12 



HANDBOOK OF PHYSIOLOGY ^^ CIRCULATION I 



heart and blood were conventionalized, and remained 

 unquestioned for millenniums. 



Stone and Bronze Age cultures all over the earth 

 were fully appreciative of the importance of blood. It 

 was recognized as being the essential life factor in 

 humans. Not only did injury and warfare contribute 

 to vague notions about the primacy of the blood and 

 heart, but also the deeply emotional factors associated 

 with widespread human sacrifice must have pro- 

 foundly influenced thought on the functions of the 

 heart and the great \'essels carrying blood from it. The 

 awe-inspiring Aztec divination, based on whether or 

 not the heart would continue to beat after being torn 

 from the body by the powerful priests, certainly re- 

 veals to our sophisticated insight that the heart has 

 automaticity. To the Aztecs, however, it was merely a 

 magical indication that events might continue to go 

 well : if it came from the body without beating, the 

 future might be disastrous. Thus was the individual 

 merely a part of the social milieu. 



The change in heart action, under the influence of 

 the emotions, which may be consciously felt, was 

 probably the background for the ancient idea that 

 the heart is the location of thought. The editorial 

 writer of Genesis referred to "The thoughts of my 

 heart." Even Aristotle (384-322 B.C.), the great 

 Greek philosophizing founder of modern science, 

 made this same mistake. 



The old Chinese ideas regarding heart and blood 

 vessels are expressed in Nei Ching, The Yellow 

 Emperor's Classic of Internal Medicine. Here it is said 

 "the heart influences the face and fills the pulse with 

 blood. . . the heart is in accord with the pulse . . . the 

 heart rules over the kidneys . . . the pulse is the store- 

 house of the blood . . . the viscera are in communica- 

 tion and hoimd to the heart, and the blood tliat is 

 stored by the heart fills the pulse with the forces of 

 life." There is much subsecjuent discussion of pulse 

 lore. Some of this indicates the direct application of 

 observations on the pulse to disease, "when the pulse 

 is quick, and contains 6 beats to one cycle of respira- 

 tion, then it indicates heart trouble; and when the 

 pulse is large the di.sease becomes grave." 



Among the Indus, Charaka and the surgeon, 

 Susruta, both of whom flomishcd in the sixth century 

 B.C., are reported as using the pulse at the wrist to 

 give an indication of heart action. 



The old Egyptian notions about the heart and blood 

 vessels were the most sophisticated of those of ancient 

 people, as far as we know, and were included in one 

 of the great teaching texts, which has survived from 



around 1700 B.C. In the Ebers Papyrus, which re- 

 cently has become so well studied, there is a section, 

 on sheets 99 to 103, entitled "The beginning of the 

 secrets of the physician : knowledge about the move- 

 ments of the heart." 



This starts with noting the relation of the heart to 

 the pulse, indicating that in examining the patient, a 

 physician applying his fingers to the arms or legs, 

 actually examines the heart, for "all the limbs possess 

 its vessels, so that the heart speaks from the vessels of 

 every limb." There follows much detail on 2, 4, and 6 

 vessels which were thought to go from the heart to 

 each part of the body. Much of this seems to be 

 annotations and glosses, made by the scribe in refer- 

 ence to some lost writing which apparently was being 

 copied. The material in general suggests etiological 

 ideas based on W'hdw, the principle of putrefaction 

 and excrements, accumulation of which was thought 

 to cause disease. This etiological notion has been well 

 analyzed by Robert .Steuer. 



There is nothing to suggest that the old Egyptians 

 had any notion of heart action in relation to blood 

 movement. There is, however, the explicit statement 

 that the breath which enters the nose goes into the 

 heart from the lung. This may have influenced later 

 Greek and Alexandrian writers to give background for 

 the Galenical scheme, part of which was based on the 

 observation that the arteries when opened after death 

 are empty, and thus were thought to contain air. 



Egyptian culture passed gradually into the Mediter- 

 ranean area, and profoundly affected the later de- 

 velopment of Greek culture. Greek medicine seems in 

 large part to have developed from old Egyptian medi- 

 cine, not only with regard to the great health temples, 

 but also with respect to technical ideas and pro- 

 cedures. At the large health temple school at Kos, 

 Hippocrates (460-375 B.C.) developed the concept 

 that health depends upon a balance of four humors: 

 blood (hot and moist, most ali\e), phlegm (cold and 

 moist), yellow bile (hot and dry), and black bile (cold 

 and dry, least alive). Excesses were thought to de- 

 termine temperaments, which still come to us under 

 the terms sanguine, phlegmatic, choleric, and melan- 

 cholic. The primacy of blood in the humoral 

 pathology was unquestioned. 



Systematic work in biology was first undertaken by 

 Aristotle (384-322 B.C.), the great pupil of Plato, and 

 the tutor of Alexander the Great. Realizing that 

 effective study could be aided by orderly arrangement 

 of material, he made the first organized classification 

 for animals, recognizing the relation of form and 



