Among the anatomists who probably discovered these valves was Michael Servetus (1511-1553); but if this is somewhat in doubt, it is certain that he discovered and described the pulmonary circulation, and had a very clear idea of the process of respiration as carried on in the lungs. The description was contained in a famous doc.u.ment sent to Calvin in 1545--a doc.u.ment which the reformer carefully kept for seven years in order that he might make use of some of the heretical statements it contained to accomplish his desire of bringing its writer to the stake.

The awful fate of Servetus, the interesting character of the man, and the fact that he came so near to antic.i.p.ating the discoveries of Harvey make him one of the most interesting figures in medical history.

In this doc.u.ment which was sent to Calvin, Servetus rejected the doctrine of natural, vital, and animal spirits, as contained in the veins, arteries, and nerves respectively, and made the all-important statement that the fluids contained in veins and arteries are the same.

He showed also that the blood is "purged from fume" and purified by respiration in the lungs, and declared that there is a new vessel in the lungs, "formed out of vein and artery." Even at the present day there is little to add to or change in this description of Servetus's.

By keeping this doc.u.ment, pregnant with advanced scientific views, from the world, and in the end only using it as a means of destroying its author, the great reformer showed the same jealousy in r.e.t.a.r.ding scientific progress as had his arch-enemies of the Inquisition, at whose dictates Vesalius became a martyr to science, and in whose dungeons etienne perished.

THE COMING OF HARVEY

The time was ripe for the culminating discovery of the circulation of the blood; but as yet no one had determined the all-important fact that there are two currents of blood in the body, one going to the heart, one coming from it. The valves in the veins would seem to show conclusively that the venous current did not come from the heart, and surgeons must have observed thousands of times the every-day phenomenon of congested veins at the distal extremity of a limb around which a ligature or constriction of any kind had been placed, and the simultaneous depletion of the vessels at the proximal points above the ligature. But it should be remembered that inductive science was in its infancy. This was the sixteenth, not the nineteenth century, and few men had learned to put implicit confidence in their observations and convictions when opposed to existing doctrines. The time was at hand, however, when such a man was to make his appearance, and, as in the case of so many revolutionary doctrines in science, this man was an Englishman. It remained for William Harvey (1578-1657) to solve the great mystery which had puzzled the medical world since the beginning of history; not only to solve it, but to prove his case so conclusively and so simply that for all time his little booklet must he handed down as one of the great masterpieces of lucid and almost faultless demonstration.

Harvey, the son of a prosperous Kentish yeoman, was born at Folkestone.

His education was begun at the grammar-school of Canterbury, and later he became a pensioner of Caius College, Cambridge. Soon after taking his degree of B.A., at the age of nineteen, he decided upon the profession of medicine, and went to Padua as a pupil of Fabricius and Ca.s.serius.

Returning to England at the age of twenty-four, he soon after (1609) obtained the reversion of the post of physician to St. Bartholomew's Hospital, his application being supported by James I. himself. Even at this time he was a popular physician, counting among his patients such men as Francis Bacon. In 1618 he was appointed physician extraordinary to the king, and, a little later, physician in ordinary. He was in attendance upon Charles I. at the battle of Edgehill, in 1642, where, with the young Prince of Wales and the Duke of York, after seeking shelter under a hedge, he drew a book out of his pocket and, forgetful of the battle, became absorbed in study, until finally the cannon-b.a.l.l.s from the enemy's artillery made him seek a more sheltered position.

On the fall of Charles I. he retired from practice, and lived in retirement with his brother. He was then well along in years, but still pursued his scientific researches with the same vigor as before, directing his attention chiefly to the study of embryology. On June 3, 1657, he was attacked by paralysis and died, in his eightieth year. He had lived to see his theory of the circulation accepted, several years before, by all the eminent anatomists of the civilized world.

A keenness in the observation of facts, characteristic of the mind of the man, had led Harvey to doubt the truth of existing doctrines as to the phenomena of the circulation. Galen had taught that "the arteries are filled, like bellows, because they are expanded," but Harvey thought that the action of spurting blood from a severed vessel disproved this. For the spurting was remittant, "now with greater, now with less impetus," and its greater force always corresponded to the expansion (diastole), not the contraction (systole) of the vessel. Furthermore, it was evident that contraction of the heart and the arteries was not simultaneous, as was commonly taught, because in that case there would be no marked propulsion of the blood in any direction; and there was no gainsaying the fact that the blood was forcibly propelled in a definite direction, and that direction away from the heart.

Harvey's investigations led him to doubt also the accepted theory that there was a porosity in the septum of tissue that divides the two ventricles of the heart. It seemed unreasonable to suppose that a thick fluid like the blood could find its way through pores so small that they could not be demonstrated by any means devised by man. In evidence that there could be no such openings he pointed out that, since the two ventricles contract at the same time, this process would impede rather than facilitate such an intra-ventricular pa.s.sage of blood. But what seemed the most conclusive proof of all was the fact that in the foetus there existed a demonstrable opening between the two ventricles, and yet this is closed in the fully developed heart. Why should Nature, if she intended that blood should pa.s.s between the two cavities, choose to close this opening and subst.i.tute microscopic openings in place of it?

It would surely seem more reasonable to have the small perforations in the thin, easily permeable membrane of the foetus, and the opening in the adult heart, rather than the reverse. From all this Harvey drew his correct conclusions, declaring earnestly, "By Hercules, there ARE no such porosities, and they cannot be demonstrated."

Having convinced himself that no intra-ventricular opening existed, he proceeded to study the action of the heart itself, untrammelled by too much faith in established theories, and, as yet, with no theory of his own. He soon discovered that the commonly accepted theory of the heart striking against the chest-wall during the period of relaxation was entirely wrong, and that its action was exactly the reverse of this, the heart striking the chest-wall during contraction. Having thus disproved the accepted theory concerning the heart's action, he took up the subject of the action of arteries, and soon was able to demonstrate by vivisection that the contraction of the arteries was not simultaneous with contractions of the heart. His experiments demonstrated that these vessels were simply elastic tubes whose pulsations were "nothing else than the impulse of the blood within them." The reason that the arterial pulsation was not simultaneous with the heart-beat he found to be because of the time required to carry the impulse along the tube.

By a series of further careful examinations and experiments, which are too extended to be given here, he was soon able further to demonstrate the action and course of the blood during the contractions of the heart.

His explanations were practically the same as those given to-day--first the contraction of the auricle, sending blood into the ventricle; then ventricular contraction, making the pulse, and sending the blood into the arteries. He had thus demonstrated what had not been generally accepted before, that the heart was an organ for the propulsion of blood. To make such a statement to-day seems not unlike the sober announcement that the earth is round or that the sun does not revolve about it. Before Harvey's time, however, it was considered as an organ that was "in some mysterious way the source of vitality and warmth, as an animated crucible for the concoction of blood and the generation of vital spirits."(3)

In watching the rapid and ceaseless contractions of the heart, Harvey was impressed with the fact that, even if a very small amount of blood was sent out at each pulsation, an enormous quant.i.ty must pa.s.s through the organ in a day, or even in an hour. Estimating the size of the cavities of the heart, and noting that at least a drachm must be sent out with each pulsation, it was evident that the two thousand beats given by a very slow human heart in an hour must send out some forty pounds of blood--more than twice the amount in the entire body. The question was, what became of it all? For it should be remembered that the return of the blood by the veins was unknown, and nothing like a "circulation" more than vaguely conceived even by Harvey himself. Once it could be shown that the veins were constantly returning blood to the heart, the discovery that the blood in some way pa.s.ses from the arteries to the veins was only a short step. Harvey, by resorting to vivisections of lower animals and reptiles, soon demonstrated beyond question the fact that the veins do carry the return blood. "But this, in particular, can be shown clearer than daylight," says Harvey. "The vena cava enters the heart at an inferior portion, while the artery pa.s.ses out above. Now if the vena cava be taken up with forceps or the thumb and finger, and the course of the blood intercepted 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 pulsation, 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 and compress the arteries at some distance from the heart, you will see, on the contrary, their included portion grow excessively turgid, the heart becoming so beyond measure, a.s.suming a dark-red color, even to lividity, and at length so overloaded with blood as to seem in danger of suffocation; but when the obstruction is removed it returns to its normal condition, in size, color, and movement."(4)

This conclusive demonstration that the veins return the blood to the heart must have been most impressive to Harvey, who had been taught to believe that the blood current in the veins pursued an opposite course, and must have tended to shake his faith in all existing doctrines of the day.

His next step was the natural one of demonstrating that the blood pa.s.ses from the arteries to the veins. He demonstrated conclusively that this did occur, but for once his rejection of the ancient writers and one modern one was a mistake. For Galen had taught, and had attempted to demonstrate, that there are sets of minute vessels connecting the arteries and the veins; and Servetus had shown that there must be such vessels, at least in the lungs.

However, the little flaw in the otherwise complete demonstration of Harvey detracts nothing from the main issue at stake. It was for others who followed to show just how these small vessels acted in effecting the transfer of the blood from artery to vein, and the grand general statement that such a transfer does take place was, after all, the all-important one, and the exact method of how it takes place a detail.

Harvey's experiments to demonstrate that the blood pa.s.ses from the arteries to the veins are so simply and concisely stated that they may best be given in his own words.

"I have here to cite certain experiments," he wrote, "from which it seems obvious that the blood enters a limb by the arteries, and returns from it by the veins; that the arteries are the vessels carrying the blood from the heart, and the veins the returning channels of the blood to the heart; that in the limbs and extreme parts of the body the blood pa.s.ses either by anastomosis from the arteries into the veins, or immediately by the pores of the flesh, or in both ways, as has already been said in speaking of the pa.s.sage of the blood through the lungs; whence it appears manifest that in the circuit the blood moves from thence hither, and hence thither; from the centre to the extremities, to wit, and from the extreme parts back again to the centre. Finally, upon grounds of circulation, with the same elements as before, it will be obvious that the quant.i.ty can neither be accounted for by the ingesta, nor yet be held necessary to nutrition.

"Now let any one make an experiment on the arm of a man, either using such a fillet as is employed in blood-letting or grasping the limb tightly with his hand, the best subject for it being one who is lean, and who has large veins, and the best time after exercise, when the body is warm, the pulse is full, and the blood carried in large quant.i.ties to the extremities, for all then is more conspicuous; under such circ.u.mstances let a ligature be thrown about the extremity and drawn as tightly as can be borne: it will first be perceived that beyond the ligature neither in the wrist nor anywhere else do the arteries pulsate, that at the same time immediately above the ligature the artery begins to rise higher at each diastole, to throb more violently, and to swell in its vicinity with a kind of tide, as if it strove to break through and overcome the obstacle to its current; the artery here, in short, appears as if it were permanently full. The hand under such circ.u.mstances retains its natural color and appearances; in the course of time it begins to fall somewhat in temperature, indeed, but nothing is DRAWN into it.

"After the bandage has been kept on some short time in this way, let it be slackened a little, brought to the state or term of middling tightness which is used in bleeding, and it will be seen that the whole hand and arm will instantly become deeply suffused and distended, injected, gorged with blood, DRAWN, as it is said, by this middling ligature, without pain, or heat, or any horror of a vacuum, or any other cause yet indicated.

"As we have noted, in connection with the tight ligature, that the artery above the bandage was distended and pulsated, not below it, so, in the case of the moderately tight bandage, on the contrary, do we find that the veins below, never above, the fillet swell and become dilated, while the arteries shrink; and such is the degree of distention of the veins here that it is only very strong pressure that will force the blood beyond the fillet and cause any of the veins in the upper part of the arm to rise.

"From these facts it is easy for any careful observer to learn that the blood enters an extremity by the arteries; for when they are effectively compressed nothing is DRAWN to the member; the hand preserves its color; nothing flows into it, neither is it distended; but when the pressure is diminished, as it is with the bleeding fillet, it is manifest that the blood is instantly thrown in with force, for then the hand begins to swell; which is as much as to say that when the arteries pulsate the blood is flowing through them, as it is when the moderately tight ligature is applied; but when they do not pulsate, or when a tight ligature is used, they cease from transmitting anything; they are only distended above the part where the ligature is applied. The veins again being compressed, nothing can flow through them; the certain indication of which is that below the ligature they are much more tumid than above it, and than they usually appear when there is no bandage upon the arm.

"It therefore plainly appears that the ligature prevents the return of the blood through the veins to the parts above it, and maintains those beneath it in a state of permanent distention. But the arteries, in spite of the pressure, and under the force and impulse of the heart, send on the blood from the internal parts of the body to the parts beyond the bandage."(5)

This use of ligatures is very significant, because, as shown, a very tight ligature stops circulation in both arteries and veins, while a loose one, while checking the circulation in the veins, which lie nearer the surface and are not so directly influenced by the force of the heart, does not stop the pa.s.sage of blood in the arteries, which are usually deeply imbedded in the tissues, and not so easily influenced by pressure from without.

The last step of Harvey's demonstration was to prove that the blood does flow along the veins to the heart, aided by the valves that had been the cause of so much discussion and dispute between the great sixteenth-century anatomists. Harvey not only demonstrated the presence of these valves, but showed conclusively, by simple experiments, what their function was, thus completing his demonstration of the phenomena of the circulation.

The final ocular demonstration of the pa.s.sage of the blood from the arteries to the veins was not to be made until four years after Harvey's death. This process, which can be observed easily in the web of a frog's foot by the aid of a low-power lens, was first demonstrated by Marcello Malpighi (1628-1694) in 1661. By the aid of a lens he first saw the small "capillary" vessels connecting the veins and arteries in a piece of dried lung. Taking his cue from this, he examined the lung of a turtle, and was able to see in it the pa.s.sage of the corpuscles through these minute vessels, making their way along these previously unknown channels from the arteries into the veins on their journey back to the heart. Thus the work of Harvey, all but complete, was made absolutely entire by the great Italian. And all this in a single generation.

LEEUWENHOEK DISCOVERS BACTERIA

The seventeenth century was not to close, however, without another discovery in science, which, when applied to the causation of disease almost two centuries later, revolutionized therapeutics more completely than any one discovery. This was the discovery of microbes, by Antonius von Leeuwenhoek (1632-1723), in 1683. Von Leeuwenhoek discovered that "in the white matter between his teeth" there were millions of microscopic "animals"--more, in fact, than "there were human beings in the united Netherlands," and all "moving in the most delightful manner."

There can be no question that he saw them, for we can recognize in his descriptions of these various forms of little "animals" the four princ.i.p.al forms of microbes--the long and short rods of bacilli and bacteria, the spheres of micrococci, and the corkscrew spirillum.

The presence of these microbes in his mouth greatly annoyed Antonius, and he tried various methods of getting rid of them, such as using vinegar and hot coffee. In doing this he little suspected that he was antic.i.p.ating modern antiseptic surgery by a century and three-quarters, and to be attempting what antiseptic surgery is now able to accomplish.

For the fundamental principle of antisepsis is the use of medicines for ridding wounds of similar microscopic organisms. Von Leenwenhoek was only temporarily successful in his attempts, however, and took occasion to communicate his discovery to the Royal Society of England, hoping that they would be "interested in this novelty." Probably they were, but not sufficiently so for any member to pursue any protracted investigations or reach any satisfactory conclusions, and the whole matter was practically forgotten until the middle of the nineteenth century.

VIII. MEDICINE IN THE SIXTEENTH AND SEVENTEENTH CENTURIES

Of the half-dozen surgeons who were prominent in the sixteenth century, Ambroise Pare (1517-1590), called the father of French surgery, is perhaps the most widely known. He rose from the position of a common barber to that of surgeon to three French monarchs, Henry II., Francis II., and Charles IX. Some of his mottoes are still first principles of the medical man. Among others are: "He who becomes a surgeon for the sake of money, and not for the sake of knowledge, will accomplish nothing"; and "A tried remedy is better than a newly invented." On his statue is his modest estimate of his work in caring for the wounded, "Je le pansay, Dieu le guarit"--I dressed him, G.o.d cured him.

It was in this dressing of wounds on the battlefield that he accidentally discovered how useless and harmful was the terribly painful treatment of applying boiling oil to gunshot wounds as advocated by John of Vigo. It happened that after a certain battle, where there was an unusually large number of casualties, Pare found, to his horror, that no more boiling oil was available for the surgeons, and that he should be obliged to dress the wounded by other simpler methods. To his amazement the results proved entirely satisfactory, and from that day he discarded the hot-oil treatment.

As Pare did not understand Latin he wrote his treatises in French, thus inaugurating a custom in France that was begun by Paracelsus in Germany half a century before. He reintroduced the use of the ligature in controlling hemorrhage, introduced the "figure of eight" suture in the operation for hare-lip, improved many of the medico-legal doctrines, and advanced the practice of surgery generally. He is credited with having successfully performed the operation for strangulated hernia, but he probably borrowed it from Peter Franco (1505-1570), who published an account of this operation in 1556. As this operation is considered by some the most important operation in surgery, its discoverer is ent.i.tled to more than pa.s.sing notice, although he was despised and ignored by the surgeons of his time.

Franco was an illiterate travelling lithotomist--a cla.s.s of itinerant physicians who were very generally frowned down by the regular pract.i.tioners of medicine. But Franco possessed such skill as an operator, and appears to have been so earnest in the pursuit of what he considered a legitimate calling, that he finally overcame the popular prejudice and became one of the salaried surgeons of the republic of Bern. He was the first surgeon to perform the suprapubic lithotomy operation--the removal of stone through the abdomen instead of through the perineum. His works, while written in an illiterate style, give the clearest descriptions of any of the early modern writers.

As the fame of Franco rests upon his operation for prolonging human life, so the fame of his Italian contemporary, Gaspar Tagliacozzi (1545-1599), rests upon his operation for increasing human comfort and happiness by restoring amputated noses. At the time in which he lived amputation of the nose was very common, partly from disease, but also because a certain pope had fixed the amputation of that member as the penalty for larceny. Tagliacozzi probably borrowed his operation from the East; but he was the first Western surgeon to perform it and describe it. So great was the fame of his operations that patients flocked to him from all over Europe, and each "went away with as many noses as he liked." Naturally, the man who directed his efforts to restoring structures that bad been removed by order of the Church was regarded in the light of a heretic by many theologians; and though he succeeded in cheating the stake or dungeon, and died a natural death, his body was finally cast out of the church in which it had been buried.

In the sixteenth century Germany produced a surgeon, Fabricius Hildanes (1560-1639), whose work compares favorably with that of Pare, and whose name would undoubtedly have been much better known had not the circ.u.mstances of the time in which he lived tended to obscure his merits. The blind followers of Paracelsus could see nothing outside the pale of their master's teachings, and the disastrous Thirty Years' War tended to obscure and r.e.t.a.r.d all scientific advances in Germany. Unlike many of his fellow-surgeons, Hildanes was well versed in Latin and Greek; and, contrary to the teachings of Paracelsus, he laid particular stress upon the necessity of the surgeon having a thorough knowledge of anatomy. He had a helpmate in his wife, who was also something of a surgeon, and she is credited with having first made use of the magnet in removing particles of metal from the eye. Hildanes tells of a certain man who had been injured by a small piece of steel in the cornea, which resisted all his efforts to remove it. After observing Hildanes'

fruitless efforts for a time, it suddenly occurred to his wife to attempt to make the extraction with a piece of loadstone. While the physician held open the two lids, his wife attempted to withdraw the steel with the magnet held close to the cornea, and after several efforts she was successful--which Hildanes enumerates as one of the advantages of being a married man.

Hildanes was particularly happy in his inventions of surgical instruments, many of which were designed for locating and removing the various missiles recently introduced in warfare.

The seventeenth century, which was such a flourishing one for anatomy and physiology, was not as productive of great surgeons or advances in surgery as the sixteenth had been or the eighteenth was to be. There was a gradual improvement all along the line, however, and much of the work begun by such surgeons as Pare and Hildanes was perfected or improved.

Perhaps the most progressive surgeon of the century was an Englishman, Richard Wiseman (1625-1686), who, like Harvey, enjoyed royal favor, being in the service of all the Stuart kings. He was the first surgeon to advocate primary amputation, in gunshot wounds, of the limbs, and also to introduce the treatment of aneurisms by compression; but he is generally rated as a conservative operator, who favored medication rather than radical operations, where possible.

In Italy, Marcus Aurelius Severinus (1580-1656) and Peter Marchettis (1589-1675) were the leading surgeons of their nation. Like many of his predecessors in Europe, Severinus ran amuck with the Holy Inquisition and fled from Naples. But the waning of the powerful arm of the Church is shown by the fact that he was brought back by the unanimous voice of the grateful citizens, and lived in safety despite the frowns of the theologians.

The sixteenth century cannot be said to have added much of importance in the field of practical medicine, and, as in the preceding and succeeding centuries, was at best only struggling along in the wake of anatomy, physiology, and surgery. In the seventeenth century, however, at least one discovery in therapeutics was made that has been an inestimable boon to humanity ever since. This was the introduction of cinchona bark (from which quinine is obtained) in 1640. But this century was productive of many medical SYSTEMS, and could boast of many great names among the medical profession, and, on the whole, made considerably more progress than the preceding century.

Of the founders of medical systems, one of the most widely known is Jan Baptista van Helmont (1578-1644), an eccentric genius who constructed a system of medicine of his own and for a time exerted considerable influence. But in the end his system was destined to pa.s.s out of existence, not very long after the death of its author. Van Helmont was not only a physician, but was master of all the other branches of learning of the time, taking up the study of medicine and chemistry as an after-thought, but devoting himself to them with the greatest enthusiasm once he had begun his investigations. His att.i.tude towards existing doctrines was as revolutionary as that of Paracelsus, and he rejected the teachings of Galen and all the ancient writers, although retaining some of the views of Paracelsus. He modified the archaeus of Paracelsus, and added many complications to it. He believed the whole body to be controlled by an archaeus influus, the soul by the archaei insiti, and these in turn controlled by the central archeus. His system is too elaborate and complicated for full explanation, but its chief service to medicine was in introducing new chemical methods in the preparation of drugs. In this way he was indirectly connected with the establishment of the Iatrochemical school. It was he who first used the word "gas"--a word coined by him, along with many others that soon fell into disuse.

The principles of the Iatrochemical school were the use of chemical medicines, and a theory of pathology different from the prevailing "humoral" pathology. The founder of this school was Sylvius (Franz de le Boe, 1614-1672), professor of medicine at Leyden. He attempted to establish a permanent system of medicine based on the newly discovered theory of the circulation and the new chemistry, but his name is remembered by medical men because of the fissure in the brain (fissure of Sylvius) that bears it. He laid great stress on the cause of fevers and other diseases as originating in the disturbances of the process of fermentation in the stomach. The doctrines of Sylvius spread widely over the continent, but were not generally accepted in England until modified by Thomas Willis (1622-1675), whose name, like that of Sylvius, is perpetuated by a structure in the brain named after him, the circle of Willis. Willis's descriptions of certain nervous diseases, and an account of diabetes, are the first recorded, and added materially to scientific medicine. These schools of medicine lasted until the end of the seventeenth century, when they were finally overthrown by Sydenham.