The Harvard Classics Part 9

CHAPTER XIII

THE THIRD POSITION IS CONFIRMED: AND THE CIRCULATION OF THE BLOOD IS DEMONSTRATED FROM IT

Thus far we have spoken of the quant.i.ty of blood pa.s.sing through the heart and the lungs in the centre of the body, and in like manner from the arteries into the veins in the peripheral parts and the body at large. We have yet to explain, however, in what manner the blood finds its way back to the heart from the extremities by the veins, and how and in what way these are the only vessels that convey the blood from the external to the central parts; which done, I conceive that the three fundamental propositions laid down for the circulation of the blood will be so plain, so well established, so obviously true, that they may claim general credence. Now the remaining position will be made sufficiently clear from the valves which are found in the cavities of the veins themselves, from the uses of these, and from experiments cognisable by the senses.

The celebrated Hieronymus Fabricius of Aquapendente, a most skilful anatomist, and venerable old man, or, as the learned Riolan will have it, Jacobus Silvius, first gave representations of the valves in the veins, which consist of raised or loose portions of the inner membranes of these vessels, of extreme delicacy, and a sigmoid or semilunar shape. They are situated at different distances from one another, and diversely in different individuals; they are connate at the sides of the veins; they are directed upwards towards the trunks of the veins; the two--for there are for the most part two together--regard each other, mutually touch, and are so ready to come into contact by their edges, that if anything attempts to pa.s.s from the trunks into the branches of the veins, or from the greater vessels into the less, they completely prevent it; they are farther so arranged, that the horns of those that succeed are opposite the middle of the convexity of those that and so on alternately.

The discoverer of these valves did not rightly understand their use, nor have succeeding anatomists added anything to our knowledge: for their office is by no means explained when we are told that it is to hinder the blood, by its weight, from all flowing into inferior parts; for the edges of the valves in the jugular veins hang downwards, and are so contrived that they prevent the blood from rising upwards; the valves, in a word, do not invariably look upwards, but always toward the trunks of the veins, invariably towards the seat of the heart. I, and indeed others, have sometimes found valves in the emulgent veins, and in those of the mesentery, the edges of which were directed towards the vena cava and vena portae. Let it be added that there are no valves in the arteries, and that dogs, oxen, etc., have invariably valves at the divisions of their crural veins, in the veins that meet towards the top of the os sacrum, and in those branches which come from the haunches, in which no such effect of gravity from the erect position was to be apprehended. Neither are there valves in the jugular veins for the purpose of guarding against apoplexy, as some have said; because in sleep the head is more apt to be influenced by the contents of the carotid arteries. Neither are the valves present, in order that the blood may be retained in the divarications or smaller trunks and minuter branches, and not be suffered to flow entirely into the more open and capacious channels; for they occur where there are no divarications; although it must be owned that they are most frequent at the points where branches join. Neither do they exist for the purpose of rendering the current of blood more slow from the centre of the body; for it seems likely that the blood would be disposed to flow with sufficient slowness of its own accord, as it would have to pa.s.s from larger into continually smaller vessels, being separated from the ma.s.s and fountain head, and attaining from warmer into colder places.

But the valves are solely made and inst.i.tuted lest the blood should pa.s.s from the greater into the lesser veins, and either rupture them or cause them to become varicose; lest, instead of advancing from the extreme to the central parts of the body, the blood should rather proceed along the veins from the centre to the extremities; but the delicate valves, while they readily open in the right direction, entirely prevent all such contrary motion, being so situated and arranged, that if anything escapes, or is less perfectly obstructed by the cornua of the one above, the fluid pa.s.sing, as it were, by the c.h.i.n.ks between the cornua, it is immediately received on the convexity of the one beneath, which is placed transversely with reference to the former, and so is effectually hindered from getting any farther.

And this I have frequently experienced in my dissections of the veins: if I attempted to pa.s.s a probe from the trunk of the veins into one of the smaller branches, whatever care I took I found it impossible to introduce it far any way, by reason of the valves; whilst, on the contrary, it was most easy to push it along in the opposite direction, from without inwards, or from the branches towards the trunks and roots. In many places two valves are so placed and fitted, that when raised they come exactly together in the middle of the vein, and are there united by the contact of their margins; and so accurate is the adaptation, that neither by the eye nor by any other means of examination, can the slightest c.h.i.n.k along the line of contact be perceived. But if the probe be now introduced from the extreme towards the more central parts, the valves, like the floodgates of a river, give way, and are most readily pushed aside. The effect of this arrangement plainly is to prevent all motion of the blood from the heart and vena cava, whether it be upwards towards the head, or downwards towards the feet, or to either side towards the arms, not a drop can pa.s.s; all motion of the blood, beginning; in the larger and tending towards the smaller veins, is opposed and resisted by them; whilst the motion that proceeds from the lesser to end in the larger branches is favoured, or, at all events, a free and open pa.s.sage is left for it.

But that this truth may be made the more apparent, let an arm be tied up above the elbow as if for phlebotomy (A, A, fig. 1). At intervals in the course of the veins, especially in labouring people and those whose veins are large, certain knots or elevations (B, C, D, E, F) will be perceived, and this not only at the places where a branch is received (E, F), but also where none enters (C, D): these knots or risings are all formed by valves, which thus show themselves externally. And now if you press the blood from the s.p.a.ce above one of the valves, from H to O, (fig. 2,) and keep the point of a finger upon the vein inferiorly, you will see no influx of blood from above; the portion of the vein between the point of the finger and the valve O will be obliterated; yet will the vessel continue sufficiently distended above the valve (O, G). The blood being thus pressed out and the vein emptied, if you now apply a finger of the other hand upon the distended part of the vein above the valve O, (fig.

3,) and press downwards, you will find that you cannot force the blood through or beyond the valve; but the greater effort you use, you will only see the portion of vein that is between the finger and the valve become more distended, that portion of the vein which is below the valve remaining all the while empty (H, O, fig. 3).

It would therefore appear that the function of the valves in the veins is the same as that of the three sigmoid valves which we find at the commencement of the aorta and pulmonary artery, viz., to prevent all reflux of the blood that is pa.s.sing over them.

[NOTE.--Woodcuts of the veins of the arm to which these letters and figures refer appear here in the original.--C. N. B. C]

Farther, the arm being bound as before, and the veins looking full and distended, if you press at one part in the course of a vein with the point of a finger (L, fig. 4), and then with another finger streak the blood upwards beyond the next valve (N), you will perceive that this portion of the vein continues empty (L, N), and that the blood cannot retrograde, precisely as we have already seen the case to be in fig. 2; but the finger first applied (H, fig. 2, L, fig. 4), being removed, immediately the vein is filled from below, and the arm becomes as it appears at D C, fig. 1. That the blood in the veins therefore proceeds from inferior or more remote parts, and towards the heart, moving in these vessels in this and not in the contrary direction, appears most obviously. And although in some places the valves, by not acting with such perfect accuracy, or where there is but a single valve, do not seem totally to prevent the pa.s.sage of the blood from the centre, still the greater number of them plainly do so; and then, where things appear contrived more negligently, this is compensated either by the more frequent occurrence or more perfect action of the succeeding valves, or in some other way: the veins in short, as they are the free and open conduits of the blood returning TO the heart, so are they effectually prevented from serving as its channels of distribution FROM the heart.

But this other circ.u.mstance has to be noted: The arm being bound, and the veins made turgid, and the valves prominent, as before, apply the thumb or finger over a vein in the situation of one of the valves in such a way as to compress it, and prevent any blood from pa.s.sing upwards from the hand; then, with a finger of the other hand, streak the blood in the vein upwards till it has pa.s.sed the next valve above (N, fig. 4), the vessel now remains empty; but the finger at L being removed for an instant, the vein is immediately filled from below; apply the finger again, and having in the same manner streaked the blood upwards, again remove the finger below, and again the vessel becomes distended as before; and this repeat, say a thousand times, in a short s.p.a.ce of time. And now compute the quant.i.ty of blood which you have thus pressed up beyond the valve, and then multiplying the a.s.sumed quant.i.ty by one thousand, you will find that so much blood has pa.s.sed through a certain portion of the vessel; and I do now believe that you will find yourself convinced of the circulation of the blood, and of its rapid motion. But if in this experiment you say that a violence is done to nature, I do not doubt but that, if you proceed in the same way, only taking as great a length of vein as possible, and merely remark with what rapidity the blood flows upwards, and fills the vessel from below, you will come to the same conclusion.

CHAPTER XIV

CONCLUSION OF THE DEMONSTRATION OF THE CIRCULATION

And now I may be allowed to give in brief my view of the circulation of the blood, and to propose it for general adoption.

Since all things, both argument and ocular demonstration, show that the blood pa.s.ses through the lungs, and heart by the force of the ventricles, and is sent for distribution to all parts of the body, where it makes its way into the veins and porosities of the flesh, and then flows by the veins from the circ.u.mference on every side to the centre, from the lesser to the greater veins, and is by them finally discharged into the vena cava and right auricle of the heart, and this in such a quant.i.ty or in such a flux and reflux thither by the arteries, hither by the veins, as cannot possibly be supplied by the ingesta, and is much greater than can be required for mere purposes of nutrition; it is absolutely necessary to conclude that the blood in the animal body is impelled in a circle, and is in a state of ceaseless motion; that this is the act or function which the heart performs by means of its pulse; and that it is the sole and only end of the motion and contraction of the heart.

CHAPTER XV

THE CIRCULATION OF THE BLOOD IS FURTHER CONFIRMED BY PROBABLE REASONS

It will not be foreign to the subject if I here show further, from certain familiar reasonings, that the circulation is matter both of convenience and necessity. In the first place, since death is a corruption which takes place through deficiency of heat, [Footnote: Aristoteles De Respirations, lib. ii et iii: De Part. Animal. et alibi.] and since all living things are warm, all dying things cold, there must be a particular seat and fountain, a kind of home and hearth, where the cherisher of nature, the original of the native fire, is stored and preserved; from which heat and life are dispensed to all parts as from a fountain head; from which sustenance may be derived; and upon which concoction and nutrition, and all vegetative energy may depend. Now, that the heart is this place, that the heart is the principle of life, and that all pa.s.ses in the manner just mentioned, I trust no one will deny.

The blood, therefore, required to have motion, and indeed such a motion that it should return again to the heart; for sent to the external parts of the body far from its fountain, as Aristotle says, and without motion it would become congealed. For we see motion generating and keeping up heat and spirits under ail circ.u.mstances, and rest allowing them to escape and be dissipated. The blood, therefore, becoming thick or congealed by the cold of the extreme and outward parts, and robbed of its spirits, just as it is in the dead, it was imperative that from its fount and origin, it should again receive heat and spirits, and all else requisite to its preservation--that, by returning, it should be renovated and restored.

We frequently see how the extremities are chilled by the external cold, how the nose and cheeks and hands look blue, and how the blood, stagnating in them as in the pendent or lower parts of a corpse, becomes of a dusky hue; the limbs at the same time getting torpid, so that they can scarcely be moved, and seem almost to have lost their vitality. Now they can by no means be so effectually, and especially so speedily restored to heat and colour and life, as by a new efflux and contact of heat from its source. But how can parts attract in which the heat and life are almost extinct? Or how should they whose pa.s.sages are filled with condensed and frigid blood, admit fresh aliment--renovated blood --unless they had first got rid of their old contents? Unless the heart were truly that fountain where life and heat are restored to the refrigerated fluid, and whence new blood, warm, imbued with spirits, being sent out by the arteries, that which has become cooled and effete is forced on, and all the particles recover their heat which was failing, and their vital stimulus wellnigh exhausted.

Hence it is that if the heart be unaffected, life and health may be restored to almost all the other parts of the body; but if the heart be chilled, or smitten with any serious disease, it seems matter of necessity that the whole animal fabric should suffer and fall into decay. When the source is corrupted, there is nothing, as Aristotle says, [Footnote: De Part. Animal., iii.]

which can be of service either to it or aught that depends on it.

And hence, by the way, it may perchance be why grief, and love, and envy, and anxiety, and all affections of the mind of a similar kind are accompanied with emaciation and decay, or with disordered fluids and crudity, which engender all manner of diseases and consume the body of man. For every affection of the mind that is attended with either pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart, and there induces change from the natural const.i.tution, in the temperature, the pulse and the rest, which impairing all nutrition in its source and abating the powers at large, it is no wonder that various forms of incurable disease in the extremities and in the trunk are the consequence, inasmuch as in such circ.u.mstances the whole body labours under the effects of vitiated nutrition and a want of native heat.

Moreover, when we see that all animals live through food digested in their interior, it is imperative that the digestion and distribution be perfect, and, as a consequence, that there be a place and receptacle where the aliment is perfected and whence it is distributed to the several members. Now this place is the heart, for it is the only organ in the body which contains blood for the general use; all the others receive it merely for their peculiar or private advantage, just as the heart also has a supply for its own especial behoof in its coronary veins and arteries. But it is of the store which the heart contains in its auricles and ventricles that I here speak. Then the heart is the only organ which is so situated and const.i.tuted that it can distribute the blood in due proportion to the several parts of the body, the quant.i.ty sent to each being according to the dimensions of the artery which supplies it, the heart serving as a magazine or fountain ready to meet its demands.

Further, a certain impulse or force, as well as an impeller or forcer, such as the heart, was required to effect this distribution and motion of the blood; both because the blood is disposed from slight causes, such as cold, alarm, horror, and the like, to collect in its source, to concentrate like parts to a whole, or the drops of water spilt upon a table to the ma.s.s of liquid; and because it is forced from the capillary veins into the smaller ramifications, and from these into the larger trunks by the motion of the extremities and the compression of the muscles generally. The blood is thus more disposed to move from the circ.u.mference to the centre than in the opposite direction, even were there no valves to oppose its motion; wherefore, that it may leave its source and enter more confined and colder channels, and flow against the direction to which it spontaneously inclines, the blood requires both force and impelling power. Now such is the heart and the heart alone, and that in the way and manner already explained.

CHAPTER XVI

THE CIRCULATION OF THE BLOOD IS FURTHER PROVED FROM CERTAIN CONSEQUENCES

There are still certain problems, which, taken as consequences of this truth a.s.sumed as proven, are not without their use in exciting belief, as it were, a posteriore; and which, although they may seem to be involved in much doubt and obscurity, nevertheless readily admit of having reasons and causes a.s.signed for them. Of such a nature are those that present themselves in connexion with contagions, poisoned wounds, the bites of serpents and rabid animals, lues venerea and the like. We sometimes see the whole system contaminated, though the part first infected remains sound; the lues venerea has occasionally made its attack with pains in the shoulders and head, and other symptoms, the genital organs being all the while unaffected; and then we know that the wound made by a rabid dog having healed, fever and a train of disastrous symptoms may nevertheless supervene. Whence it appears that the contagion impressed upon or deposited in a particular part, is by-and-by carried by the returning current of blood to the heart, and by that organ is sent to contaminate the whole body.

In tertian fever, the morbific cause seeking the heart in the first instance, and hanging about the heart and lungs, renders the patient short-winded, disposed to sighing, and indisposed to exertion, because the vital principle is oppressed and the blood forced into the lungs and rendered thick. It does not pa.s.s through them, (as I have myself seen in opening the bodies of those who had died in the beginning of the attack,) when the pulse is always frequent, small, and occasionally irregular; but the heat increasing, the matter becoming attenuated, the pa.s.sages forced, and the transit made, the whole body begins to rise in temperature, and the pulse becomes fuller and stronger. The febrile paroxysm is fully formed, whilst the preternatural heat kindled in the heart is thence diffused by the arteries through the whole body along with the morbific matter, which is in this way overcome and dissolved by nature.

When we perceive, further, that medicines applied externally exert their influence on the body just as if they had been taken internally, the truth we are contending for is confirmed.

Colocynth and aloes in this way move the belly, cantharides excites the urine, garlic applied to the soles of the feet a.s.sists expectoration, cordials strengthen, and an infinite number of examples of the same kind might be cited. Perhaps it will not, therefore, be found unreasonable, if we say that the veins, by means of their orifices, absorb some of the things that are applied externally and carry this inwards with the blood, not otherwise, it may be, than those of the mesentery imbibe the chyle from the intestines and carry it mixed with the blood to the liver. For the blood entering the mesentery by the coeliac artery, and the superior and inferior mesenteries, proceeds to the intestines, from which, along with the chyle that has been attracted into the veins, it returns by their numerous ramifications into the vena portae of the liver, and from this into the vena cava, and this in such wise that the blood in these veins has the same colour and consistency as in other veins, in opposition to what many believe to be the fact. Nor indeed can we imagine two contrary motions in any capillary system--the chyle upwards, the blood downwards. This could scarcely take place, and must be held as altogether improbable. But is not the thing rather arranged as it is by the consummate providence of nature?

For were the chyle mingled with the blood, the crude with the digested, in equal proportions, the result would not be concoction, trans.m.u.tation, and sanguification, but rather, and because they are severally active and pa.s.sive, a mixture or combination, or medium compound of the two, precisely as happens when wine is mixed with water and syrup. But when a very minute quant.i.ty of chyle is mingled with a very large quant.i.ty of circulating blood, a quant.i.ty of chyle that bears no kind of proportion to the ma.s.s of blood, the effect is the same, as Aristotle says, as when a drop of water is added to a cask of wine, or the contrary; the ma.s.s does not then present itself as a mixture, but is still sensibly either wine or water.

So in the mesenteric veins of an animal we do not find either chyme or chyle and blood, blended together or distinct, but only blood, the same in colour, consistency, and other sensible properties, as it appears in the veins generally. Still as there is a certain though small and inappreciable portion of chyle or incompletely digested matter mingled with the blood, nature has interposed the liver, in whose meandering channels it suffers delay and undergoes additional change, lest arriving prematurely and crude at the heart, it should oppress the vital principle.

Hence in the embryo, there is almost no use for the liver, but the umbilical vein pa.s.ses directly through, a foramen or an anastomosis existing from the vena portae. The blood returns from the intestines of the foetus, not through the liver, but into the umbilical vein mentioned, and flows at once into the heart, mingled with the natural blood which is returning from the placenta; whence also it is that in the development of the foetus the liver is one of the organs that is last formed. I have observed all the members, perfectly marked out in the human foetus, even the genital organs, whilst there was yet scarcely any trace of the liver. And indeed at the period when all the parts, like the heart itself in the beginning, are still white, and except in the veins there is no appearance of redness, you shall see nothing in the seat of the liver but a shapeless collection, as it were, of extravasated blood, which you might take for the effects of a contusion or ruptured vein.

But in the incubated egg there are, as it were, two umbilical vessels, one from the alb.u.men pa.s.sing entire through the liver, and going straight to the heart; another from the yelk, ending in the vena portae; for it appears that the chick, in the first instance, is entirely formed and nourished by the white; but by the yelk after it has come to perfection and is excluded from the sh.e.l.l; for this part may still be found in the abdomen of the chick many days after its exclusion, and is a subst.i.tute for the milk to other animals.

But these matters will be better spoken of in my observations on the formation of the foetus, where many propositions, the following among the number, will be discussed: Wherefore is this part formed or perfected first, that last, and of the several members, what part is the cause of another? And there are many points having special reference to the heart, such as wherefore does it first acquire consistency, and appear to possess life, motion, sense, before any other part of the body is perfected, as Aristotle says in his third book, "De partibus Animalium"? And so also of the blood, wherefore does it precede all the rest? And in what way does it possess the vital and animal principle, and show a tendency to motion, and to be impelled hither and thither, the end for which the heart appears to be made? In the same way, in considering the pulse, why should one kind of pulse indicate death, another recovery? And so of all the other kinds of pulse, what may be the cause and indication of each? Likewise we must consider the reason of crises and natural critical discharges; of nutrition, and especially the distribution of the nutriment; and of defluxions of every description. Finally, reflecting on every part of medicine, physiology, pathology, semeiotics and therapeutics, when I see how many questions can be answered, how many doubts resolved, how much obscurity ill.u.s.trated by the truth we have declared, the light we have made to shine, I see a field of such vast extent in which I might proceed so far, and expatiate so widely, that this my tractate would not only swell out into a volume, which was beyond my purpose, but my whole life, perchance, would not suffice for its completion.

In this place, therefore, and that indeed in a single chapter, I shall only endeavour to refer the various particulars that present themselves in the dissection of the heart and arteries to their several uses and causes; for so I shall meet with many things which receive light from the truth I have been contending for, and which, in their turn, render it more obvious. And indeed I would have it confirmed and ill.u.s.trated by anatomical arguments above all others.

There is but a single point which indeed would be more correctly placed among our observations on the use of the spleen, but which it will not be altogether impertinent to notice in this place incidentally. From the splenic branch which pa.s.ses into the pancreas, and from the upper part, arise the posterior coronary, gastric, and gastroepiploic veins, all of which are distributed upon the stomach in numerous branches and twigs, just as the mesenteric vessels are upon the intestines. In a similar way, from the inferior part of the same splenic branch, and along the back of the colon and r.e.c.t.u.m proceed the hemorrhoidal veins. The blood returning by these veins, and bringing the cruder juices along with it, on the one hand from the stomach, where they are thin, watery, and not yet perfectly chylified; on the other thick and more earthy, as derived from the faeces, but all poured into this splenic branch, are duly tempered by the admixture of contraries; and nature mingling together these two kinds of juices, difficult of coction by reason of most opposite defects, and then diluting them with a large quant.i.ty of warm blood, (for we see that the quant.i.ty returned from the spleen must be very large when we contemplate the size of its arteries,) they are brought to the porta of the liver in a state of higher preparation. The defects of either extreme are supplied and compensated by this arrangement of the veins.

CHAPTER XVII

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 one 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 h.o.m.ogeneous and without limbs; so that by the contraction and relaxation of the whole body they a.s.sume 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-gla.s.s; in pediculi, also, the same thing may be seen, and as the body is transparent, the pa.s.sage of the food through the intestines, like a black spot or stain, may be perceived by the aid of the same magnifying-gla.s.s.

But in some of the pale-blooded and colder animals, as in snails, whelks, shrimps, and sh.e.l.l-fish, there is a part which pulsates, --a kind of vesicle or auricle without a heart,--slowly, indeed, and not to be perceived except 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 very properly doubted.