Part 22

Thirdly, he enquires why, when one notes the resemblance between the passages and vessels connected with the opposite sides of the heart, one should regard one side as destined to a private purpose, namely, that of nourishing the lungs, the other to a more public function? Furthermore, he enquires, since the lungs are so near, and in continual movement, and the vessels supplying them of such dimensions, what can be the use of the pulse of the right ventricle, which he had often observed in the course of his experiments? He sums up his inability to accept the explanations previously offered with a phrase which reads rather strangely, even in original Latin: "Deus bone! Quomodo tricuspides impediunt aëris egressum, non sanguinis." i. e., "Good God! how should the mitral valves prevent the regurgitation of air and not of blood?"

He then takes up the views of those who have believed that the blood oozed through the septum of the heart from the right to the left side by certain secret pores, and to them he replied "By Hercules, no such pores can be demonstrated, nor, in fact, do any such exist." Again, "Besides, if the blood could permeate the substance of the septum, or could be emptied from the ventricles, what use were there for the coronary artery and vein, branches of which proceed to the septum itself, to supply it with nourishment?"

Further on in the treatise Harvey sets forth his motives for writing, stating how greatly unsettled had become his mind in that he did not know what he himself should conclude nor what to believe from others. He says: "I was not surprised that Laurentius should have written that the movements of the heart were as perplexing as the flux and reflux of Euripus had appeared to Aristotle." He apologizes for the crime, as some of his friends considered it, that he should dare to depart from the precepts and opinions of all anatomists. He acknowledged that he took the step all the more willingly, seeing that Fabricius, who had accurately and learnedly delineated almost every one of the several parts of animals in a special work, had left the heart entirely untouched.

Passing more directly to the actual work of the heart, he shows that not only are the ventricles contracted by virtue of the muscular structure of their own walls, but further that those fibers or bands, styled "Nerves" by Aristotle, that are so conspicuous in the ventricles of larger animals when they contract simultaneously, by an admirable adjustment, help to draw together all the internal surfaces as if with cords, thus expelling the charge of contained blood with force. Later on he says that if the pulmonary artery be opened, blood will be seen spurting forth from it, just as when any other artery is punctured, and that the same result follows division of the vessel which in fishes leads from the heart. He furnishes a very happy simile to prove that the pulses of the arteries are due to the impulses of the left ventricle by showing how, when one blows into a glove all of its fingers will be found to have become distended at one and the same time. He quotes Aristotle, who made no distinction between veins and arteries, but said that the blood of all animals palpitates within their vessels and by the pulse is sent everywhere simultaneously, all of this depending upon the heart.

It is in Chapter Five of the treatise that he gives, probably for the first time, an accurate published account of just what transpires with one complete cycle of cardiac activity. The passage need not be quoted here, but deserves to be read by everyone interested in the subject, as who should not be? One sentence, however, is worth quotation or, at least, a summary, as follows: "But if the divine Galen will here allow, as in other places he does, that all the arteries of the body arise from the great artery, and that this takes its origin from the heart; that all the vessels naturally contain and carry blood; that the three semilunar valves situated at the orifice of the aorta prevent the return of the blood into the heart, and that they were here for some important purpose,--I do not see how he can deny that the great artery is the very vessel to carry the blood, when it has attained its highest triumph of perfection, from the heart for distribution to all parts of the body."

His Chapter Six deals with the course by which blood is carried from the right into the left ventricle, and here one must admire the large number of experimental demonstrations which Harvey had undertaken upon all classes of animals, for he speaks even of that which occurs in small insects, whose circulation he had studied so far as he could with the simple lens. Furthermore he described the prenatal circulation, omitting practically nothing of that which is taught to-day, showing that in embryos, while the lungs are yet in a state of inaction, both ventricles of the heart are employed, as if they were but one, for the transmission of blood. In concluding this chapter he again states briefly the course of the blood, and promises to show, first, that this may be so and, then, to prove that it really is so.

His Chapter Seven is devoted to showing how the blood passes through the substance of the lungs from the right ventricle and then on into the pulmonary vein and left ventricle. He alludes to the multitude of doubters as belonging, as the poet had said, to that race of men who, when they will, assent full readily, and when they will not, by no matter of means; who, when their assent is wanted, fear, and when it is not, fear not to give it. A little later on he says: "As there are some who admit nothing unless upon authority, let them learn that the truth I am contending for can be confirmed from Galen's own words, namely, that not only may the blood be transmitted from the pulmonary artery into the pulmonary veins and then into the left ventricle of the heart, but that this is effected by the ceaseless pulsation of the heart and the movements of the lungs in breathing." He then shows how Galen explained the uses of the valves and the necessity for their existence, as well as the universal mutual anastomosis of the arteries with the veins, and that the heart is incessantly receiving and expelling blood by and from its ventricles, for which purpose it is furnished with four sets of valves, two for escape and two for inlet and their regulation.

Harvey then noted a well-known clinical fact, that the more frequent or forcible the pulsations, the more speedily might the body be deprived of its blood during hemorrhage, and that it thus happens that in fainting fits and the like, when the heart beats more languidly, hemorrhages are diminished and arrested. The balance of the book is practically devoted to further demonstration and corroboration of statements already made. A study of this work of Harvey's illustrates how much respect even he and his contemporaries still showed for the authority of Galen. It shows still further how nearly Galen came to the actual truth concerning the circulation. Had the latter not adopted too many of the notions of his predecessors concerning the nature of the soul (Anima) and the spirits (Pneuma) of man, he might himself have anticipated Harvey by a thousand years, and by such announcement of a great truth have set forward physiology by an equal period. Independent and original as Harvey showed himself, he seems to have failed to get away from the notion of the vapors and spiritual nature of the blood which he had inherited from the writings of Galen and many others. Nevertheless he also alludes to this same blood as alimentive and nutritive. We must not forget, however, that this was years before Priestly's discovery of oxygen and that Harvey had, like others, no notion of the actual purpose of the lungs, believing that the purification and revivification of the blood was the office of the heart itself.

Along with its other intrinsic merits Harvey's book possesses a clear and logical arrangement, the author first disposing of the errors of antiquity, describing next the behavior of the heart in the living animal, showing its automatic pumplike structure, its alternate contractions and the other phenomena already alluded to, thus piling up facts one upon another in a manner which proved quite irresistible. The only thing that he missed was the ultimate connection between the veins and the arteries, i. e., the capillaries, which it remained for Malpighi to discover with the then new and novel microscope, which he did about 1657, showing the movement of the blood cells in the small vessels, and confirming the reality of that ultimate communication which had been held to exist. Malpighi discovered the blood corpuscles in 1665, but it remained for Leeuwenhoek, of Delft, in 1690, by using an improved instrument to demonstrate to all observers the actual movements of the circulating blood in the living animal. One historian has said that with Harvey's overthrow of the old teachings regarding the importance of the liver and of the spirits in the heart "fell the four fundamental humors and qualities" while Daremberg exclaims: "As in one of the days of the creation, chaos disappeared and light was separated from darkness."

It remains now only to briefly consider how Harvey's great discovery was received. To quote the words of one writer: "So much care and circumspection in search for truth, so much modesty and firmness in its demonstration, so much clearness and method in the development of his ideas, should have prepossessed everyone in favor of the theory of Harvey; on the contrary, it caused a general stupefaction in the medical world and gave rise to great opposition."

During the quarter of a century which elapsed after Harvey's announcement there probably was not an anatomist nor physiologist of any prominence who did not take active part in the controversy engendered by it; even the philosopher Descartes was one of the first adherents of the doctrine of the circulation, which he corroborated by experiments of his own.

Two years after the appearance of Harvey's book appeared an attack, composed in fourteen days by one Primerose, a man of Scotch descent, born and educated in France, but practising at Hull, in which he pronounced the impossibilities of surpassing the ancients or improving on the work of Riolan, who already had written in opposition to Harvey, and who was the only one to whom the latter vouchsafed an answer. It was Riolan who procured a decree of the Faculty of Paris prohibiting the teaching of Harvey's doctrine. It was this same Riolan who combated with equal violence and obstinacy the other great discovery of the age, namely,--the circulation of the lymph.

One of the earliest and fiercest adversaries of Harvey's theory was Plempius, of Louvaine, who, however, gave way to the force of argument and who finally publicly and voluntarily passed over to the ranks of its defenders in 1652, becoming one of Harvey's most enthusiastic advocates.

Harvey's conduct through the controversy was always of the most dignified character; in fact, he rarely ventured to reply in any way to his adversaries, believing in the ultimate triumph of the truths which he had enunciated. His only noteworthy reply was one addressed to Riolan, then Professor in the Paris Faculty and one of the greatest anatomists of his age, to whose opinion great value was always attached. Even in debating or arguing against him, Harvey always spoke of him with great deference, calling him repeatedly The Prince of Science. Riolan was, however, never converted, though whether he held to his previous position from obstinacy, from excess of respect for the ancients, or from envy and jealousy of his contemporary, is not known.

Another peculiar spectacle was afforded by one Parisunus, who died in 1643, a physician in Venice, who, like Harvey, had been a pupil of Fabricius of Aquapendente, who had been stigmatized by Riolan as an ignoramus in anatomy, but who joined with others in declaring that he had seen the heart beat when perfectly bloodless, and that no beating of the heart and no sounds were to be heard as Harvey had affirmed.

With the later and more minute studies into the structure and function of the heart we are not here concerned. The endeavor has been rather to place before you the sentiments, the knowledge and the habits of thought of the men of Harvey's time, with the briefest possible epitome of what they knew, or rather of how little they knew, to account for this later slavish adherence to authority by unwillingness to reason independently, or to observe natural phenomena intelligently, still less to experiment with them. It is, then, rather the brief history of an epochal discovery than an effort to trace out its far-reaching consequences that I have endeavored to give.

Here must close an account which perhaps has been to you tedious, and yet which is really brief, of Harvey's life and labors. He lived to see his views generally accepted and to enjoy his own triumph, a pleasure not attained by many great inventors or discoverers. Lessons of great importance may be gathered from a more careful study of this great historical epoch, but they must be left to your own powers of reasoning rather than to what I may add here. I commend it to you as a fertile source of inspiration, and a line of research worthy of both admiration and imitation. Few men have rendered greater service to the world by the shedding of blood than did Harvey, in his innocent and wonderful studies of its natural movement. Perhaps it might be said of him that he was the first man to show that "blood will tell." What he made it tell has been thus briefly told to you.

I know not how I may better close this account than by quoting the concluding words of his famous book, and especially repeating the lines which he has quoted from some Latin author whom I have not been able to identify. His paragraph and his quotation are as follows:

"Finally, if any use or benefit to this department of the republic of letters should accrue from my labors, it will, perhaps, be allowed that I have not lived idly, and, as the old man in the comedy says:

'For never yet hath anyone attained To such perfection, but that time, and place, And use, have brought addition to his knowledge; Or made correction, or admonished him, That he was ignorant of much which he Had thought he knew; or led him to reject What he had once esteemed of highest price.'"

XIII

HISTORY OF ANAESTHESIA AND THE INTRODUCTION OF ANAESTHETICS IN SURGERY[10]

[10] Commemorative Address delivered at the Medical Department, University of Buffalo, October 16, 1896.

IN COMMEMORATION OF THE SEMI-CENTENNIAL OF THE INTRODUCTION OF ETHER AS AN ANAESTHETIC AGENT

Fifty years ago to-day--that is to say, on the 16th of October, 1846,--there occurred an event which marks as distinct a step in human progress as almost any that could be named by the erudite historian. I refer to the first demonstration of the possibility of alleviating pain during surgical operations. Had this been the date of a terrible battle, on land or sea, with mutual destruction of thousands of human beings, the date itself would have been signalized in literature and would have been impressed upon the memory of every schoolboy, while the names of the great military murderers who commanded the opposing armies would have been emblasoned upon monuments and the pages of history. But this event was merely the conquest of pain and the alleviation of human suffering, and no one who has ever served his race by contributing to either of these results has been remembered beyond his own generation or outside the circle of his immediate influence. Such is the irony of fate. The world erects imposing monuments or builds tombs, like that of Napoleon, to the memory of those who have been the greatest destroyers of their race; and so Cæsar, Hannibal, Genghis Khan, Richard the Lion-hearted, Gustavus Vasa, Napoleon and hundreds of other great military murderers have received vastly more attention, because of their race-destroying propensities and abilities, than if they had ever fulfilled fate in any other capacity. But the men like Sir Spencer Wells, who has added his 40,000 years of life to the total of human longevity, or like Sir Joseph Lister, who has shown our profession how to conquer that arch enemy of time past, surgical sepsis, or like Morton, who first publicly demonstrated how to bring on a safe and temporary condition of insensibility to pain, are men more worthy in our eyes of lasting fame, and much greater heroes of their times, and of all time,--yet are practically unknown to the world at large, to whom they have ministered in such an unmistakable and superior way.

This much, then, by way of preface and reason for commemorating in this public way the semi-centennial of this really great event. Because the world does scant honor to these men we should be all the more mindful of their services, and all the more insistent upon their public recognition.

Of all the achievements of the Anglo-Saxon race, I hold it true that the two greatest and most beneficent were the discovery of ether and the introduction of antiseptic methods,--one of which we owe to an American, the other to a Briton.

The production of deep sleep and the usual accompanying abolition of pain have been subjects which have ever appeared, in some form, in myth or fable, and to which poets of all times have alluded, usually with poetic license. One of the most popular of these fables connects the famous oracle of Apollo, at Delphi, whence proceeded mysterious utterances and inchoate sounds, with convulsions, delirium and insensibility upon the part of those who approached it. To what extent there is a basis of fact in this tradition can never be explained, but it is not improbable from what we now know of hypnotic influence.

From all time it has been known that many different plants and herbs contained principles which were narcotic, stupefying or intoxicating. These properties have especially been ascribed to the juices of the poppy, the deadly nightshade, henbane, the Indian hemp and the mandrágora, which for us now is the true mandrake, whose juice has long been known as possessing soporific influence. Ulysses and his companions succumbed to the influence of _Nepenthe_; and, nineteen hundred years ago, when crucifixion was a common punishment of malefactors, it was customary to assuage their last hours upon the cross by a draught of vinegar with gall or myrrh, which had real or supposititious narcotic properties. Even the prophet Amos, seven hundred years before the time of Christ, spoke of such a mixture as this as "the wine of the condemned," for he says, in rehearsing the iniquities of Israel by which they had incurred the anger of the Almighty: "And they lay themselves down upon the clothes laid to pledge by every altar, and they drink the wine of the condemned in the house of their God," (Chap. II, verse 8), meaning thereby undoubtedly that these people, in their completely demoralized condition, drank the soporific draught kept for criminals. Herodotus mentions a habit of the Scythians, who employed a vapor generated from the seed of the hemp for the purpose of producing an intoxication by inhalation. Narcotic lotions were also used for bathing the people about to be operated upon. Pliny, who perished at the destruction of Herculaneum, A. D. 79, testified to the soporific power of the preparations made from mandrágora upon the faculties of those who drank it. He says: "It is drunk against serpents and before cuttings and puncturings, lest they should be felt." He also describes the indifference to pain produced by drinking a vinous infusion of the seeds of eruca, called by us the rocket, upon criminals about to undergo punishment. Dioscorides relates of mandrágora that "some boil down the roots in wine to a third part, and preserve the juice thus procured, and give one cyathus of this to cause the insensibility of those who are about to be cut or cauterized." One of his later commentators also states that wine in which mandrágora roots have been steeped "does bring on sleep and appease pain, so that it is given to those who are to be cut, sawed or burnt in any parts of their body, that they may not perceive pain." Apuleius, about a century later than Pliny, advised the use of the same preparation. The Chinese, in the earlier part of the century, gave patients preparations of hemp, by which they became completely insensible and were operated upon in many ways. This hemp is the cannabis Indica which furnishes the _Hasheesh_ of the Orient and the intoxicating and deliriating _Bhang_, about which travelers in the East used to write so much. In Barbara, for instance, it was always taken, if possible, by criminals condemned to suffer mutilation or death.

According to the testimony of medieval writers, knowledge of these narcotic drugs was practically applied during the last of the Crusades, the probability being that the agent principally employed was this same hasheesh. Hugo di Lucca gave a complete formula for the preparation of the mixture, with which a sponge was to be saturated, dried, and then, when wanted, was to be soaked in warm water, and afterward applied to the nostrils, until he who was to be operated upon had fallen asleep; after which he was aroused with the vapor of vinegar.

Strangely enough, the numerous means of attaining insensibility, then more or less known to the common people, and especially to criminals and executioners, do not appear to have found favor for use during operations. Whether this was due to unpleasant after-effects, or from what reason, we are not informed. Only one or two surgical writers beside Guy de Chauliac (1498) refer in their works to agents for relief of pain, and then almost always to their unpleasant effects, the danger of producing asphyxiation, and the like. Ambrose Paré wrote that preparations of mandrágora were formerly used to avert pain. In 1579, an English surgeon, Bulleyn, affirmed that it was possible to put the patient into an anaesthetic state during the operation of lithotomy, but spoke of it as a "terrible dream." One Meisner spoke of a secret remedy used by Weiss, about the end of the XVII Century, upon Augustus II., king of Poland, who produced therewith such perfect insensibility to pain that an amputation of the royal foot was made without suffering, even without royal consent. The advice which the Friar gave Juliet regarding the distilled liquor which she was to drink, and which should presently throw her into a cold and drowsy humor, although a poetic generality, is Shakespeare's recognition of a popular belief. Middleton, a tragic writer of Shakespeare's day, in his tragedy known as "Women beware Women," refers in the following terms to anesthesia in surgery:

"I'll imitate the pities of old surgeons To this lost limb, who, ere they show their art, Cast one asleep; then cut the diseased part."

Of course, of all the narcotics in use by educated men, opium has been, since its discovery and introduction, the most popular and generally used. Surgeons of the last century were accustomed to administer large doses of it shortly before an operation, which, if serious, was rarely performed until the opiate effect was manifested. Still, in view of its many unpleasant after-effects, its use was restricted, so far as possible, to extreme cases.