||Tome III||Tome IV|
From Paracelsus to Harvey
The coming of Harvey
|The time was ripe
for the culminating discovery of the circulation of the blood; but as yet
no one had determined the all-important fact that there are two currents
of blood in the body, one going to the heart, one coming from it. The valves
in the veins would seem to show conclusively that the venous current did
not come from the heart, and surgeons must have observed thousands of times
the every-day phenomenon of congested veins at the distal extremity of
a limb around which a ligature or constriction of any kind had been placed,
and the simultaneous depletion of the vessels at the proximal points above
the ligature. But it should be remembered that inductive science was in
its infancy. This was the sixteenth, not the nineteenth century, and few
men had learned to put implicit confidence in their observations and convictions
when opposed to existing doctrines. The time was at hand, however, when
such a man was to make his appearance, and, as in the case of so many revolutionary
doctrines in science, this man was an Englishman. It remained for William
Harvey (1578-1657) to solve the great mystery which had puzzled the medical
world since the beginning of history; not only to solve it, but to prove
his case so conclusively and so simply that for all time his little booklet
must he handed down as one of the great masterpieces of lucid and almost
Harvey, the son of a prosperous Kentish yeoman, was born at Folkestone. His education was begun at the grammar-school of Canterbury, and later he became a pensioner of Caius College, Cambridge. Soon after taking his degree of B.A., at the age of nineteen, he decided upon the profession of medicine, and went to Padua as a pupil of Fabricius and Casserius. Returning to England at the age of twenty-four, he soon after (1609) obtained the reversion of the post of physician to St. Bartholomew's Hospital, his application being supported by James I. himself. Even at this time he was a popular physician, counting among his patients such men as Francis Bacon. In 1618 he was appointed physician extraordinary to the king, and, a little later, physician in ordinary. He was in attendance upon Charles I. at the battle of Edgehill, in 1642, where, with the young Prince of Wales and the Duke of York, after seeking shelter under a hedge, he drew a book out of his pocket and, forgetful of the battle, became absorbed in study, until finally the cannon-balls from the enemy's artillery made him seek a more sheltered position.
On the fall of Charles I. he retired from practice, and lived in retirement with his brother. He was then well along in years, but still pursued his scientific researches with the same vigor as before, directing his attention chiefly to the study of embryology. On June 3, 1657, he was attacked by paralysis and died, in his eightieth year. He had lived to see his theory of the circulation accepted, several years before, by all the eminent anatomists of the civilized world.
A keenness in the observation of facts,
characteristic of the mind of the man, had led Harvey to doubt the truth
of existing doctrines as to the phenomena of the circulation. Galen had
taught that "the arteries are filled, like bellows, because they are expanded,"
but Harvey thought that the action of spurting blood from a severed vessel
disproved this. For the spurting was remittant, "now with greater, now
with less impetus," and its greater force always corresponded to the expansion
(diastole), not the contraction (systole) of the vessel. Furthermore, it
was evident that contraction of the heart and the arteries was not simultaneous,
as was commonly taught, because in that case there would be no marked propulsion
of the blood in any direction; and there was no gainsaying the fact that
the blood was forcibly propelled in a definite direction, and that direction
away from the heart.
Having convinced himself that no intra-ventricular opening existed, he proceeded to study the action of the heart itself, untrammelled by too much faith in established theories, and, as yet, with no theory of his own. He soon discovered that the commonly accepted theory of the heart striking against the chest-wall during the period of relaxation was entirely wrong, and that its action was exactly the reverse of this, the heart striking the chest-wall during contraction. Having thus disproved the accepted theory concerning the heart's action, he took up the subject of the action of arteries, and soon was able to demonstrate by vivisection that the contraction of the arteries was not simultaneous with contractions of the heart. His experiments demonstrated that these vessels were simply elastic tubes whose pulsations were "nothing else than the impulse of the blood within them." The reason that the arterial pulsation was not simultaneous with the heart-beat he found to be because of the time required to carry the impulse along the tube,
By a series of further careful examinations and experiments, which are too extended to be given here, he was soon able further to demonstrate the action and course of the blood during the contractions of the heart. His explanations were practically the same as those given to-day - first the contraction of the auricle, sending blood into the ventricle; then ventricular contraction, making the pulse, and sending the blood into the arteries. He had thus demonstrated what had not been generally accepted before, that the heart was an organ for the propulsion of blood. To make such a statement to-day seems not unlike the sober announcement that the earth is round or that the sun does not revolve about it. Before Harvey's time, however, it was considered as an organ that was "in some mysterious way the source of vitality and warmth, as an animated crucible for the concoction of blood and the generation of vital spirits."
In watching the rapid and ceaseless contractions of the heart, Harvey was impressed with the fact that, even if a very small amount of blood was sent out at each pulsation, an enormous quantity must pass through the organ in a day, or even in an hour. Estimating the size of the cavities of the heart, and noting that at least a drachm must be sent out with each pulsation, it was evident that the two thousand beats given by a very slow human heart in an hour must send out some forty pounds of blood - more than twice the amount in the entire body. The question was, what became of it all? For it should be remembered that the return of the blood by the veins was unknown, and nothing like a "circulation" more than vaguely conceived even by Harvey himself. Once it could be shown that the veins were constantly returning blood to the heart, the discovery that the blood in some way passes from the arteries to the veins was only a short step. Harvey, by resorting to vivisections of lower animals and reptiles, soon demonstrated beyond question the fact that the veins do carry the return blood. "But this, in particular, can be shown clearer than daylight," says Harvey. "The vena cava enters the heart at an inferior portion, while the artery passes out above. Now if the vena cava be taken up with forceps or the thumb and finger, and the course of the blood intercepted for some distance below the heart, you will at once see it almost emptied between the fingers and the heart, the blood being exhausted by the heart's pulsation, the heart at the same time becoming much paler even in its dilatation, smaller in size, owing to the deficiency of blood, and at length languid in pulsation, as if about to die. On the other hand, when you release the vein the heart immediately regains its color and dimensions. After that, if you leave the vein free and tie and compress the arteries at some distance from the heart, you will see, on the contrary, their included portion grow excessively turgid, the heart becoming so beyond measure, assuming a dark-red color, even to lividity, and at length so overloaded with blood as to seem in danger of suffocation; but when the obstruction is removed it returns to its normal condition, in size, color, and movement."
This conclusive demonstration that the veins return the blood to the heart must have been most impressive to Harvey, who had been taught to believe that the blood current in the veins pursued an opposite course, and must have tended to shake his faith in all existing doctrines of the day.
His next step was the natural one of demonstrating that the blood passes from the arteries to the veins. He demonstrated conclusively that this did occur, but for once his rejection of the ancient writers and one modern one was a mistake. For Galen had taught, and had attempted to demonstrate, that there are sets of minute vessels connecting the arteries and the veins; and Servetus had shown that there must be such vessels, at least in the lungs.
However, the little flaw in the otherwise complete demonstration of Harvey detracts nothing from the main issue at stake. It was for others who followed to show just how these small vessels acted in effecting the transfer of the blood from artery to vein, and the grand general statement that such a transfer does take place was, after all, the all-important one, and the exact method of how it takes place a detail. Harvey's experiments to demonstrate that the blood passes from the arteries to the veins are so simply and concisely stated that they may best be given in his own words.
"I have here to cite certain experiments," he wrote, "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 by anastomosis from the arteries into the veins, or immediately by the pores 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 thence hither, and hence thither; from the centre to the extremities, to wit, and from the extreme parts back again to the centre. Finally, upon grounds of circulation, 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.
"Now let any one make an experiment on the arm of a man, either using such a fillet as is employed in blood-letting or grasping the limb tightly 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 large quantities 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, that at the same time 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 permanently full. The hand under such circumstances retains its natural color and appearances; 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 some short time in this way, let it be slackened a little, brought to the state or term of middling tightness which is used in bleeding, and it will be seen that the whole hand and arm will instantly become deeply suffused and distended, injected, gorged with blood, DRAWN, as it is said, by this middling ligature, without pain, or heat, or any horror of a vacuum, or any other cause yet indicated.
"As we have 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, while the arteries shrink; and such is the degree of distention 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 any careful observer to learn that the blood enters an extremity by the arteries; for when they are effectively compressed nothing is DRAWN to the member; the hand preserves its color; 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 when they do not pulsate, or 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 distention. But the arteries, in spite of the 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 bandage."
This use of ligatures is very significant, because, as shown, a very tight ligature stops circulation in both arteries and veins, while a loose one, while checking the circulation in the veins, which lie nearer the surface and are not so directly influenced by the force of the heart, does not stop the passage of blood in the arteries, which are usually deeply imbedded in the tissues, and not so easily influenced by pressure from without.
The last step of Harvey's demonstration was to prove that the blood does flow along the veins to the heart, aided by the valves that had been the cause of so much discussion and dispute between the great sixteenth-century anatomists. Harvey not only demonstrated the presence of these valves, but showed conclusively, by simple experiments, what their function was, thus completing his demonstration of the phenomena of the circulation.
The final ocular demonstration of the passage of the blood from the arteries to the veins was not to be made until four years after Harvey's death. This process, which can be observed easily in the web of a frog's foot by the aid of a low-power lens, was first demonstrated by Marcello Malpighi (1628-1694) in 1661. By the aid of a lens he first saw the small "capillary" vessels connecting the veins and arteries in a piece of dried lung. Taking his cue from this, he examined the lung of a turtle, and was able to see in it the passage of the corpuscles through these minute vessels, making their way along these previously unknown channels from the arteries into the veins on their journey back to the heart. Thus the work of Harvey, all but complete, was made absolutely entire by the great Italian. And all this in a single generation.