CHAPTER VIII
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 blood from the veins into the arteries, and of the manner
in which it is transmitted and distributes 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 the 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 intricate 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.
CHAPTER IX
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-ill 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,
CHAPTER IX
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 that 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 in 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
nonnaturals,-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 tumours in the human subject.
Nor would this argument lose any 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 butcher
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.
CHAPTER X
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 FURTHER
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 noon-day 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 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 be come 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 in 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.
CHAPTER XI
THE SECOND POSITION IS DEMONSTRATED
That this may the more clearly appear to every one, 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 again 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 ingesta, 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 causes, 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
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 bloodletting, 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 more 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 connection 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 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 bloodletting: 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 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 escaped 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 now 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 below 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 hinderance; 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 slacked, 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 the other the channels of influx,
the arteries, are impeded.
CHAPTER XII
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 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
impetuosity, 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, in 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 practicing 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 distills by drops only. The reason is, that with the 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 a continuous stream.
CHAPTER XIII
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 cognizable by the senses.
The celebrated Hieronymus Fabricius of Aquapendente, a most skillful anatomist, and
venerable old man, or, as the learned Riolan will have it, Jacobus Silvius, first gave
representations of the valves in the veins, which consist of raised or loose portions of
the inner membranes of these vessels, of extreme delicacy, and a sigmoid or semilunar
shape. They are situated at different distances from one another, and diversely in
different individuals; they are connate at the sides of the veins; they are directed
upwards or towards the trunks of the veins; the two-for there are for the most part two
together-regard each other, mutually touch, and are so ready to come into contact by their
edges, that if anything attempt to pass from the trunks into the branches of the veins, or
from the greater vessels into the less, they completely prevent it; they are farther so
arranged, that the horns of those that succeed are opposite the middle of the convexity of
those that precede, and so on alternately.
The discoverer of these valves did not rightly understand their use, nor have
succeeding anatomists added anything to our knowledge: for their office is by no means
explained when we are told that it is to hinder the blood, by its weight, from all flowing
into inferior parts; for the edges of the valves in the jugular veins hang downwards, and
are so contrived that they prevent the blood from rising upwards; the valves, in a word,
do not invariably look upwards, but always towards the trunks of the veins, invariably
towards the seat of the heart. I, and indeed others, have sometimes found valves in the
emulgent veins, and in those of the mesentery, the edges of which were directed towards
the vena cava and vena 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).
---figure
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).
---figure
The blood being thus pressed out, and the vein emptied, if you now apply a finger of
the other hand upon the distended part of the vein above the valve O, (fig. 3,) and press
downwards, you will find that you cannot force the blood through or beyond the valve; but
the greater effort you use, you will only see the portion of vein that is between the
finger and the valve become more distended, that portion of the vein which is below the
valve remaining all the while empty (H, O, fig. 3).
It would therefore appear that the function of the valves in the veins is the same as
that of the three sigmoid valves which we find at the commencement of the aorta and
pulmonary artery, viz., to prevent all reflux of the blood that is passing over them.
Farther, the arm being bound as before, and the veins looking full and distended, if
you press at one part in the course of a vein with the point of a finger L, fig. 4), and
then with another finger streak the blood upwards beyond the next valve (N), you will
perceive that this portion of the vein continues empty (L N), and that the blood cannot
retrograde, precisely as we have already seen the case to be in fig. 2; but the finger
first applied (H, fig. 2, L, fig. 4), being removed, immediately the vein is filled from
below, and the arm becomes as it appears at D C, fig. l. That the blood in the veins
therefore proceeds from inferior or more remote to superior parts, and towards the heart,
moving in these vessels in this and not in the contrary direction, appears most obviously.
And although in some places the valves, by not acting with such perfect accuracy, or where
there is but a single valve, do not seem totally to prevent the passage of the blood from
the centre, still the greater number of them plainly do so; and then, where things appear
contrived more negligently, this is compensated either by the more frequent occurrence or
more perfect action of the succeeding valves, or in some other way: the veins, in short,
as they are the free and open conduits of the blood returning to the heart, so are they
effectually prevented from serving as its channels of distribution from the heart.
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.
CHAPTER XIV
CONCLUSION OF THE DEMONSTRATION OF THE CIRCULATION
And now I may be allowed to give in brief my view of the circulation of the blood, and
to propose it for general adoption .
Since all things, both argument and ocular demonstration, show that the blood 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.
CHAPTER XV
THE CIRCULATION OF THE BLOOD IS FURTHER CONFIRMED BY PROBABLE REASONS
It will not be foreign to the subject if I here show further, from certain familiar
reasonings, that the circulation is matter both of convenience and necessity. In the first
place, since death is a corruption which takes place through deficiency of heat, 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 all 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 well-nigh 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, 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 an impelling power. Now such is
the heart and the heart alone, and that in the way and manner already explained.
CHAPTER XI
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 adrnit of having reasons and causes assigned for them. Of such a nature are those
that present themselves in connection with contagions, poisoned wounds, the bites of
serpents and rabid animals, lues venerea and the like. We sometimes see the whole system
contaminated, thougll 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 shortwillded, 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 celiac 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
retums by their numerous ramifications into the vena portae of the liver, and from this
into the vena cava, and 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 consumunate 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 proportion of chyle
or incompletely digested matter mingled with this 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 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 fortnation 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 sec
how mally questions can bc 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 spell out into a volume, which was beyond my purpose, but my whole
life, perchance would not suffice for its completion.
In this place, therefore, and that indeed in a single chapter, I shall only endeavour
to refer the various particulars that present themselves in the dissection of the heart
and arteries to their several uses and causes; for so I shall meet with many things which
receive light from the truth I have been contending for, and which, in their turn, render
it more obvious. And indeed I would have it confirmed and illustrated by anatomical
arguments above all others.
There is but a single point which indeed would be more correctly placed among our
observations on the use of the spleen, but which it will not be altogether impertinent to
notice in this place incidelltally. From the splenetic branc
which passes into the pancreas, and from the upper part, arise the posterior coronary,
gastric, and gastroepiploic veins, all of which are distributed UpOII the stomach in
numerous branches and twigs, just as the mesenteric vessels are upon the intestines. In a
similar way, from the inferior part of the same splenic branch, and alone the back of the
colon and rectum proceed the hemor rhoidal veins. The blood returning by these veins, and
bringing the cruder juices along with it, on the one halld from the stomach, where they
are thin, watery, and not yet perfectly chylified; on the other thick and more earthy, as
derived from the feces, but all poured into this splenic branch, are duly tempered by the
admixture of contraries; and nature mingling together these two kinds of juices, difficult
of coction by reason of most opposite defects, and then diluting them with a large
quantity of warm blood, (for we see that the quantity returned from the spleen must be
very large when we contemplate the size of its they are brought to the porta of the state
of higher preparation. The defects extreme are supplied and compensated by this
arrangement of the veins.
