The Works of William Harvey M.D. William Harvey
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from the fountain-head—from Harvey himself, with whom, for several years at least, he was contemporaneous.[53]
The passages quoted above are referred to all the more willingly, from their having preceded the teaching of Harvey by a few years only; but Shakespeare probably referred to nothing more than the accredited opinion that the blood was in motion within the vessels, particularly the veins of the body. In ancient times, indeed, the veins were regarded, as they are esteemed by the vulgar at the present hour, as the principal vessels of the body; they only were once believed to contain true blood; the arteries were held to contain at best but a little blood, different from that of the veins, and mixed accidentally in some sort with the vital spirits, of which they were the proper conduits.
In former times, farther—times anterior to Harvey whether more remotely or more nearly—the liver, as the organ of the hæmapoësis, was regarded as the source of all the veins, i.e. of all the proper blood-vessels; the heart, as the generator of heat and the vital spirits, was viewed as the mere cistern of the blood, whence it was propelled by the act of inspiration, and whither it reverted during the act of expiration, its flow to this part of the body or to that, being mainly determined by certain excitations there inherent or specially set up. By and by, however, the liver was given up as the origin of the venous system generally; but such anatomists as Jacobus Sylvius, Realdus Columbus, Bartholomæus Eustachius, and Gabriel Fallopius, may be found opposing Vesalius in regard to the origin of the vena cava, and asserting that it takes its rise from the liver, not from the heart, as the great reformer in modern anatomy had maintained.
In the progress of anatomical investigation, the valves in the interior of the heart, at the roots of the two great cardiac arterial trunks, and in the course of the veins at large, were perceived and their probable uses and actions canvassed. The general and prevalent notion was that they served to break or moderate the force of the current in the interior of the vessels or parts where they were encountered; though Berengarius of Carpi,[54] in describing the cardiac valves, had already said that the effect of the tricuspid valves, between the right auricle and ventricle, must be to prevent the blood in the former cavity from escaping into the latter; whilst the office of the semilunar valves, at the origins of the pulmonic artery and aorta, he declared, from their position, must be to prevent the entrance of the blood of the great arterial trunks into the heart. Fabricius, the master of Harvey, may be said to have perfected anatomical knowledge in regard to the valves of the veins—for he by no means first directed attention to their existence, or discovered them, as is generally asserted. Fabricius believed that their function was to act as obstacles to congestions of blood, as strengtheners of the veins and preventives to their becoming over-distended.
Another long and much agitated point in the anatomy of the sanguiferous system, was the state of the septum ventriculorum of the heart, in respect of permeability or impermeability. The reason of the vast importance attached to this point was connected with the ancient, and, in Harvey’s time, generally accredited hypothesis of the Three Spirits—the natural, the vital, and the animal. The hypothesis to be brought into play, was presumed to require the intermixture in the heart of the two kinds of blood that were held appropriate to the two ventricles and to the arteries and veins respectively, and that were farther believed to meet in the cavities of the cranium, thorax, and abdomen, from which they returned to the heart by the way they came, for a fresh supply of the spirits (now exhausted or enfeebled), under the agency of which all the important operations of the body were believed to be accomplished.
Now, Galen, the author of this hypothesis, in order to obtain an admixture of the two kinds of blood, feigned and described the partition between the two ventricles, either as perforated like a sieve, or as filled with depressions of depth sufficient to entitle them to be viewed as constituting a kind of third ventricle—the last assumption doubtless to accommodate each order of spirits with its own particular officine or workshop. With the revival of anatomical knowledge in modern Europe, however, the partition of the ventricles was soon perceived not to be porous or cribriform, but, as was first said, to be so nearly solid that any filtration of blood through it was well nigh impossible (Berengarius, 1521), and next, to be so completely solid that all permeation of blood was impossible (Vesalius, 1555), and another means must therefore be found for securing the necessary admixture of the two kinds of blood in order to effect the engenderment of the natural, animal, and vital spirits.
Such was the state of anatomical science and physiological belief on this particular point when Michael Servetus came upon the stage, and suggested the transit of the blood through the lungs from the right side of the heart to the left, with a view of meeting the difficulty which the undeniable solidity of the septum ventriculorum opposed to the presumed necessary admixture of the two kinds of blood. Servetus’s idea, consequently—if at the distance of three hundred years we may presume to follow the mental process that led to the penning of the remarkable and often-quoted passage which occurs in his works—appears to be nothing more than a suggestion or proposition as a means of meeting a difficulty; it is very much as though he had said: If you cannot go straight through, you must even go round about. To so much and to no more, do Servetus’s claims to be considered a discoverer, in the sense we would attach to that word, amount. The passage from the ‘Restitutio Christianismi’ of Servetus, 1553, if viewed from the point proposed, will not fail to set his title to be regarded as the discoverer of the lesser circulation in its true light—in a light under which it has not yet been seen. We translate so much of the passage as bears on the question under review. “The vital spirit has its origin in the left ventricle, the lungs assisting especially in its generation. It is a subtile spirit * * * It is engendered from the mixture that takes place in the lungs of the inspired air with the elaborated subtile blood which the right ventricle of the heart communicates to the left. But this communication takes place, not by the middle septum of the heart, as is commonly believed, but by a remarkable artifice; the subtile blood of the right side of the heart is agitated in a lengthened course through the lungs, whereby it is elaborated, from which it is thrown of a crimson colour, and from the vena arteriosa (pulmonary artery) is transfused into the arteria venosa (pulmonary veins); it is then mixed in the arteria venosa itself with the inspired air, and by the act of expiration is purified from fuliginous vapours, when, having become the fit recipient of the vital spirit, it is at length attracted by the diastole. Now, that the communication and preparation take place as stated through the lungs, is proclaimed by the various conjunctions and communications of the arterial vein with the venous artery. The remarkable size of the arterial vein (pulmonary artery) confirms this, a vessel which could neither have its actual constitution nor dimensions, nor transmit such a quantity of the purest blood direct from the heart itself, for the mere nourishment of the lungs. Neither would the heart supply the lungs in such proportion, (especially when we see the lungs in the embryo nourished from another source) by reason of those membranes or valves which remain unopened until the hour of birth, as Galen teaches. The blood, consequently, from the moment of birth, is sent, and in such quantity is sent, for another purpose from the heart into the lungs; from the lungs also it is not simple air that is sent to the heart, but air mixed with blood is transmitted through the arteria venosa (pulmonary vein). In the lungs consequently does the mixture take place. The crimson colour is imparted to the spirituous blood by the lungs, not by the heart. There is not room enough in the left ventricle of the heart for so important and so great an admixture; neither is there space there for the elaboration into the crimson colour. Finally, the septum medium, seeing that it is without vessels and properties, is not adapted to accomplish that communication and elaboration, although something may transude through it.”
The discussion in this passage from Servetus obviously concerns the generation of the vital spirit, not the pulmonic circulation properly so called—that is altogether secondary and subordinate. His mention of “numerous communications between the vena arteriosa and the arteria venosa,” is plainly conjectural; neither he, nor any one else for a century after him, saw such communications. The course through the lungs, then, as suggested by Servetus, was a mere hypothetical proposal for getting over the difficulty of the solid, or nearly solid, septum ventriculorum. As to the means by which such a transfusion as he suggests, is effected, Servetus, as he was profoundly ignorant himself, so does he leave his readers entirely in the dark. The transmission of the blood from the right to the left side of the heart, which Servetus proposed, is in fact, no great improvement on the