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 Doctrines of the c'reulation; a history o 
 
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DOCTRINES 
 
 OF THE 
 
 CIRCULATION. 
 
 A HISTORY OF PHYSIOLOGICAL OPINION AND DIS- 
 COVERY, IN REGARD TO THE CIRCULATION 
 OF THE BLOOD. 
 
 BY 
 
 J. C. DALTON, M.D., 
 
 PROFESSOR EMERITUS OF PHYSIOLOGY IN THE COLLEGE OF PHYSICIANS 
 AND SURGEONS, NEW YORK ; AND PRESIDENT OF THE COLLEGE. 
 
 PHILADELPHIA: 
 
 HENRY C. LEA'S SON & CO. 
 1884. 
 
Entered, accofding to Act of Congress, in the year 1884, 
 
 By henry C. LEA'S SON,& CO., 
 
 In the ofiSce of the Librarian of Corgress, at Washington, D. C. 
 
TABLE OF CONTENTS. 
 
 PAGE 
 
 Introduction, 13-15 
 
 CHAPTER I. 
 
 ARISTOTLE. 
 
 The age of Aristotle — His parentage^His resources — His ana- 
 tomical and physiological works — His doctrine of the heart 
 and bloodvessels — Of nutrition and alimentation— Of the tra- 
 chea and the pulmonary vessels — Of the cardiac and vascular 
 pulsation — Of vital heat — Of respiration — Summary, . . 17-36 
 
 CHAPTER II. 
 
 PRAXAGORAS. 
 
 Innovation introduced by Praxagoras — His age and reputation 
 — His doctrine of the arterial pulsation — Of the veins as 
 bloodvessels — Of the arteries as air-tubes — Anatomical basis 
 for this doctrine — Its relation to modern nomenclature, . . 37-41 
 
 CHAPTER III. 
 
 THE SCHOOL OF ALEXANDRIA. 
 
 Importance of the School of Alexandria — Its foundation and 
 organization — Its library — Its reputation and success — He- 
 rophilus and Erasistratus — Their services to anatomy — Their 
 discoveries in the nervous system — Their doctrines of the vas- 
 cular system — Of the pneuma, or spirits — Of the vital spirits 
 
TABLE OF CONTENTS. 
 
 and animal spirits — Of the vena arterialis and the arteria 
 venalis — Of the cardiac valves — Of the vascular anastomosis 
 — Of the transfusion of blood from the veins to the arteries — 
 Of the complementary action of the venous and arterial sys- 
 tems 42-60 
 
 CHAPTER IV. 
 
 GALEN. 
 
 Position and influence of Galen — Extent of his authority — Rea- 
 sons for its continuance — His works — The " sects " in ancient 
 medicine — Galen's vievi'S of sectarianism — His devotion to 
 anatomy — His doctrine of the arteries as bloodvessels — Its 
 experimental demonstration — His system of physiology in 
 general — His doctriije of sanguification and nutrition — Of 
 venous and arterial blood — Of the cardiac and arterial pulse 
 — Of the mechanical action of the heart — Of its physiological 
 function — Of respiration — Of the distribution of blood by the 
 Veins — Of the vascular anastomosis and its experimental proof 
 — Of the perforaiions of the interventricular septum— Of the 
 arterialization of venous blood in the left ventricle, . . . 61-92 
 
 CHAPTER V. 
 
 tERlOb OF THE RETJAISSANCE. 
 MONDINl. CARPI. VESALIUS. 
 
 Mondihi da Luzzi— His vtoxV on anatomy — Its success — tts af- 
 tangelnent and topics— Its account of the heart and bloodves- 
 sels— Berengario da Carpi^His treatise on anatomy — Its 
 comparison with the preceding— Vesalius— Mis birth and 
 education — His professorships— His work on anatomy- His 
 Criticisms of Galen— 'Iheir truth— His doctrine of the heart 
 and bloodvessels— His doubts as to the perfbralion of the sep- 
 tum— As to other parts of the vascular system — His appoint- 
 ment as court physician to the emperor, . . , 93^110 
 
TABLE OF CONTENTS. yii 
 
 CHAPTER VI. 
 
 SERVETUS. 
 
 FAGB 
 
 Birth and education of Servetus — His theological controversies — 
 His graduation in medicine — His difficulties with the Faculty 
 — His establishment as practitioner at Vienne — Renewal of 
 his theological disputes — His Christianismi Restitutio — His 
 doctrine of the pulmonary circulation — His physiological ex' 
 travagances— His arrest, trial and execution — Reprint of his 
 book in 1790, . . . . . i 1 . . Ii.i-t22 
 
 CHAPTER Vn. 
 
 DAWN OF THE CIRCULATIONi 
 
 COLOMBO. CAESALPINUS. FABRICIU3. 
 
 Medical science in Italy, in the sixteenth century — Colombo^"- 
 His work on anatomy — His criticisms and imitation of Vesa- 
 lius — His doctrine of the pulmonary circulation — His reasons 
 for its adoption — Its reception and influence — Difficulties in 
 the way of its general acceptance — Caesalpihus — His works — 
 His philosophical opinions — His views on the pulmonary circu- 
 lation — His claims to a knowledge of the general circulation 
 — Fabricius — His discovery of the venoiis valves — Their sup- 
 ■ posed use — Physiological doctrines of the sixteenth century 
 — As to the function of the heart — As to the two vascular 
 systems — As to venous and arterial blood — As to the move- 
 ment of blood in the vessels — As to the fuliginous vapors of 
 the breath — As to the tefrigeralion of the blood by respira- 
 tion, .•..1.11.. 123-161 
 
 CHAPTER VHL 
 
 HARVEY. 
 
 Education of Harvey — His lectures in the College of Physicians 
 — His book on the circulation — His doubts as to the existing 
 doctrine — His reasons for publication — His investigations on 
 the heart's motion — On the arterial motion — On the motion of 
 
vjii TABLE OF CONTENTS. 
 
 PAGE 
 
 the auricles— On the motion, action and function of the heart 
 — On the course of the blood, from the right side of the heart 
 to the left — On the quantity of blood passing through the heart, 
 from the veins to the arteries — On the peripheral circulation, 
 from the arteries to the veins— On the return of blood, through 
 the veins, to the heart — His disbelief in the vascular anasto- 
 mosis—His change in the significance of the terms, " artery " 
 and "vein," 162-189 
 
 CHAPTER IX. 
 
 THE DISCUSSION AND THE VERDICT. 
 PRIMEROSE. RIOLAN. BARTHOLINUS. 
 
 The impression produced by Harvey's book — Primeuose — His 
 parentage and education — His book against the doctrine of 
 the circulation — His objections to it — Difference between 
 venous and arterial blood — Absence of vascular communica- 
 tions — Porosity of the septum — Small quantity of venous blood 
 required for arterialization — The venous valves exceptional, 
 not general — Plempius — His adhesion to the doctrine of the 
 circulation — His experimental proofs — His doubts and diffi- 
 culties — Their refutation and solution — RiOLAN — His posi- 
 tion and reputation — His conservatism — His objections to 
 Harvey's doctrine — His theory of a partial circulation — 
 Slegel's defence of the doctrine of the circulation— Harvey's 
 reply to Riolan— Pecquet — His discovery of the thoracic duct 
 and the receptaculum chyli — His experiments on the general 
 circulation — On the abdominal circulation — On the pulmo- 
 nary circulation^BARTHOLlNUS — His anatomical works — 
 Gradual adoption of Harvey's doctrine — Veslingius — Trul- 
 lius — Marchetti — Adoption of Harvey's doctrine in France — 
 Dionis — His lectures at the Garden of Plants — His experi- 
 mental demonstrations, ....... 190-220 
 
 CHAPTER X. 
 
 VISIBLE PROOF OF THE CIRCULATION. 
 
 Question of the vascular anastomosis — Malpighi — His re- 
 searches on the anatomy of the lun^ — His difficulty in the use 
 
TABLE OF CONTENTS. 
 
 of injections — His discovery of the pulmonary vesicles — Of 
 . the capillary circulation and bloodvessels — Microscopic dem- 
 onstrations by Molyneux — By Leeuwenhoek — Vascular in- 
 jections by Blancard — By Ruysch — General success of this 
 method, 221-228 
 
BIBLIOGRAPHY. 
 
 The References in this Volume, to the Authors mentioned 
 below, are to the following editions: 
 
 Aristotle. — Opera Omnia; Greece et Latine. Firmin Didot, Parisiis, 
 
 MDCCCXLVIII-LXXIV. 
 
 Galen. — Opera Omnia, curavit Carolus Gottlob Kuhn. Lipsise, 1821 
 
 -1833- 
 RuFUS Ephesius. — De Appellationibus partium corporis humani 
 
 Libri III. Latinized version by Julius Paulus Crassus. 
 In Medica Artis Principles post Hippocratem et Galenum ; Printed 
 
 by Henricus Stephanus, MDLXVII. 
 
 Ammianus Marcellinus. — Res gestae. Editionem absolvit Car. 
 Gottlob Aug. Erfurdt. Lipsiae cio lO cccvill. 
 
 Vesalius. — Andreae Vesalii Brujtellensis, Scholse medicorum Patauinae 
 professoris, de Humani corporis fabrica Libri septem. Basileae, 
 MDXLIII. 
 
 Also ; Andreae Vesalii Bruxellensis, Invictissimi Caroli V. Imper- 
 atoris medici, de Humani corporis fabrica Libri septem. Basileae, 
 
 MDLV. 
 
 Servetus. — Christianismi Restitutio. Totius ecclesiae est ad sua limina 
 vocatio, in integrum restituta cognitione Dei, fidei Christi, iustifi- 
 cationis nostrae, regenerationis baptismi, et caenae domini mandu- 
 cationis. Restituto denique nobis regno caelesti, Babylonis impise 
 captiuitate soluta, et Antichristo cum suis penitus destructo. 
 
 M. D. LIII. 
 Reprinted from the Vienna exemplar, 1790. 
 
 Colombo. — Realdi Columbi Cremonensis, in almp Gymnasio Romano 
 Anatomici celeberrimi, De Re Anatomica Libri XV. Venetiis, 
 Ex typographia Nicolai Beuilacquas, MDLIX. 
 
 Caesalpinus. — Quaestionum Peripateticarum Lib. V. 
 
 Daemonum inuestigatio Peripatetica, 
 
 Secunda Editio. 
 
 Quaestionum Medicafum Libri 11. 
 
 De Medicament, facultatibus Lib. II. 
 
 nunc primum editi. 
 
 Venetiis, apud luntas, mdxciii. 
 
BIBLIOGRAPHY. 
 
 XI 
 
 Also ; De Plantis Libri XVI Andreae Caesalpini Aretini, Medici 
 clarissimi, doctissimiq ; atque Philosophi celeberrimi, ac subtilis- 
 simi. Florentiae, MDLXXxni. 
 
 Also ; KaTOTrfov, sive Speculum Artis Medicse Hippocraticum. 
 Francofurti, MDCV. 
 
 Fabricius. — Hieronymi Fabricii ab Aquapendente, Anatomicl Patavini, 
 De Venarum Ostiolis. Patavii, mdciii. 
 
 Harvey. — Exercitatio anatomica de motu Cordis et Sanguinis in ani- 
 malibus, Guilielmi Harvei Angli, Medici Regii & Professoris 
 Anatomise in CoUegio Medicorum Londinensi. Francofurti. 
 Anno M. DC. XXVIII. 
 
 also; Opera Omnia: a CoUegio Medicorum Londinensi edita; 
 MDCCLXVI. 
 
 RiOLAN. — Opuscula Anatomica Nova quae nunc primiim in lucera 
 prodeunt. Instauratio magna Physicse & Medicinse, per novam 
 Doctrinam De Motu Circulatorio Sanguinis in Corde. Londini. 
 M DC XLIX. 
 
 Bartholinus. — Casp. Bartholini, D. & Profes. Regii Institutiones 
 Anatomicae, Novis Recentiorum opinioni'bus & observationibus, 
 quarum innumerse hactenus edhx non sunt, figuris que auctae ab 
 Auctoris Filio Thoma Bartholino. Lug. Batavorum, do lo CXLI. 
 
 also ; Thomse Bartholini Casp. F. Anatomia, ex Caspari Bartho- 
 lini Parentis Institutionibus, omniumque Recentiorum & propriis 
 Observationibus Tertiiim ad sanguinis Circulationem Reformata. 
 Lugd. Batav. & Roterod. do Id c lix. 
 
 also ; Thomse Bartholini Anatome ex omnium Veterum Recentio- 
 rumque Observationibus inprimis Institulionibus b. m. Parentis 
 Caspari Bartholini, ad Circulationem Harvejanam, et vasa Lym- 
 phatica quartdm Renovata. Lugduni Batavorum: do lo c LXXIII. 
 
 Malpighi. — Opera Omnia, seu Thesaurus loculpletissimus botanico- 
 medico-anatomicus, viginti qualuor tractatus complectens, et in 
 duos tomos distributus. 
 Lugduni Batavorum, mdclxxxvii. 
 
The numerals inclosed in parentheses ( ), in the 
 body of the work, refer to corresponding figures in 
 the Appendix. 
 
INTRODUCTION. 
 
 If any apology were offered for the appearance of 
 this volume, it would be that the circulation of the 
 blood is of such commanding importance, as a physio- 
 logical function, that the interest involved in the history 
 of its discovery is not easily exhausted. In some re- 
 spects this interest increases with the examination of 
 the subject. At the present day the circulation of the 
 blood is so familiar to us, and so easily demonstrated 
 by methods accessible to all, that we regard it as one 
 of the simplest facts in physiological science; and we 
 are apt to look with surprise at the mental blindness 
 of the older physiologists who did not know it, or who 
 were reluctant to acknowledge its truth when first an- 
 nounced. But these men were neither ignorant nor 
 dull. They were conversant with everything then 
 known in physiology. Many of them were laborious, 
 original investigators, who contributed not a little to 
 the advancement of science, and who were equal, in 
 learning and capacity, to any of the celebrities of 
 modern times. It becomes apparent, in reading their 
 works, that the knowledge of the circulation of the 
 blood was no easy acquisition. In the dead body, the 
 
14 INTRODUCTION. 
 
 blood in the bloodvessels was as stationary as the bile 
 in the gall-bladder ; and its movement during life was 
 indicated by no external sign. Like many other 
 things of a similar kind, when once fully demonstrated 
 it seemed plain enough ; but until then it was one of 
 the secrets of nature, not to be unveiled except with 
 much labor and after many trials. 
 
 Differences of this sort, between one period and 
 another, are often accompanied by changes in medical 
 nomenclature.. In the gradual progress of thought 
 and discussion, the opinions of medical writers are so 
 modified that after a time even their language becomes 
 unintelligible, unless we remember the state of knowl- 
 edge existing when they wrote. A student of anatomy, 
 for example, in the present century, would be hope- 
 lessly confused by the contradictory appellations of 
 the " vena arteriosa " and " arteria venosa," which once 
 expressed so well the character and relations of the 
 pulmonary artery and the pulmonary vein. The 
 phrases, " vital spirits " and " animal spirits,'' would con- 
 vey no meaning whatever in a physiological treatise of 
 to-day ; and yet they formerly represented ideas, per- 
 haps as distinct and useful as those which we now 
 designate by the terms " reflex action " or " animal 
 ferment." 
 
 This modification of phraseology, due to the pro- 
 gressive changes in medical knowledge, may some- 
 times serve as a guide in exploring the literature of 
 the past. It is often difificult to appreciate the impor- 
 
INTR OD UCTION. 
 
 15 
 
 tance or even the significance of a former discovery, 
 unless we know the condition of medicine in the period 
 immediately preceding. The obscurities and miscon- 
 ceptions which then existed may have long ago disap- 
 peared ; but they were none the less real for the writers 
 of that time, and they would still exist for us, had it 
 not been for the successful work of our predecessors. 
 This must always be kept in view, in attempting to 
 follow the development of a particular doctrine. Har- 
 vey's book, De Motu Cordis et Sanguinis, contains many 
 things which to the modern reader are by no means 
 easy of comprehension. The difficulties which he en- 
 countered, the doubts which perplexed him, and the 
 incredulities which he had to meet, belong to a set of 
 ideas which have now passed into oblivion. To un- 
 derstand them, we must refer from Harvey to Caesal- 
 pinus and Colombo and Vesalius; from them to the 
 earlier writers of the renaissance; and from them, of 
 course, to Galen and Herophilus and Aristotle. In 
 this way, the student of physiological history is led 
 back from one century to another, and his interest 
 excited in periods successively remote. The labor 
 required for such an investigation turns out, therefore, 
 to be greater than at first supposed ; but it is fully 
 compensated by the connected view which it affords 
 of the progress of science, and it enhances the value 
 of our present knowledge by showing the obstacles 
 and uncertainties which impeded its acquisition. 
 
DOCTRINES 
 
 CIRCULATION. 
 
 CHAPTER I. 
 
 ARISTOTLE. 
 
 If the period represented by Aristotle is sometimes 
 called the dawn of natural science, this must be under- 
 stood only in a comparative sense, and as applied to 
 an age seen through the medium of remote antiquity. 
 It was a period of great intellectual activity, not only 
 in the abstruse field of metaphysical philosophy, but 
 also in the direct investigation of nature. In this de- 
 partment Aristotle was pre-eminent ; and it would be 
 impossible to form an estimate of the state of physio- 
 logical knowledge at that time, without relying prin- 
 cipally upon his works. A large part of his informa- 
 tion was, no doubt, original ; but he also alludes to 
 many facts of a more strictly medical interest, which 
 he probably acquired from earlier or contemporaneous 
 sources. He was the son of a physician,* and may 
 have inherited in this way his taste for natural history 
 
 * Nikomachus, physician to Amyntas, king of Macedonian, and the 
 father of Philip. 
 
1 8 DOCTRINES OF THE CIRCULATION. 
 
 and his predilection for scientific methods. His oppor- 
 tunities were unusually great, and enabled him to fol- 
 low successfully the natural bent of his disposition. 
 All writers agree that he had large resources at his 
 command, which he used liberally in the purchase of 
 books and otherwise ; and he is said to have received, 
 from the treasury of Alexander, funds to the amount 
 of 800 talents ($800,000),* for making his collections 
 and prosecuting his researches in natural history. 
 
 The works in which Aristotle treats of anatomical 
 and physiological matters are those on the Natural His- 
 tory of Animals, on the Parts of Animals, on Animal 
 Locomotion, on Respiration, on the Pneuma or Spiritus, 
 and on Generation. There was also a special treatise 
 on anatomy, which is however one of his lost books. 
 Some of the above contain many passages which are 
 obscure ; either from our inability to comprehend allu- 
 sions which were understood at the time, or from im- 
 perfect restoration of injured portions.f But they 
 present a large and varied collection of facts relating 
 to the structure and action of the animal body, a com- 
 parative view of different functions, and a description 
 of the habits and modes of life in different animals. 
 A prevailing feature throughout is the attention paid 
 to the final object or purpose of an organ and its func- 
 tion ; this idea being generally inseparable from the 
 consideration of its structure and immediate operation. 
 
 * This statement rests on the authority of Athenasus, a Greek 
 writer of the third century after Christ, some of whose worlds are still 
 in existence, 
 
 f A large part of Aristotle's works were seriously damaged, from 
 neglect, after his death and before they were purchased for the library 
 of Apellikon. 
 
ARISTOTLE. ig 
 
 The physiological relation between lungs and gills, 
 the air-breathing and mammalian character of whales, 
 dolphins, and other cetacea, the .distinction between 
 the fully viviparous mammalians and the cartilaginous 
 fishes, which produce living young from partly devel- 
 oped eggs in their interior, are all clearly and accu- 
 rately discussed (i). Neither of these works is ar- 
 ranged on a plan like that which would now be adopted 
 for a treatise on the skme subject ; but they are full of 
 interest from an historical point of view, and some of 
 their descriptions are regarded by naturalists as hardly 
 surpassed by any which have appeared since. 
 
 In Aristotle's conception of the sanguiferous system, 
 the heart is the central organ and prime mover of the 
 whole ; but in a different sense from that in which it 
 is now understood. For us the heart is a sac-shaped 
 muscle, causing by its contractions the physical pro- 
 pulsion of the blood through the vascular system. 
 For Aristotle it was the seat of vitality ; in which the 
 blood received its final elaboration and its impregna- 
 tion with animal heat (2). The heart was, therefore, 
 the immediate source of the blood; not because it 
 propelled this fluid in a moving current, but because it 
 united its ingredients in due combination and endowed 
 them with the stimulus of life. The whole mass of 
 the blood, thus originating from the heart, was con- 
 tained in the bloodvessels as in a vase; since, as he 
 expresses it, every liquid must have a vessel, or vase, 
 to contain it. This idea is still traceable in the name 
 used at present; for the term h\ood,-vessel does not 
 necessarily imply a tubular form, nor any movement of 
 the contained fluids. The bloodvessels extended, by 
 their branches and ramifications, throughout the body. 
 
20 DOCTRINES OF THE CIRCULATION. 
 
 in order that the blood, as the material of nutrition, 
 might come in contact with every part. 
 
 With Aristotle there is no radical distinction between 
 arteries and veins. The term ipXs-v]^, usually translated 
 " vein," means simply a bloodvessel ; and all the blood- 
 vessels ((pXi?sf) contain blood of the same quality. 
 The^nly difference between them is in their size, the 
 structure of their coats, and the regions which they 
 occupy. The Great Bloodvessel (vj ^syixKr^ ip^e4/) is the 
 vena cava, which, with its branches and ramifications, 
 has thin and flexible walls, and is situated in front 
 and on the right side. The aorta (aopTij) is a blood- 
 vessel of fibrous texture (v6upcJ(Sr)s Isti <pXs4^), smaller in 
 size, and situated behind and toward the left. Its ter- 
 minal ramifications are altogether fibrous, their cavities 
 being obliterated (3). 
 
 " The body of the heart is central in position, dense 
 in structure, hollow, and filled with blood. Central, 
 as the point of origin for the bloodvessels ; hollow, for 
 containing the blood in its cavity ; and dense, for the 
 protection and preservation of the animal heat. It is 
 the only part of the body where we find blood otherwise 
 than in bloodvessels ; in every other organ this fluid 
 is enclosed in bloodvessels. There is good reason for 
 this difference ; since the blood is distributed from the 
 heart to the bloodvessels, but is not brought into the 
 heart from elsewhere. It is the source and fountain 
 of the blood, and its prime receptacle " (4). 
 
 " Animation and the possession of vitality, as already 
 said, are necessarily associated with heat. The pro- 
 cess of digestion, through which the nourishment of 
 animals is accomplished, cannot be carried on without 
 heat as well as vitality; for everything is elaborated 
 
ARISTOTLE. 21 
 
 by fire. Consequently in whatever region of the body, 
 and in whatever organ, the principle of heat is prima- 
 rily located, there also must be the original vital prin- 
 ciple of nutrition In the bloodless animals this 
 
 organ has no distinct name ; but in those provided 
 with blood, it is the heart. The nutriment from 
 which the tissues and organs are produced is the sub- 
 stance of the blood ; and the bloodvessels must have 
 the same point of origin with the blood, since they 
 exist only for the sake of containing it, as its vase or 
 receptacle. Now the origin of the bloodvessels, in 
 animals provided with blood, is the heart; for, as we 
 learn from dissections, they all have attachments to this 
 organ without passing through its substance. The 
 other active functions of life, for reasons to be ex- 
 plained hereafter, cannot go on without that of nutri- 
 tion ; nor that of nutrition without the fire of nature 
 (animal heat). For nature kindles the nutritive func- 
 tion in this fire" (5). 
 
 To estimate fairly the theory of the blood and blood- 
 vessels in any physiological system, we must also take 
 into account the functions of nutrition and alimenta- 
 tion. The character of the blood, as the general nutri- 
 tive fluid of the body, is fully recognized in Aristotle's 
 doctrine. With its elements originally derived from 
 the food, but elaborated and perfected in the heart, it 
 contains all the ingredients requisite for the nourish- 
 ment of the animal frame. Disseminated through the 
 body by the vascular system it penetrates the entire 
 structure ; and by its exudation or transfusion, in due 
 proportion, it supplies everywhere the materials of 
 growth and secretion. The parenchymatous organs 
 are thus, in a manner, deposits from the blood which 
 
22 DOCTRINES OF THE CIRCULATION. 
 
 has transuded through the vessels, as the perspiration 
 or the saliva is a transudation of its watery parts. 
 This final consumption or assimilation of the blood, in 
 local nutrition, is plainly described and illustrated ; the 
 loss incurred at the periphery being made good at the 
 heart, by the formation of new blood from the materials 
 of the food. There is no movement of the blood, in 
 a mass, from the heart outward through the vessels ; 
 but it is unceasingly renewed by consumption at one 
 end of the vascular system and an equivalent supply 
 at the other. How rapid this change in the substance 
 of the blood may be, is not estimated in definite terms ; 
 but it is implied that it corresponds with the daily 
 amount of the products of digestion (6). 
 
 The function of alimentation, according to Aristotle, 
 consists of two successive acts ; first, the digestion of 
 the food ; and secondly, the absorption of digested 
 nutriment from the alimentary canal. 
 
 Digestion is a process of coction (^^4/1?) ; that is, a 
 modification of the nutritive ingredients by the action 
 of heat. The different portions of the alimentary canal 
 are well described, with their varieties in different ani- 
 mals ; and their functions are indicated sometimes with^ 
 remarkable clearness. The mastication of the food, 
 for example, in the mouth, does not accomplish any 
 part of its real digestion ; but only its physical disinte- 
 gration, by .which it becomes more amenable to the 
 digestive action of the stomach (7). The main divis- 
 ions of the alimentary canal in the abdomen are: 1st, 
 the stomach or upper cavity, in which the masticated 
 food is received ; 2d, the small intestine, where its di- 
 gestion and separation go on ; and 3d, the colon or 
 lower cavity, in which it becomes exhausted and fecu- 
 
ARISTOTLE. 
 
 23 
 
 lent, until at last only its surperfluous parts remain, 
 under the form of excrement (8). Thus the entire act 
 of digestion, in the alimentary canal, consists of a mo- 
 lecular change in the nutritive ingredients of the food, 
 and their separation from the unnutritious or feculent 
 portions. But as the latter are the only substances 
 remaining in the lower part of the intestine, it is plain 
 that the former must have passed out of the alimentary 
 canal, in the meantime, by transudation through its 
 walls. The manner in which this is accomplished 
 forms a second and very interesting part of the func- 
 tion of alimentation. 
 
 The digested nutriment, according to Aristotle, is 
 absorbed from the alimentary canal by the mesenteric 
 bloodvessels. The act of digestion thus far is only 
 preliminary. The materials so produced are mingled 
 with the blood, where they undergo still further changes 
 until their final elaboration in the heart. Aristotle em- 
 ploys, in treating this part of the subject, two striking 
 similitudes. He speaks of the body in general taking 
 its nourishment from the stomach and bowels, " as out 
 of a manger;" as if the more important phases of its 
 modification were to take place farther on. He has 
 also aJavorite comparison between the contents of the 
 alimentary canal, as a source of nourishment for ani- 
 mals, and the earth, as a source of nourishment for 
 plants. The natural heat of the earth, he says, brings 
 the ingredients of the soil into the required condition, 
 so that they need no further change to fit them for 
 absorption ; while the mixture of digested and undi- 
 gested food in the intestine is a sort of soil, from which 
 the nutritive portions are taken up by the bloodvessels 
 of the mesentery. This comparison, which is not 
 
2 A DOCTRINES OF THE CIRCULATION. 
 
 wanting in aptitude, is sometimes made by modern 
 writers, who speak of the valvulse conniventes and 
 villi of the intestine, imbedded in the nutritious magma, 
 like the rootlets of a plant; often, undoubtedly, with- 
 out any suspicion that the idea is as old as Aristotle. 
 
 "As the mouth and the part contiguous with it, 
 known as the oesophagus, give passage for the imper- 
 fectly prepared food as far as the stomach, so there 
 must be other means by which the entire body may 
 get its nourishment out of the stomach and bowels as 
 from a manger. Plants draw their nutriment ready 
 formed from the soil, and consequently they have no 
 superfluous or residual matters ; for the soil, with its 
 inherent warmth, serves them in place of a stomach. 
 Nearly all animals, on the other hand, especially those 
 provided with limbs, have within themselves a sort of 
 soil, namely, the cavity of the stomach, from which 
 they take up their nourishment into some other organ, 
 as plants take up theirs by their roots until its subse- 
 quent digestion is complete " (g). 
 
 " The mesentery, so-called, is a membrane stretch- 
 ing continuously from along the intestines to the vena 
 cava and aorta, full of numerous and closely-set blood- 
 vessels, which also extend from the intestines .*o the 
 vena cava and aorta. In its growth and formation 
 this membrane is, of course, similar -to other parts; 
 the purpose of its existence, in animals provided with 
 blood, being evident on examination. Since animals 
 must needs be supplied with food, from which again 
 is produced the perfected aliment for distribution to 
 the organs (which perfected aliment has no special 
 name in bloodless animals, but in the others is called 
 blood), there must be some way for its conveyance, as 
 
ARISTOTLE. 25 
 
 if by roots, from the alimentary canal into the blood- 
 vessels. While plants accordingly have roots fixed in 
 the soil, in animals the stomach and bowels furnish a 
 kind of soil, from which their nourishment is to be 
 drawn ; and for that is provided the structure of the me- 
 sentery, with its bloodvessels like so many roots " (10). 
 
 It is plain, accordingly, that the products of diges- 
 tion are considered as absorbed from the intestine into 
 the bloodvessels, to be there mingled with the blood ; 
 and that, af ter having passej ^ into_the_vag£u].ai:_syat£m, 
 the y receive thei r complete t ransforma tion-or sanguifi- 
 ration in the _r.avity of^he heart. It seems natural to 
 infer from such a description the existence of a vascu- 
 lar current, proceeding from the intestines toward the 
 heart, to deliver into that organ the materials absorbed 
 in digestion. But this was not the idea of Aristotle. 
 Notwithstanding his unmistakable recognition of ab- 
 sorption by bloodvessels from the intestine, there is no 
 evidence that he imagined anything like a physical 
 movement of the blood from thence toward the heart. 
 For him the mesenteric vessels absorbed the digested 
 fluids, either by endosmosis or by the aid of minute 
 orifices ; or, to use his own expression, as the roots of 
 a plant absorb materials from the soil. By a continu- 
 ance of this process the change in the ingredients of 
 the blood would at last be perceptible in the heart, 
 where they are subjected to a further influence, to be 
 then disseminated in a similar way throughout the 
 vascular system. 
 
 To a great extent, this is what really takes place. 
 The local circulation of the blood, that is, its continuous 
 movement through the capillaries of the mucous mem- 
 brane, and from them toward the heart, is not essential 
 
26 DOCTRINES OF THE CIRCULATION. 
 
 to the imbibition or endosmosis of fluids from the in- 
 testine; it only facilitates this action and increases its 
 rapidity, by the incessant renovation of the absorbing 
 medium. Aristotle must, therefore, have regarded the 
 absorption of nutriment by the mesenteric bloodvessels 
 as a much slower process than we now know it to be ; 
 but he nevertheless believed it to take place, and con- 
 sidered it as the route by which the digested material 
 found its way into the general system. 
 
 In Aristotle's anatomy of the lungs we are struck 
 by the unexpected use of a term which we are accus- 
 tomed to regard as designating a bloodvessel. With 
 him the word apTijpi'a (artery or air-tube) signifies the 
 trachea. It is the passage through which air is intro- 
 duced into the chest, and which, by its divisions and 
 ramifications, disseminates the inspired breath through- 
 out the pulmonary tissue. Its cartilaginous structure, 
 the angular division of its branches, and the interming- 
 ling of air-passages and bloodvessels in the substance 
 of the lung, are all accurately described, so far as they 
 could be determined by the anatomical methods then 
 in use. It is an additional evidence that the division 
 of the vascular system into so-called arteries and veins 
 had no existence in the physiology of the period. 
 
 "The trachea (^ apriipja), in all animals having this 
 organ, is situated in front of the oesophagus ; and it is 
 present in all animals with lungs. It is cartilaginous 
 in texture, and has but little blood, though there are 
 many slender bloodvessels surrounding it. Its upper 
 extremity lies toward the mouth, below the orifice of 
 communication with the nares, by which liquids, when 
 ejected in drinking, find their way out through the nos- 
 trils. Between the openings (of the mouth and nostrils), 
 
ARISTOTLE. 
 
 27 
 
 it has the so-called epiglottis, which is attached to the 
 posterior part of the tongue, and can be applied over 
 the orifice of the trachea (tjjs dpTT)pjag), toward the 
 mouth. In the other direction the trachea passes 
 down between the lungs, and there divides, running to 
 
 each of the pulmonary lobes If the trachea 
 
 be inflated ((putfu(Aevr)s hi t^s apriip/as), it delivers the air 
 into the pulmonary cavities ; and in these cavities there 
 are cartilaginous septa, joined at an acute angle, and 
 forming, in this way, openings or passages extending 
 throughout the lung, and constantly diminishing in 
 
 size, from greater to less The trachea (-/j apTJipw) 
 
 has therefore the structure above described. It serves 
 only for the ingress and egress of the breath, not for 
 the admission of solids or liquids ; and any such mat- 
 ters, if they gain entrance into it, cause continued dis- 
 tress until they are discharged " (i i). 
 
 The foregoing passage cannot leave any question 
 that by "artery" Aristotle means the trachea. This 
 use of the term was not peculiar to him, as it had been 
 employed in the same sense, three-quarters of a century 
 before, by Hippocrates (12) ; and it was, no doubt, the 
 common designation for the trachea, or windpipe, at 
 that time. 
 
 The remaining anatomical feature to be noticed in 
 this connection relates to the pulmonary artery and the 
 pulmonary vein. Aristotle has little to say about these 
 vessels, but it is plain that he does not regard them as 
 bloodvessels,— at least not in the same sense with the 
 other members of the vascular system. He speaks of 
 them as " channels " (■^opoi), reaching from the right and 
 left cavities of the heart to the lung, into which their 
 branches penetrate. Their office is to receive from the 
 
28 DOCTRINES OF THE CIRCULATION. 
 
 lungs the "spiritus," or *vsufAa, which is thus conveyed 
 to the heart, and there mingled with the blood. It is 
 not easy to say precisely what this •jrvsuaa may be, but 
 it certainly is not the inspired air absorbed in mass from 
 the pulmonary passages. It seems to be rather a va- 
 porous ingredient, extracted from the breath and appro- 
 priated by the blood in the process of sanguification. 
 At all events, the pulmonary artery and vein, which 
 serve for its conveyance, are evidently regarded as dis- 
 tinct in character and function from the bloodvessels 
 in general, which are expressly described under a sepa- 
 rate title as branches, of the vena cava and aorta. 
 
 " For there are channels extending from the heart to 
 the lung which divide in the same way as the trachea, 
 their branches running throughout the lung in com- 
 pany with those of the trachea, but above them. They 
 have no open communication with the latter, but 
 through their mutual contact they take in the spiritus, 
 and convey it to the heart. One of them leads into the 
 right cavity (of the heart), the other into the left. As 
 for the vena cava and the aorta, we shall speak of them 
 later on" (13). 
 
 Perhaps the most important phenomenon to be ac- 
 counted for in the physiology of the sanguiferous sys- 
 tem is that of the cardiac and va&c\Azx pulsation ; and 
 this was regarded by Aristotle as taking place in a 
 manner totally different from that which is admitted 
 now. In his view it was caused by an expansion of 
 the blood within the heart and bloodvessels. 
 
 "The cardiac pulsation, on the other hand, which is 
 always going on without interruption, is analogous to 
 that of inflammatory swellings, where it is accompanied 
 by pain owing to the abnormal changes going on in 
 
ARISTOTLE. 29 
 
 the blood, and which finally terminate in suppuration. 
 This morbid process resembles an ebullition, in which 
 the boiling liquids are inflated with heat, and thrown 
 up by their expansion. In inflammatory swellings, 
 where transpiration cannot take place, and the liquids 
 become thickened, it results in their decomposition ; 
 while a boiling liquid escapes from the containing 
 vessel. 
 
 " In the heart there is a continual accession of liquids 
 from the nourishment ; and their expansion by heat ex- 
 tending to the walls of the organ causes its pulsation. 
 This goes on continually. For there is an incessant 
 ingress of fluids to supply the substance of the blood 
 elaborated in the interior of the heart. This is evident 
 from the manner of its earliest formation in the em- 
 bryo ; for the heart may be seen, already containing 
 blood, before the bloodvessels are yet distinctly marked 
 out. The pulsation, accordingly, is greater in the 
 young than in the old, because in the young the exha- 
 lation or expansion from heat is more active. All the 
 bloodvessels moreover ((pXegss iratfai) pulsate, and simul- 
 taneously with each other, since they are attached to 
 the heart, which is itself in constant motion ; conse- 
 quently the bloodvessels also move, all together, and 
 at the same time with the heart" (14). 
 
 The dominant idea in the physiology of Aristotle is 
 the idea of innate vitality operating through the agency 
 of animal heat. In the ancient theory of physics the 
 so-called " fire," or principle of heat, was one of the 
 material elements ; the most attenuated and ethereal of 
 all, and at the same time the most efficient. It repre- 
 sented the immediate cause of all chemical and mo- 
 lecular activity. The external phenomenon of sensible 
 
 3 
 
30 DOCTRINES OF THE CIRCULATION. 
 
 warmth was only one of its manifestations ; it also 
 produced a variety of other results. It converted 
 solids into liquids, or liquids into vapors. It caused 
 the ebullition of water, and the fermentation of organic 
 mixtures ; and it excited, in the vegetable and animal 
 worlds, the internal movement of germination and 
 growth. 
 
 This is the view taken by Aristotle. " There are 
 some," he says, " who do not admit heat to be the 
 agency that works in material substances ; because, as 
 they say, fire has only one kind of force or action, and 
 that a destructive one. But this is a mistake. Even 
 in inanimate things, fire does not always produce the 
 same effect ; some of them it thickens, some it relaxes 
 and liquifies, and some it changes to a solid condition. 
 And the natural fire of living creatures we should 
 study in the same way as we do that of artificial origin. 
 In the mechanical arts, fire produces a different effect 
 as used by the goldsmith, the brass-worker, the joiner, 
 or the cook. Perhaps it would be better to say that its 
 effects depend rather on the arts themselves than on 
 the kind of fire employed. The arts use it as their 
 instrument; to soften, liquefy, or desiccate, and some- 
 times to adjust or modify. The various natures in the 
 living body (a[ (puifsis) do the same thing, and so differ 
 from each other in their action. It would be absurd, 
 therefore, to judge from external appearances. Whether 
 the act of heating and combustion consist in a decom- 
 position or rarefaction, or whatever it may be, its effect 
 will vary according to the hands by which it is used. 
 Now the arts use it as an instrument only, but nature 
 also as material "* (iS)- 
 
 * That is, combines it with the other ingredients of an animal tissue 
 or fluid, so that this tissue or fluid shall itself have the active force or 
 
ARISTOTLE. 3 1 
 
 With Aristotle, accordingly, the vital heat of the 
 animal organism acts in many ways. By its aid the 
 form of the embryo is first sketched out in the egg 
 during incubation; and it produces, in the fully formed 
 animal, the manifold changes of digestion, assimilation, 
 and nutrition. One of its most striking effects is 
 shown in the cardiac and vascular pulsation. By its 
 increment in the blood, and its combination with the 
 other ingredients of this fluid, the blood is expanded 
 in a manner analogous to that of boiling water, distend- 
 ing by its impulse the heart and bloodvessels. Ac- 
 cording to this doctrine, it is the blood which palpitates 
 in the vascular system, from the internal force of its 
 own vital heat; and the pulsation of the heart, as well 
 as that of the bloodvessels, is a passive effect of this 
 cause. There is no difference in this respect between 
 what we call the veins and the arteries ; for they are 
 all bloodvessels, containing the same kind of blood, 
 and having their common origin in the heart. The 
 expansion of the bloodvessels, moreover, is every- 
 where synchronous with that of the heart. The for- 
 mation or elaboration of the blood, and its impregna- 
 tion with the vital heat, take place in the cardiac 
 cavities ; but the stimulus thus produced is at once 
 communicated to the blood throughout the body, and 
 all the bloodvessels consequently pulsate simultane- 
 ously with each other and with the heart* 
 
 power of heat, and can exercise it on other substances. As if we were 
 to say that the pepsine, dissolved in the gastric juice, imparts to this 
 fluid its catalytic action on albuminous matters. 
 
 * This seems, perhaps, a great error. But Aristotle, and others of 
 his time, naturally regarded the stroke of the heart against the walls of 
 the chest as due to its dilatation ; and this stroke or pulsation is really 
 synchronous with the arterial expansion at the wrist and elsewhere. It 
 
32 DOCTRINES OF THE CIRCULATION. 
 
 The phenomena of respiration, according to Aris- 
 totle, are in some respects of a similar character, and 
 its purpose as a function is closely allied to the fore- 
 going. A full supply of heat is indispensable for the 
 vital operations. But, as in the mechanical arts, it must 
 not exceed a certain intensity ; otherwise it becomes a 
 source of disturbance, causing abnormal changes in the 
 organs. Respiration provides against this difficulty, 
 and confines the animal heat within- physiological 
 limits. The cool air, introduced from without, comes in 
 contact, in the pulmonary passages, with the surround- 
 ing bloodvessels, and reaches through them the source 
 of heat in the blood. It takes away a portion of this 
 heat, becoming itself consequently warmed ; and it is 
 then discharged by expiration to make way for a fresh 
 supply. The cooling influence is thus repeated at short 
 intervals, and is even regulated in a sort of automatic 
 way, according to the demands of the system. For 
 when the bodily temperature rises too high, either 
 from unusual warmth of the atmosphere or from accu- 
 mulation of internal heat, respiration is accelerated 
 and the normal balance restored. 
 
 This is the main object of the function of respira- 
 tion. It is frequently alluded to by Aristotle, and is 
 fully described in his special treatise on that subject. 
 " As for the reason," he says, " why animals provided 
 with lungs take in air by respiration, and why this 
 function is especially active where the lungs are abun- 
 dantly supplied with blood, it depends upon the spongy 
 and cancellated texture of the lung, and its excessive 
 
 was only Harvey who learned that the external impulse of the heart 
 represents its contraction and not its dilatation. This was his very first 
 discovery, and the basis of all the rest. 
 
ARISTOTLE. 
 
 33 
 
 vascularity. As this organ is unusually full of blood, 
 and its heat so readily liable to, vary in intensity, it 
 needs a rapid cooling influence, and one that can pene- 
 trate easily throughout. Air is well adapted for this 
 purpose, since its rarity enables it to disseminate 
 rapidly and carry its cooling influence to every part.'' 
 
 . . . . " The animal organism in all cases requires a 
 cooling influence, on account of the fiery kindling 
 (ifji'n-upuffis) of the principle of life within the heart. In 
 animals with both heart and lungs, this is supplied by 
 the act of inspiration. In fishes, which have a heart 
 but no lungs, the same thing is effected by means of 
 water through the gills " (i6). 
 
 There is evidence that Aristotle also regarded the 
 inspired air as furnishing to the blood a certain aeri- 
 form ingredient, the tveu/ak, or "spiritus" (page 28), 
 which was important in some way to the vital opera- 
 tions. But his observations on this point are too ob- 
 scure to admit of a satisfactory interpretation. His 
 doctrine as to the cooling action of the breath, on the 
 otheir hand, is perfectly distinct, and is consonant 
 morever with the results of modern investigation. The 
 mere fact that the air, as he says, is cool when it enters 
 the lung and warm at its exit, shows that it must have 
 taken away a certain quantity of heat from the internal 
 parts. We know from experiment that this is actually 
 the case ; the blood being cooled during its passage 
 through the lung, and its diminution of temperature in 
 these organs amounting sometimes to more than one 
 degree Fahrenheit. If we consider, furthermore, that 
 the vaporization of water from both lungs and skin 
 consumes in twenty-four hours about one-fifth of all 
 the animal heat produced, it is plain that the refrige- 
 
34 
 
 DOCTRINES OF THE CIRCULATION. 
 
 rating influence of the external atmospliere is of no 
 small value in regulating the animal functions. Respi- 
 ration has, in addition, a much more important office, 
 namely, that of supplying oxygen to the blood. But 
 this was unknown in ancient times, and had no place 
 in the physiology of the period. 
 
 The mechanism of respiration, according to Aristotle, 
 is somewhat like that of the cardiac pulsation. The 
 increase of internal heat produces an expansion of the 
 lung; and by this expansion the air is drawn, through 
 the trachea, into the pulmonary cavities. Its heat 
 having been moderated by the contact of the air, the 
 lung again collapses and the breath is expelled. Thus 
 the movements of inspiration and expiration follow 
 each other in regular order, as the tension of the lung 
 is alternately increased by the accumulation of animal 
 heat, and relaxed by its diminution. 
 
 " Respiration depends on the growth or augmenta- 
 tion of the animal heat, in which is the principle of 
 nutrition. As the other constituents of the living body 
 require nourishment, so also does this one ; and even 
 more than the rest, since it is the cause of nourishment 
 for all. With its increase in quantity it necessarily 
 expands the lung. This organ must be regarded as in 
 structure somewhat like the bellows of a forge; both 
 the lung and the heart having a form not very dis- 
 similar to that."* " This seems to be what hap- 
 pens in respiration. The thorax expands because the 
 principle of the organ contained within it does the 
 same. By this expansion the outer air is drawn into 
 
 * The ancient "bellows" was a leather bag, made from the entire 
 skin of a goat, or other animal of suitable size. 
 
ARISTOTLE. 
 
 35 
 
 it as into a bellows, and by its coolness moderates the 
 excess of internal heat. But, as the thorax is ex- 
 panded with the increase of the internal heat, so must 
 it collapse with its diminution. By this collapse the 
 air is again expelled, being cool at its entrance, but 
 warm at its exit, from contact with the internal heat of 
 the parts ; especially in animals with lungs that are 
 highly vascular. For it penetrates into numerous hollow 
 passage-ways in the lung, the bronchial tubes; each of 
 which is accompanied by bloodvessels, making the 
 lung apparently everywhere full of blood. The entrance 
 of air is called inspiration ; its discharge, expiration " 
 
 (17). 
 
 There appears to be something like a contradiction 
 in the idea of the lung being expanded by a distension 
 from within, and yet drawing into it the external air, 
 to satisfy a vacuum; because such a distending force 
 would seem likely to oppose, rather than invite, the 
 entrance of anything from without. But this difficulty 
 does not really exist in Aristotle's doctrine. The in- 
 ternal heat which excites the movement of respiration 
 is in the blood contained in the bloodvessels; which are 
 themselves in contact with the bronchial tubes, but 
 outside their cavities. The expansion is, therefore, in 
 the tissues surrounding the pulmonary channels; and 
 it consequently lifts the walls of the thorax^, without 
 impeding the influx of the air. So long, therefore, as 
 the lungs perform their office, every immoderate in- 
 crease of heat brings with it its own remedy; for it sets 
 in motion a mechanism which at once introduces cool 
 air in the needed proportion. 
 
 It appears, accordingly, that, in the earliest system 
 of physiology known to us, many essential features of 
 
36 
 
 DOCTRINES OF THE CIRCULATION. 
 
 the nutritive process were fairly appreciated, although 
 its more important physical conditions were unknown. 
 The blood was regarded as the great nutritive fluid of 
 the body, absorbing new material from the digestive 
 apparatus, and supplying it to the tissues through the 
 medium of the bloodvessels ; but without the aid of a 
 physical transportation. There was no outward cur- 
 rent through the arteries, and no returning current 
 through the veins; but only a continual renovation of 
 the blood by the act of nutrition, as there might be in 
 any reservoir of fluid constantly drawn upon at one end 
 and fed at the other. The ideas entertained by Aris- 
 totle, in regard to the heart and bloodvessels, may 
 therefore be summarized as follows : 
 
 I. The heart was an organ for giving to the blood 
 its final elaboration, and for communicating to it the 
 necessary element of vital heat. 
 
 II. The perfected blood was received from the heart 
 into the bloodvessels, arteries and veins alike, and 
 brought, by their branches and ramifications, into 
 proximity with the solid tissues, which it nourished 
 by exudation. 
 
 III. The pulsation of the heart was a momentary 
 dilatation from expansion of the blood in its cavities; 
 this expansion being produced by the animal heat com- 
 bining with the ingredients of the blood. The pulsa- 
 tion of the bloodvessels was due to the same cause, and 
 was simultaneous with that of the heart; the impulse 
 originating in the cardiac cavities being at once com- 
 municated to the blood in every part. 
 
CHAPTER II. 
 
 PRAXAGORAS. 
 
 With Praxagoras there appears a new feature in the 
 history of the vascular system ; namely, a physiological 
 distinction between the veins and the arteries. Before 
 his time, they were classed together as bloodvessels, 
 distinguished only by the anatomical structure of their 
 coats. They are now separated into two distinct sy.s- 
 tems, with different functions and designated by dif- 
 ferent names ; that is, the veins containing blood, and 
 the arteries containing air. 
 
 Praxagoras, who was a native, and probably a resi- 
 dent, of the island of Cos, opposite the coast of Asia 
 Minor, lived between 300 and 400 years before Christ. 
 He was a man of great eminence in his time, well 
 known throughout the Grecian world, and of high 
 reputation in both scientific and practical medicine. 
 Celsus enumerates him,* in the same category with 
 Hippocrates, Diodes, and Chrysippus, as among those 
 who had exercised the greatest influence on medical 
 art. His original works have long since disappeared, 
 but they are known through quotations or references 
 by Pliny, Rufus Ephesius, Galen, and Caelius Aure- 
 Ipnus ; all writers' of the first two centuries after Christ. 
 He seems to have made a special study of the fluids of 
 the body, both in health and disease ; considering their 
 
 * Celsus, De Medicina, Prsefatio, Leipzig edition, 1746, p. 3. 
 4 
 
38 
 
 DOCTRINES OF THE CIRCULATION. 
 
 alteration or perversion as the cause of many morbid 
 affections. Some of his doctrines in regard to diagnosis 
 and treatment, if correctly reported, were very striking. 
 According to Cselius Aurelianus,* he regarded sterco- 
 raceous vomiting as the sign of acute tumor (obstruc- 
 tion) of the intestine ; and for its relief, when other 
 manipulations failed, he advised opening the abdomen 
 and dividing the intestine to remove the obstruction; 
 after which the intestine was to be reunited by sutures. 
 If this recommendation were the result of his own ex- 
 perience, it would imply that the modern surgery of 
 the abdominal cavity was not altogether unknown in 
 ancient times. 
 
 But the most important innovation of Praxagoras, at 
 least for the vascular system, related to the character 
 and function of the arteries. The change which he 
 introduced into the physiology of these vessels was 
 twofold. In the first place, he observed that the phe- 
 nomenon oi pulsation, previously regarded as a common 
 attribute of arteries and veins, really belonged only to 
 the arteries (i 8). They were consequently seen to differ 
 in this respect from the veins, in which no such move- 
 ment was perceptible. They were, furthermore, dis- 
 tinguished by the nature of their contents ; for, while 
 the veins were still considered as receptacles for the 
 blood, the arteries, according to the new view, con- 
 tained no blood, nor any liquid material (19), but only 
 an invisible gas or air. 
 
 By nearly all writers on the history of medicine the 
 origin of this distinction between ve;ns and arteries is 
 attributed to Praxagoras ; although the fact has been 
 
 * De Morbis Acutis, liber iii., cap. xvii. 
 
PRAXAGORAS. jQ 
 
 sometimes called in question, especially by Littre* and 
 Kiihn.t The meagreness of our information from 
 original documents leaves, perhaps, some room for 
 doubt ; but the weight of evidence, as well as the pre- 
 ponderance of authority, seems to indicate that this 
 doctrine was certainly promulgated at the time of Praxa- 
 goras, and in all probability by him, as the anatomist 
 of greatest repute in the period immediately following 
 Aristotle. 
 
 It is generally believed that the idea of the vacuity 
 of the arteries was derived from examination of the 
 dead body. At the time of death the blood is mainly 
 expelled from the arterial system, and accumulates in 
 the veins. But when, in the course of dissection, the 
 vessels are cut across, and air admitted to their in- 
 terior, the flaccid veins still contain the coagulated 
 blood, or collapse, if it be withdrawn; while the elastic 
 arteries resume their original form and appear as empty 
 cylindrical tubes. Under these circumstances, the two 
 sets of vessels are really in the condition described by 
 Praxagoras; the veins containing. blood and the arteries 
 containing air. He had found, moreover, that, during 
 life, the veins or bloodvessels are quiescent, while the 
 arteries pulsate ; and this action he attributed to the 
 stimulus of their gaseous contents. It is impossible 
 to say with certainty what was the supposed nature of 
 this aeriform fluid in the arterial system ; but it seems 
 to have been identical with the so-called pneuma, or 
 spiritus, already admitted by Aristotle, which afterward 
 became so important an element in the physiology and 
 pathology of the Alexandrian school. Praxagoras was 
 
 * CEuvres Completes d'Hippocrate, Paris, 1839, torn, i., p. 202. 
 \ Opuscula Academica, Lipsise, 1828, vol. ii., p. 136. 
 
40 
 
 DOCTRINES OF THE CIRCULATION. 
 
 the preceptor of Herophilus, one of the most eminent 
 of the Alexandrian anatomists ; and he, no doubt, fur- 
 nished the basis for much of the doctrine developed by 
 his pupil. 
 
 The physiology of Praxagoras was plainly an im- 
 provement on that of his predecessors ; since the im- 
 portant phenomenon of vascular pulsation, attributed 
 until then to all the bloodvessels alike, was referred by 
 him to its true place in the arterial system. But this 
 advance was associated with a singular misconception ; 
 inasmuch as the arteries, previously regarded as blood- 
 vessels, were separated from the sanguiferous system, 
 and credited with an unreal function, as the recipients 
 of a hypothetical gas. It is evident, furthermore, that 
 the difference in nomenclature introduced by Praxa- 
 goras does not correspond with the distinction between 
 veins and arteries, as now understood. In his doctrine 
 the veins, as containing blood, still bore their old name 
 of (pXeSsf, or bloodvessels, while the latter assumed a new 
 character, and were designated accordingly as arteries, 
 or air-tubes. This forms a remarkable episode in the 
 history of medicine; in which a serious error, apparently 
 grounded on anatomical evidence, appears as a neces- 
 sary phase in the development of physiological knowl- 
 edge. At all events, it remained for several centuries the 
 accepted doctrine, and passed the inspection of more 
 than one investigator, no less able and distinguished 
 than its author. 
 
 But what became of the trachea after its name, apT?ip/a, 
 had been applied to another system of vessels ? The 
 term was modified to correspond with the structural 
 peculiarities of the organ. The arteries proper are of 
 smooth and uniform texture ; but the trachea is rough 
 
PRAXAGORAS. 4 1 
 
 and uneven, being formed of cartilaginous rings with 
 membranous spaces between them ; and it was called, 
 therefore, the dpTijpta Tpn^^sra, or the " rough air-tube." 
 This is the first appearance of our modern name for the 
 organ. We have now dropped half its title, and call 
 it simply the " trachea." But the French retain the 
 double appellation, and with them it is still known as 
 the " trachee-artere." 
 
CHAPTER III. 
 
 THE SCHOOL OF ALEXANDRIA. 
 
 The school of Alexandria was in some respects the 
 most remarkable product of Greek civilization. Created 
 under the auspices of a successful military commander, 
 it survived a change of masters at the- Roman con- 
 quest, and a change of religion after the Christian era. 
 Situated in Egypt, it drew teachers and students from 
 every country bordering on the Mediterranean, and 
 exercised an influence in science, literature, and phi- 
 losophy, over the whole civilized world. It is of espe- 
 cial interest in connection with the history of medicine, 
 because some of its most important achievements, for 
 the first two hundred years of its existence, were in 
 that department; and even, so late as two or three 
 centuries after Christ,* it was still the resort of those 
 who wished to enjoy the best opportunities for medical 
 instruction. 
 
 The city of Alexandria owed its origin to the politi- 
 cal and military plans of the conqueror whose name 
 it bears. When Alexander the Great had pushed his 
 dominions to the east and south of the Mediterranean, 
 he looked for a spot which should be capable of sus- 
 taining a great capital, and of serving as the centre of 
 his extended empire. For this purpose he selected a 
 site on the northern shore of Egypt, where a small 
 
 * Ammianus Marcellinus, Res gestae, lib. xxii., cap. xvi. 
 
THE SCHOOL OF ALEXANDRIA. 45 
 
 village already existed, and which seemed to possess 
 the requisite advantages. It commanded the main 
 entrance to the inland navigation of the delta and 
 valley of the Nile ; and from its position on the Medi- 
 terranean it offered a central point of communication 
 for travel and commerce between the north, the east, 
 and the south. 
 
 But Alexander died about three hundred and twenty 
 years before Christ, not long after the foundation of 
 the city; and his favorite general, Ptolemy, who was 
 already in command of the country as a province, be- 
 came its permanent ruler, under the title of Ptolemy I., 
 king of Egypt. He proved fully equal to the task of 
 government ; and under the impulse of his energy and 
 foresight Alexandria became a large and prosperous 
 city. It had two harbors protected by a long island 
 running parallel with the shore, and joined to the 
 mainland by a stone causeway or mole, three-quarters 
 of a mile in length. The modern town is said to be built 
 mostly on the ruins of this mole and the debris accu- 
 mulated round it. The city extended for four miles 
 along the shore, which was lined with piers and dock- 
 yards, bu.sy with the commerce of the Mediterranean ; 
 and in the last century before Christ it had over half a 
 million of inhabitants, and an annual revenue equiva- 
 lent to more than ;^5, 000,000,* from port dues alone. 
 It was the second city in importance of the known 
 world, and the first in commercial enterprise and ac- 
 tivity. 
 
 But beside its advance in material prosperity, Alex- 
 andria also became a centre of learning. Ptolemy, 
 
 * Smith's Dictionary of Greek and Roman Geography, Boston, 
 1854, vol. i., p. 100. 
 
44 
 
 DOCTRINES OF THE CIRCULATION. 
 
 who was a man of some education, wished to make 
 his capital a resort for scholars, and a place where 
 knowledge as well as wealth could be imparted and 
 acquired. For this purpose he founded and main- 
 tained, from the treasury of his kingdom, the Musaeum 
 of Alexandria — an institution corresponding to our 
 modern idea of a university. It was an establishment 
 for the general teaching and cultivation of science, 
 literature, and art. It was provided with buildings 
 containing a library, apartments for professors, a thea- 
 tre for public meetings, lectures, and addresses, and in 
 course of time with botanical and zoological gardens 
 for the practical study of natural history. One of its 
 most important and original features was its library; a 
 department which was established and fostered with 
 such zeal and liberality of expenditure, as to be an 
 object of active but unsuccessful rivalry among the 
 neighboring States.- It is not quite certain by whom 
 its formation was suggested ; but it is generally ad- 
 mitted that nothing of the kind had been in existence 
 before. There were many valuable manuscripts in the 
 hands of private owners who, no doubt, spent much 
 time and labor in completing or enlarging their collec- 
 tions. But the idea of a great public library, open to 
 all comers, for the general increase and dissemination 
 of knowledge, was first conceived and carried into exe- 
 cution at Alexandria. Whenever manuscripts of rec- 
 ognized merit were known to be for sale, they were 
 purchased and deposited in the musaeum, until its pos- 
 sessions amounted to about 500,000 volumes. The 
 office of director of the library was an important and 
 responsible post, both for the preservation and man- 
 agement of the books already acquired, and for the 
 
THE SCHOOL OF ALEXANDRIA. 
 
 45 
 
 selection and purchase of others. These abundant 
 resources, no doubt, offered to all interested in literary 
 or scientific matters a great attraction, as well as an 
 invaluable aid for the prosecution of their studies ; and 
 in the opinion of some writers* such an establishment 
 must have exerted, in ancient times, as great an influ- 
 ence as the invention of printing in modern civilization. 
 
 The school of Alexandria had a success commensu- 
 rate with its opportunities, at least during the earlier 
 periods of its existence and in the natural and mathe- 
 matical sciences. The list of its teachers and pupils 
 includes Euclid in geometry, Strabo and Eratosthenes 
 in geography, Archimedes in physics, and Hipparchus 
 and Ptolemseus in astronomy; representative men, 
 whose names are indispensable landmarks in the his- 
 tory of human knowledge. In medicine it became so 
 pre-eminent as to take the lead of all contemporary 
 schools.f It was for several centuries the source from 
 which all medical discoveries emanated, and a common 
 centre where all medical theories and doctrines were 
 promulgated and discussed. 
 
 Among the medical celebrities of the school of 
 Alexandria the two, whose names stand out in deserved 
 prominence from the rest, are the anatomists, Herophi- 
 lus and Erasistratus. They lived within the reigns of 
 the first two Ptolemies, and were probably contempo- 
 rary or nearly so with each other. Herophilus seems 
 to have been earliest on the ground, and probably acted 
 as teacher of anatomy almost from the foundation of 
 the school ; while Erasistratus came to Alexandria later 
 
 * Renouard, Histoiie de la Mfedecine, Paris, 1846, torn, i., p. 261. 
 f Matter, Essai Historique sur I'Ecole d'AIexandrie, Paris, 1820, 
 torn, i., p. 4; torn. ii.,p. 79. 
 
46 DOCTRINES OF THE CIRCULATION. 
 
 in life, giving up the study and practice of other de- 
 partments to devote himself wholly to anatomy. But 
 the two were so closely associated in time, by the nature 
 of their discoveries, and by the influence which they 
 exerted, that their names appear together as belonging 
 to a single epoch. 
 
 The services which they rendered to anatomy did 
 not consist alone in the discovery of details, or the 
 more accurate description of bodily structures. They 
 inaugurated a new method, which placed anatomy on 
 a surer and more advantageous footing than it had 
 ever before occupied. It was in their time, and at the 
 Alexandrian school, that the dissection of the human 
 body was first legalized by public enactment. Ptolemy 
 I. and Ptolemy II. authorized these anatomists to use 
 for dissection the bodies of condemned criminals, as- 
 signed to them for that purpose from the public prisons. 
 This enlightened policy certainly reflects credit on the 
 monarchs who adopted it; but it also shows the char- 
 acter and influence of the anatomists who could advise 
 and carry out^such an innovation. Human anatomy, 
 it is true, was by no means a new science. The works 
 of earlier authors contain descriptions and allusions 
 which can hardly admit a reasonable doubt that it had 
 already been studied by means of dissection. But 
 this method had not been employed, so far as we know, 
 in any systematic way, nor with any other sanction 
 than the individual judgment and responsibility of the 
 dissector. At Alexandria it was made a recognized 
 means of instruction; and it is easy to see how greatly 
 this must have contributed to the progress of anatomi- 
 cal science. Herophilus and Erasistratus were not the 
 first anatomists ; but they were the first who, under 
 
THE SCHOOL OF ALEXANDRIA. 47 
 
 legal provision, pursued the study of practical anatomy, 
 for their own improvement and the benefit of their 
 pupils, in a public institution. 
 
 •The original works of the Alexandrian anatomists 
 are no longer in existence, and our knowledge of them 
 is obtained through Plutarch, Celsus, Rufus Ephesius, 
 and especially through Galen, who quotes them with 
 great frequency and on a variety of topics. From 
 these sources we learn that they enriched anatomical 
 science with many important facts, and in not a few 
 instances gave to organs or structures the names 
 which are retained at the present day. The tricuspid 
 valves of the heart,* and the parenchyma of the inter- 
 nal organsf received their designations from Erasistra- 
 tus or his disciples ; the duodenum,X and the calamus 
 scriptorius,% from Herophilus; the term choroid^ was 
 first applied by him to the vascular lining of the ven- 
 tricles of the brain (tela choroidea), and also probably 
 to that of the eyeball^f (tunica choroidea) ; and the 
 occipital confluence of the sinuses of the dura mater 
 is called the torcular Herophili, because he compared 
 it to the receptacle of a wine-press.** 
 
 Our knowledge of the anatomy and physiology of 
 the nervous system dates from Herophilus and Erasis- 
 tratus. Before their time the word vsvpov (nerve) signi- 
 
 * Galen, Opera Omnia, vol. v., p. 548. 
 •j- Galen, Opera Omnia, vol. xv., p. 8. 
 J Galen, Opera Omnia, vol. ii., p. 780. 
 \ Galen, Opera Omnia, vol. ii., p. 731. 
 II Rufus Ephesius, De Appellationibus, lib. i., cap. xxii. 
 \ Rufus Ephesius, De Appellationibus, lib. i., cap. xxiii. 
 ** Galen, Opera Omnia, vol. iii., p. 708. 
 
48 DOCTRINES OF THE CIRCULATION. 
 
 fied simply a cord, and would be correctly translated 
 " tendon," " sinew," or " ligament ;" for the nerves 
 proper were confounded with the tendinous structures, 
 and were supposed to act in the production of move- 
 ment only by their physical properties. Herophilus 
 first made a physiological distinction between these 
 different kinds of cords ; some of them, the nerves 
 proper, which are the ministers of volition, taking their 
 origin from the brain and spinal cord ; while others 
 have both their origin and insertion in the bones (liga- 
 ments), or pass from muscle to muscle ("fasciae), or serve 
 to connect the articulations (tendons or sinews).* 
 
 He, as well as Erasistratus,t furthermore distin- 
 guished two classes of nerves, namely, the nerves of 
 sense, mo'h-r^'moi, and those of motion, v.Kt\<mu\ and it is 
 a striking instance of the progress made during their 
 time in this department, that Erasistratus, who at first 
 believed the nerves of sense to originate from the dura 
 mater, afterward described their true origin from the 
 brain. The reasons for this mistake, and the mode in 
 which it was corrected, are explained by Galen ;J and 
 they show how naturally the older anatomists were led 
 to confound nerves and tendons together. The nerves 
 of the body and limbs have, in fact, much of the physi- 
 cal quality of tendons, owing to their neurilemma or 
 external fibrous envelope, which is dense and resisting. 
 The internal or medullary portions must have required, 
 for their first demonstration, no little skill and expe- 
 
 * Rufus Ephesius, De Appellationibus, lib. ii., cap. xvii. 
 I Galen, Opera Omnia, vol. iii., p. 813; and Rufus Ephesius, De 
 Appellationibus, lib. ii., cap. xvii. 
 
 J Galen, Opera Omnia, vol. v., p. 602. 
 
THE SCHOOL OF ALEXANDRIA. aq 
 
 rience in the dissector. According to Galen, the atten- 
 tion of Erasistratus being taken up for a time with 
 the fibrous investment of the nerve, which really pro- 
 ceeds from the dura mater, he supposed its whole 
 structure to be derived from this membrane ; and in 
 most of his works the nerves are described as origi- 
 nating from the membranous envelope of the brain. 
 But in the latter part of his life, when he devoted more 
 time to technical investigation, and dis.sected with 
 greater accuracy, he recognized the medullary part of 
 the nerve as an outgrowth from the cerebral substance. 
 The knowledge of the structure and properties of 
 the brain and spinal cord was also greatly advanced by 
 the Alexandrian anatomists. Both these organs had 
 been misunderstood by earlier writers. Largely com- 
 posed of a white, soft, apparently homogeneous and 
 non-vascular substance, they had been regarded as in- 
 active deposits of lardaceous material, somewhat analo- 
 gous to the marrow of the bones.* The name, " spinal 
 marrow," so long retained afterward, indicates the 
 unimportant character at first attributed to this part of 
 the nervous system. Herophilus, on the other hand, 
 made the brain an organ of commanding influence 
 in the animal economy. According to him, it was 
 the seat of conscious individuality,t the centre of 
 the perceptive faculties, and the source of voluntary 
 action. With its nerves of sense and motion it thus 
 became, in his doctrine, the essential instrument for 
 the manifestations of animal life; that is, the imme- 
 diate functions of the so-called " anima," the immate- 
 rial principle of independent existence. He probably 
 
 * Aristotle, Opera Omnia, vol. iii., p. 237. 
 ■f Galen, Opera Omnia, vol. xix., p. 315. 
 
50 
 
 DOCTRINES OF THE CIRCULATION. 
 
 treated of its anatomy very fully, as he knew all its 
 ventricles, attributing to the fourth, or that embraced 
 by the cerebellum, the most important part in the 
 transmission of stimulus to the spinal cord ;* and he 
 recognized, on the floor of this ventricle, the well- 
 known configuration of the medulla oblongata which 
 he designated by an appropriate name.f Erasistratus 
 described faithfully the convoluted structure of the 
 cerebrum and cerebellum, and asserted that these con- 
 volutions were more abundant in man than in the 
 lower animals, in proportion to the superiority of his 
 intelligence^ There appears ample reason to justify 
 the opinion of Le Clerc,§ that " Herophilus and Era- 
 sistratus discovered the real uses of the brain and 
 nerves." 
 
 In regard to the vascular system the doctrines of the 
 Alexandrian school were a continuation of those of 
 Praxagoras. The veins and the arteries were divided 
 in function as before; the veins serving for the recep- 
 tion and distribution of blood, the arteries for the con- 
 veyance of air. The truth of this doctrine was never 
 doubted throughout the long period of four or five 
 centuries, which was marked in this school at first by 
 so much original investigation, and afterward by an 
 equal activity in theoretical discussion. It formed the 
 basis of numerous researches on the character and 
 significance of the pulse, of nearly all explanations of 
 febrile and inflammatory affections, and of the mode of 
 action of most of the organic functions. It was the 
 
 * Galen, Opera Omnia, vol. iii., p. 667. 
 
 •|- Calamus scriptorius. 
 
 J Galen, Opera Omnia, vol. iii., p. 673 ; and vol. v., p. 603. 
 
 \ Histoire de la Medecine, Paris, 1729, p. 299. 
 
THE SCHOOL OF ALEXANDRIA. 
 
 SI 
 
 main feature in the vascular physiology of this period, 
 to which all its principal phenomena were referable 
 and subservient. 
 
 It is, therefore, important to understand, if possible, 
 the nature of the aeriform fluid, the so-called /i«^«»2rt,* 
 which the arteries were supposed to contain. But it is 
 very difficult to gain an adequate comprehension of 
 this term, as used by the ancient writers. There is 
 nowhere to be found an exact definition or even a de- 
 scription of it ; probably for the reason that it was then 
 universally understood in a general way, perhaps with- 
 out being susceptible of delineation in concise lan- 
 guage. We are obliged to depend for our conception 
 of its significance mainly on the context ; and even 
 this varies somewhat in different instances. Usually it 
 is plain that the pneuma is derived from the external 
 air, is introduced into the lungs by inspiration, and 
 thence transferred to the heart and arteries. But it is 
 not the atmospheric air in bulk which gains access to 
 these vessels ; it is something either extracted or pro- 
 duced from it, which only assumes the name and quali- 
 ties of the " pneuma " after its entrance into the system. 
 An over-zealous interpretation of the ancient writers 
 might even suggest the idea that they knew of the 
 existence and properties of oxygen as an element in 
 the atmosphere, and the part which it plays in respira- 
 tion. On the other hand, they not unfrequently speak 
 of the arteries as containing " air ;" and even the name 
 of these vessels, which was that originally applied to 
 the trachea, shows that they were in some sense re- 
 garded as " air-tubes." 
 
 * Vi.viv^a, from -ntiia, to breathe. Its Latin equivalent is spiritus, 
 brealli, contracted in English into spirits. 
 
52 
 
 DOCTRINES OF THE CIRCULATION. 
 
 But this discrepancy is easily explained. Among 
 the ancients the term " air " did not mean the atmos- 
 phere, but simply an aeriform fluid ; that is, any sub- 
 stance having a gaseous or vaporous constitution. 
 Furthermore, they did not understand the atmosphere 
 in its modern sense, as a definite mixture of specific 
 gases, of known qualities and in known proportions. 
 It was for them only an invisible aeriform envelope, 
 which might contain a variety of substances undistin- 
 guishable from each other, except by the effects which 
 they were capable of producing. The pneuma itself 
 they never attempted to isolate or examine by means 
 like those of modern chemistry, and consequently they 
 could not describe it in terms like those now em- 
 ployed. But it is evident that they fully believed both 
 in its existence and its importance ; and we can per- 
 haps make an approach to understanding their views 
 in the following way : 
 
 The most palpable fact in physiology is the vivify- 
 ing influence of the atmospheric air. Its access is in- 
 dispensable to the maintenance of life ; and in all the 
 higher animals the process of respiration, must go on 
 without serious interruption, in order to keep up the 
 phenomena of consciousness and vitality. This is a 
 truth which must have been known from time imme- 
 morial, and does not require for its demonstration any 
 elaborate scientific research. The act of respiration 
 is instinctively regarded as the sign of vitality; and 
 the "breath of life" is an expression which probably 
 has its equivalent in every language. Whatever may 
 be the constitution of the atmospheric air, it is plain 
 that it supplies to the living body something essential 
 to its existence. This something is not a solid nor a 
 
THE SCHOOL OF ALEXANDRIA. c, 
 
 liquid. It does not add to the mass of the bones or 
 the flesh or the blood. But it is of great power, for it 
 quickens into activity the bodily organs, and stimulates 
 them to the performance of their functions. It is an 
 invisible, intangible vapor; and as it is taken in by 
 respiration, it is called " pneuma," or the essential ele- 
 ment of the breath (20). It represents the impulsive 
 force of the living organism ; while the solids and the 
 fluids are the instruments with which it works, or the 
 materials used for nutrition. 
 
 The doctrine of the pneuma received, early in the 
 history of the Alexandrian school, a further amplifica- 
 tion. Erasistratus recognized two kinds of pneuma, 
 with different qualities and modes of action. One 
 was that immediately produced from the inspired air, 
 namely, the irvEvfta ^wtixJv, spiritus vitalis, or " vital spir- 
 its." It was this which filled the left cavities of the 
 heart, and the arteries throughout the body.* As its 
 name implied, it gave the immediate stimulus to the 
 functions of organic life. It was the cause of the car- 
 diac and arterial pulsations, the source of internal heat, 
 and the direct agent in the production and maintenance 
 of digestion, nutrition, and assimilation. The other 
 was the wvsvfAa it\sy(\ii.0M^ spiritus animalis, or " animal 
 spirits." It was elaborated from the former in the 
 brain,t where it occupied the cavity of the ventricles, 
 and was thence sent through the nerves to the organs 
 of sensibility and volition. It was consequently the 
 direct agent of the -Vux'i. or animaX the moving force of 
 
 * Galen, Opera Omnia, vol.v., p. 185 ; vol. viii., p. 714. 
 f Galen, Opera Omnia, vol. v., p. 281. 
 X Usually translated " soul." 
 
 s 
 
54 DOCTRINES OF THE CIRCULATION. 
 
 individual consciousness and life, with its powers of 
 perception and spontaneous action. 
 
 The reasons for introducing this additional element 
 in the doctrine of the physiological forces were, no 
 doubt, the discoveries of Herophilus and Erasistratus 
 in the nervous system. These discoveries showed that 
 there was something to be accounted for which had 
 not yet received explanation. The brain, never before 
 regarded as of any special physiological value, was now 
 the centre of consciousness and volition ; and the nerves, 
 no longer simple tendinous cords, were the pathways 
 of an invisible force between the brain and distant parts. 
 Thus the functions of the living body were divided 
 into two classes, confided to two different sets of organs. 
 In the vascular system and the abdominal viscera were 
 the processes of organic life, maintained and directed 
 by the spiritus vitalis, the immediate product of respi- 
 ration. In the nervous system were the acts of animal 
 life, bringing the individual into conscious relation with 
 the outer world, through the special agency of the 
 spiritus animalis, or nerve force, generated in the brain. 
 This subtle emanation, impelled through the nerves of 
 sense and motion,* gave rise to the perceptions of sight, 
 smell, hearing, taste, and touch, or conveyed the stim- 
 ulus for voluntary movement ;t and by its influx into 
 the muscles it caused their contraction, by expanding 
 them laterally and shortening their longitudinal dimen- 
 sions (21). 
 
 * These nerves were called ixhpoi and odoi, "passage-ways" or 
 "paths." Galen, Opera Omnia, vol. iii., p. 813; vol. vii., p. 89; vol. 
 xix., p. 30. 
 
 f Galen, Opera Omnia, vol. v., pp. 614, 616; vol. viii., p. 233; vol. 
 xix., p. 313. 
 
THE SCHOOL OF ALEXANDRIA. 55 
 
 This doctrine was evidently well suited to the needs 
 of physiological science at the time, for it was not only 
 immediately accepted, but remained firmly established 
 long afterward. The terms, "vital spirits" and "ani- 
 mal spirits," held their place in medical literature 
 throughout the remainder of the ancient period, during 
 the whole of the middle ages, and even for a consider- 
 able part of the modern epoch. Their, reality began 
 to be doubted in the seventeenth century,* but their 
 probable existence and modes of action were still dis- 
 cussed by Hallerf in the eighteenth ; and in Bonnet's 
 Theory of the Inclusion of Germs,X the " nervous fluid," 
 or animal spirits, plays an important part. Since then 
 the effects formerly attributed to " spirits " have been 
 referred to the so-called property of irritability resident 
 in the tissues and nerves. 
 
 Another change of nomenclature, adopted about the 
 same time in the school of Alexandria, was in regard 
 to the two great vessels connecting the lungs and the 
 heart. According to the views then in vogue, the vas- 
 cular apparatus in general consisted of the veins or 
 bloodvessels on one side, and the arteries or air-tubes 
 on the other, connected respectively with the right and 
 left cavities of the heart. On the right side were the 
 great veins supplying bipod to the body at large, and 
 a .special vein (now the pulmonary artery) conveying 
 nutriment to the lungs. On the left side was a special 
 artery (now the pulmonary vein) coming from the lungs 
 
 * On the Nullitie of Spirits, in the Discourse of James De Back, 
 London, 1653. 
 
 f Elementa Physiologic, Lausannse, 1757, torn, iii., p. 332; torn, 
 iv., pp. 386, 403. 
 
 + Bonnet, GEuvres completes, Neuchatel, 1781, torn, x., pp. 7, 8, 9. 
 
eg DOCTRINES OF THE CIRCULATION. 
 
 to the heart, and bringing into the left ventricle the 
 pneuma, which it had received from the bronchial tubes, 
 and which was then disseminated by the aorta and its 
 branches throughout the body. A vein, accordingly, 
 was called a vein because it contained blood ; and an 
 artery was an artery because it contained pneuma or 
 air. But in the case of the lungs these vessels were 
 peculiar in structure. The vein, or bloodvessel, lead- 
 ing from the right ventricle to the lung, had thick and 
 fibrous walls, like those of an artery ; and it was named 
 by Herophilus the 9X^4^ apnipiu5»is, vena arterialis. On 
 the other hand, the vessel coming from the lung to the 
 left ventricle, though belonging to the arterial system 
 and performing the office of an artery, had thin and 
 flexible walls, like a vein ; it was, therefore, called the 
 aprripia (pXegu5*)s, arteria venalis (22). 
 
 These vessels continued to be known as the vena 
 arterialis and the arteria venalis so late as the seven- 
 teenth century. Harvey usually calls them the vena 
 artenosa and the arteria venosa, though he sometimes 
 employs the older form. In the latter part of the cen- 
 tury there is evidence of a change of appellation, the 
 vena arteriosa being called by some the " pulmonary 
 artery," and the arteria venosa the "pulmonary vein;"* 
 and in the works of Hallerf the modern designation 
 only is used. By that time the doctrine of the circu- 
 lation was so fully established that the terms "artery" 
 and "vein" signified mainly the direction of the blood- 
 current to or from the organ in question ; the vessel 
 bringing the blood from the heart to the organ being 
 
 * Bartholinus, Anatome, ad circulationem Harvejanam et vasa 
 lymphatica quartum renovata, Lugduni Batavorum, 1673, p. 404. 
 j- Elementa Physiologiae, Lausannae, 1757. 
 
THE SCHOOL OF ALEXANDRIA. 
 
 57 
 
 an artery, and that returning the blood from the organ 
 to the heart being a^vein. Under this nomenclature, 
 the vessels of the same name are alike in structure as 
 well as in function. 
 
 A most important contribution to the anatomy and 
 physiology of the circulatory apparatus was that of the 
 cardiac and arterial valves. It is plain, from references 
 by Galen, that Erasistratus accurately described all 
 these valves and their action. According to him, they 
 provide the mechanism by which the heart alternately 
 takes in and expels blood on the right side and pneuma 
 on the left. They are designated as "membranes," 
 attached to the orifices of the incoming and outgoing 
 vessels, and so arranged that they open in one direction 
 and close in the other. Those at the entrance of the 
 vena cava, in the right ventricle, have .the form of triple 
 points, and are therefore called " tricuspid ;" those at 
 the entrance of the pulmonary vein, in the left ventricle 
 (mitral valves), are also pointed, but are only two in 
 number. Both these sets of valves open inwardly, 
 allowing an influx into the heart at its diastole, but 
 close outwardly, preventing an escape at its systole. 
 Each of the outgoing orifices (pulmonary artery and 
 aorta) has three valves, of semilunar form, which open 
 from the heart toward the vessels, but close in a back- 
 ward direction, and prevent regurgitation (23). 
 
 Notwithstanding this complete knowledge of the 
 cardiac valves, there was no idea of a circulation of the 
 fluids, or even of a continuous current. The diastole 
 of the heart, in the physiology of the period, is an 
 active expansion, drawing into the right ventricle, as if 
 by suction, a little blood to be used for the nourishment 
 of the lung, and into the left ventricle a little pneuma 
 
58 DOCTRINES OF THE CIRCULATION. 
 
 or " spirit," to supply the arteries. Both veins and 
 arteries, as in the time of Aristotle, are still called " re- 
 ceptacles," and provide for the diffusion of their con- 
 tents through the body, only by their form of tubular 
 ramification. 
 
 Lastly, an equally remarkable feature in the teaching 
 of the Alexandrian school was that of the anastomosis 
 between the veins and the arteries. The evidence of 
 this doctrine is unmistakable ; and it even formed a 
 basis for important pathological theories. It was 
 not an anastomosis by continuous channels, nor did it 
 provide for the constant passage of fluids from one set 
 of vessels to the other. It was rather a communica- 
 tion which might be open or shut according to circum- 
 stances, and when open was usually a cause of injury, 
 rather than benefit, to the system at large. It is de- 
 scribed by Galen, in his account of the production of 
 fevers and inflammations according to Erasistratus. ■ 
 
 " In considering this subject," he says, " I think it 
 best to begin with the doctrines of Erasistratus, which 
 I will present^as briefly as possible. According to him, 
 the artery is a vessel containing pneuma, the vein one 
 containing blood. The vessels, as they are distributed 
 through the body, continually divide, diminishing in size 
 and increasing in number, so that there is no place with- 
 out a vascular extremity. But these terminal ramifica- 
 tions are so small that the blood is retained within them 
 by the coaptation of their walls. Consequently, although 
 the mouths of the vein and the artery lie side by side, 
 the blood nevertheless remains in its own vessels, and 
 nowhere penetrates into those of the pneuma. So far, 
 the system is in its normal condition. But when, from 
 
THE SCHOOL OF ALEXANDRIA. 59 
 
 any disturbing cause, the blood is forced over from the 
 veins into the arteries, a morbid action results. There 
 may be several such causes, one of the most important 
 of which is a plethora of the blood. By this, the blood- 
 vessel is distended, and its extremities, previously closed, 
 forced open ; when the blood is transfused into the 
 arteries, coming in conflict with the pneuma from the 
 heart, and interfering with its motion. If this take 
 place near the source of the pneuma, toward the heart, 
 it produces fever ; but if the blood be driven forward 
 by the pneuma and impacted in the terminal arteries, 
 it causes inflammation. It is in this way that inflam- 
 mation arises from plethora. It may also result from 
 wounds ; but in that case the transfusion is due to the 
 natural movement for filling a vacuum. For as the 
 pneuma escapes from the divided arteries it tends to 
 leave behind it a vacancy ; and the blood consequently 
 follows, through the vascular anastomoses, to occupy 
 its place."* 
 
 These alleged communications between the veins 
 and the arteries were, therefore, to all appearance hy- 
 pothetical. It was not claimed that they were demon- 
 .strable to the senses; and they were hardly supposed 
 to exist, as practicable openings, in the usual state of 
 the vessels. But they seem to have been assumed, as 
 affording an explanation of the general disturbance in 
 febrile affections, and of the congestion and throbbing 
 in local inflammations. ^ In the physiological operation 
 of the vascular system they had no part; for under all 
 normal conditions the blood was contained only in 
 
 * Galen, Opera Omnia, vol. xi.,p. 152. 
 
6o DOCTRINES OF THE CIRCULATION. 
 
 the venous portion of this system, and the pneuma or 
 " spirits " in its arterial portion. In this way the 
 body was supplied, on the one hand, through the veins, 
 with the liquid materials of nutrition and growth ; on 
 the other, through the arteries, with the exciting and 
 controlling forces of physiological action. 
 
CHAPTER IV. 
 
 GALEN. 
 
 In the second century of the Christian era the error 
 which had so long obscured the doctrine of the arteries 
 came to an end. For five hundred years these vessels 
 had been regarded as air-tubes; and this mistaken 
 belief, lying at the foundation of vascular physiology, 
 had interposed an effectual barrier to any further ad- 
 vance in the knowledge of the circulation. It was 
 dissipated at last by the genius and originality of 
 Galen ; and the arterial system took its place as a sys- 
 tem of vessels for the reception and conveyance of 
 blood. From that time the distinction between veins 
 and arteries became a real one. Both were bloodves- 
 sels ; but in one set the blood which they contained 
 was venous, in the other it was arterial. 
 
 In every respect the name of Galen stands preemi- 
 nent in the history of medicine. He is the central 
 figure, representing at once the culmination of medical 
 science and art in the old world, and their preservation 
 for further development under a new civilization. He 
 lived at a time when the Roman empire had reached 
 its highest point of prosperity, without yet showing 
 the signs of its deterioration. A Greek by birth and 
 education, he practiced his profession at Rome, where 
 he was the medical adviser of the imperial family and 
 the most eminent among his colleagues in public esti- 
 "mation. He was, therefore, for some years the leading 
 
 6 
 
62 DOCTRINES OF THE CIRCULATION. 
 
 physician in the first city of the world. On the other 
 hand, he had no successor who could be called a rival. 
 His age was followed by the disintegration of the em- 
 pire and the disappearance of learning in the middle 
 ages ; and for a long time afterward his works were 
 the principal depository of medical knowledge^ to 
 which other writers resorted for their supply of mate- 
 rials. In the thirteenth century, the recognized text- 
 books for instruction, in the school of Salernum, were 
 the authentic works of Hippocrates and Galen.* So 
 late as the sixteenth century, the lectures of the pro- 
 fessors, in the Faculty of Medicine at Paris, consisted 
 mainly of commentaries on the same authors ;t and at 
 that time the authority of Galen in anatomy was still 
 so great, that it was considered presumptuous to ques- 
 tion the accuracy of his descriptions, even from the 
 evidence of actual dissection. J 
 
 This extraordinary supremacy, which lasted for over 
 fourteen centuries, was due, partly but not entirely, to 
 the ignorance of the middle ages, which made [t im- 
 possible for them to compete with the best writers of 
 antiquity. As a matter of fact, Galen was the medical 
 teacher of Europe during the period of its intellectual 
 pupilage ; but his reputation had been established be- 
 forehand, from the real superiority of his talent, the 
 extent of his knowledge, and the value of his discove- 
 ries and investigations. 
 
 Fortunately his writings have come down to us with 
 
 * Huillard-Breholles, Historia diplomatica Frederici Secundi, Pa- 
 ris, 1854, torn, iv., p. 236. 
 
 f Corlieu, L'ancienne Faculte de Medecine, Paris, 1877, pp. 125, 134. 
 
 % Daremberg, Histoire des Sciences medicales, Paris, 1870, torn, 
 i., p. 211. 
 
GALEN. 
 
 (>l 
 
 but little loss or mutilation. Nearly the whole of his 
 more important works are now preserved, in various 
 European libraries, in the form of manuscripts in the 
 original text (24), beside Latin versions and commen- 
 taries by medieval writers ; and, with one or two ex- 
 ceptions, they are all contained in an Aldine edition, 
 printed in 1525. These works are extensive and 
 varied. They include systematic treatises on anatomy, 
 physiology, hygiene, the action of drugs, diagnosis and 
 prognosis, pathology and therapeutics; beside special 
 works, or monographs, on the pulse, the vocal organs, 
 dyspncea, epilepsy, phlebotomy, antidotes, mental affec- 
 tions, and malingering. They present an epitome of 
 medical doctrine and practice in the time of their 
 author, enriched by his own contributions and his 
 commentaries on previous writers. 
 
 The most marked peculiarity of medicine in Galen's 
 time was that of the so-called " sects," into which the 
 profession was divided. These sects had grown up 
 during the later periods of the Alexandrian school, 
 owing to its activity in theoretical discussion and the 
 wide influence of its successful teachers. They were 
 mainly four in number: first, the "dogmatists," who 
 contended for rationalism in medicine, that is, an in- 
 telligent study of the pathology of disease, and a rea- 
 sonable adaptation of treatment to morbid conditions ; 
 secondly, the " empiricists," who believed in experience 
 as the only guide to successful practice, rejecting the 
 consideration of morbid causes as too obscure ; thirdly, 
 the " methodists," who admitted in their pathology 
 only the simplest and most intelligible conditions, such 
 as constriction and relaxation, with increased or dimin- 
 ished freedom of movement in the molecules of the 
 
64 DOCTRINES OF THE CIRCULATION. 
 
 body; and lastly the "pneumatists," who referred dis- 
 ease to the operation of unseen influences [pneumata), 
 derived from without. It appears that these systems 
 all had their foundation of truth ; and each was no 
 doubt adopted, in the first instance, as a protest against 
 the extravagances of the rest. But in course of time 
 they had become so amplified and elaborated by the 
 zeal of their partisans, that each claimed to represent 
 the whole of medical science and art; and in order to 
 meet these extended requirements, they had been so 
 overloaded with verbal distinctions and niceties of 
 definition as to be often practically unintelligible. 
 Nearly every physician belonged to one or the other 
 of these sects. The adherents of each were in oppo- 
 sition to all the rest; and they were so exclusively 
 attached to particular doctrines that, as Galen says, the 
 " followers of Moses and of Christ would give up their 
 religion, rather than these doctors the tenets of their 
 sect."* 
 
 Galen was thoroughly acquainted with these systems, 
 and presents them to the reader in a very impartial 
 way; but he did not profess adhesion to either, and he 
 considered it a "' servitude " to embrace exclusively the 
 doctrines of any single belief f He had great admira- 
 tion for Hippocrates, as the teacher whose precepts 
 were sounder and more valuable than those of any 
 other. But this was not a servile and barren admira- 
 tion ; for he believed that the highest tribute which 
 could be paid to such a master would be the adoption 
 of his method for adding to knowledge by continued 
 research. 
 
 * Galen, Opera Omnia, vol. viii., p. 657; vol. xi., p. 432. 
 f Galen, Opera Omnia, vol. xix., p. 13. 
 
GALEN. 
 
 65 
 
 " There are many physicians," he says, " like the 
 athletes who would like to win prizes in the Olympic 
 games, but will not take the pains necessary to gain 
 them. For they are loud in their praises of Hippocrates, 
 and give him the highest rank as a physician, yet never 
 
 think of imitating him themselves." " It is 
 
 certainly no small advantage that we enjoy, to live at 
 the present day with the arts already brought to such 
 a state of perfection ; and it would seem not too much 
 for us, after learning in a short time what Hippocrates 
 discovered by many years of labor, to employ the rest 
 of our lives in investigating what still remains un- 
 known."* 
 
 Galen had no taste for disputing about words or 
 names, which he thought of but little consequence, 
 except for what they signified ; and he criticised the 
 sectarian writers of the day for their verbose techni- 
 calities, many of which, he said, were as hard to com- 
 prehend as the " riddles of the Sphinx."f One of these 
 authors, Archigenes, had written a book of some 
 celebrity on the pulse, in which he multiplied the sub- 
 tleties of definition and classification, and increased 
 their obscurity by his unusual and peculiar phraseology. 
 He assigned to the pulse eight different qualities, which 
 he designated by a new term, representing its size, 
 force, velocity, frequency, fulness, regularity, uniformity, 
 and rhythm, beside divisions and subdivisions of the 
 two extremes and the natural mean, the long, the 
 large, and the high pulse, and so on, to an excessive 
 degree. 
 
 Galen objected to this that there was too much fancy 
 
 * Galen, Opera Omnia, vol. i., pp. 53, 57. 
 
 f (lalen, Opera Omnia, vol. xviii., part 2d, p. 300. 
 
66 DOCTRINES OF THE CIRCULATION. 
 
 in it, and too little reality. " There is a mistake," he 
 says, " that Archigenes makes at the outset, in enumer- 
 ating the qualities of the pulse. For he does not attempt 
 to show why they should be reckoned as so many, 
 but simply makes the assertion, and says that there 
 are eight qualities belonging to the pulse, called by 
 the purists Sirnyriidvai. As for me, however, I cannot 
 even guess the meaning of this term ScTj-cnifiinac^ and 
 do not know of its being used by any of the Greek 
 writers. Consequently I have no idea what Archigenes 
 means by it, especially as he has not written a book to 
 explain his own idiom, as Chrysippus did about the 
 words in his Dialectics. That would really have been 
 the way to make himself understood. Without the 
 context, indeed, you might suppose that he used the 
 word in its regular and customary sense. But he is 
 careful to prevent this, for the qualities of the pulse, he 
 says, are so called, not by everybody, but only by the 
 ' purists ;' and we do not even know who these purists 
 are."* 
 
 The faults of excessive sectarianism are illustrated 
 by Galen from the case of two patients bitten by a mad 
 dog; and the passage shows how well the symptoms 
 and treatment of this malady were understood in an- 
 cient times. Galen is pointing out the error of the 
 empiricists in repudiating all consideration of the hid- 
 den causes of disease, and depending only on what is 
 evident to the senses. " But, perhaps, I can show," he 
 says, "that you overlook something in this exclusive 
 attention to the phenomena. Suppose that two men 
 have been bitten by a mad dog, and that each has gone 
 
 * Galen, Opera Omnia, vol. viii., p. 578. 
 
GALEN. 
 
 67 
 
 to his physician for treatment. The injury in either 
 case is a sh'ght one, and does not quite go through the 
 skin. One of the physicians is sohcitous only for the 
 cure of the wound, and in a few days has the part en- 
 tirely healed. The other, understanding that the dog 
 was rabid, does exactly the opposite, enlarging the 
 wound by strong and caustic applications, and giving 
 the patient in the meantime anti-rabific medicines. But 
 what is the result in these two cases ? The patient who 
 was treated with remedies comes out safe and sound ; 
 the other, who thought there was nothing the matter 
 with him, is suddenly taken with hydrophobia, and 
 dies in convulsions."* 
 
 Galen was devotedly fond of anatomy, and insisted 
 upon it as an indispensable basis for rational medicine. 
 He was much impressed with the manner in which the 
 animal structures are adapted to their functions; de- 
 claring that in his view there " is nothing in the body 
 useless or inactive, all parts being arranged to perform 
 their offices together, and endowed by the Creator with 
 specific powers."t 
 
 Among his anatomical descriptions there are none 
 more striking than that of the heart and bloodvessels 
 in the foetus, and their changes after birth. The Alex- 
 andrian anatomists had already described the cardiac 
 and arterial valves as they exist in the adult. Galen's 
 knowledge went farther. He was not only acquainted 
 with the foramen ovale and the ductus arteriosus, as 
 peculiarities of the foetus, but his account of the manner 
 in which these communications become obliterated 
 
 * Galen, Opera Omnia, vol. i., p. 88. 
 ■j- Galen, Opera Omnia, vol. iii., p. 268. 
 
68 DOCTRINES OF THE CIRCULATION. 
 
 after birth, one by the agglutination of its membranous 
 valve, the other by a process of atrophy and shrinkage, 
 is remarkable for its faithful and graphic description. 
 " In this matter," he says, " we have reason to admire 
 the provisions of nature. For so long as the lung has 
 only to be nourished and grow, it is supplied simply 
 with blood ; but, when it is ready to take on an active 
 motion, its tissue becomes lighter and capable of ex- 
 pansion and compression by the movements of the 
 chest. On that account the vena cava, in the foetus, 
 communicates by an opening* with the arteria venalis 
 (pulmonary vein). As this latter vessel thus performs 
 for the lung the office of a vein (that is, supplies it with 
 blood for its nourishment), its companion (the pul- 
 monary artery) must needs at this time serve the pur- 
 pose of an artery, and it is consequently made to 
 communicate with the aorta. As these two vessels 
 (pulmonary artery and aorta) are situated a little dis- 
 tance apart, their communication is effected by means 
 of a third smaller one (ductus arteriosus), which forms 
 a junction with each. In the case of the other two 
 (vena cava and pulmonary vein), which lie in contact 
 with each other, there is a kind of orifice or fenestra 
 (foramen ovale), common to both. At this orifice there 
 is attached a membrane, like a lid or cover, opening 
 toward the pulmonary vessel, so that it will yield to 
 the influx of blood from the vena cava, but will pre- 
 vent its regurgitation into that vessel." 
 
 " So far, no doubt, we have much to admire in these 
 contrivances of nature ; but what surpasses them all is 
 
 * This opening is the foramen ovale, leading from the right auricle 
 to the left. Like other ancient writers, Galen regarded the auricular 
 cavities only as expansions of the vena cava and the pulmonary vein. 
 
GALEN. 
 
 69 
 
 the way in which the foramen not long afterward be- 
 comes occluded. For soon after birth, either within a 
 day or two, or, in some animals, after four or five days 
 or a little longer, you will find the membrane at the 
 foramen coalescing, but not yet fully adherent. Look- 
 ing at the same place in the adult animal, you would 
 say there had never been^a time when it was open ; 
 and, on the other hand, in a foetus, before or immedi- 
 ately after birth, when this membrane is attached, so 
 to speak, only by its root, the rest of it hanging free 
 in the vascular cavity, you would hardly believe in 
 its ever becoming agglutinated. In like manner the 
 connecting vessel (ductus arteriosus) between the aorta 
 and the vena arterialis, while all other parts of the body 
 increase in size, not only stops growing but actually 
 diminishes, becoming after a time completely shrivelled 
 and solidified."* 
 
 Galen's demonstration of the function of the arteries 
 as bloodvessels is mainly given in his special treatise 
 entitled, " Whether the arteries naturally contain bloody'\ 
 The significance of this designation is apparent when 
 we remember that, according to the accepted doctrine 
 which had come down from Erasistratus, the arte- 
 ries, though normally containing only spirits, might 
 sometimes become filled with blood from the veins ; 
 and that this unnatural transfusion was especially 
 liable to occur when an artery was wounded. Under 
 these circumstances the aeriform spirits were first dis- 
 charged from the wounded vessel ; the vacuum being 
 supplied by a transudation of blood, which filled the 
 artery and appeared at the wound (25). In this way 
 
 * Galen, Opera Omnia, vol. iv., p. 243. 
 f Galen, Opera Omnia, vol. iv., p. 703. j 
 
70 
 
 DOCTRINES OF THE CIRCULATION. 
 
 the doctrine accounted for the discharge of blood 
 from an open artery, referring it to the unnatural rela- 
 tions established by the wound. Galen's demonstration 
 was intended to show that the arteries contain- blood 
 in their normal condition ; and that, when it escapes 
 from their wounded orifices, it does so because it was 
 there beforehand. 
 
 But this demonstration, apparently so simple now, 
 involved at that time many other considerations. It 
 was believed that two sets of vessels, so unlike in struc- 
 ture as arteries and veins, could not be intended to 
 contain the same liquid. The idea of the vital spirits, 
 disseminated throughout the body by the arterial sys- 
 tem, had been accepted'for centuries as a fundamental 
 truth of physiology; and, moreover, the pulsating 
 movement of the arteries, so different from the inac- 
 tivity of the veins, was a distinctive feature, correspond- 
 ing with their supposed function as the channels of 
 vitality and force. This doctrine was so fixed in the 
 minds of physiologists that they failed to appreciate 
 the simple fact of hemorrhage from a wounded artery ; 
 and all their ingenuity was employed in finding an 
 explanation for the entrance of the blood into a vessel 
 where it naturally did not belong. 
 
 Galen treats the subject wholly from the opposite 
 direction. He insists on the importance of the visible 
 facts ; and if there are hypothetical difficulties, he en- 
 deavors to reconcile them with the existing phenomena, 
 instead of explaining the phenomena to suit the diffi- 
 culties. He declares that, when an artery is wounded, 
 it discharges blood at once, under all circumstances, 
 wherever it is situated, and whether the wound be large 
 or small. The direct inference from this would be that 
 
GALEN. 
 
 71 
 
 the vessel contained blood beforehand. It must be so, 
 or else the blood is transfused into it from elsewhere. 
 According to the doctrine of Erasistratus, the trans- 
 fusion takes place at the anastomosing extremities of 
 the arteries and veins. But this assumption presents 
 an unavoidable contradiction. Before the blood can 
 arrive at a wounded orifice all the vital spirits which 
 the artery previously contained must first be discharged 
 from the opening, and no such discharge is perceptible. 
 Even if the vital spirits be so thin and ethereal as to 
 escape detection by the senses, it must require some 
 time for complete evacuation from a wound of moderate 
 size. Yet the fact is, that if an artery be punctured 
 " even by the finest needle," it is blood which is dis- 
 charged "from the very first instant."* 
 
 To test this point, Galen performed a variety of ex- 
 periments under different conditions. According to 
 the received opinion, an artery which contains blood 
 must have been previously emptied of its vital spirits. 
 In that case, the arterial pulsation and muscular power 
 would at once disappear in the parts below, because 
 they were both dependent on the dissemination of 
 vital spirits through the arteries. But the contrary is 
 the fact ; for the artery supplying an entire limb may 
 be shown to be full of blood, though its trunk and 
 branches are still pulsating, and the limb retains its 
 muscular power. 
 
 " Any one who wishes can try the experiment, as 
 we have often done, by opening the axillary artery. 
 You can find it without difficulty, being guided by its 
 pulsation even before removing the integument; for the 
 
 * Galen, Opera Omnia, vol. iv., p. 708. 
 
72 
 
 DOCTRINES OF THE CIRCULATION. 
 
 motion is perceptible for a considerable space in ani- 
 mals that are thin, and in those that are fat near the 
 bend of the elbow. You will then open it by applying 
 to it, as you choose, either the point of a writing style, 
 a needle, a slender scalpel, or any similar instrument 
 that will make a narrow cut ; and you may thus prove 
 on the spot all the facts before mentioned, and also that 
 neither the arterial pulsation nor the action of the 
 muscles is in any degree impaired " (26). 
 
 If these two important functions, therefore, go on 
 undisturbed, notwithstanding that the artery is full of 
 blood, what foundation is there for the claim that its 
 condition is an unnatural one ? Galen considers this 
 point as of great importance; and he carries its demon- 
 stration still farther by applying to an artery two liga- 
 tures a little distance apart, and then opening the vessel 
 between them. 
 
 " On many occasions, after uncovering some large 
 artery convenient for the purpose (the most convenient 
 are those of the shoulders or thighs), we have asked 
 the adherents of Erasistratus whether even then, im- 
 mediately after being exposed, the vessel did not ap- 
 pear to contain blood. They could not help admitting 
 the fact, both because Erasistratus himself says that, 
 in removing the integument, there is a discharge of 
 blood from the artery ; and, furthermore, because it 
 was made evident to the senses ; for, by securing the 
 artery with a cord on two sides, and then opening it 
 in the middle, we showed it to be full of blood" (27). 
 
 The Alexandrian physiologists were at a loss to 
 understand how vitality and motion could be preserved, 
 and the life-giving pneuma distributed throughout the 
 body, if the arterial system were occupied by so gross 
 
GALEN. 
 
 73 
 
 a liquid as the blood. But Galen showed that their 
 own hypothesis, when tested by experiment, presented 
 a still greater difficulty. If a wounded artery, owing to 
 the escape of its vital spirits, fills with blood from its 
 anastomotic extremities, the whole of its trunk and 
 branches, between these extremities and the wound, 
 must first be emptied of spirits and then filled with 
 blood. If it be the axillary artery, all the arteries of 
 the arm, forearm, and hand must be in this condition 
 before a drop of blood can exude from the punctured 
 vessel. But, furthermore, the vital spirits must also 
 be evacuated, in such an experiment, from the portion 
 of the artery toward the heart, and even from the aorta 
 and its main divisions; for the cavities of all these ves- 
 sels are continuous, and there is nothing to prevent the 
 escape of the thin and volatile spirits from either direc- 
 tion. Consequently before a wounded artery, even 
 of moderate size, can bleed, the vital spirits must be 
 evacuated from the whole arterial system. This, ac- 
 cording to the doctrine of Erasistratus, would leave the 
 animal without sense or motion ; and we know that 
 nothing of the kind happens. That it must be so, if 
 the arteries are normally filled with-spirits instead of 
 blood, is shown by the fact that when you bleed an 
 animal to death by opening an artery of considerable 
 size, he loses blood, not only from the distal portion of 
 the vessel, but from that toward the heart, and also 
 from all the other arteries, the whole of the blood in 
 the body being discharged from the wound (28). As 
 the supposed transfusion takes place only at the ter- 
 minal extremities of the vessels, this general emptying 
 of the vascular system could not take place, unless the 
 
74 DOCTRrNES OF THE CIRCULATION. 
 
 flow of blood from the wound were everywhere pre- 
 ceded by the evacuation of the vital spirits.* 
 
 It is evident that Galen in this, as in all his physio- 
 logical works, bases his convictions mainly on the 
 visible and palpable phenomena. He believes in di- 
 rect experiment as the surest guide to truth ; and, 
 if his discourse often takes the form of dialectic ar- 
 gumentation, it is only for the purpose of convincing 
 his opponents, and showing the futility of their objec- 
 tions. The dogma, that " nature could not have made 
 two kinds of vessels, both intended to contain blood," 
 does not trouble him. " You might as well say," he 
 replies, "that the several stomachs of ruminating ani- 
 mals were not all intended as recipients of the food ; 
 but that one must be meant for solids, one for liquids, 
 and one for spirits. They are all recipients of the same 
 thing, but each nevertheless has its separate use. So 
 it is with the arteries and veins. "f 
 
 According to Galen, therefore, the arteries are blood- 
 vessels. After giving in detail the proofs of his doc- 
 trine and refuting the objections against it, he touches 
 upon the question why this truth has been so long 
 obscured by the errors of the past. This is not the 
 least interesting part of his treatise ; and it places in 
 strong relief the character of his mind and his scientific 
 methods. " One may naturally ask," he say-s, " how 
 it is that men of so much intelligence could have main- 
 tained an opinion so contrary to the truth, since they 
 must have had some plausible reason for their belief? 
 To which I reply that they have left on record in their 
 writings the grounds on which their belief was founded ; 
 
 * Galen, Opera Omnia, vol. iv., pp. 712-715. 
 f Galen, Opera Omnia, vol. iv., p. 722. 
 
GALEN. 
 
 75 
 
 and these grounds, though plausible, are not really- 
 sufficient. In such matters a frequent source of error 
 is the following. Everything which comes under the 
 cognizance of human intelligence is comprehended 
 either through the senses or by the reason ; and as 
 there are many things of a physical nature which es- 
 cape the senses, so our reason often fails to master 
 those of a different kind. A sincere lover of the truth, 
 therefore, should never withhold his assent from things 
 plainly evident on account of others which are ob- 
 scure, nor accept those which are doubtful for the sake 
 of what is really known." " This is the mis- 
 take made by the disciples of Erasistratus. For their 
 doctrine of the vacuity of the arteries was not based 
 upon demonstration of the fact, but upon their uncer- 
 tainty in regard to other matters. In this particular 
 they were somewhat like those philosophers who de- 
 nied that there could be any such thing as motion (29), 
 because they were unable to solve their own prob- 
 lems in regard to it. In my opinion, it would have 
 been better to concede the existence of motion in the 
 first place as an evident fact, and study out the diffi- 
 culties afterward at leisure. For the same reason I 
 would admit that the arteries contain blood, from the 
 fact that they discharge it at once whenever punctured 
 by the finest needle. But why nature should have 
 made two kinds of vessels to hold one kind of liquid ; 
 or how the spirits taken in with the breath can be 
 transported throughout the body, if the arteries are 
 filled with blood; or how, if the spirits be not so trans- 
 ported, the pulse and voluntary motion can be pre- 
 served ; — all these are special difficulties, very proper 
 to be considered and investigated by themselves, even 
 
76 DOCTRINES OF THE CIRCULATION. 
 
 if regarded as matters of uncertainty. But they ought 
 not to outweigh the direct testimony of visible phe- 
 nomena."* 
 
 In this way Galen accomplished a revolution in 
 physiology, hardly surpassed in importance by any 
 before or since. The older doctrine disappeared before 
 the convincing force of his arguments and demonstra- 
 tions; and his assertion that arteries, as well as veins, 
 were the normal recipients of the blood, became the 
 assured belief of the scientific world. But what were 
 his ideas as to the physiological action of the heart 
 and bloodvessels, and the functions of respiration, nu- 
 trition, and circulation ? This is a question of much 
 importance, because his views remained the accepted 
 physiological doctrines for centuries afterward, and 
 formed the basis for all subsequent changes and modi- 
 fications. 
 
 The general features of Galen's physiology are to 
 be found in his books on The Functions of the Parts, 
 The Causes of the Pulse, The Use of Respiration, and 
 The Physiological Forces. In this system, the liver was 
 the central organ of nutrition and sanguification. From 
 it all the veins took their origin ; and in its glandular 
 tissue the blood was prepared from the elements of the 
 digested food. The veins of the portal system ab- 
 sorbed from the stomach and intestine the chyle (30), 
 produced in digestion; and the chyle, conducted by 
 the portal vein to the liver, was elaborated in this organ 
 by a further process of coction or fermentation. This 
 elaboration, Galen is careful to say, is not accomplished 
 by the arteries, veins, or nerves of the liver, nor by 
 the biliary ducts ; but by the intervening substance of 
 
 * Galen, Opera Omnia, vol. iv., p. 720. 
 
GALEN. 
 
 77 
 
 the organ (gland-tissue), which has the power of as- 
 similation. Under its influence, the chyle approxi- 
 mated in its physical qualities to those of the liver sub- 
 stance, becoming thicker in consistency and ruddy in 
 color, and was then ready to join the general mass of 
 venous blood, for distribution throughout the body. 
 From the convexity of the liver the vena cava ex- 
 tended in two opposite directions, upward and down- 
 ward; supplying on the one hand the head and upper 
 extremities, on the other the trunk and lower ex- 
 tremities. But the superior vena cava, communicating 
 laterally with the right cavities of the heart, had a 
 further extension beyond the right ventricle to the 
 lungs. This branch, our pulmonary artery, was called 
 the vena arterialis, because it resembled an artery in 
 the thickness of its coats. But it was nevertheless a 
 vein, continuous with the rest of the venous system, 
 and containing, like the rest, venous blood. 
 
 In this way the blood in the venous system pro- 
 vided for the general nourishment of the tissues. On 
 the other hand, the arteries were also full of blood, but 
 of a different kind. The venous blood was dark, thick, 
 and rich in the grosser elements of nutritive material. 
 The arterial blood was thinner, warmer, bright-colored, 
 and, above all, spirituous ; that is, it contained an abun- 
 dant supply of the vital spirits, which it distributed 
 throughout the body. Its warmth it obtained from 
 the heart, and especially from the left ventricle, in 
 which the animal heat was generated ; its vital spirits 
 being also acquired in the same organ, but derived 
 from the inspired air of the lungs. Thus, according 
 to Galen, the arteries contained vital spirits, not in the 
 
 7 
 
78 
 
 DOCTRINES OF THE CIRCULATION: 
 
 form of a distinct gaseous body, but amalgamated with 
 the other ingredients of the blood.* 
 
 The destination of these two kinds of blood cor- 
 responded with their different properties. Venous 
 blood was for the nourishment of the thicker and 
 denser parts, arterial blood for those of a lighter and 
 more spongy nature ; and, since every organ is sup- 
 plied with both arteries and veins, it can absorb each 
 kind of nutriment in due proportion for its own needs. 
 In every case the process of nutrition was accom- 
 plished by transudation of the blood through the vas- 
 cular walls.f 
 
 As the liver was the origin of the veins, so the heart 
 was the origin of the arteries. From the left ventricle, 
 the principal part of the organ, the great artery, or 
 aorta, supplied, by its ascending and descending divi- 
 sions, the head and upper extremities on the one hand, 
 the trunk and lower extremities on the other ; while a 
 separate vessel was distributed to the lungs. This 
 vessel (our pulmonary vein) was called the arteria 
 venalis, because its walls were like those of a vein ; but 
 it was part of the arterial system, and contained arterial 
 blood. 
 
 The vessels of this system were distinguished by the 
 characteristic phenomenon of ^z pulse. As its name 
 indicates, this was a shock, perceptible to the finger 
 and caused by a dilatation of the artery in every direc- 
 tion.J Its importance was manifest from the fact that 
 its continuance was a sure indication of vitality, and its 
 cessation the sign of death. According to Galen, it 
 
 * Galen, Opera Omnia, vol. viii., p. 707. 
 
 \ Galen, Opera Omnia, vol. iii., pp. 318, 449, 450. 
 
 \ Galen, Opera Omnia, vol. viii., p. 455. 
 
GALEN. 
 
 79 
 
 was due to a "pulsatile force " (3 1) resident in the walls 
 of the artery, but derived by them from the heart, in 
 which it also existed. This was a force of active ex- 
 pansion, dilating the artery and attracting the fluids 
 into its cavity; while its subsequent contraction caused 
 an expulsion of its contents in the same degree. Thus 
 the diastole of the artery was an active, and its systole 
 a passive movement, like those of the chest in inspi- 
 ration and expiration;* and the two followed each 
 other in turn, keeping up a continual interchange of 
 the vascular contents. At its diastole the arterial sys- 
 tem drew in spirituous blood from the heart, and at its 
 systole it expelled the excrementitious impurities of 
 the bodily waste. By this means it provided for the 
 maintenance and supply of vital heat, and for the elimi- 
 nation of its deleterious products. According to Galen, 
 these substances were excreted by the arterial system ; 
 through its terminal branches in the skin and other 
 membranous surfaces on the one hand, and through 
 the arteria venalis (pulmonary vein) in the lungs on 
 the other. They consisted mainly of "fuliginous va- 
 pors;" that is, volatile products like those from burn- 
 ing fuel. 
 
 The same " pulsatile force " which moved the arte- 
 ries was also active in the heart. The beat of the heart, 
 perceptible through the walls of the chest, was its ex- 
 pansion or diastole, by which it drew into its cavities 
 the blood from the incoming vessels ; while its subse- 
 quent contraction, or systole, effected an expulsion 
 through the outgoing vessels. f 
 
 Galen, Opera Omnia, vol. iii., p. 512; vol. v., pp. 163, 164, 168, 
 169, 172; vol. ix., p. 7. 
 f Galen, Opera Omnia, vol. v., p. 164. 
 
8o DOCTRINES OF THE CIRCULATION. 
 
 Galen devoted much time and study to the mechan- 
 ism of the heart's movement, which he examined, both 
 with the heart in situ, after cutting away the sternum, 
 and in the separated organ immediately after its re- 
 moval from the chest.* He considered its movements 
 as effected by the alternate or simultaneous action 
 of its different fibres, longitudinal, transverse, and 
 oblique. 
 
 " For when, by the contraction of the longitudinal 
 fibres, and the elongation and separation of the rest, the 
 organ is diminished in length and increased in width, at 
 that time you will see that the whole heart is dilated ; on 
 the other hand, when the longitudinal fibres elongate, 
 and those situated transversely are drawn together, 
 then the heart is in its systole; and between these mo- 
 tions there is a short interval of quiescence, the heart 
 closely embracing its contents, when all its fibres ' are 
 in action, but more especially the oblique." . . . . ■ 
 " Thus the heart dilates, to attract the necessary mate- 
 rials ; remains fixed while using what it has drawn into 
 it ; and contracts when discharging its superfluities."t 
 
 The direction of the fluids, as they enter or leave 
 the heart, was determined by the position of the cardiac 
 valves, all of which were accurately described. On 
 the right side, the tricuspid valves allowed venous blood 
 to enter from the vena cava at the diastole of the heart, 
 and at its systole a portion of the same blood was 
 impelled past the pulmonary valves into the vena 
 arterialis ; but both these sets of valves obstructed 
 regurgitation in the opposite direction. On the left 
 side, the mitral and aortic valves acted in a similar 
 
 * Galen, Opera Omnia, vol. iii., p. 439. 
 
 ■)• Galen, Opera Omnia, vol. iii., p. 439, 440. 
 
GALEN. 8 1 
 
 way ; only Galen maintained, in opposition to Erasis- 
 tratus, that the closure of the valves was incomplete, 
 thus allowing a certain reflux in each direction. Both 
 the venous blood in the vena arterialis (pulmonary ar- 
 tery) and the arterial blood in the arteria venalis (pul- 
 monary vein) were thought to serve for the nourish- 
 ment of the lung ; this organ, like the rest, requiring a 
 supply of both kinds of blood. But the arteria venalis 
 had furthermore the double office of introducing into 
 the left ventricle the vital spirits derived from the lungs, 
 and of discharging from the blood its fuliginous ex- 
 halations. The various acts of reception and delivery 
 were thus accomplished by the cardiac movements, 
 aided by the valves. 
 
 But this mechanical action of the heart, according 
 to Galen, was the least important of its functions. For 
 him, as for the older writers, the heart was the centre 
 of organic life, the immediate residence of the anima- 
 ting principle, " the source and, as it were, the fire-place 
 of the innate heat, by which the living organism is di- 
 rected and controlled " (32). Galen confesses his ina- 
 bility to say what is the nature or essence of this 
 principle of life ;* but its immediate manifestation is 
 the vital heat, implanted in the organism from its 
 commencement, with its headquarters in the heart and 
 thence distributed throughout the body. In the dif- 
 ferent organs and tissues it determines the special acts 
 of growth, nutrition, transformation, and assimilation 
 peculiar to each, which are thus dependent upon it for 
 their continuance and regulation. This vital heat is 
 generated in the heart, and especially in the left ventricle, 
 where it first makes its appearance under the form of 
 
 * Galen, Opera Omnia, vol, iv., p. 472. 
 
82 DOCTRINES OF THE CIRCULATION. 
 
 sensible warmth. It is communicated to other regions, 
 partly by the venous blood and partly through the 
 solid tissues ; but its principal medium of distribution 
 is the arterial blood.* 
 
 The functions of the heart and bloodvessels are 
 inseparably connected with the act of respiration ; and 
 in Galen's doctrine this subject received its due share 
 of attention. The main features of the respiratory 
 process were regarded in the same light as before, but 
 its details were more carefully considered and more 
 clearly explained by him than by any previous writer. 
 /The prime object of respiration was the introduction 
 of the pneuma, or spirits, the characteristic ingredient 
 of arterial blood. The inspired air, penetrating into the 
 pulmonary passages, underwent, in the lung tissugf a 
 change which resulted in the production of vital spirits. 
 The spirits accordingly represented, not the substance 
 of the atmospheric air, but something produced from 
 it by the transforming agency of the lung. This aeriform 
 product was taken up by the arteria venalis (pulmonary 
 vein) in the following manner: The terminal orifices of 
 the vessel were " naturally of such size as to be pervious 
 to vapor and spirits, but impervious to blood and fluids , 
 of like density." It could therefore take in spirits, or 
 exhale fuliginous vapors, without allowing the escape 
 of blood. The spirits, mingled with the blood of the 
 arteria venalis, could thus be introduced into the left 
 ventricle, and thence transmitted to the arterial blood 
 of the whole body.f 
 
 The process of respiration, as described above, con- 
 sisted in the absorption from the lungs of an unknown 
 
 * Galen, Opera Omnia, vol. v., p. i6o. 
 
 f Galen, Opera Omnia, vol. iii., pp. 497, 539, 540, 541. 
 
GALEN. 83 
 
 gaseous or " spirituous " substance essential to ]ife, and 
 the discharge of volatile impurities resulting from its 
 action. But how was this supposed to maintain vitality, 
 and in what way was it useful to the living" organism ? 
 
 In Galen's time, as now, there was no other illustra- 
 tion so apt, for the phenomenon of organic life, as that 
 which compares it to a flame ; and he discusses the 
 conditions necessary for both, to determine if possible 
 the uses of respiration. 
 
 " These ideas," he says, " have no doubt been sug- 
 gested, in great measure, by what is noticed in regard 
 to flames. Like animals, they quickly perish if de- 
 prived of air, as we see in our cupping-vessels (34) ; 
 and any similar narrow receptacle, which prevents tran- 
 spiration, will easily extinguish them. If we could find 
 out, therefore, for what reason a flame is smothered 
 under these conditions, we should then know in what 
 way respiration maintains the vital heat." * 
 
 In endeavoring to decide this question, Galen enu- 
 merates the various causes which favor or impede 
 combustion, such as coolness and warmth, ventilation 
 or fanning, and the supply of fuel. All these, in mod- 
 erate degree, are useful or essential ; but if in exces- 
 sive quantity, or too rapidly supplied, they repress 
 or extinguish the flame. Every combustive process 
 requires to be fed with combustible material, and it 
 must also be relieved from the accumulation of its 
 smoky impurities. So it is with the vital heat. The 
 blood is the material on which it feeds, and the heart 
 is the wick in which the fuel is consumed. The lung 
 is compared to the containing vessel ; but it is a vessel 
 
 * GaUii, Opera Omnia, vol. iv., p. 487. 
 
84 DOCTRINES OF THE CIRCULATION. 
 
 perforated throughout, and giving passage everywhere 
 to the incoming and outgoing air.* 
 
 " We must therefore admit,'' he says, " that the 
 function of respiration is to maintain the animal heat. 
 Ventilation and coolness, if moderate in degree, are 
 both serviceable by invigorating the internal heat; and 
 there must also be a movement of expiration, to dis- 
 charge the smoky matter, as one might call it, de- 
 rived from the combustion of the blood " (35). 
 
 The foregoing sketch presents the main features of 
 Galen's physiology in regard to the organs of circula- 
 tion and respiration ; though it is far from exhausting 
 his many judicious observations and inferences, and his 
 frequent remarks on the correspondence between the 
 structure of an organ and its function. It remains to 
 be seen whether this doctrine included anything which 
 might indicate a circulation of the blood ; that is, 
 whether the blood was regarded as moving, in a con- 
 tinuous current, to or from any part of the vascular 
 system or through any portion of its cavities. 
 
 There are several passages in Galen's works which, 
 taken by themselves, would seem to imply such a 
 movement. This is especially the case in his descrip- 
 tion of the origin and distribution of the vena cava, 
 where he compares the bloodvessels > to a system of 
 irrigating canals. 
 
 " Then the blood is received," he says, " by a single 
 great vein, arising from the convexity of the liver, 
 and extending toward both regions of the body, up- 
 ward and downward. You would say it was a sort of 
 conduit, full of blood, with a multitude of canals, large 
 
 * Galen, Opera Omnia, vol. iv., p. 491. , 
 
GALEN. 
 
 85 
 
 and small, running out from it and distributed to every 
 part of the body" (36). 
 
 The suggestion is still stronger where he explains 
 how these smaller vessels provide for local nutrition. 
 " This is most easily understood from (the example of) 
 irrigating canals in gardens. A certain quantity of 
 moisture is supplied by them to the parts immediately 
 adjacent, but it cannot reach those which are farther 
 off. Consequently there are numerous smaller water- 
 ways cut from the main one, to provide for the access 
 of water to all parts of the garden ; and the spaces 
 between these little canals are of such dimensions as 
 to give them the full benefit of the moisture on each 
 side. So it is with the animal body. Many canals, 
 dispersed through all its parts, convey to them blood, 
 as those of a garden convey moisture ; and the inter- 
 vals separating these canals are wonderfully disposed 
 by nature in such a way that they should neither lack 
 a sufficient quantity of blood for absorption, nor be 
 overloaded at any time with an excessive supply" (37). 
 
 This account might readily be supposed to represent 
 the blood as running in a multitude of currents from 
 the centre of the vascular system, through its ramifica- 
 tions, to the periphery. Other parts of the doctrine 
 might bear a similar interpretation ; namely, that of the 
 chyle absorbed from the alimentary canal, transported 
 by the portal vein to the liver, and thence distributed, 
 with the rest of the blood, to the system at large ; the 
 blood taken into the right ventricle at its diastole, and 
 expelled at its systole into the vena arterialis ; a similar 
 discharge from the left ventricle into the aorta ; and 
 the declaration that the heart is the origin of the arte- 
 rial system, as the liver is the origin of the veins. With 
 
86 DOCTRINES OF THE CIRCULATION. 
 
 our present views it would be difficult to admit these 
 facts, without supposing some sort of circulatory move- 
 ment in the blood. 
 
 And yet it is abundantly evident, from Galen's works 
 taken together, that nothing of the kind entered into 
 his conception of the vascular system. For him, the 
 arteries and veins were bloodvessels ; but they were 
 vessels for containing blood, not channels for its trans- 
 portation. He used the simile of irrigating canals 
 without fear of its being misinterpreted or taken too 
 literally. His venous aqueducts were reservoirs of 
 blood, from which a supply might be drawn at any 
 point for the neighboring parts ; but it was by a process 
 of transudation or exosmosis, in which each tissue 
 absorbed the requisite materials for its own nourish- 
 ment. The beating of an artery Was not the sign of 
 its distension by an advancing current ; it was a spon- 
 taneous movement of expansion and collapse, by which 
 the vessel alternately drew into itself materials from 
 either direction, and expelled them toward every point* 
 As the doctrine of a continuous movement of the blood 
 had not yet presented itself in physiological science, 
 Galen, of course, had no reason to contradict it ; and 
 we reach the conviction that it was not recognized in 
 his system, chiefly from the absence or incompleteness 
 of all expressions in regard to it. In the case of the 
 arteries, however, the non-existence of such a current, in 
 our sense of the word, is made plain by his direct state- 
 ment. Erasistratus had taught that the arteries were 
 filled with aeriform spirits, driven into and through 
 them by the force of the heart ; but Galen asserts that, 
 as the arteries contain blood, which is comparatively 
 
 * Galen, Opera Omnia, vol. v., p. 164. 
 
GALEN. 
 
 ,87 
 
 dense and sluggish, no such rapid motion is possible. 
 " We have elsewhere shown," he- says, " in a special 
 treatise, that the arteries contain blood, even in the 
 normal condition of the animal. This being true, it is 
 plain that the arteries are not, as Erasistratus thought, 
 dilated by the pneuma sent into them from the heart. 
 If they were empty of blood, it might perhaps be possi- 
 ble for what passes into them from the heart to arrive 
 in a short time at their extremities. But if they contain 
 blood, it cannot be that the rapidity of movement 
 corresponds with the notion that they are dilated by 
 being filled from the Ijeart. They are not dilated 
 because they are filled; they are filled because they 
 dilate" (38). 
 
 But this mechanical force of dilatation and contrac- 
 tion was not the only one, according to Galen, by 
 which the animal fluids were drawn or impelled in the 
 needful direction. There was also a physiological 
 force, which he compares with that of a magnet,* by 
 which each tissue attracted the ingredients appropriate 
 for its nourishment. By the aid of both these forces 
 combined, all parts of the body, at various times or 
 under different conditions, could draw their nutriment 
 from the common storehouse of the blood ; and even 
 the materials which had been distributed to distant re- 
 gions could be recalled through the same vessels, and 
 delivered to other parts which demanded them for 
 nourishment.f The various organs and tissues are 
 compared in this respect to a number of animals, sup- 
 plied with fodder in the same field. Some of them 
 are already satisfied, while others are feeding; some 
 
 * Galen, Opera Omnia, vol. ii., p. 206. 
 
 f Galen, Opera Omnia, vol. ii., pp. 202, 203. 
 
88 DOCTRINES OF THE CIRCULATION. 
 
 feed together, some separately; some leave off when 
 others begin; and some, who are more famished or 
 more aggressive, will even take away the food from 
 their weaker or less eager companions. Thus the 
 transfer of nutritive material by the blood, in one di- 
 rection or another, was effected mainly by the accu- 
 mulation of fluids from the source of supply, and the 
 attraction of each tissue for the substances needed in 
 its growth. It was aided at certain points by the car- 
 diac pulsation and the action of the valVes; and a spe- 
 cial activity of attraction and expulsion was also kept 
 up throughout the arterial system. This was the idea 
 entertained by Galen as to the process of nutrition and 
 the movement of the blood; and it was the idea handed 
 down by him to the physiologists of later times. 
 
 There is still another feature of Galen's doctrin*, 
 especially interesting in a historical sense ; that is, the 
 terminal anastomosis between arteries and veins. This 
 had already been a tenet of the Alexandrian school ; 
 but Galen asserted it with greater distinctness, and 
 supported it, moreover, by the evidence of experiment. 
 " The arteries," he says, " anastomose with the veins 
 over the whole body, and they mutually receive from/ 
 each other blood and spirits, through certain invisibfe~~^ 
 and extremely minute passages " (39). For this rea- 
 son, the difference in quality between arterial and ve- 
 nous blood is not absolute, but only comparative. 
 Each kind contains both gross and spirituous ingredi- 
 ents ; only in venous blood it is the denser elements 
 which preponderate, in arterial blood the finer and more 
 spirituous (40). " For as all the other parts participate 
 in everything, so, too, do the arteries and veins; the 
 former containing blood in small quantity, fine and 
 
GALEN. 
 
 89 
 
 vaporous, the latter also containing a little spirits, but 
 that cloudy and thick."* 
 
 In the doctrine of Erasistratus this anastomosis was 
 assumed, to account for the appearance of blood in a 
 wounded artery. Galen does not admit it on such in- 
 sufficient grounds; and in his opinion, since the com- 
 munications are invisible, they need some other rea- 
 sonable proof of their existence. This proof is not 
 wanting; for when an animal is bled to death by open- 
 ing the larger arteries, the venous system is also drained 
 of blood, although no vein has been wounded. "The 
 communication between the arteries and veins is never 
 in the large vessels; and their anastomoses are not to 
 be detected by the senses. On that account you might 
 very properly doubt their existence; but you would 
 nevertheless believe in it for the reasons given by 
 former writers, and, not least, from this fact. If you 
 take an animal, like the ox, ass, horse, sheep, etc., in 
 which the veins and arteries are large and easily recog- 
 Tijzable, and open several of the principal arteries, you 
 will evacuate from them the whole of the blood. We 
 have often-<performed this experiment; and, always 
 finding the veins empty as well as the arteries, we are 
 convinced that the dogma of their mutual anastomosis 
 is true."t 
 
 That is to say, as the blood of the venous system, 
 in such an animal, finds its exit through the arteries, 
 there must be a communication between them. No 
 communications are to be seen in the larger vessels, 
 where they would certainly be perceptible if they ex- 
 
 * Galen, Opera Omnia, vol. iii., p. 450. 
 
 f Galen, Opera Omnia, vol. v., p. 165; also a passage to the same 
 effect in vol. ii,, p. 207. 
 
pO DOCTRINES OF THE CIRCULATION. 
 
 isted ; they are, no doubt, therefore, in the extreme 
 ramifications, and invisible by reason of their minute- 
 ness. 
 
 It is remarkable to see this important doctrine, of the 
 terminal communications between arteries and veins, 
 established on such reasonable evidence, fifteen centu- 
 ries before the microscope and injections revealed them 
 to the eye of the anatomist. It has also a special in- 
 terest in regard to the lungs. The vascular anasto- 
 moses throughout the body were supposed to allow, in 
 some measure, a mutual interchange of blood and 
 spirits between the venous and arterial systems. In 
 the lungs this interchange would be arrested in expi- 
 ration, were it not for the semilunar valves of the vena 
 arterialis ; because this vessel and its branches would 
 be compressed, and its blood forced back into the right 
 ventricle. But since the blood is sustained, even in 
 contraction of the chest, by the semilunar valves, it 
 may still find its way through the anastomoses to the 
 arteria venalis on the opposite side of the lung.* 
 
 This interchange of fluids between the bloodvessels 
 of the lungs is, of course, very far from representing 
 what actually takes place in these organs. Like simi- 
 lar actions in other parts of the body, it was regarded 
 as a local occurrence, having little or no influence on 
 the system at large. But it was, nevertheless, a transfer 
 of blood from the veins to the arteries within the lung ; 
 and it was aided and guaranteed by the action of the 
 pulmonary valves. Its significance might easily be 
 enlarged without changing its character; and it is evi- 
 dent that the idea of the pulmonary circulation has its 
 roots in the physiology of Galen. 
 
 * Galen, Opera Omnia, vol. iii., pp. 453, 454, 455, 456. 
 
GALEN. 
 
 91 
 
 Lastly, this part of the subject is connected with 
 Galen's well-known doctrine of the perforations in the 
 septum of the ventricles. According to him, the vessels 
 of the lung are not the only channels by which blood 
 finds its way from the venous to the arterial system ; 
 it also passes through porosities in the inter-ventricular 
 septum, from the right ventricle to the left* These 
 perforations are visible in the right ventricle, as fun- 
 nel-shaped depressions in the substance of the septum ; 
 but they are supposed to become so narrow, after pene- 
 trating a certain distance, that their orifices on the left 
 side are imperceptible (41). The reasons adduced by 
 Galen, for regarding them as complete channels, were 
 as follows : First, their infundibuliform figure, so far 
 as they were visible, made it likely that their remain- 
 ing portions were canalicular; since a funnel could 
 be of no use, unless its smaller extremity were per- 
 vious. Secondly, of the two vascular orifices on the 
 right side of the heart, that of the vena cava, bringing 
 blood into the ventricle, was larger than that of the 
 vena arterialis carrying it out. It was apparent, there- 
 fore, that the blood which entered from the vena cava 
 could not all pass into the vena arterialis ; a portion 
 of it filtered through the septum into the left ventricle. 
 This was corroborated by an inverse discrepancy in 
 size between the two orifices on the left side ; that of 
 the arteria venalis, bringing spirits from the lung, being 
 smaller than that of the aorta, carrying spirituous blood 
 out. The volume of the blood in the left ventricle was 
 manifestly increased by that arriving, through the sep- 
 tum, from the right side of the heart (42). 
 
 By this means a portion of the venous blood became 
 
 * Galen, Opera Omnia, vol. ii., p. 208; vol. iii., pp. 495, 496, 497. 
 
92 
 
 DOCTRINES OF THE CIRCULATION. 
 
 arterialized ; that is, its finer parts, passing through the 
 septum into the left ventricle, were there amalgamated 
 with the spirituous contents of this cavity, thus com- 
 pleting the formation of the arterial blood. As the 
 products of digestion, accordingly, were elaborated to 
 supply the ingredients of venous blood, so this was 
 afterward elaborated to supply those of arterial blood ; 
 or, as Galen expresses it, "what the stomach is to the 
 veins, the veins are to the arteries." 
 
 But the channels for the transfer of blood through 
 the cardiac septum were regarded by Galen as of the 
 same nature with the vascular communications in gen- 
 eral. He repeatedly mentions them in connection with 
 each other, and he sometimes uses the same word, 
 anastomosis, to designate both. * The passage of the 
 blood through these communications was not a cur- 
 rent ; it was a transudation or distillation, drop by 
 drop : and a moderate quantity, thus transferred from 
 the venous system, was sufficient to take part in the 
 generation of vital spirits and the renovation of the 
 arterial blood. 
 
CHAPTER V. 
 
 PERIOD OF THE RENAISSANCE. 
 MONDINI. CARPI. VESALIUS. 
 
 The principal seat of learning in Italy, in the early 
 part of the fourteenth century, was the University of 
 Bologna. At this institution, in the year 13 15, the 
 chair of Medicine, which included in its duties the 
 teaching of anatomy, was occupied by Mondini da 
 Luzzi. His name is the first, after Galen, of any im- 
 portance in connection with our present subject ; and 
 it marks the point of contact, in scientific matters, be- 
 tween ancient and mediaeval times. Mondini has some- 
 times been called the " restorer of anatomy," because 
 he performed, on two occasions, before the pupils in his 
 lecture room, the dissection of a human body. This 
 would give him but slender claim to such a title, ex- 
 cept for the fact that any demonstration in public was 
 at that time an innovation, and because he followed it 
 soon after by the earliest modern work on human an- 
 atomy,* presumably founded, in some measure, on his 
 own dissections. 
 
 This work had a great success. Notwithstanding 
 its imperfections, it must have contained something 
 which was useful at the time, for it was adopted as a 
 text-book in many, if not all, of the Italian schools of 
 medicine. It continued in use during the whole of the 
 
 * Mundinus, De omnibus humani corporis interioribus membris 
 Anathoraia. 
 
Q4 DOCTRINES OF THE CIRCULATION. 
 
 fourteenth and fifteenth centuries, and was still em- 
 ployed even in the sixteenth.* For a hundred and fifty 
 years it existed only in manuscript. It first appeared 
 in type at Pavia in 1478, only twelve years after the 
 introduction of printing into Italy; and from that time 
 there are enumerated no less than thirteen editions, the 
 last of which was in 1550. The edition of 15 13 has a 
 most complimentary preface by the editor, Joannes 
 Adelphus, in which he speaks of Mundinus as " ipse 
 physicus preclarissimus, quern omnis studentium uni- 
 versitas colit ac veneratur ut deum." 
 
 The Anatomy of Mondini is intended as a manual of 
 dissections, and makes a small octavo or duodecimo vol- 
 ume of seventy-four pages. After a short introduction, 
 which opens with a quotation from Galen, the author, in 
 his first chapter, takes a view of the body as a whole, and 
 is especially interested in pointing out how and why 
 the human body differs from that of other animals. Its 
 most striking peculiarity, namely, its erect posture, he 
 attributes to four causes. First, it is of a lighter, more 
 spirituous, and aereal substance, and is consequently 
 more easily kept erect. Secondly, it contains a greater 
 quantity of heat, the quality of which is naturally to 
 lift it upward. Thirdly, it has, among all animated 
 creatures, the most perfect form, which it shares in 
 common with the angels and the intelligences which 
 regulate the universe; and fourthly, the sense of sight, 
 through which most of our intelligence comes, needs 
 to be placed at the highest point of the body, like the 
 sentinel on a watch-tower. Among other peculiarities 
 distinguishing man from animals, the one last men- 
 tioned is that he has no tail ; " because, being naturally 
 
 * Sprenge], Geschichte der Arzneykunde, Halle, 1823; vol ii., p. 609. 
 
PERIOD OF THE RENAISSANCE. 
 
 95 
 
 erect, he rests himself by the sitting posture, and a tail 
 would interfere with his sitting down." The chapter 
 closes with the remark, Hec siifficiant de anathomia totius. 
 The author goes on to enumerate the different regions 
 of the body, giving rules for their dissection and a de- 
 scription of their interior parts ; beginning with the 
 abdomen, for the reason that " the organs there are the 
 first to become putrid." He recommends the dissection 
 to be done with a razor (43), making first an incision 
 from over the larynx to the pubes, and then a cross 
 cut at the level of the umbilicus. His description of 
 the organs is very meagre, often hardly indicating 
 more than their general form and position ; and much 
 of the book is occupied with the supposed function of 
 the parts, the reasons why they have been made as they 
 are, and the disorders to which they are subject. In 
 the large intestine, mucous and biliary humors, when 
 retained in the sacculi, give rise to tapeworm or cu- 
 curbitini, as the case may be. If there is sufficient 
 humor between the adjacent sacculi, it generates a 
 continuous tapeworm; if not, a single worm, or cucur- 
 bitinus, is generated in each sacculus.* In the chapter 
 on the heart, the pyramidal or conical form of this organ 
 is accounted for by the fact that it is the source of 
 animal heat, and " because a pyramidal form is the 
 special figure belonging to the principle of heat." 
 The auricles of the heart are most briefly described as 
 " certain additional membranous parts, capable of dila- 
 tation and constriction ; " but the author explains at 
 some length that they are made for the purpose of 
 relieving the ventricles by their dilatation, " when an 
 unusual quantity of blood is produced in the body, or 
 
 * Mundinus, chapter, De Anathomia intesiinorum. 
 
96 DOCTRINES OF THE CIRCULATION. 
 
 of spirits in the left ventricle, as sometimes happens." 
 To the objection that nature might have provided for 
 this by making the ventricles larger, he replies that, 
 " as this abundant production of blood or spirits does 
 not take place constantly, if the heart had been very 
 large, much of its cavity would often be empty; while 
 the auricles easily contract when not distended, and so 
 leave no vacancy " (44). He has an equally singular 
 reason for the walls of the left ventricle being thicker 
 than those of the right ; namely, that as the blood in 
 the right side of the heart is heavier than the spirits in 
 the left, the parietes of the organ on the left side are 
 made thicker, to counterbalance the weight of the blood 
 on the right (45). 
 
 As for the action of the heart and bloodvessels, it is 
 described by Mondini mainly according to the views 
 of Galen, but without any clear or connected statement. 
 His account, always very brief, is sometimes so imper- 
 fect as to suggest a doubt whether he fully understood 
 Galen's doctrine. The right ventricle, he says, receives 
 blood from the vena cava and transmits a part of it to 
 the lung by the vena arterialis, while a part passes 
 through the septum into the left ventricle to become 
 spirituous; and the left ventricle receives air from the 
 lung by the arteria venalis, and expels blood and spirits 
 by the aorta to the whole body. But he also enumer- 
 ates a " middle ventricle," situated in the septum, which 
 is, however, not a single cavity but " many little cavi- 
 ties, wider toward the right side than the left, which 
 gradually refine the blood during its passage, and pre- 
 pare it for its conversion into spirits." These are 
 evidently Galen's perforations, but the term middle 
 ventricle, as applied to them, is a palpable misnomer ; 
 
PERIOD OF THE RENAISSANCE. 
 
 97 
 
 and the figure introduced as an illustration in the edi- 
 tion of Adelphus certainly does not make the matter 
 clearer. Galen is quoted, on the average, once in every 
 two or three pages. There are occasional references 
 to Averrhoes and Avicenna, and a few to Hippocrates 
 and Aristotle. The style of the book is extremely 
 uncouth ; its Latin is barbarous ; and its only merit lies 
 in the earnest desire of the author to do what he can 
 for the benefit of his pupils and fellow anatomists (46). 
 
 The Anatomy of Mondini, and its general use as 
 a text-book, afford a good criterion of the scientific 
 status of Europe during the period of the renaissance; 
 that is, from about the year 1300 to about 1550. At 
 that time both the desire and the capacity for learning 
 were farther advanced in Italy than elsewhere. The 
 most studious and well-informed men in that country 
 had begun to appreciate the literature of the past, and 
 to depend upon it for their own instruction. They saw 
 and felt the intellectual superiority of the ancients, 
 without knowing how to account for it or how to 
 emulate it. This explains their implicit reliance, in 
 medical matters, on the authority and doctrines of 
 Galen ; for his works represented to them, not only the 
 learning and talent of their author, but the whole per- 
 fected science of an enlightened antiquity. 
 
 Consequently, their unquestioning acceptance of Ga- 
 len's teaching was far from being unreasonable. They 
 were not in a condition to criticise or test ; they could 
 only appropriate the knowledge derived from a superior 
 source, and use it for their own guidance. And when 
 an anatomist of more than ordinary enterprise or de- 
 votion, like Mondini, illustrated his course by dissec- 
 tions, it was because he wished to see for himself, and 
 
98 
 
 DOCTRINES OF THE CIRCULATION. 
 
 show to others, the things described by Galen. If he 
 met with difficulties, they could no doubt be accounted 
 for by the rudeness of his methods and his limited 
 experience. He could neither convince himself nor 
 satisfy others, unless his anatomical demonstrations 
 were in accordance with those of his master; and as 
 for a physiological doctrine, that was, of course, quite 
 beyond the scope of his judgment or investigation. 
 Nevertheless, the work of Mondini has its importance 
 as the earliest anatomical treatise of the middle ages, 
 based, at least in some degree, on the dissection of the 
 human body. 
 
 Berengario da Carpi was professor in the university 
 of Bologna two centuries after Mondini ; but during that 
 interval the physiology of the vascular system had 
 made no advance. Dissection had been practiced, ac- 
 cording to the method of Mondini, in most of the 
 European schools, without leading to any noticeable 
 discovery or improvement. Carpi, who was distin- 
 guished both as surgeon and anatomist, is said to have 
 dissected for his own purposes an unusually large 
 number of subjects; and his results are embodied in a 
 treatise* first published at Bologna in 1514, and after- 
 ward reprinted in that and various other places. This 
 work, like that of Mondini, has the form of a manual 
 for dissections, and is arranged in a similar manner. It 
 is rather more copious than its predecessor, and its 
 statements are somewhat better expressed; but they do 
 not differ in any important particular from those of the 
 
 * Isagogse breues plucidjE ac uberrimse in Anntomiam humatii cor- 
 poris a communi Medicorum Academia usitatam a Carpo in Almo Bo- 
 noniensi Gymnasio Ordinariam Chirurgise docente ad suorum Scholas- 
 ticorum pees in lueem datse. Bononise, 1523. 
 
PERIOD OF THE RENAISSANCE. gg 
 
 former work. In many instances the language of 
 Carpi is almost a paraphrase of that employed by 
 Mondini. He offers the same explanation of the 
 thickness of the left ventricle as compared with the 
 right, namely, the necessity for counterbalancing the 
 greater weight of the blood in the right cavity; and 
 the use of the auricles, according to him, is still to 
 provide for the occasional superabundance of blood or 
 spirits, so that the ventricles might not be too large. 
 He differs from Mondini as to the significance of the 
 pyramidal form of the heart, which, he thinks, " is not 
 principally because as a source of heat it assumes the 
 peculiar figure of fire ;" but his own interpretation is 
 hardly more intelligible (47)1 The point of the organ, 
 he says, is made small because this part, lying in con- 
 tact with the walls of the chest, is the one likely to be 
 injured during its movements, " and consequently the 
 smaller it is, the less injury will be received." He 
 mentions the report that men have sometimes been 
 born with the heart covered with hair, on which account 
 they were braver than other people; and cites, on 
 Pliny's authority, the case of Aristomenes, a Messenian, 
 who killed three hundred Spartans, and, when wounded 
 and captured, exhibited such extraordinary and per- 
 sistent audacity that the Spartans opened his chest to 
 discover its cause, when they found that his heart was 
 hairy. At the end of the book the author excuses 
 himself, on account of other unavoidable occupations, 
 for not having made it more extensive ; and in case his 
 readers are not satisfied, he refers them to his " very 
 full commentaries on the anatomy of Mondinus." 
 
 It seems that the progress in anatomical knowledge 
 since the fourteenth century, if any there were, could 
 
lOO DOCTRINES OF THE CIRCULATION. 
 
 only have been connected with very ordinary details, 
 like the ramification of nerves and bloodvessels ; for 
 there was no difference in the general treatment of the 
 subject, nor in the mode of inferring the function of a 
 part from its structure. The physiology of Carpi, so 
 far as regards the heart and bloodvessels, is a repetition 
 of that of Mondini ; except that some things are stated 
 with greater clearness and in a more attractive way. 
 The action of the cardiac valves ; the ingress and 
 egress of blood and spirits by the different orifices ; 
 the filtration of blood through the septum into the left 
 ventricle; the passage of air for the generation of vital 
 spirits through the arteria venalis to the heart ; and the 
 discharge of fuliginous vapors into the lung by the same 
 channel, are all given without modification, and evi- 
 dently without any idea of testing or even of ques- 
 tioning their reality. The anatomist was satisfied with 
 the commonest exposition of the form and connection- 
 of the parts, and with a very incomplete description of 
 their texture. Their physiological action, except so 
 far as known on the authority of the ancients, was a 
 subject only for inference or surmise. 
 
 But a short time after Carpi, anatomy received a 
 fresh impulse from the scientific zeal and ability of 
 Vesalius. His appearance in the sixteenth century 
 makes an epoch in the history of medicine; for he 
 placed its most fundamental department on a different 
 footing from that which it had occupied before. He 
 was the first to treat anatomy as a science to be studied 
 and taught by itself, and as worthy of a devotion com- 
 mensurate with its importance and extent. As he 
 originated the idea, so he gave to its execution an 
 
PERIOD OF THE RENAISSANCE. , iqi 
 
 industry and intellectual capacity above the average. 
 One cannot help thinking of his predecessors as men 
 who owed much of their celebrity to the imperfect 
 knowledge of the times and the absence of competition. 
 But this will not apply to Vesalius. In any age and in 
 any country, he would have taken the highest rank as 
 a scientific investigator ; and the remarkable' develop- 
 ment of anatomy during the remainder of the century 
 was largely due to the effect of his influence and 
 example. 
 
 Vesalius was born in 1514, at Brussels, the principal 
 city in the Netherlands, at that time, next to Italy, 
 the most populous, the wealthiest, and most cultivated 
 portion of Europe. After receiving a classical educa- 
 tion, he began his medical studies at a very early age, 
 pursuing them at the academies of Louvain and Mont- 
 pellier, and finally at Paris, where he attended for three 
 years the lectures and demonstrations of Sylvius (48), 
 then the most celebrated professor in the Parisian 
 schools. While here, the instinctive readiness and 
 activity of Vesalius began to show themselves. His 
 dexterity and success in dissection became equal or 
 superior to those of his master ; and before the end of 
 his course he was more than once invited, by both 
 professors and students, to conduct anatomical demon- 
 strations in public. He was also for some time a pupil 
 of Joannes Guinther of Andernach, whose manuscript 
 lectures he edited in 1536; and he afterward taught 
 anatomy, probably as a private enterprise, at his alma 
 mater, the academy of Louvain. 
 
 His reputation had by this time extended so far, that 
 in 1537 he was called to the professorship of anatomy 
 and surgery in the university of Padua, in which chair 
 
 9 
 
102 DOCTRINES OF THE CIRCULATION. 
 
 he continued for nearly seven years. In addition to 
 his duties at Padua, he was soon after invited to teach 
 anatomy at Bologna, and finally also at Pisa ; giving his 
 course successively during the same winter in each of 
 the three universities. His industry and devotion were 
 rewarded by an increased facility in obtaining anatomi- 
 cal material. While at Paris he, with his companions, 
 made nocturnal excursions to the cemetery of Mont- 
 faucon, to collect bones for the formation of a skeletoH \ 
 and while a teacher at Louvain, he despoiled by night 
 the gibbet of a malefactor for the same purpose. But 
 at Padua and Bologna he was supplied with subjects 
 by the voluntary exertion of his pupils; and on his 
 appointment at the university of Pisa, the Duke Cosmo 
 dei Medici legalized the appropriation of bodies from 
 the public cemetery for purposes of anatomy (49). 
 
 While professor at the university of Padua, he pub- 
 lished his earliest and most important work, on the 
 Structure of the Human Body,* which advanced the 
 science of anatomy at a single step, farther than it had 
 progressed for several centuries. The book of Carpi, 
 published less than thirty years before, will bear no 
 comparison with that of Vesalius. It is a small quarto 
 of eighty pages, of inferior scope and execution, illus- 
 trated with a few coarse woodcuts, the most important 
 of which are quite beneath criticism. The work of 
 Vesalius is a well printed folio of six hundred and 
 seventy-eight pages, with a copious index and a large 
 number of correct, instructive, and artistic illustrations. 
 The full-length figures were engraved from designs by 
 John de Calcar, one of the best pupils in the school of 
 
 * Andrew Vesalii de Humani corporis fabrica Libri septera. 
 Basilese, 1543. 
 
PERIOD OF THE RENAISSANCE.- 
 
 103 
 
 Titian, whose pictures are said to have been often mis- 
 taken, by good j udges, for those of Titian himself* A 
 second edition, printed at Basle, under the author's re- 
 vision, in 1555, is still more carefully executed, and is 
 a magnificent specimen of the printer's art. 
 
 There is an equal difference in style and method 
 between Vesalius and his predecessors. Mondini and 
 Carpi are both denizens of the middle ages ; but Ves- 
 alius is a modern. Retreats his subject from the out- 
 set in a direct, comprehensive, and systematic way. 
 He sees the end of his work from the beginning ; and 
 he leaves no room for doubt, as to the originality of 
 his plan, his reasons for adopting it, or the sources of 
 his knowledge. When we see, from the dates en- 
 graved on the frontispiece, that this work, the first of 
 its kind, was written and published by a mantwenty- 
 eight years of age, it seems hardly less than phenom- 
 enal. It was republished, one hundred and eighty 
 years afterward, by Boerhaave and Albinus.f who 
 speak of it, in their preface, as " opus incomparabile 
 anatomicum, quod periturum nunquam, omnis jevi 
 tempore praeclarissimum habebitur omnium quje in 
 banc usque horam ab ulio mortalium edita fuerunt." 
 
 Vesalius represents the first attempt of scientific 
 medicine in Europe to emerge from its condition of 
 tutelage. Until that time, professors and practitioners 
 alike were simply the disciples of Galen. His writings 
 were to them the fountain of knowledge, as unquestion- 
 
 * Vasari, Vite de' pin' eccellenli pittori, Milano, 1807, vol. x., p. 
 234; and Biographic Universelle, Paris, 1812; article, Calcar. 
 
 f AndrcEC Vesalii Opera omnia anatomica, & chirurgica. Cura 
 Hermanni Boerhaave & Bernhardi Siegfried Albini. 
 
 Lugduni Batavornm, 1725. 
 
I04 DOCTRINES OF THE CIRCULATION. 
 
 able as holy writ ; and their highest ambition was to 
 study his books and understand his doctrines. Vesa- 
 lius shared this feeling so far as to appreciate the in- 
 dispensable value of the works of Galen, whom he calls 
 the "prince of physicians," the " chief of anatomists," 
 and the " author of all good things." But he had also 
 the instinct of investigation, and a practical belief in 
 its results. In his dissections he met with various de- 
 tails, not in accordance with the descriptions of Galen ; 
 and on repeating his observations, and comparing them 
 carefully with the text, he at last reached the convic- 
 tion that Galen's anatomy was not the anatomy of the 
 human body, but was founded mainly on the dissection 
 of animals.* This conviction, once established, left 
 him free to describe the parts according to his own 
 observation, and gave him a greater stimulus to do 
 so ; for his own work was devoted exclusively to the 
 "structure of the human body," while Galen's was rather 
 a " general anatomy and physiology " of the higher 
 animals. 
 
 The assertion that Galen's descriptions were not 
 entirely accurate, as applied to human anatomy, was 
 received with great disfavor. It seemed to impugn 
 the authority from which everything of value in med- 
 ical science had been derived ; and it was resented by 
 some as a treason to medical science itself. The age 
 was not yet quite ready to admit the possibility of 
 imperfection in its ancient doctrines ; and the idea, 
 that Galen's dissections were practiced only on animals, 
 continued to meet with disbelief and opposition from 
 many prominent men of the time. It is now generally 
 acknowledged to be true (50) ; and its announcement in 
 
 "^ Vesalius, De humani corporis fabrica, Praefatio. 
 
PERIOD OF THE RENAISSANCE. 
 
 lOS 
 
 the sixteenth century was the earliest movement toward 
 emancipating the profession from its blind subserviency 
 to the text of a standard author. Vesalius himself 
 may be partly responsible for the incredulity of his 
 contemporaries. His criticisms of Galen are perhaps 
 repeated with unnecessary frequency ; and he some- 
 times appears to take for an error what is only a dif- 
 ferent way of viewing the subject, equally legitimate 
 with his own (51). But he has the great merit of an 
 absolute and abiding faith in the direct observation 
 of nature as a source of knowledge, and its superiority 
 in value to any scientific tradition, however widely 
 accepted. 
 
 The doctrine of Vesalius, in regard to the heart and 
 bloodvessels, is, except in one particular, the same 
 with that previously in vogue ; but it is presented by 
 him in a remarkably graphic and intelligible style. 
 The venous blood, formed in the liver from the chylous 
 juice.s brought by the portal vein, is the nourishing 
 material for the substance of the tissues. By the vena 
 cava, it enters the right side of the heart, whence a 
 portion of it is distributed to the lungs by the vena 
 arterialis. But the heart is especially the centre of 
 life, and the focus of animal heat ; and in its left ven- 
 tricle the blood, elaborated and united with the aeri- 
 form product of the lung, becomes fine and spirituous, 
 and fit for distribution by the arterial system. The 
 pulsations of the heart are due to its three sets of fibres.; 
 of which the longitudinal effect its dilatation, drawing 
 the blood into its cavities; the transverse or circular 
 cause its contraction, and expel the blood ; while by 
 the oblique, its contents are momentarily retained for 
 elaboration. The arterial pulsation is a similar move- 
 
IC6 DOCTRINES OF THE CIRCULATION. 
 
 ment of expansion and contraction ; a kind of general 
 respiration or ventilation throughout the body, in 
 which the vital spirits reanimate or rekindle the in- 
 nate heat of the parts. 
 
 The single point in which Vesalius differs from the 
 classical doctrine is an important one ; namely, that of 
 the passage of blood, through the cardiac septum, 
 from the right ventricle to the left. He does not ad- 
 mit the perforations in the septum, described by Galen. 
 He is well acquainted with the pits or depressions on 
 its surface ; but they exist, also, he says, in other parts 
 of the ventricles ; and they do not, so far he can per- 
 ceive, lead to any passages through which blood could 
 find its way. 
 
 " The surface of each ventricle is extremely uneven, 
 and beset with numerous pit-like indentations, deeply 
 sunk in its fleshy substance. These pits, however, are 
 not confined to the side by which the right ventricle 
 corresponds with the left (notwithstanding it is so 
 understood by all other anatomists), but are found 
 over the whole ventricular surface. They are apparent, 
 not only in recently killed animals, but also in the 
 preserved heart, as long as it is kept ; and even in the 
 desiccated organ they still remain open. But however 
 conspicuous these depressions may be, none of them, 
 so far as perceptible by the senses, penetrate through 
 the septum from the right ventricle into the left. Nor 
 do I find even the minutest channels which would 
 make the septum pervious, although such perforations 
 are described by anatomical professors, who believe 
 implicitly in the passage of blood from the right ven- 
 tricle to the left. I am therefore in no little doubt as 
 to the function of this part, of the heart " (52). 
 
PERIOD OF THE RENAISSANCE. 
 
 107 
 
 The doubt here expressed by Vesalius is a very 
 serious one. The^ blood,' he says, which enters the 
 right ventricle from the vena cava is destined to supply, 
 " not only the heart itself and the lungs, but also all 
 the arteries, which, we believe, are filled with blood 
 from the heart."* He knows, therefore, that, in some 
 way/or other, blood must be transferred from the right 
 ventricle to the left ; and yet its passage through th'ls 
 septum, acknowledged by all the anatomists of his 
 time, seems too hypothetical to satisfy him. He re- 
 members, it is true, that the extremities of the portal 
 vein absorb their chylous juices from the alimentary 
 canal through passage-ways that have never been seen. 
 He will not, therefore, hazard a positive denial in re- 
 gard to the septum of the ventricles ; but he prefers to 
 remain in doubt, rather than adopt an opinion with so 
 little evidence in its favor. At all events he declares, 
 that the supposed perforations in the septum do not 
 exist in the form and with the distinctness that anat- 
 omists have asserted and believed. 
 
 " In recounting as above," he says, "the structure 
 of the heart, and the use of its different parts, I have 
 followed in the main the doctrines of Galen ; not that 
 I regard them in all particulars as consonant with the 
 truth, but because, in attributing new functions and 
 uses to a number of parts, I am still distrustful of my- 
 self, and not long ago should hardly. have ventured to 
 differ from that prince of physicians by so much as a 
 finger's breadth. As for the dividing wall or septum 
 between the ventricles, forming the right side of the 
 left cavity, the student of anatomy should consider 
 carefully that it is equally thick, compact, and dense, 
 
 * De Human! corporis fabrics, liber iii., cap, vii. 
 
Io8 DOCTRINES OF THE CIRCULATION. 
 
 with all the rest of the cardiac substance enclosing the 
 left ventricle. And accordingly, notwithstanding what 
 I have said about the pits in this situation, and at the 
 same time not forgetting the absorption by the portal 
 vein from the stomach and intestines, I still do not see 
 how even the smallest quantity of blood can be trans- 
 fused, through the substance of the septum, from the 
 right ventricle to the left" (53). 
 
 Vesalius accordingly finds the door in the septum of 
 the ventricles closed; and he does not indicate any 
 other route by which the blood might pass from the 
 right side of the heart to the left. But there are two 
 points which present themselves to the reader of Ve- 
 salius, which are very noticeable in this connection. 
 The first is that he, as well as other anatomists, already 
 knew. the circulation through the liver; or atleast they 
 believed in some communication between the portal 
 and hepatic veins. The classical doctrine had long 
 recognized the transfer of blood as an elaborated pro- 
 duct through the liver from the portal vein to the vena 
 cava ; but it was stated by Vesalius more distinctly 
 than before. " The branches of this vein " (vena cava), 
 he says, " distributed through the body of the liver, 
 come in contact with those of the portal vein ; and the 
 extreme ramifications of these veins inosculate with 
 each other, and in many places appear to unite and be 
 continuous" (54). Thus, at least in one of4he vascu- 
 lar organs, a way seemed open for the passage of blood, 
 by vascular continuity, from one set of vessels to 
 another. 
 
 Secondly, it is evident, from the language of Vesa- 
 hus, that the perforation of the cardiac septum was not 
 
PERIOD OF THE RENAISSANCE. 
 
 109 
 
 the only thing which he held in doubt. There were 
 several peculiarities in the arrangement of the vascular 
 
 'system not clearly explained by the existing doctrine; 
 and some of his expressions are so pointed as to be 
 extremely suggestive in the light of our present knowl- 
 edge. 
 
 " When these matters are taken into account, many 
 things at once present themselves in regard to the ar- 
 terial system which deserve careful consideration; espe- 
 cially the fact that there is hardly a single vein going to 
 the stomach, the intestines, or even the spleen, without its 
 accompanying artery, and that nearly every member of 
 the portal system has a companion artery associated 
 with it in its course. Again, the arteries going to the 
 kidneys are of such a size that they can by no means 
 be affirmed to serve merely for regulating the heat of 
 these organs ; and still less can we assert that so many 
 arteries are distributed to the stomach, intestines » and 
 spleen for that purpose alone. And there is, further- 
 more, the fact, which we must for many reasons admit, 
 that there is through the arteries and veins a mutual 
 flux and reflux of materials, and that within these ves- 
 sels the weight and gravitation of their contents has no 
 effect" (S5). 
 
 Vesalius was evidently impressed with the idea that 
 in several particulars the accepted physiology of the 
 vascular system was an inadequate expression of the 
 truth. If he did not say more about them, it, was be- 
 cause his opinions were too incomplete or uncertain 
 for definite statement. But when we remember his 
 intellectual activity and independence of mind, we can 
 readily believe that continued research would have led 
 him to more positive results. If Vesalius had re- 
 
no DOCTRINES OF THE CIRCULATION. 
 
 mained professor of anatomy at Padua, instead of being 
 called to be court physician at Madrid (56), it seems 
 quite within the bounds of probability that the circu- ' 
 lation of the blood might have been discovered in the 
 sixteenth century. 
 
CHAPTER VI. 
 
 SERVETUS. 
 
 The most singular episode in the history of the cir- 
 culation is that of the existence and writings of Ser- 
 vetus. He was unlike any other character among those 
 who took part in its development or discovery. He 
 had no apparent connection with any predecessor or 
 any follower. He dealt with one of the most import- 
 ant questions in physiology, and yet he was a theolo- 
 gian and a heretic more than a physician or anatomist. 
 His tragic fate adds to the strangeness of the interest 
 that surrounds him ; and his book, after being inter- 
 dicted and suppressed in the sixteenth century, was 
 resuscitated in the eighteenth as an ecclesiastical and 
 medical curiosity. 
 
 Michael Servetus was born in Spain about the year 
 1 510; but there is a doubt as to the exact date and 
 place of his birth, one account making him a native of 
 Tudela in Navarre, the other of Villaneuva in Arra- 
 gon. There is a similar uncertainty in regard to his 
 early life and education. He is thought to have been 
 a pupil in the university of Saragossa, and afterward 
 to have entered as a student of law at Toulouse; and 
 he was for a time attached in some capacity to the 
 service of Quintana, father confessor to the emperor, 
 Charles V. But his first appearance in any definite 
 character was in the year 1530, when he became known 
 by his correspondence and interviews with the Swiss 
 
112 DOCTRINES OF THE CIRCULATION. 
 
 and German Reformers. Servetus was then only about 
 twenty years of age, but he was so absorbed in ques- 
 tions of controversial theology that he was bent on 
 discussing them with the leaders of the Reformation; 
 andin the following year he published a book on the 
 " Errors of the Trinity,"* which excited great animad- 
 version on account of its alleged heretical doctrines. 
 It was denounced and condemned by both Protestant 
 and Catholic authorities ; and Servetus found himself 
 obliged to withdraw from the field, to avoid the conse- 
 quences of his temerity. 
 
 He then went to Paris, and under the assumed name 
 of Michel Villeneitve entered as a student at the Univer- 
 sity, where, four years afterward, in 1 5 36, he graduated 
 as Doctor in Medicine. His first essays, however, in his 
 newprolv-ssion were but little acceptable to the medical 
 faculty; since he attracted attention by public lectures 
 on Geography and Astrology, and in his practice was 
 said to employ largely the casting of nativities and 
 astrological divination. When cited before the Medi- 
 cal Council and reproved for these irregularities, he 
 printed in reply a pamphlet,t in which he defends the 
 science and art of astrology with much dialectic ability, 
 and characterizes his critics as "sophists," who have 
 '• demonstrated nothing except their own ignorance." 
 But the case having been brought before the Parlia- 
 ment of Paris, Servetus was ordered to withdraw his 
 pamphlet from publication, and to refrain in future from 
 the teaching or practice of astrology or divination. 
 
 * De Trinitalis Erroribus, 1531. The book did not bear the im- 
 print of publisher, printer or place of publication. 
 
 f Michaelis Villanovani in quendam medicum apologetica discep- 
 tatio pro astrologia, Parisiis, 1538. Reprint by Henri Tollin, Berlin, 
 1880. 
 
SERVE,TUS. 113 
 
 He also published a treatise on the action of medici- 
 nal syrups, entitled " Syruporum universa ratio, ad 
 Galeni censuram diligenter explicata," which was 
 mainly a citation and comparison of the views of older 
 writers on this subject, and which does not seem to 
 have contained anything especially remarkable in medi- 
 cal doctrine. Not long afterward, about 1540, he gave 
 up his residence in Paris, and established himself as 
 physician in the archiepiscopal city of Vienne, in the 
 south of France, still under the name of Michel Ville- 
 neuve, by which lie was exclusively known. Beside 
 the attention which he gave to medical practice, he 
 occupied himself to a considerable extent as proof- 
 reader and corrector for the publishing houses of Lyons 
 and Vienne; and under their auspices acted as editor 
 and annotator for several non-medical books of some 
 importance. His fancy, however, for theological con- 
 troversy was as strong as ever, and soon led him into 
 a correspondence with Calvin, then the most influential 
 personage in Geneva and the acknowledged head of 
 the Swiss Reformers. The correspondence turned 
 out to be mutually unsatisfactory, and produced on 
 both sides no little acrimony of feeling. Servetus 
 then applied himself to writing a book, in which his 
 views should be set forth in full, and which he finally 
 printed, secretly and at his own expense, in a private 
 house at Vienne (57). 
 
 It was this book, the " Christianismi Restitutio," 
 which was the principal production of Servetus' life, 
 and also the cause of his death. As its name implies, 
 it was a plea for the restoration of Christianity to its 
 original form, which, Servetus thought, had been al- 
 tered and corrupted since the time of the early churches. 
 
114 DOCTRINES OF THE CIRCULATION. 
 
 But this reformation was not one of morals or practical 
 Christianity. It was concerned mainly with abstruse 
 questions regarding the Father, Son, and Holy Spirit, 
 and their relations to the doctrine of the Trinity. 
 Servetus considered these questions sufficiently im- 
 portant to absorb most of his interest and attention, 
 and to justify the dangerous experiment of issuing his 
 opinions in printed form. In their discussion, how- 
 ever, his metaphysical distinctions are often so finely 
 drawn, or so obscurely expressed, that they are practi- 
 cally unintelligible to all but experts in theological 
 technicalities (58); and to the ordinary reader he 
 sometimes appears to destroy in one paragraph the 
 meaning expressed in another. His sincerity and 
 enthusiasm cannot be doubted ; and at the present day 
 it seeriis difficult to conjecture why Servetus should 
 have ventured so much for the promulgation of these 
 intangible abstractions, or why his opponents should 
 have considered them, when printed, as dangerous to 
 the public welfare. 
 
 In this book Servetus, most unexpectedly, announces 
 the physiological doctrine that the transfer of blood, 
 from the right side of the heart to the left, takes place 
 through the lungs and not through the septum of the 
 ventricles. The passag'e occurs in a part of the volume 
 where Servetus is treating of the Holy Spirit, which 
 he considers as the mode of communication from the 
 Deity to man ; and in this connection he offers an 
 exposition, or what he calls a " divine philosophy," of 
 the life and spirits in the corporeal frame. After giving 
 the usual account of the vital spirits as produced in the 
 heart, and the animal spirits in the brain, he proceeds 
 to explain how it is that the life, or soul, is not seated 
 
SERVE TVS. 
 
 "5 
 
 in the substance of the solid organs, but in the blood, 
 and that the life itself is the blood, or the sanguineous 
 spirit, as taught by Holy Writ. 
 
 " To this end," he says, " we must first understand 
 the substantial generation of the vital spirit, which is 
 formed and nourished from the inspired air and the 
 finest part of the blood. The vital spirit originates in 
 the left ventricle of the heart, the lungs taking a very 
 important part in its generation. It is a thin spirit, 
 elaborated by the power of heat, of a bright golden 
 hue and fiery potency ; — as it were, a transparent exha- 
 lation from the purer kind of blood, containing in itself 
 the substance of water, air, and fire. It is generated 
 from the mixture made in the lungs between, the in- 
 spired air and the finely elaborated blood which the 
 right ventricle of the heart communicates to the left. 
 This communication, however, does not take place through 
 the median wall of the heart, as commonly believed ; but, 
 by, a grand device, the refined blood is driven from the 
 right ventricle of the heart, in a long course, through the 
 lungs. By the lungs it is prepared, assuming a bright 
 color, and from the vena arteriosa is transferred into the 
 arteria venosa. Then, in the arteria venosa itself, it is min- 
 gled with the inspired air, and purged of its fuliginous 
 matter by expiration. And so, at length, the left ven- 
 tricle of the heart attracts by its diastole the whole 
 mixture, a suitable furnishing material, that it may 
 become vital spirit. 
 
 "That the communication and preparation takes 
 place in this way, through the lungs, is shown by the 
 varied conjunction and communication of the vena 
 arteriosa with the arteria venosa in the lungs. It is 
 confirmed by the remarkable size of the vena arteriosa. 
 
Il6 DOCTRINES OF THE CIRCULATION: 
 
 which would not have been made either of such con- 
 struction or so large, and would not convey from the 
 heart such an abundance of blood into the lungs for 
 their nourishment alone, nor would the heart supply 
 the lungs in this way; especially as at an earlier time, 
 in the embryo, the lungs themselves were nourished 
 from another source, owing to those membranes or 
 valves of the heart which are not closed until the hour 
 of birth,* as Galen teaches. Consequently, it is for 
 another purpose that the blood is poured from the 
 heart into the lungs at the hour of birth and in such 
 abundance. Moreover, it is not simple air which is 
 sent from the lungs to the heart through the arteria 
 venosa, but air mixed with blood; therefore, the mix- 
 ture takes place in the lungs. The bright color is 
 given to the spirituous blood by the lungs, not by the 
 heart. In the left ventricle of the heart there is not 
 sufficient space for so great and copious a mixture, nor 
 an elaboration capable of producing that bright color. 
 And, finally, the median wall, having no vessels or 
 vital endowments, is unfit for slich a communication 
 and elaboration, though something may possibly trans- 
 ude through it. By means of the same device, which in 
 the liver makes a transfusion from the portal vein to the 
 vena cava for the blood, there is in the lung a transfusion 
 from the vena arteriosa to the arteria venosa for the 
 spirit. Whoever compares this with what is written by 
 Galen, in the 6th and 7th books De Usu Partium, will 
 comprehend a truth not noticed by Galen himself "(59). 
 Certainly nothing could be more distinctly stated 
 than this. The obscurities met with elsewhere in the 
 writings of Servetus have no place here. The reader 
 
 * That is, the valve of the foramen ovale. 
 
SEX varus. 117 
 
 is not for a moment in doubt as to what he means ; 
 and if his idea needed any further explanation, it is fully 
 supplied by his admirable comparison of the transfusion 
 through the lungs, for the formation of arterial blood, 
 with that through the liver for the formation of venous 
 blood. Moreover, he is perfectly well aware that his 
 doctrine is a new one, although he announces it with 
 entire confidence ; and he refers to Galen's opposite 
 views in a way almost disdainful, as if it were hardly 
 worth while to discuss the coKrectness of his own 
 opinion as against the great teacher of antiquity. 
 
 This makes it the more remarkable to find so im- 
 portant a physiological doctrine announced in a volume 
 like the " Christianismi Restitutio." The book of 
 Servetus was not addressed to medical readers, but to 
 ecclesiastical reformers and schismatics. It could not 
 be expected to have a circulation in France, or in any 
 other Catholic country ; and those whom it might 
 reach in Germany or Switzerland would care but little 
 about the transfusion of blood through the lungs, in 
 comparison with the niceties of trinitarian metaphysics. 
 It would seem natural for so ambitious a man as Ser- 
 vetus, in possession of such a physiological novelty, to 
 declare it as his own discovery to the medical world 
 and establish it as the doctrine of the time. Instead 
 of that, it is inserted, as a matter of secondary consid- 
 eration, in a book on a different subject, secretly 
 printed for distribution abroad, and to which the au- 
 thor could not venture to append his name. 
 
 Perhaps these incongruities may be accounted for 
 in part by the erratic character of Servetus, and the 
 singularity of his ideas, which was as remarkable in 
 the domain of physiology as in that of religion. We 
 
Il8 DOCTRINES OF THE CIRCULATION. 
 
 should have a very imperfect idea of Servetus as a 
 physiologist, if we were to confine ourselves to his 
 brief passage on the transfusion of blood through the 
 lungs. This is only a part of his '' divine philosophy" 
 as to the nature of life, spirit, and soul, and their mode 
 of existence and generation in the body. In the 
 further elaboration of this philosophy, he so intermin- 
 gles the ideas of life, soul, mind, vital spirits, animal 
 spirits, breath, inspiration, and even of the Holy Ghost, 
 that it seems uncertain whether he regards either of 
 them as an incorporeal being or force, or as a material 
 vapor that may be taken in through the nostrils and 
 contained in the cavities or vessels of the body. This 
 obscurity reaches its climax when he treats of the 
 ventricles of the brain and the vessels of the choroid 
 plexus, containing the animal spirits, and, as he asserts, 
 the " very mind itself" and the soul, which is fanned, 
 like a flame, by the air inspired into the ventricles 
 through the ethmoid bone. 
 
 " In the second place," he says, " the ventricles are 
 for this purpose, that a portion of the inspired air, pene- 
 trating into their vacant spaces through the ethmoid 
 bones, and attracted by diastole into the vessels of the 
 soul, may renew the animal spirit contained within them 
 and ventilate the soul (anima). In theSe vessels is the 
 mind, soul, and fiery spirit, which requires a double flab- 
 ellation (that is, a to-and-fro fanning, or ventilation from 
 without inward and from within outward) ; otherwise it 
 would be smothered, like an external fire in a closed place. 
 It needs, like a fire, inward and outward ventilation, 
 not only to get its pabulum from the air, but also for 
 the discharge of its fuliginous matter. As the external 
 elementary fire unites with a dense earthy sabstance, 
 
SERVETOS. 
 
 119 
 
 owing to the quality of dryness and the form of light 
 common to both, having for its pabulum the moisture, 
 and is ventilated, maintained, and nourished by the air : 
 in like manner this igneous spirit and soul of ours is 
 associated with the body, making one with it, having 
 the blood for its pabulum ; and by the aerial spirit, in 
 inspiration and expiration, is ventilated, maintained 
 and nourished, so that it has a two-fold aliment, spirit- 
 ual and corporeal. By reason, therefore, of its locality 
 and of its spiritual nourishment, it is most appropriate 
 that this same lucid dwelling place of our spirit should 
 receive the afflatus of another, sacred, celestial, lucid 
 spirit, by expiration from the mouth of Christ, as we 
 by inspiration draw our spirits into the same place. It 
 is fitting that the same place which is the seat of our 
 intelligence and luminous soul, should be illuminated 
 anew by the light of another celestial fire. For God 
 lights in us the first lamp, and the shadows that spring 
 up there he again turns into light, as saith David, 
 Psalm xvii, and II. Samuel, 22, also Elihu, in Job xxii. 
 and xxxiii. The same thing is taught by Zoroaster, 
 Trismegistus and Pythagoras, as I_ shall cite presently. 
 Moreover, a good formation and temperament of the 
 vessels conduces to goodness of mind, so that those 
 persons have a better soul in whom the disposition of 
 the parts is a good one. But as this indwelling light is 
 more and more illuminated by a good spirit, so it is 
 obscured by a bad one. If into those vessels of the 
 brain, together with our lucid animal spirit, a dark and 
 bad spirit intrudes itself, then you will see demoniacal 
 ravings, as by a good spirit come lucid revelations. 
 But these vessels are easily attacked by the evil spirit 
 which has its seat near by, in those watery abysses 
 
I20 DOCTRINES OF THE CIRCULATION. 
 
 and cavities of the ventricles of the brain. This evil 
 spirit, whose power is of the air, goes freely in and out 
 of those cavities, to contend there unceasingly with 
 our spirit, dwelling within those vessels as in a citadel. 
 And it so besets our spirit on all sides that it can hardly 
 breathe, unless when the supervening light of the spirit 
 of God puts the bad spirit to flight. How appropriate 
 to that place is the constitution of mind, spirit, revela- 
 tion and intelligence, and the fight with higher temp- 
 tations, to say nothing of the others!" (60). 
 
 Throughout this part of his treatise, Servetus makes 
 no distinction, as to the certainty of his opinions, be- 
 tween those which have turned out to be well founded 
 and those which are chimerical. His account of the 
 mode of communication, in the lungs, between the two 
 sets of vessels, is very striking ; where he says that it 
 is by " another kind of vessel, formed from the vein and 
 the artery,'' as if he had divined the existence of the 
 pulmonary capillaries. But in describing the small 
 arteries of the brain and their communication with the 
 nerves, he speaks with the same confidence of " another 
 kind of vessel " here also, through which the animal 
 spirits are conducted from the terminal arteries to 
 the nerves ; and the nerves " retain in their interior 
 cavity, a membrane common to themselves and to the 
 above mentioned vessels, for the safe custody of the 
 spirit."* In his chapter on Faith, he has also a discus- 
 sion to show that faith is in the heart, and that 
 the heart is free, notwithstanding that the source 
 of volition and action, according to Galen, is in 
 the brain; because the animal spirits of the brain are 
 formed from the vital spirits of the heart, and in the 
 
 * Christianismi Restitutio, p. 172. 
 
SERVE TUS. 121 
 
 heart, accordingly, is the prime origin of the life and 
 soul.* 
 
 Even if Servetus' book had come to the knowl- 
 edge of the medical world, it is doubtful whether a 
 doctrine accompanied by so many extravagances 
 would have found favor with the profession. But it 
 was destined to meet with immediate suppression from 
 another source, and to pass, with its author, into the 
 oblivion of a century and a half The printing of the 
 " Christianismi Restitutio " was completed, without the 
 knowledge of the authorities, in the early part of 1553 ; 
 and a copy was sent, either by Servetus or by one of 
 his friends, to Calvin at Geneva, in the hope that it 
 might recommend itself to so determined an opponent 
 of the Catholic Church. But the Reformer, instead of 
 being pleased, was shocked at its contents. He recog- 
 nized the polemical style and heretical ideas of the 
 author of the former book " De Trinitatis Erroribus," 
 and also of his recent correspondent Villeneuve, now 
 seen to be one and the same person. He caused in- 
 formation of these facts to be transmitted to the author- 
 ities at Vienne, who at once arrested and examined 
 Servetus and his printer, but without as yet discover- 
 ing where the books were concealed. Servetus em- 
 braced the first opportunity of escaping from prison, 
 and made his way to Geneva ; intending, it is said, to 
 pass from thence into Italy. But while at Geneva he 
 was recognized, denounced, imprisoned, and arraigned 
 for heresy ; and, after a trial which lasted over two 
 months, was condemned to be burned at the stake. 
 This sentence was carried out on the following day, 
 October 27th, 1^53; and his books, which had been 
 
 * Christianismi Restitutio, p. 301. 
 
122 DOCTRINES OF THE CIRCULATION. 
 
 discovered in the meantime, some in France and some 
 in Germany, were also burned by the public executioner. 
 It does not appear that they had yet been offered for 
 sale ; and not more than four or five were retained by 
 the legal authorities for use in the prosecution. At 
 the present day, there are only two copies of the origi- 
 nal work known to be in existence ; namely, one in the 
 National Library at Paris, the other in the Imperial 
 Royal Library at Vienna. The passage on the pul- 
 monary circulation was quoted for the first time, in an 
 English book,* in 1697; and in 1790 a small edition of 
 the entire work was reprinted in fac-simile from the 
 Vienna exemplar. It is from a copy of this reprint 
 that the foregoing quotations have been made. 
 
 The story of Servetus is most interesting as a psy- 
 chological study, and also as the instance of a re- 
 markable physiological truth first stated by an author 
 who afterward remained unknown until the doctrine 
 of the circulation had advanced far beyond its condi- 
 tion as understood by him. In his announcement of 
 the transfer of blood through the lungs, Servetus 
 jumped to a conclusion which Vesalius hesitated to 
 adopt; but it was overshadowed by the number and 
 importance of other topics in the same volume ; and 
 the book and its author were both forgotten, when the 
 short-lived interest in his trial had passed away (61). 
 
 * Wotton, Reflections on Ancient and Modern Learning, London, 
 1697, p. 229. 
 
CHAPTER VII. 
 
 DAWN OF THE CIRCULATION. 
 COLOMBO. CAESALPINUS. FABRICIUS. 
 
 Throughout the sixteenth century, the principal 
 centres of medical learning, and the headquarters of 
 medical progress and discovery, were in Italy. The 
 universities of Padua, Pisa, Pavia, Bologna and Rome, 
 all had their medical professors, attracting .students and 
 teachers from every direction ; and during this period 
 most of the names, permanently connected with the 
 advancement of anatomical science, were those of na- 
 tive or resident Italians. 
 
 Colombo was in his earlier years an apothecary in 
 the city of Cremona, where his father was engaged in 
 the same occupation. He afterward entered as a pupil 
 in the university of Padua, and there pursued the study 
 of anatomy under the instruction of Vesalius. In this 
 department he became so proficient that in 1544 he 
 succeeded his master in the vacant chair of anatomy, 
 going soon afterward in the same capacity to Pisa, and 
 finally to Rome, and teaching anatomy in each of these 
 places with acknowledged success. The result of his 
 labors is embodied in a treatise* published in 1559, 
 immediately after the death of the author. On the last 
 leaf is the imprint of Frater Felix Perettus, Hcereticce 
 pravitatis Inquisitor, certifying that he has duly read 
 
 * De Re Anatomica Libri xv. Venetiis, MDLIX. 
 
124 DOCTRINES OF THE CIRCULATION. 
 
 the book and found in it nothing contrary to the Cath- 
 oHc faith, good morals or principles. 
 
 Colombo's book is a handsome quarto, of two hun- 
 dred and seventy pages. It bears, throughout, the 
 marks of the example and teaching of Vesalius. It is 
 systematically arranged, treating, in successive divi- 
 sions, of the bones, cartilages, ligaments, muscles, the 
 liver and veins, the heart and arteries, the nervous 
 system, and the viscera. Colombo follows his teacher 
 in declaring his independence of Galen, whom he 
 asserts, on similar and sometimes the same * grounds, 
 to have confined his dissection to animals. He does 
 not hesitate, upon occasion, to question the opinions of 
 Aristotle, and even, of Hippocrates ; and he frequently 
 differs with Vesalius, whose supposed errors or omis- 
 sions he points out with unsparing hand. But where 
 a leader has once shown the way, it is easy for a fol-- 
 lower to see the deviations of his track ; and while 
 Colombo is no doubt entitled, in some cases, to the 
 credit of improving upon the account given by Vesa- 
 lius, his improverhents relate, for the most part, to 
 matters of detail. At the end of the volume, as in that 
 of Vesalius, there is a chapter on vivisections, showing 
 the reasons for their usefulness, the proper mode of 
 preparing the animal, and conducting the operation, for 
 studying the motions of the diaphragm, lung, heart, 
 and arteries, the existence of the pericardial fluid, and 
 the functions of the nerves ; and though there are no 
 anatomical plates, properly speaking, the ornamental 
 headings of the chapters, and even the elaborate front- 
 ispiece, representing the anatomist demonstrating to 
 
 * Compare Vesalius, lib. vi., cap. vii. ; and Colombo, lib. xi., cap. 
 ii., on the pulmonary lobes. 
 
DAWN OF THE CIRCULATION 
 
 125 
 
 his audience from a human cadaver, are plainly in imi- 
 tation of his teacher's larger work. The book is 
 written in a style not precisely elegant, but very clear 
 and simple ; and in many instances the descriptions 
 which it contains are both more concise and more in- 
 telligible than those of any previous writer. 
 
 The important feature in Colombo's work is his 
 doctrine of the conversion of venous into arterial blood 
 in the lungs, and its delivery thence by the arteria 
 venosa to the left ventricle of the heart; that is, 
 of the pulmonary circulation. This doctrine hestates 
 repeatedly, with his accustomed force and perspicuity, 
 in his chapters On the Heart and Arteries and On 
 the Lung, as a matter of great importance, which 
 " no one has ever before observed or mentioned," or 
 " even hinted at." 
 
 " Between the ventricles of the heart,'' he says, 
 " there is a septum, through which, as nearly all believe, 
 there is a passage for the blood from the right ventricle 
 to the left, in order that it may be refined, during its 
 transit, for the generation of the vital spirits. But in 
 this they are very far from the truth ; for the blood is 
 carried through the vena arteriosa to the lung and 
 refined there, and thence, together with the air, it is 
 brought away by the arteria venalis, to the left ventricle 
 of the heart " (62). " These three vessels, accordingly 
 (namely ; the trachea, the vena arteriosa, and the arteria 
 venosa), are surrounded by a light, thin, and porous 
 substance ; thus making up the tissue of the lung, which 
 has for its function, as correctly taught by anatomists, 
 first, the refrigeration of the heart by means of the 
 cool air thus introduced, and furthermore, the act of 
 inspiration and expiration for the formation of the voice. 
 
126 DOCTRINES OF THE CIRCULATION. 
 
 These uses of the lung are already known to former 
 writers. Beside them, I now add another of the 
 greatest importance, tp which no one has ever alluded 
 even by a hint ; that is, the preparation, and all but 
 generation, of the vital spirits, which are afterward more 
 thoroughly perfected in the heart. For the air, in- 
 spired through the mouth and nostrils, and dissemi- 
 nated by the trachea throughout the pulmonary sub- 
 stance, is mingled by the lung with the blood brought 
 to it from the right ventricle of the heart through the 
 vena arterialis. This vein, indeed, beside bringing blood 
 for the nourishment of the organ, is large enough to 
 bring blood also for another purpose. The venous 
 blood, agitated and refined by the continual motion of 
 the lungs, is mingled with the air, which has been also 
 prepared by the same collision and comminution ; so 
 that the intermingled blood and air are taken up to- 
 gether by the branches of the arteria venalis, and finally 
 conveyed through its trunk to the left ventricle of the 
 heart. There they arrive in a condition of such com- 
 plete mixture and attenuation, that there is but little 
 further for the heart to do; and when that little is 
 accomplished, giving, as it were, the last touch to the 
 vital spirits, it only remains for the heart to dis- 
 tribute them, by means of the aorta, throughout the 
 body" (63). 
 
 The main innovation in the doctrine of Colombo 
 is plainly the transfer of the important operation of vi- 
 talizing or arterializing the blood from the heart to the 
 lungs. It was understood by all that the vital spirits 
 resulted from a mixture of air from the lungs with blood 
 from the venous system. According to the older doc- 
 trine, this intimate union and generation took place in 
 
DAWN OF THE CIRCULATION. 127 
 
 the left ventricle of the heart ; the air, received and 
 elaborated by the lungs, being conveyed thence by the 
 arteria venosa (pulmonary vein) to the left ventricle, 
 and there united with the blood to become spirits, 
 thus maintaining the quality and supply of arterial or 
 " spirituous " blood. According to Colombo, the re- 
 finement and admixture of blood and air takes place 
 in the lung itself; and the blood, thus almost com- 
 pletely changed, is conveyed in that condition by the 
 arteria venosa to the left ventricle. He believes, how- 
 ever, that a small part of the refining operation is still 
 left for the heart to do ; and that the formation of the 
 vital spirits is not quite complete until it has received 
 this "last touch" from the left ventricle. Why he 
 should suppose that anything of this sort remained to 
 be done, after the action of the lungs, does not appear; 
 but it was probably due to the persistent influence of a 
 familiar idea, namely, the existence in the heart of im- 
 portant powers of coction or elaboration, of which he 
 could not fully divest himself At all events, his theory 
 with regard to the mechanical course of the blood was 
 complete. It was blood supplied to the lung from the 
 right side of the heart by the vena arteriosa (pulmonary 
 artery), which, after being mixed with air in the 
 lung, returned to the heart on the left side by the ar- 
 teria venosa (pulmonary vein). 
 
 But it is interesting to know how Colombo reached 
 his conclusion, and for what reasons he was induced 
 to make this change in the doctrine of the vascular 
 system, the most important since the time of Galen. 
 These reasons were three in number. 
 
 In the first place, he adduces the great size of the 
 lungs, and the necessity, in order to provide for and 
 
128 DOCTRINES OF THE CIRCULATION. 
 
 maintain the vitality of such organs, that they should 
 be supplied with spirituous, arterial, or " vital " blood, 
 as he calls it, as distinguished from the non spirituous, 
 venous, or " natural " blood, which is only for the pur- 
 pose of material nutrition. All other organs are sup- 
 plied with arterial blood by branches from the aorta. 
 But the lungs do not receive from this vessel any branch 
 whatever, " large or small ;" and how can spirituous or 
 vital blood be conveyed to them either by the vena 
 arterialis or the arteria venalis, neither of which pul- 
 sate? Consequently the arteria venalis must be for 
 bringing the blood, already elaborated, from the lung 
 to the heart ; not for carrying it out of the heart to the 
 lung (64). 
 
 It is evident that this reasoning is based partly upon 
 an error, namely ; that there are no arterial branches 
 from the aorta to the lungs. The bronchial arteries 
 were unknown to both Vesalius and Colombo, and 
 were first described by Ruysch * a little over one 
 hundred years later. But even admitting the absence 
 of the bronchial arteries, it is not quite clear why that 
 should have appeared so decisive to Colombo. For 
 according to Galen and his followers, the arteria ve- 
 nalis supplied the lungs with spirituous blood in ample 
 abundance , for their vivification ; the elaborated air 
 having become vital spirits by virtue of the transform- 
 ing agency of the left ventricle, an agency partly ac- 
 knowledged by Colombo himself. 
 
 Secondly, in Colombo's opinion, the arterializing 
 
 * Delucidatio valvularum in vasis lymphaticis et lacteis. Accesserunt 
 qusedam Observationes anatomicEe rariores. Hague Comitis, 1665. 
 Amsterdam edition, 1720, p. ig. 
 
DAWN OF THE CIRCULATION. y2Q 
 
 action of the lungs is sho^vn by another circumstance 
 namely, that the blood in these organs is already ar- 
 terial ; that is, thin, florid, and bright-colored, since 
 clinical experience had long taught physicians to recog- 
 nize blood as coming from the lungs, not only because 
 it was expelled by coughing, but also because it had 
 the above-named qualities, similar to those of arterial 
 blood (65). In regard to this reason, it must be observed 
 that the facts mentioned by Colombo, as well known 
 to medical men, were explained by Galen in another 
 way : namely, that the openings between the arteria 
 venalis and the bronchial tubes were naturally of such 
 size as to admit the passage of air into the artery, but 
 not the exit of its blood into the bronchial tubes ; and 
 that it was only when these openings became unduly 
 enlarged that a discharge of blood, necessarily arterial, 
 took place from the lungs. It is evident that the same 
 thing would occur, whether the arterial blood were 
 formed in the lungs, or were produced in the left ven- 
 tricle of the heart and thence supplied to the lungs by 
 the arteria venalis. 
 
 But, finally, what seems to have impressed Colombo 
 more than anything else was drawn from his observa- 
 tions and experiments on animals ; in which he always 
 found the arteria venalis containing no air, but full of 
 arterial blood and yet not pulsating. As the arterial 
 pulsation is an act having its origin in the heart, whence 
 the vital spirits are disseminated, if the arteria venalis 
 does not pulsate, it is because the blood in this vessel 
 is going to -the heart, not coming from it. Colombo 
 thought very highly of experiments on the living body 
 and inspection of the organs in actual operation. In 
 
136 DOCTRINES OF THE CIRCULATION. 
 
 his chapter on this subject he declares that whoever 
 will study in this way the motions of the heart, " can 
 learn more in a little while about the variations of the 
 pulse than he could in many months from external 
 examination of the arteries;" and that he "could 
 hardly gain, either as much pleasure or as much knowl- 
 edge, from three months' study of Galen De Pulsibus, 
 as in one short hour from the inspection of the heart 
 in a living animal." He appeals to this evidence in 
 support of his doctrine on the pulmonary circulation. 
 He " advises, begs, and urges " his reader, whom he 
 takes for granted to be an "' earnest student of learned 
 authors, but still more earnest for the truth," to make 
 his observations on animals, and see whether what 
 Colombo tells him is not borne out by the appear- 
 ances ; whether he do not find the arteria venalis full of 
 spirituous blood, without any air, or " so-called fuligi- 
 nous vapors," and also without pulsation (66). 
 
 This appears to be really the most important consid- 
 eration in support of Colombo's doctrine. The pul- 
 sating action of the arteries was acknowledged to pro- 
 ceed from the heart, and to accompany everywhere the 
 dissemination of the vital spirits throughout the body. 
 If the arteria venalis alone, of all these vessels, did not 
 pulsate, this must indicate some essential difference in 
 its mode of action ; the most natural explanation being 
 that in this artery the blood is coming to the heart, not 
 being carried away from it. Such an explanation was 
 corroborated by the backward closure of the mitral 
 valves, which, Colombo maintained, was not partial, 
 but complete. For all these reasons combined, he was 
 persuaded of the circuitous course of the blood from 
 
DAWN OF THE CIRCULATION. 131 
 
 % * 
 
 the right side of the heart, through the lungs, to the left 
 ventricle. 
 
 Notwithstanding the extreme importance of this doc- 
 trine, and its great advance on all previous ideas, it 
 still did not precisely represent the pulmonary circula- 
 tion as now understood. Colombo by no means re- 
 garded the entire mass of blood, carried to the lungs 
 by the pulmonary artery, as pouring through these 
 organs and returning, in a continuous stream, through 
 the pulmonary vein to the left ventricle. With him, as 
 with former anatomists, it was a part only of the blood 
 from the right side of the heart, which was destined to 
 be mingled with the air of respiration, and thus become 
 spirituous or arterial ; the remainder of that contained 
 in the pulmonary artery being used for the nutrition of 
 the lungs, as the venous blood in general was for the 
 nutrition of other bodily organs. His merit consisted 
 in showing that that portion of the blood which was 
 to replenish the arterial system passed from the right 
 side to the left through the lungs ; and, furthermore, 
 that, its arterialization took place in these organs, and 
 not in the left ventricle. 
 
 But how was Colombo's doctrine received, and what 
 influence did it exert on the progress of medical opin- 
 ion ? An exaniination of medical literature, for the 
 remainder of the sixteenth century and the early part 
 of the seventeenth, shows that it was considered, during 
 that time, rather as an uncertain hypothesis than a 
 demonstrated fact. It marks an historical epoch, but 
 it did not make a revolution. Although for Colombo 
 its truth was established beyond a doubt, it did not 
 seem so clear to his contemporaries and followers ; and 
 the reasons which he found sufficient for his own be- 
 
1^2 
 
 doctrInes of the circulation. 
 
 lief were by no means convincing to others. Some 
 adopted his conclusions wholly or in part ; others held 
 them in suspense ; and by many they were denied or 
 disregarded. 
 
 Ambrose Pare, in 1 561, in his Anatomie Universelle 
 du Corps Humain* cites Colombo as having discovered 
 (invente) a new route for the blood from the right ven- 
 tricle to the left, namely, that through the lungs and 
 the arteria venosa, and speaks of this opinion as a 
 " very probable" one. 
 
 Caesalpinus, in his Peripatetic Questions,^ published 
 in 1569, says that the lungs "are supplied with blood 
 from the right ventricle by the vena arterialis, and 
 transfer it by anastomosis through the arteria venalis 
 to the left ventricle." According to him, however, the 
 bronchial tubes, which are filled with cool air from 
 without, " do not communicate with the arteria venalis, 
 but run alongside its branches, and so temper its blood 
 by their contact alone." 
 
 Felix Plater, Professor of Practical Medicine in the 
 University of Basle, and author of a work on anatomy 
 in 1583,1 maintains that the "spirituous blood is formed 
 by the mutual admixture of air and venous blood in 
 the lungs ;" and that, " when the heart contracts, the 
 thick blood of the veins is poured out into the lungs ; 
 and when it dilates it draws into it the spirituous blood 
 already formed in the lungs." 
 
 Bauhinus, Professor of Practical Medicine at the 
 
 * Qitivres completes d'Ambroise Par6, Paris, 1840. Anatomie Uni- 
 verselle du Corps Humain, livre ii., chap. xiv. 
 
 ■j- Quaestionum Peripateticarum, lib. v., quEEst. iv. , 
 \ Felicius Platerus, De Corporis Human! Structura, Basilese, 
 MDLXXXIII., p. 172. 
 
DA WN OF THE CIRCULA TION. j ^ , 
 
 university of Basle in 1605, in his treatise on anatomy,* 
 presents Galen's doctrine of the transit of blood through 
 the porous septum of the ventricles ; but says that 
 " some deny this transit, making the blood pass by the 
 vena arteriosa into the lungs, where a part of it is used 
 for nutrition ; while the rest, altered and mixed with 
 air, is carried by the arteria venosa to the left ventricle, 
 for the generation and supply of the vital spirits and 
 blood." " This opinion," he adds, probably in allusion 
 to Plater, " was some time ago received with favor. But 
 for our part we leave these matters to the philosophers 
 (philosophantibus), as our object is to describe the real 
 structure and use of the parts, so far as, with God's 
 help, we are able to do it." 
 
 On the other hand, Falloppius, who was, like Co- 
 lombo, a professor in the university of Padua, and 
 whose complete worksf were first collected and pub- 
 lished in 1584, makes no mention of the pulmonary 
 circulation. He says that the " elaboration of the vital 
 spirits takes place in the left ventricle of the heart ;" 
 that the " vena arteriosa supplies the lungs with a finer 
 quality of blood, corresponding with their finer and 
 aereal texture;" the arteria venosa, "carrying fuligi- 
 nous matter from the left ventricle to the lungs, and 
 bringing air, already prepared in the lungs, to the 
 heart for its refrigeration." The blood of the right 
 
 * Caspar! Bauhini Basileensis Theatrum Anatomicum. Francofuiti, 
 1605, pp. 421, 422. 
 
 f Gabrielis Falloppii Mutinensis, Physici ac Chirurgicipraeclarissinii, 
 in felicissimo Gymnasio Patavino olim rem Anatoinicam et Chirurgicam 
 admirabili cum laude publice profitentis, omnia qute adhuc extant opera 
 nunc primum tali ordine exciisa, Venetiis, MDLXXXIIII., pp. 275- 
 278. Institutiones Anatomicse, Cap. De Thoracis. 
 
 12 
 
134 
 
 DOCTRINES OF THE CIRCULATION. 
 
 ventricle "is partly for generating afterward vital spirits 
 in the left ventricle, and partly for the nourishment of 
 the lungs, to which it is sent by the vena arterialis.'' 
 The reason why the lungs require so much blood for 
 their nourishment is " on account of their continual 
 movement, to supply the continual loss of substance 
 thus expended." Although Falloppius admits that the 
 spirituous blood is formed in the left ventricle, he says 
 nothing about the interventricular septum, nor does 
 he suggest in what way the blood reaches the left ven- 
 tricle from the right. 
 
 Louis Duret, who was physician in chief to Charles 
 X. and Henry III., and professor in the College of 
 France from 1568 to 1586, wrote a commentary on 
 HoUerius, De Morbis internis, which was first pub- 
 lished the year after his death, in 1587. In this work* 
 he says that "the dilatation of the heart draws air into 
 the left ventricle and blood from the vena cava into 
 the right, whence it is carried into the left by a pas- 
 sage which is inconspicuous and difficult to find in the 
 dead body." By the heart's contraction, on the other 
 hand, fuliginous matter is expelled through the arteria 
 venosa; th^ thicker kind of blood through the vena 
 arteriosa to the lungs ; and the finer kind through the 
 aorta to the body at large. 
 
 Andreas Laurentius, physician in chief to Henry 
 IV. of France, and chancellor of the university of 
 Montpellier, in his treatise on Anatomyf in the year 
 
 * lacobi Hollerii Stempani Opera omnia practica. Deinde Lud, 
 Dureti, M. Regii ac Professoris in eundem enarrationibus, etc., etc., 
 1623. In caput xxix De cordis tremore seu palpitatione Dureti in 
 suam enarratiojiem annotatio, p. 223. 
 
 f Andreee Laurentii Historia anatomica humani corporis et singu- 
 larum ejus partium. Parisiis, 1600. Lib. ix., cap. xi., pp. 482, 483. 
 
DA WN OF THE CIRCULA TION. i 3 5 
 
 1600, quotes Colombo's doctrine and the reasons in 
 its favor, but rejects them as insufficient. The first 
 of these reasons, namely, that the vena arteriosa car- 
 ries more blood than is needed for the nutrition of 
 the lungs, he says, has no weight; because the lungs, 
 from their loose, spongy texture and their incessant 
 motion, require an unusual quantrty of nourishment 
 to supply the waste. The second reason adduced by 
 Colombo, namely, that the arteria venosa already 
 contains spirituous blood, he says, is also invalid; 
 since this vessel carries spirituous blood from the 
 heart to the lungs, which need it, like other parts, 
 for their vivification. In this connection he employs, 
 on his own side, the same argument which Colombo 
 used in an opposite sense ; namely, that there are no 
 branches going from the aorta to the lungs, to sup- 
 ply them with spirituous blood. "The more likely it 
 seems," according to Laurentius, "and even indispen- 
 sable, that the vital spirits should be distributed to 
 these organs by the arteria venosa." Laurentius ac- 
 cordingly adheres to the doctrine of Galen and the 
 transudation of blood through the septum of the ven- 
 tricles. 
 
 Alpinus, Professor of Materia Medica in the uni- 
 versity of Padua in 1601, in his book on Prognosis,* 
 says that "the lungs in their dilatation receive from 
 without cool air, which they communicate through the 
 arteries (pulmonary veins) to the heart, to cool and 
 moderate its fiery spirit, and in their contraction venti- 
 
 * Prosperi Alpini Maroticensis, Philosophi et Medici, in Gymnasio 
 Patavino Medicamentorum simplicium Professoris ordinarii, De Prse- 
 sagienda Vita et Morte ^^rotantium Libri septem, Venetiis MDCI., 
 lib. iv., cap. i. 
 
136 DOCTRINES OF THE CIRCULATION. 
 
 late the innate heat and purify the vital spirits by ex- 
 pelling from the heart its fuliginous vapors." 
 
 Fabricius, in 161 5, in his work on the Organs of Res- 
 piration,* says that "the generation of heat and vital 
 spirits is in the heart;" that the lungs are provided 
 with the vena arterialis " for their own nutriment," while 
 the arteria venalis " carries air from the lungs to the 
 heart ; " that the arteria venalis " is a passage for air, 
 isince, having the texture of a vein, it can take in air 
 when it dilates, which would be impossible if it had 
 the texture of an artery ;" and that the vena arterialis 
 "is a vein and contains blood, but has the texture of 
 an artery to enable it to convey blood fine enough for 
 the nutrition of the lungs." The meaning of the last 
 phrase is, that if the vena arterialis had thin walls, like 
 other veins, its blood, partly refined in the right ven- 
 tricle, and consequently more attenuated than other 
 venous blood, would escape from it and thus fail to 
 reach the lungs; but that, having thick walls like an 
 artery, it can retain this refined blood, as the arteries 
 retain the still finer and more attenuated spirituous 
 blood. 
 
 Finally Spigelius, in his Anatomy of the Human 
 Body,t which was first published in 1625, embraces 
 vigorously the doctrine of the passage of blood through 
 the lungs from the right side of the heart to the left; 
 but he says that, up to that time, " nearly all anatomi- 
 cal writers have maintained that the vena arteriosa 
 
 * Hieronymi Fabricii Opera Omnia Anatomica et Physiologica. 
 Lipsise, 1687, p. 161. De Respiratione et ejus Instrumentis, cap. iii., 
 De Corde, & cap. xii., De Pulmonibus. 
 
 j- Adriani Spigelii Bruxellensis Opera Omnia. Amsterdami, 1645, 
 p. 139, 184. DeHuraani Corporis Fabrica, lib. v., cap. i., &lib vi., 
 cap. vi. 
 
DA WN OF THE CIRCULA TION. 
 
 137 
 
 conveys nutriment to the lungs, while the arteria venosa 
 carries air from the lungs to the heart.'' And although 
 he acceprs the doctrine of Colombo in so far as regards 
 the course of the blood, he nevertheless emasculates it 
 of a most important part ; namely, the mixture of blood 
 and air, and consequent arterialization of the blood in 
 the lungs. For Spigelius still believes that the attenu- 
 ation and elaboration of spirituous blood take place 
 in the left ventricle; and he maintains, like Caesalpinus, 
 that the air in the bronchial tubes only cools the blood 
 by contact with the adjacent pulmonary vessels, and is 
 not taken up by them or conveyed, in any form, to the 
 heart. Of all the writers above mentioned, on one 
 side or the other. Pare and Laurentius are the only 
 ones who quote Colombo by name. 
 
 It is evident that there were difficulties in the way 
 of the pulmonary circulation, not easily overlooked by 
 the anatomists of the sixteenth century. Vesalius had 
 shaken their faith in the perforations of the interven- 
 tricular septum, but had not indicated any other route 
 from the right side of the heart to the left. Beside 
 the doctrine of Colombo there were no less than three 
 other ways proposed, to account for the supply of blood 
 to the arterial system. 
 
 I. Leonardo Botalli, in 1565, published a monograph 
 on the Vena arteriarum nutrix, a ?iullo antea notata* 
 which was nothing less than a notice of certain cases of 
 persistency, in adult life, of the foramen ovale, forming 
 a communication between the right and left auricles.- 
 This foramen, as it exists in the foetal heart, had al- 
 ready been described by Galen, as well as the normal 
 
 * Leonard! Hotalli Opera Omnia. Lugd. Bat., 1660, p. 66. Obser- 
 vationes Anatomicjc. Observatio iii. 
 
138 DOCTRINES OF THE CIRCULATION. 
 
 process of its obliteration afterbirth;* but Botalli im- 
 agined that he had discovered, in his exceptional cases, 
 the " duct or vein which might be properly said to 
 supply the arteries and the vital spirits, because through 
 it, and not through either the septum or the arteria 
 venosa, the blood finds its way into the left ventricle, 
 and consequently into all the arteries." At the time 
 of the publication of this discovery, Botalli was court 
 physician to Charles IX., of France ; and notwithstand- 
 ing it was afterward recognized as a mistake, his name 
 remained attached to the foramen, which is still some- 
 times designated by French writers ~ as the"trou de 
 Botal." 
 
 II. Varolius, in his work on Anatomy.f first pub- 
 lished in 1573, does not believe that the blood of the 
 left ventricle has ever come, by any passage whatever, 
 from the right side of the heart. He observes that in 
 the foetus there is one umbilical vein, bringing venous 
 blood from the mother to the liver and vena cava of 
 the foetus ; and two umbilical arteries, bringing arterial 
 blood from the mother and opening into the abdominal 
 aorta of the foetus. He concludes that in the adult 
 there is a similar condition ; namely, that the portal 
 vein absorbs from the intestine the materials appro- 
 priate for venous blood, while the mesenteric arteries 
 absorb what is required for the generation of arterial 
 blood, and transmit it to the abdominal aorta. Accord- 
 ing to him, therefore, "the material needed for this 
 generation is taken up from the intestines and delivered 
 
 * Galen, Opera Omnia, vol. iv., pp. 243-245. 
 
 f Constantii Varolii, Philosophi ac Medici Bononiensis, Anatomise, 
 siue De Resolutione Corporis Humani Libri iiii. Francofurti, 1591. 
 Lib. ii., cap. i., p. 54, & lib. iii., cap. iv., p. 72. 
 
DAWN OF THE CIRCULATION. 
 
 139 
 
 directly through the arteries to the heart." In this 
 way he avoids the difficulty of supposing a transit of 
 blood from the right ventricle to the left, when there 
 are no passages for such a transit, '" unless we imagine 
 some which are imperceptible to the senses.'' 
 
 III. Thirdly, Umeau* fixed upon the spleen as the 
 organ in which a portion of the venous blood, freighted 
 with the juices of digestion and freed from its biliary 
 dregs, was transferred to the arteries and so conveyed 
 to the heart, to be mingled with air in the left ventricle 
 for the generation of the vital spirits. But these physi- 
 ological ventures do not seem to have met with suc- 
 cess; and there is little evidence that either of them 
 received any other support than that of its author. 
 
 Among the obstacles encountered by the doctrine 
 of Colombo was, no doubt, the familiar idea of the ar- 
 teria venosa (pulmonary vein) as a vessel containing 
 air rather than blood ; and this idea frequently recurs, 
 notwithstanding Colombo's assertion that in vivisec- 
 tions the vessel in question is always full of blood. 
 Galen taught that the arterial blood was vaporous 
 and spirituous in quality, but that neither air, vapor, 
 spirits, nor anything else of the kind, were perceptible 
 in it under their own form.f According to him, these 
 gaseous and spirituous substances were incorporated 
 with the blood of the arteries, or, as we should say, in 
 solution; and he makes no exception to this in the 
 case of the arteria venosa. His references to the 
 matter are too numerous^ to admit of a doubt, that in 
 
 * Franciscus Ulmus, De Liene, Parisiis, 1578. Haller, Bibliotheca 
 Anatomica, Lugd. Bat., 1774, torn, i., p. 247. 
 
 I Galen, Opera Omnia, vol. iv., p. 707. 
 
 J Galen, Opera Omnia, vol. ii., p. 597; vol. iii., pp. 451, 452, 539, 
 54'. 544- 
 
140 
 
 DOCTRINES OF THE CIRCULATION. 
 
 his doctrine, as against Erasistratus, this vessel con- 
 tained spirituous blood, and not spirits alpne, or any 
 aeriform substance.- But this seems to have been over- 
 looked or misapprehended by writers of the middle 
 ages ; and because Galen sometimes speaks of the 
 heart " drawing air from the lungs by the arteries of 
 these organs, as plants by their roots draw nutriment 
 from the soil,"* they imagined the pulmonary vessels 
 to be filled with air in bulk, coming from theflung to 
 the left ventricle. 
 
 Another misconception was that in regard to the 
 pulsation of the pulmonary vein. In the doctrine of 
 Erasistratus this vessel, the arteria venosa, pulsated 
 like other arteries, and for the same reason. But 
 Galen, who devotes nearly a chapter to this subject, 
 is careful to say that such pulsation cannot be detected 
 in it in vivisections,t and he prefers to distinguish the 
 vessels of the lung as arteries or veins, only as they 
 contain arterial or venous blood. Subsequently, the 
 pulsation of the arteria venosa seems to have been 
 taken for granted simply because it was an artery, 
 although Colombo's experiments had shown that this 
 was not true ; and in the Institutiones AnatomiccB of 
 Caspar Bartholinus, first published in i6ii, the defini- 
 tion of this vessel was concisely given as follows : " It 
 is called an artery from its function ; for, first, it pul- 
 sates, since it is continuous with the left ventricle; and, 
 secondly, it contains and carries air" (67). These dis- 
 crepancies show the uncertainty which existed, both as 
 to the truth of Colombo's opinion, and the grounds on 
 which it was based. 
 
 * Galen, Opera Omnia, vol. v., p. 525. 
 
 f Galen, Opera Omnia, vol. v., pp. 596, 600. 
 
DAWN OF THE CIRCULATION. 14, 
 
 Among the earliest to admit the doctrine of the 
 transit of blood through the lungs was Andreas 
 Gaesalpinus. He was for a long time professor of 
 Philosophy and Medicine in the university of Pisa, 
 where he was also director of the Botanical Garden. 
 While a resident of that city, he is supposed to have 
 followed the anatomical lectures of Colombo, from 
 1546 to 1548. Afterward he was called to Rome, 
 where he passed the remainder of his life as physician 
 in chief to Pope Glement VIII., and as professor of Medi- 
 cine in the Sapienza college. His works were on a 
 variety of subjects, namely, philosophy (Qusestiones 
 Peripateticae, 1569), daemonology (Dsemonum Investi- 
 gatio Peripatetica, 1580), botany (De Plantis, 1583), 
 Materia Medica (De Medicamentorum Facultatibus, 
 1593), mineralogy (De Metallicis, 1596), and general 
 medicine (Quaesti ones Medicae, 1593; Speculum Artis 
 Medicae Hippocraticum, 1601 ; Praxis Universa Artis 
 Medicae, 1606). The last of these works was posthu- 
 mous, as its author died in 1603. His reputation was 
 first established as a writer on philosophy; although 
 he was afterward distinguished for his works on botany, 
 in which he first introduced a classification of plants 
 founded on the organs of fructification. His position 
 in Rome as professor and medical adviser to the Pope 
 shows the estimate in which he was held as a physician ; 
 and his Speculum Hippocraticum was republished soon 
 after hjg death in Germany, as a desirable epitome of 
 the medical art. 
 
 Gaesalpinus represents very well the excessive erudi- 
 tion which was more or less in vogue at the time when 
 he wrote. His book of " Peripatetic Questions " is 
 not easy reading. Its topics are so profound, and 
 
142 
 
 DOCTRINES OF THE CIRCULATION. 
 
 their treatment so extensive, that the perseverance of 
 the reader is soon exhausted, and he wiUingly accepts 
 the advice of Chereau, in the Dictionnaire Encyclope- 
 dique des Sciences Medicates, to resort for further infor- 
 mation to the comments of some philosophical expert. 
 All critics agree that Caesalpinus was devotedlyattached 
 to the philosophy of Aristotle, whose opinions and 
 methods he advocated with an almost " religious zeal." 
 This was the case even in regard to anatomical and 
 physiological matters, a number of which are intro- 
 duced in the fifth book of his " Peripatetic Ques- 
 tions." In one of these he discusses the spontaneous 
 generation of animal bodies, even of man himself, 
 from putrefying material ; in another, the different 
 parts taken by the male and female elements in the 
 formation of the foetus ; in another, the supreme im- 
 portance of the heart as the origin, not only of the 
 arteries, but also of the veins and the nerves; and in 
 another, the residence of the vital principle, not in the 
 separate parts of the body, but in the heart alone. In 
 this book he also presents his view of the course of 
 the blood from the right ventricle through the lungs 
 to the left, during which passage it is cooled by the 
 contact of the bronchial tubes containing air. " The 
 lung accordingly," he says, " drawing warm blood, by 
 the vena arterialis, from the right ventricle of the heart, 
 and transmitting it, by anastomosis, to the arteria ve- 
 nalis which goes to the left ventricle, tempers it, by 
 contact alone, by means of the cold air transmitted in 
 the meantime through the bronchial tubes which run 
 alongside the arteria venalis, but do not, as Galen 
 thought, communicate with it by inosculations " (68). 
 He still, however, believes that the transit of blood 
 
DAWN OF THE CIRCULATION. 
 
 143 
 
 through the lungs is only partial ; as a portion of it 
 transudes through the interventricular septum, accord- 
 ing to the doctrine of Galen. " All the parts there- 
 fore,". he says, "are admirably constructed. For since 
 the blood needs to be warmed in the heart, in order 
 that its nutritive material may be brought to perfec- 
 tion ; first in the right ventricle, where the blood is 
 still of a thicker consistency, then in the left, where 
 it is already more refined; it is transmitted, partly 
 through the median septum, partly through the lungs 
 for the purpose of refrigeration, from the right ventricle 
 to the left " (69). 
 
 But the chief interest connected with Caesalpinus 
 lies in his having been credited by some writers with a 
 knowledge of the general circulation (70). De Renzi 
 endeavors to establish this, in part, by a somewhat 
 elaborate collation and explanation of quotations from 
 the Quaestiones Peripateticse and the QuEstiones Med- 
 icae ; but it depends mainly on a single sentence in 
 the botanical treatise, entitled De Plantis. In this 
 work the author begins by treating of vegetable phy- 
 siology in general ; that is, the organic character of 
 plants as distinguished from animals, their mode of 
 nutrition, germination, fructification, reproduction, and 
 morphology. This occupies the whole of the first 
 book. The main distinction between the animal and 
 vegetable kingdoms, according to Caesalpinus, is, that 
 while plants are endowed only with that kind of vitality 
 (anima) which provides for nutrition, growth, and re- 
 production, animals have, in addition, the faculties of 
 sense and motion. They require, accordingly, a finer 
 kind of nutriment, over and above what is needed for 
 vegetative life, and a more multiplied preparation and 
 
144 
 
 DOCTRINES OF THE CIRCULATION. 
 
 coction; so that, although both plants and animals 
 have " veins,'' or their analogues, for the absorption 
 and distribution of aliment, these vessels are differently 
 arranged in the two classes. . This is the occasion of 
 his well known reference to the vascular apparatus, in 
 this book. 
 
 The passage in question is as follows : " We will now 
 consider how the attraction of aliment and the process 
 of nutrition take place in plants ; for in animals we see 
 the aliment brought through the veins to the heart, as 
 to a laboratory of innate heat, and, after receiving there 
 its final perfection, distributed through the arteries to 
 the body at large, by the agency of the spirits produced 
 from this same aliment in the heart" (71). 
 
 To all conversant with the history of physiological 
 doctrine, it must be evident that there is nothing in 
 this passage which would imply in Caesalpinus a 
 knowledge of the general circulation. It was not taken 
 in that sense by his contemporaries, nor was such an 
 idea alluded to by any other writer of the sixteenth 
 century. There was no reason why it should be ; for it 
 is not presented by Caesalpinus as anything new, but 
 only to illustrate the different modes of nutrition in 
 animals and in plants. It expressed the accepted 
 doctrine, namely, that the aliment, first produced as 
 chyle in the stomach, and brought to the liver by 
 the portal vein for sanguification, is thence taken 
 through the hepatic veins and vena cava to the heart, 
 where its "ultimate perfection" is given to it by the 
 formation of the vital spirits, under the stimulus of 
 which it is distributed by the arteries throughout the 
 body. The same language might have been used by 
 Galen or any subsequent writer, without attracting 
 
DAWN OF THE CIRCULATION: 
 
 145 
 
 attention as anything novel. To suppose that Caesal- 
 pinus meant to describe an inward current toward the 
 heart through the veins in general, as contrasted with 
 an outward current through the arteries, would be an 
 unnecessary and forced construction of a very simple 
 statement ; namely, that of the delivery of nutritious 
 blood from the liver through the vena cava to the right 
 ventricle of the heart, to be used for the production of 
 spirituous blood in the left ventricle. The great mass 
 of venous blood was believed by Caesalpinus, as by 
 everyone else, to be distributed over the body, through 
 the vena cava and its branches, for the nourishment of 
 the parts. His only peculiarity in this respect was 
 that he recognized, in accordance with Aristotle, two 
 ]<inds of aliment in the blood ; one an " alimentum 
 auctivum," which provided for the increase of substance 
 in the parts ; the other, an " alimentum nutritivum," 
 which replenished their specific qualities.* The first 
 of these resided in the blood of the vena ^ava, and 
 was prepared by the coction of the stomach and the 
 liver ; the second was the more perfected aliment, pro- 
 duced in the heart and distributed by the arterial 
 blood. 
 
 Should there be any doubt remaining on this point, 
 it is easily removed by reference to other passages in 
 the works of Caesalpinus. In the fifth book of the 
 Peripatetic Questions, the third chapter is devoted to 
 establishing the doctrine, in conformity with Aristotle, 
 that the heart is the origin, not only of the arteries, but 
 also of the veins and the nerves. In the course of this 
 chapter he says : " But if the heart be the origin of the 
 blood, it must also be the origin of the arteries and 
 
 * Quaestiones Peripateticze, lib. v., qusest. iii., p. 117, E, F. 
 
146 DOCTRINES OF THE CIRCULATION. 
 
 the veins ; for these are vessels intended for the blood. 
 As, therefore, rivulets derive their water from a foun- 
 tain, so do the veins and the arteries from the heart " 
 
 (72)- 
 
 " For they both (vena cava and aorta) flow from the 
 
 same origin, the heart; because a single origin is 
 better than several, and also for the other reasons 
 adduced above; from the hot and capacious right ven- 
 tricle, containing a thicker blood in which the heat is 
 more intense, goes the vena cava ; while from the other 
 and smaller ventricle, containing a tempered and puri- 
 fied blood, passes out the aorta on the left side " (73). 
 
 In speaking of the supply of blood to the brain he 
 says : " From the heart pass out the veins and the 
 arteries, of which those which go to the head, after 
 entering the calvaria, partly make up the retiform 
 plexus in the ventricles, and partly constitute certain 
 common sinuses in the dura mater, from which are 
 distributed the bloodvessels to the pia mater " (74). 
 
 Finally, in his Speculum Artis Medicse, the last work 
 published during his life, he says : " The vena cava 
 supplies a material from the liver, which Aristotle calls 
 the alimentum auctivum. The aorta receives a per- 
 fected aliment, called the alimentum nutritivum, because 
 it provides for consumption " (75). And farther on, in 
 the section on the organs of the abdomen : " There are 
 two great veins, giving off numerous branches, the 
 vena porta and the vena cava, which have their roots, 
 as it were, in the liver. From the portal vein many 
 branches extend to the stomach and intestines, passing 
 in company with the arteries through the mesentery, 
 whence . they are called mesaraic veins, absorbing the 
 
DAWN OF THE CIRCULATION: 
 
 147 
 
 chyle, in order to carry it to the liver, converting it 
 
 meanwhile into blood The vena cava, on 
 
 the other hand, distributes its branches through the 
 whole body, in order that, simultaneously with the 
 arteries, they may nourish all its parts " (76). 
 
 If we recall what is said by Caesalpinus on the pas- 
 sage of blood through the lungs, it is plain that, so far 
 from being acquainted with the circulation of blood 
 through the body in general, he did not even accept 
 the pulmonary circulation in the full sense given to it 
 by Colombo ; since he acknowledged a partial transu- 
 dation through the interventricular septum, and re- 
 garded the air in the lungs as having only a cooling, 
 not an arterializing, action on the blood. His main 
 purpose is to defend the physiological ideas of Aris- 
 totle as against Galen, rather than to carry the doctrine 
 of either to a further development. 
 
 The discovery of the valves of the veins we owe to 
 HiERONYMUS Fabricius, Called, from the place of his 
 birth, Fabricius ab Aquapendente. It is true that 
 valves had been already seen, in a number of veins, 
 by various observers ; among whom were Etienne, 
 Cannani, Amatus Lusitanus, Sylvius, and Alberti. 
 But they seem to have been regarded as local or 
 exceptional formations, and were doubted or denied 
 by anatomists of such reputation as Falloppius* and 
 Eustachius.f Fabricius demonstrated their existence 
 as a general feature of the venous system, and de- 
 
 * Observationes de Venis. Observatio Quarta. Opera omnia, 1584, 
 
 P- 332. 
 
 f Opuscula anatomica. De Vena sine pari. Antigramma xi. 
 
148 DOCTRINES OF THE CIRCULATION. 
 
 scribed them in such a way that there was no longer 
 any uncertainty as to their reality or importance. 
 
 Fabricius was educated at the university of Padua, 
 where he was the pupil of Falloppius ; and his industry 
 and talent were so soon recognized, that at the age of 
 twenty-five years he was chosen to conduct the ana- 
 tomical demonstrations in place of his deceased master. 
 He afterward became Professor of Anatomy in the 
 same university, and discharged the duties of this chair 
 for a period of thirty years. He reached an advanced 
 age, and is said to have been engaged for nearly fifty 
 years in the work of medical teaching. He was also 
 successful as a practical surgeon ; and appears to have 
 been highly esteemed for his personal qualities, espe- 
 cially for his disinterestedness and liberality in pro- 
 fessional matters. 
 
 His observations on the valves of the venous 
 system were first made in 1574. They were subse- 
 quently continued and amplified, and made the subject 
 of demonstration in his public lectures; and in 1603 
 they were embodied in a special treatise,* amply illus- 
 trated with large and well-executed engravings. 
 
 Fabricius tells us how he discovered the venous 
 valves, " to his great delight," while engaged in dis- 
 secting. He calls them " little doors " (ostiola), or 
 " delicate membranes " within the veins, opening up- 
 ward toward the root of the veins, that is, toward the 
 heart, but closing downward, that is, toward their 
 ramifications. He thinks former anatomists in some 
 measure excusable for having overlooked so extraor- 
 dinary a formation. " For who could have expected 
 
 '^ Hieronymi Fabricii ab Aquapendente, Anatomici Patavini, De 
 Venarum Ostiolis. Patavii, 1603. 
 
DAWN OF THE CIRCULATION. 
 
 149 
 
 such membranes to be found within the veins ? Es- 
 pecially as we should anticipate that these vessels, in- 
 tended to convey blood throughout the body, would 
 have their cavities free, for the free passage of the 
 blood." He describes faithfully the semilunar form 
 and mode of attachment of the valves; their arrange- 
 ment singly or in pairs ; their alternate position in the 
 same vein, like the successive branches of a plant ; their 
 abundance in the veins of the limbs, and their absence 
 from the trunk of the vena cava and the internal 
 jugulars; and among his plates there are two of the 
 crural vein turned inside out, showing the valves in 
 that position. 
 
 The use of the valves, according to Fabricius, is as 
 follows : In his opinion, they are " so constructed, in 
 order that they may in some measure retard the blood 
 and prevent its running pell-mell, like a river, into the 
 feet, hands, or fingers, and being impacted there." If 
 that were to happen there would be two difficulties : 
 " First, the upper parts of the limb would suffer from 
 a deficiency of aliment, and secondly, the hands and 
 feet would be burdened by a constant tumefaction." 
 But, owing to the form and action of the valves, this 
 danger is avoided, and all parts of the limb are enabled 
 to receive the blood in just quantity and proportion; 
 That shows why the valves are numerous in the veins 
 of the arms and legs, but infrequent or wanting in those 
 of the great cavities of the body. " Because the brain, 
 heart, lungs, liver, and kidneys, organs which serve to 
 keep up the general vitality of the system, need an 
 abundance of aliment (which, for them, should not be 
 in the least retarded), both for replenishing their sub- 
 stance and for generating the vital and animal spirits." 
 
 13 
 
150 ^DOCTRINES OF THE CIRCULATION. 
 
 Another advantage of the valves is that they 
 strengthen the veins, and enable them to bear a pres- 
 sure which might otherwise cause their dilatation ; and 
 the resisting capacity of the valves, notwithstanding 
 their delicate appearance, is duly noticed. " For in the 
 case of varices, where the ostiola are either relaxed or 
 ruptured, we always see the veins more or less dilated. 
 From this we can no doubt conclude that the ostiola 
 are also useful for preventing venous distension, be- 
 cause the veins, with their thin membranous walls, are 
 especially liable to be distended and dilated." 
 
 Lastly, Fabricius notes that the locality and action of 
 the valves may be made visible in the superficial veins 
 by the swellings or sinuses above them when they are 
 filled as in an arm prepared for venesection, which is 
 very handsomely illustrated in one of his plates. 
 " Furthermore," he says, " any one can make the 
 demonstration, either in the exposed veins of the dead 
 body, or by ligature of the limb in the living subject, 
 as in the operation of bloodletting. For if you try to 
 urge or force on the blood by stroking it downward, 
 you will plainly see its course intercepted and retarded 
 by the ostiola." 
 
 Fabricius, accordingly, discovered and described a 
 most important element in the structure of the venous 
 system, which to us seems like an unmistakable guide- 
 post, to show the inward course of the blood through 
 these vessels. In fact, it afterward became a valuable 
 aid in the discovery of the circulation. But for the 
 time being, notwithstanding its apparent significance, 
 it remained barren of results ; and the veins were still 
 believed, as implicitly as ever, to serve for the supply 
 of blood from the central to the peripheral parts. This 
 
DAWN OF THE CIRCULATION. 
 
 iSi 
 
 has often been regarded as a matter of surprise ; and it 
 is sometimes considered as almost inexplicable why an 
 indication, which appears so positive at the present 
 day, was not equally plain to Fabricius and his con- 
 temporaries. 
 
 But a still more striking instance makes it evident 
 that the mechanical structure of a part is not always 
 sufficient to show its mode of operation. The car- 
 diac valves had already been known since the time 
 of Erasistratus, that is, for eighteen hundred years ; and 
 yet these valves, all opening in one direction and closing 
 in the opposite, nevdr even suggested the idea of a 
 circuitous course of the blood through the heart and 
 lungs, until it was announced by Colombo. Even then 
 the doctrine of the pulmonary circulation was by no 
 means generally accepted, and did not find favor with 
 Fabricius himself. 
 
 Secondly, both the cardiac and the venous valves wfere 
 largely regarded as closing imperfectly, and as forming 
 therefore only a partial, not a complete, obstacle to the 
 passage of the blood. This is true in regard to many 
 of the venous valves, and with some anatomists is still 
 a matter of question as to the tricuspid valves of the 
 heart. Fabricius especially mentions that even the 
 double valves do not always obstruct the entire calibre 
 of the vein, thus leaving a portion of it still free for the 
 passage of blood. 
 
 But the principal reason why the anatomists of that 
 day did not appreciate the full meaning of this dis- 
 covery is to be found in their inadequate knowledge 
 of the motion of the blood. According to them, the 
 blood in the veins moved from within outward, to 
 supply nourishment for the tissues; but it moved, of 
 
152 DOCTRINES OF THE CIRCULATION. 
 
 course, no faster than it was absorbed and consumed 
 at the periphery. The flow of blood, as they under- 
 stood it, was very different from that which is now 
 famihar to the student of physiology. The idea of a 
 continuous current, carrying all before it, and moving, 
 under the heart's impulse, with a velocity of ten or 
 fifteen inches per second, had no place in their con- 
 ception of the vascular apparatus. To them it was 
 rather like the slow swelling of the tide, in an inlet 
 already nearly full. The valves, consequently, did not 
 present so absolute an obstruction. Such a quiet stream 
 might, no doubt, creep past these valves ; though any 
 forcible or unusual impetus would distend them and 
 block the passage. That was why nature had made 
 them especially abundant in the limbs, where the fre- 
 quent exercise of muscular activity was a source of 
 danger from excessive impulsion. Thus the valves 
 were regarded, not very unreasonably, as a safeguard 
 against congestion of the parts beyond, from temporary 
 or accidental causes. Is not that exactly the function 
 which we still attribute to them ? The difference be- 
 tween our doctrine and theirs is, that with us the source 
 of the possible congestion is the compression of the 
 venous trunk, obstructing the flow of blood from the 
 capillaries ; with them it was the undue impulse of 
 blood from the trunk of the vein toward its branches. 
 At all events, it is certain that the kno^edge of the 
 venous valves did not change, in any essential particu- 
 lar, the accredited doctrine of the vascular system. 
 Like many other improvements of similar character, 
 it had its value as a necessary step in the develop- 
 rrient of anatomical and physiological science; but 
 its significance was greatly enhanced when it came 
 
DAWN OF THE CIRCULATION. 
 
 153 
 
 to be considered, at a later day, in the light of further 
 discoveries. 
 
 At the close of the sixteenth century the study of 
 anatomy and physiology was marked by great activity 
 of independent research. From Vesalius to Fabricius 
 there had been a succession of ambitious and enter- 
 prising investigators, each endeavoring, so far as in 
 him lay, to enlarge the boundaries of medical knowl- 
 edge, and to confirm or improve its ancient doctrines. 
 The progress which had been made consisted chiefly 
 in the addition of anatomical details, and the more 
 correct description of structures already known. The 
 physiological action of the heart and bloodvessels re- 
 mained for the most part what it had been from the 
 time of Galen. As generally understood, the heart 
 was still the seat of vitality, the source of animal heat, 
 the laboratory of vital spirits and arterial blood ; and 
 the two great systems of vessels, veins and arteries, both 
 served for the supply of blood throughout the body. 
 But in some particulars the vascular physiology of that 
 day deserves a closer examination, in order to appre- 
 ciate the changes afterward introduced. 
 
 One of the features in the doctrine of the sixteenth 
 century which often seems obscure, is that it rec- 
 ognized two systems of bloodvessels, both carrying 
 blood from the centre to the periphery, but none 
 bringing it back. How could the anatomists of that 
 time have supposed it possible that all this movement 
 should be in the direction of expenditure, and none in 
 that of return ? Must not the tissues, under such a 
 dispensation, be inevitably overwhelmed with the blood 
 thrown upon them by two simultaneous currents, with- 
 out any means of relief from its superabundance ? 
 
154 
 
 DOCTRINES OF THE CIRCULATION. 
 
 But this becomes more intelligible if we remember 
 that in the physiology of the time the wants of nutri- 
 tion, as we understand it, were supplied, mainly or 
 altogether, by the venous blood. It was this blood, 
 rich in the immediate products of digestion, which 
 distributed to the tissues the substances required for 
 their material growth and renovation. The arterial 
 blood, on the other hand, supplied them with the 
 stimulus o{ vitality and heat. It was the vehicle of the 
 vital spirits, communicating to all parts the endowments 
 of life ; and a portion of the vital spirits, converted in 
 the brain into animal spirits, provided through the 
 nerves for the active manifestation of the senses and 
 will. Thus the two kinds of blood were subservient, 
 each in its own way, to the process of supply which 
 we now attribute to arterial blood alone. This dis- 
 tinction is evident from many expressions used by the 
 writers of the period, which show that, in their view, 
 the venous blood served the organic system for its nu- 
 trition, the arterial blood for its vivification {Tj). 
 
 Furthermore, the ingredients of both venous and ar- 
 terial blood, distributed from the centre of the sangui- 
 ferous system, were expended and consumed at its 
 periphery. The source of daily supply for venous 
 blood was the digested food, or chyle, absorbed from 
 the intestines by the portal vein, and distributed by the 
 vena cava and its branches throughout the body, where 
 it was appropriated, in corresponding measure, by the 
 tissues. Thus the exhaustion of the blood at the 
 venous extremities kept pace with its renovation at 
 their source. " As the stomach, when it has digested 
 the food received by the (Esophagus, and delivered it 
 to the intestine lower down, soon calls for more food, 
 
DAWN OF THE CIRCULATION. 15^ 
 
 SO the liver, transmitting to the veins the chyle brought 
 by the vena porta, and converting it into blood for the 
 continual nourishment of the body, at once demands, 
 as if famished, a fresh supply of chyle. In like manner 
 each particle of the body takes blood from the little 
 veins, not indeed to transmit it to other parts, but to 
 retain it for its nourishment, and assimilate it to its own 
 substance ; and the blood, thus appropriated and assimi- 
 lated, is soon after resolved into vaporous excretions 
 and disappears. So all parts of the body require new 
 aliment, as the stomach must have new food, the liver 
 new chyle, or the milk-glands new blood."* Botallus 
 estimates f that at least one pound (twelve ounces) of 
 blood is produced and consumed daily by the healthy 
 human body. 
 
 On the other hand, the arterial blood was expended 
 still more rapidly ; for its essential ingredient, the vital 
 spirits, generated incessantly from the breath, was dif- 
 fused throughout the system by the arterial pulsation, 
 and dissipated in the production of heat and vitality; 
 while that portion of it which, in the brain, became 
 animal spirits, passed through the nerves to the organs 
 of sense and motion. The supply of blood, there- 
 fore, both venous and arterial, was no more than re- 
 quired to maintain the normal structure and activity 
 of the bodily frame. 
 
 Another point of interest for the student of physi- 
 ological history relates to the kind of movement, 
 believed to go on within the bloodvessels. That a 
 movement of some sort was recognized is evident 
 
 * Botallus. De Curatione per sanguinis rnissionem. Antverpiae, 
 1583, cap. i., p. 17. 
 f Ibid., cap. xxxiii., p. 174. 
 
156 DOCTRINES OF THE CIRCULATION. 
 
 from the frequent passages which represent the blood 
 as " agitated," " carried," or " transmitted " from one 
 place to another. But these terms would be liable 
 to misconception if we supposed them to indicate a 
 definite and continuous transportation, like that which 
 we now know takes place in the bloodvessels. The 
 anatomists of the sixteenth century did not believe 
 in two streams of blood, arterial and venous, running 
 continually outward, from the centre to the periphery. 
 That was manifestly impossible ; and what has already 
 been said on the subject of nutrition, shows that their 
 idea of the motion of the venous blood was quite un- 
 like that of a current or stream. 
 
 The motion of the blood in the veins, as then under- 
 stood, was, in the first place, independent of the heart's 
 action. A portion of the venous blood was drawn into 
 the right ventricle for further elaboration, or for trans- 
 mission to the lungs; but its distribution to the body 
 at large was effected by the action of the veins them- 
 selves' and the tissues which they supplied. Nearly all 
 anatomists, like Vesalius, described the venous walls as 
 containing three sets of fibres, longitudinal, transverse, 
 and oblique ; serving respectively to expand the vessel 
 and draw into it blood from the neighborhood, to con- 
 tract it and partially expel the blood, and finally to hold 
 and retain its contents, for the time being, at rest. 
 
 By the action of these different fibres, the blood was 
 attracted or impelled in the required direction for the 
 needs of the various organs. But their effect was local 
 and momentary, like a gentle peristaltic movement, 
 which might come and go at successive intervals. 
 
 The action of the veins is very distinctly explained 
 
DAWN OF THE CIRCULATION. 157 
 
 by Laurentius,* who calls them "canals or aqueducts 
 for containing, preserving, and distributing the blood." 
 They are, first of all, " vessels, or receptacles," for they 
 " hold the blood, as it were, in safe-keeping ; and if 
 withdrawn from them, it at once putrefies or coagulates." 
 Furthermore, they serve for its distribution ; and this 
 is accomplished " by attraction from neighboring veins 
 and transmission to others, by means of their longi- 
 tudinal and circular fibres." 
 
 Consequently the tendency of the blood, at any par- 
 ticular point in the venous system, might be in one 
 direction or the other at different times. . But beside 
 this, there was an " insensible attraction," somewhat 
 like our elective affinity, or force of osmosis, by which 
 different ingredients of the venous blood might pass at 
 once in opposite directions through the same vein. A 
 striking example of this is the passage of blood through 
 the portal veins to the intestine for its nourishment, 
 and the absorption and transfer of chyle from the in- 
 testine to the liver by the same vessels. Laurentius 
 avers distinctlyf that this double passage may take 
 place in a single vein at the same time. According to 
 nearly all writers, the arteria venosa brought air or 
 spirituous blood from the lungs to the heart, and also 
 conveyed fuliginous vapors from the heart to the lungs ; 
 a thing which Bartholinus J regards as not extraordi- 
 nary, " since it often happens that aliments are attracted 
 and excretions discharged by the same route." It is 
 evident, accordingly, that the great mass of the venous 
 blood was considered as in a comparatively quiescent 
 
 * Historia anatomica humani corporis, 1600, lib. iv., cap. ii. 
 
 f Historia anatomica humani corporis, lib. iv., cap. vii., qucest. v. 
 
 \ Institutiones anatomicse, lib. ii., cap vii. 
 
 H 
 
158 DOCTRINES OF THE CIRCULATION. 
 
 condition ; its renovation and distribution taking place 
 gradually and without noticeable physical disturbance. 
 
 With the arterial blood it was very different. This 
 was charged with the vital spirits, a vaporous or gas- 
 eous ingredient, incessantly generated and disseminated, 
 by its own expansive force and the pulsific action of the 
 vessels, to the confines of the arterial system. The 
 bright color, attenuation and mobility of arterial blood, 
 as distinguished from that of the veins, are forcibly 
 described by Spigelius. " In the first place," he says, 
 " the blood of the veins is more fibrous ; that is, it 
 contains more fibres (coagulating material). Secondly, 
 it is thicker; that of the arteries, on the contrary, 
 being more attenuated, owing to its coction in the 
 heart. And lastly, they are distinguished by their 
 color : for one is dark, the other ruddy ; one destitute 
 of spirits, the other impregnated with them ; the one 
 at rest, the other agitated by perpetual and incessant 
 motion" (78). 
 
 But this motion or agitation of the arterial blood 
 was still, in some sense, local both in its production 
 and operation. It is not easy to gain a precise idea of 
 its nature as understood in the sixteenth century, but 
 it appears certain that it depended mainly on the ac- 
 tion of the arteries. The heart, it is true, at each ven- 
 tricular contraction expelled spirituous blood into the 
 aorta. But the arteries were themselves gifted with a 
 pulsific force; and the most important manifestation of 
 this force was the active expansion of the vessel, by 
 which blood, spirits and fuliginous vapors were drawn 
 into it from adjacent parts. By its contraction, on the 
 other hand, the vaporous materials of the blood were 
 discharged through the skin and superficial membranes. 
 
DAWN OF THE CIRCULATION. 
 
 159 
 
 some of the liquid and solid ingredients being retained 
 by the tissues. Thus the pulsating^ movement of the 
 arterial blood, as a whole, was not so much a progress 
 as an agitation. It resembled the boiling of a cauldron 
 rather than the undulations of a river. That it could 
 not have had a very different significance from this is 
 shown by the fact that the arterial branches were re- 
 garded, in some cases, as agents of absorption as well 
 as of supply. The terminal anastomosis between ar- 
 teries and veins was more frequently described as al- 
 lowing a passage of blood from the veins to the arteries 
 than in the opposite direction (79); and the mesenteric 
 arteries were declared by Varolius* and Eustachius 
 (80) to perform the function of absorbing nutriment 
 from the intestine in the same manner as the mesen- 
 teric veins. These doctrines, of course, exclude the 
 idea of a continuous current of blood, in the modern 
 sense of the term, even from the arteries. 
 
 Not the least remarkable among the doctrines of this 
 period was that of the fuliginous vapors produced 
 in the living body and discharged by expiration. These 
 vapors are so often mentioned, and their existence so 
 confidently admitted, that it almost seems to imply, in 
 the writers of that day, an intuitive perception of the 
 modern results of physiological chemistry; for how 
 otherwise could they have imagined the excretions of 
 the breath to be identical in their nature with the gase- 
 ous products of combustion? 
 
 This doctrine, however, may be accounted for with- 
 out attributing to the anatomists of the sixteenth cen- 
 tury any gift of prescience or anticipation of modern 
 
 * De Resolutione Corporis Humani, lib. iii., cap. iv. 
 
l6o DOCTRINES OF THE CIRCULATION. 
 
 discovery ; for it only expressed certain truths already 
 in their possession. They knew nothing, it is true, of 
 oxygen or carbonic acid But they knew that a sup- 
 ply of fresh air was equally necessary for the mainte- 
 nance of life and the process of combustion; and that 
 air which had once been employed for either purpose 
 was unfit for further use. Its quality was changed, so 
 that it could neither support respiration nor feed a 
 flame. In this respect, the vapors discharged with the 
 breath were like those exhaled from burning fuel ; and 
 in each case the contamination of the air was preceded 
 or accompanied by the production of heat. By nearly 
 all writers, therefore, the resemblance in the effects 
 was referred to the operation of the same cause. Co- 
 lombo,* indeed, ridicules the idea of these "fuliginous 
 or smoky vapors," discharged from the heart through 
 the arteria venosa, " as if from the burning of green 
 firewood." But he seems to have misapprehended, in 
 some measure, the physical qualities attributed to these 
 excretions. They were not to be looked for as opaque, 
 dusky fumes, like the smoke of imperfect combustion; 
 but rather like the transparent and invisible gases from 
 the mouth of a furnace chimney, ^s the internal 
 heat was produced in the arterial blood, together with 
 the generation of vital spirits, the resulting vapors 
 were discharged, and found their way out of the body, 
 mainly through the lungs. 
 
 Lastly, the idea of respiration, as useful by its cool- 
 ing or refrigerating influence, may also find a plausible 
 explanation. It sometimes appears self contradictory; 
 because both the purpose and the result of this cool- 
 
 * De Re Anatomica, p. 178. 
 
DAWN OF THE CIRCULATION. i6l 
 
 ing influence are supposed to be the generation or 
 maintenance of the internal heat. But the notion of 
 a moderate degree of cold being favorable, and too 
 much warmth unfavorable, to igneous activity was as 
 old as Aristotle ; and although it is not clearly ex- 
 plained by any of the ancient writers, many allusions 
 employed .by those of the sixteenth century help to 
 make it intelligible. They observed that in the pro- 
 cess of respiration the air which enters the lungs is 
 cool, but when returned by expiration it is warm. So 
 that which feeds a furnace fire is fresh and cool at its 
 entrance, but comes out hot and stifling ; and if fire 
 be allowed to burn in a confined space, the warmer 
 the air becomes the less it is capable of sustaining 
 combustion. Their knowledge of the constitution of 
 the atmosphere was limited, of course, to its physical 
 qualities ; and among the most noticeable of these 
 were its coolness and warmth. They were accordingly 
 disposed to regard its coolness as a property which fed 
 or stimulated in some way the internal fire; especially 
 as it disappeared from air which was vitiated and 
 warmed by combustion. This explains why some, like 
 Falloppius and Fabricius, regarded the air as taken up 
 in the lungs and conveyed to the heart, there to per- 
 form its work of rekindling the vital heat ; while others, 
 like Caesalpinus and Spigelius, believed it to accom- 
 plish the same result by cooling the blood in the pul- 
 monary vessels. In either case the maintenance of 
 vital activity required a constant renewal of the air in 
 respiration, while its efiete products were discharged 
 with the expired breath. 
 
CHAPTER VIII. 
 
 HARVEY. 
 
 Within the limits of our present chronology there 
 are two periods of commanding interest in the history 
 of the vascular system; that of Galen and that of 
 Harvey. Separated from each other by an interval of 
 nearly fifteen centuries, they overlook all the interme- 
 diate epochs, and mark, each for itself, the starting 
 point of a new physiology. They gain, rather than 
 lose, from the effect of remoteness, and their impor- 
 tance becomes more apparent with the lapse of time. 
 
 In the year 1616, William Harvey began to dis- 
 charge the duties of lecturer on anatomy at the Col- 
 lege of Physicians in London. He was then thirty- 
 eight years of age, a member of the college, and phy- 
 sician to St. Bartholomew's Hospital. He had received 
 his early education in the university of Cambridge ; 
 after which he became a student of medicine at the 
 university of Padua, where he continued for four years, 
 obtaining his medical degree in 1602. He was conse- 
 quently a pupil of Fabricius, at that time professor in 
 the university, and probably the most celebrated anato- 
 mist of Europe. After completing his medical educa- 
 tion, Harvey returned to London and engaged in 
 general practice ; where his appointment in the College 
 of Physicians, some years later, shows the position 
 which he gained in the estimation of his colleagues. 
 
 Not long after entering upon his office as lecturer 
 
HARVEY. 
 
 163 
 
 Harvey began to present to the audience his new belief 
 in regard to the " motion and use of the heart, and the 
 circuit of the blood." He illustrated it by dissections 
 and experiments ; discussing with his hearers the 
 doubts and objections which occurred to them, and 
 appealing in their presence to the test of "ocular 
 demonstration." This he did for the reason that his 
 conclusions were so different from the accepted doc- 
 trine, and diverged so much "from the path followed 
 for ages by men of learning and renown," that he felt 
 it would be an arrogance to declare them in public, 
 without first submitting them to the judgment of hi5 
 colleagues. He continued to pursue this course for 
 nine years,* at the end of which time, in 1628, he pub- 
 lished his work,f already completed in manuscript 
 several years before (81). 
 
 This volume, a small quarto of seventy-twq pages, 
 undoubtedly contains a greater amount pf important 
 material in small compass than any other medical worlj 
 ever published. Its doctrines are presented with such 
 clearness of statement, and in such regyl^r sequence 
 as to leave no uncertainty in regard to the convic- 
 tions of the author or the manner in which he came 
 to adopt them. Notwithstanding his confidence in 
 the truth of his opinions, there is never in his lan- 
 guage anything like.assumption ; for he relies through- 
 out on the candor and intelligence of his reader, and 
 
 i^ Dedicatory Epistle to the President and Fellows of the College 
 of Physicians, 
 
 f Exercitatio Anatomica de Motu Cordis et Sanguinis in animalibus, 
 Guilielmi Harvei Angli, Medici Regii & Professbris Anatomiae in 
 CoUegio Medicorum Londinensi. Francofurti, M.DC.xxviil. There 
 is a fine copy of this edition in the Astor Library, New York, presented 
 in 1874 by Prof. Austin Flint, Jr., M.D. 
 
l64 DOCTRINES OF THE CIRCULATION. 
 
 on the reasonable evidence of observation and experi- 
 ment. It is by this means that he reached his own 
 conclusions, and he believes that the same proof will 
 be sufficient for others. 
 
 The idea of a new departure in the physiology of the 
 heart and bloodvessels seems to have taken origin, in 
 Harvey's mind, from the discordances and incongrui- 
 ties which he found in the existing doctrine. With the 
 majority, these imperfections passed unnoticed; or, if 
 dimly perceived, were accepted as a necessity. But 
 with him they were difficulties which needed explana- 
 tion ; and he could not rest satisfied with anything 
 which implied a physiological contradiction, or which 
 did not correspond with the testimony of the senses. 
 These uncertainties are set forth by Harvey in his 
 " Prooemium," or Introduction ; where he enumerates 
 the current opinions, which often seem " so inconsistent 
 with each other that they are fairly open to suspicion." 
 The first of these relates to the cardiac and arterial 
 pulsation, usually regarded as an act similar to that of 
 respiration : namely, a movement of expansion, in 
 which the heart or bloodvessel attracts into its cavity 
 material from the adjacent parts ; so that the arteries 
 "are filled, like bellows, because they are expanded, 
 not distended like bags, because they are filled." But 
 this doctrine, which had come down from Galen,* was 
 not in accordance with the facts ; for, as Harvey says, 
 " when an artery is wounded the blood escapes in jets, 
 now with greater, now with lesser impetus ; and its 
 more forcible expulsion is always at the diastole of the 
 vessel, and not at its systole. This would not be so if 
 
 * Galen, Opera Omnia, vol. iii., p. 512 ; vol. iv., pp. 730-731 ; vol. 
 v., pp. 163, 164; vol. xi., p. 598. 
 
HARVEY. 165 
 
 the diastole were a movement of expansion and attrac- 
 tion ; for in that case it would draw air through the 
 wound into the vessel, rather than expel the blood 
 from it." 
 
 Secondly, there was an evident contradiction in the 
 doctrine that the diastole of the heart and that of the 
 arteries were simultaneous ; for how was it possible, " if 
 they work together in this way, that one should attract 
 anything from the other, or that anything should be 
 transmitted from one to the other ?" 
 
 The assumption of porosities in the interventricular 
 septum, for the passage of blood through it (82), was 
 equally unsatisfactory; for, in the first place, " By Her- 
 cules, there are no such porosities, and they cannot be 
 demonstrated." Beside, if there were any, "how could 
 either ventricle draw anything from the other, since they 
 both dilate at the same moment ?" Furthermore, it 
 seemed incredible and inconsistent that the thick blood 
 should pass through these minute and imperceptible 
 channels, while the air to be mixed with it had the 
 widely open passage of the arteria venosa for its ac- 
 commodation. This inconsistency was still more ap- 
 parent from the fact that in the foetus, " where the 
 tissues are softer and more delicate," the foramen ovale 
 was provided for communication between the right side 
 of the heart and the left; and yet it was claimed that in 
 the adult heart, " with all the density of age," trans- 
 fusion could take place through the septum itself - 
 
 The transfer of air and blood, together or separately, 
 to and from the heart, by the arteria venosa, was also a 
 stumbling-block ; for supposing the left ventricle to 
 attract air and blood into itself for the generation of 
 spirits, and to discharge spirituous blood into the aorta, 
 
1 66 DOCTRINES OF THE CIRCULATION. 
 
 thus expelling one way fuliginous vapors by the arteria 
 venosa, and the other way spirits by the aorta, what 
 caused their separation ? And how was it that spirits 
 and fuliginous vapors could pass this way and that 
 without mixture or confusion ? If the mitral, valves did 
 not obstruct the exit of fuliginous vapors toward the 
 lung, how could they prevent the regurgitation of air 
 in the same direction ? It was said, furthermore, that, 
 notwithstanding the mitral valves, the arteria venosa 
 distributed to the lung spirituous blood. How could 
 these valves prevent the passage of air, and not that of 
 blood ? 
 
 These were the difficulties, and others like them, 
 which set Harvey's mind at work. Seeing so many 
 things that were obscure or unreasonable in the 
 teaching of his predecessors, he thought it would be 
 well to consider the subject more closely, and he de- 
 termined to study the action of the vascular system, 
 " not only in man, but also in animals ; and to prove 
 and investigate the truth by frequent vivisections and 
 repeated examination ;'' not to test his theory, for he 
 had none, but to see whether he could find anything 
 to remove the doubts and complications of the existing 
 doctrine. y^ 
 
 When we recall the state of physiological science 
 immediately before Harvey's time everything seems 
 ready for his discovery. Anatomy had been culti- 
 vate"d with ardor and success for nearly a century. The 
 two kinds of blood, arterial and venous, were well 
 known and fully distinguished by their physical quali- 
 ties. The porosity of the interventricular septum was 
 at least open to doubt, and the passage of blood through 
 the lungs had been offered as a substitute by one of the 
 best anatomists in Europe. Finally, the valves of the 
 
HARVEY. 
 
 167 
 
 veins, opening toward the heart and dosing toward the 
 periphery, had been described and demonstrated to 
 the satisfaction of all. They were there, to indicate 
 plainly, one would think, to the first comer, that the 
 movement of blood in the veins was from without 
 inward, and not from within outward. This appears 
 to us like the only thing wanting to establish the fact 
 of the general circulation, and as the first with which 
 a new investigator would almost certainly commence. 
 
 But what happened was exactly the contrary.. Har- 
 vey began with the motion and uses of the heart, and 
 its relation to the arteries. The course of the blood in 
 the veins was the last fact at which he arrived, and fol- 
 lowed as a final result upon his earlier investigations. 
 
 In his first chapter Harvey gives the reasons which 
 induced him to write. They were as follows : When 
 he first undertook to study the motion and uses of the 
 heart by inspection of the living organ, he found great 
 difficulty in understanding them. The movements were 
 so confusing to the eye, by reason of their rapidity, 
 that he could not even determine which was the sys- 
 tole and which the diastole; and he was almost ready 
 to think, with Fracastorius, that the problem was too 
 intricate for human comprehension. But at last, after 
 many trials and much perseverance, he was enabled to 
 solve the difficulty ; and believed that he had succeeded 
 in understanding the motion of both the heart and the 
 arteries, and the work which they performed. Since 
 then, he had freely presented the matter in his anatom- 
 ical lectures, meeting with approval from some and 
 vdissent from others; and he was now led to publish it 
 in printed form, "' in order that all might share in the 
 
l68 DOCTRINES OF THE CIRCULATION. 
 
 result of his labors," and " might form a judgment both 
 of himself and his conclusions." 
 
 The second chapter is on the character of the heart's 
 motion, as shown by vivisections. When the organ is 
 exposed to view in a living animal, the first thing which 
 strikes the observer is that it is alternately in motion 
 and at rest; and that these two conditions follow each- 
 other in unceasing regularity. At the time of its motion 
 three phenomena are noticeable : 
 
 " First. That the heart is erected, and raises itself up 
 into an apex ; so that at that time it can strike the 
 chest, and a pulsation may be felt externally. 
 
 " Secondly. That it is contracted every way, but more 
 so at the sides ; so that it appears smaller, elongated, 
 and drawn together. 
 
 " Thirdly. If taken in the hand, it perceptibly hardens 
 at the time of its motion ; this hardening being due to 
 tension, like that felt in the sinews of the forearm, 
 which grow tense and more resisting when they move 
 the fingers." 
 
 In addition to the above, it can be seen in cold- 
 blooded animals, as fish and reptiles, that the heart 
 "at the time of its motiqn grows paler; but when at 
 rest is deeply tinged with the color of blood " (83). 
 
 From these appearances Harvey draws the inference 
 that the activity of the heart consists in a muscular 
 tension and constriction of its fibres, producing in- 
 duration and thickening of its walls and diminution of 
 its cavities ; and that, by this means and at this time, 
 it expels the blood from its ventricles. This effect is 
 especially indicated by the last-mentioned observation 
 in cold-blooded animals, namely, that at the time of 
 the heart's movement and erection it becomes pale from 
 
HARVEY. 
 
 169 
 
 the absence of blood, while in its quiescence it re- 
 sumes its deep red color. But this point is too im- 
 portant to be left for surmise ; and Harvey's instinct 
 carries him straight to the experimental test which 
 shall settle it beyond dispute. " But no one," he says, 
 " need have any further doubt about it; for if he make 
 an opening into the cavity of the ventricle, he will see 
 the blood escape forcibly at each successive tension or 
 pulsation of the heart" (84). Consequently there are 
 four occurrences simultaneous with each other; namely, 
 the tension of the heart; the stroke of its apex, making 
 an impulse externally ; the thickening of its walls ; and 
 the forcible expulsion of blood, from constriction of its 
 ventricles. 
 
 This chapter, the first in which Harvey's experi- 
 ments are detailed, is not a long one, but it contains 
 the substance of a volume. It opened the way for the 
 whole discovery of the circulation ; for it changed 
 completely the idea entertained of the heart's move- 
 ment, and reversed the significance of its sensible pul- 
 .sation. The pulsation, striking against the walls of 
 the chest, had been considered, very naturally, as due 
 to the cardiac expansion or diastole ; and this move- 
 ment, the visible and palpable expression of the heart's 
 activity, was credited with the power of drawing into 
 it the liquids of the vascular system. Harvey demon- 
 strated that the opposite of this was true ; that the 
 active movement of the heart was its systole, expelling 
 the blood and coinciding with the external impulse ; 
 while its diastole was a passive condition, in which its 
 fibres were relaxed. " Nor is there any truth," he 
 says in conclusion, " in the common belief, that the 
 heart by any spontaneous motion or dilatation attracts 
 
I70 
 
 DOCTRINES OF THE CIRCULATION. 
 
 blood into the ventricles ; for at the time of its move- 
 ment and tension it expels the blood, and receives it 
 at the time of its collapse or relaxation " (85). 
 
 The next chapter treats of the character of the arte- 
 rial motion, as shown by vivisections. In this chapter, 
 Harvey applies to the motion of the arteries the same 
 inexorable test of observation which he had used 
 for that of the heart. With the aid of the facts al- 
 ready established, he sees that at the moment of the 
 heart's tension, constriction, and impulse, in a word, at 
 its systole, the arteries are in diastole ; and vice versa, 
 the systole of the arteries corresponds with the diastole 
 of the heart. The more laftguid the tension of the 
 heart, the less perceptible is the arterial pulsation ; and 
 when the heart's action ceases altogether, the move- 
 ment of the arteries also disappears. Furthermore, if 
 an artery be divided or opened, the blood is driven out 
 with impetus at the moment of the ventricular tension; 
 and in the operation of arteriotomy, the forcible jet of 
 blood is coincident with the arterial diastole and the 
 heart's impulse at the chest. 
 
 Consequently there is a change to be made in the doc- 
 trine of the arteries, as well as in that of the heart. The 
 arteries have no pulsific power, nor any force of expan- 
 sion for attracting fluids into their cavity. They are 
 filled and distended, at their diastole, " by the impulse 
 and intrusion of the blood sent into them by the heart;" 
 somewhat in the same way as when you blow into a 
 glove, the fingers of the glove are distended by the 
 force of the ingoing air. For this reason the arterial 
 pulses follow exactly, in force, frequency, rhythm, and 
 regularity, the tension of the heart ; because they are 
 dependent upon it for their existence. Anything which 
 
HARVEY. 
 
 171 
 
 obstructs the movement of blood through the arteries, 
 diminishes in the same ratio their diastole beyond the 
 obstruction ; " since the pulsation of the arteries is 
 nothing else than the impulse of the blood within 
 them." 
 
 Next to be considered is the motion of the auricles, 
 and its relation to that of the heart. Anatom'ists in 
 the seventeenth century still agreed in regarding the 
 heart as properly consisting of the ventricles; the 
 auricles being looked upon as appendages, either of 
 the heart itself, or, more frequently, of the veins. This 
 accounts for the phraseology in which the pulsation of 
 the auricles is spoken of as one thing, and that of the 
 " heart," or ventricles, as another. 
 
 Harvey observes that in the living heart there are 
 four visible pulsations, or contractions, namely, two of 
 the auricles and two of the ventricles. But although 
 these pulsations are four in number, they are only two 
 in time ; for the auricles contract simultaneously with 
 each other, and the ventricles also beat together ; the 
 auricular contraction preceding a little that of the ven- 
 tricle. He gives an accurate account of the way in 
 which these motions become successively enfeebled 
 and disappear while the heart is dying ; namely, that 
 the left ventricle stops first, then the left auricle, then 
 the right ventricle, and lastly, that the right auricle 
 keeps up its action after all other parts of the organ 
 are motionless. 
 
 These facts he does not offer as a novelty, for they 
 were known before. He uses them to introduce an 
 important observation, which can only be made while 
 the right auricle continues to beat, though the other 
 parts have lost their activity. " If at this time," he 
 
172 
 
 DOCTRINES OF THE CIRCULATION. 
 
 says, " you place your finger on the ventricle, while 
 the auricle is still pulsating, you will perceive separate 
 pulsations in the ventricle; in the same way as we 
 have already shown the pulsation of the ventricles to 
 be felt in the arteries, namely, from their distension by 
 the impulse of the blood. And at the same time, the 
 auricle alone pulsating, 2/"j)/(3?< cut off the point of the 
 heart with a pair of scissors, you will see the blood escape 
 from it with each auricular pulsation. This shows, con- 
 sequently, how it is that the blood gets into the ven- 
 tricle ; not by attraction or cardiac dilatation, but be- 
 cause it is impelled by the pulsation of the auricle." 
 
 The mechanism of the heart, therefore, is similar in 
 all its parts. Its pulsation is everywhere a systole, or 
 movement of contraction, expelling the blood from 
 one cavity and introducing it into another. The only 
 difference is in the strength of this contraction, which 
 is very forcible in the left ventricle, less so in the right, 
 and least of all in the auricles, whose walls are the 
 thinnest. But the auricles also propel the blood, and 
 they grow visibly paler in contraction, especially about 
 their points and edges. 
 
 Having explained these essential preliminaries, Har- 
 vey goes on, in the fifth chapter, to describe fully the 
 motion, action, and function of the heart. This is the 
 way its motions take place. First the auricle contracts, 
 propelling its blood into the ventricle; then the heart 
 becomes erected, tightens its fibres, constricts the ven- 
 tricles, and makes a pulse; by which the blood, intro- 
 duced from the auricle, is discharged into the arteries ; 
 from the right ventricle into the vessel going to the 
 lungs, and from the left ventricle into the aorta and its 
 branches. 
 
HARVEY. 
 
 173 
 
 But these motions, although performed by different 
 parts, are so connected with each other that there is no 
 interval between them ; and the whole cardiac pulsa- 
 tion forms a single continuous act. Every on,e who 
 has watched the movements of the living heart will 
 recognize the faithfulness of this description. Harvey 
 compares it to the working of machinery, in which one 
 wheel sets another in rotation, and yet all apparently 
 move together ; or, still better, to " the mechanism of 
 a musket, where, at the touch of the trigger, the flint 
 comes down, hits the steel and drives it forward, strikes 
 fire into the powder, the ignition runs inward, there is 
 an explosion, the bullet flies out and pierces the mark ; 
 and all these motions, from their quick succession, 
 seem to happen at once, in the twinkling of an eye" 
 (S6). It is also like the movements of the tongue, 
 fauces, pharynx, and oesophagus in swallowing. These 
 movements are consecutive but continuous, and alto- 
 gether they effect a single uninterrupted act of deglu- 
 tition. 
 
 Here we arrive at the essential part of this chapter. 
 The action of the heart, within the chest, is also a 
 deglutition. It is a transport or transfusion of blood, 
 from the veins to the arteries, by the successive parts 
 of the cardiac apparatus. The similarity is such that 
 Harvey cites it as an illustration. " When a horse 
 drinks," he says, '' and is swallowing water, we can 
 perceive its transit through successive parts of the 
 oesophagus, in its downward course to the stomach ; 
 for these motions make a sound, and cause a certain 
 audible and tangible pulsation. So the transfer of 
 blood, by the heart's motion, from the veins to the 
 
 IS 
 
174 
 
 DOCTRINES OF THE CIRCULATION. 
 
 arteries, makes a pulse which can be heard within the 
 chest." 
 
 The singularity of this illustration marks its import- 
 ance. At the present day, to associate the cardiac cir- 
 culation with the deglutition of water through the 
 gullet df a horse, would seem a coarse and clumsy 
 comparison. But as used by Hai'vey, it was the plain 
 and forcible announcement of a physiological truth. 
 It represented the heart for the first time as an organ 
 of propulsion for the blood ; that is, an apparatus of 
 muscular cavities, transmitting it in successive undu- 
 lations from one part of the vascular system to another. 
 Before, it had been regarded as in some mysterious 
 way the source of vitality and warmth, as an animated 
 crucible for the concoction of blood and the genera- 
 tion of vital spirits. Harvey does not presume to say 
 how far it may share in such endowments ; but he 
 declares that, so far as observation can show, it per- 
 forms a work of physical transportation. " The 
 motions of the heart, accordingly, are altogether 
 after this fashion, and their single effect is the transfu- 
 sion of the blood (from the veins to the arteries), and 
 its propulsion through the arteries, to distant parts ; 
 the beat which we feel in the arteries being simply the 
 impulse of the blood derived from the heart" (87). 
 
 But by what route is the blood carried, from the vena 
 cava to the arteries, or from the right ventricle of the heart 
 to the left? This is the title of the sixth chapter. 
 The principal cause of difficulty on this point, accord- 
 ing to Harvey, has been the mode of connection, in 
 man and the higher animals, between the heart and the 
 lungs. As the vena arteriosa from the right ventricle 
 loses itself, apparently, in the pulmonary, tissue, and the 
 
HARVEY. 
 
 175 
 
 arteria venosa, on the left side, has a similar blind con- 
 nection with the lung, anatomists were at a loss to see 
 how the blood could pass that way, from the vena 
 cava and right ventricle, to the left ventricle and the 
 aorta. Nevertheless, that is the route which it follows ; 
 and this would not have appeared so improbable if 
 anatomists had extended their dissection to animals of 
 different classes, instead of confining it so much to the 
 human cadaver. 
 
 Harvey shows, first, that in the animal kingdom for 
 the most part, the passage of blood from the veins to 
 the arteries, through the heart, is perfectly evident, and 
 not open to doubt. This is the case in fishes, which 
 have but one ventricle and no lungs ; where the blood 
 can be plainly seen entering the heart by the auricular 
 appendage at its base, and expelled by the artery going 
 to the gills, in the opposite direction. In frogs, ser- 
 pents, and lizards, though they have lungs, these organs 
 do not interfere with the transit of blood through the 
 heart ; and here also the way is manifest, with no more 
 difficulty or doubt about it than there would be in man, 
 if the septum of the ventricles were perforated or absent. 
 Now, as the animals which do not have lungs are more 
 numerous than those which have, and as there are more 
 with only one ventricle than with two, it is fair to say 
 that, " as a rule," in the animal kingdom, the blood 
 passes from the veins to the arteries through the heart, 
 by a plainly visible route. 
 
 But, in the second place, the same thing is true for 
 all animals, and man himself, during foetal life. The 
 foramen ovale and ductus arteriosus are open chan- 
 nels, whereby the blood reaches the arterial system 
 from the veins. At this time the lungs are inactive. 
 
176 DOCTRINES OF THE CIRCULATION. 
 
 motionless, and practically non-existent ; and such a 
 foetus is in the condition of an adult animal where there 
 never are any lungs (88). But after birth, when the 
 lungs come into activity, these passages are closed, and 
 there is no longer any way by which the Wood can 
 reach its destination except through the lungs. Harvey 
 contends that it passes by this route ; and he proposes 
 to show, first, that such a transfer is possible, and next, 
 that it actually takes place. 
 
 The following chapter is devoted to this point, namely, 
 that the blood transudes, through the pulmonary paren- 
 chyma, from the right ventricle of the heart into the arte- 
 ria venosa and the left ventricle. There is no impossi- 
 bility in a transudation of this kind, for we constantly 
 see rain-water filter through the earth, to reappear in 
 springs and rivulets. Furthermore, perspiration passes 
 in the same way through the skin, and urine through 
 the kidneys. There is another physiological action, 
 admitted by all, which is even more to the purpose. 
 The entire product of digestion must pass, every 
 day, through the liver, to reach the vena cava and 
 replenish the blood. How can we accept this, as we 
 must do, and deny tha't the blood can pass through the 
 lungs ? If the animal fluids transude through the 
 dense and motionless substance of the liver and kid- 
 neys, they must be able to penetrate the spongy and 
 movable tissue of the lung. Why, therefore, Harvey 
 asks, should not his readers give the same credence to 
 the passage of blood through the lung as to the per- 
 meability of the kidneys and the liver ? and " why 
 should they not admit the same thing, with Colombo, 
 that most skillful and learned anatomist, from the size 
 and structure of the pulmonary vessels, and the fact 
 
HARVEY. 
 
 177 
 
 that the arteria venosa, as well as the left ventricle, is 
 always filled with blood, which must have come from 
 the veins, and by no other path than through the lungs ; 
 as both Colombo and myself believe to be plainly 
 manifest, from what has gone before, from actual ob- 
 servation, and from other proofs beside " (89). 
 
 He holds it, therefore, to be undeniable that the blood 
 passes continuously through the porosities of the lung, 
 from the right ventricle to the left, and so from the 
 vena cava to the aorta. Since it is going incessantly, 
 from the right ventricle to the lungs and from the 
 lungs to the left ventricle, as shown by the position of 
 the valves, its continuous transudation must be ad- 
 mitted ; and, in like manner, since it is constantly going 
 into the right ventricle on one side, and as constantly 
 coming out of the left ventricle on the other, it must 
 necessarily be transmitted without interruption from 
 the vena cava to the aorta. 
 
 Harvey now approaches, in his eighth and ninth 
 chapters, a most important part of the subject ; namely, 
 that of the amount of blood passing through the heart, 
 from the veins to the arteries. Heretofore he has occupied 
 himself only with the fact that such a transfer takes 
 place, and that it is effected through the lungs. But 
 to an observer like him, the question of quantity could 
 not long fail to present itself; and he sets himself at 
 work to ascertain how much blood must pass the above 
 route at each cardiac pulsation, and to how much this 
 amounts in a given time. The results are most unex- 
 pected ; and they carry him forward at once to a new 
 stage of inquiry. 
 
 The left ventricle of the heart in a state of dilatation, 
 that is, when it is full, may contain one ounce and a 
 
178 
 
 DOCTRINES OF THE CIRCULATION. 
 
 half, two ounces, or three ounces of blood. Harvey 
 has found it to contain, after death, more than two 
 ounces. Now the same ventricle in a state of con- 
 traction contains less blood than when it was full ; and 
 this difference represents, of course, what has been dis- 
 charged into the aorta. It thus appears that at each 
 contraction of the ventricle it expels one-quarter, one- 
 fifth, one-sixth, or at the very least, one-eighth of its 
 contents. 
 
 But the heart's pulsations are very frequent; and 
 small quantities, continually added at short intervals, 
 often accumulate to a surprising amount. So it is in 
 this instance. In the human heart, at least one drachm 
 of blood must be expelled at each contraction of the 
 ventricle. With even the slowest pulse, there are, in 
 the space of half an hour, more than one thousand 
 pulsations. This represents one thousand drachms, or 
 a little over ten pounds of blood, passing through the 
 heart in half an hour, or twenty pounds per hour ; 
 that is, more blood than is contained in the whole body. 
 If the estimate be extended over the entire day, it be- 
 comes evident that the quantity of blood thus passing 
 through the heart and lungs, from the venous to the 
 arterial side of the vascular system, is far greater than 
 can be accounted for by the fluids already present, with 
 the addition of those supplied by digestion. Such a 
 superabundant transit would, in a short time, inevitably 
 empty the veins and overwhelm the arteries with blood. 
 There is only one condition in which it could be pos- 
 sible, that is, in case the blood were to pass again from 
 the arteries to the veins, and so return to the right side 
 of the heart. This would be, as it were, a " motion in 
 a circle," in which the blood would be sent from the 
 
HARVEY. 
 
 179 
 
 heart through the arteries to all parts of the body, and 
 brought back by the veins to the vena cava and right 
 auricle. 
 
 The rapid transit of blood through the arteries, in 
 like proportion to the above, is made evident by de- 
 monstration. For if you open, in a living animal, the 
 aorta, or even a small artery, the whole body will be 
 emptied of blood in less than half an hour. Butchers 
 know that they can drain the body of an ox, and make 
 the whole of it exsanguine, within a quarter of an hour, 
 by cutting off the arteries in the neck. It cannot be 
 said that this blood is lost from the veins as much as 
 from the arteries, for the same abundant hemorrhage 
 comes from a divided artery when the vein has been 
 left untouched ; and in all cases the more active the 
 arterial pulsation, the more rapid is the hemorrhage 
 and the more quickly is the body drained of blood. 
 
 This is the way in which Harvey reached the idea 
 of the circulation ; first, by seeing that the pulsation of 
 the heart is a muscular constriction, expelling the blood 
 from its cavities ; second, that the beat of the arteries 
 is a dilatation, caused by the impulse of blood sent 
 into and through them by the heart ; third, that by the 
 successive auricular and ventricular contractions the 
 blood is transmitted, through the lungs and heart, from 
 the veins to the arteries ; and fourth, that this trans- 
 mission takes place in such abundance and rapidity 
 that it can only be kept up by the blood returning again 
 to its starting point. 
 
 But in order to establish the reality of this circular 
 motion, it must be shown to be continuous and com- 
 plete in all its parts; namely, from the veins to the 
 
l8o DOCTRINES OF THE CIRCULATION. 
 
 arteries through the lungs and heart, from the arteries 
 to the veins in the distant organs, and lastly from these 
 organs through the veins back to the heart; and 
 everywhere in greater volume than can be explained 
 by the quantity of blood or the daily supply of nutri- 
 ment. 
 
 The first part of this circulation, from the veins to 
 the arteries through the heart, has already been shown 
 by computing the quantity of blood discharged from 
 a wounded artery, and of that expelled, in the normal 
 condition, at each ventricular pulsation. But in the 
 tenth chapter it is corroborated by a further experi- 
 ment, which gives decisive proof that the blood going 
 out from the heart by the arteries has been supplied to 
 it from the veins. If a living serpent be laid open, the 
 heart can be seen pulsating regularly and quietly for a 
 long time ; growing'pale in its systole and red in its di- 
 astole, and exhibiting distinctly all the appearances for- 
 merly described. " But this, in particular, can be shown 
 clearer than daylight. The vena cava enters the heart at 
 its 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 inter- 
 cepted 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 pul- 
 sation, 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 or compress the arteries at some dis- 
 
HARVEY. 
 
 ISI 
 
 tance from the heart, you will see, on the contrary, 
 their included portion grow excessively turgid, the 
 heart becoming distended beyond measure, assuming 
 a dark red color, even to lividity, and at length so over- 
 loaded with blood as to seem in danger of suffocation ; 
 but when the obstruction is removed, it returns to its 
 natural condition, in size, color and movement" (90). 
 
 The above experiment is well chosen. A serpent 
 is especially useful for the purpose, owing to the pe- 
 culiar elongated pattern on which its organs are con- 
 structed. The heart lies but a short distance below 
 the neck; the superior vena cava being small, and 
 much the greater part of the blood returning to the 
 heart by the vena cava inferior. In a black water- 
 snake (Tropidonotus sipedon) three feet long, the vena 
 cava may be tied or compressed at a distance of two 
 and a half inches below the heart ; when the phe- 
 nomena described by Harvey, namely, the emptying 
 of the vein above the point of compression, the con- 
 sequent exsanguine condition of the heart, and the 
 quick return of blood from below on detaching the 
 ligature, are all plainly visible. To one in Harvey's 
 position, duly instructed in the common belief that the 
 veins distribute their blood from within outward, this 
 experiment must have been extremely impressive. It 
 is especially convincing as to the rapidity with which 
 the blood moves through the heart, from the venous 
 to the arterial side of the circulation. 
 
 The next chapter is on the transit of blood in the 
 
 peripheral organs, from the arteries to the veins. It is 
 
 , mainly taken up with the effect produced by various 
 
 ligatures, and the difference between them. They 
 
 are of two kinds ; the " tight " ligature and the " mod- 
 
 16 
 
i82 DOCTRINES OF THE CIRCULATION. 
 
 erate " ligature. The first is that by which a limb is 
 so constricted that no pulsation can be felt in the parts 
 below ; such as those used to prevent hemorrhage in 
 amputations, for the castration of cattle, or for the 
 removal of tumors. The second, or moderate liga- 
 ture, is one which embraces the limb completely, but 
 without producing pain or suppressing arterial action 
 below ; like that used in venesection. 
 
 For Harvey's purpose they are employed as fol- 
 lows : 
 
 Let the arm be encircled above the elbow by a 
 " tight " ligature, drawn as closely as possible without 
 causing pain. It will then be observed that there 
 is no pulsation below the ligature, either in the fore- 
 arm, at the wrist, or in the hand; but just above it 
 the artery has a wider diastole, and beats more forci- 
 bly than usual, as if to overcome an obstacle ; the 
 hand meanwhile retaining its size and color, only losing 
 gradually a little of its warmth. 
 
 After the ligature has been kept for a time in this 
 condition, let it be gently loosened, so as to become 
 a " moderate " ligature, as in venesection. Instantly 
 the hand grows flushed and distended, with its veins 
 standing out tumid and tortuous; and after ten or 
 twelve pulsations of the artery the parts are filled 
 to repletion with the blood impelled and crowded 
 into them. While the ligature is being loosened, a 
 finger, placed upon the artery just below, will feel the 
 blood gliding along beneath its touch ; and the person 
 subjected to the experiment perceives distinctly the 
 ingress of warmth and blood into the limb, when the 
 obstruction is removed. 
 
 From this it is plain that the blood enters the 
 
HARVEY. 183 
 
 limb by the artery and leaves it by the veins. For 
 while the artery is compressed there is no influx, nor 
 drscoloration, nor .distension ; but as soon as it is re- 
 leased, the blood penetrates with force and causes tu- 
 mefaction. None of it comes in through the veins, 
 for they are compressed ; and the proof of this is that 
 they are more swollen below the ligature than else- 
 where, and that, so long as the ligature remains, they 
 cannot be emptied by pressure into the parts above. 
 On the other hand, the moment the ligature is re- 
 moved the swollen veins collapse, unloading them- 
 selves toward the heart; and the redness, turgidity 
 and congestion at once disappear. 
 
 While treating of these effects produced by the 
 " moderate ligature," Harvey takes pains to show that 
 the distension visible in the part is not due to " pain, 
 heat, or any force of a vacuum." The ordinary effect 
 of this ligature was, of course, woU known to physi- 
 cians ; but it was generally attributed to a sort of " at- 
 traction" exerted upon the fluids, drawing them into 
 the affected part. It was thought to be analogous to 
 the heat, redness, pain and swelling of local inflam- 
 mation ; and seems to have been explained somewhat 
 on the principle of tibi irritatio, ibifluxus. But Harvey 
 points out that the swelling, in case of such a liga- 
 ture, is without either pain or irritation ; and that there 
 is none of it above the ligature, though it may occupy 
 the whole of the limb below. In place of the obscure 
 hypothesis of attraction, he offers the simple and in- 
 telligible explanation of the free entrance of blood by 
 the arteries and its obstructed exit by the veins. 
 
 But how large is x!cA~quantity of blood passing in 
 this way, at the periphery, from the arteries to the 
 
1 84 
 
 DOCTRINES OF THE CIRCULATION. 
 
 veins ? This can be shown by opening one of the su- 
 perficial veins in an arm prepared for venesection by 
 the moderate ligature. In a short time the whole of 
 the blood previously contained in the arm will be 
 evacuated ; and after that, the blood which continues 
 to flow comes from the arteries of the internal parts. 
 The impetus of its discharge is from the heart ; for 
 it has already been shown that the heart's action is 
 the only force by which the blood is propelled. If 
 the hemorrhage go on, the blood expelled at last 
 from the wounded orifice must have come from the 
 heart, and through the heart from the vena cava. It 
 capnot descend from the veins above the ligature, for 
 the)' are impervious ; and if the bleeding be kept up 
 for half an hour, most of the blood will have come 
 from the great veins, through the heart to the arte- 
 ries, and so through the vessels of the arm to the 
 opened vein. Now, if we estimate how much blood 
 can be drawn, in this way, from the cephalic or ba- 
 silic vein, within the space of twenty or thirty pulsa- 
 tions; how much passes during the same time through 
 the arm of the opposite side; how much through the 
 thighs and legs, the head and neck, and all the other 
 vascular organs ; it will be evident that this quantity is 
 greater than the whole mass of the blood, and vastly 
 more than can be derived from the daily aliment, or 
 consumed in the nutrition of the parts. It must be 
 supplied from the centre of the circulation ; that is, 
 from the blood discharged by the left ventricle, which 
 has come, through the lungs and heart, from the 
 vena cava. 
 
 Lastly, Harvey arrives at his third division of the 
 subject; namely, the return of the blood, through the 
 
HARVEY. 
 
 185 
 
 veins, from the periphery to the heart. He begins this 
 chapter with a description of the venous valves, the 
 discovery of his former master, the " clarissimus Hier- 
 onymus Fabricius, peritissimus anatomicus et venera- 
 bilis senex." It is the structure of these valves, and 
 their operation in the living subject, which furnish the 
 last proof of the circular motion of the blood. 
 
 Harvey has little to add to the anatomical description 
 of the valves as given by Fabricius ; but he declares 
 that they offer a complete, not a partial, obstacle to the 
 passage of blood from within outward. He has often 
 tried this experiment. If a probe be passed into the 
 vein, in a direction from its trunk toward its branches, 
 however carefully managed it will never go far without 
 being arrested by a valve. But if turned in the oppo- 
 site direction, from the branches toward the trunk, it 
 passes with entire ease. In many instances the valves 
 are arranged in pairs, with their corresponding edges 
 so closely adapted that when shut, their line of junction 
 is imperceptible ; and yet when an instrument is intro- 
 duced from the periphery toward the centre, they yield 
 at once, and open without difificulty. He believes ac- 
 cordingly that the valves oppose an absolute resistance 
 to any movement of blood from the larger veins to 
 the smaller; allowing it, on the contrary, free passage 
 from the smaller to the larger. 
 
 But the fact can be more clearly shown by experi- 
 ments on the veins during life. Let the arm be tied 
 above the elbow with a moderate ligature, as for vene- 
 section. The superficial veins will then show them- 
 selves, with their lateral branches of communication 
 more or less turgid, and with spheroidal swellings or 
 " nodes " at various points, marking the situation of the 
 
l86 DOCTRINES OF THE CIRCULATION. 
 
 valvular attachments. Now if the finger be firmly placed 
 on one of these veins, immediately below such a node, 
 and then moved downward two or three inches away 
 from the node and along the track of the vein, so as to 
 empty it of blood for this distance, the vein will remain 
 empty between the point of its compression by the finger 
 and the node above. No blood will come into it from 
 the upper part of the vein ; and even if, with the fingers 
 of the other hand, you stroke the upper part of the vein 
 downward toward the node, you cannot force the blood 
 through, and the vein below still remains empty. This 
 shows that the valves, in a healthy, unopened vein, are 
 an impassable obstacle for the blood from above down- 
 ward. On the other hand, the moment the finger is 
 removed from the vein below, it is at once refilled from 
 this direction. 
 
 The experiment may be varied by first compressing 
 a vein several inches below a node, and then rubbing 
 it upward, with the fingers of the other hand, toward 
 the node. This will empty its included portion; the 
 blood passing through the valves of the node into 
 the vein above, but none of it returning in a down- 
 ward direction. When this has been done, lift up the 
 cortipressing finger for a moment, and let the vein 
 fill from below. Then empty it as before, by pressing 
 the blood upward past the valves. Then repeat the 
 former operation ; and so on, computing the quantity 
 of blood which passes this small section of the vein 
 at each repetition, and you will begin to appreciate 
 the volume of the mass returning from all quarters 
 toward the heart. And if you' object to the possible 
 violence or abnormal condition of such an experi- 
 ment, then, without any such violence or abnormal 
 
BAR VE V. 
 
 187 
 
 condition, empty a superficial vein upward by pressure 
 between two valvular nodes, and see how rapidly 
 the blood from below follows the retreating finger. 
 After that, there will be little probability of any remain- 
 ing doubt. 
 
 Beside the proofs and arguments already cited, others 
 are given in the latter part of the work, from various 
 physiological and pathological phenomena, the require- 
 ments of surgical practice, and the details of anatomical 
 structure, in both foetal and adult life. But these are 
 only in the way of confirmation ; and with the con- 
 clusion of his thirteenth chapter, on the valves of the 
 veins, the reader feels that Harvey's work is done. He 
 has gone, in orderly succession, through the entire round 
 of the vascular system, demonstrating, at each step, 
 the physical action of the parts, and the movement and 
 volume of the circulating blood ; and he leaves the 
 subject at last, with a wholly new interpretation of the 
 action of the heart and bloodvessels. 
 
 There are two features remaining, in connection with 
 Harvey's doctrine, of sufficient interest to attract the 
 reader's attention. 
 
 The first is that Harvey did not believe in the termi- 
 nal anastomosis between arteries and veins. Such an 
 anastomosis had been admitted almost from time im- 
 memorial ; and it had been especially corroborated by 
 Galen* from experimental evidence. For a new dis- 
 coverer, filled with the conviction of a perpetual transfer 
 of blood from the arteries to the veins, we should an- 
 ticipate that he would seize with avidity on the doctrine 
 
 * Galen. Opera Omnia, vol. v., p. 165. 
 
1 88 DOCTRINES OF ThE CIRCULATION. 
 
 of their communication. But these anastomoses seem 
 to have been too hypothetical for Harvey's fancy. 
 The actual passage of the blood between the two sets 
 of vessels was established on other evidence, too de- 
 cisive for doubt. But the precise method of its transfer 
 had not been demonstrated ; and Harvey preferred the 
 idea of a filtration through the porosities of the or- 
 gans, to that of communication by vascular orifices. 
 Throughout his work, De Motu Cordis et Sanguinis, he 
 is careful to speak of both methods as possible means 
 of transudation for the blood, without deciding posi- 
 tively in favor of either (91); but in his first letter to 
 Riolan, published in 1649, he declares that notwith- 
 standing he has endeavored, with all due diligence, to 
 discover the vascular anastomosis, he has never been 
 able to do so. 
 
 " I could never find," he says, " arteries and veins 
 communicating with each other by orifices, though I 
 might easily learn of them from others, who think so 
 much of Galen that they will make oath to whatever 
 he says. Neither in the liver, the spleen, the lungs, 
 the kidneys, or any internal organ is there any anas- 
 tomosis ; although, after boiling them until the whole 
 parenchyma is friable, so that it can be shaken like dust 
 or detached with a needle from the vascular fibres, I 
 have been able to see plainly all their filaments of sub- 
 division and hairy tufts. I can therefore confidently 
 assert that there is no anastomosis, either of the portal 
 vein with the vena cava, of the arteries with the veins, 
 or of the ramifications of the biliary duct, which are 
 distributed through the whole under part of the liver, 
 with the veins " (92). 
 
 If Harvey had possessed the finer methods of ana- 
 
HAR VE V. 
 
 189 
 
 tomical research of our own day, he would have seen 
 these vascular communications which he refuses to 
 acknowledge. But with his means of investigation 
 they could not be recognized ; and he was perhaps only 
 sensible and judicious not to accept them without better 
 evidence. It may be remembered, also, that the com- 
 munications now known to exist are not, after all, the 
 simple anastomoses admitted in Harvey's time. They 
 are a network of capillary bloodvessels, differing in 
 structure from both arteries and veins ; and the blood 
 in traversing them suffers a delay, somewhat like that 
 which it would meet with in filtering through the 
 porosities of a permeable tissue. 
 
 Secondly, Harvey's discovery introduced into anat- 
 omy a new definition of the terms, artery and vein. 
 Previously, a '' vein " was a vessel containing venous 
 blood ; and an " artery " was a vessel containing spirit- 
 uous blood. For the most part, the veins, under this 
 nomenclature, had thin and flexible walls, while those 
 of the arteries were thick and resisting. But there was 
 a notable exception to this rule in the case of the lungs, 
 where the texture of the two vessels was reversed ; and 
 for that reason the vessel carrying venous blood to the 
 lungs was the " vena arteriosa," while that carrying 
 spirituous blood to the same organs was the "' arteria 
 venosa." According to Harvey, on the other hand, the 
 arteries, which are always the same in texture, carry 
 blood from the heart to the organs ; the veins, also all 
 similar to each other, bring it from the organs to the 
 heart. Consequently, the " vena arteriosa " becomes 
 the pulmonary artery, and the " arteria venosa " the 
 pulmonary vein. 
 
CHAPTER IX. 
 
 THE DISCUSSION AND THE VERDICT. 
 PRJMEROSE. RIOLAN. BARTHOLINUS. 
 
 There is no circumstance of greater interest in the 
 history of the circulation than the impression produced 
 by the appearance of Harvey's book. Its doctrines 
 implied, by their novelty, an entire revolution in the 
 physiology of the blood and bloodvessels ; and they 
 were supported by an array of evidence which gave 
 them an unmistakable claim to attention. They had 
 been already presented in the author's lectures, and 
 were, of course, known to his associates in the College 
 of Physicians ; but they had received in this way only 
 a limited publicity, and were liable at any time to 
 revision or modification. With the publication of his 
 book, they assumed a definite and permanent form, and 
 were laid before the profession for their final consider- 
 ation. 
 
 The first work which appeared on the subject, after 
 that of Harvey, was one in opposition to it, by James 
 Primerose, a medical practitioner of some note, living 
 in Yorkshire. Primerose was of Scottish parentage, 
 but born in France, where he graduated in medicine, 
 in 1617, at the university of Montpellier. Soon after 
 receiving his degree, he went to England and engaged 
 in practice, in which he seems to have been very 
 successful. He was a man of good education, and a 
 ready writer, with a rather unusual facility of expres- 
 
THE DISCUSSION AND THE VERDICT. ipi 
 
 sion. He published a number of medical works, 
 two of which are said to have been much esteemed, 
 namely, one on "Vulgar Errors in Medicine," 1639; 
 and one on " Diseases of Women and their Symp- 
 toms," 1655. His treatise on the circulation * was 
 his earliest production. Like Harvey's book,, it is 
 dedicated, first to the King, and next to the President 
 and Fellows of the College of Physicians. The author 
 is induced to write, because the " learned and ingenious 
 doctrine " of the circulation of the blood seems to him 
 " of doubtful value to the medical art," and " beset 
 with most serious difficulties;" which he desires to 
 bring forward, that the truth may be made evident by 
 their discussion. 
 
 The book of Primerose is a protest and an argu- 
 mentation. He is opposed to " too great license in 
 impugning the doctrine of the ancients," and he enters 
 at length into the objections against the new system. 
 This part of his work is very instructive, as showing 
 the obstacles which delayed at that time the acceptance 
 of Harvey's views. 
 
 One of the most important of these difficulties was 
 the deeply rooted belief in two different kinds of blood, 
 contained in separate vascular systems, and destined 
 for essentially different purposes. The thick, dark- 
 colored, and sluggish venous blood was for the mate- 
 rial nourishment of the parts ; the highly elaborated, 
 
 * Jacobi Primirosii Exercitationes & Animadversiones in Librum 
 (iuilielmi Harveii de Motu Cordis et Circulatione Sanguinis. London, 
 1630. 
 
 It appeared subsequently, in company with the work of Parisanus, 
 under the title : Guilielmi Harveii de Motu Cordis & Sanguinis Ana- 
 tomica Exercitatio. Cum Refutationibus vEmylii Parisani et Jacobi 
 Primirosii. Lugd. Eat., 1639. 
 
193 
 
 DOCTRINES OF THE CIRCULATION. 
 
 scarlet, and spirituous arterial blood supplied the stim- 
 ulus of vitality for their more active functions. The 
 mobility of arterial blood was therefore, in great mea- 
 sure, a property of its own, dependiag on its ingre- 
 dient of vital spirits; the "spirits" being everywhere 
 the moving forces, according to Hippocrates. This 
 made it unnecessary to assume a physical propulsion 
 by the heart, to account for the motion of the arte- 
 rial blood ; and this is the reason, according to Prime- 
 rose, that .when an artery is opejjed, the blood escapes 
 with such impetus. It is ejected by the expansive 
 force of its vital spirits, not by a mechanical impulse 
 from the heart. Consequently, it is not surprising 
 that the blood escapes with greater violence at the 
 time of the arterial diastole; especially as it moves 
 from all the other arteries at once into the wounded 
 vessel. 
 
 The spirituous quality of arterial blood gave an air 
 of probability to other points in the accepted belief, 
 such as the filtration through the cardiac septum. 
 This filtration took place in very small quantity ; but 
 when the venous blood, once introduced into the left 
 ventricle, became impregnated with air, the combined 
 product of the two., that is, spirituous blood, was much 
 more abundant. " Blood," says Primerose, " is denser 
 than air ; but when it becomes attenuated, a very little 
 blood swells by rarefaction into a large mass. Philo- 
 sophers tell us that one volume of water will make ten 
 volumes of vapor; consequently, only a small amount 
 of blood is needed for the left ventricle." * 
 
 Another obstacle for the new doctrine was the sup- 
 
 * Primerose. Exercitatio xxv. 
 
THE DISCUSSION AND THE VERDICT. 
 
 193 
 
 posed absence of free communication between the 
 arteries and veins. Harvey did not admit the mutual 
 continuity of these vessels, and regarded the blood as 
 passing from one system to the other through the 
 substance of the tissues. But if the blood, as he 
 maintained, were carried through its course, in a con- 
 tinuous round, by the heart's impulse, how could this 
 impulse be effective in the veins beyond the inter- 
 vening tissues ? And if it were so effective, why did 
 not the veins pulsate as well as the arteries ? In 
 the pulmonary circulation there were additional diffi- 
 culties, which are duly set forth by Primerose. " In 
 case the blood follows that course," he says, " it must, 
 in the first place, escape from the vena arteriosa, 
 notwithstanding the thickness and density of its coats ; 
 which can only take place by anastomosis, or else 
 by rupture or exudation. But that is nothing to 
 what follows ; for, in the next place, it must find its 
 way to the arteria venosa and penetrate its walls. 
 Why should it get into the arteria venosa rather 
 than into the bronchial tubes? In hemoptysis, in 
 purulent expectoration, in pleurisy, we see the blood 
 and pulmonary humors ejected by the bronchi and 
 trachea. How fortunate would it be for such patients, 
 if'extravasated blood could get back into the arteria 
 venosa.'' 
 
 Primerose states the propositions of Harvey in their 
 regular order for special consideration, and he has no 
 difficulty in seeing which are the important points in 
 the argument. If his objections sometimes appear 
 captious, they are often forcible, and occasionally rather 
 unexpected, in their ingenuity and plausibility. For 
 instance, he says, addressing Harvey : " You deny the 
 
194 DOCTRINES OF THE CIRCULATION. 
 
 existence of the porosities of the septum ; but do you 
 think it any more difficult for the blood to pass that 
 way, than from the vena arteriosa to the arteria venosa 
 through the pulmonary parenchyma? Certainly, the 
 pores of the lungs are no less obscure than those of 
 the septum." 
 
 In his seventh chapter, to show the possibility of 
 the pulmonary circulation, Harvey adduces the transu- 
 dation of rain water through the earth, of perspiration 
 through the skin, of urine through the kidneys, and 
 of the blood, with the products of digestion, through 
 the liver. " But for those very reasons," says Prime- 
 rose, " I wonder that you should deny its transit 
 through the septum. If blood can pass through the 
 dense and compact liver, from the portal vein to the 
 vena cava, why not through the septum from the right 
 ventricle to the left ? " 
 
 When describing the peculiarities of the fcetal circu- 
 lation, in his sixth chapter, Harvey shows how the 
 blood passes from the veins to the arteries through the 
 foramen ovale and the ductus arteriosus ; and he asks 
 why Nature should not accomplish the same transit 
 through the lung, after the fcetal passages are closed. 
 " To that," says Primerose, " I should reply, that it is 
 because Nature chose to do differently. The question 
 is about the course of blood in the adult, and you have 
 described it as it is in the foetus. As to its significance 
 that is a point on which anatomists greatly differ." 
 
 The author is especially urgent in his criticisms on 
 Harvey's ninth chapter, in which it is maintained that 
 the blood is transmitted, by the heart's pulsation, from 
 the venous to the arterial system in greater abundance 
 
THE DISCUSSION AND THE VERDICT. 
 
 195 
 
 and rapidity than can be accounted for. by the whole 
 mass of blood or the daily supply of aliment. " This," 
 says Primerose, " is the turning point of the whole 
 question. If fairly proved, the thing is done, and no 
 further discussion will be necessary. For if the entire 
 blood really pass in this way from the veins to the 
 arteries, it must either all collect in the arterial system, 
 which we know is not the case, or else it must come 
 back by the veins. But physicians do not believe the 
 whole of the blood to be made spirituous in the left 
 ventricle, but only a part of it ; that, namely, which is 
 required for elaboration, with the aid of the inspired 
 air, to produce arterial blood." The expansion and 
 attenuation of blood, when it becomes spirituous, is 
 illustrated by the increased volume, of honey or milk 
 in a state of ebullition, when a very small quantity of 
 the original liquid will swell so as to overflow the con- 
 taining vessel. Harvey says he has found in the left ven- 
 tricle no less than two ounces of blood. It may be true, 
 replies Primerose, that the ventricle contains so much; 
 but that quantity will be sufficient for very many pulsa- 
 tions. The left ventricle attracts blood only as it is 
 required for elaboration ; and as for the quantity ex- 
 pelled at each cardiac contraction, he dissents entirely 
 from Harvey's estimate, that this is to be measured in 
 ounces, or drachms, or scruples. It is, perhaps, not 
 even a grain, but only a third or a quarter of a grain ; 
 and this quantity of blood can certainly be supplied 
 from the liquids absorbed in digestion. 
 
 It is evident from, the above, and other similar pas- 
 sages in Primerose's book, that in the combination of 
 blood and spirits, to make arterial blood, the resulting 
 compound was supposed to consist in a small proportion 
 
ig6 DOCTRINES OF THE CIRCULATION. 
 
 of blood and a much larger proportion of spirits. This 
 is the reason, according to Primerose, why, after death, 
 the arteries are nearly empty, though the veins are full 
 of blood. The spirits which the arteries contained 
 have then been dissipated, and the blood in these ves- 
 sels has subsided to its original volume. 
 
 The last proof adduced by Harvey that the blood 
 returns through the veins, from the periphery toward 
 the heart, depends on the existence and action of the 
 venous valves. But this, according to Primerose, has 
 no force. First, because the blood is supposed to re- 
 turn through all the veins, while only those of the 
 limbs and part of the trunk are provided with valves. 
 You cahnot, in a case like this, make an inference from 
 the particular to the general. How can the valves in 
 the veins of the limbs show an inward current in the 
 veins of the portal system or the head, where there 
 are no such valves ? The valves in the veins of the 
 limbs, according to Primerose, are only exceptional, 
 and intended to delay the afflux of blood to the mus- 
 cular parts, when attracted by unusual activity of mo- 
 tion. If they were for the purpose of preventing an 
 outward flow and favoring an inward current, why 
 should they not be found in the portal veins as well as 
 in those of the limbs ? As for Harvey's experiment with 
 the probe, which is arrested by the valves when pushed 
 from within outward, that does not show that blood 
 could not pass, in some measure, even when the valves 
 are closed. Like a stricture of the urethra, which 
 may retard the flow of urine without obstructing it 
 completely, the valves do not at any time quite pre- 
 vent the afflux of blood by the veins, though they 
 regulate it according to circumstances. 
 
THE DISCUSSION AND THE VERDICT. 197 
 
 One cannot help giving Primerose the credit of sin- 
 cerity. His increduh'ty seems due to a wrong estimate 
 of Harvey's proofs, rather than to intentional disregard 
 of their value. Although he quotes a number of ex- 
 periments in favor of his own opinion (93), it does 
 not appear that he performed any of them himself, or 
 that he attempted to verify those of Harvey. An 
 experiment actually witnessed often carries a very 
 different conviction to the mind from one that is 
 taken on hearsay; since objections, which might other- 
 wise seem plausible, are disposed of in advance by 
 the nature of its conditions and its results. Prime- 
 rose was well equipped with the armament of medi- 
 cal literature, and he could use it with skill in the 
 treatment of controverted topics; but he was satis- 
 fied with the existing doctrines of physiology, and he 
 could see in the new system only uncertainties and 
 defects. 
 
 A very different commentator appeared some years 
 afterward in thei person of Plempius, professor of Prac- 
 tical Medicine in the university of Louvain. Plem- 
 pius, who was a native of Amsterdam, began his medi- 
 cal studies in Leyden, and finally graduated at the 
 university of Bologna. After practising for a few 
 years at Amsterdam he became, in 1634, professor at 
 Louvain, where he passed the remainder of his life. 
 He is principally known from two of his publications; 
 one on ophthalmology, and one on the principles of 
 medicine. In the last of these works* he maintains 
 
 * Vopisci Fortunati Plenipii Amstelredamensis Fundamenta Medi- 
 cinse. Editio altera, recognita, interpolata, aucta. Lovanii, 1644. Lib. 
 ii., cap. vii. De Sanguinis Circulatione. 
 
 17 
 
Ip8 DOCTRINES OF THE CIRCULATION. 
 
 the doctrine of the circulation of the blood ; having 
 been convinced of its truth, after receiving it at , first 
 with incredulity. 
 
 This treatise is especially interesting from the vigor- 
 ous and outspoken style of the author, and from its 
 faithful presentation of the subject. Plempius takes 
 the reader fully into his confidence ; and shows him 
 plainly the doubts experienced by a well informed 
 and candid inquirer, and how they were set at rest 
 by means of direct observation. He gives a succinct 
 account of Harvey's doctrine, which, he says, had 
 been supported by its author with so many plausible 
 reasons, that it was already beginning to find favor 
 with not a few learned men. As for himself, "At 
 first," he says, " I did not believe in it, as I showed 
 publicly, both in words and writing. But afterward, 
 on going to work in good earnest to refute and explode 
 it altogether, I find I am refuted and exploded myself. 
 Its evidences are not persuasive ; they are irresistible. 
 I have diligently scrutinized them all, in living dogs 
 which I opened for the purpose, and find them to be 
 perfectly true." 
 
 He goes on to enumerate these evidences, from which 
 the doctrine of the circulation must be admitted; be- 
 ginning with the main proppsition, that the blood is 
 transfused by the heart's action, from the vena cava to 
 the arteries, more abundantly than can be accounted 
 for by the daily supply of nutriment. He makes this 
 calculation in the same manner with Harvey, and 
 comes to a similar result. " What are we to do now," 
 he says, " to save the ancient doctrine ? Where does 
 all this blood come from, to supply the heart ? Cer- 
 tainly not from the aliment. For the same thing hap- 
 
THE DISCUSSION AND THE VERDICT. igg 
 
 pens when no food has been taken for a couple of days. 
 There is no other possible explanation than this, that 
 the blood which is expelled from the heart into the 
 arteries again insinuates itself into the veins, and thence 
 hurries back to the heart, to be once more refunded 
 into the arteries." 
 
 This is the only conclusion that seems reasonable ; 
 and furthermore, " It must be adopted, because experi- 
 ment makes it imperative." He details Harvey's ob- 
 servation on the vena cava of the serpent, showing 
 that obstruction of this vessel arrests the return of 
 blood, which recommences on removing the compres- 
 sion ; and then adds one of his own on the crural 
 vein. " Or uncover," he says, " in a live dog, one of 
 the larger veins in the groin, tie it with a thread, or 
 take it up with forceps or the fingers, and you will see 
 the upper part of the vein toward the vena cava become 
 collapsed and emptied. The other part of it, on the 
 contrary, toward the foot, will swell up, until from re- 
 pletion it appears harder even than the artery; but 
 take away the ligature, and the blood at once moves 
 upward, relieving the vein from its hardness and dis- 
 tension." 
 
 The same thing may be seen in the veins of the arm, 
 when secured by a bandage for blctodletting; and this 
 proof is still more accessible, for nearly every one 
 sometimes does the operation of venesection, or, at 
 least, may see it done by others. Now when such a 
 bandage is placed on the arm, what happens ? The 
 veins below the ligature become tumid. But why 
 should they not swell above the ligature, if the blood 
 naturally comes down that way ? Furthermore, when 
 the vein has been opened and the blood is spout- 
 
200 DOCTRINES OF THE CIRCULATION. 
 
 ing out, if you compress the vein a short distance 
 below the orifice, the blood stops ; but if you compress 
 above the wound, it keeps on running. What could 
 show more conclusively than this, that the blood es- 
 caping at the wound does not come down from above, 
 but comes up from below ? Do you ask anything 
 better? Cut across, in a live dog (as Plempius has 
 done several times), the crural vein, and you will see 
 that there is no bleeding from the upper orifice, but 
 plenty from the lower; while if the same thing be done 
 with the jugular vein, all the blood comes from the 
 upper orifice, and none from the lower. In his opinion, 
 therefore, it is " decided and established, by these ex- 
 periments, so sure, constant, unquestioned, and unde- 
 niable, that the blood flows through the veins to the 
 heart, that it may again flow out from the heart into 
 the arteries ; that is, it moves in a circle.'' 
 
 But Plempius did not arrive at this conviction with- 
 out some mental conflict. He could not easily divest 
 himself of his " deeply imbibed " belief in the teaching 
 of the ancients, and he labored to find some way of 
 reconciling it with the facts. Might it not be that the 
 heart discharged into the arteries at each pulsation 
 much less than half a scruple; and that even this was 
 nearly all spirits rather than blood ? And might not 
 the heart often dilate and contract without receiving or 
 transmitting anything, as we see it do sometimes after 
 it is cut out of the chest ? '*In that case, the blood 
 supplied day by day from the liver might be sufficient 
 for the generation of vital spirits, and so for all the 
 spirituous blood discharged into the arteries. As for 
 . the experiment of the bandaged arm, and the swelling 
 of the included veins, perhaps that was because the 
 
THE DISCUSSION AND THE VERDICT. 20I 
 
 blood was compressed below the ligature and could 
 not escape, while above the ligature it had all the space 
 of the other veins to relieve its tension. 
 
 This is the way that Plempius argued with himself; 
 and he even says that in his lectures he could " satisfy 
 his audience '' with the same arguments. But on the 
 whole they were hardly convincing, and he was obliged 
 to confess that, " when duly considered, they did not 
 help the cause of the ancients." For who but a blind 
 man could believe -that nothing but spirituous matter 
 is sent from the heart into the arteries ? Ocular exam- 
 ination shows that the arteries and the left ventricle 
 both contain a ruddy liquid, which is as much blood 
 as that in the veins ; and what the ventricle contains 
 must be expelled by its contraction. The arteria venosa 
 is for the passage of blood as certainly as the vena 
 arteriosa ; that is made evident by vivisections, for all 
 who have eyes to see. Consequently the arteries are 
 distended by what is sent into them from the heart ; 
 and the heart and the arteries contract and dilate, not 
 together, as formerly supposed, but alternately with 
 each other. The arteries are dilated when the heart 
 contracts ; and when the heart is dilated the arteries 
 contract. There is no such thing as arterial pulsation, 
 except from the force of the blood propelled by the 
 heart. 
 
 The proposed explanation of the swelling of the 
 veins below a ligature is also futile. If it were true, 
 then they would swell in a dead man as well as in a 
 live one, under the same conditions. But nothing of 
 the kind takes place. Besides, it is not necessary to 
 bind the whole limb. A single vein, constricted by a 
 thread, becomes swollen below by the blood poured 
 
202 DOCTRINES OF THE CIRCULATION. 
 
 into it from the artery; and this is plainly shown by 
 the fact that, if the bandage be tight enough to com- 
 press the artery, there is no swelling of the part, be- 
 cause no more blood flows into it. 
 
 One difficulty in accepting the doctrine of the circu- 
 lation, with Plempius as well as others, had been the 
 following. If the blood circulated, as claimed by 
 Harvey, going out by the arteries and returning by 
 the veins, then all parts of the body must be nourished 
 by the same blood, and, moreover, by spirituous blood 
 only. But that was an unheard of thing, and con- 
 trary to all the ideas then entertained in regard to 
 nutrition. However, Plempius remembers that its 
 being up to that time unheard of does not necessarily 
 make it false. The venous blood, previously thought 
 to do most of the work of nutrition, must itself supply 
 a great variety of parts ; and why might not arterial 
 blood do the same? In fact there is no reason for 
 believing the two kinds of blood radically different. If 
 you take arterial blood and venous blood from the 
 same animal, and leave them until they have cooled 
 and coagulated, you will hardly be able to tell one 
 from the other. 
 
 There are several minor objections which Plempius 
 enumerates and refutes with equal success. His re- 
 marks are everywhere to the point; and his terse and 
 cogent reasoning must have had much influence in 
 winning adherents for the new doctrine. 
 
 In the meantime the question had been debated by 
 a number of other writers, who expressed their opin- 
 ions, either for or against the circulation, in. special 
 treatises or in published letters on the subject (94). 
 
THE DISCUSSION- AND THE VERDICT. 
 
 203 
 
 But the most important, among those who dissented 
 from Harvey's views, was Riolan, professor of Anat- 
 omy and Pharmacy in the Parisian School of Medicine, 
 Dean of the Faculty, a man of great influence among 
 his colleagues, and generally regarded throughout 
 Europe as the first anatomist of his day (95). He was 
 a native of Paris, where he became at an early age pro- 
 fessor in the Medical 'School, as his father had been 
 before him. He was a prolific Writer; no less than 
 twenty-eight of his works being enumerated by his 
 biographers, the most important -of which were on 
 anatomical and physiological subjects. His earliest 
 book, a treatise on surgery, was published in 1601 ; 
 but that which made his greatest reputation was his 
 Antropographia, which appeared in 161 8, and went 
 through many subsequent editions. He was physician 
 in chief to the Queen mother of France; and it was 
 mainly his influence in this position which resulted in 
 obtaining a royal edict for the establishment of the 
 Garden of Plants. 
 
 Riolan was the zealous advocate of conservatism in 
 medicine ; but by no means always in an excessive or 
 unreasonable way. He was the leader and mouthpiece 
 of the Paris faculty, in opposition to the noisy preten- 
 sions of the medical chemists ; who at that time claimed 
 to revolutionize the theory and practice of medicine, 
 though they were hardly better than so many alchem- 
 ists. Riolan defended the ancient system against these 
 unprofitable crudities with ardor and success. When 
 a number of large-sized bones were brought to Paris, 
 and exhibited as the remains of a certain legendary 
 giant, he pronounced them the bones of an animal ; 
 and soon after published his Gigantologie , showing that 
 
204 
 
 DOCTRINES OF THE CIRCULATION. 
 
 the men of unusual stature in ancient times were no 
 larger than those of modern periods, and that in all 
 times there have been instances of both giants and 
 dwarfs. He was the first to give a genuine interpreta- 
 tion to the story, repeated by various writers, of men 
 with hairy hearts and corresponding audacity. He 
 declared this hairy covering to be only coagulated 
 fibres from the pericardial liquid.* 
 
 Riolan saw that the evidence of a circular motion of 
 the blood was too strong to be disregarded. He com- 
 prehended its importance, and believed in its value as 
 a discovery. But he was fervently attached to the 
 ancient system of medicine, and he could not tolerate 
 the idea of its complete overthrow and disruption. 
 According to the doctrine of Harvey, this seemed inev- 
 itable. For if all the blood in the body were hurried 
 through the vessels, from the arteries to the veins, and 
 thence back to the heart and arteries, in an incessant 
 revolution, where was the opportunity for its sanguifi- 
 cation in the liver, and the expulsion of its impurities 
 by the abdominal organs ? How could it provide for 
 the nutrition of the parts ? How were the peccant 
 ■humors of the blood to be collected in particular locali- 
 ties, as in gouty and rheumatic affections, or concocted 
 and eliminated by the emunctories ? How could blood- 
 letting cause derivation of blood from the affected part ; 
 or how could local depletion or revulsive applications 
 be of any service in the treatment of disease ? And, 
 finally, what became of the distinction between arterial 
 and venous blood, and the special ofifice of each in the 
 vivification and nourishment of the tissues ? 
 
 * Casp. Bartholini Instilutiones Anatomicae, Lngd. Bat., 164I ; lib. 
 ii., cap. vi. 
 
THE DISCUSSION AND THE VERDICT. 
 
 205 
 
 Beside, the advocates of Harvey's doctrine did not 
 agree with each other in certain particulars ; such as 
 the quantity of blood propelled at each cardiac pulsa- 
 tion, the time required for its return to the heart, the 
 immediate cause of the heart's action, an(J the nature 
 of the arterial movement. The passage of blood through 
 the lungs, furthermore, was an unnecessary supposition 
 for its circular motion through the body. Galen's doc- 
 trine of its passage through the interventricular septum 
 was more probable, and attended with none of the 
 dangers or inconveniences of a pulmonary circulation. 
 Why should we deny the transit of blood through the 
 septum, when we know that serum can pass through 
 the walls of the veins, or penetrate the bones from their 
 medullary cavity ? And if the blood pass in a constant 
 stream through the pulmonary vessels, why are not 
 wounds of the lung always fatal from incontroUable 
 hemorrhage ? 
 
 Riolan accordingly refuses to accept the " Harveian 
 circulation," and offers, instead, one of his own;* which 
 shall have the double advantage of preserving the time- 
 honored Galenic system in its essentials " safe and 
 inviolate," and of avoiding at the same time the im- 
 probabilities and obscurities of the recent doctrine. 
 
 First of all, he rejects the circulation of blood through 
 the lungs, for the reason already given ; and adheres to 
 the dogma of its transudation through the interven- 
 tricular septum, the conveyance of air from the lungs 
 
 * Encheiridium Anatomicum et Pathologicutn. Paris, 1648. Also, 
 Opuscula Anatomica Nova, InstauratLo magna Physics & Medicinse, 
 per novam Doctrinam de Motu Circulatorio Sanguinis in Corde. Au- 
 tliore Joanne Riolano, Professorum Regioruiti Decano. London, 1649. 
 
 l8 
 
2o6 DOCTRINES OF THE CIRCULATION. 
 
 by the arteria venosa, and the formation of spirituous 
 blood in the left ventricle. 
 
 Secondly, the liver is still the organ of sanguifica- 
 tion. The blood is formed in this organ from the 
 daily products of digestion. A part of it is delivered 
 into the vena cava to replenish the system at large ; 
 the rest is contained in the portal system to supply the 
 abdominal organs. The hepatic vein and the portal 
 vein, therefore, in the liver, have no communication 
 with each other; and the blood of the portal system 
 is wholly disconnected from that of the vena cava. 
 Consequently there is no " circulation " of the blood 
 in the abdominal region, since none of it returns thence 
 to the heart; all of it, both in the portal vein and the 
 mesenteric arteries, being consumed in the acts of 
 nutrition and secretion. 
 
 Thirdly, the arterial blood of the left ventricle, re- 
 plenished from the vena cava through the interven- 
 tricular septum, is sent out by the arteries to all parts 
 of the body and limbs. Here a portion of it pa-sses 
 through the vascular anastomoses into the veins, which 
 are thus filled quite to their extremities. Fully one- 
 half this blood, that is, all contained in the smaller 
 venous branches and ramifications, does not circulate ; 
 it is employed for local nutrition, and remains in the 
 vessels of the part. The rest of it fills the vena cava 
 and its main divisions from the neck downward, and 
 through these channels returns to the heart, where it 
 passes through the interventricular septum, acquires 
 fresh heat and vitality in the left ventricle, and again 
 passes out by the arteries as before. This is Riolan's 
 " new circulation ;" .and this is why he calls it the 
 " motus circulatorius sanguinis in corde." There is no 
 
THE DISCUSSION AND THE VERDICT. 
 
 207 
 
 movement of the blood through the lungs or through 
 the abdominal organs; and only a portion of it returns 
 by the veins in order that it may pass through the 
 heart, where its spirituous quality is renovated and its 
 animating power restored. 
 
 By this means all uneasy doubts are satisfied. As 
 the blood does not circulate through the lungs, there 
 is no 'danger of its causing ecchymoses or aneurisms 
 in these organs, or being infected with their mucous 
 impurities or excretions. The incredible rapidity of 
 the circulating current, as estimated by its advocates, 
 is also reduced' to a more moderate computation ; for 
 Riolan believes that the heart admits and expels only 
 one or two drops of blood* at each pulsation ; which 
 would amount in fifteen or sixteen hours to hardly 
 more than twenty pounds. Thus that part of the blood 
 which returns to the heart would pass through the 
 round of the circulation only two or three times a day, 
 instead of forty or fifty times, as claimed by Harvey. 
 Furthermore, the established methods of practice might 
 continue in use; for since a large proportion of the 
 nutrient blood remains at rest in the veins of each 
 part, it may be influenced by venesection and local ap- 
 plications, as before. 
 
 It does not appear that this system obtained gen- 
 eral support, even among the opponents of Harvey. 
 It was discussed in the meetings of the Paris Faculty, 
 and was defended by its author with much persistence 
 and reiteration. But it did not satisfy the extreme 
 adherents of traditional dogmas, and it could hardly 
 find favor with those who believed in the experimental 
 
 * Opuscula Anatomica Nova. Liber de Circulatione Sanguinis, 
 cap. XV. 
 
2o8 DOCTRINES OF THE CIRCULATION. 
 
 development of a new physiology. Riolan remained 
 steadfast in his opinion, and would never allow of any 
 further concession, to the detriment of Hippocrates 
 and Galen. 
 
 Shall we blame Riolan for his obstinacy in resisting 
 the doctrine of Harvey ? On the contrary, it is an 
 advantage to medical science that there are always 
 some who are ready to question and doubt such an 
 innovation ; for they compel it to run the gauntlet of 
 adverse criticism, before being accepted by the profes- 
 sion at large. If it fail to bear this test, the cause of 
 failure is in its Own demerits, and it ought not to suc- 
 ceed. If founded in truth, it is all the better for being 
 subjected to opposition and scrutiny ; for they prove its 
 reality, and establish it at last upon evidence that none 
 can di.spute. 
 
 The publication of Riolan was soon followed by a 
 reply from one of his old pupils and admirers, Paul 
 Maquart Slegel, of Hamburg.* 
 
 Slegel says that when, some months before, a friend 
 brought him from Paris a number of recent medical 
 works, he was greatly pleased to see among them one 
 by Riolan, on the Circular Motion of the Blood ; for he 
 thought that the authority of so consummate an anat- 
 omist, and the example of the flourishing Parisian 
 School, would now suffice to settle the dispute and 
 secure general acceptance for the doctrine of the circu- 
 lation. But on reading the book he found, to his dis- 
 appointment, that its influence was in the opposite 
 direction ; and that the true doctrine of the circula- 
 
 * Pauli Marquarti Slegelii, Med. Hamburgensis, De Sanguinis Mqtu 
 Commentatio, in qua pifEcipue in Joh. Riolani, V. C. sententiam in- 
 quiritur. Hamburgi, 1650. 
 
THE DISCUSSION AND THE VERDICT. 20Q 
 
 tion, SO far from being corroborated, was hampered 
 with objections and disputations, and arrested, so to 
 speak, in the middle of its course. This gave him 
 much uneasiness. " Is it possible," he says, " that 
 I have been, for the last twenty years, all wrong 
 in believing this doctrine, which I liave taught and' 
 defended with so much ardor?" But his belief had 
 been founded on observation and experiment. And 
 after repeating the experiments, and subjecting them 
 to a second examination, he obtained the same results, 
 and his confidence was reestablished. So he determined 
 to write a letter of remonstrance to Riolan; but the sub- 
 ject grew under his hand, as often happens, and ended 
 in the production of a volume. 
 
 Slegel goes over the ground covered by Riolan step 
 by step, refuting his opinions with fairness and judg- 
 ment; though he hardly succeeds in making the subject 
 equallyattractive. His book shows somewhat ofthe pro- 
 lixity and taste for argumentation which he imputes to 
 Riolan, but without the talent and vivacity of the 
 French professor. 
 
 But the most appropriate person, to speak for the doc- 
 trine of Harvey, was Harvey himself; and he accord- 
 ingly replied to Riolan in two discourses,* which ap- 
 peared a short time before the work of Slegel. 
 
 Somewhat to his surprise, the reader does not take 
 much interest in Harvey's " Exercitationes ad Joannem 
 Riolanum." They are in response to a theoretical 
 
 * Exercitationes duse Anatomicse de circulatione sanguinis: ad 
 Joannem Riolanum, Filium, Parisiensem. These discourses are con- 
 tained in the edition of Harvey's worlcs by the London College of 
 Physicians, 1766; and in the English version of Dr. Willis, published 
 by the Sydenham Society, 1847. 
 
2IO DOCTRINES OF THE CIRCULATION. 
 
 system which is unsupported by material evidence, and 
 which represents hardly anything more than the opin- 
 ions and inferences of its author. Harvey's reply 
 occupies a similar ground ; and it^ mainly in the style 
 of controversial dialectics, rather than that of experi- 
 mental demonstration. In fact, the demonstrative part 
 of Harvey's work had been done before. His book, 
 De Motu Cordis et Sanguinis, had presented the 
 subject in so simple and concise a manner, that its 
 function was complete. Why should he amplify it 
 by a repetition of the same proofs, or by stating them 
 again in different form ? He adduces a number of ob- 
 servations which he had formerly omitted, as being 
 " redundant or useless " for the doctrine of the circu- 
 lation ; but they could have little weight with those 
 who were not already convinced on other grounds. 
 The debt which physiological science owes to Harvey 
 would have remained equally great if he had made no 
 addition to his first essay. 
 
 It. is in one of these Discourses, as already quoted 
 (page 1 88), that Harvey expresses his disbelief in the 
 supposed arterial and venous anastomoses. He declares 
 that neither Galen nor Riolan has ever made these 
 communications perceptible to the eye, and that they 
 are admitted only as matter of inference. This leads 
 to the curious result, that Harvey, who maintains the 
 circulation of the blood, denies the fact of vascular 
 anastomosis ; while Riolan, who denies the circulation, 
 accepts the existence of the anastomoses. The reason 
 is, that Harvey believes the whole of the blood to pass 
 from the arteries to the veins through the intervening 
 tissues for their sustenance and growth ; while Riolan 
 maintains that a part of it escapes from the arteries into 
 
THE DISCUSSION AND THE VERDICT. 2II 
 
 the veins without reaching the tissues, and goes back 
 to the heart for spirituous renovation. 
 
 So far, the doctrine of the circulation had made 
 greater progress in the north of Europe than in its 
 middle and southern portions. But it now received 
 powerful aid in France from the advocacy of Pecquet ; 
 who was led to investigate the movement of the blood 
 in connection with that of the chyle. The lacteal 
 vessels had been discovered by Asellius in 1622; but 
 as he saw only their origin from the intestine and their 
 convergence toward the root of the mesentery, he in- 
 ferred that they continued their course to the liver, after 
 the manner of the mesenteric veins. Pecquet, while a 
 student in the university of Montpellier, in 1647, dis- 
 covered the thoracic duct, in an animal opened during 
 digestion. In repeated experiments, by tracing this 
 vessel downward, he reached its origin, the receptaadum 
 chyli, into which the lacteals empty themselves; and by 
 tracing it upward he found its termination in the sub- 
 clavian vein. Consequently^ the chyle in the lacteal 
 vessels is carried, not to the liver, but through the 
 thoracic duct to the great veins near the heart ; and its 
 movement is directly connected with that of the blood 
 in these veins. 
 
 In Pecquet's treatise,* he demonstrates "the circular 
 movement of the blood throughout the animal body " 
 by the effect of ligatures on the arteries and veins. 
 Most, if not all these experiments had been done be- 
 fore; but he gives them the guarantee of his own testi- 
 
 * loannis Pecquet! Diepsei Experimenta nova anatomica, quibus in- 
 cognitum hactenus Chyli Receptaculum, & ab eo per Thoracem in ra- 
 mos usque Subclavios vasa lactea deteguntur. Ejusdem Dissertatio 
 Anatomica de Circulatione Sanguinis & Cliyli Motu. Parisiis, 1651. 
 
212 DOCTRINES OF THE CIRCULATION. 
 
 mony, and shows much originality in their arrange- 
 ment and in the directness of his conclusions. 
 
 He begins with the arteries and veins in general. 
 If, in the living animal, a ligature be placed on the 
 crural, brachial, or carotid artery, the vessel is emptied 
 beyond the ligature, but becomes turgid on the side 
 toward the heart; and if it be opened beyond the 
 ligature, there is no bleeding, while a puncture on 
 the side toward the heart causes abundant hemor- 
 rhage. But a similar experiment on the crural or 
 brachial vein gives the opposite result. The vein col- 
 lapses toward the heart and swells toward the per- 
 iphery; and a puncture below the ligature is followed 
 by hemorrhage, but above it has no effect. To make 
 sure that the blood which escapes from a wounded vein 
 has come from the arteries, he places a ligature, while 
 the hemorrhage is going on, upon the corresponding 
 artery. When this ligature is tightened, the bleeding 
 from the vein first diminishes, and then stops ; but 
 when it is relaxed, the hemorrhage begins again as 
 vigorously as before. 
 
 Pecquet supplements these results by an ingenious 
 experiment, applied to the exceptional cases where a 
 vein bleeds from a puncture above the ligature. 
 
 " You need not be disturbed," he says, " because 
 sometimes, though rarely, there is a certain amount ot 
 bleeding from the vein above the ligature. This comes 
 from some of its branches opening, here and there, into 
 the main trunk ; and I do not wish you to take my 
 word for it, but hear the proof." 
 
 " I was operating, one day, in the way described, and 
 had punctured the crural vein on both sides of the 
 ligature ; when, unexpectedly, I saw a flow of blood, 
 apparently continuous, not only below the ligature, 
 
THE DISCUSSION AND THE VERDICT. 2 r 3 
 
 but also above it. I then followed the vein upward as 
 far as the division of the iliacs, tying its small branches 
 as I met with them here and there, until they were en- 
 tirely closed ; when the flow of blood finally ceased. 
 The vein remained empty from the ligature upward, to 
 the situation of the valve in the groin ; and this valve, 
 obstructing the vein completely when I pressed it 
 above, showed conclusively that the blood has no pas- 
 sage through the veins from above downward." * 
 
 He then turns his attention to the arteries and veins 
 of the abdominal system, and soon finds that the coeliac 
 and mesenteric arteries follow the general law : that is, 
 they become turgid above the ligature, and flaccid 
 below it. But the veins of this region show a certain 
 peculiarity. When a mesenteric branch of the portal 
 system is tied, the vein swells, it is true, below the 
 ligature; but, at the same time, it is by no means 
 completely emptied in the direction of the liver, and 
 furthermore it bleeds when punctured on either side of 
 the ligature. 
 
 This brings to his mind the opinion of Riolan, that 
 the blood of the portal vein does not pass through the 
 liver into the vena cava; and he " would have been de- 
 terred, by the authority of so great a man, from further 
 experiments," if he did not feel that he ought to follow 
 the investigation throughout, and " subject it fully to 
 the severe judgment of the senses." 
 
 Accordingly, he returns to the examination of the 
 portal system. " I secured by a ligature the mesenteric 
 branch of the portal vein at a distance of three fingers' 
 breadth from the liver ; and then, at a similar distance, 
 placed a ligature upon the splenic branch, so that it 
 
 * Pecquet. Dissertatio anatomica de circulatione sanguinis, cap. i. 
 
214 DOCTRINES OF THE CIRCULATION. 
 
 could be tightened or relaxed at will. I had hardly 
 drawn this second ligature close, when the whole portal 
 trunk, from the ligatures to the liver, became collapsed 
 and exsanguine ; both of its branches, with their rami- 
 fications, being at the same time crowded with blood 
 from the intestines, mesentery, stomach, and spleen." 
 
 " If I relaxed either ligature, the exhausted portal 
 trunk was at once refilled, to be emptied again when 
 the ligature was tightened ; until, by frequent repeti- 
 tion of the experiment, there was no longer any doubt 
 of the abundant and rapid flow oT blood from the portal 
 vein into the liver."* 
 
 A similar trial with ligatures, on the hepatic vein 
 above the liver, proved in the same way that the 
 blood which enters this organ by the portal vein below 
 passes out by the hepatic vein above. The circulation 
 through the abdominal organs, notwithstanding its 
 local peculiarities, comes therefore, at last, to the same 
 result as that through the body at large ;. and the blood 
 of the portal system, like that everywhere else, is 
 continually supplied from the arteries, and as continu- 
 ally returned through the veins. 
 
 Finally, the pulmonary artery and the pulmonary 
 vein, subjected to the same test, act in a similar way: 
 that is, the artery swells from the heart toward the 
 ligature, and collapses between the ligature and the 
 lungs; while the vein becomes turgid from the lungs to 
 the ligature, and collapses between the ligature and the 
 heart. The course of the blood is, therefore, from the 
 right ventricle through the pulmonary artery to the 
 lungs, and from the lungs through the pulmonary vein 
 to the left side of the heart. 
 
 * Pecquet. Disserlatio anatomica de circulatioiie sanguinis, cap. ii. 
 
THE DISCUSSION AND THE VERDICT. 2 1 5 
 
 Pecquet, accordingly, followed in his experiments 
 the opposite route to that taken by Harvey. The in- 
 vestigations of Harvey began with the heart and the 
 pulmonary circulation, and finished with the return of 
 blood from the periphery by the veins. Pecquet began 
 with its movement through the vessels of the periph- 
 ery, and finished with that through the lungs and 
 heart. 
 
 The gradual adoption of Harvey's views may be 
 traced almost continuously in successive editions of 
 the anatomical textbook of Bartholinus. Caspar 
 Bartholinus was professor of Medicine in the university 
 of Copenhagen from 161 2 to 1623. His Institutiones 
 Anatomicce were first published in 161 1, and afterward 
 in 1626 and 1632; the last issue being four years after 
 the publication of Harvey's book, in 1628. But Bar- 
 tholinus died in 1629; and it could hardly have been 
 expected that he should so soon indorse the most 
 radical innovation in modern physiology. In his work 
 the structure and uses of the heart and bloodvessels 
 are set forth clearly and concisely, according to the 
 classical doctrine of the time. The heart is "the 
 abode of life and of innate heat." Its uses are : i. To 
 elaborate the vital spirits ; 2. To prepare blood for the 
 nutrition of the lungs ; and 3. To preserve the blood 
 from putrescence by its incessant pulsation. Its diastole 
 draws blood from the vena cava into the right ven- 
 tricle, an,d air from the lungs through the arteria venosa 
 into the left ventricle. Its systole discharges blood 
 from the right ventricle to the lungs by the vena arte- 
 riosa, expelling at the same time from the left ventricle 
 vital spirits into the aorta, and spirituous blood with 
 fuliginous vapors through the arteria venosa to the 
 lungs. The venous valves are for strengthening the 
 
2i6 DOCTRINES OF THE CIRCULATION. 
 
 veins, which are so much thinner than the arteries, 
 and especially for opposing a too abundant afflux of 
 blood to the limbs when in a hanging position or in 
 active motion. 
 
 Thomas Bartholinus, one of the discoverers of. the 
 lymphatic system (96), was the son of the preceding. 
 He studied under his father, and, like him, became 
 professor in the university of Copenhagen. He con- 
 tinued the editions of his father's work ; introducing at 
 first notes and appendices relating to matters of recent 
 interest, and afterward transforming the whole into 
 his own book, with the gradual accumulation of new 
 material and the increasing importance of his own 
 discoveries. 
 
 The first edition issued in this way appeared in 1641, 
 under the title Casp. Bartholini Institutiones Anatomiccs, 
 novis Recentiorum opinionibus & observationibus, quarum 
 innumercB hactenus editcz non sunt, fignris que auctm, ab 
 auctorisfilio, Thoma Bartliolino. The progressive policy 
 of the editor is indicated by a design on the frontis- 
 piece of a bird in full flight, with the legend movendo. 
 In his appendix to the sixth chapter of the second 
 book in this edition, devoted to the pulse, he says, that 
 William Harvey considers the pulsation of the heart 
 as excited by the influx of blood from neighboring 
 parts and its consequent distention ; an opinion which 
 Bartholinus thinks commendable for its simplicity, 
 since we "ought not to multiply causes unnecessarily." 
 However, reasons may be adduced in favor of other 
 explanations ; and, as the question is not to be deter- 
 mined by his judgment, he " will leave it to those who 
 are more learned." In a note on the interventricular 
 septum and the filtration of blood through its porosi- 
 ties, he says, although these foramina are imperceptible. 
 
THE DISCUSSION AND THE VERDICT. 217 
 
 " neither are there any visible channels for the passage 
 of perspiration through the skin, or of blood through 
 the parenchyma of the lungs, from the vena arteriosa 
 to the arteria venosa." To the function of the vena 
 arteriosa, for supplying blood for the nutrition of the 
 lungs, he adds, " and, according to the opinion of more 
 recent writers, to transmit it, through the arteria venosa, 
 to the left ventricle of the heart." In the body of the 
 work he does not further modify the physiology of the 
 heart and bloodvessels ; but, after the chapters on the 
 veins and arteries, he introduces two letters, " De Motu 
 Sanguinis," by Joannes Walaeus, professor in the uni- 
 versity of Leyden, who had embraced the doctrine of 
 the circulation, and who was greatly esteemed in the 
 profession. Bartholinus does this, as he says, be- 
 cause he does not yet feel himself capable of forming 
 a decisive opinion on such new questions, "' which 
 should be submitted for adjudication only to men of 
 the highest attainments." In these letters Walseus 
 presents the evidence in favor of the circulation, and 
 indorses it with the results of his own experience. 
 
 The next edition, of 1645, bears the same title, and 
 contains no essential alteration of text on the question 
 of the circulation. After the paragraph on the use of 
 the venous valves, a note is inserted as follows : "Ac- 
 cording to Harvey, the valves have a different use, 
 namely, to prevent movement of the blood from the 
 larger veins into the smaller." 
 
 In 1651 the work appeared under a new title, as the 
 Anatomy of Tliomas Bartholinus, still constructed on 
 the basis of the Institutiones Anaiomiccs of his father, 
 but enlarged and modified in accordance with the 
 times, and still further designated as Tertium ad san- 
 guinis Circulationem reformata. In this edition the 
 
2l8 DOCTRINES OF THE CIRCULATION. 
 
 author formally adopts the doctrine of the circulation. 
 The text of his father's book, he says in the preface, 
 which had become obsolete, he has remodelled and 
 made his own, correcting what was contrary to later 
 observations, and introducing all the recent discov- 
 eries ; and, " what is of prime importance, the circu- 
 lar motion of the blood, maintained by Harvey and 
 Walseus, and now accepted by most," he has "de- 
 scribed in full, with great care." 
 
 The book was reprinted in several successive issues 
 in the above form until 1673, when it was again 
 revised, enlarged, and published with additional illus- 
 trations and the following title: ThomcB BarthoHni 
 Anatome, ex omnium Veteruin Recentiorumqiie Ob- 
 servationibus, ad Circulationem Harvejanam et Vasa 
 lymphatica renovata. The author, in the preface, 
 calls this edition his " New Anatomy;" and says that 
 he has finished everything " according to the Harveian 
 circulation and the Lymphatic vessels," on which, as 
 foundations, " the whole superstructure is built." By 
 that time there was, probably, no difference of opinion, 
 in the north of Europe, in regard to the circulation. 
 
 In Italy, Veslingius, who was professor of Anatomy 
 in the university of Padua, had already, in 1647, ap- 
 proved the doctrine of the circulation,* though not 
 in a very serviceable or decisive way. TruUius, how- 
 ever, at Rome, in 165 1, maintained and demonstrated 
 it with such success that, according to Sprengel,t his 
 experiments convinced many who were before incredu- 
 lous ; and a few years later, in 1655, it was illustrated 
 
 * Veslingius. Syntagma Anatomicum, cap. a., De Corde et Pul- 
 monibus. 
 
 f Geschichte der Arzneykunde. Halle, 1827, Band iv., p. 85. 
 
THE DISCUSSION AND THE VERDICT. 2I9 
 
 on the human cadaver by Domenico Marchetti, who 
 had been the coadjutor of Veslingius, and who was 
 then supplying the anatomical chair in the university 
 of Padua. This circumstance is mentioned in the 
 Collection of Letters* by Thomas Bartholinus, in 
 which so many other matters of historical interest are 
 to be found. It appears that a certain Henry de Mo- 
 inichen, a native of Copenhagen, who had studied 
 under Bartholinus, was spending some time in Italy 
 for further improvement. While at the university of 
 Padua he witnessed this experiment, which he thought 
 of sufficient consequence to make the subject of a let- 
 ter to his former preceptor. "On the 13th and 14th 
 of March," he says, " Dominichus Marchettus, al- 
 though not professor, gave two lectures in the hospital, 
 one on the circulation of the blood, the other on the 
 
 lymphatic vessels He showed the circulation 
 
 in the arm of a dead woman, by injecting warm water 
 into the artery at the axilla, which returned by the 
 median vein, where it was opened by a lancet.'' 
 
 In France, the resistance of official conservatism 
 lasted longer ; and the doctrine of the circulation 
 was still excluded from the formal teaching of the 
 Paris Faculty, as not in accordance with the tenets 
 of medicine. But more liberal views were already 
 common among the physicians of the day. This 
 is proved by. the success of Moliere's admirable rep- 
 resentations of the medical pedant and routinist.f and 
 the readiness with which these satires were compre- 
 
 * Thomse BarthoUnse Epistolarum Medicinalium a Doctis vel ad 
 Doctos scriplaruni Centurias i. & ii., Hafnise, 1663. Cent, ii., Epis- 
 tola Ix. 
 
 j- In the Malade imaginaire, M. de Pourceaugnac, and V Amour 
 viedecin. 
 
220 DOCTRINES OF THE CIRCULATION. 
 
 hended and enjoyed by his audience ; for the faithful- 
 ness of such delineations is understood by the public 
 only after it has been already recognized by the pro- 
 fession (97). 
 
 But. modern physiology found expression at last 
 in an institution not connected with the Paris Faculty. 
 The Museum of Natural History in the Garden of 
 Plants was founded, in 1635, as a medium of indepen- 
 dent research and instruction; and in 1673 it was pro- 
 vided with a chair of anatomy, especially " for the 
 propagation of new discoveries." This chair was occu- 
 pied by Pierre Dionis, who lectured with great success 
 for a series of years on The Anatomy of Man, according 
 to the circulation of the blood and the latest discov- 
 eries. These lectures were afterward published in book 
 form;* and, like the rest of Dionis' works, in the 
 French language. Their dress, as well as their sub- 
 stance, was therefore in modern style ; although an 
 edition, published at Geneva in 1696, underwent be- 
 forehand a translation into I^atin. Dionis does not 
 originate any new doctrine on this subject, but he 
 presents the experimental evidence in favor of the 
 circulation, which he has himself verified. He recom- 
 mends, as especially convincing and easy of perform- 
 ance, the ligature and puncture of the crural ar- 
 tery and vein. "This experiment," he says, "which 
 may be done on a variety of animals, will satisfy you 
 that the blood is transported by the arteries from the 
 heart to the extremities, and that it is returned by the 
 veins from the extremities to the heart." 
 
 * Nouvelle Anatomie de I'Homme, suivant la circulation du sang 
 and les dernieres D^couvertes, D^montree au Jardin Royal par Mr. 
 Dionis, premier Chirurgien de feue Madame la Dauphine, &c., Paris, 
 1690. 
 
CHAPTER X. 
 
 VISIBLE PROOF OF THE CIRCULATION. 
 
 It appears, from the foregoing, that the question of 
 a peripheral anastomosis between arteries and veins 
 was a difficulty for both the friends and the enemies 
 of the circulation. Many of its friends denied the 
 existence of a direct anastomosis, and believed that 
 the blood passed by filtration through the paren- 
 chyma of the organs. Its enemies held that so abun- 
 dant a transit could only take place by vascular con- 
 tinuity, and they declared that such continuity had 
 never received a practical demonstration. But this 
 demonstration was at last accomplished. 
 
 The first to see the blood passing through the 
 capillary vessels, from the arteries to the veins, was 
 Marcello Malpigui, professor of medicine in the uni- 
 versity of Bologna. In 1661 Malpighi was engaged 
 in investigating the structure of the internal organs ; 
 and among his most valuable results were those ob- 
 tained from the study of the lungs. They are embraced 
 in two letters, Z'f Pulmonibus, written, the same year, 
 to his friend and benefactor Borelli, mathematical pro- 
 fessor in the university of Pisa.* 
 
 In the first letter he informs Borelli of the success 
 which has attended his researches on the lung tissue. 
 These organs had been regarded as consisting, in addi- 
 tion to the bronchial tubes and bloodvessels, of a fleshy 
 
 * Marcelli Malpighii Opera Omnia. Londini, 1686, torn, ii., p. 133. 
 19 
 
222 DOCTRINES OF THE CIRCULATION. 
 
 " parenchyma ; " that is, of a semi-solid material, de- 
 rived from sanguineous exudation, and not anatomically- 
 different from that of the liver or the spleen. But 
 Malpighi found the whole of the pulmonary substance, 
 attached to the bronchial tubes, to be "an aggregation 
 of the finest and most delicate membranes, forming, 
 by their extensions and sinuosities, innumerable 
 rounded vesicles, like the cells of a honeycomb with 
 their thin wax partitions." He discovered this structure 
 by inflating the lungs, taken fresh from the recently 
 killed animal, and observing with his magnifier (98) 
 the distended vesicles on its surface : or still better, by 
 first making the lung exsanguine with a watery injec- 
 tion, expelling the superfluous moisture by compression, 
 then inflating the organ and'drying it rapidly; when 
 it became throughout so colorless and transparent that 
 its vesicular texture could be seen both on the surface 
 and internally. The repeated bifurcation of the bron- 
 chial tubes was also finely shown in such a preparation ; 
 and if the pulmonary artery, or one of its main divi- 
 sions, were previously inflated and tied, its branches 
 could be traced to their finest ramifications. An injec- 
 tion with mercury made these ramifications still more 
 perceptible. 
 
 But the experimenter could not succeed in finding 
 the actual termination of the pulmonary bloodvessels ; 
 and he gives a striking picture of the difficulties met 
 with by a pioneer in such matters. " Whether these 
 vessels have a mutual anastomosis, either in the follicles 
 or elsewhere, by which the blood gets to the vein 
 through a continuous channel, or whether they open 
 into the pulmonary substance, is an enigma which, so 
 far, distracts my mind ; though, to solve it, I have made 
 
VISIBLE PROOF OF THE CIRCULATION. 223 
 
 many and many attempts, quite unsuccessfully, with 
 air and various colored liquids. After injecting ink 
 with a syringe by the pulmonary artery, I have often 
 seen it escape at several points ; a very little compres- 
 sion will make it exude from the investing membrane 
 and even collect in the interstices, though the greater 
 part comes out, mixed with blood, by the pulmonary 
 vein, and, what is more surprising, by the trachea, 
 frothy, diluted, and pale-looking. The same thing 
 happens with a mercurial injection. When the pul- 
 monary artery is filled, the mercury penetrates to its 
 extreme bifurcations ; and if they are subjected to the 
 least pressure, it escapes from the investing membrane, 
 sometimes making its way into the interstices, and 
 nearly the whole of it collecting there. These experi- 
 ments do not give us the natural pathway of the blood ; 
 because the injected liquid makes for itself a variety of 
 channels, not followed in the normal condition, from 
 the mechanical disturbance of the parts and the unnat- 
 ural constitution of the liquids." 
 
 In the second letter Malpighi has a more important 
 communication to make. He has found that by using 
 the lung of \}s\G.frog, owing to its simplicity and trans- 
 parency of texture, he can perceive many details which 
 had before escaped him ; and he says that by this means 
 he " has had the good fortune to see such things " 
 that he may well use in regard to them the expression 
 of Homer: 
 
 " Magnum certum opus oculis video." 
 
 He opens the abdomen of the frog and allows the 
 lung to protrude ; when he can see in it the arrange- 
 ment of the pulmonary membrane, with its internal 
 prolongations and partitions, the interior cavities, and 
 
224 
 
 DOCTRINES OF THE CIRCULATION. 
 
 the arterial and venous ramifications. But beside these 
 particulars relating to the structure of the part, micro- 
 scopic observation shows something still more remark- 
 able. " For while the heart is pulsating, the opposite 
 motion of the blood may be seen in the vessels, so ■ 
 that the circulation of the blood is evidently exhibited; and 
 it may be perceived even better in the mesentery and 
 in other larger veins in the abdomen." He sees the 
 bloods coming into a follicle by the arterial branch, 
 then bursting out, as in an overflow, into a multiplicity 
 of tortuous channels, spreading all over the follicle, 
 and then, at the partitions and angles, reaching the 
 little branches of the vein which take it up. 
 
 He not only sees, in this way, the peripheral move- 
 ment of the blood, but he also sees that it takes place 
 through a network of new vessels, which are neither 
 arteries nor veins ; that is, he discovers the existence 
 and character of the capillary plexus. " For such," he 
 says, " is the divarication of these little vessels, coming 
 .in each direction from the vein and the artery, that the 
 order in which the vessel ramifies is no longer pre- 
 served, but it appears like a network interwoven from 
 the offshoots of both." Finally, he recommends, as 
 the best method of observation, to lay the protruded 
 frog's lung on a glass plate illuminated from below 
 through a tube, and then to examine it '' with a 
 microscope of two lenses," when the whole distribu- 
 tion of the vessels and the movement of the blood will 
 be visible; and by changing the intensity of the light, 
 and similar contrivances which may be varied <it will, 
 he can bring into view still other things " which escape 
 description by the pen." It may be readily conceded 
 that the observer who first witnessed the capillary cir- 
 
VISIBLE PROOF OF THE CIRCULATION. 225 
 
 culation in a living animal might consider himself as 
 inadequate to its complete description. 
 
 From that time the batrachians did good service as 
 subjects for microscopic observation. In 1684 Mr. 
 William Molyneux, founder of the Dublin Royal So- 
 ciety, exhibited the circulation in the lung of the 
 water newt. " In the body of this Animal there are 
 two long Sacculi Aerei, on which the bloodvessels are 
 curiously Ramified, to these bloodvessels applying a 
 Microscope he showed the Circulation of the blood ad 
 Oculum, as plainly as water running in a River, and 
 more rapidly than any common Stream." * 
 
 The microscope employed by Molyneux was, no 
 doubt, provided with the improved eye-piece invented 
 by Divini in 1668. Instead of one double-convex 
 lens, this eye-piece vi^as composed of two plano-convex 
 lenses so placed as to touch each other at the middle 
 of their convex surface ; and it enabled the instrument 
 to " show the objects flat, and not crooked. "f But it 
 could hardly have been adapted to very high magnify- 
 ing powers, and probably exhibited the motion of the 
 blood as a glimmering current, without showing its 
 minuter details. 
 
 Leeuwenhoek's microscope, with which he made so 
 many discoveries, was a small glass globule, supported 
 between two perforated silver plates. It was an instru- 
 ment of imperfect definition, and not at all achromatic, 
 but of very high magnifying power ; and with it Leeu- 
 wenhoek had already, in 1674, discovered the red 
 globules of the blood. He afterward applied it to 
 
 * Philosophical Transactions, vol. xv., Oxford, 1686, p. 1236. 
 f Philosophical Transactions for the year 1668, vol. iii., p. 842. 
 
226 DOCTRINES OF THE CIRCULATION. 
 
 the circulation in the tail of the tadpole, where he 
 could distinguish the globules following each other, 
 in the smallest vessels, in single file, and sometimes 
 even compressed or distorted in passing the narrowest 
 part of the channel. 
 
 " The motion of the Blood," he says, " in these 
 Tadpoles exceeds all the rest of small Animals and 
 Fish, I have seen ; nay, this pleasure has oftentimes 
 been so recreating to me, that I do not believe that all 
 the pleasure of Fountains or Waterworks, either natu- 
 ral or made by Art, could have pleased my sight so 
 well." 
 
 " And now at last I spied a small artery, that not- 
 withstanding it is so small that, I judge, but one small 
 red globule of blood could pass through it ; "... . 
 " Yet what was most remarkable was, to see the mani- 
 fold small arteries, that came forth from the great one, 
 and which were spread into several branches, and 
 turning came into one again, and were reunited, that 
 at last they did powr out the blood again into the great 
 vein; this last was a sight that would amaze any eye, 
 that was greedy of knowledge." * 
 
 Finally, the vascular communication was also studied 
 by means of injections. This method, which Mal- 
 pighi had found unsatisfactory, seems to have been 
 first successfully employed by Blancard, a medical 
 practitioner of Amsterdam, in 1676, to demonstrate 
 the terminal connection between arteries and veins. 
 He used a wax injection, differently colored for 
 different orders of vessels, a description of which is 
 
 * Philosophical Transactions for January, 1700, vol. xxii., London, 
 1702, p. 447. 
 
VISIBLE PROOF OF THE CIRCULATION. 
 
 227 
 
 given in his treatise on anatomy,* published some 
 years afterward. " You can obtain," he says, " a re- 
 markable view of the capillary bloodvessels distrib- 
 uted through all parts of the body by filling them with 
 wax and red lead or other coloring matter. To show, 
 for example, the minute vessels of the lungs ; the 
 organs having been first freed from blood by a watery 
 injection, and the moisture discharged by pressure, the 
 artery is to be filled, by a syringe, with liquid wax and 
 red lead. The vein may then be filled with black wax, 
 the bronchial artery with green, and the trachea with 
 white. The membranes and vesicles are then allowed 
 to putrefy, and treated with cold water till the putrid 
 matter is washed away. All the little branches of the 
 arteries and veins, as well as those of the trachea, will 
 then appear in the form of arborizations." 
 
 But the great master in the art of vascular injections 
 was Frederick Ruysch, professor of Anatomy and 
 Medicine at Amsterdam for the extraordinary period 
 of sixty-two years; namely, from 1666 to 1728. His 
 indefatigable industry and rare skill in anatomical 
 preparations produced a cabinet of specimens which 
 was celebrated throughout Europe, and which he cata- 
 logued in a series of illustrated publications. His 
 preparations were remarkable for their neatness, per- 
 manency, brilliancy of color, and fineness of injection ; 
 but they were intended, for the most part, as cabinet 
 specimens, to be viewed by the unaided eye or with 
 a single loup. They especially illustrated the different 
 forms of terminal ramification of arteries and veins in 
 
 * Stephani Blancardi Anatomia Reformata, Lugd. Bat., 1695, De 
 Balsamatione nova Methodus. 
 This work first appeared in 1687. 
 
228 DOCTRINES OF THE CIRCULATION. 
 
 different organs ; the most important feature, accord- 
 ing to Ruysch, for determining the special secretory 
 or nutritive action of a gland or tissue. Although 
 it does not appear, therefore, that they had a direct 
 bearing on the question of capillary communication, 
 they exerted an important influence in turning the at- 
 tention of anatomists in that direction. The success 
 attained by Ruysch in the production of injected prep- 
 arations showed the value and capabilities of this 
 method, for investigating the vascular distribution 
 throughout the body; and it was afterward applied 
 to vessels of smaller calibre, the fineness of the injec- 
 tion keeping pace with gradual improvements in the 
 microscope, until the mechanism of the capillary cir- 
 culation, with all its varieties in different parts, was 
 permanently demonstrated to the eye. 
 
APPENDIX. 
 
 (0 
 
 The following passages, among many which might 
 be cited, will serve to illustrate the extent and variety 
 of Aristotle's information : 
 
 The cetacea and the selachia (cartilaginous fishes) 
 are both viviparous ; but of these the selachia begin 
 by the internal formation of an egg. — Opera Omnia, 
 Vol. iii., p. 5. 
 
 Sponges are ranked among the animals, and are 
 credited with a certain kind of sensibility. — Ibid., p. 7. 
 
 The elephant's tnmk is an elongated nose, which 
 serves the purposes of a hand. — Ibid., p. 10. 
 
 The brain is covered by two membranes ; the -outer 
 one, in contact with the skull, stronger, the inner one 
 more delicate. — Ibid., p. 13. 
 
 In man, the heart is inclined toward the left ; in 
 other animals it is in the median line of the chest. — 
 Ibid., p. 15. 
 
 In some animals, as the fox, wolf, polecat, and 
 weasel, tht penis is bony. — Ibid., p. 21. 
 
 In the ox and the horse, there is a bone in the heart. 
 — Ibid., p. 30. 
 
 The gall-bladder is wanting in the stag, the fallow- 
 deer, the horse, the ass, the elephant, the seal, the 
 
 20 229 
 
230 APPENDIX. 
 
 dolphin, and some of the mouse family. — Opera Omnia, 
 Vol. iii , p. 30. 
 
 There is sometimes transposition of the abdominal' 
 organs, so that the spleen is on the right side and the 
 liver on the left. But these cases are regarded as 
 monstrosities. — Ibid., p. 31. 
 
 Another kind of fibres are those produced in the 
 blood (fibrine). The blood no longer coagulates if this 
 substance be taken out of it. Otherwise it coagulates. 
 — Ibid., p. 44. 
 
 In all animals provided with bones, the spinal col- 
 umn is the central or fundamental part ((Xp2;>7) of the 
 skeleton. — ibid., p. 44. 
 
 The bones die (sphacelate) if deprived of their peri- 
 osteum. — Ibid , p, 49. 
 
 Fat does not putrefy. Blood, on the other hand, as 
 well as the tissues containing it, putrefies readily. — 
 Ibid., p. 52. 
 
 The marrow of the bones in young animals is san- 
 guineous throughout ; in the older it becomes fatty or 
 lardaceous, according to the species of animal. — Ibid., 
 
 P- S3- 
 
 The mammce are found in all the completely vivip- 
 arous animals; such as man, the horse, and cetacea, 
 namely, the dolphin, the seal, the whale, etc. All of , 
 these have mammae and milk. — Ibid., p. 53. 
 
 The male, both of man and other animals, ordina- 
 rily has no milk, though the contrary sometimes hap- 
 pens. Occasionally, in man, at the age of puberty, a 
 little milk may be expressed from the glands, and 
 sometimes in considerable quantity. — Ibid., p. 53. 
 
 The natural time for conception, in women, is that 
 immediately after the katamenia; and women who 
 
APPENDIX. 231 
 
 have no katamenia are generally sterile. But there 
 are some exceptions to this rule. — Opera Omnia, Vol. 
 iii., p. 136. 
 
 The right kidney, in all animals provided with 
 these organs, is placed higher than the left. Owing 
 to this position it lies in contact with the liver, which 
 is also situated on the right side. — Ibid., p. 267. 
 
 There is a provision against interference with res- 
 piration from the ingestion of food. Air-breathing 
 animals never inspire . a^id swallow at the same time. 
 Should they do so, the food, whether solid or liquid, 
 gets into the trachea, and so down to the lung, caus- 
 ing strangulation. The trachea lies in front of the 
 oesophagus, through which the food passes to the 
 stomach ; and in the quadrupeds having an abun- 
 dance of blood (mammalians) it is provided with the 
 epiglottis, which serves as a sort of cover. In birds 
 and oviparous quadrupeds (reptiles), where there is 
 no epiglottis, the same thing is accomplished by an act 
 of constriction. At the time of deglutition, in these 
 animals, the trachea is constricted ; in the former, it 
 is covered by the epiglottis. After the passage of the 
 food the epiglottis is lifted, or the trachea opened, 
 and the breath is inhaled. — Ibid., p. 544. 
 
 In diseases which produce induration of the lung, 
 either by morbid growths, exudations, or excess of 
 unnatural heat, as in fevers, respiration is accelerated, 
 because the expansion and collapse of the lung are lim- 
 ited in extent. — Ibid., p. 549. 
 
 (2) 
 'H hk xap^ia, 8ia to ruv ^T^sSdv dpx'^ slvai xai 
 
232 APPENDIX. 
 
 i'XJsiv hv au-T"^ trtv Svvafiiv ri^v ^yifiiovpyovaav ro 
 al^a npdyf/iv, ev'X.oyov, e^ otag Ssy^^srau tpo^'^g, ix 
 tOLavryii avvecitdvai xai avrriv. 
 
 "The heart, on the other hand, being the origin of 
 the blood-vessels, and containing within itself the 
 primal force for the formation of the blood, consists, 
 no doubt, of materials drawn directly from the nutri- 
 ment." — Aristotle Opera Omnia, Vol. iii., p. 230. 
 
 Kap5ta [lev oiv xai ■^vtap nadLV dvayxala rolg 
 ^aoig, h ^ev Sia tyiv tyjg dspfiorriTog dp^riv [Sel yap 
 elvai tiva olop iatiav, sv vi xsiaETai. t^g ^vaeug to 
 ^(onvpovv, xai Tovro ev^vT^axtov, aanep dxpoTtoXig 
 oiaa Tov aofiarog), to 6' vinap T>7S ne4'^ug xdpiv. 
 
 "The heart and the liver, accordingly, are indispen- 
 sable organs in all animals ; — the former as the source 
 of heat, since there must be a focus or fire-place of 
 some kind, where the embers of nature are kept alive 
 — well protected and, as it were, the citadel of the 
 body; and the liver to aid in digestion." — Ibid., p. 265. 
 
 (3) 
 
 '^X^^ ^^ Toi^TTov Tov Tponov n TCdv ^"keSissv ^vaig ' 
 8vo ^"keSeg eiaiv sv tu dapaxi, xard tyiv pdj(^iv h- 
 Tog ■ IcTTt he xei^evYi avTistv y\ fiev fiei^cov ev Tolg 
 efiTipoadev, ri 6' s^Attuv omaQev ravTvig, xai y[ 
 (lev ^el^iov sv Tolg hs^iolg fiaTuXov, n 8' sTidrTOiv sv 
 Tolg dpiGTEpolg, yiv xa'kova'i Tivsg dopTY/v ex Tov 
 TsOsdadai xai tv Tolg TsdveSxn to vevpC^hsg avry^g 
 (lopcov. 
 
 "The arrangement of the vascular system is as fol- 
 
APPENDIX. 233 
 
 lows : — There are two blood-vessels within the tho- 
 rax, along the spinal column. The larger of them is 
 toward the front, the smaller behind. The larger is 
 rather on the right side ; the smaller, sometimes 
 called the ' aorta,' because of its fibrous texture, per- 
 ceptible even in the dead body, is on the left." — 
 Aristotle. Opera Omnia, Vol. iii., p. 40. 
 
 Toi' V avrov rponov xal rd TJ75 J/ldTTorog ^Xe- 
 66g, xa?iOVfisvr;g 6' dopTvjg, eaj^carai fiepy;, avfina- 
 paxoTiOvdovwa Tolg trie, fieyd?ii^g, tcXyiv e^dttovg 
 01 Ttopoi xal rd ^T^kSia toTJk^ s'kdtti^ ravr' earl 
 Ttjv T>7S (j.sydTu'^g (p2.e66g. 
 
 "The divisions of the smaller blood-vessel, called 
 the aorta, are distributed in the same way — running 
 in company with and alongside those of the larger; 
 only their channels and branchlets are much smaller 
 than those of the great blood-vessel." — /did., p. 42. 
 
 Kat n xa^ov^evYi dopry; vsvp68y!g earl ^/Ie^'j "^d 
 (lEv teksvta.la xal navTeXdg am:^g ' dxoika ydp 
 iari, xal rdaiv ej(^el toiavtYiv, oiav Ttep td j'frpa, 
 f Te^evrq Ttpog Tag xafindg tuv oarup. 
 
 "The so-called aorta is a blood-vessel of fibrous 
 texture, its extreme branches being entirely so; for 
 they have no cavity, and resemble in consistency the 
 sinews where they terminate at the bony articula- 
 tions." — /did., p. 43. 
 
 Enofievov 6' dv elr; Ttepl tuv ^XeSihv siTtelv, tvjg 
 IE (isydT^Yig xal trig dopTv^g ' avtai ydp ix t^g ;cap- 
 
234 APPENDIX. 
 
 Stag 7tpo<rat hsj(pv'ta.i to alfia, at Se Xomai tovtav 
 ano^vdhsc, elaiv. "Oti ^ev oiv tov atuatoq ^dpiv 
 eiai, npoTspov el^Yirai ' to re yap vypov aTtav dy- 
 yeiov helTai, xcd to ^TisSCiv ysrog dyyelov, to S' 
 cd^a iv ravraic, ' hiori he hvo xal and ^lag dp^'^g 
 xad' oLTtav to crcOjUa hiatelvovOi, ?^eyuifiev. ToC (lev 
 oiv elg fiiav dp'x/iv avvte'kelv xal aTtb (iiag altiov to 
 (liav ej^eiv ndwa tyiv aiadyinxyiv ^l/v^viv svspyelq., 
 aare xal to fiopiov ev to ravTviv ej(pv npciTug, sv 
 IJ.EV Tolg svaifiotg xard hvva^tv xal zar' evepyeiav, 
 TCdv h' dvaifiuv svioig xar' ivepyeiav (lovov • bio xal 
 TYiv TOV dep^ov dpj^Yiv dvayxalov iv Ta arro) Tono) 
 elvaf avTYi 6' iarlv airia xal tcj al^ari tj?? i^ypo- 
 TYiTog xal Tvjg depfioTyjTog. Aid [lep oiv to ev evl 
 elvai (iopiij) tvjv aiaQviTixriv dpjviv xal tyiv tyu dep- 
 [lorriTog xal n tov ai^aTog dm (iioLg ioTiv dp%>7s, 
 bid be TYiv TOV aijUaTog evorviTa xal n Tuv ^XeSuv 
 dno ^idg' bvo b' elai bid to rd aafiaTa elvai bi^epij 
 Tuv evai^idv xal TtopevTixiiv iv ixMSi yap Tovroig 
 bi6piaTai to eunpoavev xal to oTtiadev, xal to be^iov 
 xal TO dpi^GTepov, xal to dva> xal To xdrio. "Offco be 
 TifitdiTepov xal nyefiovixiiTepov to efinpoadev tov 
 omadev, ToaovTCi xal n ^eyaT.ri ^"ke-^ Trig dopTrig ' 
 r, nev ydp ev Tolg efinpoaQev, v[ b' ev Tolg omadev 
 xelTai, xal tyiv ^ev dmiavT ejei to, evaifia <|)ai'epog, 
 Ty;v b' Evia ^ev dfivbpi^g, evia b' d^avag. Tov b' 
 eig TO Tiav btabeboadai to (T(j|ua Td§ ^^.eSag alTiov 
 TO TtavTog elvai tov a6(iarog vTiriv to alfia, Tolg b' 
 dvaifioig to dvd2.oyov, raCTa b' iv ^?^e6l xal to 
 dvd?ioyov xeladai. 
 
 "We now come to speak of the blood-vessels, both 
 the great one (vena cava) and the aorta. These first 
 receive the blood ft-om the heart, and the other blood- 
 vessels are offshoots from them. They exist, as we 
 
APPENDIX. 235 
 
 have said, for the sake of the blood. For every liquid 
 must have a containing receptacle, and the vascular 
 system is a receptacle in which the blood is contained. 
 We have next to consider why there are two blood- 
 vessels, coming from one source, and distributed 
 through the entire body. That they originate at a 
 single starting-point is because the principle of life 
 and sensibility is, in all animals, actually a single one, 
 and is therefore primarily located in a single organ;— 
 both potentially and actually single in animals pro- 
 vided with blood, and actually single in all. Where- 
 fore the prime source or principle of heat must have 
 the same location, being itself the cause of warmth 
 and fluidity in the blood. The blood, therefore, is 
 derived from a single source, because that of sensibil- 
 ity and heat is in a single organ; and the blood-ves- 
 sels start from one origin because the blood itself is 
 single. They are two in number because the body is 
 divided into different parts and regions; at least, in 
 animals having blood and limbs, where there is a dis- 
 tinction between front and back, right and left, and 
 upper and under parts. As the front part is more 
 important and more fully developed than the back, 
 so is the great blood-vessel (vena cava) more than 
 the aorta. The former is situated in front, the latter 
 behind; and the former, in animals provided with 
 blood, is always conspicuous, while the latter is some- 
 times obscure or imperceptible. The reason, fur- 
 thermore, why the blood-vessels extend everywhere 
 throughout the body, is that they contain the blood, 
 which is the nutritive material for the whole body; — 
 both blood and blood-vessels being represented, in 
 
236 APPENDIX. 
 
 the exsanguine animals, by other analogous parts." — 
 Aristotle. Opera Omnia, Vol. iii., p. 261. 
 
 (4) 
 
 Mecrov ya^ to tr\c, xap^iag sari aHfia, Ttvxvov 
 xai xolTbOv TCe^vxog, eti Se ■nX'^peg aifiarog, wg tuv 
 ^"keSdv svrevdsv ripyfievcdv, xoi^ov fj.Ev npog tyiv 
 VTtoSo'^^v tov alfiarog, nvxvov 8e Ttpog to ^v2.da- 
 GSLV TYiv dp^T^v TJ75 dspfioryjrog' sv tavrvi yap 
 [lovTi rOtv a7i?id.y^vo)v xai tov aa/iatog a'l^a avsv 
 ^?b£SS)v 8(TTt, Tdv b' o./l/lui' fiop'udv exadtov sv talg 
 ^T^s^tv E^6t TO alfj.a, xai tovr sv^oycog ' ix trig 
 zap^ittg yap iTtoj^ersvEtai xai elg rag ^?ie6ag, slg 
 ^6 tviv xapbiav ovx a^Xodev ' avty; yap sativ dpj(^yi 
 xai Ttviyvi tov ai^atog, yj VTtoSo^y; TtpwT)?. 
 
 /did., p. 258. 
 
 (5) 
 
 'ETtei 5' sipyitai Ttpotspov on to ^^v xai n TJ7g 
 ''^v^^g e^ig fista dspfiotvitog tivog iativ ' ovbe yap 
 yi 7t£4"Sj ^i'' 'Ki ^ tpo^yj y'lvetai tolg ^oioig, out' avsv 
 4'Vx^i; ovt' avEV depfxotyitog sativ ■ nvpi yap spyd- 
 ^staL ndvta ' hionsp sv ci TtptoTCi) Tono Toi; c6^atog 
 xai sv Si TtpwTCi) TOW tottod toutow ftoptci triv dp'^riv 
 dvayxalov elvat triv toiavr/iv, svtavda xai triv 
 TtpcitYiv tYiv dpsTttixriv '^vx/iv dvayxalov imap^sLv. 
 * * * Tolg fisv oiv dvaifiotg dvuvv/xov, tolg 6' svai- 
 fxoig n ;cap6ta Toi>ro to (lopiov sativ h tpo^ri ^ev 
 yap s^ f 5 ^^57 yivetai to. ^opia tolg ^cootg, n tov 
 alfiatog ^vcxig sativ tov 6' al^atog xai Tuv ^Xe- 
 6S)V ty;v avtYiv dpj(Yiv dvayxalov slvai' Oatspov 
 yap EVExa Batspov sativ, og dyyslov xai hextixov " 
 dpx^ ^e tCdv ^/le^ov y\ xaphia tolg ivaifioig " ov yap 
 bid TaiJTjjg, d/lyl' sx tavt/ig nptTi^kvai Ttaaal tvy- 
 
APPENDIX. 257 
 
 j(a.vovaiv. AyiTmv 6' r\fiiv tov'To ex tiiv dvatofxuv. 
 Tag fiev ovv a'kTiag Svvd/j.eig tvji; "^^x^i dSvvarov 
 vTidp^eiv avsv TJ^g dpenTLX^g (5i' ■^v S' ahiav, 
 e'lpyjrai Ttporepov h> tolg Ttepi '4'VZ'^'s)> tOLVtYiv h^ 
 CLVEV rov ^vaixov nvpog • iv tovtoi yap n ^vaig 
 ifiTtenvpevxsv avr^v. 
 
 Aristotle. Opera Omnia, Vol. iii., p. 542. 
 
 (6) 
 
 TauTvi S' rtxo^.oidrixs xal ti^v aX^(s>v Tur 5ca/lov- 
 fievcdv anTidyj^vuv exaotov ' ex trig ainrig yap v?i,7;g 
 avvearacnv aluanxy; yap n <pvaig ndvruv av'tav 
 Sid TO TT^v Beaiv ey^eiv inl nopotg <p^e6txolg xal Sia- 
 T^Yi^sdLV. Ka^aTiep oiv pkovtog vSaTog 'Od^g, tdXka 
 anTidyxva Ti7g hid rdv ^"keS&v 'pvUEng tov alfiarog 
 olov npoy^svfiard icniv v, he xaph'ia, hid to rdv 
 ^"keSi^v dpx^ slvai xal e;getv ev aiT'^ tviv Svvafiiv 
 rriv SrifiLovpyovaav to alfia npatriv, evT^oyov, e^ olag 
 ^ij^etai tpo^'^g, ex toiavri^g avveardvai xal ainriv. 
 
 "The rest of the so-called viscera are subsequent 
 in formation to this one (the heart), and are all pro- 
 duced from one and the same material. They derive 
 their growth and constitution from the blood, owing 
 to their position at the passages and interspaces of 
 the blood-vessels. For as mud or clay is deposited 
 from running water, so these viscera are, as it were, 
 deposits from the flux of the blood through the (walls 
 of the)* blood-vessels. The heart, on the other hand, 
 being the origin of the blood-vessels, and containing 
 within itself the primal force for the formation of the 
 blood, consists, no doubt, of materials drawn directly 
 from the nutriment." — Ibid., p. 230. 
 *The word 6ia means " through," in the sense of penetration. 
 
238 APPENDIX. 
 
 nog [lev oiv tpe<pstaL ra ^wa, xal ex rlvog, xal TtVa 
 t^OTiQV dva^afiOavovcfiV ix tviq xoLXiag, iv Tolg nepi 
 'ysviaeciq "koyoic, fiaXkov apfio^st axonelv xal Xeysiv ■ 
 avvtara^evov 8e twv fxopiav ix tov olfiatoq, xa6d- 
 Ttsp elnofiEv, evXoyug n tuv ^T^sSCov piaig hia nav- 
 rog rov aafiarog 7tE<pvxev • SeI yap xal to al/xa Sia 
 Ttavtog xal napa. nav slvai, elnEp Tiov (lopiav exa- 
 arov EX rovrov avvsary^xEv. 'Eolxe 6' a^nEp ev te 
 tolg xyiTtoig at vhpa/yayiat, xataaxEvd^^ovrai dnd 
 [iLag dp^j^g xal nriy9ig Eig ■no'kT.ovg 6;j;fToj;g xal 
 aXkovg det itpog to navrvi fiEtaSiSovai, xal iv ralg 
 oixohofilaLg napd Tiacav f/jv tu»' dEfiE^iov vnoypa- 
 ^riv XidoL TtapaSkST^riWaL bid to rd fiev xriTtEVoiieva 
 ^veaQat ix rov vSarog, tovg Ss QeuET^lovg ex tdv 
 Xtdciv OLxobofiEiadai, tov avrov rponov xal r\ ^vaig 
 TO aifia Sid Ttavrog axEtsvxe rov ac){iarog, insihyi 
 Ttavrog vkri tie^vxe rovro. 
 
 "How the nutrition of animals is accomplished, 
 and through what organs and in what way they take 
 up their nourishment from the alimentary canal, may 
 be more appropriately discussed elsewhere. Never- 
 theless, since the substance of the organs is supplied, 
 as we have said, from the blood, the flux,* or exuda- 
 
 *The word l>vaic, or pevaig, translated "flux" in these two 
 passages, does not mean a flowing, as of the current in a river, 
 but a running or discharge of liquid from a membranous sur- 
 face. Other medical terms derived from pia, to flow, are Kara'p- 
 l>oog, catarrh, a flux or discharge downward, as in nasal catarrh; 
 Siappoia, diarrhoea, a discharge through the intestine ; and peviia, 
 rheum, the substance or hquid matter discharged. This distinc- 
 tion is of some importance, since otherwise Aristotle might be 
 supposed to speak of the blood as flowing m a current within 
 the blood-vessels ; — an idea which was never present to his 
 mind. 
 
APPENDIX. 239 
 
 tion, of the blood-vessels is established by nature 
 throughout the body. For the blood, if it be indeed 
 the constituent material of all the organs, must be 
 everywhere present and permeate every part. As, 
 in the irrigation of gardens, sluices are constructed to 
 lead from a single fountain-head into many different 
 waterways for general distribution; and as, in build- 
 ing houses, stones are brought and laid everywhere 
 alongside the trace of the foundations — in order that 
 the garden crops may be nourished with water, and 
 the foundation walls be built of stone — so nature has 
 distributed the blood throughout the body, it being 
 the material from whicli every part is formed." — 
 Aristotle. Opera Omnia, Vol. iii., p. 261. 
 
 (7) 
 
 5(d Tov aroixatog ovaa xal tqv iv tovto) ^oplov, 
 oauv n Tpoql»7 Selrai. Siaipeaeug' dll/l' avrr; ^ev 
 ovhsfiiag aiTt'a ne"^sidg, a'X.X' evns-^lag fiaTiXov n 
 ydp elg (Utxpd Stalpeaig trig Tpo^jjg pau Ttotel tcj 
 depfi^ triv spyaoilav n Se trig avco xal ryjg xdra 
 xoLTilag yjSi^ ^eta depfiorT^rog ^vuix^g noielTai. 'zrtv 
 
 "The first of these operations, in animals whose 
 food requires comminution, is that performed by the 
 mouth and the organs therein situated. This does 
 not itself produce any digestive effect, but serves 
 rather to facilitate digestion. For the minute divi- 
 sion of the food makes the action of heat upon it 
 more easy; and the stomach and bowels then accom- 
 plish its digestion by their own natural warmth." — 
 Jbid., p. 234. 
 
240 APPENDIX. 
 
 (8) 
 
 'ETtft V sv tvi ava ^ev xoLTiia xard triv Ttpd^Tviv 
 elcioSov trig tpo^^g veapdv dvayxamv elvai triv Tpo- 
 ^571^, xcLtoi he npo'iovGav xoTtpMr; xal B^LX^aafievviv, 
 dvayxalov elvai n xal to fista^v, iv cj ^etaSak'^ei, 
 xal ovr' l-Ti Ttpocr^aTog, out' rihri xonpog ' Sid rovro 
 ndvra Td toiavta ^wa triv xa'kov^evriv s^ei 
 vvjanv xal sv tcj ^etd triv xoMav ivtepa ta 
 /IfTtTCj' tovTo yap iisra^v trig t' dvu, iv f to 
 dnsntov, xal trjg xdtu, iv -^ to a^priatov riSri 
 Tiepitto^a. 
 
 "As the food at its first entrance in the stomach is 
 in a recent condition, becoming exhausted and fecu- 
 lent farther down, there must be an intermediate place, 
 in which its metamorphosis is going on, and where 
 it is neither fresh food nor yet feces. For this, the 
 above-mentioned animals have what is called the je- 
 junum, in the narrow part of the intestine below the 
 stomach; lying between the upper cavity, in which is 
 the undigested food, and the lower, in which is the 
 superfluous residue." — Aristotle. Opera Omnia, Vol. 
 iii., p. 273. 
 
 (9) 
 
 Siaitep Se xal to ato^a trig dxatepydotov tpo- 
 ^rjg nopog iatl xal to avvey^eg ai'Toi fioptor xa- 
 ^ovaiv oiao^dyov, ocra ttjv ^oudv e^eu tovto to 
 fiopiov, ecog eig fftv xoiTiiav, ovtu xal dll^as dp;^ds 
 Sel 7l?^,eiovg elvai, Sl &v anav /l/.Tj/ETat to a{b(ia triv 
 tpo^riv, aanep ex ^drv^g, ex trjg xoCkiag xal trig 
 tu>v ivtepov ^vaeoig " <rd ^ev ydp (pvtd TxL^Sdvet 
 triv tpo^riv xat£ipya<s^evriv ix trig y^i '^oiig pi^aig 
 {810 xal Tiepittu^a ov ylvetat tolg ^vtolg ' fir ydp 
 
APPENDIX. 241 
 
 y\, %aX T^ iv ai'iT-p dep^on^n ;^p>7Tai uffTtep xoi^^iq.) , 
 Toi 8e ^^a 7idi"ra juev (T;^e^6j', toc ^e TtopevTixd 
 ^avepi^g, olov y^v iv avTolg e^^i to r^g xoi/'iiag 
 xvTog, i^ rig, &anep ixelva talg pl^aig, rai'Ta 6eI 
 tLVi triv TQO^yiv XafiSdveiv, eiog to tyjg sy^o^Evrig 
 nsTi/sog yldo'p Ti/log. 
 
 Aristotle. Opera Omnia, Vol. iii., p. 234. 
 
 (10) 
 
 To 5e xoD^v^evov [xscfevTEpiov eati (lev vy.yiv, Sta- 
 tsivei 6e avvsj^eg (XTto TJ75 ruv ivrspuv Tiapatdasag 
 eig TYiv ^T^kSa tviv y-eydTiriv xal tyiv aopTviv, nT^ripeg 
 6v ^TisSCiV Tto/l/Loi' xal 7tvxvG>v, al telvovGiv dno 
 Tuv ivTepcdv elg ts tyjv (isydXrjv ^2,e§a xal tyjv 
 aoptriv. Tviv y.Ev oiv ykvEOLV i^ avdyxvig oiaav 
 evpi^oiofiEv ofioiag rolg d/l/lotg ^opioig' 5td rtva S' 
 airiav vTidp^Ei, tolg ivaifioLg, ^avepov ianv STtiaxo- 
 Ttovaiv • sTtEL yap dvayxalov rd ^aa Tpo^jjr XajU^d- 
 VELV 0i;pa6er, xal mLkiv ix tavrrig ylvEoQai triv 
 eo'xd'tviv rpo^riv, e^ y;g yjSy; SiaSiSorai, Eig rd (xopia 
 {tovto Se Tolg (J.EV dvaifioig dvavvfiov, tolg 6' ivai- 
 fiOLg alfia xaXEltat), SeI Tt Eivai 81 ov Eig Td$ 
 ^T^kSag EX trig xoiXlag olov bid pi^Ctv nopEWEtai ri 
 tpo^ri. Td f.iEV ovv ^urd rdg pifag e;^Et eig triv 
 yriv {exeIBev ydp XafiSdvet triv tpo^viv), tolg hs 
 ^(jioig n xoiXia xal n Tuv ivtspiov Svva^ig yri iativ, 
 i^ rig hsl Tia^SdvEiv triv tpo^riv ' SioTtEp n tov fis- 
 GEvtEpiov ^vaig iatlv, olov pi^ag E^ovcia tag Su 
 avtrjg (p^iSag. Ibid., p. 276. 
 
 (II) 
 
 Tlp6tEpov be t^ Qeoel n dptripia xsltai tov oho- 
 ^dyov Ev noLat, tolg e^ovolv avt^v • e^el Se tavtriv 
 
242 APPENDIX. 
 
 Tia^vra, ocfa Tttp xal n^^evfiora e^^zl. "EffTt h' n fisv 
 dpT)7pta ^ovl^p^^rig triv ^volv xai b?dyai^og, noK- 
 Xolg "ksntolc, ^?L£6L0Lg Tte^iexo^evTi, xslrau b' sni fzsv 
 TO, avu Tipog to arofia xarca triv ex Tdv fivxrmuv 
 avvroyjOiV eig to aro^a, '^ xal, otclv nivovTeq ava- 
 (T7rd(7(j(Tt Ti Tov TtoTov, x^psl SX TOV GTOfiaTOg Sid 
 Tuv (ii}XTy^piov 1^6). Mera^v S' eyji tuv rp^creuj' 
 TYjv sTtiy^MTTiSa xaTuOV^kvriv, sTiLTtTvaasaBai hvva- 
 fiEvyiv anl to Tvjg apTripiag Tptri^a, To eig to OTo^a 
 TeIvov Tavrvi 8e to Tiepa? cvvripTyiTai Tjyg y/LcjT- 
 T>75. 'Etii Se Qdrepa xaQrixEi eig to (leTa^v tov 
 TtTisvfiovog, eIt and to'utov ay^^i^eTai Eig exa/tEpov 
 tCsv fiEpdv TOV TtTiEVfiovog. * * * ^vaafiEV/ig he 
 T>75 aprripiag, SiahiSuCiv eig to, xoXka fispyj tov 
 Tikevfiovog to nvev^a. TafJira he hia^vasig e^si 
 ^ovhpahetg eig b^v avvexovaag " ex he Tdv hia^vae(s>v 
 Tpri^a/ta. hid navTog eaTi tov Ti^evfiovog, (XeI ex 
 fiei^ovoiv Eig i?idTTa hiahih6(iEva. * * * 'H fiEv 
 oiv dpTTipia tovtov e^el tov Tponov, xai hsxEtai 
 fiovov TO nvEv^ia xal dipiriaiv, dXTio 6' ovdev ovte 
 !E,yipbv, ovd' itypov, vj novov vtaps^Ei, log av exS^^ip 
 TO xaTETidov. 
 
 Aristotle. Opera Omnia,Yo\. iii., p. 14. 
 
 (12) 
 
 Kai eg Tyjv dpTriplav xaTeplivvi roiovrov, oiov 
 ema'x^e'iv hia'keyd^Evov, xal dodfiaivsiv ev Tfyi hia- 
 ?^EyEo:dat ofioiug xvpayy^ixat 6payy(^C)hsi. 
 
 "And there was such a flux into the trachea that 
 in talking he had stoppage of the voice and dys- 
 pnoea, like a man with suffocative bronchitis." — 
 Ilept ETtihri^im', vii, 9. CEuvres d'Hippocrate, Littre's 
 edition, Paris, 1839-61, Vol. v., p. 380. 
 
APPENDIX. 243 
 
 (13) 
 
 4>epoi;<yt 5e y.(£i elg t'ov Ttkev^ova Ttopot (xtto TJ7; 
 xa^hiaq, xal a^.i-^ovrai tov aviov rponov ovncp n 
 dprripla, xard Tidi'ta top n'Asvfiova TiapaxoTiOvdovi'- 
 teq Tolc, (XTto TJyg dpT>7ptas ' fTidi'u ^' etcrtv oi citio 
 't>7S xai^hiaq Ttdpot ' Ttopog ^' ovQe'ig sarc xoLVoq, ti/l/ld 
 ^td Tjjv aijva^'tv hex^vtai to nvevfia xal rirt xapSlci. 
 SLa7isfi7iovai,v ^epet ydp 6 /usv eig to Se^lov xoO^ov 
 tdv Ttopuv, 6 6' efg TO uptaTEpov. Hfpt he ryjg 
 <P2.e66^ TJ75 (isydXrig xal tj^s uopTJjg jjaO' avrdg 
 xoLvf Ttepl d^tpoTEpcjv ipov/^ev vcyrepov. 
 
 Aristotle. Opera Omnia, Vol. iii , p. 15. 
 
 (14) 
 
 'H hk av/i§aivov(ya atpv^ig tyjq xapSiag, ^v del 
 ^aivetai TtOLOVfievyi avve^Sig, ofioia ^vfiaaiv iartv, 
 riv noLOVvrai xivYiaiv j^et' d/iyrihovog Sid to Ttapd 
 ^VOLV slvai Tco iXLiiari ryiv fj.sra'yo'A.Yiv ■ yivsrai he 
 |Ue;^pt ov dv nvLddri ne^dev. "Eart 6' ofioiov ^eaat. 
 TovTo TO Ttddog ' n yap ^saig ylvstat Ttvsvfiarovfie- 
 vov tov vypov VTto tov depfiov ' alpstaL ydp 6id to 
 7t/lft6) yipsadai tov oyxov. Ilai'^a 6' sv uev tolg 
 ^vfiaaiv, idv (iyi SianvevGvi, na'x^vtepov yivofiivov 
 tov vypov, G^il/ig, tt? Se ^EOet r\ exntaatg ^td Toi' 
 opi^ovtuv. 'Ev he t7i xapSla n tov del npoaiovtog 
 £x trig tpo^vjg vypov hid trig 6epf/.6tyitog oyxuaig 
 TtOLel a^pvy^ov, aipofievyj Tipog top ecij(atov j(^itCiva 
 TJ75 ^irap^tag. Kat toCt' del ylvetai avi^e^Qig ' imp- 
 pel ydp del to vypov avvej(^(^g, e^ ov ylvetai n tov 
 aifiatog ^vaig " TtpuTov ydp ev tvi xaphiq. hy;^(ovp- 
 yeltai. AJ7/I0V h' sv trt yeveaei i^ dp^yjg " ovTtid ydp 
 himpia^EVidv tcjj' ^yle^uv, ^aivetai sj^^ovaa aifia. 
 Kat hid toi'to crc^ij^ei (j-aXTMV tolg vsutepoig t&v 
 
244 APPENDIX. 
 
 TtpeaSvrepuv ylvsta.i yap n dvaOvfilaatg nXeiav 
 tolg I'ajTfoots. Kal a^v^ovatv al ^XsSsg naaai, 
 xal afia d/l^jyAaig, Sid to riptrjadaL ix fffg xap^tag, 
 xivel 8' del, Stare xaxetvai aiel, xal d^a d/l/Lj^Aatg, 
 ore xivel. — Aristotle. Opera Omnia, Vol. iii., p. 550. 
 
 (15) 
 
 Ot dvaipovvreq oig ov ro dspfiovrd ipyoU^ofievov sv 
 rolg aaij.aaiv, [57] oTt fiia nq ^opd xal Svvafiig ri 
 r^YinxYi rov nvpog, ov xaXS>q T^yovGLV ■ ovhe ydp 
 6?M rolq d'4^v'^oiq ravro noiel nadtv, d/l/ld rd ^ev 
 Ttvxvol, rd 8e ^avol xal rvixei, td he nyiyvvaiv. 
 'Ev he hv} rolq ifi^^v^oLq ovrcoq imoTirinreov, aanep 
 ^weaq nvp ^virovvra, xaQdnep rej(vyjq " xal ydp iv 
 ralq rey^vaiq erepov rd j^^pvaoj^^olxov xal ro j^^aXxev- 
 rLxov xal ro rexrovixbv nvp dnore^iel, xal ro (lOr 
 yeipixov. 'Icrug h' d^.videarepov on at Tf;fi'ai.' 
 ^pi^vrai ydp uxmep opydva fia/idrrovaai xal ry;- 
 xovaai xal ^ripaivovaai, evia he xal pvd^l^ovaai. 
 To avro he rovro xal at ^vaeiq " odev hyj xal npoq 
 d\Xri7^a hta^opai " hio yeXolov npoq ro e^u xpiveiv " 
 eire ydp hiaxplvov, elre Xenrvvov, eW onhyinor' 
 sari rd Bspfiaiveadai xal nvpovadai, hLa(popdv e^ei 
 rd epya rolq ^pcdfievotq. 'A9b?i ai (lev rkx^ai uq 
 opyavGi j(^pavrai, n he ^vaiq afia xal oiq vTivi. 
 
 Ibid., p. 66g., 
 
 (16) 
 
 Atd ri he rd ej^ovra hej(^eraL rov depa xal dva- 
 nveovai, xal (xd2.Lar avrCtv oca ey^ovaiv evaifiov, 
 alriov rov fiev dvanvelv 6 nvevfiuv aofx^oq &v xal 
 avpiyyoiv nT^f/ipriq. Kat evatfiorarov hi^ ^dTnara 
 rovro ro fiopiov rdv xaTiovnevav anXdyxvuyv. 
 
APPENDIX. 245 
 
 "OcTa hy] l%£t svaiiiov avto, taxsiccg [lev Seltai 
 TTjg xata-^v^£a<; hid To fZLxpav elvai, ti^v poni^v tov 
 •^l/v^LXOV Ttupog, slaci h' sioisvat hta navTog Sid to 
 nTi^doq tov alfiatog xal ryjq depfiofyitog. TafiTa h' 
 (i[i^6repa 6 fiev dr;p Svvarai pq.8'tcig Ttoielv ' 5td ydp 
 TO T^ETiTriv E^stv TYiv ^volv hid Ttavtog re xal ra- 
 XSidg hiahvofievog hia'^^vj^ei. * * * Kata-^^v^ec^g 
 fiev oiv oXcog n tuiv ^cawv helrai ^vacg hid triv iv 
 T'ip xaphia T^g 'i'^x^i ifinvpuaiv ■ ravtriv he TCoiel- 
 Tat hid ryjg dvanvovjg, baa fir; fiovov sxovai xaphiav, 
 d^/i-d xal TtTiSVfwva rQv ^ucov. Td he xaphiav fiev 
 ExovTa, 71'A.evfiova he (ly;, xaddnep ol i^Qveg, hid to 
 evvhpov avrGtv rviv ^vaiv elvai, T^ vhan noiovvTat 
 triv xaTd-^v^iv hud T&v ^payx'i^v. 
 
 Aristotle. Opera Omnia, Vol. iii., p. 547. 
 
 (17)^ 
 'H 5' ava-nvori yiverai av^avofisvov tov depuov, 
 sv a> n dpxy; n Bpenr lxyi ■ xaBdnep ydp xal rd/l/la 
 helrai rpo^'^g, xdxelvo, xal tuv dXTuov (ia22j6v " xal 
 ydp Tolg dT^'koig ixelvo trig rpo^^g difiov sotiv. 
 'Avdyxy; hr; nXeov yivofievov alpeiv to opyavov. 
 Ael o VTto'kaBelv tyiv avoTaaiv tov opyavov Ttapa- 
 nT^.tqaiav fiev elvai Talg ^vaaig Taig iv Tolg ;^a/lzei- 
 oig' oi Ttoppo ydp ovd' 6 n^evfiuv, ovd' n xaphia 
 npog To he^aadai axvf^oi toiovtov * * * oTtep 
 (l)aivovTai noielv o\ dvaTtveovreg ' alpovGi ydp tov 
 66paxa hid To t-/iv dp^viv tyiv evoiaav aiircj tov 
 TOIOVTOV (lopiov ravTo tovto noielv ■ aipofievov ydp, 
 xaddnep elg Tdg ^mag, dvayxalov eia<pepeiv tov 
 d.epa TOV 0i;pa6ei', xal "^v^pov ovTa xal xaTa'4'V- 
 XovTa aSevvvvai tyiv vnepoxw '^^l'^ "^ov nvpog. 
 "D-dnep 6' av^avoftevov '^psTo tovto to (lopiov, xal 
 ^divovTog dvayxalov avvi^eiv, xal avvi^ovtog i^ievai 
 
246 APPENDIX. 
 
 tbv depa tov elaeTbQovra itakw, daiovxa [lev ■\i/v- 
 XPOV, s^iovra Se dspfiov ^id tyjv a^riv tov dspfiov 
 tov ivovTog iv tcj noplci tovta, xal fid'^iata tolq 
 tov Tt'Xevfiova evaifiov sxovaiv ei'g no^kovg ydp 
 olov ai'/luvag, rdg avpiyyag e^niTtteiv rdg h Ta 
 7i?L£VfiovL, uv nap' §xd<yryiv TKLpatETavtai ^XeSsg, 
 State Soxslv olov elvai, tov ■7t'?i,EVfiova iCkripYi alfia- 
 tog. Ka/leTTai 8' n fJ.£v slaoSog tov depog dvuTtvoyi, 
 n S' e^oSog Bxnvori. 
 
 Aristotle. Opera Omnia, Vol. iii., p. 550. 
 
 (18) ^ 
 
 'H he Tlpa^aydpou ts xal 'Tipo^i?iov ^p'^Gig eti 
 xal dg tdSs xpatel. 'S,<pvy^6v ydp ovtot naaav 
 dptyiptav xivyiaiv ty;v aiaQiqtriv xakovaiv. OwTog 
 hs xal ol uet' avtovg dnavtsg, et xal tolg 6piafj.olg 
 SiaipepoTtau 
 
 "The terms used by Praxagoras and Herophilus 
 hold good to the present day. For every movement 
 of the arteries they call a pulse, as is also the custom 
 with all writers since their time, notwithstanding the 
 variety of definitions employed." — Galen. Opera Om- 
 nia, Vol. viii., p. 498. 
 
 ^ Kotvipiag praeterea vetustissimi Graeci ^^.eSag, 
 venas, vocaverunt. Quumque aipv^eiv tdg ^leSag, 
 venas micare, dicebant, dptripiag intelligebant. Arte- 
 riarum enim micare, seu palpitare, munus est. 
 
 "The oldest Greek writers also called the arteries 
 blood-vessels. And when they spoke of the blood- 
 vessels pulsating, they meant the arteries. For to 
 pulsate or palpitate is a function which belongs to the 
 arteries." — Rufus Ephcsius. De Appellationibus, Liber 
 I., cap. xxxiv. 
 
APPENDIX. 247 
 
 (19) 
 
 To \Lkv ys rov Tlpa^ayopov xai OavfzaOTov tffog 
 aoi ^avelrau M^y^e ydp nspLSxs(jOca Tisycdv iv dp- 
 tyipiaig tovg y^Vfiovg, ofiug sx tQiv a^vy^Siv iSeag 
 rivdg avtStv dvaT^oyi^ecdaL n-ipdrai. 
 
 " You may, perhaps, be surprised at the view taken 
 by Praxagoras. For though he denies altogether 
 that there are in the arteries any Hquid matters, he 
 yet assumes to judge of their condition by means of 
 the pulse." — Galen. Opera Omnia, Vol. viii., p. 941. 
 
 (20) 
 
 Qspfiaaiav autem, calorem, atque nvEVua, spiritum, 
 T^&no) idem esse censuit; sed medici distinxerunt, 
 Ttvsvi^a, quod spirando trahimus, dspfiaaiav vero 
 spiritus elision em appellantes. 
 
 "According to Zeno, the vital heat and the pneuma 
 are identical. But medical writers have made a dis- 
 tinction, understanding by pneuma what we take in 
 by respiration, and calling the vital heat an emanation 
 from it." — Rjifus Ephesius. De Appellationibiis,\J^&x\., 
 cap. xxxvi. 
 
 (21) 
 
 Ktti yap ovv xal rovg ^vg 6 'EpacTtCTTpaTog ex tov 
 TtTiYipovadai nvevuarog dg evpog STtLbioovrag d^at- 
 pelv ipy^ciL n:ov firixovg, xal hid tovr' dvscJTtdcjdaL. 
 
 "For Erasistratus says that the muscles also are 
 drawn up from being filled with pneuma, increasing 
 in breadth but diminishing in length." — Galeii. Opera 
 Omnia, Vol. viii., p. 429. 
 
248 APPENDIX. 
 
 (22) 
 
 Herophilus venam crassissimam grandissimamque, 
 ex corde pulmones petentem, dpTjypico^)?, arterialem 
 appellavit. In pulmonibus enim contra atque in aliis 
 res habet. Nam vense in his validse sunt, proximeque 
 ad arterialem naturam accedunt. Arterise, contra, 
 imbecillse, venarum que naturam sapiunt. — Rufus Ephe- 
 sius. De Appellatioiiibus, Lib. i., cap. xxxiii. 
 
 (23) 
 
 TlepaTa 5' latl ravta t&v htl rolq OTOfiaoi TJ75 
 xapBlag vfievav, vTiep Stv 'Epaalarparog fiev dxpi6<Iig 
 sypail/sv. 
 
 "The extremities " (of the chordae tendinese) "are 
 attached to the membranes at the orifices of the heart, 
 which Erasistratus described minutely." — Galen. Op- 
 era Omnia, Vol. v., p. 206. 
 
 Airia, ^e at t^v vjievcdv STti^vaeig, vnep S}v av- 
 rdpxug 'Epaaiarpdrov hiei^sy^evov, nspitTov nfi&g 
 vi'v ypd^siv. 'AAA,' exslvog fisr eoixev hnoTui^Sd- 
 VELV, ^Yihev o^ug etc, triv xaphiav ix t&v dpry;pi(^v 
 [xe'ta'kafi6dvsaQaL, it'kYiv ys did tu)v iv nvsv^ovi. 
 
 "This is owing to the attachment of the mem- 
 branes" (valves), "which it is unnecessary to describe 
 here, as they have been sufficiently treated of by Era- 
 sistratus. He, however, seems to have believed that 
 nothing at all passes into the heart from the arteries 
 in general, but only from those of the lung" (pulmo- 
 nary veins). — Galen. Opera Omnia, Vol. v., p. 166. 
 
APPENDIX. 249 
 
 Eip>7Tat hi TO ^aivojxevov vnep 'Epaauy-rpdrov 
 xard Tvjv tuv Ttvperov npayfiareiav, ug viieveg 
 fTtiTte^vxadi Tolg GTo/xaai rdv dyyeiuv, olg iig vTfy;- 
 psalav iASiv eiaayc.yyyjg te xai avdig i^ayuy^g n 
 xaphia Ttpodj^p^rai. Tovrovg Tovg {i^evag eroXfiyi- 
 adv Tiveg ovx slvat Xeysiv, alX vn 'EpcWLdTpdrov 
 Sieaxsvdadat Soyfiarog evexev xaraaxev^g. UXyip 
 sig roaovroi' ^xovcji yvaasag dnadL tolg iarpolg, 
 &ar dp^alog ovtcog slvac So^eiev dv 6 (iri yivcixjxov 
 avrovg. Rial S' ini (lev to arofiart, trig xoiT^rig 
 ^T^sSog Tpffg dxiScdv y?iCiy(laiv ofioioraroL ryjv avv- 
 ta^LV, odev, olfiai, xai rpiy^aj^ivag eviol tuv 'Epa- 
 GiarpatEWiv sxd?.saav avrovg ' sTtl 6s r^g dpTyiplag 
 trig ^7^e66hovg (pvra Ss ovo^d^co ty;v sx TJyg ctpt- 
 ffTepdj xoi2.iag TYJg jjap^tag e'lg tbv nvsv^ova xa.ta- 
 aj(^i^oiJ.£vy;v) ofioioraroL fisv to elSog, dpiQ^O) 6' ovx 
 tffof ^ovo) yap Toi;T6) tcj at6y.atL hvolv v^evidv 
 ini^vaig ian, rQv 6' d/l/lov arofidroiv sxatEpa 
 tpelg vfisvsg eialv dnavrsg dLyfiosiSelg. 'E^dyei S% 
 ug 'EpafftffTpaTog ^riOiv s^riyovfievog to ^aivo^evov, 
 ExdTspov fiev Tc5v arofidrcdv al^a fj.ev sig tov tcvev- 
 fiova eTepo*- avtSiv, vtvEVfia 5' slg o/Lor To ^mv ete- 
 pov. lov Tuv i'fiEvuv, (5$ EXEivCji hoxEi, Ttpog Evavrlag 
 vnYipEGiag rii xaphlq 'x^povov, diioiSalg iyxalpoig 
 vnaXkattonEvag, tovg (j.ev etu tolg sladyovaiv Tag 
 wXag dyyEtOLg STtiTts^vxorag e^uOev Ictu ^EpofiEvovg, 
 dvarpETtEadai fisv vno Tyjg EiaoSov tCSv vku^v, di'a- 
 TtlnTovtag S' Eig rag xoiT^orrirag rrig ^cap^tag dvoL- 
 yvvvrag Ta Gro^ara Ttaps^ELV dx6?uvrov rriv <popdv 
 rolg Eig rriv avrviv t?ixofiEvoig. Ov yap hri avro- 
 [idrug ye Tot; i5/lag EiadElv ^t^div, d)g Eig d-^/vxpv 
 rLva hE^auEvyiv, dTJC avri^v rriv xapS'iav Siaare?..- 
 XofiEVT^v, (dunsp Tag rov j^aTixEcov <|)i;(7a5, iniOTta- 
 adai 7i7iy;povaav rri SLaaro2.ri. 'Erci hs rolg i^d- 
 yovGiv dyyEbOLg T0C5 £/lag skkyoiisv inLxsladai, xai 
 
250 APPENDIX. 
 
 TovvavTiov rij/fi(T0at nddog ndaj^eiv, sacodev yap 
 6^(0 pEnovtag, avarpeno^evovg fiEv vno r&v i^tov- 
 Tcov dvoiyvvvao ra arofiara, xad' ov dv n xap^ia 
 Tidyov sj^^opriysi Tag vTjxq ' iv 5e ta XotTicj Tiavrl 
 xl,s'bSLV dzpt^ug m atofiata, ^yjS' sv'iag ruv exnefi- 
 ^devTiov enafspj^sadaL avy^apovvtag " oiitcdg ^e xal 
 rolg £7ii Tolg iiadyovai, orav ri xapbia avateXkritaL, 
 xT^eiELV rd ato^ara, (iriSev tcSv s?i,y^dEvTuv Im' 
 avr^g aiD^ig e'^u naT^ivhpo^Elv inLrpETtovrag. 
 
 " Erasistratus, in his treatise on fevers, has described 
 how membranes are attached to the mouths of the 
 vessels which serve the heart in the alternate recep- 
 tion and expulsion of materials. Some have ventured 
 to deny the existence of these membranes, implying 
 that they were made up by Erasistratus for the pur- 
 pose of supporting his doctrine; but they have now 
 come to be so well known to physicians generally, 
 that one would seem very ill informed not to be ac- 
 quainted with them. At the mouth of the vena cava 
 there are three, shaped very much like spear points; 
 whence, I suppose, they were called 'tricuspids' 
 {'TpLy?id)'^Lvag) by some of the Erasistrateans. Those 
 at the arteria venalis, that is, the artery which has its 
 ramification from the left ventricle of the heart into 
 the lung, are of nearly the same form but not so 
 many, for at this orifice the membranous appendages 
 are two in number, while at each of the remaining 
 mouths there are three, all of them sigmoid* in 
 shape. Each of these (last) mouths, as Erasistratus 
 
 * The ancient Greek sz£-»ia, in the older monumental inscrip- 
 tions, as well as in some existing manuscripts, has the form of 
 C. The valves of the pulmonary artery and aorta were, there- 
 fore, properly named, from their semilunar or crescentic shape. 
 
APPENDIX. 25 1 
 
 says, in his description, is a channel of exit, one of 
 them for blood, to the lung, the other for pneuma to 
 the body at large. The use of the membranes, as he 
 thinks, is to perform for the heart contrary functions, 
 alternating at successive intervals. Those attached 
 to the vessels which bring in materials, when pressed 
 from without inward, yield to the influx of the mate- 
 rials, and, falling into the cavities of the heart, throw 
 open its orifices and leave an unobstructed passage 
 for what is drawn into it. For these matters, he 
 says, do not come in of their own impulse, as into 
 a passive receptacle; but the heart itself, expanding 
 like a brazier's bellows, distends itself by its diastole. 
 The membranes attached, on the other hand, to the 
 vessels of exit, act in the contrary way. For, turning 
 from within outward, they yield before the efflux, and 
 open the orifices when the heart discharges its con- 
 tents; while in the whole remaining interval they 
 exactly close the orifices, preventing any return of 
 what has been discharged." — Galen. Opera Omnia, 
 Vol. v., p. 548. 
 
 The whole of the foregoing extract is given by 
 Galen as representing the views of Erasistratus, and 
 mainly for the purpose of contesting a part of its 
 doctrine. Erasistratus claims that the cardiac valves, 
 in their backward closure, entirely prevent regur- 
 gitation by complete occlusion of the orifices; while 
 Galen believes that this occlusion is incomplete, 
 allowing a partial reflux. His next sentence be- 
 gins: "But if this be so, O Erasistrateans," etc., 
 etc. 
 
252 APPENDIX. 
 
 (24) 
 Although Galen lived at Rome, his works were 
 written in Greek, as was customary at that time for 
 books on scientific subjects. Modern writers em- 
 ployed Latin for the same purpose long after it was 
 in disuse for any other. Two hundred years ago, it 
 would have been thought very unprofessional for an 
 important medical work to be published in English. 
 Still later, Van Swieten's Commentaries (1742), Hal- 
 ler's Physiology (1757), Morgagni's Seats and Causes 
 of Disease (176 1 ), and Soemmering's Anatomy (1794), 
 were printed in Latin; and even within the present- 
 century, such works as Prochaska, Disquisitio Anato- 
 mico-physiologica (1812); Blumenbach, Collectio Cra- 
 niorum (1820); Mascagni, Anatomia Universa (1823); 
 and Otto, Monstrorum Descriptio (1841), have ap- 
 peared in the same classical dress. 
 
 (25) 
 The dogma of the ancients, that "nature abhors a 
 vacuum," was only a truthful expression of the facts 
 so far as they had been observed. It explained the 
 non- occurrence of a vacuum by supposing a natural 
 capacity in every movable body to extend itself 
 into any adjacent space which would otherwise be 
 empty ; and by virtue of this tendency, the blood of 
 the veins would penetrate into the neighboring arte- 
 ries, whenever the latter were vacated by their escap- 
 ing spirits. A similar property is now attributed to 
 gases, which are capable of indefinite expansion; the 
 ancients believed it to reside also in bodies of a liquid 
 form. 
 
APPENDIX. 253 
 
 (26) 
 
 n£(pa0J7i'at hi aati Ttavri ru ^ovTiOfisva, xadori 
 xal r^fielg STieLpddyiusv Tio^Xccztg rpojaavteg t^v npo- 
 eipriiiEVYiv apTYipiav. Ov j^aT^snCi^ he i^evpi^aetg 
 ainyjv xal nplv yujuvwcrat to hep^a Tco a^vyfic^ 
 TEXjiaipofievog. AtaaysfiaiVEL yap n xivr,aig iv fiev 
 Toig la^volg ^(oocg enmXeov, iv he rolg nioOLV lO^ri- 
 aiov tov xat' o^expavov apdpov. TaiSr^ rohvv, 
 elnsp av hsi^aip, tLtpcxXysig, vj ypa^slov opdaaag xal 
 xadLEig,- J7 ^e^6vYiv, ri n tSiv larpixi^v //.a^aLpudv 
 Tui' iaj(^vCiv, J7 Tt rG>v napan'XyiGiuv opyd^wv, oaa 
 ^paxslav hvvaraL Ttoi'^aai Tyjv hiaipEGLV, Iva ra t' 
 d/l/La 7tavQ\oaa TipoadEv etpjyrat, xatd tov tonov 
 dnohEi^rig aituv, xal ug oibev ovQ' at twv dptri- 
 piuiv xivriaeig ovQ' a\ tC^v ^vG^v napaS'ka.TttovtaL. 
 Galen. Opera Omnia, Vol. iv., p. 715. 
 
 (27) 
 
 Vv^LvovvtEg oiv n^elg exdatots fisydTiag dpT>7- 
 piag, ag ivhsy^^EtaL, ^d'kiata h' ivhE^EtaL rdg xard 
 xSthi, tovg 'EpaaiatpatEiovg Bpardfisv, ei xav vvv 
 yovvj onoTE yeyvfivuvtai, Soxovgiv iv aiVatg ej(^Eiv 
 aifxa. Oi h' i^ dvdyxrig ojio'koyovaiv, d|Ua fiiv on 
 xal avtog 'Epaciatpatog awdg iv tcj hiaipelaQaL 
 to hspfia Ttapefintuaiv alfiatog ex tfig dpTjjpt'ag 
 yiyveadai ^T^aiv, a^Ma 6' oti xal to ^aivofievov ov- 
 Tcog E'x^Ei. Bp6;^o ydp 'hfJ-clg exatEpcodev Tag ysyv- 
 fivufiEvag dptyipiag hiaT^a^Sdvovtsg, elt ixts^vov- 
 Tfg toi'v fieaa, BelxvvfiEv al^atog fieatdg. 
 
 Galen. Opera Omnia, Vol. iv., p. 723. 
 
254 APPENDIX. 
 
 (28) 
 
 "Tlie whole of the blood in the body is discharged from 
 the ibound." This statement is not strictly true, since 
 a certain fraction of the blood, usually about one- 
 fourth, remains in the vessels after death by hem- 
 orrhage, owing to failure of the heart's action. But 
 it is valid in the sense intended by Galen, because 
 enough blood is discharged to render the animal gen- 
 erally exsanguine, and to drain, not only the parts 
 immediately adjacent to the wound, but also the vas- 
 cular organs in the rest of the body. 
 
 (29) 
 This was a favorite dogma with some of the dialec- 
 ticians at the school of Alexandria, who were fond of 
 multiplying verbal discussions, to the frequent mysti- 
 fication of themselves and their hearers. The anato- 
 mists, on the other hand, held these metaphysical 
 subtleties in something like contempt. One of the 
 most noted of the dialecticians was Diodorus Cronos, 
 whose argument against the existence of motion was 
 as follows: "If anything moves, it must do so either 
 in the place where it is, or in some other place. But 
 it cannot move where it is, because as soon as it 
 moves it is already somewhere else; and it cannot do 
 so in any other place, because when it begins to move 
 it has not yet arrived there." This acute philosopher 
 one day suffered a dislocation of the shoulder, and 
 came to Herophilus for treatment. But Herophilus 
 objected. The shoulder, he said, could not have been 
 dislocated without moving; and as it was impossible 
 for it to move, of course it could not be dislocated. 
 
APPENDIX. 255 
 
 Diodorus begged him to defer that question to an- 
 other time, and to give him the benefit of his surgical 
 skill; which Herophilus proceeded to do, and put the 
 shoulder back i-nto its place. This story is told by 
 Sextus Empiricus (a. d. 2OC-250), Leipzig edition, 1840, 
 Vol. i., p. 200. 
 
 (30) 
 The term ;^U/ldg, chyle, as used by Galen, did not 
 mean the white, milky fluid found in the small intes- 
 tines and lacteals, but the liquid juices extracted from 
 the food by stomach digestion. The original signifi- 
 cation of the word is simply a "juice," generally that 
 expressed from fruits or vegetables; and it was also 
 applied by anatomists to the nutritious liquids of ani- 
 mal tissues. After the discovery of the lacteals and 
 lymphatics in the seventeenth century, its use was 
 restricted to the milky emulsion produced by the 
 digestion of oleaginous matters. 
 
 (31) 
 
 'H ToiJS o^vyfiovg ipyai^ofXEvi^ Svvafiig. 
 
 Galen. Opera Omnia, Vol. ix., p. 6. 
 
 (32) 
 
 'Etiei Tolvvv n xa^Sta Tyjg sfi^vrov depfiaaiag, ri 
 hioLxelTaL to ^Cdov, olov iaria tk lig iazL xal nYiyYi, 
 X. T. PL. Galen. Opera Omnia, Vol. iii., p. 436. 
 
 (33) 
 
 The word used in this sense is '^vjj.d, to cool by 
 breathing or blowing uf)on, with its compounds 
 drai|'i;;^fd, xata-^vji^io., and e^^v^a. 
 
256 APPENDIX. 
 
 (34) 
 
 The ancient cupping vessels were made of bronze, 
 and were long and narrow, like a cucumber; whence 
 their name, OLXvai. 
 
 (35) 
 
 'E^ andvTuv oiv rovTcdv egtlv dnoSe^aaQai ruv 
 Xeyoi'Tuv, r^g sfi^vrov dsp/^aaiag evsxsv dvanvelv 
 TO. ^coa. Kat ydp to pmi^sadai avfi/ierpiig ;^p>7(7(- 
 fiov, xal to nerpLog 4"^zeo'^at. 'Afj-^o yap Taf5Ta 
 ^aiveTai pcdvvvvra rriv etcru dspfiaaiav, xivriaiv re 
 dvayxalov £J(^eiv ;jdT(j to xanvCiSeg, wg av sItwi rig, 
 ixxevovv trig rov cu^aTog avyxavaecog. 
 
 Galen. Opera Omnia, Vol. iv., p. 492. 
 
 (36) 
 
 'Ej£^e%ETat 5' avrCdv ivravda ^ia ^^e^' iWfytO'Tiy, 
 sx ri^v xvptdv rov ^natog hiane^vxvla, npog afi^cd 
 Tov ^6ov Ta fxepy^ ^epo^evri, to T£ chvcd xal to xa/m. 
 <i>al7]g av olov dycyyqv TLva fieaTov at^aTog vTtdp- 
 j^ovaav avTYiv, xal bj(^sT0vg na^no'XT^ovg dnoppeov- 
 Tag la^ELV, e/ldtTToiig Te xal fisi^ovg, eig nav.^opiov 
 TOV fcjou vtvE^rjfisvovg. 
 
 Galen. Opera Omnia, Vol. iii., p. 272. 
 
 . (37) 
 
 2a(pE(TTaTa V av avro fiddotg snl tov sv Tolg 
 XYpioig oy^eTQv. 'Ex TovTcdv yap slg fiev to, Ttapa- 
 xe'insva xal n'kYi<siov dnavTa hiahlhoTal Ttc ixfidg, 
 eig Se Ta TtoppuTcpw TtpoaeXdelv ovxetl SuraTaf 
 xal Slol tovto dvayxd^ovTai TioylXolg o^erolg fiixpolg 
 (XTto Toii fieyd?i.QV TsT^yjfievoig sig ExaOTov (lEpog Tov 
 
APPENDIX. 257 
 
 Kypvav tyiv inippvaiv ifov vSatog htLre'xvaaQaL' xai 
 tyi^ixavrd ye to, ^ETa^v hiaOTYiuara rovruv tov 
 fiixpHv bj^stiiv Ttoiovaiv, nkixa ^laXiaTa vofii^ovdiv 
 dpxslv fJ5 TO ixavidg dno^^avetv e'kxovta ryjg ixare- 
 pudsv aiVotg enippEovaviq vyp&tYiTog. Outo; oiv 
 e^Ei xdv tolc, Tdv ^(k,iv a6(xaaLV. '0;^eTot 7to/l/lot 
 xard Ttavta rd (lEpy; SiECfTtapfihoL Ttapd/yovacv av- 
 rolg aifia., xaddnep ev xrinioi vSpsiap Tivd. Kai 
 tovrov Ttjv oj^^eruv id (lETa^v haatrina'va dav- 
 jUaffTGJg V7i6 rrig ^vOECog evdvg i^ «PX'7? SiatETaxrai 
 Ttpog TO jUJjr' ivSECJg j(ppi^YElaQai Totg fisTa^v fiopioig 
 sXxovaiv Eig eavrd to alfia, (ii^te xaTax^jV^eadai 
 Ttot' ai'Ta 7t/^>70£i TtEpiTf^g vypoT/itog dxaiputg 
 eTtippEoiavig. 
 
 Galen. Opera Omnia, Vol. ii., p. 210. 
 
 (38) 
 
 'Hj(if£g hi xai 81 EtEpov nvog oTjjv (3i6?[,iov Tto/lu- 
 Eihiog dnESei^afiEv, al^a xq.v tcj xaird ^vaiv e;^£(v 
 TO ^aov iv avralg talg dpTwtaig TtEpLEy^saQai. Ei 
 8e rovto, navri nov hriXov, ag ov^,, on Ttkr^povvtai 
 tov Ttapd trig zap^tag STiiTiEfiTtofiEvov nvev^arog, 
 wg 'EpaffiffTpaTog svofiL^E, Sid Tovro SiaarE^yiovrai, 
 (idX^jOv, VI, otL SiaarE?i?iovraL, §id rovto nXripovv- 
 Tat. Kevu>v fXEv lydp alfiatog ovaS>v, svSexoit dv 
 tffug EV okiyo) xpova to dno trig xotp^tag imppVEV 
 i^ixsadai y.E'x^pt tov TtEpdtav ' alfia oe eiTtep e^oiev, 
 ovSa^ug iy^apEl to Ta^og trig xivt^GEag ofio^yEiv 
 Tfy) Ttapd Tyjg zap^iag nXi^povfiEvag aiirdg 6tacrTE/l- 
 ^Eodai. Ov yap, on n^yipovvrai, Sid rovto Sia- 
 GtE?j^ovrai, d2.X oTt ^laoTe^/lo^Tat, Sid tovro 
 nkripovvraL. 
 
 Galen. Opera Omnia, Vol. v., p. 168. 
 
258 APPENDIX. 
 
 (39) ^ 
 XvvavEaro^avtai ^ih ai a^tvi^Lai Taig ^T^s'^l 
 xaff qTjov to CTu^a, koI fiETaXafiSdvovcytv i^ d^ilri- 
 Xcov aI|Wa xai nvEVfia Sid tlvc^v dopdroj' re xai 
 Gteviiv dxpiSiog oSCov. 
 
 Galen. Opera Omnia, Vol. iii., p. 455. 
 
 (40) 
 It is noticeable how this doctrine corresponds with 
 what is known at present, as to the relative composi- 
 tion of arterial and venous blood; arterial blood con- 
 taining a large quantity of oxygen and but little car- 
 bopic acid, while in venous blood there is a scanty 
 proportion of oxygen and abundance of carbonic acid, 
 
 (41) 
 These infundibuliform depressions on the surface 
 of the septum, in the right ventricle, are interspaces 
 between the muscular bundles, which are more or 
 less prominent and interlace with each other. In 
 the human heart they are plainly enough visible, but 
 very shallow. In the heart of the ox they are deeper, 
 often admitting a probe to the depth of one-quarter to 
 three-quarters of an inch. In the dog's heart they 
 are few in number, from one-eighth to three-eighths 
 of an inch deep, and usually in the form of elongated 
 clefts. In the sheep and pig they are hardly notice- 
 able, except along the borders of the conus arteriosus. 
 It must be acknowledged that where they are well 
 developed, as in the heart of the ox, they are fre- 
 quently seen also on the inner surface of the outer 
 wall of the ventricle, where, according to Galen, they 
 would be of no use. 
 
APPENDIX. 259 
 
 (42) 
 
 Galen's estimate of the comparative size of the car- 
 diac orifices, as they appear to the eye, is correct. 
 All anatomists are agreed that the auriculo-ventricu- 
 lar orifice on the right side is considerably larger 
 than that of the pulmonary artery; the tricuspid 
 valves, which are thin and flaccid, like the sigmoid, 
 lying back in contact with the walls of the ventricle. 
 The mitral valves, in the left ventricle, are thicker 
 and stiffen The large one, on the inner side, slants 
 downward and outward, reducing the auriculo-ven- 
 tricular orifice, when viewed from above, to a some- 
 what narrow and irregular opening of triangular form ; 
 while the aortic orifice, just below the sinuses of Val- 
 salva, when viewed from the same direction, is nearly 
 circular in form and looks decidedly larger. This is 
 especially noticeable in the heart of the ox, where the 
 valves and their fibrous attachments are quite thick, 
 and the cadaveric rigidity of the muscular walls nearly 
 always strongly pronounced. Herbert Davies {Pro- 
 ceedings of the Royal Society of London, March 17th, 
 1870) makes the area of the mitral opening larger 
 than that of the aortic; the difference between them, 
 according to him, being the same as that between the 
 tricuspid and pulmonary. But in his estimate the 
 area of each opening was calculated from its circum- 
 ference, assuming in every case the form of the orifice 
 to be that of a circle; and this assumption is vigor- 
 ously disputed by other writers. . 
 
 (43) 
 
 The razor of the fourteenth century may have had 
 
26o APPENDIX. 
 
 a form better adapted for anatomical purposes than 
 our own ; but, in any case, the use of such an instru- 
 ment, and the want of any other especially intended 
 for dissection, show the low grade of the medical 
 sciences at that time. 
 
 (44) 
 
 Additamenta cordis sunt quedam partes pelliculares, 
 apte ad dilatandum et constringendum, genite ad hoc 
 ut quum in corpora nostro generatur multum de san- 
 guine, vel de spiritu in ventriculo sinistro, dilatentur 
 ut contineant sanguinem multum, vel spiritum mul- 
 tum, qui interdum generatur. * * * Secunda causa 
 fuit quia cum non semper generetur in nobis multa 
 quantitas spiritus, et etiam sanguinis, cum cor fuisset 
 •magnum, ut plurimum concavitas cordis extitisset 
 vacua, sed quia iste auricule possuut faciliter contrahi 
 quum non sunt replete, ibi non erit vacuitas. — Mundi- 
 rms. Chapter De Anathomia cordis. 
 
 (45) 
 
 Primo quia hie ventriculus debet continere spiritum, 
 dexter vero sanguinem, sanguis autem gravior est spi- 
 ritu, propter quod ratione contentorum plus aggrava- 
 ret pars dextra quam sinistra, et ideo cor non fuisset 
 equalis stature: ut ilia esset equalis ponderis fecit 
 (natura) parietem sinistram grossiorem, ut recompen- 
 saret sua gravitate gravitati sanguinis. — Mundinus. 
 Chapter entitled Partes cordis intrinsece. 
 
 (46) 
 Mondini's book contains a number of anatomical 
 terms, some of them, no doubt, derived from the 
 
APPENDIX. 261 
 
 Arabic, which are strange to modern ears. For ex- 
 ample : the vena cava is the vena chilis ; the caput 
 coH is the monoculum ; the front wall of the abdomen 
 is inyrach; the peritoneum is cyphach; the oesopha- 
 gus is men (indeclinable); the omentum is zyrbus; 
 and the mesentery is euchanim. 
 
 (47) 
 
 Figuram habet pyramidalem, gibbam tamen, non 
 talem principaliter quia sit calidum, ignis sequens 
 formam, sed quia est mixtum, perfectum, animatum, 
 possidet formam operi suo competentem. — Carpus. 
 IsagogcE, Chapter De Corde. 
 
 (48) 
 
 Jacobus Sylvius (Jacques Dubois) was a teacher of 
 anatomy at Paris from about the year 1530 to 1555; 
 the latter part of the time as professor in the Royal 
 College of France. He was distinguished for the at- 
 tractive style of his lectures and demonstrations, and 
 for his observations on the structure of the brain. It 
 is from him that the fissure of Sylvius and the aque- 
 duct of Sylvius derive their names. 
 
 (49) 
 
 These details concerning the life of Vesalius are 
 drawn mainly from the preface, by Boerhaave and 
 Albinus, in their edition of his complete works, pub- 
 lished at Leyden in 1725. 
 
262 APPENDIX. 
 
 (50) 
 
 We do not find that Galen anywhere asserts that 
 he dissected the human body, at least habitually. 
 He often refers to his experiments and observations 
 on various animals. In his opening chapter on the 
 "Anatomy of the Veins and Arteries," he expressly 
 states that this book is a compendium of the dissec- 
 tion which his pupil has seen performed "on the 
 body of the ape;" and his prolongation of the cavi- 
 ties of the cerebral ventricles into the olfactory lobes 
 {Opera Omnia, Vol. ii , p. 859) evidently represents 
 this formation in the brain of the rodentia, carnivora, 
 ruminantia, and pachydermata. 
 
 (51) 
 It is not always easy to understand the importance 
 attached to certain points by the writers of former 
 times. Vesalius, for example, devotes the sixth 
 chapter of his third book mainly to a discussion with 
 Galen whether the vena cava takes its origin from 
 the liver or from the heart. As there is no difference 
 between them in regard to the physiology of the 
 parts, or the course of the blood at either point, the 
 question as to whether the vein may be said to " orig- 
 inate " from one organ or the other seems like a dispute 
 about words. But it had, no doubt, in the mind of the 
 author, some significance which we fail to perceive. 
 
 (52) 
 
 Vtriusq; uetriculi superficies perquam inaequalis 
 est, & multis quasi foueis in carnea substantiam peni- 
 
APPENDIX. 263 
 
 tius itfipressis obsita. Neq; istae ad latera tatum 
 cosistunt, quibus dexter uetriculus sinistru respicit, 
 uerum (etsi interim secus caeteris omnib. Anatomen 
 profitentibus uisum sit) per uniuersam prorsus uentri- 
 culoru superficiem, no solum in nuper occisis animan- 
 tibus, sed perpetuo, tatisper dum cor ipsum seruare 
 uolueris, apparentes, neq; unqua uel in exiccato corde 
 coniuentes. Vtcuq ; interim hae foueae sint cospi- 
 cuae, nuUae tamen, quod sensu coprehendi potest, 
 ex dextro uentriculo in sinistrQ per eorunde uentricu- 
 loru septu permeat: neq; etia mihi meatus uel obscu- 
 rissimi occurrut, quibus uentriculorii septum sit per- 
 uiia, quauis illi a dissectionum professorib. enarretur, 
 quu sanguine ex dextro uetriculo in sinistrum assumi 
 persuasissimfl habet. Vnde etia fit (quemadmodu 
 quoq ; alicubi monebo apertius) de cordis hac in parte 
 officio, me baud mediocriter ambigere. — Vesalius. De 
 Humani corporis fabrica. Liber VI., cap. xi. 
 
 (53) 
 
 In cordis itaq; costructionis ratione, ipsiusq; par- 
 tium usu recensendis, magna ex parte Galeni dognrra- 
 tibus sermonem accommodaui: non sane, quod undiq; 
 haec ueritati consona existimem, uerum quod in nouo 
 passim partium usu officioq; referendo, adhuc mihi 
 diffidam, neq; ita pridem de medicorum principis 
 Galeni sentetia uel latum unguem hic declinare ausus 
 fuerim. Haud enim leuiter studiosis expendendii est 
 uentriculorum cordis interstitium, aut septum, ipsurfi 
 ue sinistri uentriculi dextrum latus, quod aeque eras- 
 sum copactumq; ac densum est atq; reliqua cordis 
 pars, sinistrum uentriculQ complectes. Adeo ut igno- 
 
264 APPENDIX. 
 
 rem (quicquid etiam de foueis hac in sede comenter, 
 & uenae portae ex uentriculo & intestinis suctionis 
 non sim immemor) qui per septi illius substantiam ex 
 dextro uentriculo in sinistrum uel minimu quid san- 
 guinis assumi possit. — Vesalius. De Humani corporis 
 fabrica. Liber VI., cap. xv. 
 
 . (54) 
 
 Huius uenae rami, per iecoris corpus exporrecti, 
 portae ramis incumbunt, & utriusq; uenae ramulorum 
 extrema osculis inter se conniuent, & multis locis 
 congredi continuariq; iam dissecantibus apparent. — 
 Ibid., Liber III., cap. vi. 
 
 (55) 
 
 Atque quum haec animo obuersantur, simul sese 
 multa in arteriarum serie offerunt, de quibus non im- 
 merito uenit ambigendum : nimirum nullam fere uenam 
 absq; comite arteria uentriculum ac intestina, lienem4; 
 adeo ipsum petere, & fere totam portae uenam sua 
 serie comitem sibi arteriam asciscere. Denique reni- 
 bus arteriae tarn grandes communicantur, ut neuti- 
 quam ad illorum calorem duntaxat temperandum eas 
 productas esse queamus affirmare: uti minus adliuc 
 solius caloris nativi gratia tantas arterias uentriculo, 
 intestinis, lieni4; insertas esse, possimus asserere. 
 His accedit.quod per uenas arteriasq; mutuos mate- 
 rieru fluxus & refluxus esse, ac nihil prorsus grauita- 
 tem & pondu^ materierQ in uenis arterijs^; agere, 
 plurimis argumentis oporteat fateri. — Ibid., Liber VI., 
 cap. XV. 
 
APPENDIX. 265 
 
 The foregoing extracts are from the revised edition 
 of Vesalius' work, printed in 1555. In his first issue 
 he does not. impugn the porosity of the cardiac sep- 
 tum, or the transudation of blood through it accord- 
 ing to Galen. He published his doubts on this sub- 
 ject only after mature consideration, and after finding 
 them confirmed by repeated observation. 
 
 (56) 
 
 Vesalius was appointed physician to the emperor, 
 Charles V., in 1544. This appointment was a per- 
 fectly natural one. The emperor, by birth Duke of 
 Burgundy and. sovereign of the Low Countries, inher- 
 ited the crown of Spain from his maternal grandfather; 
 but he was born and educated in the Netherlands, 
 and was always more of a Fleming than a Spaniard. 
 He was proud of the success and reputation of Vesa- 
 lius ; and when he established his court at Madrid he 
 gave the anatomist the highest professional appoint- 
 ment at his command. 
 
 (57) 
 
 The personal history of Servetus, so far as known, 
 is to be found in De la Roche, Memoirs of Literature, 
 London, 1722, Vol. iv., pp.73, 127, 187, 264, 299, 319; 
 Mosheim, Ecclesiastical History, Ancient and Modern, 
 English edition, Berwick, 18 19, Vol. iv., p. 488; Bio- 
 graphie Universelle, Paris, 1825, article Servet; and 
 Willis, Servetus and Calvin, London, 1877. 
 
 (58) 
 
 Even Mosheim, who was chancellor of the Univer- 
 sity of Gottingen, and reputed to be very learned in 
 
266 APPENDIX. 
 
 such matters, says, in his Ecclesiastical History, that 
 "it is difficult to unfold, in a few words, the doctrine 
 of this unhappy man; nor indeed would any detail 
 render it intelligible in all its branches." And De la 
 Roche, in his Memoirs of Literature, says that Serve- 
 tus sometimes "expresses himself so confusedly that 
 'tis no easy thing to have a notion of his doctrine." 
 
 (59) 
 
 Ad quam rem est prius intelligenda substanfialis 
 generatio ipsius vitalis spiritus, qui ex acre inspirato 
 at subtilissimo sanguine componitur et nutritur. Vi- 
 talis spiritus in sinistro cordis ventriculo suam origi- 
 nem habet, iuuantibus maxime pulmonibus ad ipsius 
 generationem. Est spiritus tenuis, caloris vi elabora- 
 tus, flauo colore, ignea potentia, vt sit quasi ex puriori 
 sanguine lucidus vapor, substantiam in se continens 
 aquae,' aeris et ignis. Generatur ex facta in pulmo- 
 nibus mixtione inspirati aeris cum elaborato subtili 
 sanguine, quem dexter ventriculus cordis sinistro 
 communicat. Fit autem communicatio haec, non per 
 parietem cordis medium, ut vulgo creditur, sed magno 
 artificio a dextro cordis ventriculo, longo per pulmo- 
 nes ductu, agitatur sanguis subtilis: a pulmonibus 
 praeparatur, flauus efficitur: et a vena arteriosa in 
 arteriam venosam transfunditur. Deinde in ipsa ar- 
 teria venosa inspirato aeri miscetur, expiratione a 
 fuligine repurgatur. Atque ita tandem a sinistro cor- 
 dis ventriculo totum mixtum per diastolem attrahitur, 
 apta supellex, vt fiat spiritus vitalis. 
 
 Quod ita per pulmones fiat communicatio, efprae- 
 paratio, docet coniunctio varia, et communicatio venae 
 arteriosae cum arteria venosa in pulmonibus. Confir- 
 
APPENDIX. 267 
 
 mat hoc magnitude insignis venae arteriosae, quae 
 nee talis, nee tanta facta esset, nee tantam a corde 
 ipso vim purissimi sanguinis in pulmones emitteret, 
 ob solum eorum nutrimentum, nee cor pulmonibus 
 hac ratione seruiret; cum praesertim antea in embry- 
 one solerent pulmones ipsi aliunde nutriri, ob mem- 
 branulas illas, seu valuulas cordis, vsque ad horam 
 natiuitatis nondum opertas. vt docet Galenus. Ergo 
 ad alium vsum effunditur sanguis a corde in pulmones 
 hora ipsa natiuitatis, et tarn copiosus. Itern a pulmo- 
 nibus ad cor non simplex aer, sed mixtus sanguine 
 mittitur, per arteriam venosam : ergo in pulmonibus 
 fit mixtio. Flauus ille color a pulmonibus datur san- 
 guini spirituoso, non a corde. In sinistro cordis ven- 
 triculo non est locus capax tantae et tam copiosae 
 mixtionis, nee ad flauum elaboratio ilia sufficiens. 
 Demum, paries ille medius, cum sit vasorum et facul- 
 tatum expers, non est aptus ad communicationem et 
 elaborationem illam, licet aliquid resudare possit. 
 Eodem artificio, quo in hepate fit transfusio a vena 
 porta ad venam cauam propter sanguinem, fit etiam 
 in pulmone transfiisio a vena arteriosa ad arteriam 
 venosam propter spiritum. Si quis hsec conferat cum 
 iis quae scribit Galenus lib. 6 et 7 de vsu partium, veri- 
 tatem penitus intelliget, ab ipso Galeno non animaduer- 
 sam. — Servettts. Christianisvii Restitutio, p. 176. 
 
 (60) 
 
 Secunda alia ratione facti sunt ventriculi illi, vt ad 
 spatia eorum inania penetrans per ossa ethmoide in- 
 spirati aeris portio, et ab ipsis animae vasis per diasto- 
 lem attracta, animalem intus contentum spiritum refi- 
 ciat et animam ventilet. In vasis illis est mens, anima 
 
268 APPENDIX. 
 
 et igneus spiritus, iugi flabellationeindigens: alioquin, 
 instar externi ignis, conclusus suffocaretur. Flabella- 
 tione et difflatione instar ignis indiget, non solum, vt 
 ab acre pabulum sumat, sed vt in eum suam fuliginem 
 evomat. Sicut elementaris hie externus ignis terreo 
 crasso corpori, ob communem siccitatem, et ob com- 
 munem lucis formam, alligatur, corporis liquorem 
 pabulum habens, et ab acre difflatur, fovetur, et nutri- 
 tur; ita igneus ille noster spiritus et anima corpori 
 similiter alligatur, unum cum eo faciens, eius sangui- 
 nem pabulum habens; et ab aereo spiritu, inspiratione 
 et expiratione, difflatur, fovetur et nutritur, vt sit ei 
 duplex alimentum, spirituale et corporale. Hac loci 
 et spiritualis fomenti ratione conveniens admodum 
 fuit, eundem nostri spiritus lucidum natura locum 
 spiritu alio sancto, cselesti, lucido, afflari, idque per 
 oris Christi expirationem, sicut a nobis inspiratione 
 in eundem locum trahitur spiritus. Decuit eundem 
 nostri intellectus, et lucentis animae locum, cselesti 
 alterius ignis luce denuo illuminari. Nam Deus pri- 
 mam . in nobis lucernam illuminat, et subortas ibi 
 tenebras denuo vertit in lucem, vt ait Dauid, psalm. 
 17 et 2 Sam. 22. Idipsum docet Elihu apud lob, cap. 
 32 et33. Idipsum docuerunt Zoroaster, Trismegistus 
 et Pythagoras, vt mox citabo. Vasorum quoque for- 
 matio et temperies bona ad mentis bonitatem facit, vt 
 illis sit anima melior, quibus sunt ilia melius disposita. 
 Sicut vero a bono spiritu insita ilia lux magis et magis 
 illuminatur, ita et a malo obscuratur. Si in vascula 
 ilia cerebri, cum animali nostro lucido spiritu tenebro- 
 sus et nequam spiritus intrudatur, tunc daemoniacos 
 furores videbis, sicut per bonumspiritum lucidas reue- 
 lationes. Vascula autem ilia facile impetit spiritus 
 
APPENDIX. 269 
 
 nequam, qui sedem' habet viciriam in abyssis illis 
 aquarum, et lacunis ventriculorum cerebri. Spiritus 
 ille nequam, cuius potestas est aeris, una cum inspi- 
 rato a nobis acre, lacunas illas libere ingreditur et 
 egreditur, vt ibi cum spiritu nostro, intra vasa ilia 
 velut in area collocato, iugiter dimicet. Imo eum ita 
 undique obsidet, vt vix illi liceat respirare, nisi quum 
 superveniens lux spiritus Dei malum spiritum fugat. 
 Ecce quam decenter loco illi conveniat, mentis, spiri- 
 tus, reuelationis, et intellectus ratio, et insita et super- 
 veniens, et tentationum superiorum pugna, ut alias 
 nunc tentationes omittam. — Servetus. Christianismi 
 Restitutio, p. 173. 
 
 (61) 
 
 According to Mosheim, "even his plans of refor- 
 mation fell into oblivion after the death of their au- 
 thor." — Ecclesiastical History, Vol. iv., p. 492. 
 
 (62) 
 
 Inter hos ventriculos septum adest, per quod fere 
 omnes existimant sanguini a dextro ventriculo ad 
 sinistrum aditum patefieri. id vt fiat facilius, in tran- 
 situ ob vitalium spirituum generationem tenuem reddi. 
 sed longa errant via; nam sanguis per arteriosam 
 venam ad pulmonem fertur, ibiq; attenuatur; deinde 
 cum acre vna per arteriam venalem ad sinistrum cor- 
 dis ventriculum defertur. — Colombo. De Re Anatomica, 
 p. 177. 
 
 (63) 
 Haec vero tria vasa a substantia rara, porosa, leuiq; 
 amplectuntur, itaq; pulmo gignitur: cuius vsus est, 
 yt recte Anatomici scribunt, ob cordis refrigerationem ; 
 
 23 
 
270 APPENDIX. 
 
 quod efficit, aerem ad illud frigidiim deferens, factus 
 praeterea fuit pulmo ad inspirationem, atq; expiratio- 
 nem, & vt voci deseruiat Atq; hos omnes pulmonis 
 vsus nouerunt, qui ante me scripsere. praeter quos 
 ego alium addo maximi momenti, de quo ne per 
 transennam quidem meminere. Est autem praepara- 
 tio, & pane generatio vitalium spirituum, qui postmo- 
 dum in corde magis perficiuntur. Aerem namq; per 
 nares, & os inspiratum suscipit; nam asperae arteriae 
 vehiculo per vniuersum pulmonem fertur, pulmo vero 
 aerem ilium vna cum eo sanguine miscet, qui a dextro 
 cordis ventriculo profectus per arterialem venam de- 
 ducitur. Vena enim haec arterialis praeterquam quod 
 sanguinem pro sui alimento defert; adeo ampla est, 
 vt alius vsus gratia deferre possit. Sanguis huius- 
 modi ob assidui pulmonum motum agitatur, tenuis 
 redditur, & vna cum aere miscetur, qui et ipse in hac 
 collisione, refractioneq; praeparatur; vt simul mixti 
 sanguis, & aer per arteriae venalis ramos suscipiantur: 
 tandemq; per ipsius truncum ad sinistrum cordis ven- 
 triculum deferantur; deferuntur vero, tam belle mixti, 
 atq; attenuati, vt cordi exiguus praeterea labor super- 
 sit: post quam exiguam elaborationem, quasi extrema 
 imposita manu vitalibus hisce spiritibus, reliquum est, 
 vt illos ope arteriae ahorti per omnes corporis partes 
 distribuat. — Colombo. De Re Anatomica, p. 223. 
 
 (64) 
 Non vereor quin nouus hie pulmonum vsus, quem 
 nemo Anatomicorum hactenus somniauit, incredulis, 
 atque Aristotelicis paradoxon videri debeat, quos oro, 
 rogo4; vt pulmonis magnitudinem contemplentur, 
 quae absq; vitali sanguine permanere non poteratj 
 
APPENDIX. 271 
 
 cum nulla sit tam minima corporis particula, quae illo 
 destituatur. Quod si vitalis hie sanguis in pulmoni- 
 bus non gignitur: a qua parte transmitti poterat, prae- 
 terquam ab ahorti arteria? at ab ahorti arteria ramus 
 nuUus, neq; magnus, neque paruulus ad pulmones 
 mittitur. Nam quo pacto per venam, aut per arteriam 
 venalem deferri sanguis vitalis ad pulmonem potest, 
 cum neutra pulset? hsec igitur candide lector, quam 
 dixi, arterialis vena* constructa fuit, vt sanguinem eo, 
 quo diximus, pacto elaboratum intro afferret ad cor 
 ipsum : non vt a corde eliciat & extra ferat. — Colombo. 
 De Re Anatomica, p. 223. 
 
 (65) 
 Ad haec, quae diximus, ilia etiam accedit ratio, 
 Medicos tunc e pulmonibus manantem sanguinem 
 coniectare, atque adeo certo scire, longo rerum vsu 
 edoctos, non modo quod cum tussi eliciatur, sed etiam 
 quia floridus est, tenuis, & pulcher, vt de sanguine 
 arteriarum quoque dicere consueuerunt. — Colombo. De 
 Re Ana(omica, p. 224. 
 
 (66) 
 
 Tu vero candide lector doctorum hominum studi- 
 ose, veritatis autem studiosissime, experire, obsecro, 
 in brutis animantibus, quae viua vt seces, moneo, at- 
 que hortor; experire inquam, an id, quod dixi, cum 
 re ipsa consentiat: nam in illis arteriam venalem illius 
 modi sanguinis plenam inuenies, non aere plenam, aut 
 fumis, vt vocant, si Deo placet, capinosis, illi duntaxat 
 pulsus deest. — Colombo. De Re Anatomica, p. 224. 
 
 * This is evidently a misprint for arteria venalis.. 
 
272 APPENDIX. 
 
 (67) 
 Dicitur ob officium Arteria. Nam I. pulsat, siqui- 
 dem sinistro ventriculo continua est. II. Aerem con- 
 tinet & devehit. — Casp. Bartholini Institutiones Anato- 
 miccB, ab auctoris filio Thoma Bartholino. Lugd. Ba- 
 tavorum, 1641. Lib. 11 , cap. vii., p. 214. 
 
 (68) 
 
 Idcirco pulmo per venam arterijs similem ex dex- 
 tro cordis ventriculo feruidum hauriens sanguinem, 
 eumque per anastoniosim arteriae venali reddens, 
 quae in sinistrum cordis ventriculum tendit, trans- 
 misso interim aere frigido per asperse arteriae cana- 
 les, qui iuxta arteriam venalem protenduntur, non 
 tamen osculis communicantes, vt putauit Galenus, 
 solo tactu temperat. — Caesalpinus. Qucestionum Peri- 
 pateticarum, Lib. V., qusest. iiii., p. 125 d. 
 
 (69) 
 Pulchre igitur condita sunt omnia: Cum enim 
 feruere oporteret in corde sanguinem, vt fieret ali- 
 menti perfectio : primo quidem in dextro ventriculo, 
 in quo crassior adhuc continetur sanguis, deinde au- 
 tem in sinistro vbi syncerior iam sanguis est: partim 
 per medium septum, partim per medics pulmones re- 
 frigerationis gratia ex dextro in sinistrum transmitti- 
 tur. — Caesalphius. QiccBstionum Peripateticanim, Lib. 
 v., qucest. iiii., p. 126 A. 
 
 (70) 
 
 The claims of Caesalpinus to a knowledge of the 
 general circulation are given at especial length by 
 
APPENDIX. 273 
 
 De Renzi, in his Storia della Medicina in Italia. Na- 
 poli, 1844-48. Tom. III., cap. iv., art. 8. The author, 
 who is .fully imbued with patriotic fervor, combats 
 zealously the opinion of adverse critics; and he 
 makes the naive remark (p. 379), that "if those who 
 would detract from the glory of Italy and Caesalpi- 
 nus are foreigners " he will excuse them, because 
 they "have no inward motive for seeking the truth;" 
 while if they are Italians, he considers them as sui- 
 cidal monomaniacs. 
 
 (71) 
 Qua autem ratione fiat alimenti attractio, & nutritio 
 in plantis, consideremus. Nam in animalibus vide- 
 mus alimentum per venas duci ad cor tanquam ad 
 ofificinam caloris insiti, & adepta inibi vltima perfec- 
 tione per arterias invniuersum corpus distribui agente 
 spiritu, qui ex eodem alimento in corde gignitur.— 
 Caesalpirms. De Plantis, Lib. I., cap. ii., p. 3. 
 
 (72) 
 Quod si cor principium est sanguinis, venarum 
 quoque & arteriarum principium esse necesse est: 
 vasa enim haec sanguini sunt destinata. Vt igitur 
 riuuli ex fonte aquam hauriunt, sic venae & arteriae 
 ex corde. — Caesalpimis. Qucestiones Peripateticce, Lib. 
 v., qusest. iii., p. 116 A. 
 
 (73) 
 
 Vtrseque autem ex eodem principio fluunt scilicet 
 corde, quia principium vnum esse melius est quam 
 plura, & propter alias causas superius dictas: ex dex- 
 
274 APPENDIX. 
 
 tro quidem eius ventriculo amplissimo & calidissimo 
 vena caua, sanguinem enim continet crassioreni, in 
 quo calor intensus est magis. Ex altero autem ven- 
 triculo qui medius est, ac minor, sanguinem tenjpera- 
 tissimum ac syncerissimum habente egreditur Aorta 
 ex latere sinistro. — Caesalpiniis. Qucsstiones Peripa- 
 teticcB, Lib. V., qusest. iii., p. 1 18 A. 
 
 (74) 
 
 Ex corde egrediuntur venae & arteriae, quarum 
 illae quae ad caput feruntur caluariam ingressae par- 
 tim in ventriculis cerebri plexus •retis mode efficiunt: 
 partim vero in membrana duriore sinus quosdam 
 communes ex vtraque vena constituunt, e quibus 
 vasa sanguinis ift tenuem membranam sparguntur. — 
 Caesalpinus. Qucestiones Peripatetics, Lib. V., quaest. 
 iii., p. 1 20, F. 
 
 (75) 
 
 Vena caua materiam subministrat ex hepate, quod 
 alimentum auctivum vocat Aristoteles. Aorta perfec- 
 tum recipit, quod alimentum nutritivum, quia dat esse. 
 — Caesalpinus. Speculum Artis Medicce, Lib. VI., cap. 
 ix., p. 443. 
 
 (76) 
 Venae latae duae, a quibus multi rami sparguntur, 
 Porta & caua, .quarum veluti radicatio in hepate est. 
 Ex Porta rami multi ad intestina & ventriculum ten- 
 dunt, una cum arteriis per mesenterium, unde venae 
 mesaraicae vocantur, sugentes chylum, vt ferant ad 
 hepar, et interim in sanguinem conuertunt. * * * 
 
APPENDIX. 27s 
 
 Vena autem caua ramos in totum corpus dispergit, vt 
 simul cum arteriis vniuersas partes nutriant. — Caesal- 
 pinus. Speculum Artis MediccB, Lib. VII., cap. i., p. 488. 
 
 (77) 
 
 Sanguis ergo venarum fibris et crassitie sua nutrit; 
 at arteriarum spiritibus et calore vivificat. — Spigelius. 
 De Humani Corporis fabrica, Lib. V., cap. i. 
 
 Est autem vena, si definitionem ipsius requires, vas 
 membranosum, sanguinem fibrosum et crassiorem, 
 pro nutritione totius corporis omnium que partium, 
 conficiens et deferens. — Ibid., Lib. V., cap. i. 
 
 Et fit (sanguis) spirituosus, sicque per arteriam 
 magnam in universum corpus pro vita singularium 
 partium pellitur. — Ibid., Lib. VI., cap. vi. 
 
 Vense alimentum suppeditant; arteriae flammse 
 spiritum recipiunt. — Caesalpinus. Qucestiones Peripa- 
 tetics, quaest. iiii. 
 
 Arteria magna, per quam cor universo corpori 
 vitam communicat. — Falloppius. Institutiones Anatho- 
 miccz, cap. De Thoracis. 
 
 (78) 
 
 Primo enim venarum sanguis fibrosior est, id est, 
 plures habet fibros. Secundo idem quoque crassior 
 est, dum contra arteriarum sanguis attenuatus sit 
 magis per coctionem, earn scilicet quse' in corde fit. 
 Color quoque utriusque sanguinis discrimen evestigio 
 exprimit; cum ille, nigrior sit; hie rubicundus: ille, 
 spirituum expers; hie prsgnans: ille, quiete fruens; 
 hie perpetuo et indesinente motu agitatus.: — Spigelius. 
 De Humani Corporis fabrica, Lib. V., cap. i. 
 
2/6 APPENDIX. 
 
 (79) 
 
 Motus continuus a corde in omnes corporis partes 
 agitur, quia continua est spiritus generatio qui sua 
 amplificatione diffundi celerrime in omnes partes ap- 
 tus est, simul autem alimentum nutritivum fert, et auc- 
 tivuni ex venis elicit per osculorum communionem quam 
 Graeci anastomosint vacant. — Caesalpinus. Qucestioties 
 Peripatetics, Lib. V., qusest. iv., j). 123 B. 
 
 Nam praeterquam quod omnes arteriae sanguinem. 
 & alias humores, nisi admodum ii crassi fuerint, a sin- 
 gulis venis per communes anastomoses recipiunt. — Eusta- 
 chius. Opuscula Anatomica. De_ Renum Officio, cap. 
 xxix. 
 
 Internse vero (arteriae) & spiritum & vaporem & 
 sanguinem trahunt: spiritum a corde, vt sit caloris 
 influentis vehiculum ; vaporem, vt sit pabulum vitalis 
 spiritus, & sanguinem a vicinis venis per occultas ana- 
 stomoses, ad sui nutritionem. — Laurentius. Historia 
 Anatomica humani corporis. Lib. IV., cap. ix. 
 
 (80) 
 
 Illae quoque arteriae, quae in mesenterio distributJE 
 sunt, chylum ipsum, ?ion secus ac mesenterii ipsius vente, 
 attrahunt et conficiunt. — Eustachius. Opuscula Anato- 
 mica. De Renum Officio, cap. xxix. 
 
 (81) 
 
 Beside the Frankfort edition of 1628, the same 
 work appeared in Leyden, 1639; Padua, 1643; and 
 Leyden. 1647. Also an English edition, The Ana- 
 tomical Exercises of Dr. William Harvey, Professor 
 of Physick, and Physician to the King's Majesty, con- 
 
APPENDIX. 1TJ. 
 
 cerning the motion of the Heart and Blood. With 
 the Preface oi Zachariah Wood, Physician oi Roterdam. 
 'To which is added Dr. James De Back his discourse 
 of the Heart, Physician in ordinary to the Town of 
 Roterdam. London, 1653 (containing also the two 
 letters addressed by Harvey to Riolan, in defence of 
 the circulation). And the same in Latin with an ad- 
 ditional index, Guilielmi Harveji, Doct. & Profess. 
 Regii Exercitationes Anatomicae De Motu Cordis & 
 Sanguinis Circulatione. Cum duplici Indice Capitum 
 & Rerum. Accessit Dissertatio de Corde Doct. Ja- 
 cobi de Back, Urbis Roterodami Medici ordinarii. 
 Roterodami, 1654. ' 
 
 These were the only editions which appeared dur- 
 ing Harvey's life. Subsequently the last-named work 
 was issued at Leyden, in 1736, and Glasgow, 1751. 
 The London College of Physicians published, in 1766, 
 a handsome folio edition of Harvey's works : Guilielmi 
 Harveii Opera Omnia: a Collegia Medicorum, Londi- 
 nensi edita; MDCCLXVI. And lastly there is an 
 English edition, translated from the Latin, with a life 
 of the author, by Robert Willis, M.D., London, 1847. 
 
 (82) 
 
 It may seem surprising that Harvey should give so 
 much consideration to the transfer of blood through 
 the median septum, notwithstanding that seventy or 
 eighty years had elapsed since Vesalius had declared 
 against the porosity of the septum and Colombo had 
 described the circulation through the lungs. But it has 
 already been shown (page 131) how imperfectly these 
 doctrines had gained foothold in general belief; and, 
 
 24 
 
278 APPENDIX. 
 
 in fact, the porosity of the septum was afterward 
 maintained, as against Harvey, by no less a person 
 than Riolan {De Motu Circulatorio Sanguinis in Corde; 
 Londini, 1649; in the Monitio ad Lectorem, cap. i., p. 
 2, and cap. ii., p. 23). 
 
 (83) 
 
 In motu, & eo quo mouetur tempore, tria prae cae- 
 teris animaduertenda. 
 
 I. Quod erigitur cor, & in mucronem se sursum 
 eleuat; sic vt illo tempore ferire pectus et foris sentiri 
 pulsatio possit. 
 
 II. Vndique contrahi, magis vero secundum latera; 
 ita vti minoris magnitudinis, & longiusculum, & col- 
 lectum appareat. 
 
 III. Comprehensum manu cor eo quo mouetur tem- 
 pore, duriusculum fieri, a tensione autem ilia durities 
 est, quemadmodum si quis lacertos in cubito manu 
 comprehendens, dum mouent digitos, illos tendi, & 
 magis renitentes fieri percipiat. 
 
 IV. Notandum insuper in piscibus, & frigidioribus 
 sanguineis animalibus, vt serpentibus, ranis, &c., illo 
 tempore, quo mouetur cor albidioris coloris esse, cum 
 quiescit a motu coloris sanguinei saturum cerni. — 
 Harvey, De Motu Cordis et Sanguinis, cap. ii. 
 
 (84) 
 
 Verum nemo amplius dubitare poterit, cum vsque 
 in ventriculi cauitatem inflicto vulnere, singulis moti- 
 bus, sive pulsationibus cordis, in ipsa tensione prosi- 
 lire cum impetu foras contentum sanguinem viderit. — 
 Ibid., cap. ii. 
 
APPENDIX. 279 
 
 (85) 
 Neque verum est similiter, quod vulgo creditur, cor 
 vllo suo motu, aut distentione, sanguinem in ventri- 
 culos attrahere; dum enim mouetur, & tenditur, ex- 
 pellit: dum laxatur, & concidit, recipit sanguinem. — 
 Harvey. De Motu Cordis et Sanguinis, cap. ii. 
 
 (86) 
 
 Et in mechanico illo artificio, quod sclopetis adap- 
 tant, vbi compressione alicuius ligulae cadit silex, 
 percutit chalybem et propellit, ignis elicitur, qui in 
 puluerem cadit, ignitur puluis, interius prorepit, dis- 
 ploditur, euolat globulus, metam penetrat, & omnes 
 isti motus proper celeritatem quasi in nictu oculi simul 
 fieri apparent. — Ibid., cap. v. 
 
 (87) 
 Motus itaq; cordis omnino ad hunc se habet mo- 
 dum, & vna actio cordis est ipsa sanguinis transfiasio, 
 & in extrema vsq; mediantibus arteriis propulsio, vt 
 pulsus, quem nos sentimus in arteriis, nil nisi sangui- 
 nis a corde impulsus sit. — Ibid., cap. v. 
 
 (88) 
 
 Et similis est conditio Embryonum pulmones ha- 
 bentium, dym adhuc pulmonibus non vtuntur, ac est 
 eorum animalium, quse pulmones non habent. — Ibid., 
 cap. vi. 
 
 (89) 
 Cur non iisdem argumentis de transitu sanguinis in 
 adultis his per pulmones, fidem similem haberent, & 
 cum Columbo peritissimo, doctissimoque Anatomico, 
 
280 APPENDIX. 
 
 idem assererent, et crederent, ex amplitudine, & fa- 
 brica vasorum pulmonum, & eo, quod arteria venosa, 
 & similiter ventriculus, repleti sint semper sanguine, 
 quern e venis hue venisse necesse est, & nulla alia, 
 quam per pulmones semita, vt & ille, & nos ex ante 
 dictis, & autopsia, aliisque argumentis palam esse ex- 
 istimemus. — Harvey. De Motu Cordis et Sanguinis, 
 cap. vii. 
 
 (90) 
 
 Sed hoc peculiariter & luce clarius meridiana expe- 
 riri licet. Vena caua partem inferiorem cordis subin- 
 greditur, exit arteria parte superiori: jam comprehensa 
 vena caua vel tenaculis, vel digito & pollice, sangui- 
 nisq; cursu intercepto, per aliquod spatium infra cor, 
 videbis expulsu, statim pene inaniri illam partem intra 
 digitos & cor, sanguine exhausto a cordis pulsu, simul 
 cor albidiori multo colore esse, etiam in dilatatione 
 sua, & ob defectum sanguinis minus esse & languidius 
 tandem pulsare, sic vt emori denique videatur. Con- 
 tra statim soluta vena, color & magnitudo redeunt 
 cordi; postea si relinquas venam, & arterias similiter 
 per aliquam distantiam a corde ligaueris, vel compres- 
 seris, videbis contra illas turgere in parte comprehensa 
 vehementer, & cor ultra modum distendi, purpureum 
 colorem contrahere usque ad liuorem & tandem op- 
 primi sanguine, sic vt suffocatum iri credas: soluto 
 vero vinculo rursus ad naturalem constitutionem in 
 colore, magnitudine, pulsu, redire. — Ibid., cap. x. 
 
 (91) 
 In adultis his per pulmonum ccecas porositates & va- 
 sorum eius oscilla, tam ex Galeni verbis, quam ex ante 
 
APPENDIX. 281 
 
 dictis illud inquam fieri aeque manifestum est. — Har- 
 vey, De Motu Cordis et Sanguinis, cap. vii. 
 
 Et quod in membris & extremitatibus sanguis, vel 
 per Anastomosin immediate, vel mediate per camis poro- 
 sitates, vel vtroque modo transire ab arteriis in venas. — 
 Ibid., cap. xi. 
 
 Signum est & sanguinem ab arteriis in venas & non 
 contra, permeare, & aut anastomosin vasorum esse, aut 
 porositates camis, & partium solidarum peruias sanguini 
 esse. — Ibid., cap. xi. 
 
 Cum hsec confirmata sint omnia, & rationibus & 
 ocularibus experimentis, quod sanguis per pulmones 
 & cor, pulsu ventriculorum pertranseat, & in vniuer- 
 sum corpus impellatur, & immittatur, & ibi in venas 
 &■ porositates camis obrepat, & per ipsas venas vndique 
 de circumferentia ad centrum ab exiguis venis in 
 raaiores remeet. — Ibid., cap. xiv. 
 
 (92) 
 
 Nusquam autem invenire potui vasa invicem, arte- 
 rias scilicet cum venis, per orificia copulari : libenter 
 ab aliis discerem, qui Galeno tantum adscribunt, ut 
 ad verba ejus jurare ausi sint. Neque in jecore, liene, 
 pulmonibus, renibus, aut aliquo viscere, est aliqua 
 anastomosis: in quibus coctis, usque quo friabile to- 
 tum redditur parenchyma et tanquam pulvis ab omni- 
 bus vasorum fibris excussus et acu detractus, omnes 
 cujusvis divaricationis fibras, omnia capillamenta, evi- 
 denter cernere potuerim. Audacter igitur affirmare 
 ausus sum, neque anastomosin esse vel venarum por- 
 tae cum cava, arteriarum cum venis, aut pori chole- 
 dochi capillarium ramulorum, qui per totam hepatis 
 
282 APPENDIX. 
 
 simam disperguntur, cum venis. — Exercitatio Anatomi- 
 ca De, Ciradatione Sanguinis, ad J. Riolanum, Prima. 
 Guilielmi Harveii Opera Omnia : a Collegia Medicorum 
 Londinensi edita, MDCCLXVI., p. 105. 
 
 (93) ^ 
 
 Primerose refers to Galen's experiment of introdu- 
 cing a tube into an artery and tying the vessel over it, 
 to show that the pulsific faculty of the arteries is 
 transmitted through their walls; and illustrates it 
 with a diagram. — Exercitatio xiv. 
 
 He speaks of the fact that the heart of a cold- 
 blooded animal, when cut out and laid upon a table, 
 will continue to beat, though it no longer receives or 
 expels any blood. — Animadversio in cap. ii. 
 
 He mentions the double experiment of Galen, 
 which consisted of tying, in different cases, the um- 
 bilical arteries and the umbilical vein of the living 
 foetus, to show the effect of these ligatures on the 
 pulsation in the membranes. — Animadversio in cap. 
 vi. ; also in cap. ix. 
 
 He says that if an animal be killed and immedi- 
 ately opened, without allowing time for any consider- 
 able quantity of blood to be intercepted by the stop- 
 page of respiration, the arteries will still be found 
 containing but little blood in comparison with the 
 veins. — Animadversio in cap. ix. 
 
 (94) 
 In favor of the circulation were; Walaeus, Epistola 
 de Motu Sanguinis ad Thomam Bartholinum, Lugd. 
 Bat, 1640; Regius, Spongia pro eluendis sordibus 
 
APPENDIX. 283 
 
 animadversionum Jacobi Primerosii in Theses de cir- 
 culatione sanguinis, Lugd. Bat, 1640; Ent, Apologia 
 pro circuitione sanguinis, qua respondetur Emilio 
 Parisano, Medico Veneto, Londini, 1641 ; Rolfink, 
 Dissertatio de Circulatione, Jena, 1642; and Conrin- 
 gius, De Sanguinis Generatione et Motu naturali, 
 Helmstadt, 1643, Lugd. Bat, 1646. 
 
 Against it were; Parisanus, Lapis Lydius de Motu 
 Cordis et Sanguinis, Venetiis, 1635; Wormius, De 
 Circulatione dubia, &c., Epistola ad Thomam Bartho- 
 linum, Hafni3e,^i643; Leichner, De motu sanguinis 
 Exercitatio Anti-Harveiana, Arnstadt, 1645 ; and Li- 
 cetus, De Motu Sanguinis, Sec, Utini, 1647. 
 
 (95) 
 Riolan is spoken of by his contemporaries with 
 much respect, even when they are writing in opposi- 
 tion to his opinions. In the somewhat turgid phrase- 
 ology of the time, Slegel calls him "Vir clarissimus," 
 " Phoenix Anatomicorum," "magnus Riolanus noster," 
 and "Princeps Anatomicorum"; Harvey addresses 
 him in his published letters as "Medicum peritissi- 
 mum," and "Anatomicorum coryphseum"; and Wa- 
 laeus, in his letter to Bartholinus on the circulation, 
 refers to him as "magnus ille Anatomicus.'' 
 
 (96) 
 The lymphatic vessels were noticed so nearly at 
 the same time (1651) by Rudbeck in Leyden and 
 Bartholinus in Copenhagen, that both these observers 
 are usually credited with the merit of independent 
 discovery. 
 
284 APPENDIX. 
 
 (97), 
 In the Malade imaginaire, Doctor Diafoirus, in 
 praising his son Thomas, says: "But above all, what 
 pleases me in him is that he follows my example and 
 attaches himself blindly to the opinions of our an- 
 cients; and that he would never have anything to 
 do with the reasons and experiments of the pre- 
 tended discoveries of our time touching the circula- 
 tion of the blood, and other opinions of the same 
 stamp." And Thomas, as a compliment to Ange- 
 lique, presents her with a Thesis which he has com- 
 posed, " contre les circulateurs!' This play was first 
 represented in 1673. 
 
 (98) 
 
 The magnifying instruments used by Malpighi con- 
 sisted either of a double convex lens, or of two such 
 lenses, one of them serving as an objective, the other 
 as an eyepiece. 
 
 THE END. 
 
INDEX. 
 
 Absorption, of digested food, 24, 25, 76 ; by tlie mesenteric arteries, 
 
 159 
 
 Air, as understood by the ancients, 52 ; conveyed from the lungs by 
 the arteria venosa, 137, 139, 140, 205 
 
 Alexander, supplied funds to Aristotle, 18 
 
 Alexandria, city of, its foundation, 42; its growth and prosperity, 43; 
 its museum and library, 44 
 
 Alexandria, school of, 42 ; founded by Ptolemy, 44; its organization, 
 44; its reputation and success, 42, 45; legalized dissection of 
 human bodies in, 46 
 
 Alimentary canal, as described by Aristotle, 22; digestion in, 23; ab- 
 sorption from, 24 
 
 Alimentation, according to Aristotle, 22; according to Galen, 76 
 
 Alpinus, on the lungs, 135 
 
 Anastomosis, between arteries and veins, according to Erasistratus, 58 ; 
 according to Galen, 88, 89; denied by Harvey, 187, 210 ; demon- 
 strated by Malpighi, 224; by Leeuwenhoek, 226 
 
 Anatomy, human, first publicly taught by dissection, 46 
 
 Anatomy, of the lungs, according to Aristotle, 26; according to Co- 
 lombo, 125; according to Malpighi, 222 
 
 Anatomy, of the nervous system, according to Herophilus and Erasis- 
 tratus, 47 
 
 Animal spirits, 53 ; elaborated in the brain, 53, 54 ; transmitted through 
 the nerves, 53 ; to the organs of sense and motion, 54 
 
 Aqueduct, of Sylvius, 261 
 
 Archigenes, on the pulse, 65 
 
 Aristotle, 17; his parentage, 17; his resources, 18; his anatomical 
 and physiological treatises, 18; his scientific information, 19, 229; 
 his doctrine of the sanguiferous system, 19; of the arteries and 
 veins, 20; of digestion and alimentation, 22, 23, 24, 25, 26; of 
 
 2S 
 
286 INDEX. 
 
 the lungs and pulmonary vessels, 26, 27 ; of the pneuma or spir- 
 itus, 28, 33 ; of respiration, 32, 33, 34, 35 ; of the cardiac and 
 vascular pulsation, 28, 29, 31, 36 
 
 Artery, ancient name for the trachea, 26, 27 
 
 Artery, pulmonary, formerly called vena arterialis and vena arteriosa, 
 
 56, 189 
 
 Arteria venalis, 56, 68, 78, 81, 82, 132, 136 ■ 
 
 Arteria venosa, 56, 133, 134, 135, 139, 140, 189 
 
 Arterialization, of venous blood, according to Galen, 91, 92; according 
 to Servetus, 115; according to Colombo, 126, 131 
 
 Arteries and veins, according to Aristotle, 20, 21, 36; according to 
 Praxagoras, 37, 38; according to Herophilus and Erasistratus, 50, 
 56, 58, 60; according to Galen, 61 ; according to Harvey, 189 
 
 Arteries, bronchial, discovered by Ruysch, 128 
 
 Arteries, pulsation of, according to Praxagoras, 38, 39 ; according to 
 Erasistratus, 87; according to Galen, 78, 86, 87; according to 
 Harvey, 170 
 
 Asellius, discovers the lacteals, 211 
 
 Atmosphere, ancient idea of, 52 
 
 Auricles, action of, according to Mondini and Carpi, 95, 99; accord- 
 ing to Harvey, 171 
 
 Baitholinus, Caspar, 215 ; his definition of the arteria venosa, 140; his 
 doctrine of the heart and bloodvessels, 215 
 
 Bartholinus, Thomas, 216; his anatomical worlds, 216, 217; his adop- 
 tion of the doctrine of the circulation, 218 
 
 Bauhinus, on the pulmonary circulation, 132 
 
 Blood, arterialization of, according to Galen, 92 ; according to Serve- 
 tus, IIS; according to Colombo, 126, 131 ; consumption of, in 
 local nutrition, 22, 85, 86, 87, 154, 155; expansion of by heat, in 
 the heart and bloodvessels, 31, 36; by combination with vital 
 spirits, 192; no continuous movement of, according to Aristotle, 
 22, 25, 36; nor in the Alexandrian doctrine, 57; nor according 
 to Galen, 86; nor in the doctrine of the sixteentli century, 155; 
 passage of, from the veins to the arteries, according to Erasistra- 
 tus, 59, 69, 71; and writers of the sixteenth century, 159; produc- 
 tion of, in the heart, according to Aristotle, 19, 20, 21, 23, 31, 36; 
 in the liver, according to Galen, 76; pulsation of, according to 
 Aristotle, 29, 31, 36; transfusion of, from the portal to the hepatic 
 vein, according to Vesalius, 108; and Servetus, 116; from the 
 vena arteriosa to the arteria venosa, according to Galen, 88, 90 ; 
 according to Servetus, 115; according to Colombo, 125; transu- 
 
INDEX. 
 
 287 
 
 dation of, through the bloodvessels, for local nutrition, 21, 36, 86 ; 
 
 through the cardiac septum, according to Galen, gi, 92 
 Blood, venous and arterial, characters of, according to Galen, 77, 78 ; 
 
 according to Spigelius, 158; according to Pnmerose, 191, 192; 
 
 according to Plempius, 202 
 Blood-globules, red, discovered by LeeuYifenhoek, 225 
 Bloodvessels, as receptacles for the blood, 19, 58 ; pulsation of, accord- 
 ing to Aristotle, 29, 31, 36; absorption by, 23, 25 
 Bloodvessels, capillary, discovered by Malpighi, 224 ; demonstrated by 
 
 Leeuwenhoek, 226 
 Botalli, on the foramen ovale, 137 ; on the daily consumption of blood 
 
 in nutrition, 155 
 Brain, character of, misunderstood by Aristotle, 49; recognized by 
 
 Herophilus and Erasistratus, 49, 50; convolutions of, described 
 
 by Erasistratus, 50; place of formation of the animal spirits, or 
 
 nerve force, 53, 54 
 
 Caesalpinus, 141 ; his works, 141 ; his vievfs on the pulmonary circu- 
 lation, 132, 142; his claims to aknovifledge of the general circula- 
 tion, 143, 147 
 
 Calamus scriptorius, named anS described by Herophilus, 47, 50 
 
 Caput coli, formerly called monoculum, 261 
 
 Carpi, 98 ; his book on anatomy, 98, 99 
 
 Cartilaginous fishes, ovo-viviparous, according to Aristotle, 19 
 
 Cetacea, air-breathing and viviparous, according to Aristotle, 19 
 
 Choroid membranes, named by Herophilus, 47 
 
 Chyle, according to Galen, 76, 255 
 
 Circulation, abdominal, denied by Riolan, 206 ; proved by Pecquet, 
 213 
 
 Circulation, capillary, discovered by Malpighi, 223, 224 ; demonstrated 
 by Leeuwenhoek, 226 
 
 Circulation, general, demonstrated by Harvey, 168-187; denied by 
 Primerose, 191 ; by Riolan, 204; by Parisanus, Wormius, Leich- 
 ner, Licetus, 283; maintained by Plempius, 197; by Walseus, 
 Regius, Ent, Rolfink, Conringius, 217, 282, 283; by Slegel, 209 ; 
 by Pecquet, 2ii; by Bartholinus, Veslingius, TruUius, 218; by 
 Marchetti, 219; by Dionis, 220 
 
 Circulation, partial, maintained by Riolan, 205 
 
 Circulation, pulmonary, described by Servetus, 114; by Colombo, 125; 
 accepted by Par4, Caesalpinus, Plater, 132; by Spigelius, 136; 
 doubted by Falloppius, Bauhinus, Buret, 133, 134 ; denied by 
 
288 INDEX. 
 
 Laurentius and Pabricius, 134, 136 ; by Botalll, Varolius; and 
 Ulmus, 137, 138, 139; by Primerose, 193; by Riolan, 205; de- 
 monstrated by Harvey, 174-177 
 
 Colombo, 123; his work on anatomy, 123; his criticisms and imita- 
 tion of Vesalius, 124; his doctrine of the pulmonary circulation, 
 125 ; of the generation of vital spirits, 126; of the arterialization 
 of venous blood, 126, 127; the reasons for his doctrine, 127, 128, 
 129; its reception and influence, 13 1 
 
 Conringius, on the circulation, 283 
 
 Convolutions, cerebral, described by Erasistratus, 50 
 
 Cupping vessels, ancient, 256 
 
 Cyphach, Arabic name for the peritoneum, 261 
 
 Diastole, of the heart, according to Aristotle, 31 ; according to the 
 Alexandrian school, 57; according to Galen, 79, 80; according 
 to Harvey, 169 ; of the arteries, according to Erasistratus, 87 ; 
 according to Galen, 79, 86, 87; according to Harvey, 170, 174 
 
 Digestion, by the agency of heat, according to Aristotle, 20, 22, 31 
 
 Dionis, 220 ; his lectures and experiments, 220 
 
 Diodorus, on the non-existence of motion, 254 
 
 Dissection, of the human body, first legalized in Alexandria, 46 
 
 Divini, his improvement in the microscope eye-piece, 225 
 
 Dogmatists, in ancient medicine, 63 
 
 Dolphins, air-breathing and viviparous, according to Aristotle, 19 
 
 Duct, thoracic, discovered by Pecquet, 211 
 
 Ductus arteriosus, described by Galen, 67, 68 ; its closure after birth, 
 69; its action, according to Harvey, 175 
 
 Duodenum, named by Herophilus, 47 
 
 Duret, on the heart and lungs, 134 
 
 Empiricists, in ancient medicine, 63 
 
 Ent, on the circulation, 283 
 
 Erasistratus, 45 ; his authorship of anatomical names, 47 ; his doctrine 
 of the nerves, 47, 48 ; of their origin from the brain, 48 ; of the 
 neurilemma and medulla, 49 ; of the cerebral convolutions, 50 ; 
 of the vascular system, 50; of the pneuma or spiritus, 51 ; of 
 vital spirits and animal spirits, 53 ; of the cardiac valves, 57 ; of 
 the vascular anastomoses, 58 ; of fevers and inflammations, 59 ; 
 of the arterial pulsation, 87 ; of the passage of blood from the 
 veins to the arteries, 59, 69, 71 
 
 Eucharum, old name for the mesentery, 261 
 
INDEX. 
 
 289 
 
 Eustachius, on absorption by the mesenteric arteries, 159 
 Experiments, of Aristotle, on the lung, 27 ; of Galen, on the arteries, 
 71, 72, 73; on the heart, 80; on the arterial pulsation, 282; on 
 the umbilical arteries and vein, 282 ; on the pulmonary vein, 140 ; 
 on vascular anastomosis, 89 ; of Colombo, on the pulmonary cir- 
 culation, 129, 130; of Fabricius, on the valves of the veins, 150; 
 of Harvey, on the heart, 168, 169, 172 ; on the arteries, 164, 170, 
 179; on the vena cava, 180; on the veins of the limbs, 182, 183, 
 184; on the valves of the veins, 185, 186; of Plempius, on the 
 circulation, 198, 199, 200, 201 ; on venous and arterial blood, 
 202 ; of Slegel, on the circulation, 209 ; of Pecquet, on the arte- 
 ries and veins, 212; on the abdominal circulation, 213; on the 
 pulmonary circulation, 214; of Trullius, on the circulation, 218; 
 of Marchetti, on the human cadaver, 219 ; of Dionis, on the arte- 
 ries and veins, 220 ; of Malpighi, on the capillary circulation, 224 ; 
 of Molyneux and Leeuwenhoek, 225, 226 
 
 Fabricius, on the heart and lungs, 136; on the venous valves, 147 
 
 Falloppius, on the lungs, 133 
 
 Fever, pathology of, according to Erasistratus, 59 
 
 Fissure of Sylvius, 261 
 
 Foramen ovale, known to Galen, 67 ; its closure after birth, 69 ; per- 
 sistence of, according to Botalli, 137 ; action of, according to 
 Harvey, 175 
 
 Fuliginous vapors, excreted by the lungs, 79, 84, 100, 115, 118, 133, 
 134, 136; their supposed nature, 159 
 
 Galen, 61 ; his merit and reputation, 62 ; his works, 63, 76; his oppo- 
 sition to sectarianism, 64 ; his devotion to anatomy, 67 ; his doc- 
 trine of the arteries as bloodvessels, 69 ; its experimental proof, 
 71 ; his system of physiology, 76; on venous and arterial blood, 
 77 ; on the pulse, 78 ; on the heart's action, 80; on the functions 
 of the heart, 81; on vital heat, 81, 83; on respiration, 82; on 
 the distribution of blood by the veins, 84, 85 ; of blood and spirits 
 by the arteries, 86 ; on local nutrition, 87 ; on the vascular anas- 
 tomosis, 88, 89; on the perforations of the cardiac septum, 91 ; 
 on the arterialization of venous blood, 92 ; his dissections prac- 
 ticed on animals, 104, 262 
 
 Gills and lungs, their physiological relation, according to Aristotle, 19, 
 
 33 
 Globules, of the blood, discovered by Leeuwenhoek, 225 
 
 25* 
 
290 
 
 INDEX. 
 
 Harvey, 162; his book on the circulation, 163; its various editions, 
 276; his doubts of the prevailing doctrine, 164, 165, 166; his 
 reasons for publication, 167 ; his investigations, on the heart's mo- 
 tion, 168; on the arterial motion, 170; on the motion of the au- 
 ricles, 171 ; on the action and function of the heart, 172; on the 
 pulmonary circulation, 174, 176, 177; on the peripheral circula- 
 tion, 181, 182, 183; on the return of blood to the heart by the 
 veins, 184, 185; his disbelief in vascular anastomosis, 187, 188, 
 210; his reply to Riolan, 209 
 
 Heart, action of, according to Aristotle, 28, 29, 31, 36; according to 
 Galen, 79; according to Harvey, 168 
 
 Heart, function of, according to Aristotle, 19, 20, 21, 31 ; according to 
 Galen, 81 ; in the doctrine of the 16th century, 153, 174, 215; 
 according to Harvey, 172, 174 
 
 Heat, ancient theory of, 29; as necessary to vitality, 20; as the agent 
 of digestion, 20 ; of nutrition, 21 ; as a physiological force, 31 ; as 
 a cause of respiration, 34 
 
 Heat, vital, produced in the heart, according to Aristotle, 19, 21, 31, 
 33; according to Galen, 8i; its physiological action, 81; its dis- 
 tribution, 82 ; its maintenance by respiration, 83, 84 
 
 Herophilus, 40 ; teacher of anatomy, 45 ; his authorship of anatomical 
 names, 47, 56 ; his doctrine of the nerves, 48 ; of the brain, 49, 50 ; 
 his humor, 254 
 
 Hydrophobia and rabies, according to Galen, 66 
 
 Inflammation, pathology of, according to Erasistratus, 59 
 Injections, vascular, by Malpighi, 223 ; by Blancard, 226 ; by Ruysch, 
 227 
 
 Lacteals, discovered by Asellius, 211 
 
 Laurentius, on the pulmonary circulation, 134, 13S; on the action of 
 the veins, 157 
 
 Leeuwenhoek, his microscope, 225 ; his discovery of the blood-globules, 
 225 ; his account of the capillary circulation, 226 
 
 Leichner, against the doctrine of the circulation, 283 
 
 Library, of Apellikon, 18 ; of Alexandria, 44; its importance, 45 
 
 Licetus, against the doctrine of the circulation, 283 
 
 Liver, the organ of sanguification, 76, 105, 155,204,206; and the origin 
 of the veins, 76, 84 
 
 Lungs, anatomy of, according to Aristotle, 26, 35 ; according to Co- 
 lombo, 125; according to Malpighi, 222 
 
INDEX. 
 
 291 
 
 Lungs, function of, according to Aristotle, 32, 34 ; according to the 
 Alexandrian school, 52 ; according to Galen, 82 ; according to 
 Servetus, 115; according to Colombo, 125, 131; according to 
 Caesalpinus, 132, 142, 161; according to Falloppius, 133, 161; 
 according to Alpinus, 135; according to Fabricius, 136, 161 ; ac- 
 cording to Spigelius, 137, 161 
 
 Lungs and gills, their physiological relation, according to Aristotle, 19, 
 
 33 
 Lymphatics, discovered by Bartholinus and Rudbeck, 216, 283 
 
 Malpighi, 221 ; his investigations on the lungs, 222; his unsuccessful 
 injections, 223 ; his discovery of the capillary circulation and blood- 
 vessels, 224; his microscope, 284 
 
 Marchetti, 219; his experiment on the circulation, 219 
 
 Marrow, spinal, why so called, 49 
 
 Meri, old name for the oesophagus, 261 
 
 Mesentery, described by Aristotle, 24; formerly called eucharum, 261 
 
 Mesenteric bloodvessels, absorption by, 23, 24, 25, 76, 105, 106, 107, 
 108, 138, 144, 146, 154, 157, 159, 276 
 
 Methodists, in ancient medicine, 63 
 
 Microscope, as used by Malpighi, 2az, 224, 284; by Molynenx and 
 Leeuwenhoek, 225 ; as improved by Divini, 225 
 
 MoliSre, his allusions to the circulation, 219, 284 
 
 Molyneux, demonstrates the circulalion, 225 
 
 Mondini, 93 ; his book on anatomy, 94 ; his doctrine of the heart and 
 bloodvessels, 96 
 
 Monoculum, old name for caput coli, 261 
 
 Motion, non-existence of, according to the dialecticians, 75, 254 
 
 Museum, of Alexandria, 44; its organization, 44 ; its reputation and 
 success, 4; 
 
 Myrach, old name for abdominal wall, 261 
 
 Nerve, early signification of, 47 
 
 Nerves, first distinguished from tendons and ligaments, 48 ; their con- 
 nection with sense and motion, 48 ;' their origin from the brain, 
 49 ; their physiological action, 54 
 
 Nervous fluid, identical with animal spirits, 55 
 
 Nervous system, according to Herophilus and Erasistratus, 47 
 
 Nikomachus, the father of Aristotle, 17 
 
 Nutrition, by exudation through the bloodvessels, 24, 36, 86 
 
292 
 
 INDEX. 
 
 (Esophagus, formerly called meri, 261 
 Omentum, formerly called Zyrbus, 261 
 
 Par6, on the pulmonary circulation, 132 
 
 Parenchyma, a term used by Erasistratus, 47 ; its significance, 222 
 
 Parisanus, against the doctrine of the circulation, 283 
 
 Pecquet, 211 ; his discovery of the thoracic duct and receptaculum 
 chyli, 211 ; his experiments on the general circulation, 211, 212; 
 on the abdominal circulation, 213; on the pulmonary circulation, 
 214 
 
 Peritoneum, formerly called cyphach, 261 
 
 Plants, nutrition of, according to Aristotle, 24 
 
 Plater, on the pulmonary circulation, 132 
 
 Plempius, 197; on the doctrine of the circulation, 198; his experi- 
 ments, 198, 199; his doubts and difficulties, 200; his conclusions, 
 201, 202 
 
 Plexus, capillary, discovered by Malpighi, 224 
 
 Pneuma, according to Aristotle, 28, 33 ; according to Praxagoras, 39 ; 
 its supposed nature and action, 51 ; its two varieties, 53 ; its source 
 and production, according to Galen, 82 ; its condition in the arte- 
 rial blood, 77, 78, 139 
 
 Pneumatists, in ancient medicine, 64 
 
 Portal vein, absorption by, according to Aristotle, 23, 24, 25 ; accord- 
 ing to Galen, 76; according to later writers, 105, 106, 107, 108, 
 138, 144, 146, 154, 157; its communication with the hepatic vein, 
 according to Vesalius, 1 08 
 
 Portal circulation, denied by Riolan, 206; proved by Pecquet, 213 
 
 Praxagoras, 37 ; his treatment for intestinal obstruction, 38 ; his doc- 
 trine of the arteries as air-tubes, 37, 38 ; of the arterial pulsation, 
 
 38,39 
 
 Primerose, 190; his book against the doctrine of the circulation, 191 ; 
 his reasons and arguments, 191, 192; on the pulmonary circula- 
 tion, 193; on the porosity of the septum, 194; on the quantity of 
 blood passing through the heart, 194, 19S; on the constitution of 
 spirituous blood, 195; on the venous valves, 196; his quotation 
 of experiments, 197, 282 
 
 Ptolemy, king of Egypt, 43 ; founds the school of Alexandria, 44 ; 
 first legalizes the dissection of the human body, 46 
 
 Pulmonary artery, formerly called vena arterialis and vena arteriosa, 
 56, 189 
 
 Pulmonary artery and vein, according to Aristotle, 27, 28 
 
INDEX. 
 
 293 
 
 Pulmonary circulation, described by Servetus, 114; by Colombo, 125; 
 accepted by Par^, Caesalpinus, Plater, 132; by Spigelius, 136; 
 doubted by Bauhinus, Falloppius, Duret, 133, 134; denied by 
 Laurentius and Fabricius, 134, 136; by Botalli, Varolius and Ul- 
 mus, 137, 138, 139; by Primerose, 193; by Riolan, 205; demon- 
 strated by Harvey, 174-177; by Pecquet, 214 
 
 Pulmonary vein, formerly called arteria venalis and arteria venosa, 
 56, 189 
 
 Pulsation of the arteries, according to Praxagoras, 38^ according to 
 Galen, 78, 86, 87 ; as understood in the i6th century, 158, 164; 
 as shown by Harvey, 170 
 
 Pulsation of the heart, caused by its expansion, according to Aristotle, 
 29, 31, 36; and Galen, 79; by its contraction, according to Har- 
 vey, 168, 169 
 
 Pulse, arterial, according to Praxagoras, 38 ; according to Erasistratus, 
 87 ; according to Galen, 78, 86, 87 ; according to Harvey, 170, 
 174 
 
 Rabies and hydrophobia, according to Galen, 66 
 Receptaculum chyli, discovered by Pecquet, 211 
 Refrigeration, of the blood by respiration, 32, 33, 83,84, 132, 133, 135, 
 
 137, 142, 147, 160 
 Riolan, 203 ; his reputation, 283 ; his objections to Harvey's doctrine, 
 
 204 ; his theory of a partial circulation, 205 
 Rolfink, supports the doctrine of the circulation, 283 
 Rudbeck, discoverer of the lymphatic system, 283 
 Ruysch, 227 ; his vascular injections, 227, 228 ; his discovery of the 
 
 bronchial arteries, 128 
 
 Sanguification, in the heart, according to Aristotle, 19, 20, 21, 23, 31, 
 36 ; in the liver, accofding to Galen, 76 
 
 Sects, in ancient medicine, 63 
 
 Septum, interventricular, porosity of, according to Galen, 91 ; doubted 
 by Vesalius, 106; denied by Servetus, 115; by Colombo, 125 ; by 
 Harvey, 165; maintained by Laurentius, 1 35; by Caesalpinus, 
 143; by Primerose, 194; by Riolan, 205 
 
 Servetus, III; his birth and education, 1 1 1 , 112; his theological con- 
 troversies, 112, 113; his " Christianismi Restitutio," 113; his 
 doctrine of the pulmonary circulation, 114; of the arterialization 
 of venous blood, 115; his physiological extravagances, 118, 119, 
 120; his arrest and execution, 121 
 
294 
 
 INDEX. 
 
 Sigmoid valves, why so called, 250 
 
 Slegel, 208; his book on the circulation, 208, 209 
 
 Spigelius, on the pulmonary circulation, 136; on venous and arterial 
 
 blood, 158 
 Spinal marrow, why so called, 49 
 Spirits, why so called, 51 ; vital and animal, 53 
 Spirits, animal, 53 ; elaborated in the brain, 53, 54 ; transmitted through 
 
 the nerves, 54 ; the agent of sense and motion, 54; identical with 
 
 the "nervous fluid," 55 
 Spirits, vital, 53 ; source and action of, 53, 54 ; condition of, in arterial 
 
 blood, according to Galen, 77, 78, 139 ; formation of, in the lungs, 
 
 82; according to Servetus, 115; and Colombo, 126 
 Spiritus, or pneuma, according to Aristotle, 28, 33 ; according to Prax- 
 
 agoras, 39; according to Herophilus and Erasistratus, 51, 53; 
 
 according to Galen, 82 
 Spleen, organ of generation for the arterial blood, according to Umeau, 
 
 139 
 
 Sylvius, his observations on the brain, 261 
 
 Systole, of the arteries, according to Galen, 79 ; according to Harvey, 
 170 
 
 Systole, of the heart, according to Galen, 79, 80 ; according to Har- 
 vey, 169 
 
 Torcular Herophili, why so called, 47 
 
 Trachea, anciently called arteria, air tube, 26, 27 ; significance of its 
 present name, 40 
 
 Transfusion of blood, from the veins to the arteries, according to Era- 
 sistratus, 59, 69, 71 ; according to Galen, 88, 89 ; from the vena arte- 
 riosa to the arteria venosa, according to Galen, 90 ; according to 
 Servetus, 115 ; according to Colombo, 125 ; according to Harvey, 
 1 74 ; from the portal vein to the hepatic vein, according to Vesa- 
 lius, 108; according to Servetus, 116 
 
 Transudation of blood, through the vessels, in local nutrition, 21, 36, 
 86; through the interventricular septum, 91, 92 
 
 Tricuspid valves, named and described by Erasistratus, 47, 57 ; why 
 so called, 57, 250 
 
 Trullius, his experiments on the circulation, 218 
 
 Umeau, on the arterialization of blood in the spleen, 139 
 
 Valve, of the foramen ovale, described by Galen, 68 ; its closure after 
 birth, 69 
 
INDEX. 
 
 29s 
 
 Valves, cardiac, described by Erasistratus, 57, 250 ; action of, according 
 to Galen, 80, 251 
 
 Valves, of the veins, discovered by Fabricius, 147 ; their supposed 
 use, 149, 150, 152, 196, 215; as shown by Harvey, 185; and 
 Pecquet, 213 
 
 Valves, sigmoid, why so called, 250 
 
 Valves, tricuspid, why sa called, 250 
 
 Varolius, on the generation of arterial blood, 138 ; on absorption by 
 the mesenteric arteries, 159 
 
 Vascular system, according to Aristotle, 20; according to Praxago- 
 ras, 37 ; according to the Alexandrian school, 50, 55 
 
 Vein, portal, absorption by, according to Aristotle, 2j, 24, 25 ; accord- 
 ing to Galen, 76 ; according to later writers, 105, 106, 107, 108, 
 138, 144, 146, 154, 157; its communication with the hepatic vein, 
 according to Vesalius, 108 ; movement of blood in, demonstrated 
 by Pecquet, 213 
 
 Vein, pulmonary, formerly called arteria venalis and arteria venosa, 
 56, 189 
 
 Veins, distribution of blood by, according to Galen, 84; action of, as 
 understood in the sixteenth century, 156; return of blood to the 
 heart by, according to Harvey, 184; according to Riolan, 206; 
 demonstrated by Pecquet, 212 
 
 Veins and arteries, according to Aristotle, 20; according to Praxago- 
 ras, 37 ; according to Galen, 61 
 
 Vena arterialis, old name for pulmonary artery, 56, 77, 81, 134, 
 136 
 
 Vena arteriosa, 56, 133, 136, 189 
 
 Vena cava, its origin and distribution, according to Galen, 84 
 
 Vena chilis, old name for vena cava, 261 
 
 Ventricles, cardiac, formerly considered the essential portions of the 
 heart, 171 
 
 Ventricles, cerebral, described by Herophilus, 50 
 
 Vesalius, 100 ; his birth and education, loi ; his work on anatomy, 
 I02; his criticiams of Galen, 104; his doctrine of the heart and 
 arteries, 105 ; his doubts as to the perforation of the septum, 106 ; 
 as to the functions of the vascular system in general, 109; his ap- 
 pointment as court physician, no, 265 
 
 Vesicles, pulmonary, discovered by Malpighi, 222 
 
 Veslingius, approves the doctrine of the circulation, 2l8 
 
 Vital spirits, 53 ; source and action of, 53, 54 
 
296 
 
 INDEX. 
 
 Walaeus, approves the doctrine of the circulation, 217, 282 
 Whales, air-breathing and viviparous,' according to Aristotle, 19 
 Wormius, against the doctrine of the circulation, 283 
 
 Zyrbus, old name for omentum, 261 
 
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 «TUDENTS' SEEIES OF MANUALS. A series of fifteen Manuals by 
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