Chapter XIV

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For my part, I believe that no other kind of attraction can be demonstrated in the living body save that of the nutriment, which gradually and incessantly passes on to supply the waste that takes place in the tissues; in the same way as the oil rises in the wick of a lamp to be consumed by the flame. Whence I conclude that the primary and common organ of all sensible attraction and impulsion is of the nature of sinew (nervus), or fibre, or muscle, and this to the end that it may be contractile, that contracting it may be shortened, and so either stretch out, draw towards, or propel. But these topics will be better discussed elsewhere, when we speak of the organs of motion in the animal body.

To those who repudiate the circulation because they neither see the efficient nor final cause of it, and who exclaim, cui bono? I have yet to reply, having hitherto taken no note of the ground of objection which they take up. And first I own I am of opinion that our first duty is to inquire whether the thing be or not, before asking wherefore it is? for from the facts and circumstances which meet us in the circulation admitted, established, the ends and objects of its institution are especially to be sought. Meantime I would only ask, how many things we admit in physiology, pathology, and therapeutics, the causes of which are unknown to us? That there are many, no one doubts--the causes of putrid fevers, of revulsions, of the purgation of excrementitious matters, among the number.

Whoever, therefore, sets himself in opposition to the circulation, because, if it be acknowledged, he cannot account for a variety of medical problems, nor in the treatment of diseases and the administration of medicines, give satisfactory reasons for the phenomena that appear; or who will not see that the precepts he has received from his teachers are false; or who thinks it unseemly to give up accredited opinions; or who regards it as in some sort criminal to call in question doctrines that have descended through a long succession of ages, and carry the authority of the ancients;--to all of these I reply: that the facts cognizable by the senses wait upon no opinions, and that the works of nature bow to no antiquity; for indeed there is nothing either more ancient or of higher authority than nature.

To those who object to the circulation as throwing obstacles in the way of their explanations of the phenomena that occur in medical cases (and there are persons who will not be content to take up with a new system, unless it explains everything, as in astronomy), and who oppose it with their own erroneous assumptions, such as that, if it be true, phlebotomy cannot cause revulsion, seeing that the blood will still continue to be forced into the affected part; that the passage of excrementitious matters and foul humours through the heart, that most noble and principal viscus, is to be apprehended; that an efflux and excretion, occasionally of foul and corrupt blood, takes place from the same body, from different parts, even from the same part and at the same time, which, were the blood agitated by a continuous current, would be shaken and effectually mixed in passing through the heart, and many points of the like kind admitted in our medical schools, which are seen to be repugnant to the doctrine of the circulation,--to them I shall not answer farther here, than that the circulation is not always the same in every place, and at every time, but is contingent upon many circumstances: the more rapid or slower motion of the blood, the strength or weakness of the heart as the propelling organ, the quantity and quality or constitution of the blood, the rigidity or laxity of the tissues, and the like. A thicker blood, of course, moves more slowly through narrower channels; it is more effectually strained in its passage through the substance of the liver than through that of the lungs. It has not the same velocity through flesh and the softer parenchymatous structures and through sinewy parts of greater compactness and consistency: for the thinner and purer and more spirituous part permeates more quickly, the thicker more earthy and indifferently concocted portion moves more slowly, or is refused admission. The nutritive portion, or ultimate aliment of the tissues, the dew or cambium, is of a more penetrating nature, inasmuch as it has to be added everywhere, and to everything that grows and is nourished in its length and thickness, even to the horns, nails, hair, and feathers; and then the excrementitious matters have to be secreted in some places, where they accumulate, and either prove a burthen or are concocted. But I do not imagine that the excrementitious fluids or bad humours when once separated, nor the milk, the phlegm, and the spermatic fluid, nor the ultimate nutritive part, the dew or cambium, necessarily circulate with the blood: that which nourishes every part adheres and becomes agglutinated to it. Upon each of these topics and various others besides, to be discussed and demonstrated in their several places, viz. in the physiology and other parts of the art of medicine, as well as of the consequences, advantages or disadvantages of the circulation of the blood, I do not mean to touch here; it were fruitless indeed to do so until the circulation has been established and conceded as a fact. And here the example of astronomy is by no means to be followed, in which from mere appearances or phenomena that which is in fact, and the reason wherefore it is so, are investigated. But as he who inquires into the cause of an eclipse must be placed beyond the moon if he would ascertain it by sense, and not by reason, still in reference to things sensible, things that come under the cognizance of the senses, no more certain demonstration or means of gaining faith can be adduced than examination by the senses, than ocular inspection.

There is one remarkable experiment which I would have every one try who is anxious for truth, and by which it is clearly shown that the arterial pulse is owing to the impulse of the blood. Let a portion of the dried intestine of a dog or wolf, or any other animal, such as we see hung up in the druggists’ shops, be taken and filled with water, and then secured at both ends like a sausage: by tapping with the finger at one extremity, you will immediately feel a pulse and vibration in any other part to which you apply the fingers, as you do when you feel the pulse at the wrist. In this way, indeed, and also by means of a distended vein, you may accurately, either in the dead or living body, imitate and show every variety of the pulse, whether as to force, frequency, volume, rhythm, &c. Just as in a long bladder full of fluid, or in an oblong drum, every stroke upon one end is immediately felt at the other; so also in a dropsy of the belly and in abscesses under the skin, we are accustomed to distinguish between collections of fluid and of air, between anasarca and tympanites in particular. If a slap or push given on one side is clearly felt by a hand placed on the other side, we judge the case to be tympanites [?]; not, as falsely asserted, because we hear a sound like that of a drum, and this produced by flatus, which never happens [?]; but because, as in a drum, every the slightest tap passes through and produces a certain vibration on the opposite side; for it indicates that there is a serous and ichorous substance present, of such a consistency as urine, and not any sluggish or viscid matter as in anasarca, which when struck retains the impress of the blow or pressure, and does not transmit the impulse.

Having brought forward this experiment I may observe, that a most formidable objection to the circulation of the blood rises out of it, which, however, has neither been observed nor adduced by any one who has written against me. When we see by the experiment just described, that the systole and diastole of the pulse can be accurately imitated without any escape of fluid, it is obvious that the same thing may take place in the arteries from the stroke of the heart, without the necessity for a circulation, but like Euripus, with a mere motion of the blood alternately backwards and forwards. But we have already satisfactorily replied to this difficulty; and now we venture to say that the thing could not be so in the arteries of a living animal; to be assured of this it is enough to see that the right auricle is incessantly injecting the right ventricle of the heart with blood, the return of which is effectually prevented by the tricuspid valves; the left auricle in like manner filling the left ventricle, the return of the blood there being opposed by the mitral valves; and then the ventricles in their turn are propelling the blood into either great artery, the reflux in each being prevented by the sigmoid valves in its orifice. Either, consequently, the blood must move on incessantly through the lungs, and in like manner within the arteries of the body, or stagnating and pent up, it must rupture the containing vessels, or choke the heart by over distension, as I have shown it to do in the vivisection of a snake, described in my book on the Motion of the Blood. To resolve this doubt I shall relate two experiments among many others, the first of which, indeed, I have already adduced, and which show with singular clearness that the blood flows incessantly and with great force and in ample abundance in the veins towards the heart. The internal jugular vein of a live fallow deer having been exposed, (many of the nobility and his most serene majesty the king, my master, being present,) was divided; but a few drops of blood were observed to escape from the lower orifice rising up from under the clavicle; whilst from the superior orifice of the vein and coming down from the head, a round torrent of blood gushed forth. You may observe the same fact any day in practising phlebotomy: if with a finger you compress the vein a little below the orifice, the flow of blood is immediately arrested; but the pressure being removed, forthwith the flow returns as before.

From any long vein of the forearm get rid of the blood as much as possible by holding the hand aloft and pressing the blood towards the trunk, you will perceive the vein collapsed and leaving, as it were, in a furrow of the skin; but now compress the vein with the point of a finger, and you will immediately perceive all that part of it which is towards the hand, to enlarge and to become distended with the blood that is coming from the hand. How comes it when the breath is held and the lungs thereby compressed, a large quantity of air having been taken in, that the vessels of the chest are at the same time obstructed, the blood driven into the face, and the eyes rendered red and suffused? Why is it, as Aristotle asks in his problems, that all the actions are more energetically performed when the breath is held than when it is given? In like manner, when the frontal and lingual veins are incised, the blood is made to flow more freely by compressing the neck and holding the breath. I have several times opened the breast and pericardium of a man within two hours after his execution by hanging, and before the colour had totally left the face, and in presence of many witnesses, have demonstrated the right auricle of the heart and lungs distended with blood; the auricle in particular of the size of a large man’s fist, and so full of blood that it looked as if it would burst. This great distension, however, had disappeared next day, the body having stiffened and become cold, and the blood having made its escape through various channels. These and other similar facts, therefore, make it sufficiently certain that the blood flows through the whole of the veins of the body towards the base of the heart, and that unless there was a further passage afforded it, it would be pent up in these channels, or would oppress and overwhelm the heart; as on the other hand, did it not flow outwards by the arteries, but was found regurgitating, it would soon be seen how much it would oppress.

I add another observation. A noble knight, Sir Robert Darcy, an ancestor of that celebrated physician and most learned man, my very dear friend Dr. Argent, when he had reached to about the middle period of life, made frequent complaint of a certain distressing pain in the chest, especially in the night season; so that dreading at one time syncope, at another suffocation in his attacks he led an unquiet and anxious life. He tried many remedies in vain, having had the advice of almost every medical man. The disease going on from bad to worse, he by and by became cachectic and dropsical, and finally, grievously distressed, he died in one of his paroxysms. In the body of this gentleman, at the inspection of which there were present Dr. Argent, then president of the College of Physicians, and Dr. Gorge, a distinguished theologian and preacher, who was pastor of the parish, we found the wall of the left ventricle of the heart ruptured, having a rent in it of size sufficient to admit any of my fingers, although the wall itself appeared sufficiently thick and strong; this laceration had apparently been caused by an impediment to the passage of the blood from the left ventricle into the arteries.

I was acquainted with another strong man, who having received an injury and affront from one more powerful than himself, and upon whom he could not have his revenge, was so overcome with hatred and spite and passion, which he yet communicated to no one, that at last he fell into a strange distemper, suffering from extreme oppression and pain of the heart and breast, and the prescriptions of none of the very best physicians proving of any avail, he fell in the course of a few years into a scorbutic and cachectic state, became tabid and died. This patient only received some little relief when the whole of his chest was pummelled or kneaded by a strong man, as a baker kneads dough. His friends thought him poisoned by some maleficent influence, or possessed with an evil spirit. His jugular arteries, enlarged to the size of the thumb, looked like the aorta itself, or they were as large as the descending aorta; they had pulsated violently, and appeared like two long aneurisms. These symptoms had led to trying the effects of arteriotomy in the temples, but with no relief. In the dead body I found the heart and aorta so much gorged and distended with blood, that the cavities of the ventricles equalled those of a bullock’s heart in size. Such is the force of the blood pent up, and such are the effects of its impulse.

We may therefore conclude, that although there may be impulse without any exit, as illustrated in the experiment lately spoken of, still that this could not take place in the vessels of living creatures without most serious dangers and impediments. From this, however, it is manifest that the blood in its course does not everywhere pass with the same celerity, neither with the same force in all places and at all times, but that it varies greatly according to age, sex, temperament, habit of body, and other contingent circumstances, external as well as internal, natural or non-natural. For it does not course through intricate and obstructed passages with the same readiness that it does through straight, unimpeded, and pervious channels. Neither does it run through close, hard, and crowded parts, with the same velocity as through spongy, soft, and permeable tissues. Neither does it flow and penetrate with such swiftness when the impulse [of the heart] is slow and weak, as when this is forcible and frequent, in which case the blood is driven onwards with vigour and in large quantity. Nor is the same blood, when it has become more consistent or earthy, so penetrative as when it is more serous and attenuated or liquid. And then it seems only reasonable to think that the blood in its circuit passes more slowly through the kidneys than through the substance of the heart; more swiftly through the liver than through the kidneys; through the spleen more quickly than through the lungs, and through the lungs more speedily than through any of the other viscera or the muscles, in proportion always to the denseness or sponginess of the tissue of each.

We may be permitted to take the same view of the influence of age, sex, temperament, and habit of body, whether this be hard or soft; of that of the ambient cold which condenses bodies, and makes the veins in the extremities to shrink and almost to disappear, and deprives the surface both of colour and heat; and also that of meat and drink which render the blood more watery, by supplying fresh nutritive matter. From the veins, therefore, the blood flows more freely in phlebotomy when the body is warm than when it is cold. We also observe the signal influence of the affections of the mind when a timid person is bled and happens to faint: immediately the flow of blood is arrested, a deadly pallor overspreads the surface, the limbs stiffen, the ears sing, the eyes are dazzled or blinded, and, as it were, convulsed. But here I come upon a field where I might roam freely and give myself up to speculation. And, indeed, such a flood of light and truth breaks in upon me here; occasion offers of explaining so many problems, of resolving so many doubts, of discovering the causes of so many slighter and more serious diseases, and of suggesting remedies for their cure, that the subject seems almost to demand a separate treatise. And it will be my business in my “Medical Observations,” to lay before my reader matter upon all these topics which shall be worthy of the gravest consideration.

And what indeed is more deserving of attention than the fact that in almost every affection, appetite, hope, or fear, our body suffers, the countenance changes, and the blood appears to course hither and thither. In anger the eyes are fiery and the pupils contracted; in modesty the cheeks are suffused with blushes; in fear, and under a sense of infamy and of shame, the face is pale, but the ears burn as if for the evil they heard or were to hear; in lust how quickly is the member distended with blood and erected! But, above all, and this is of the highest interest to the medical practitioner,--how speedily is pain relieved or removed by the detraction of blood, the application of cupping-glasses, or the compression of the artery which leads to a part? It sometimes vanishes as if by magic. But these are topics that I must refer to my “Medical Observations,” where they will be found exposed at length and explained.

Some weak and inexperienced persons vainly seek by dialectics and far-fetched arguments, either to upset or establish things that are only to be founded on anatomical demonstration, and believed on the evidence of the senses. He who truly desires to be informed of the question in hand, and whether the facts alleged be sensible, visible, or not, must be held bound either to look for himself, or to take on trust the conclusions to which they have come who have looked; and indeed there is no higher method of attaining to assurance and certainty. Who would pretend to persuade those who had never tasted wine that it was a drink much pleasanter to the palate than water? By what reasoning should we give the blind from birth to know that the sun was luminous, and far surpassed the stars in brightness? And so it is with the circulation of the blood, which the world has now had before it for so many years, illustrated by proofs cognizable by the senses, and confirmed by various experiments. No one has yet been found to dispute the sensible facts, the motion, efflux and afflux of the blood, by like observations based on the evidence of sense, or to oppose the experiments adduced, by other experiments of the same character; nay, no one has yet attempted an opposition on the ground of ocular testimony.

There have not been wanting many who, inexperienced and ignorant of anatomy, and making no appeal to the senses in their opposition, have, on the contrary, met it with empty assertions, and mere suppositions, with assertions derived from the lessons of teachers and captious cavillings; many, too, have vainly sought refuge in words, and these not always very nicely chosen, but reproachful and contumelious; which, however, have no farther effect than to expose their utterer’s vanity and weakness, and ill breeding and lack of the arguments that are to be sought in the conclusions of the senses, and false sophistical reasonings that seem utterly opposed to sense. Even as the waves of the Sicilian sea, excited by the blast, dash against the rocks around Charybdis, and then hiss and foam, and are tossed hither and thither; so do they who reason against the evidence of their senses.

Were nothing to be acknowledged by the senses without evidence derived from reason, or occasionally even contrary to the previously received conclusions of reason, there would now be no problem left for discussion. Had we not our most perfect assurances by the senses, and were not their perceptions confirmed by reasoning, in the same way as geometricians proceed with their figures, we should admit no science of any kind; for it is the business of geometry, from things sensible, to make rational demonstration of things that are not sensible; to render credible or certain things abstruse and beyond sense from things more manifest and better known. Aristotle counsels us better when, in treating of the generation of bees, he says:[51] “Faith is to be given to reason, if the matters demonstrated agree with those that are perceived by the senses; when the things have been thoroughly scrutinized, then are the senses to be trusted rather than the reason.” Whence it is our duty to approve or disapprove, to receive or reject everything only after the most careful examination; but to examine, to test whether anything have been well or ill advanced, to ascertain whether some falsehood does not lurk under a proposition, it is imperative on us to bring it to the proof of sense, and to admit or reject it on the decision of sense. Whence Plato in his Critias says, that the explanation of those things is not difficult of which we can have experience; whilst they are not of apt scientific apprehension who have no experience.

[51] De Generat. Animal. lib. iii, cap. x.

How difficult is it to teach those who have no experience, the things of which they have not any knowledge by their senses! And how useless and intractable, and unimpregnable to true science are such auditors! They show the judgment of the blind in regard to colours, of the deaf in reference to concords. Who ever pretended to teach the ebb and flow of the tide, or from a diagram to demonstrate the measurements of the angles and the proportions of the sides of a triangle to a blind man, or to one who had never seen the sea nor a diagram? He who is not conversant with anatomy, inasmuch as he forms no conception of the subject from the evidence of his own eyes, is virtually blind to all that concerns anatomy, and unfit to appreciate what is founded thereon; he knows nothing of that which occupies the attention of the anatomist, nor of the principles inherent in the nature of the things which guide him in his reasonings; facts and inferences as well as their sources are alike unknown to such a one. But no kind of science can possibly flow, save from some pre-existing knowledge of more obvious things; and this is one main reason why our science in regard to the nature of celestial bodies, is so uncertain and conjectural. I would ask of those who profess a knowledge of the causes of all things, why the two eyes keep constantly moving together, up or down, to this side or to that, and not independently, one looking this way, another that; why the two auricles of the heart contract simultaneously, and the like? Are fevers, pestilence, and the wonderful properties of various medicines to be denied because their causes are unknown? Who can tell us why the fœtus in utero, breathing no air up to the tenth month of its existence, is yet not suffocated? Born in the course of the seventh or eighth month, and having once breathed, it is nevertheless speedily suffocated if its respiration be interrupted. Why can the fœtus still contained within the uterus, or enveloped in the membranes, live without respiration; whilst once exposed to the air, unless it breathes it inevitably dies?[52]

[52] Vide