Even so does it come to pass with the motions and action of the heart, which constitute a kind of deglutition, a transfusion of the blood from the veins to the arteries. And if anyone, bearing these things in mind, will carefully watch the motions of the heart in the body of a living animal, he will perceive not only all the particulars I have mentioned, viz., the heart becoming erect, and making one continuous motion with its auricles; but farther, a certain obscure undulation and lateral inclination in the direction of the axis of the right ventricle, as if twisting itself slightly in performing its work. And indeed everyone may see, when a horse drinks, that the water is drawn in and transmitted to the stomach at each movement of the throat, which movement produces a sound and yields a pulse both to the ear and the touch; in the same way it is with each motion of the heart, when there is the delivery of a quantity of blood from the veins to the arteries a pulse takes place, and can be heard within the chest.
The motion of the heart, then, is entirely of this description, and the one action of the heart is the transmission of the blood and its distribution, by means of the arteries, to the very extremities of the body; so that the pulse which we feel in the arteries is nothing more than the impulse of the blood derived from the heart.
Whether or not the heart, besides propelling the blood, giving it motion locally, and distributing it to the body, adds anything else to it—heat, spirit, perfection,—must be inquired into by— and—by, and decided upon other grounds. So much may suffice at this time, when it is shown that by the action of the heart the blood is transfused through the ventricles from the veins to the arteries, and distributed by them to all parts of the body.
The above, indeed, is admitted by all, both from the structure of the heart and the arrangement and action of its valves. But still they are like persons purblind or groping about in the dark, for they give utterance to various, contradictory, and incoherent sentiments, delivering many things upon conjecture, as we have already shown.
The grand cause of doubt and error in this subject appears to me to have been the intimate connexion between the heart and the lungs. When men saw both the pulmonary artery and the pulmonary veins losing themselves in the lungs, of course it became a puzzle to them to know how or by what means the right ventricle should distribute the blood to the body, or the left draw it from the venae cavae. This fact is borne witness to by Galen, whose words, when writing against Erasistratus in regard to the origin and use of the veins and the coction of the blood, are the following [Footnote: De Placitis Hippocratis et Platonis, vi.]: "You will reply," he says, "that the effect is so; that the blood is prepared in the liver, and is thence transferred to the heart to receive its proper form and last perfection; a statement which does not appear devoid of reason; for no great and perfect work is ever accomplished at a single effort, or receives its final polish from one instrument. But if this be actually so, then show us another vessel which draws the absolutely perfect blood from the heart, and distributes it as the arteries do the spirits over the whole body." Here then is a reasonable opinion not allowed, because, forsooth, besides not seeing the true means of transit, he could not discover the vessel which should transmit the blood from the heart to the body at large!
But had anyone been there in behalf of Erasistratus, and of that opinion which we now espouse, and which Galen himself acknowledges in other respects consonant with reason, to have pointed to the aorta as the vessel which distributes the blood from the heart to the rest of the body, I wonder what would have been the answer of that most ingenious and learned man? Had he said that the artery transmits spirits and not blood, he would indeed sufficiently have answered Erasistratus, who imagined that the arteries contained nothing but spirits; but then he would have contradicted himself, and given a foul denial to that for which he had keenly contended in his writings against this very Erasistratus, to wit, that blood in substance is contained in the arteries, and not spirits; a fact which he demonstrated not only by many powerful arguments, but by experiments.
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 these 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 nature never connected them with this, the most noble viscus of the body, unless for some important end"; if, I say, this father of physicians concedes all these things,—and I quote his own words,—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 term for term of perfection, from the heart for distribution to all parts of the body. Or would he perchance still hesitate, like all who have come after him, even to the present hour, because he did not perceive the route by which the blood was transferred from the veins to the arteries, in consequence, as I have already said, of the intimate connexion between the heart and the lungs? And that this difficulty puzzled anatomists not a little, when in their dissections they found the pulmonary artery and left ventricle full of thick, black, and clotted blood, plainly appears, when they felt themselves compelled to affirm that the blood made its way from the right to the left ventricle by transuding through the septum of the heart. But this fancy I have already refuted. A new pathway for the blood must therefore be prepared and thrown open, and being once exposed, no further difficulty will, I believe, be experienced by anyone in admitting what I have already proposed in regard to the pulse of the heart and arteries, viz., the passage of the blood from the veins to the arteries, and its distribution to the whole of the body by means of these vessels.
OF THE COURSE BY WHICH THE BLOOD IS CARRIED FROM THE VENA CAVA INTO THE ARTERIES, OR FROM THE RIGHT INTO THE LEFT VENTRICLE OF THE HEART
Since the intimate connexion of the heart with the lungs, which is apparent in the human subject, has been the probable cause of the errors that have been committed on this point, they plainly do amiss who, pretending to speak of the parts of animals generally, as anatomists for the most part do, confine their researches to the human body alone, and that when it is dead. They obviously do not act otherwise than he who, having studied the forms of a single commonwealth, should set about the composition of a general system of polity; or who, having taken cognizance of the nature of a single field, should imagine that he had mastered the science of agriculture; or who, upon the ground of one particular proposition, should proceed to draw general conclusions.
Had anatomists only been as conversant with the dissection of the lower animals as they are with that of the human body, the matters that have hitherto kept them in a perplexity of doubt would, in my opinion, have met them freed from every kind of difficulty.
And first, in fishes, in which the heart consists of but a single ventricle, being devoid of lungs, the thing is sufficiently manifest. Here the sac, which is situated at the base of the heart, and is the part analogous to the auricle in man, plainly forces the blood into the heart, and the heart, in its turn, conspicuously transmits it by a pipe or artery, or vessel analogous to an artery; these are facts which are confirmed by simple ocular inspection, as well as by a division of the vessel, when the blood is seen to be projected by each pulsation of the heart.
The same thing is also not difficult of demonstration in those animals that have, as it were, no more than a single ventricle to the heart, such as toads, frogs, serpents, and lizards, which have lungs in a certain sense, as they have a voice. I have many observations by me on the admirable structure of the lungs of these animals, and matters appertaining, which, however, I cannot introduce in this place. Their anatomy plainly shows us that the blood is transferred in them from the veins to the arteries in the same manner as in higher animals, viz., by the action of the heart; the way, in fact, is patent, open, manifest; there is no difficulty, no room for doubt about it; for in them the matter stands precisely as it would in man were the septum of his heart perforated or removed, or one ventricle made out of two; and this being the case, I imagine that no one will doubt as to the way by which the blood may pass from the veins into the arteries.
But as there are actually more animals which have no lungs than there are furnished with them, and in like manner a greater number which have only one ventricle than there are with two, it is open to us to conclude, judging from the mass or multitude of living creatures, that for the major part, and generally, there is an open way by which the blood is transmitted from the veins through the sinuses or cavities of the heart into the arteries.
I have, however, cogitating with myself, seen further, that the same thing obtained most obviously in the embryos of those animals that have lungs; for in the foetus the four vessels belonging to the heart, viz., the vena cava, the pulmonary artery, the pulmonary vein, and the great artery or aorta, are all connected otherwise than in the adult, a fact sufficiently known to every anatomist. The first contact and union of the vena cava with the pulmonary veins, which occurs before the cava opens properly into the right ventricle of the heart, or gives off the coronary vein, a little above its escape from the liver, is by a lateral anastomosis; this is an ample foramen, of an oval form, communicating between the cava and the pulmonary vein, so that the blood is free to flow in the greatest abundance by that foramen from the vena cava into the pulmonary vein, and left auricle, and from thence into the left ventricle. Further, in this foramen ovale, from that part which regards the pulmonary vein, there is a thin tough membrane, larger than the opening, extended like an operculum or cover; this membrane in the adult blocking up the foramen, and adhering on all sides, finally closes it up, and almost obliterates every trace of it. In the foetus, however, this membrane is so contrived that falling loosely upon itself, it permits a ready access to the lungs and heart, yielding a passage to the blood which is streaming from the cava, and hindering the tide at the same time from flowing back into that vein. All things, in short, permit us to believe that in the embryo the blood must constantly pass by this foramen from the vena cava into the pulmonary vein, and from thence into the left auricle of the heart; and having once entered there, it can never regurgitate.
Another union is that by the pulmonary artery, and is effected when that vessel divides into two branches after its escape from the right ventricle of the heart. It is as if to the two trunks already mentioned a third were superadded, a kind of arterial canal, carried obliquely from the pulmonary artery, to perforate and terminate in the great artery or aorta. So that in the dissection of the embryo, as it were, two aortas, or two roots of the great artery, appear springing from the heart. This canal shrinks gradually after birth, and after a time becomes withered, and finally almost removed, like the umbilical vessels.
The arterial canal contains no membrane or valve to direct or impede the flow of blood in this or in that direction: for at the root of the pulmonary artery, of which the arterial canal is the continuation in the foetus, there are three semilunar valves, which open from within outwards, and oppose no obstacle to the blood flowing in this direction or from the right ventricle into the pulmonary artery and aorta; but they prevent all regurgitation from the aorta or pulmonic vessels back upon the right ventricle; closing with perfect accuracy, they oppose an effectual obstacle to everything of the kind in the embryo. So that there is also reason to believe that when the heart contracts, the blood is regularly propelled by the canal or passage indicated from the right ventricle into the aorta.
What is commonly said in regard to these two great communications, to wit, that they exist for the nutrition of the lungs, is both improbable and inconsistent; seeing that in the adult they are closed up, abolished, and consolidated, although the lungs, by reason of their heat and motion, must then be presumed to require a larger supply of nourishment. The same may be said in regard to the assertion that the heart in the embryo does not pulsate, that it neither acts nor moves, so that nature was forced to make these communications for the nutrition of the lungs. This is plainly false; for simple inspection of the incubated egg, and of embryos just taken out of the uterus, shows that the heart moves in them precisely as in adults, and that nature feels no such necessity. I have myself repeatedly seen these motions, and Aristotle is likewise witness of their reality. "The pulse," he observes, "inheres in the very constitution of the heart, and appears from the beginning as is learned both from the dissection of living animals and the formation of the chick in the egg." [Footnote: Lib de Spiritu, cap. v.] But we further observe that the passages in question are not only pervious up to the period of birth in man, as well as in other animals, as anatomists in general have described them, but for several months subsequently, in some indeed for several years, not to say for the whole course of life; as, for example, in the goose, snipe, and various birds and many of the smaller animals. And this circumstance it was, perhaps, that imposed upon Botallus, who thought he had discovered a new passage for the blood from the vena cava into the left ventricle of the heart; and I own that when I met with the same arrangement in one of the larger members of the mouse family, in the adult state, I was myself at first led to something of a like conclusion.
From this it will be understood that in the human embryo, and in the embryos of animals in which the communications are not closed, the same thing happens, namely, that the heart by its motion propels the blood by obvious and open passages from the vena cava into the aorta through the cavities of both the ventricles, the right one receiving the blood from the auricle, and propelling it by the pulmonary artery and its continuation, named the ductus arteriosus, into the aorta; the left, in like manner, charged by the contraction of its auricle, which has received its supply through the foramen ovale from the vena cava, contracting, and projecting the blood through the root of the aorta into the trunk of that vessel.
In embryos, consequently, whilst the lungs are yet in a state of inaction, performing no function, subject to no motion any more than if they had not been present, nature uses the two ventricles of the heart as if they formed but one, for the transmission of the blood. The condition of the embryos of those animals which have lungs, whilst these organs are yet in abeyance and not employed, is the same as that of those animals which have no lungs.
So it clearly appears in the case of the foetus that the heart by its action transfers the blood from the vena cava into the aorta, and that by a route as obvious and open, as if in the adult the two ventricles were made to communicate by the removal of their septum. We therefore find that in the greater number of animals— in all, indeed, at a certain period of their existence—the channels for the transmission of the blood through the heart are conspicuous. But we have to inquire why in some creatures—those, namely, that have warm blood, and that have attained to the adult age, man among the number—we should not conclude that the same thing is accomplished through the substance of the lungs, which in the embryo, and at a time when the function of these organs is in abeyance, nature effects by the direct passages described, and which, indeed, she seems compelled to adopt through want of a passage by the lungs; or why it should be better (for nature always does that which is best) that she should close up the various open routes which she had formerly made use of in the embryo and foetus, and still uses in all other animals. Not only does she thereby open up no new apparent channels for the passages of the blood, but she even shuts up those which formerly existed.
And now the discussion is brought to this point, that they who inquire into the ways by which the blood reaches the left ventricle of the heart: and pulmonary veins from the vena cava, will pursue the wisest course if they seek by dissection to discover the causes why in the larger and more perfect animals of mature age nature has rather chosen to make the blood percolate the parenchyma of the lungs, than, as in other instances, chosen a direct and obvious course—for I assume that no other path or mode of transit can be entertained. It must be because the larger and more perfect animals are warmer, and when adult their heat greater—ignited, as I might say, and requiring to be damped or mitigated, that the blood is sent through the lungs, in order that it may be tempered by the air that is inspired, and prevented from boiling up, and so becoming extinguished, or something else of the sort. But to determine these matters, and explain them satisfactorily, were to enter on a speculation in regard to the office of the lungs and the ends for which they exist. Upon such a subject, as well as upon what pertains to respiration, to the necessity and use of the air, etc., as also to the variety and diversity of organs that exist in the bodies of animals in connexion with these matters, although I have made a vast number of observations, I shall not speak till I can more conveniently set them forth in a treatise apart, lest I should be held as wandering too wide of my present purpose, which is the use and motion of the heart, and be charged with speaking of things beside the question, and rather complicating and quitting than illustrating it. And now returning to my immediate subject, I go on with what yet remains for demonstration, viz., that in the more perfect and warmer adult animals, and man, the blood passes from the right ventricle of the heart by the pulmonary artery, into the lungs, and thence by the pulmonary veins into the left auricle, and from there into the left ventricle of the heart. And, first, I shall show that this may be so, and then I shall prove that it is so in fact.
THE BLOOD PASSES THROUGH THE SUBSTANCE OF THE LUNGS FROM THE RIGHT VENTRICLE OF THE HEART INTO THE PULMONARY VEINS AND LEFT VENTRICLE
That this is possible, and that there is nothing to prevent it from being so, appears when we reflect on the way in which water permeating the earth produces springs and rivulets, or when we speculate on the means by which the sweat passes through the skin, or the urine through the substance of the kidneys. It is well known that persons who use the Spa waters or those of La Madonna, in the territories of Padua, or others of an acidulous or vitriolated nature, or who simply swallow drinks by the gallon, pass all off again within an hour or two by the bladder. Such a quantity of liquid must take some short time in the concoction: it must pass through the liver (it is allowed by all that the juices of the food we consume pass twice through this organ in the course of the day); it must flow through the veins, through the tissues of the kidneys, and through the ureters into the bladder.
To those, therefore, whom I hear denying that the blood, aye, the whole mass of the blood, may pass through the substance of the lungs, even as the nutritive juices percolate the liver, asserting such a proposition to be impossible, and by no means to be entertained as credible, I reply, with the poet, that they are of that race of men who, when they will, assent full readily, and when they will not, by no manner of means; who, when their assent is wanted, fear, and when it is not, fear not to give it.
The substance of the liver is extremely dense, so is that of the kidney; the lungs, however, are of a much looser texture, and if compared with the kidneys are absolutely spongy. In the liver there is no forcing, no impelling power; in the lungs the blood is forced on by the pulse of the right ventricle, the necessary effect of whose impulse is the distension of the vessels and the pores of the lungs. And then the lungs, in respiration, are perpetually rising and falling: motions, the effect of which must needs be to open and shut the pores and vessels, precisely as in the case of a sponge, and of parts having a spongy structure, when they are alternately compressed and again are suffered to expand. The liver, on the contrary, remains at rest, and is never seen to be dilated or constricted. Lastly, if no one denies the possibility in man, oxen, and the larger animals generally, of the whole of the ingested juices passing through the liver, in order to reach the vena cava, for this reason, that if nourishment is to go on, these juices must needs get into the veins, and there is no other way but the one indicated, why should not the same arguments be held of avail for the passage of the blood in adults through the lungs? Why not maintain, with Columbus, that skilful and learned anatomist, that it must be so from the capacity and structure of the pulmonary vessels, and from the fact of the pulmonary veins and ventricle corresponding with them, being always found to contain blood, which must needs have come from the veins, and by no other passage save through the lungs? Columbus, and we also, from what precedes, from dissections, and other arguments, conceive the thing to be clear. But as there are some who admit nothing unless upon authority, let them learn that the truth I am contending for can be confirmed from Galen's own words, namely, that not only may the blood be transmitted from the pulmonary artery into the pulmonary veins, then into the left ventricle of the heart, and from thence into the arteries of the body, but that this is effected by the ceaseless pulsation of the heart and the motion of the lungs in breathing.
There are, as everyone knows, three sigmoid or semilunar valves situated at the orifice of the pulmonary artery, which effectually prevent the blood sent into the vessel from returning into the cavity of the heart. Now Galen, explaining the use of these valves, and the necessity for them, employs the following language: [Footnote: De Usu partium, lib. vi, cap. 10] "There is everywhere a mutual anastomosis and inosculation of the arteries with the veins, and they severally transmit both blood and spirit, by certain invisible and undoubtedly very narrow passages. Now if the mouth of the pulmonary artery had stood in like manner continually open, and nature had found no contrivance for closing it when requisite, and opening it again, it would have been impossible that the blood could ever have passed by the invisible and delicate mouths, during the contractions of the thorax, into the arteries; for all things are not alike readily attracted or repelled; but that which is light is more readily drawn in, the instrument being dilated, and forced out again when it is contracted, than that which is heavy; and in like manner is anything drawn more rapidly along an ample conduit, and again driven forth, than it is through a narrow tube. But when the thorax is contracted the pulmonary veins, which are in the lungs, being driven inwardly, and powerfully compressed on every side, immediately force out some of the spirit they contain, and at the same time assume a certain portion of blood by those subtle mouths, a thing that could never come to pass were the blood at liberty to flow back into the heart through the great orifice of the pulmonary artery. But its return through this great opening being prevented, when it is compressed on every side, a certain portion of it distils into the pulmonary veins by the minute orifices mentioned." And shortly afterwards, in the next chapter, he says: "The more the thorax contracts, the more it strives to force out the blood, the more exactly do these membranes (viz., the semilunar valves) close up the mouth of the vessel, and suffer nothing to regurgitate." The same fact he has also alluded to in a preceding part of the tenth chapter: "Were there no valves, a three-fold inconvenience would result, so that the blood would then perform this lengthened course in vain; it would flow inwards during the disastoles of the lungs and fill all their arteries; but in the systoles, in the manner of the tide, it would ever and anon, like the Euripus, flow backwards and forwards by the same way, with a reciprocating motion, which would nowise suit the blood. This, however, may seem a matter of little moment: but if it meantime appear that the function of respiration suffer, then I think it would be looked upon as no trifle, etc." Shortly afterwards he says: "And then a third inconvenience, by no means to be thought lightly of, would follow, were the blood moved backwards during the expirations, had not our Maker instituted those supplementary membranes. "In the eleventh chapter he concludes: "That they (the valves) have all a common use, and that it is to prevent regurgitation or backward motion; each, however, having a proper function, the one set drawing matters from the heart, and preventing their return, the other drawing matters into the heart, and preventing their escape from it. For nature never intended to distress the heart with needless labour, neither to bring aught into the organ which it had been better to have kept away, nor to take from it again aught which it was requisite should be brought. Since, then, there are four orifices in all, two in either ventricle, one of these induces, the other educes." And again he says: "Farther, since there is one vessel, which consists of a simple covering implanted in the heart, and another which is double, extending from it (Galen is here speaking of the right side of the heart, but I extend his observations to the left side also), a kind of reservoir had to be provided, to which both belonging, the blood should be drawn in by one, and sent out by the other."
Galen adduces this argument for the transit of the blood by the right ventricle from the vena cava into the lungs; but we can use it with still greater propriety, merely changing the terms, for the passage of the blood from the veins through the heart into the arteries. From Galen, however, that great man, that father of physicians, it clearly appears that the blood passes through the lungs from the pulmonary artery into the minute branches of the pulmonary veins, urged to this both by the pulses of the heart and by the motions of the lungs and thorax; that the heart, moreover, is incessantly receiving and expelling the blood by and from its ventricles, as from a magazine or cistern, and for this end it is furnished with four sets of valves, two serving for the induction and two for the eduction of the blood, lest, like the Euripus, it should be incommodiously sent hither and thither, or flow back into the cavity which it should have quitted, or quit the part where its presence was required, and so the heart might be oppressed with labour in vain, and the office of the lungs be interfered with. [Footnote: See the Commentary of the learned Hofmann upon the Sixth Book of Galen, "De Usu partium," a work which I first saw after I had written what precedes.] Finally, our position that the blood is continually permeating from the right to the left ventricle, from the vena cava into the aorta, through the porosities of the lungs, plainly appears from this, that since the blood is incessantly sent from the right ventricle into the lungs by the pulmonary artery, and in like manner is incessantly drawn from the lungs into the left ventricle, as appears from what precedes and the position of the valves, it cannot do otherwise than pass through continuously. And then, as the blood is incessantly flowing into the right ventricle of the heart, and is continually passed out from the left, as appears in like manner, and as is obvious, both to sense and reason, it is impossible that the blood can do otherwise than pass continually from the vena cava into the aorta.
Dissection consequently shows distinctly what takes place in the majority of animals, and indeed in all, up to the period of their maturity; and that the same thing occurs in adults is equally certain, both from Galen's words, and what has already been said, only that in the former the transit is effected by open and obvious passages, in the latter by the hidden porosities of the lungs and the minute inosculations of vessels. It therefore appears that, although one ventricle of the heart, the left to wit, would suffice for the distribution of the blood over the body, and its eduction from the vena cava, as indeed is done in those creatures that have no lungs, nature, nevertheless, when she ordained that the same blood should also percolate the lungs, saw herself obliged to add the right ventricle, the pulse of which should force the blood from the vena cava through the lungs into the cavity of the left ventricle. In this way, it may be said, that the right ventricle is made for the sake of the lungs, and for the transmission of the blood through them, not for their nutrition; for it were unreasonable to suppose that the lungs should require so much more copious a supply of nutriment, and that of so much purer and more spirituous a nature as coming immediately from the ventricle of the heart, that either the brain, with its peculiarly pure substance, or the eyes, with their lustrous and truly admirable structure, or the flesh of the heart itself, which is more suitably nourished by the coronary artery.
OF THE QUANTITY OF BLOOD PASSING THROUGH THE HEART FROM THE VEINS TO THE ARTERIES; AND OF THE CIRCULAR MOTION OF THE BLOOD
Thus far I have spoken of the passage of the blood from the veins into the arteries, and of the manner in which it is transmitted and distributed by the action of the heart; points to which some, moved either by the authority of Galen or Columbus, or the reasonings of others, will give in their adhesion. But what remains to be said upon the quantity and source of the blood which thus passes is of a character so novel and unheard-of that I not only fear injury to myself from the envy of a few, but I tremble lest I have mankind at large for my enemies, so much doth wont and custom become a second nature. Doctrine once sown strikes deep its root, and respect for antiquity influences all men. Still the die is cast, and my trust is in my love of truth and the candour of cultivated minds. And sooth to say, when I surveyed my mass of evidence, whether derived from vivisections, and my various reflections on them, or from the study of the ventricles of the heart and the vessels that enter into and issue from them, the symmetry and size of these conduits,—for nature doing nothing in vain, would never have given them so large a relative size without a purpose,—or from observing the arrangement and intimate structure of the valves in particular, and of the other parts of the heart in general, with many things besides, I frequently and seriously bethought me, and long revolved in my mind, what might be the quantity of blood which was transmitted, in how short a time its passage might be effected, and the like. But not finding it possible that this could be supplied by the juices of the ingested aliment without the veins on the one hand becoming drained, and the arteries on the other getting ruptured through the excessive charge of blood, unless the blood should somehow find its way from the arteries into the veins, and so return to the right side of the heart, I began to think whether there might not be a MOTION, AS IT WERE, IN A CIRCLE. Now, this I afterwards found to be true; and I finally saw that the blood, forced by the action of the left ventricle into the arteries, was distributed to the body at large, and its several parts, in the same manner as it is sent through the lungs, impelled by the right ventricle into the pulmonary artery, and that it: then passed through the veins and along the vena cava, and so round to the left ventricle in the manner already indicated. This motion we may be allowed to call circular, in the same way as Aristotle says that the air and the rain emulate the circular motion of the superior bodies; for the moist earth, warmed by the sun, evaporates; the vapours drawn upwards are condensed, and descending in the form of rain, moisten the earth again. By this arrangement are generations of living things produced; and in like manner are tempests and meteors engendered by the circular motion, and by the approach and recession of the sun.
And similarly does it come to pass in the body, through the motion of the blood, that the various parts are nourished, cherished, quickened by the warmer, more perfect, vaporous, spirituous, and, as I may say, alimentive blood; which, on the other hand, owing to its contact with these parts, becomes cooled, coagulated, and so to speak effete. It then returns to its sovereign, the heart, as if to its source, or to the inmost home of the body, there to recover its state of excellence or perfection. Here it renews its fluidity, natural heat, and becomes powerful, fervid, a kind of treasury of life, and impregnated with spirits, it might be said with balsam. Thence it is again dispersed. All this depends on the motion and action of the heart.
The heart, consequently, is the beginning of life; the sun of the microcosm, even as the sun in his turn might well be designated the heart of the world; for it is the heart by whose virtue and pulse the blood is moved, perfected, and made nutrient, and is preserved from corruption and coagulation; it is the household divinity which, discharging its function, nourishes, cherishes, quickens the whole body, and is indeed the foundation of life, the source of all action. But of these things we shall speak more opportunely when we come to speculate upon the final cause of this motion of the heart.
As the blood-vessels, therefore, are the canals and agents that transport the blood, they are of two kinds, the cava and the aorta; and this not by reason of there being two sides of the body, as Aristotle has it, but because of the difference of office, not, as is commonly said, in consequence of any diversity of structure, for in many animals, as I have said, the vein does not differ from the artery in the thickness of its walls, but solely in virtue of their distinct functions and uses. A vein and an artery, both styled veins by the ancients, and that not without reason, as Galen has remarked, for the artery is the vessel which carries the blood from the heart to the body at large, the vein of the present day bringing it back from the general system to the heart; the former is the conduit from, the latter the channel to, the heart; the latter contains the cruder, effete blood, rendered unfit for nutrition; the former transmits the digested, perfect, peculiarly nutritive fluid.
THAT THERE IS A CIRCULATION OF THE BLOOD IS CONFIRMED FROM THE FIRST PROPOSITION
But lest anyone should say that we give them words only, and make mere specious assertions without any foundation, and desire to innovate without sufficient cause, three points present themselves for confirmation, which, being stated, I conceive that the truth I contend for will follow necessarily, and appear as a thing obvious to all. First, the blood is incessantly transmitted by the action of the heart from the vena cava to the arteries in such quantity that it cannot be supplied from the ingesta, and in such a manner that the whole must very quickly pass through the organ; second, the blood under the influence of the arterial pulse enters and is impelled in a continuous, equable, and incessant stream through every part and member of the body, in much larger quantity than were sufficient for nutrition, or than the whole mass of fluids could supply; third, the veins in like manner return this blood incessantly to the heart from parts and members of the body. These points proved, I conceive it will be manifest that the blood circulates, revolves, propelled and then returning, from the heart to the extremities, from the extremities to the heart, and thus that it performs a kind of circular motion.
Let us assume, either arbitrarily or from experiment, the quantity of blood which the left ventricle of the heart will contain when distended, to be, say, two ounces, three ounces, or one ounce and a half—in the dead body I have found it to hold upwards of two ounces. Let us assume further how much less the heart will hold in the contracted than in the dilated state; and how much blood it will project into the aorta upon each contraction; and all the world allows that with the systole something is always projected, a necessary consequence demonstrated in the third chapter, and obvious from the structure of the valves; and let us suppose as approaching the truth that the fourth, or fifth, or sixth, or even but the eighth part of its charge is thrown into the artery at each contraction; this would give either half an ounce, or three drachms, or one drachm of blood as propelled by the heart at each pulse into the aorta; which quantity, by reason of the valves at the root of the vessel, can by no means return into the ventricle. Now, in the course of half an hour, the heart will have made more than one thousand beats, in some as many as two, three, and even four thousand. Multiplying the number of drachms propelled by the number of pulses, we shall have either one thousand half ounces, or one thousand times three drachms, or a like proportional quantity of blood, according to the amount which we assume as propelled with each stroke of the heart, sent from this organ into the artery—a larger quantity in every case than is contained in the whole body! In the same way, in the sheep or dog, say but a single scruple of blood passes with each stroke of the heart, in one half-hour we should have one thousand scruples, or about three pounds and a half, of blood injected into the aorta; but the body of neither animal contains above four pounds of blood, a fact which I have myself ascertained in the case of the sheep.
Upon this supposition, therefore, assumed merely as a ground for reasoning, we see the whole mass of blood passing through the heart, from the veins to the arteries, and in like manner through the lungs.
But let it be said that this does not take place in half an hour, but in an hour, or even in a day; any way, it is still manifest that more blood passes through the heart in consequence of its action, than can either be supplied by the whole of the ingesta, or than can be contained in the veins at the same moment.
Nor can it be allowed that the heart in contracting sometimes propels and sometimes does not propel, or at most propels but very little, a mere nothing, or an imaginary something: all this, indeed, has already been refuted, and is, besides, contrary both to sense and reason. For if it be a necessary effect of the dilatation of the heart that its ventricles become filled with blood, it is equally so that, contracting, these cavities should expel their contents; and this not in any trifling measure. For neither are the conduits small, nor the contractions few in number, but frequent, and always in some certain proportion, whether it be a third or a sixth, or an eighth, to the total capacity of the ventricles, so that a like proportion of blood must be expelled, and a like proportion received with each stroke of the heart, the capacity of the ventricle contracted always bearing a certain relation to the capacity of the ventricle when dilated. And since, in dilating, the ventricles cannot be supposed to get filled with nothing, or with an imaginary something, so in contracting they never expel nothing or aught imaginary, but always a certain something, viz., blood, in proportion to the amount of the contraction. Whence it is to be concluded that if at one stroke the heart of man, the ox, or the sheep, ejects but a single drachm of blood and there are one thousand strokes in half an hour, in this interval there will have been ten pounds five ounces expelled; if with each stroke two drachms are expelled, the quantity would, of course, amount to twenty pounds and ten ounces; if half an ounce, the quantity would come to forty-one pounds and eight ounces; and were there one ounce, it would be as much as eighty-three pounds and four ounces; the whole of which, in the course of one-half hour, would have been transfused from the veins to the arteries. The actual quantity of blood expelled at each stroke of the heart, and the circumstances under which it is either greater or less than ordinary, I leave for particular determination afterwards, from numerous observations which I have made on the subject.
Meantime this much I know, and would here proclaim to all, that the blood is transfused at one time in larger, at another in smaller, quantity; and that the circuit of the blood is accomplished now more rapidly, now more slowly, according to the temperament, age, etc., of the individual, to external and internal circumstances, to naturals and non-naturals—sleep, rest, food, exercise, affections of the mind, and the like. But, supposing even the smallest quantity of blood to be passed through the heart and the lungs with each pulsation, a vastly greater amount would still be thrown into the arteries and whole body than could by any possibility be supplied by the food consumed. It could be furnished in no other way than by making a circuit and returning.
This truth, indeed, presents itself obviously before us when we consider what happens in the dissection of living animals; the great artery need not be divided, but a very small branch only (as Galen even proves in regard to man), to have the whole of the blood in the body, as well that of the veins as of the arteries, drained away in the course of no long time—some half-hour or less. Butchers are well aware of the fact and can bear witness to it; for, cutting the throat of an ox and so dividing the vessels of the neck, in less than a quarter of an hour they have all the vessels bloodless—the whole mass of blood has escaped. The same thing also occasionally occurs with great rapidity in performing amputations and removing tumors in the human subject.
Nor would this argument lose of its force, did any one say that in killing animals in the shambles, and performing amputations, the blood escaped in equal, if not perchance in larger quantity by the veins than by the arteries. The contrary of this statement, indeed, is certainly the truth; the veins, in fact, collapsing, and being without any propelling power, and further, because of the impediment of the valves, as I shall show immediately, pour out but very little blood; whilst the arteries spout it forth with force abundantly, impetuously, and as if it were propelled by a syringe. And then the experiment is easily tried of leaving the vein untouched and only dividing the artery in the neck of a sheep or dog, when it will be seen with what force, in what abundance, and how quickly, the whole blood in the body, of the veins as well as of the arteries, is emptied. But the arteries receive blood from the veins in no other way than by transmission through the heart, as we have already seen; so that if the aorta be tied at the base of the heart, and the carotid or any other artery be opened, no one will now be surprised to find it empty, and the veins only replete with blood.
And now the cause is manifest, why in our dissections we usually find so large a quantity of blood in the veins, so little in the arteries; why there is much in the right ventricle, little in the left, which probably led the ancients to believe that the arteries (as their name implies) contained nothing but spirits during the life of an animal. The true cause of the difference is perhaps this, that as there is no passage to the arteries, save through the lungs and heart, when an animal has ceased to breathe and the lungs to move, the blood in the pulmonary artery is prevented from passing into the pulmonary veins, and from thence into the left ventricle of the heart; just as we have already seen the same transit prevented in the embryo, by the want of movement in the lungs and the alternate opening, and shutting of their hidden and invisible porosities and apertures. But the heart not ceasing to act at the same precise moment as the lungs, but surviving them and continuing to pulsate for a time, the left ventricle and arteries go on distributing their blood to the body at large and sending it into the veins; receiving none from the lungs, however, they are soon exhausted, and left, as it were, empty. But even this fact confirms our views, in no trifling manner, seeing that it can be ascribed to no other than the cause we have just assumed.
Moreover, it appears from this that the more frequently or forcibly the arteries pulsate, the more speedily will the body be exhausted of its blood during hemorrhage. Hence, also, it happens, that in fainting fits and in states of alarm, when the heart beats more languidly and less forcibly, hemorrhages are diminished and arrested.
Still further, it is from this, that after death, when the heart has ceased to beat, it is impossible, by dividing either the jugular or femoral veins and arteries, by any effort, to force out more than one-half of the whole mass of the blood. Neither could the butchers ever bleed the carcass effectually did he neglect to cut the throat of the ox which he has knocked on the head and stunned, before the heart had ceased beating.
Finally, we are now in a condition to suspect wherefore it is that no one has yet said anything to the purpose upon the anastomosis of the veins and arteries, either as to where or how it is effected, or for what purpose. I now enter upon the investigation of the subject.
THE FIRST POSITION: OF THE QUANTITY OF BLOOD PASSING FROM THE VEINS TO THE ARTERIES. AND THAT THERE IS A CIRCUIT OF THE BLOOD, FREED FROM OBJECTIONS, AND FARTHER CONFIRMED BY EXPERIMENT
So far our first position is confirmed, whether the thing be referred to calculation or to experiment and dissection, viz., that the blood is incessantly poured into the arteries in larger quantities than it can be supplied by the food; so that the whole passing over in a short space of time, it is matter of necessity that the blood perform a circuit, that it return to whence it set out.
But if anyone shall here object that a large quantity may pass through and yet no necessity be found for a circulation, that all may come from the meat and drink consumed, and quote as an illustration the abundant supply of milk in the mammae—for a cow will give three, four, and even seven gallons and more in a day, and a woman two or three pints whilst nursing a child or twins, which must manifestly be derived from the food consumed; it may be answered that the heart by computation does as much and more in the course of an hour or two.
And if not yet convinced, he shall still insist that when an artery is divided, a preternatural route is, as it were, opened, and that so the blood escapes in torrents, but that the same thing does not happen in the healthy and uninjured body when no outlet is made; and that in arteries filled, or in their natural state, so large a quantity of blood cannot pass in so short a space of time as to make any return necessary—to all this it may be answered that, from the calculation already made, and the reasons assigned, it appears that by so much as the heart in its dilated state contains, in addition to its contents in the state of constriction, so much in a general way must it emit upon each pulsation, and in such quantity must the blood pass, the body being entire and naturally constituted.
But in serpents, and several fishes, by tying the veins some way below the heart you will perceive a space between the ligature and the heart speedily to become empty; so that, unless you would deny the evidence of your senses, you must needs admit the return of the blood to the heart. The same thing will also plainly appear when we come to discuss our second position.
Let us here conclude with a single example, confirming all that has been said, and from which everyone may obtain conviction through the testimony of his own eyes.
If a live snake be laid open, the heart will be seen pulsating quietly, distinctly, for more than an hour, moving like a worm, contracting in its longitudinal dimensions, (for it is of an oblong shape), and propelling its contents. It becomes of a paler colour in the systole, of a deeper tint in the diastole; and almost all things else are seen by which I have already said that the truth I contend for is established, only that here everything takes place more slowly, and is more distinct. This point in particular may be observed more clearly than the noonday sun: the vena cava enters the heart at its lower part, the artery quits it at the superior part; the vein being now seized either with forceps or between the finger and the thumb, and the course of the blood for some space below the heart interrupted, you will perceive the part that intervenes between the fingers and the heart almost immediately to become empty, the blood being exhausted by the action of the heart; at the same time the heart will become of a much paler colour, even in its state of dilatation, than it was before; it is also smaller than at first, from wanting blood: and then it begins to beat more slowly, so that it seems at length as if it were about to die. But the impediment to the flow of blood being removed, instantly the colour and the size of the heart are restored.
If, on the contrary, the artery instead of the vein be compressed or tied, you will observe the part between the obstacle and the heart, and the heart itself, to become inordinately distended, to assume a deep purple or even livid colour, and at length to be so much oppressed with blood that you will believe it about to be choked; but the obstacle removed, all things immediately return to their natural state and colour, size, and impulse.
Here then we have evidence of two kinds of death: extinction from deficiency, and suffocation from excess. Examples of both have now been set before you, and you have had opportunity of viewing the truth contended for with your own eyes in the heart.
THE SECOND POSITION IS DEMONSTRATED
That this may the more clearly appear to everyone, I have here to cite certain experiments, from which it seems obvious that the blood enters a limb by the arteries, and returns from it by the veins; that the arteries are the vessels carrying the blood from the heart, and the veins the returning channels of the blood to the heart; that in the limbs and extreme parts of the body the blood passes either immediately by anastomosis from the arteries into the veins, or mediately by the porosities of the flesh, or in both ways, as has already been said in speaking of the passage of the blood through the lungs whence it appears manifest that in the circuit the blood moves from that place to this place, and from that point to this one; from the centre to the extremities, to wit; and from the extreme parts back to the centre. Finally, upon grounds of calculation, with the same elements as before, it will be obvious that the quantity can neither be accounted for by the ingeata, nor yet be held necessary to nutrition.
The same thing will also appear in regard to ligatures, and wherefore they are said to draw; though this is neither from the heat, nor the pain, nor the vacuum they occasion, nor indeed from any other cause yet thought of; it will also explain the uses and advantages to be derived from ligatures in medicine, the principle upon which they either suppress or occasion hemorrhage; how they induce sloughing and more extensive mortification in extremities; and how they act in the castration of animals and the removal of warts and fleshy tumours. But it has come to pass, from no one having duly weighed and understood the cause and rationale of these various effects, that though almost all, upon the faith of the old writers, recommend ligatures in the treatment of disease, yet very few comprehend their proper employment, or derive any real assistance from them in effecting cures.
Ligatures are either very tight or of medium tightness. A ligature I designate as tight or perfect when it so constricts an extremity that no vessel can be felt pulsating beyond it. Such a ligature we use in amputations to control the flow of blood; and such also are employed in the castration of animals and the ablation of tumours. In the latter instances, all afflux of nutriment and heat being prevented by the ligature, we see the testes and large fleshy tumours dwindle, die, and finally fall off.
Ligatures of medium tightness I regard as those which compress a limb firmly all round, but short of pain, and in such a way as still suffers a certain degree of pulsation to be felt in the artery beyond them. Such a ligature is in use in blood-letting, an operation in which the fillet applied above the elbow is not drawn so tight but that the arteries at the wrist may still be felt beating under the finger.
Now let anyone make an experiment upon the arm of a man, either using such a fillet as is employed in blood-letting, or grasping the limb lightly with his hand, the best subject for it being one who is lean, and who has large veins, and the best time after exercise, when the body is warm, the pulse is full, and the blood carried in larger quantity to the extremities, for all then is more conspicuous; under such circumstances let a ligature be thrown about the extremity, and drawn as tightly as can be borne, it will first be perceived that beyond the ligature, neither in the wrist nor anywhere else, do the arteries pulsate, at the same time that immediately above the ligature the artery begins to rise higher at each diastole, to throb mere violently, and to swell in its vicinity with a kind of tide, as if it strove to break through and overcome the obstacle to its current; the artery here, in short, appears as if it were preternaturally full. The hand under such circumstances retains its natural colour and appearance; in the course of time it begins to fall somewhat in temperature, indeed, but nothing is drawn into it.
After the bandage has been kept on for some short time in this way, let it be slackened a little, brought to that state or term of medium tightness which is used in bleeding, and it will be seen that the whole hand and arm will instantly become deeply coloured and distended, and the veins show themselves tumid and knotted; after ten or twelve pulses of the artery, the hand will be perceived excessively distended, injected, gorged with blood, drawn, as it is said, by this medium ligature, without pain, or heat, or any horror of a vacuum, or any other cause yet indicated.
If the finger be applied over the artery as it is pulsating by the edge of the fillet, at the moment of slackening it, the blood will be felt to glide through, as it were, underneath the finger; and he, too, upon whose arm the experiment is made, when the ligature is slackened, is distinctly conscious of a sensation of warmth, and of something, viz., a stream of blood suddenly making its way along the course of the vessels and diffusing itself through the hand, which at the same time begins to feel hot, and becomes distended.
As we had noted, in connexion with the tight ligature, that the artery above the bandage was distended and pulsated, not below it, so, in the case of the moderately tight bandage, on the contrary, do we find that the veins below, never above, the fillet, swell, and become dilated, whilst the arteries shrink; and such is the degree of distension of the veins here, that it is only very strong pressure that will force the blood beyond the fillet, and cause any of the veins in the upper part of the arm to rise.
From these facts it is easy for every careful observer to learn that the blood enters an extremity by the arteries; for when they are effectually compressed nothing is drawn to the member; the hand preserves its colour; nothing flows into it, neither is it distended; but when the pressure is diminished, as it is with the bleeding fillet, it is manifest that the blood is instantly thrown in with force, for then the hand begins to swell; which is as much as to say, that when the arteries pulsate the blood is flowing through them, as it is when the moderately tight ligature is applied; but where they do not pulsate, as, when a tight ligature is used, they cease from transmitting anything, they are only distended above the part where the ligature is applied. The veins again being compressed, nothing can flow through them; the certain indication of which is, that below the ligature they are much more tumid than above it, and than they usually appear when there is no bandage upon the arm.
It therefore plainly appears that the ligature prevents the return of the blood through the veins to the parts above it, and maintains those beneath it in a state of permanent distension. But the arteries, in spite of its pressure, and under the force and impulse of the heart, send on the blood from the internal parts of the body to the parts beyond the ligature. And herein consists the difference between the tight and the medium ligature, that the former not only prevents the passage of the blood in the veins, but in the arteries also; the latter, however, whilst it does not prevent the force of the pulse from extending beyond it, and so propelling the blood to the extremities of the body, compresses the veins, and greatly or altogether impedes the return of the blood through them.
Seeing, therefore, that the moderately tight ligature renders the veins turgid and distended, and the whole hand full of blood, I ask, whence is this? Does the blood accumulate below the ligature coming through the veins, or through the arteries, or passing by certain hidden porosities? Through the veins it cannot come; still less can it come through invisible channels; it must needs, then, arrive by the arteries, in conformity with all that has been already said. That it cannot flow in by the veins appears plainly enough from the fact that the blood cannot be forced towards the heart unless the ligature be removed; when this is done suddenly all the veins collapse, and disgorge themselves of their contents into the superior parts, the hand at the same time resumes its natural pale colour, the tumefaction and the stagnating blood having disappeared.
Moreover, he whose arm or wrist has thus been bound for some little time with the medium bandage, so that it has not only got swollen and livid but cold, when the fillet is undone is aware of something cold making its way upwards along with the returning blood, and reaching the elbow or the axilla. And I have myself been inclined to think that this cold blood rising upwards to the heart was the cause of the fainting that often occurs after blood-letting: fainting frequently supervenes even in robust subjects, and mostly at the moment of undoing the fillet, as the vulgar say, from the turning of the blood.
Farther, when we see the veins below the ligature instantly swell up and become gorged, when from extreme tightness it is somewhat relaxed, the arteries meantime continuing unaffected, this is an obvious indication that the blood passes from the arteries into the veins, and not from the veins into the arteries, and that there is either an anastomosis of the two orders of vessels, or porosities in the flesh and solid parts generally that are permeable to the blood It is farther an indication that the veins have frequent communications with one another, because they all become turgid together, whilst under the medium ligature applied above the elbow; and if any single small vein be pricked with a lancet, they all speedily shrink, and disburthening themselves into this they subside almost simultaneously.
These considerations will enable anyone to understand the nature of the attraction that is exerted by ligatures, and perchance of fluxes generally; how, for example, when the veins are compressed by a bandage of medium tightness applied above the elbow, the blood cannot escape, whilst it still continues to be driven in, by the forcing power of the heart, by which the parts are of necessity filled, gorged with blood. And how should it be otherwise? Heat and pain and a vacuum draw, indeed; but in such wise only that parts are filled, not preternaturally distended or gorged, and not so suddenly and violently overwhelmed with the charge of blood forced in upon them, that the flesh is lacerated and the vessels ruptured. Nothing of the kind as an effect of heat, or pain, or the vacuum force, is either credible or demonstrable.
Besides, the ligature is competent to occasion the afflux in question without either pain, or heat, or a vacuum. Were pain in any way the cause, how should it happen that, with the arm bound above the elbow, the hand and fingers should swell being the bandage, and their veins become distended? The pressure of the bandage certainly prevents the blood from getting there by the veins. And then, wherefore is there neither swelling nor repletion of the veins, nor any sign or symptom of attraction or afflux, above the ligature? But this is the obvious cause of the preternatural attraction and swelling below the bandage, and in the hand and fingers, that the blood is entering abundantly, and with force, but cannot pass out again.
Now is not this the cause of all tumefaction, as indeed Avicenna has it, and of all oppressive redundancy in parts, that the access to them is open, but the egress from them is. closed? Whence it comes that they are gorged and tumefied. And may not the same thing happen in local inflammations, where, so long as the swelling is on the increase, and has not reached its extreme term, a full pulse is felt in the part, especially when the disease is of the more acute kind, and the swelling usually takes place most rapidly. But these are matters for after discussion. Or does this, which occurred in my own case, happen from the same cause? Thrown from a carriage upon one occasion, I struck my forehead a blow upon the place where a twig of the artery advances from the temple, and immediately, within the time in which twenty beats could have been made I felt a tumour the size of an egg developed, without either heat or any great pain: the near vicinity of the artery had caused the blood to be effused into the bruised part with unusual force and velocity.
And now, too, we understand why in phlebotomy we apply our ligature above the part that is punctured, not below it; did the flow come from above, not from below, the constriction in this case would not only be of no service, but would prove a positive hindrance; it would have to be applied below the orifice, in order to have the flow more free, did the blood descend by the veins from superior to inferior parts; but as it is elsewhere forced through the extreme arteries into the extreme veins, and the return in these last is opposed by the ligature, so do they fill and swell, and being thus filled and distended, they are made capable of projecting their charge with force, and to a distance, when any one of them is suddenly punctured; but the ligature being slackened, and the returning channels thus left open, the blood forthwith no longer escapes, save by drops; and, as all the world knows, if in performing phlebotomy the bandage be either slackened too much or the limb be bound too tightly, the blood escapes without force, because in the one case the returning channels are not adequately obstructed; in other the channels of influx, the arteries, are impeded.
THAT THERE IS A CIRCULATION OF THE BLOOD IS SHOWN FROM THE SECOND POSITION DEMONSTRATED
If these things be so, another point which I have already referred to, viz., the continual passage of the blood through the heart will also be confirmed. We have seen, that the blood passes from the arteries into the veins, not from the veins into the arteries; we have seen, farther, that almost the whole of the blood may be withdrawn from a puncture made in one of the cutaneous veins of the arm if a bandage properly applied be used; we have seen, still farther, that the blood flows so freely and rapidly that not only is the whole quantity which was contained in the arm beyond the ligature, and before the puncture was made, discharged, but the whole which is contained in the body, both that of the arteries and that of the veins.
Whence we must admit, first, that the blood is sent along with an impulse, and that it is urged with force below the ligature; for it escapes with force, which force it receives from the pulse and power of the heart; for the force and motion of the blood are derived from the heart alone. Second, that the afflux proceeds from the heart, and through the heart by a course from the great veins; for it gets into the parts below the ligature through the arteries, not through the veins; and the arteries nowhere receive blood from the veins, nowhere receive blood save and except from the left ventricle of the heart. Nor could so large a quantity of blood be drawn from one vein (a ligature having been duly applied), nor with such impetuousity, such readiness, such celerity, unless through the medium of the impelling power of the heart.
But if all things be as they are now represented, we shall feel ourselves at liberty to calculate the quantity of the blood, and to reason on its circular motion. Should anyone, for instance, performing phlebotomy, suffer the blood to flow in the manner it usually does, with force and freely, for some half hour or so, no question but that the greatest part of the blood being abstracted, faintings and syncopes would ensue, and that not only would the arteries but the great veins also be nearly emptied of their contents. It is only consonant with reason to conclude that in the course of the half hour hinted at, so much as has escaped has also passed from the great veins through the heart into the aorta. And further, if we calculate how many ounces flow through one arm, or how many pass in twenty or thirty pulsations under the medium ligature, we shall have some grounds for estimating how much passes through the other arm in the same space of time: how much through both lower extremities, how much through the neck on either side, and through all the other arteries and veins of the body, all of which have been supplied with fresh blood, and as this blood must have passed through the lungs and ventricles of the heart, and must have come from the great veins, we shall perceive that a circulation is absolutely necessary, seeing that the quantities hinted at cannot be supplied immediately from the ingesta, and are vastly more than can be requisite for the mere nutrition of the parts.
It is still further to be observed, that in practising phlebotomy the truths contended for are sometimes confirmed in another way; for having tied up the arm properly, and made the puncture duly, still, if from alarm or any other causes, a state of faintness supervenes, in which the heart always pulsates more languidly, the blood does not flow freely, but distils by drops only. The reason is, that with a somewhat greater than usual resistance offered to the transit of the blood by the bandage, coupled with the weaker action of the heart, and its diminished impelling power, the stream cannot make its way under the ligature; and farther, owing to the weak and languishing state of the heart, the blood is not transferred in such quantity as wont from the veins to the arteries through the sinuses of that organ. So also, and for the same reasons, are the menstrual fluxes of women, and indeed hemorrhages of every kind, controlled. And now, a contrary state of things occurring, the patient getting rid of his fear and recovering his courage, the pulse strength is increased, the arteries begin again to beat with greater force, and to drive the blood even into the part that is bound; so that the blood now springs from the puncture in the vein, and flows in continuous stream.
THE THIRD POSITION IS CONFIRMED: AND THE CIRCULATION OF THE BLOOD IS DEMONSTRATED FROM IT
Thus far we have spoken of the quantity of blood passing through the heart and the lungs in the centre of the body, and in like manner from the arteries into the veins in the peripheral parts and the body at large. We have yet to explain, however, in what manner the blood finds its way back to the heart from the extremities by the veins, and how and in what way these are the only vessels that convey the blood from the external to the central parts; which done, I conceive that the three fundamental propositions laid down for the circulation of the blood will be so plain, so well established, so obviously true, that they may claim general credence. Now the remaining position will be made sufficiently clear from the valves which are found in the cavities of the veins themselves, from the uses of these, and from experiments 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 pass from the trunks into the branches of the veins, or from the greater vessels into the less, they completely prevent it; they are farther so arranged, that the horns of those that succeed are opposite the middle of the convexity of those that 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 pass from larger into continually smaller vessels, being separated from the mass and fountain head, and attaining from warmer into colder places.
But the valves are solely made and instituted lest the blood should pass from the greater into the lesser veins, and either rupture them or cause them to become varicose; lest, instead of advancing from the extreme to the central parts of the body, the blood should rather proceed along the veins from the centre to the extremities; but the delicate valves, while they readily open in the right direction, entirely prevent all such contrary motion, being so situated and arranged, that if anything escapes, or is less perfectly obstructed by the cornua of the one above, the fluid passing, as it were, by the chinks between the cornua, it is immediately received on the convexity of the one beneath, which is placed transversely with reference to the former, and so is effectually hindered from getting any farther.
And this I have frequently experienced in my dissections of the veins: if I attempted to pass a probe from the trunk of the veins into one of the smaller branches, whatever care I took I found it impossible to introduce it far any way, by reason of the valves; whilst, on the contrary, it was most easy to push it along in the opposite direction, from without inwards, or from the branches towards the trunks and roots. In many places two valves are so placed and fitted, that when raised they come exactly together in the middle of the vein, and are there united by the contact of their margins; and so accurate is the adaptation, that neither by the eye nor by any other means of examination, can the slightest chink along the line of contact be perceived. But if the probe be now introduced from the extreme towards the more central parts, the valves, like the floodgates of a river, give way, and are most readily pushed aside. The effect of this arrangement plainly is to prevent all motion of the blood from the heart and vena cava, whether it be upwards towards the head, or downwards towards the feet, or to either side towards the arms, not a drop can pass; all motion of the blood, beginning; in the larger and tending towards the smaller veins, is opposed and resisted by them; whilst the motion that proceeds from the lesser to end in the larger branches is favoured, or, at all events, a free and open passage is left for it.
But that this truth may be made the more apparent, let an arm be tied up above the elbow as if for phlebotomy (A, A, fig. 1). At intervals in the course of the veins, especially in labouring people and those whose veins are large, certain knots or elevations (B, C, D, E, F) will be perceived, and this not only at the places where a branch is received (E, F), but also where none enters (C, D): these knots or risings are all formed by valves, which thus show themselves externally. And now if you press the blood from the space above one of the valves, from H to O, (fig. 2,) and keep the point of a finger upon the vein inferiorly, you will see no influx of blood from above; the portion of the vein between the point of the finger and the valve O will be obliterated; yet will the vessel continue sufficiently distended above 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 passing 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 passage of the blood from the centre, still the greater number of them plainly do so; and then, where things appear contrived more negligently, this is compensated either by the more frequent occurrence or more perfect action of the succeeding valves, or in some other way: the veins in short, as they are the free and open conduits of the blood returning TO the heart, so are they effectually prevented from serving as its channels of distribution FROM the heart.
But this other circumstance has to be noted: The arm being bound, and the veins made turgid, and the valves prominent, as before, apply the thumb or finger over a vein in the situation of one of the valves in such a way as to compress it, and prevent any blood from passing upwards from the hand; then, with a finger of the other hand, streak the blood in the vein upwards till it has passed the next valve above (N, fig. 4), the vessel now remains empty; but the finger at L being removed for an instant, the vein is immediately filled from below; apply the finger again, and having in the same manner streaked the blood upwards, again remove the finger below, and again the vessel becomes distended as before; and this repeat, say a thousand times, in a short space of time. And now compute the quantity of blood which you have thus pressed up beyond the valve, and then multiplying the assumed quantity by one thousand, you will find that so much blood has passed through a certain portion of the vessel; and I do now believe that you will find yourself convinced of the circulation of the blood, and of its rapid motion. But if in this experiment you say that a violence is done to nature, I do not doubt but that, if you proceed in the same way, only taking as great a length of vein as possible, and merely remark with what rapidity the blood flows upwards, and fills the vessel from below, you will come to the same conclusion.
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 passes 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 circumference 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 quantity 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.
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 passes 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 circumstances, 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 passages 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 constitution, 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 circumstances 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 constituted that it can distribute the blood in due proportion to the several parts of the body, the quantity 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 mass 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 circumference 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.
THE CIRCULATION OF THE BLOOD IS FURTHER PROVED FROM CERTAIN CONSEQUENCES
There are still certain problems, which, taken as consequences of this truth assumed 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 assigned 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 pass 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 passages 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 assists 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, transmutation, and sanguification, but rather, and because they are severally active and passive, 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 quantity of chyle is mingled with a very large quantity of circulating blood, a quantity of chyle that bears no kind of proportion to the mass 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 mass 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 passes 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 albumen passing 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 shell; for this part may still be found in the abdomen of the chick many days after its exclusion, and is a substitute 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 illustrated 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.