Читать книгу The Works of William Harvey M.D - William Harvey - Страница 23

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THAT THERE IS A CIRCULATION OF THE BLOOD IS CONFIRMED FROM THE FIRST PROPOSITION.

But lest any one 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 wise that the whole mass 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 all 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, 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, seeing that 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 inferred, 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: were there with each stroke two drachms expelled, the quantity would of course amount to twenty pounds and ten ounces; were there 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, &c. of the individual, to external and internal circumstances, to naturals and non-naturals—sleep, rest, food, exercise, affections of the mind, and the like. But indeed, 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; in short 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, wherefore in our dissections we usually find so large a quantity of blood in the veins, so little in the arteries; wherefore there is much in the right ventricle, little in the left; circumstances 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 this perhaps: 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 minute orifices and invisible pores. 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.