The Works of William Harvey M.D. / Translated from the Latin with a life of the author

by William Harvey

But we shall have more to say on this topic when we treat of that wherein a part consists, and how many kinds of parts there are. Meantime, I cannot be silent on the remarkable fact, that the heart itself, this most distinguished member in the body, appears to be insensible.

A young nobleman, eldest son of the Viscount Montgomery, when a child, had a severe fall, attended with fracture of the ribs of the left side. The consequence of this was a suppurating abscess, which went on discharging abundantly for a long time, from an immense gap in his side; this I had from himself and other credible persons who were witnesses. Between the 18th and 19th years of his age, this young nobleman, having travelled through France and Italy, came to London, having at this time a very large open cavity in his side, through which the lungs, as it was believed, could both be seen and touched. When this circumstance was told as something miraculous to his Serene Majesty King Charles, he straightway sent me to wait on the young man, that I might ascertain the true state of the case. And what did I find? A young man, well grown, of good complexion, and apparently possessed of an excellent constitution, so that I thought the whole story must be a fable. Having saluted him according to custom, however, and informed him of the king’s expressed desire that I should wait upon him, he immediately showed me everything, and laid open his left side for my inspection, by removing a plate which he wore there by way of defence against accidental blows and other external injuries. I found a large open space in the chest, into which I could readily introduce three of my fingers and my thumb; which done, I straightway perceived a certain protuberant fleshy part, affected with an alternating extrusive and intrusive movement; this part I touched gently. Amazed with the novelty of such a state, I examined everything again and again, and when I had satisfied myself, I saw that it was a case of old and extensive ulcer, beyond the reach of art, but brought by a miracle to a kind of cure, the interior being invested with a membrane, and the edges protected with a tough skin. But the fleshy part, (which I at first sight took for a mass of granulations, and others had always regarded as a portion of the lung,) from its pulsating motions and the rhythm they observed with the pulse,—when the fingers of one of my hands were applied to it, those of the other to the artery at the wrist—as well as from their discordance with the respiratory movements, I saw was no portion of the lung that I was handling, but the apex of the heart! covered over with a layer of fungous flesh by way of external defence, as commonly happens in old foul ulcers. The servant of this young man was in the habit daily of cleansing the cavity from its accumulated sordes by means of injections of tepid water; after which the plate was applied, and, with this in its place, the young man felt adequate to any exercise or expedition, and, in short, he led a pleasant life in perfect safety.

Instead of a verbal answer, therefore, I carried the young man himself to the king, that his majesty might with his own eyes behold this wonderful case: that, in a man alive and well, he might, without detriment to the individual, observe the movement of the heart, and, with his proper hand even touch the ventricles as they contracted. And his most excellent majesty, as well as myself, acknowledged that the heart was without the sense of touch; for the youth never knew when we touched his heart, except by the sight or the sensation he had through the external integument.

We also particularly observed the movements of the heart, viz.: that in the diastole it was retracted and withdrawn; whilst in the systole it emerged and protruded; and the systole of the heart took place at the moment the diastole or pulse in the wrist was perceived; to conclude, the heart struck the walls of the chest, and became prominent at the time it bounded upwards and underwent contraction on itself.

Neither is this the place for taking up that other controversy; to wit, whether the blood alone serves for the nutrition of the body? Aristotle in several places contends that the blood is the ultimate aliment of the body, and in this view he is supported by the whole body of physicians. But many things of difficult interpretation, and that hang but indifferently together, follow from this opinion of theirs. For when the medical writers speak of the blood in their physiological disquisitions, and teach that the above is its sole use and end, viz.: to supply nourishment to the body, they proceed to compose it of four humours, or juices, adducing arguments for such a view from the combinations of the four primary qualities; and then they assert that the mass of the blood is made up of the two kinds of bile, the yellow and the black, of pituita, and the blood properly so called. And thus they arrive at their four humours, of which the pituita is held to be cold and moist; the black bile cold and dry; the yellow bile hot and dry; and the blood hot and moist. Further, of each of these several kinds, they maintain that some are nutritious, and compose the whole of the body; others, again, they say are excrementitious. Still further, they suppose that the blood proper is composed of the nutritious or heterogeneous portions; but the constitution of the mass is such, that the pituita is a cruder matter, which the more powerful native heat can convert into perfect blood. They deny, however, that the bile can by any means be thus transformed into blood; although the blood, they say, is readily changed into bile, an event which they conceive takes place in melancholic diseases, through an excess of the concocting heat.

Now, if all this were true, and there be no retrogressive movement, viz. from black bile to bile, from bile to blood, they would be brought to the dilemma of having to admit that all the juices were present for the production of black bile, and that this was a principal and most highly concocted nutriment. It would further be imperative on them to recognize a kind of twofold blood, viz. one consisting of the entire mass of fluid contained in the veins, and composed of the four humours aforesaid; and another consisting of the purer, more fluid and spirituous portion, the fluid, which in the stricter sense they call blood, which some of them contend is contained in the arteries apart from the rest, and which they then depute upon sundry special offices. On their own showing, therefore, the pure blood is no aliment for the body, but a certain mixed fluid, or rather black bile, to which the rest of the humours tend.

Aristotle,[281] too, although he thought that the blood existed as a means of nourishing the body, still believed that it was composed as it were of several portions, viz. of a thicker and black portion which subsides to the bottom of the basin when the blood coagulates, and this portion he held to be of an inferior nature;[282] “for the blood,” he says, “if it be entire, is of a red colour and sweet taste; but if vitiated either by nature or disease, it is blacker.” He also will have it fibrous in part or partly composed of fibres, which being removed, he continues,[283] the blood neither sets nor becomes any thicker. He farther admitted a sanies in the blood: “Sanies is unconcocted blood, or blood not yet completely concocted, or which is as yet dilute like serum.” And this part, he says, is of a colder nature. The fibrous he believed to be the earthy portion of the blood.

According to the view of the Stagirite, therefore, the blood of different animals differs in several ways; in one it is more serous and thinner, a kind of ichor or sanies, as in insects, and the colder and less perfect animals; in another it is thicker, more fibrous, and earthy, as in the wild boar, bull, ass, &c. In some where the constitution is distempered, the blood is of a blacker hue; in others it is bright, pure, and florid, as in birds, and the human subject especially.

Whence, it appears, that in the opinion of the physicians, as well as of Aristotle, the blood consists of several parts, in some sort of the same description, according to the views of each. Medical men, indeed, only pay attention to human blood, taken in phlebotomy and contained in cups and coagulated. But Aristotle took a view of the blood of animals generally, or of the fluid which is analogous to it. And I, omitting all points of controversy, and passing by any discussion of the inconveniences that wait upon the opinions of writers in general, shall here touch lightly upon the points that all are agreed in, that can be apprehended by the senses, and that pertain more especially to our subject; intending, however, to treat of everything at length elsewhere.

Although the blood be, as I have said, a portion of the body,—the primogenial and principal part, indeed,—still, if it be considered in its mass, and as it presents itself in the veins, there is nothing to hinder us from believing that it contains and concocts nourishment within itself, which it applies to all the other parts of the body. With the matter so considered, we can understand how it should both nourish and be nourished, and how it should be both the matter and the efficient cause of the body, and have the natural constitution which Aristotle held necessary in a primogenial part, viz. that it should be partly of similar, partly of dissimilar constitution; for he says, “As it was requisite for the sake of sensation that there should be similar members in animal bodies, and as the faculty of perceiving, the faculty of moving, and the faculty of nourishing, are all contained in the same member (viz. the primogenate particle), it follows necessarily that this member, which originally contains inherent principles of the above kind, be extant both simply, that it may be capable of sensation of every description, and dissimilarly, that it may move and act. Wherefore, in the tribes that have blood, the heart is held to be such a member; in the bloodless tribes, however, it is proportional to their state.”