There are still certain problems, which, taken as consequences of this truth assumed as proven, are not without their use in exciting belief, as it were, a posteriore; and which, although they may seem to be involved in much doubt and obscurity, nevertheless readily admit of having reasons and causes assigned for them. Of such a nature are those that present themselves in connexion with contagions, poisoned wounds, the bites of serpents and rabid animals, lues venerea and the like. We sometimes see the whole system contaminated, though the part first infected remains sound; the lues venerea has occasionally made its attack with pains in the shoulders and head, and other symptoms, the genital organs being all the while unaffected; and then we know that the wound made by a rabid dog having healed, fever and a train of disastrous symptoms may nevertheless supervene. Whence it appears that the contagion impressed upon or deposited in a particular part, is by-and-by carried by the returning current of blood to the heart, and by that organ is sent to contaminate the whole body.
In tertian fever, the morbific cause seeking the heart in the first instance, and hanging about the heart and lungs, renders the patient short-winded, disposed to sighing, and indisposed to exertion, because the vital principle is oppressed and the blood forced into the lungs and rendered thick. It does not pass through them, (as I have myself seen in opening the bodies of those who had died in the beginning of the attack,) when the pulse is always frequent, small, and occasionally irregular; but the heat increasing, the matter becoming attenuated, the passages forced, and the transit made, the whole body begins to rise in temperature, and the pulse becomes fuller and stronger. The febrile paroxysm is fully formed, whilst the preternatural heat kindled in the heart is thence diffused by the arteries through the whole body along with the morbific matter, which is in this way overcome and dissolved by nature.
When we perceive, further, that medicines applied externally exert their influence on the body just as if they had been taken internally, the truth we are contending for is confirmed. Colocynth and aloes in this way move the belly, cantharides excites the urine, garlic applied to the soles of the feet assists expectoration, cordials strengthen, and an infinite number of examples of the same kind might be cited. Perhaps it will not, therefore, be found unreasonable, if we say that the veins, by means of their orifices, absorb some of the things that are applied externally and carry this inwards with the blood, not otherwise, it may be, than those of the mesentery imbibe the chyle from the intestines and carry it mixed with the blood to the liver. For the blood entering the mesentery by the coeliac artery, and the superior and inferior mesenteries, proceeds to the intestines, from which, along with the chyle that has been attracted into the veins, it returns by their numerous ramifications into the vena portae of the liver, and from this into the vena cava, and this in such wise that the blood in these veins has the same colour and consistency as in other veins, in opposition to what many believe to be the fact. Nor indeed can we imagine two contrary motions in any capillary system — the chyle upwards, the blood downwards. This could scarcely take place, and must be held as altogether improbable. But is not the thing rather arranged as it is by the consummate providence of nature? For were the chyle mingled with the blood, the crude with the digested, in equal proportions, the result would not be concoction, transmutation, and sanguification, but rather, and because they are severally active and passive, a mixture or combination, or medium compound of the two, precisely as happens when wine is mixed with water and syrup. But when a very minute quantity of chyle is mingled with a very large quantity of circulating blood, a quantity of chyle that bears no kind of proportion to the mass of blood, the effect is the same, as Aristotle says, as when a drop of water is added to a cask of wine, or the contrary; the mass does not then present itself as a mixture, but is still sensibly either wine or water.
So in the mesenteric veins of an animal we do not find either chyme or chyle and blood, blended together or distinct, but only blood, the same in colour, consistency, and other sensible properties, as it appears in the veins generally. Still as there is a certain though small and inappreciable portion of chyle or incompletely digested matter mingled with the blood, nature has interposed the liver, in whose meandering channels it suffers delay and undergoes additional change, lest arriving prematurely and crude at the heart, it should oppress the vital principle. Hence in the embryo, there is almost no use for the liver, but the umbilical vein passes directly through, a foramen or an anastomosis existing from the vena portae. The blood returns from the intestines of the foetus, not through the liver, but into the umbilical vein mentioned, and flows at once into the heart, mingled with the natural blood which is returning from the placenta; whence also it is that in the development of the foetus the liver is one of the organs that is last formed. I have observed all the members, perfectly marked out in the human foetus, even the genital organs, whilst there was yet scarcely any trace of the liver. And indeed at the period when all the parts, like the heart itself in the beginning, are still white, and except in the veins there is no appearance of redness, you shall see nothing in the seat of the liver but a shapeless collection, as it were, of extravasated blood, which you might take for the effects of a contusion or ruptured vein.
But in the incubated egg there are, as it were, two umbilical vessels, one from the albumen passing entire through the liver, and going straight to the heart; another from the yelk, ending in the vena portae; for it appears that the chick, in the first instance, is entirely formed and nourished by the white; but by the yelk after it has come to perfection and is excluded from the shell; for this part may still be found in the abdomen of the chick many days after its exclusion, and is a substitute for the milk to other animals.
But these matters will be better spoken of in my observations on the formation of the foetus, where many propositions, the following among the number, will be discussed: Wherefore is this part formed or perfected first, that last, and of the several members, what part is the cause of another? And there are many points having special reference to the heart, such as wherefore does it first acquire consistency, and appear to possess life, motion, sense, before any other part of the body is perfected, as Aristotle says in his third book, “De partibus Animalium”? And so also of the blood, wherefore does it precede all the rest? And in what way does it possess the vital and animal principle, and show a tendency to motion, and to be impelled hither and thither, the end for which the heart appears to be made? In the same way, in considering the pulse, why should one kind of pulse indicate death, another recovery? And so of all the other kinds of pulse, what may be the cause and indication of each? Likewise we must consider the reason of crises and natural critical discharges; of nutrition, and especially the distribution of the nutriment; and of defluxions of every description. Finally, reflecting on every part of medicine, physiology, pathology, semeiotics and therapeutics, when I see how many questions can be answered, how many doubts resolved, how much obscurity illustrated by the truth we have declared, the light we have made to shine, I see a field of such vast extent in which I might proceed so far, and expatiate so widely, that this my tractate would not only swell out into a volume, which was beyond my purpose, but my whole life, perchance, would not suffice for its completion.
In this place, therefore, and that indeed in a single chapter, I shall only endeavour to refer the various particulars that present themselves in the dissection of the heart and arteries to their several uses and causes; for so I shall meet with many things which receive light from the truth I have been contending for, and which, in their turn, render it more obvious. And indeed I would have it confirmed and illustrated by anatomical arguments above all others.
There is but a single point which indeed would be more correctly placed among our observations on the use of the spleen, but which it will not be altogether impertinent to notice in this place incidentally. From the splenic branch which passes into the pancreas, and from the upper part, arise the posterior coronary, gastric, and gastroepiploic veins, all of which are distributed upon the stomach in numerous branches and twigs, just as the mesenteric vessels are upon the intestines. In a similar way, from the inferior part of the same splenic branch, and along the back of the colon and rectum proceed the hemorrhoidal veins. The blood returning by these veins, and bringing the cruder juices along with it, on the one hand from the stomach, where they are thin, watery, and not yet perfectly chylified; on the other thick and more earthy, as derived from the faeces, but all poured into this splenic branch, are duly tempered by the admixture of contraries; and nature mingling together these two kinds of juices, difficult of coction by reason of most opposite defects, and then diluting them with a large quantity of warm blood, (for we see that the quantity returned from the spleen must be very large when we contemplate the size of its arteries,) they are brought to the porta of the liver in a state of higher preparation. The defects of either extreme are supplied and compensated by this arrangement of the veins.
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