第 32 节
作者:
换裁判 更新:2021-02-20 04:34 字数:9322
left there is seen the stemma which appears as tailpiece to this chapter; put up by a young Englishman; William Harvey; who had been a student at Padua for four years。 He belonged to the 〃Natio Anglica;〃 of which he was Conciliarius; and took his degree in 1602。 Doubtless he had repeatedly seen Fabricius demonstrate the valves of the veins; and he may indeed; as a senior student; have helped in making the very dissections from which the drawings were taken for Fabricius' work; 〃De Venarum Osteolis;〃 1603。 If one may judge from the character of the teacher's work the sort of instruction the student receives; Harvey must have had splendid training in anatomy。 While he was at Padua; the great work of Fabricius; 〃De Visione; Voce et Auditu〃 (1600) was published; then the 〃Tractatus de Oculo Visusque Organo〃 (1601); and in the last year of his residence Fabricius must have been busy with his studies on the valves of the veins and with his embryology; which appeared in 1604。 Late in life; Harvey told Boyle that it was the position of the valves of the veins that induced him to think of a circulation。
Harvey returned to England trained by the best anatomist of his day。 In London; he became attached to the College of Physicans; and taking his degree at Cambridge; he began the practice of medicine。 He was elected a fellow of the college in 1607 and physician to St。 Bartholomew's Hospital in 1609。 In 1615 he was appointed Lumleian lecturer to the College of Physicians; and his duties were to hold certain 〃public anatomies;〃 as they were called; or lectures。 We know little or nothing of what Harvey had been doing other than his routine work in the care of the patients at St。 Bartholomew's。 It was not until April; 1616; that his lectures began。 Chance has preserved to us the notes of this first course; the MS。 is now in the British Museum and was published in facsimile by the college in 1886。'26'
'26' William Harvey: Prelectiones Anatomiae Universalis; London; J。 & A。 Churchill; 1886。
The second day lecture; April 17; was concerned with a description of the organs of the thorax; and after a discussion on the structure and action of the heart come the lines:
W。 H。 constat per fabricam cordis sanguinem per pulmones in Aortam perpetuo transferri; as by two clacks of a water bellows to rayse water constat per ligaturam transitum sanguinis ab arteriis ad venas unde perpetuum sanguinis motum in circulo fieri pulsu cordis。
The illustration will give one an idea of the extraordinarily crabbed hand in which the notes are written; but it is worth while to see the original; for here is the first occasion upon which is laid down in clear and unequivocal words that the blood CIRCULATES。 The lecture gave evidence of a skilled anatomist; well versed in the literature from Aristotle to Fabricius。 In the MS。 of the thorax; or; as he calls it; the 〃parlour〃 lecture; there are about a hundred references to some twenty authors。 The remarkable thing is that although those lectures were repeated year by year; we have no evidence that they made any impression upon Harvey's contemporaries; so far; at least; as to excite discussions that led to publication。 It was not until twelve years later; 1628; that Harvey published in Frankfurt a small quarto volume of seventy…four pages;'27' 〃De Motu Cordis。〃 In comparison with the sumptuous 〃Fabrica〃 of Vesalius this is a trifling booklet; but if not its equal in bulk or typographical beauty (it is in fact very poorly printed); it is its counterpart in physiology; and did for that science what Vesalius had done for anatomy; though not in the same way。 The experimental spirit was abroad in the land; and as a student at Padua; Harvey must have had many opportunities of learning the technique of vivisection; but no one before his day had attempted an elaborate piece of experimental work deliberately planned to solve a problem relating to the most important single function of the body。 Herein lies the special merit of his work; from every page of which there breathes the modern spirit。 To him; as to Vesalius before him; the current views of the movements of the blood were unsatisfactory; more particularly the movements of the heart and arteries; which were regarded as an active expansion by which they were filled with blood; like bellows with air。 The question of the transmission of blood through the thick septum and the transference of air and blood from the lungs to the heart were secrets which he was desirous of searching out by means of experiment。
'27' Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus; Francofurti; 1628。
One or two special points in the work may be referred to as illustrating his method。 He undertook first the movements of the heart; a task so truly arduous and so full of difficulties that he was almost tempted to think with Fracastorius that 〃the movement of the heart was only to be comprehended by God。〃 But after many difficulties he made the following statements: first; that the heart is erected and raises itself up into an apex; and at this time strikes against the breast and the pulse is felt externally; secondly; that it is contracted every…way; but more so at the sides; and thirdly; that grasped in the hand it was felt to become harder at the time of its motion; from all of which actions Harvey drew the very natural conclusion that the activity of the heart consisted in a contraction of its fibres by which it expelled the blood from the ventricles。 These were the first four fundamental facts which really opened the way for the discovery of the circulation; as it did away with the belief that the heart in its motion attracts blood into the ventricles; stating on the contrary that by its contraction it expelled the blood and only received it during its period of repose or relaxation。 Then he proceeded to study the action of the arteries and showed that their period of diastole; or expansion; corresponded with the systole; or contraction; of the heart; and that the arterial pulse follows the force; frequency and rhythm of the ventricle and is; in fact; dependent upon it。 Here was another new fact: that the pulsation in the arteries was nothing else than the impulse of the blood within them。 Chapter IV; in which he describes the movements of the auricles and ventricles; is a model of accurate description; to which little has since been added。 It is interesting to note that he mentions what is probably auricular fibrillation。 He says: 〃After the heart had ceased pulsating an undulation or palpitation remained in the blood itself which was contained in the right auricle; this being observed so long as it was imbued with heat and spirit。〃 He recognized too the importance of the auricles as the first to move and the last to die。 The accuracy and vividness of Harvey's description of the motion of the heart have been appreciated by generations of physiologists。 Having grasped this first essential fact; that the heart was an organ for the propulsion of blood; he takes up in Chapters VI and VII the question of the conveyance of the blood from the right side of the heart to the left。 Galen had already insisted that some blood passed from the right ventricle to the lungsenough for their nutrition; but Harvey points out; with Colombo; that from the arrangement of the valves there could be no other view than that with each impulse of the heart blood passes from the right ventricle to the lungs and so to the left side of the heart。 How it passed through the lungs was a problem: probably by a continuous transudation。 In Chapters VIII and IX he deals with the amount of blood passing through the heart from the veins to the arteries。 Let me quote here what he says; as it is of cardinal import:
〃But what remains to be said upon the quantity and source of the blood which thus passes; is of a character so novel and unheard of that I not only fear injury to myself from the envy of a few; but I tremble lest I have mankind at large for my enemies; so much doth wont and custom become a second nature。 Doctrine once sown strikes deeply its root; and respect for antiquity influences all men。 Still the die is cast; and my trust is in my love of truth; and the candour of cultivated minds。〃'28' Then he goes on to say:
'28' William Harvey: Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus; Francofurti; 1628; G。 Moreton's facsimile reprint and translation; Canterbury; 1894; p。 48。
I began to think whether there might not be A MOVEMENT; AS IT WERE; IN A CIRCLE。 Now this I afterwards found to be true; and I finally saw that the blood; forced by the action of the left ventricle into the arteries; was distributed to the body at large; and its several parts; in the same manner as it is sent through the lungs; impelled by the right ventricle into the pulmonary artery; and that it then passed through the veins and along the vena cava; and so round to the left ventricle in the manner already indicated。〃'29'
'29' Ibid。 p。 49。
The experiments dealing with the transmission of blood in the veins are very accurate; and he uses the old experiment that Fabricius had employed to show the valves; to demonstrate that the blood in the veins flows to