
had seen the heart beat when perfectly bloodless, and that no beating
of the heart and no sounds were to be heard as Harvey had affirmed.
With the later and more minute studies into the structure and function
of the heart we are not here concerned. The endeavor has been rather
to place before you the sentiments, the knowledge and the habits of
thought of the men of Harvey's time, with the briefest possible epitome
of what they knew, or rather of how little they knew, to account for
this later slavish adherence to authority by unwillingness to reason
independently, or to observe natural phenomena intelligently, still
less to experiment with them. It is, then, rather the brief history
of an epochal discovery than an effort to trace out its far-reaching
consequences that I have endeavored to give.
Here must close an account which perhaps has been to you tedious, and
yet which is really brief, of Harvey's life and labors. He lived to see
his views generally accepted and to enjoy his own triumph, a pleasure
not attained by many great inventors or discoverers. Lessons of great
importance may be gathered from a more careful study of this great
historical epoch, but they must be left to your own powers of reasoning
rather than to what I may add here. I commend it to you as a fertile
source of inspiration, and a line of research worthy of both admiration
and imitation. Few men have rendered greater service to the world by
the shedding of blood than did Harvey, in his innocent and wonderful
studies of its natural movement. Perhaps it might be said of him that
he was the first man to show that "blood will tell." What he made it
tell has been thus briefly told to you.
I know not how I may better close this account than by quoting the
concluding words of his famous book, and especially repeating the lines
which he has quoted from some Latin author whom I have not been able to
identify. His paragraph and his quotation are as follows:
"Finally, if any use or benefit to this department of the republic of
letters should accrue from my labors, it will, perhaps, be allowed that
I have not lived idly, and, as the old man in the comedy says:
'For never yet hath anyone attained
To such perfection, but that time, and place,
And use, have brought addition to his knowledge;
Or made correction, or admonished him,
That he was ignorant of much which he
Had thought he knew; or led him to reject
What he had once esteemed of highest price.'"
XIII
HISTORY OF ANAESTHESIA AND THE INTRODUCTION OF ANAESTHETICS IN
SURGERY[10]
[10] Commemorative Address delivered at the Medical Department,
University of Buffalo, October 16, 1896.
IN COMMEMORATION OF THE SEMI-CENTENNIAL OF THE INTRODUCTION OF ETHER AS
AN ANAESTHETIC AGENT
Fifty years ago to-day--that is to say, on the 16th of October,
1846,--there occurred an event which marks as distinct a step in human
progress as almost any that could be named by the erudite historian.
I refer to the first demonstration of the possibility of alleviating
pain during surgical operations. Had this been the date of a terrible
battle, on land or sea, with mutual destruction of thousands of human
beings, the date itself would have been signalized in literature and
would have been impressed upon the memory of every schoolboy, while the
names of the great military murderers who commanded the opposing armies
would have been emblasoned upon monuments and the pages of history. But
this event was merely the conquest of pain and the alleviation of human
suffering, and no one who has ever served his race by contributing to
either of these results has been remembered beyond his own generation
or outside the circle of his immediate influence. Such is the irony
of fate. The world erects imposing monuments or builds tombs, like
that of Napoleon, to the memory of those who have been the greatest
destroyers of their race; and so Cæsar, Hannibal, Genghis Khan, Richard
the Lion-hearted, Gustavus Vasa, Napoleon and hundreds of other great
military murderers have received vastly more attention, because of
their race-destroying propensities and abilities, than if they had ever
fulfilled fate in any other capacity. But the men like Sir Spencer
Wells, who has added his 40,000 years of life to the total of human
longevity, or like Sir Joseph Lister, who has shown our profession
how to conquer that arch enemy of time past, surgical sepsis, or like
Morton, who first publicly demonstrated how to bring on a safe and
temporary condition of insensibility to pain, are men more worthy in
our eyes of lasting fame, and much greater heroes of their times, and
of all time,--yet are practically unknown to the world at large, to
whom they have ministered in such an unmistakable and superior way.
This much, then, by way of preface and reason for commemorating in this
public way the semi-centennial of this really great event. Because
the world does scant honor to these men we should be all the more
mindful of their services, and all the more insistent upon their public
recognition.