on by the pulse of the right ventricle, the necessary effect of whose impulse is the distension of the vessels and pores of the lungs. And then the lungs, in respiration, are perpetually rising and falling; motions, the effect of which must needs be to open and shut the pores and vessels, precisely as in the case of a sponge, and of parts having a spongy structure, when they are alternately compressed and again suffered to expand. The liver, on the contrary, remains at rest, and is never seen to be dilated and constricted. Lastly, if no one denies the possibility of the whole of the ingested juices passing through the liver, in man, oxen, and the larger animals generally, in order to reach the vena cava, and for this reason, that if nourishment is to go on, these juices must needs get into the veins, and there is no other way but the one indicated, why should not the same arguments be held of avail for the passage of the blood in adults through the lungs? Why not, with Columbus, that skillful and learned anatomist, maintain and believe the like, from the capacity and structure of the pulmonary vessels; from the fact of the pulmonary veins and ventricle corresponding with them, being always found to contain blood, which must needs have come from the veins, and by no other passage save through the lungs? Columbus, and we also, from what precedes, from dissections, and other arguments, conceive the thing to be clear. But as there are some who admit nothing unless upon authority, let them learn that the truth I am contending for can be confirmed from Galen's own words, namely, that not only may the blood be transmitted from the pulmonary artery into the pulmonary veins, then into the left ventricle of the heart, and from thence into the arteries of the body, but that this is effected by the ceaseless pulsation of the heart and the motion of the lungs in breathing. There are, as every one knows, three sigmoid or semilunar valves situated at the orifice of the pulmonary artery, which effectually prevent the blood sent into the vessel from returning into the cavity of the heart. Now Galen, explaining the uses of these valves, and the necessity for them, employs the following language: "There is everywhere a mutual anastomosis and inosculation of the arteries with the veins, and they severally transmit both blood and spirit, by certain invisible and undoubtedly very narrow passages. Now if the mouth of the vena arteriosa, or pulmonary artery, had stood in like manner continually open, and nature had found no contrivance for closing it when requisite, and opening it again, it would have been impossible that the blood could ever have passed by the invisible and delicate mouths, during the contractions of the thorax, into the arteries; for all things are not alike readily attracted or repelled; but that which is light is more readily drawn in, the instrument being dilated, and forced out again when it is contracted, than that which is heavy; and in like manner is anything drawn more rapidly along an ample conduit, and again driven forth, than it is through a narrow tube. But when the thorax is contracted, the pulmonary veins, which are in the lungs, being driven inwardly, and powerfully compressed on every side, immediately force out some of the spirit they contain, and at the same time assume a certain portion of blood by these subtile mouths; a thing that could never come to pass were the blood at liberty to flow back into the heart through the great orifice of the pulmonary artery. But its return through the great opening being prevented, when it is compressed on every side, a certain portion of it distils into the pulmonary veins by the minute orifices mentioned." And shortly afterwards, in the very next chapter, he says: "The more the thorax contracts, the more it strives to force out the blood, the more exactly do these membranes (viz., the sigmoid valves) close up the mouth of the vessel, and suffer nothing to regurgitate." The same fact he has also alluded to in a preceding part of the tenth chapter: "Were there no valves, a three-fold inconvenience would result, so that the blood would then perform this lengthened course in vain; it would flow inwards during the diastoles of the lungs, and fill all their arteries; but in the systoles, in the manner of the tide, it would ever and anon, like the Euripus, flow backwards and forwards by the same way, with a reciprocating motion, which would nowise suit the blood. This, however, may seem a matter of little moment; but if it meantime appear that the function of respiration suffer, then I think it would be looked upon as no trifle," etc. And again, and shortly afterwards: "And then a third inconvenience, by no means to be thought lightly of, would follow, were the blood moved backwards durings the expiration, had not our Maker instituted those supplementary membranes [the sigmoid valves]." Whence, in the eleventh chapter he concludes: "That they have all a common use, (to wit, the valves), and that it is to prevent regurgitation or backward motion; each, however, having a proper function, the one set drawing matters from the heart, and preventing their return, the other drawing matters into the heart, and preventing their escape from it. For nature never intended to distress the heart with needless labour, neither to bring aught into the organ which it had been better to have kept away, nor to take from it again aught which it was requisite should be brought. Since, then, there are four great orifices in all, two in either ventricle, one of these induces, the other educes." And again he says: "Farther, since there is one vessel, consisting of a simple tunic, implanted in the heart, and another having a double tunic, extending from it, (Galen is here speaking of the right side of the heart, but I extend his observations to the left side also,) a kind of reservoir had to be provided, to which both belonging, the blood should be drawn in by one, and sent out by the other." This argument Galen adduces for the transit of the blood by the right ventricle from the vena cava into the lungs; but we can use it with still greater propriety, merely changing the terms, for the passage of the blood from the veins through the heart into the arteries. From Galen, however, that great man, that father of physicians, it clearly appears that the blood passes through the lungs from the pulmonary artery into the minute branches of the pulmonary veins, urged to this both by the pulses of the heart and by the motions of the lungs and thorax; that the heart, moreover, is incessantly receiving and expelling the blood by and from its ventricles, as from a magazine, or cistern, and for this end is furnished with four sets of valves, two serving for the induction and two for the eduction of the blood, lest, like the Euripus, it should be incommodiously sent hither and thither, or flow back into the cavity which it should have quitted, or quit the part where its presence was required, and so the heart be oppressed with labour in vain, and the office of the lungs be interfered with. Finally, our position that the blood is continually passing from the right to the left ventricle, from the vena cava into the aorta, through the porous structure of the lungs, plainly appears from this, that since the blood is incessantly sent from the right ventricle into the lungs by the pulmonary artery, and in like manner is incessantly drawn from the lungs into the left ventricle, as appears from what precedes and the position of the valves, it cannot do otherwise than pass through continuously. And then, as the blood is incessantly flowing into the right ventricle of the heart, and is continually passed out from the left, as appears in like manner, and as is obvious both to sense and reason, it is impossible that the blood can do otherwise than pass continually from the vena cava into the aorta. Dissection consequently shows distinctly what takes place [in regard to the transit of the blood] in the greater number of animals, and indeed in all, up to the period of their [foetal] maturity; and that the same thing occurs in adults is equally certain, both from Galen's words, and what has already been said on the subject, only that in the former the transit is effected by open and obvious passages, in the latter by obscure porosities of the lungs and the minute inosculations of vessels. Whence it appears that, although one ventricle of the heart, the left to wit, would suffice for the distribution of the blood over the body, and its eduction from the vena cava, as indeed is done in those creatures that have no lungs, nature, nevertheless, when she ordained that the same blood should also percolate the lungs, saw herself obliged to add another ventricle, the right, the pulse of which should force the blood from the vena cava through the lungs into the cavity of the left ventricle. In this way, therefore, it may be said that the right ventricle is made for the sake of the lungs, and for the transmission of the blood through them, not for their nutrition; seeing it were unreasonable to suppose that the lungs required any so much more copious supply of nutriment, and that of so much purer and more spiritous a kind, as coming immediately from the ventricle of the heart, than either the brain with its peculiarly pure substance, or the eyes with their lustrous and truly admirable structure, or the flesh of the heart itself, which is more commodiously nourished by the coronary artery. OF THE QUANTITY OF BLOOD PASSING THROUGH THE HEART FROM THE Thus far I have spoken of the passages of the blood from the veins into the arteries, and of the manner in which it is transmitted and distributed by the action of the heart; points to which some, moved either by the authority of Galen or Columbus, or the reasonings of others, will give in their adhesion. But what remains to be said upon the quantity and source of the blood which thus passes, is of so novel and unheard-of character, that I not only fear injury to myself from the envy of the few, but I tremble lest I have mankind |