a history of science-2-第31部分
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pears 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 quantity 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 quantities to the extremities； for all then is more conspicuous； under such circumstances 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 circumstances 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 passage 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 passage 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 passage 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 principal forms of microbesthe 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 anticipating 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； God 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 s
