The Works of William Harvey/An Anatomical Disquisition on the Motion of the Heart and Blood in Animals/Introduction
AN ANATOMICAL DISQUISITION
ON THE
MOTION OF THE HEART AND BLOOD IN ANIMALS.
INTRODUCTION.
As we are about to discuss the motion, action, and use of the heart and arteries, it is imperative on us first to state what has been thought of these things by others in their writings, and what has been held by the vulgar and by tradition, in order that what is true may be confirmed, and what is false set right by dissection, multiplied experience, and accurate observation.
Almost all anatomists, physicians, and philosophers, up to the present time, have supposed, with Galen, that the object of the pulse was the same as that of respiration, and only differed in one particular, this being conceived to depend on the animal, the respiration on the vital faculty; the two, in all other respects, whether with reference to purpose or to motion, comporting themselves alike. Whence it is affirmed, as by Hieronymus Fabricius of Aquapendente, in his book on 'Respiration,' which has lately appeared, that as the pulsation of the heart and arteries does not suffice for the ventilation and refrigeration of the blood, therefore were the lungs fashioned to surround the heart. From this it appears, that whatever has hitherto been said upon the systole and diastole, on the motion of the heart and arteries, has been said with especial reference to the lungs.
But as the structure and movements of the heart differ from those of the lungs, and the motions of the arteries from those of the chest, so seems it likely that other ends and offices will thence arise, and that the pulsations and uses of the heart, likewise of the arteries, will differ in many respects from the heavings and uses of the chest and lungs. For did the arterial pulse and the respiration serve the same ends; did the arteries in their diastole take air into their cavities, as commonly stated, and in their systole emit fuliginous vapours by the same pores of the flesh and skin; and further, did they, in the time intermediate between the diastole and the systole, contain air, and at all times either air, or spirits, or fuliginous vapours, what should then be said to Galen, who wrote a book on purpose to show that by nature the arteries contained blood, and nothing but blood; neither spirits nor air, consequently, as may be readily gathered from the experiments and reasonings contained in the same book? Now if the arteries are filled in the diastole with air then taken into them (a larger quantity of air penetrating when the pulse is large and full), it must come to pass, that if you plunge into a bath of water or of oil when the pulse is strong and full, it ought forthwith to become either smaller or much slower, since the circumambient bath will render it either difficult or impossible for the air to penetrate. In like manner, as all the arteries, those that are deep-seated as well as those that are superficial, are dilated at the same instant, and with the same rapidity, how were it possible that air should penetrate to the deeper parts as freely and quickly through the skin, flesh, and other structures, as through the mere cuticle? And how should the arteries of the foetus draw air into their cavities through the abdomen of the mother and the body of the womb? And how should seals, whales, dolphins and other cetaceans, and fishes of every description, living in the depths of the sea, take in and emit air by the diastole and systole of their arteries through the infinite mass of waters? For to say that they absorb the air that is infixed in the water, and emit their fumes into this medium, were to utter something very like a mere figment. And if the arteries in their systole expel fuliginous vapours from their cavities through the pores of the flesh and skin, why not the spirits, which are said to be contained in these vessels, at the same time, since spirits are much more subtile than fuliginous vapours or smoke? And further, if the arteries take in and cast out air in the systole and diastole, like the lungs in the process of respiration, wherefore do they not do the same thing when a wound is made in one of them, as is done in the operation of arteriotomy? When the windpipe is divided, it is sufficiently obvious that the air enters and returns through the wound by two opposite movements; but when an artery is divided, it is equally manifest that blood escapes in one continuous stream, and that no air either enters or issues. If the pulsations of the arteries fan and refrigerate the several parts of the body as the lungs do the heart, how comes it, as is commonly said, that the arteries carry the vital blood into the different parts, abundantly charged with vital spirits, which cherish the heat of these parts, sustain them when asleep, and recruit them when exhausted? and how should it happen that, if you tie the arteries, immediately the parts not only become torpid, and frigid, and look pale, but at length cease even to be nourished? This, according to Galen, is because they are deprived of the heat which flowed through all parts from the heart, as its source; whence it would appear that the arteries rather carry warmth to the parts than serve for any fanning or refrigeration. Besides, how can the diastole [of the arteries] draw spirits from the heart to warm the body and its parts, and, from without, means of cooling or tempering them? Still further, although some affirm that the lungs, arteries, and heart have all the same offices, they yet maintain that the heart is the workshop of the spirits, and that the arteries contain and transmit them; denying, however, in opposition to the opinion of Columbus, that the lungs can either make or contain spirits; and then they assert, with Galen, against Erasistratus, that it is blood, not spirits, which is contained in the arteries.
These various opinions are seen to be so incongruous and mutually subversive, that every one of them is not unjustly brought under suspicion. That it is blood and blood alone which is contained in the arteries is made manifest by the experiment of Galen, by arteriotomy, and by wounds; for from a single artery divided, as Galen himself affirms in more than one place, the whole of the blood may be withdrawn in the course of half an hour, or less. The experiment of Galen alluded to is this: "If you include a portion of an artery between two ligatures, and slit it open lengthways, you will find nothing but blood;" and thus he proves that the arteries contain blood only. And we too may be permitted to proceed by a like train of reasoning: if we find the same blood in the arteries that we find in the veins, which we have tied in the same way, as I have myself repeatedly ascertained, both in the dead body and in living animals, we may fairly conclude that the arteries contain the same blood as the veins, and nothing but the same blood. Some, whilst they attempt to lessen the difficulty here, affirming that the blood is spirituous and arterious, virtually concede that the office of the arteries is to carry blood from the heart into the whole of the body, and that they are therefore filled with blood; for spirituous blood is not the less blood on that account. And then no one denies that the blood as such, even the portion of it which flows in the veins, is imbued with spirits. But if that portion which is contained in the arteries be richer in spirits, it is still to be believed that these spirits are inseparable from the blood, like those in the veins; that the blood and spirits constitute one body (like whey and butter in milk, or heat [and water] in hot water), with which the arteries are charged, and for the distribution of which from the heart they are provided, and that this body is nothing else than blood. But if this blood be said to be drawn from the heart into the arteries by the diastole of these vessels, it is then assumed that the arteries by their distension are filled with blood, and not with the ambient air, as heretofore; for if they be said also to become filled with air from the ambient atmosphere, how and when, I ask, can they receive blood from the heart? If it be answered: during the systole; I say, that seems impossible; the arteries would then have to fill whilst they contracted; in other words, to fill, and yet not become distended. But if it be said: during the diastole, they would then, and for two opposite purposes, be receiving both blood and air, and heat and cold; which is improbable. Further, when it is affirmed that the diastole of the heart and arteries is simultaneous, and the systole of the two is also concurrent, there is another incongruity. For how can two bodies mutually connected, which are simultaneously distended, attract or draw anything from one another; or, being simultaneously contracted, receive anything from each other? And then, it seems impossible that one body can thus attract another body into itself, so as to become distended, seeing that to be distended is to be passive, unless, in the manner of a sponge, previously compressed by an external force, whilst it is returning to its natural state. But it is difficult to conceive that there can be anything of this kind in the arteries. The arteries dilate, because they are filled like bladders or leathern bottles; they are not filled because they expand like bellows. This I think easy of demonstration; and indeed conceive that I have already proved it. Nevertheless, in that book of Galen headed 'Quod Sanguis continetur in Arteriis,' he quotes an experiment to prove the contrary: An artery having been exposed, is opened longitudinally, and a reed or other pervious tube, by which the blood is prevented from being lost, and the wound is closed, is inserted into the vessel through the opening. "So long," he says, "as things are thus arranged, the whole artery will pulsate; but if you now throw a ligature about the vessel and tightly compress its tunics over the tube, you will no longer see the artery beating beyond the ligature." I have never performed this experiment of Galen's, nor do I think that it could very well be performed in the living body, on account of the profuse flow of blood that would take place from the vessel which was operated on; neither would the tube effectually close the wound in the vessel without a ligature; and I cannot doubt but that the blood would be found to flow out between the tube and the vessel. Still Galen appears by this experiment to prove both that the pulsative faculty extends from the heart by the walls of the arteries, and that the arteries, whilst they dilate, are filled by that pulsific force, because they expand like bellows, and do not dilate because they are filled like skins. But the contrary is obvious in arteriotomy and in wounds; for the blood spurting from the arteries escapes with force, now farther, now not so far, alternately, or in jets; and the jet always takes place with the diastole of the artery, never with the systole. By which it clearly appears that the artery is dilated by the impulse of the blood; for of itself it would not throw the blood to such a distance, and whilst it was dilating; it ought rather to draw air into its cavity through the wound, were those things true that are commonly stated concerning the uses of the arteries. Nor let the thickness of the arterial tunics impose upon us, and lead us to conclude that the pulsative property proceeds along them from the heart. For in several animals the arteries do not apparently differ from the veins; and in extreme parts of the body, where the arteries are minutely subdivided, as in the brain, the hand, &c., no one could distinguish the arteries from the veins by the dissimilar characters of their coats; the tunics of both are identical. And then, in an aneurism proceeding from a wounded or eroded artery, the pulsation is precisely the same as in the other arteries, and yet it has no proper arterial tunic. This the learned Riolanus testifies to, along with me, in his Seventh Book.
Nor let any one imagine that the uses of the pulse and the respiration are the same, because under the influence of the same causes, such as running, anger, the warm bath, or any other heating thing, as Galen says, they become more frequent and forcible together. For, not only is experience in opposition to this idea, though Galen endeavours to explain it away, when we see that with excessive repletion the pulse beats more forcibly, whilst the respiration is diminished in amount; but in young persons the pulse is quick, whilst respiration is slow. So is it also in alarm, and amidst care, and under anxiety of mind; sometimes, too, in fevers, the pulse is rapid, but the respiration is slower than usual.
These and other objections of the same kind may be urged against the opinions mentioned. Nor are the views that are entertained of the offices and pulse of the heart, perhaps, less bound up with great and most inextricable difficulties. The heart, it is vulgarly said, is the fountain and workshop of the vital spirits, the centre from whence life is dispensed to the several parts of the body; and yet it is denied that the right ventricle makes spirits; it is rather held to supply nourishment to the lungs; whence it is maintained that fishes are without any right ventricle (and indeed every animal wants a right ventricle which is unfurnished with lungs), and that the right ventricle is present solely for the sake of the lungs.
1. Why, I ask, when we see that the structure of both ventricles is almost identical, there being the same apparatus of fibres, and braces, and valves, and vessels, and auricles, and in both the same infarction of blood, in the subjects of our dissections, of the like black colour, and coagulated—why, I say, should their uses be imagined to be different, when the action, motion, and pulse of both are the same? If the three tricuspid valves placed at the entrance into the right ventricle prove obstacles to the reflux of the blood into the vena cava, and if the three semilunar valves which are situated at the commencement of the pulmonary artery be there, that they may prevent the return of the blood into the ventricle; wherefore, when we find similar structures in connexion with the left ventricle, should we deny that they are there for the same end, of preventing here the egress, there the regurgitation of the blood?
2. And again, when we see that these structures, in point of size, form, and situation, are almost in every respect the same in the left as in the right ventricle, wherefore should it be maintained that things are here arranged in connexion with the egress and regress of spirits, there, i.e. in the right, of blood. The same arrangement cannot be held fitted to favour or impede the motion of blood and of spirits indifferently.
3. And when we observe that the passages and vessels are severally in relation to one another in point of size, viz., the pulmonary artery to the pulmonary veins; wherefore should the one be imagined destined to a private or particular purpose, that to wit, of nourishing the lungs, the other to a public and general function?
4. And, as Realdus Columbus says, how can it be conceived that such a quantity of blood should be required for the nutrition of the lungs; the vessel that leads to them, the vena arteriosa or pulmonary artery being of greater capacity than both the iliac veins?
5. And I ask further; as the lungs are so close at hand, and in continual motion, and the vessel that supplies them is of such dimensions, what is the use or meaning of the pulse of the right ventricle? and why was nature reduced to the necessity of adding another ventricle for the sole purpose of nourishing the lungs?
When it is said that the left ventricle obtains materials for the formation of spirits, air to wit, and blood, from the lungs and right sinuses of the heart, and in like manner sends spirituous blood into the aorta, drawing fuliginous vapours from thence, and sending them by the arteria venosa into the lungs, whence spirits are at the same time obtained for transmission into the aorta, I ask how, and by what means, is the separation effected? and how comes it that spirits and fuliginous vapours can pass hither and thither without admixture or confusion? If the mitral cuspidate valves do not prevent the egress of fuliginous vapours to the lungs, how should they oppose the escape of air? and how should the semilunars hinder the regress of spirits from the aorta upon each supervening diastole of the heart? and, above all, how can they say that the spirituous blood is sent from the arteria venalis (pulmonary veins) by the left ventricle into the lungs without any obstacle to its passage from the mitral valves, when they have previously asserted that the air entered by the same vessel from the lungs into the left ventricle, and have brought forward these same mitral valves as obstacles to its retrogression? Good God! how should the mitral valves prevent regurgitation of air and not of blood?
Further, when they dedicate the vena arteriosa (or pulmonary artery), a vessel of great size, and having the tunics of an artery, to none but a kind of private and single purpose, that, namely, of nourishing the lungs, why should the arteria venalis (or pulmonary vein), which is scarcely of similar size, which has the coats of a vein, and is soft and lax, be presumed to be made for many—three or four, different uses? For they will have it that air passes through this vessel from the lungs into the left ventricle; that fuliginous vapours escape by it from the heart into the lungs; and that a portion of the spirituous or spiritualized blood is distributed by it to the lungs for their refreshment.
If they will have it that fumes and air—fumes flowing from, air proceeding towards the heart—are transmitted by the same conduit, I reply, that nature is not wont to institute but one vessel, to contrive but one way for such contrary motions and purposes, nor is anything of the kind seen elsewhere.
If fumes or fuliginous vapours and air permeate this vessel, as they do the pulmonary bronchia, wherefore do we find neither air nor fuliginous vapours when we divide the arteria venosa? why do we always find this vessel full of sluggish blood, never of air? whilst in the lungs we find abundance of air remaining.
If any one will perform Galen's experiment of dividing the trachea of a living dog, forcibly distending the lungs with a pair of bellows, and then tying the trachea securely, he will find, when he has laid open the thorax, abundance of air in the lungs, even to their extreme investing tunic, but none in either the pulmonary veins, or left ventricle of the heart. But did the heart either attract air from the lungs, or did the lungs transmit any air to the heart, in the living dog, by so much the more ought this to be the case in the experiment just referred to. Who, indeed, doubts that, did he inflate the lungs of a subject in the dissecting-room, he would instantly see the air making its way by this route, were there actually any such passage for it? But this office of the pulmonary veins, namely, the transference of air from the lungs to the heart, is held of such importance, that Hieronymus Fabricius, of Aquapendente, maintains the lungs were made for the sake of this vessel, and that it constitutes the principal element in their structure.
But I should like to be informed wherefore, if the pulmonary vein were destined for the conveyance of air, it has the structure of a blood-vessel here. Nature had rather need of annular tubes, such as those of the bronchia, in order that they might always remain open, not have been liable to collapse; and that they might continue entirely free from blood, lest the liquid should interfere with the passage of the air, as it so obviously does when the lungs labour from being either greatly oppressed or loaded in a less degree with phlegm, as they are when the breathing is performed with a sibilous or rattling noise.
Still less is that opinion to be tolerated which (as a two-fold matter, one aëreal, one sanguineous, is required for the composition of vital spirits,) supposes the blood to ooze through the septum of the heart from the right to the left ventricle by certain secret pores, and the air to be attracted from the lungs through the great vessel, the pulmonary vein; and which will have it, consequently, that there are numerous pores in the septum cordis adapted for the transmission of the blood. But, in faith, no such pores can be demonstrated, neither in fact do any such exist. For the septum of the heart is of a denser and more compact structure than any portion of the body, except the bones and sinews. But even supposing that there were foramina or pores in this situation, how could one of the ventricles extract anything from the other—the left, e.g. obtain blood from the right, when we see that both ventricles contract and dilate simultaneously? Wherefore should we not rather believe that the right took spirits from the left, than that the left obtained blood from the right ventricle, through these foramina? But it is certainly mysterious and incongruous that blood should be supposed to be most commodiously drawn through a set of obscure or invisible pores, and air through perfectly open passages, at one and the same moment. And why, I ask, is recourse had to secret and invisible porosities, to uncertain and obscure channels, to explain the passage of the blood into the left ventricle, when there is so open a way through the pulmonary veins? I own it has always appeared extraordinary to me that they should have chosen to make, or rather to imagine, a way through the thick, hard, and extremely compact substance of the septum cordis, rather than to take that by the open vas venosum or pulmonary vein, or even through the lax, soft and spongy substance of the lungs at large. Besides, if the blood could permeate the substance of the septum, or could be imbibed from the ventricles, what use were there for the coronary artery and vein, branches of which proceed to the septum itself, to supply it with nourishment? And what is especially worthy of notice is this: if in the fœtus, where everything is more lax and soft, nature saw herself reduced to the necessity of bringing the blood from the right into the left side of the heart by the foramen ovale, from the vena cava through the arteria venosa, how should it be likely that in the adult she should pass it so commodiously, and without an effort, through the septum ventriculorum, which has now become denser by age?
Andreas Laurentius|,[1] resting on the authority of Galen[2] and the experience of Hollerius, asserts and proves that the serum and pus in empyema, absorbed from the cavities of the chest into the pulmonary vein, may be expelled and got rid of with the urine and fæces through the left ventricle of the heart and arteries. He quotes the case of a certain person affected with melancholia, and who suffered from repeated fainting fits, who was relieved from the paroxysms on passing a quantity of turbid, fetid, and acrid urine; but he died at last, worn out by the disease; and when the body came to be opened after death, no fluid like that he had micturated was discovered either in the bladder or in the kidneys; but in the left ventricle of the heart and cavity of the thorax plenty of it was met with; and then Laurentius boasts that he had predicted the cause of the symptoms. For my own part, however, I cannot but wonder, since he had divined and predicted that heterogeneous matter could be discharged by the course he indicates, why he could not or would not perceive, and inform us that, in the natural state of things, the blood might be commodiously transferred from the lungs to the left ventricle of the heart by the very same route.
Since, therefore, from the foregoing considerations and many others to the same effect, it is plain that what has heretofore been said concerning the motion and function of the heart and arteries must appear obscure, or inconsistent or even impossible to him who carefully considers the entire subject; it will be proper to look more narrowly into the matter; to contemplate the motion of the heart and arteries, not only in man, but in all animals that have hearts; and further, by frequent appeals to vivisection, and constant ocular inspection, to investigate and endeavour to find the truth.