"Blood Biography", by [Belgium] Marc Bogartz, translated by Zhang Yichi, unread丨Tianjin Science and Technology Press, June 2023.
Since ancient times, blood has been regarded as the mysterious law that nurtures life, and it is essential for our health and growth, and it can be found in every tiny corner of the body. How blood works in the body, how it is made and "digested", how it causes fever and inflammation ... These questions fascinate scientists.
A still from the documentary In Search of Blood (2015).
Classical doctrine: bodily fluids and gas
The ancient Egyptians had a very deep understanding of the internal and external structure of the human body in the process of mummifying corpses. Unfortunately, much of the medical knowledge they accumulated is not recorded. In the time of the ancient Greek physician Hippocrates, that is, in the 1st century BC, dissecting the human body was absolutely not allowed. The ancient Greeks believed that the dignity of the body was inviolable, even after death. Alexandria, on the other side of the Mediterranean, is less fancy. Legend has it that between 300 BC and 200 BC, many "researchers" such as Herofiras and Erasistratus had begun secretly dissecting human corpses, and they even did some experiments with living slaves.
Herofiras "discovered" the prostate and duodenum (the Latin duodenum is "duodenum", so named for the length equivalent of twelve horizontal fingers), and he also proposed a revolutionary concept at the time that nerves originated in the brain and could communicate "the instructions of the soul" to the limbs. He may have been the first to prove that the arteries were not filled with air, but with flowing blood, although it was widely believed that this was also the case.
Sometimes it is not a good thing that a person's mind is ahead of his or her time. Claudius Galen (129–199) was the spoiled son of a wealthy architect in the Kingdom of Pergamon (present-day Turkey). He directly ignored the discovery made by his "colleague" Herofiras 500 years ago. He is known to be very arrogant and proclaimed to be the emperor of the medical community of the Roman Empire. One of his favorite phrases on his lips is: "I, and only I, can demonstrate the right medical treatment." ”
Although he presented some impressive theories, he was mainly inspired by some famous medical figures around the 6th century BC, including Asclepius (the god of medicine in Western mythology), Hippocrates (460-370 BC), and Aristotle (384-322 BC). His knowledge derives mainly from the dissection of animals. He once said he had never heard of Herofelas.
Hippocrates believed that man is a small universe within the great universe of the world. Both consist of the four main elements (earth, air, water, and fire) and the corresponding four constitutions (cold, dry, wet, and warm). The combination of these four elements produces four "body fluids," which can also be called sap — blood, mucus, yellow bile, and black bile.
Galen believes that the body fluid in everyone's body is naturally excessive, and according to a person's body fluid level, people can be divided into bloody, mucus, bile and depressive. Usually these four body fluids are kept in balance in the body, but if there are disturbing factors, such as bad habits or environmental influences (Galen was an early environmentalist), people can get sick.
These four bodily fluids produce different "qi" (a type of steam or air) that rises to the brain and controls the temperament. Therefore, people with many bloodlines are naturally happy, cheerful, enthusiastic, and generous; Mucus people are cold, mean, annoying, and quiet; Choleric people are irritable, irritable, and like to quarrel; Depressive people are lazy, sad, gloomy, and apathetic.
A still from the anime "Blood Type 2: Blood Type" (2015).
A trained physician can use the diagnostic form to make a diagnosis, prognosis, and implement comprehensive therapy. If a person's constitution is too bile (too hot and dry), the doctor will give some dietary advice: eat some wet and cold fish. Patients who are too wet and cold (mucus) will be advised to eat some hot and dry food, such as grilled meat. Some food gurus may be inspired by this: recipes can't be one-size-fits-all, but personalize them based on the customer's physique.
If a person has a severe cold, it is caused by excessive cold (winter) and too much damp discharge from the nose, throat and lungs (excessive mucus) – wet and cold phlegm that upsets the fluid balance in the body. Lifestyle and diet should also be adjusted accordingly. Warm baths, laxatives, and enemas will restore fluid balance. If none of these therapies help, bloodletting therapy is indicated. Phlebotomy includes direct bloodletting, scratching (making a small cut in the skin), blistering (blistering on the skin), or using leeches to suck blood. After all, blood is the most readily available of the four body fluids, and "skillful" bloodletting usually "recovers" the patient's fluids before they pass out due to excessive blood loss.
Galen also described the process by which the male body converts blood into semen, which contrasts with the female body. He believes that there is too little hot blood in women's bodies to convert blood into semen. A woman's excess blood is used to nourish the fetus in the womb and is converted into breast milk after the fetus is born. For women who are not pregnant, excess blood must be drained, which is why women menstruate. It is also seen in some medieval paintings that one vein carries blood to the breast to produce breast milk, and the other vein transports menstrual blood outside the body.
Galen also proposed a special theory about blood circulation. He believed that veins originated in the liver and arteries from the heart. The liver constantly produces and prepares blood, which flows from the liver into tissues and organs like water for irrigating farmland. The blood flows like a ebb and flow, so it doesn't flow back. After delivering nutrients to the various organs, the blood is also depleted. The blood flowing from the liver to the heart is divided into two parts: a small amount is supplied to the lungs through the pulmonary artery, and the other large part passes across the heart from left to right (through an imaginary hole between the two chambers of the heart) that separates them from each other. Blood mixes with air there before flowing into the arteries and from the arteries to all parts of the body.
A still from the documentary In Search of Blood (2015).
This doctrine may seem strange and illogical to us today, but it has been promoted for more than 1,500 years. In the early Middle Ages, it was even thought that stars, planets, and constellations (the zodiac) also had an impact on human health. For centuries, Galen's doctrine based purely on animal anatomy was impeccable. It was not until 1482 that Pope Sixtus IV decreed that experiments on human dissection were permitted, provided that only the bodies of executed criminals could be used, and that the bodies were still buried in Christian funeral rites after the experiments. It was an important step forward in the development of science, a decree that satisfied the curiosity of researchers such as Paracelsus, Leonardo da Vinci, André Vesarius and William Harvey about anatomical truth.
Light comes from the East
Before delving into the groundbreaking medical discoveries of the 16th and 17th centuries, let's take a look at the ancient Oriental medicine therapies employed in the medieval East. Undoubtedly, the representative of Oriental medicine was Ibn Sinah (980-1037). The Western world called him "Avicenna". His father was a high-ranking official in the royal court of the city of Bukhara (in present-day Uzbekistan) and was his mentor in the fields of philosophy, mathematics, and astronomy. Eventually, Ibn Sinah went into medicine. A child prodigy from an early age, he was hired as the personal physician of the Emperor of Bukhara at the age of 18. In this way, he had free access to the famous court library to find all the classics he wanted in Greek, Latin, Indian, Chinese and Arabic.
He soon published The Treatise, a medieval encyclopedic work. The book covers a variety of fields such as philosophy, poetry, astronomy, music, mathematics, and physics. Bizarrely, there is not a chapter in the book devoted to medicine. This has a lot to do with the view he holds, which is, after all, a second-rate science, practice-oriented, and mostly done by well-trained but poorly educated low-level and low-level surgeons.
He went on to publish the medical dictionary, the medical dictionary, which immortalized him in human history, a five-volume collection (up to 800 pages) that gathered all known knowledge about the human body, diseases, and subtle medicinal therapies! ）。 Surprisingly, Avicenna believes that the environment and living conditions of patients play an important role. He emphasized the importance of a healthy mental state for a healthy body, along with adequate exercise, adequate sleep and a varied diet. The book also discusses in detail preventive measures, such as filtering drinking water, and the importance of preventing diseases and epidemics through proper education. This is in stark contrast to the prevailing practice in the West, and Avicenna has been ridiculed and ridiculed by some European "intellectuals".
Sinah's philosophical ideas were largely derived from the teachings of Socrates and Plato in ancient Greece, and he was criticized by religious people in his region and forced to lead a nomadic life in Persia and the Middle East. As early as the 11th century, his fame and works were transmitted to the West, thanks to cultural exchanges along the main trade routes from China and India to Europe, as well as the conquest of most of the Spanish territory by the caliphate. It was not until about 1085, when the Spanish monarchs were gaining further progress in their reconquistas, that a reliable Latin translation of Avicenna's Medical Codex was translated and published by Gerald of Cremona.
At that time, in the early Western universities of southern Europe, the Medical Codex was commented on by many scholars, and it was considered to be comparable to Galen's writings. After all, everything from the Arab world was considered plagiarism at the time, or too advanced fantasy... Nothing new under daylight. It was not until the 16th century that Avicenna's works began to be translated and republished, for example by the Venetian Andrea Alpago. Avicena's greatest achievement was to integrate and bring to the West all the human knowledge accumulated by Greek, Mesopotamian and Indian and Chinese cultures.
Renaissance: Cradle of Hematology
The Renaissance in Europe caused a veritable earthquake in medicine. It is undeniable that Philipps Orioles Deaufleste Bombassz von Hohenheim (1493-1541) was one of the key figures of this period, although he was not so famous in later life. It turned out that the Swiss-born visionary's middle name, "Bombasti," was not appropriated from someone else. Like many others, he completed his studies at the University of Bologna and began his career as a surgeon in the Venetian army. In the army, he was known for the "strange" theory of thoroughly disinfecting and cleaning wounds. He believes that infections are harmful to the human body, a concept that goes against the universal medical principle that infection is an inevitable part of the healing process. It was with this view in mind that he was not only a loyal supporter of Avicenna, but also a pioneer of the embalming campaign later launched by the famous British surgeon Joseph Lister and his colleagues.
Perhaps his achievements in the field of military medicine made him get a little carried away, he changed his name to Paracelsus and considered himself a descendant of the ancient medical masters Celsus and Alan. Soon he began to consider himself more important than these outstanding predecessors. Later he even called Galen a liar, claiming that he "knows more about every hair on my neck than my erudite peers, and that my shoelaces possess wisdom that Galen and Avicenna combined cannot match." Bombasz, how dare you say it!
A still from the movie "Dracula" (2020).
After returning to Basel, he was hired as a university professor even though he had done so many outrageous things, and he asked his students to burn precious medical textbooks, because he firmly believed that the theory of the four qi defended in the book was complete nonsense. At the same time, he rejected bloodletting, a widely used therapy, and turned his attention to chemical elements such as sulfur, mercury, and salt (perhaps inspired by the rise of alchemy at the time). This was an important turning point: from then on, medicine treated the human body as a chemical system rather than a humoral system.
"Thanks to" Paracelsus, thousands of syphilis patients received highly toxic mercury therapy in the 19th century. He also introduced opium tincture into medicine, the most effective painkiller known at the time. He probably came up with this idea while practicing medicine in the Byzantine army, perhaps "borrowed" from Avicenna. Deophrast Bombassz also believes that "dosage" is the first principle: anything can be toxic or harmful – even water, which can be harmful if consumed too much. He has mentioned that this principle also applies to blood, and that too much or too little is unhealthy.
Perhaps his greatest achievement was writing about the diseases afflicted by German miners. For the first time, the book links working conditions in the metalworking industry to (occupational) diseases, such as anemia, which is very common. Later, due to conflicts with the church, Deophrast Bombassz died alone in Salzburg. Undoubtedly, he was well aware that he was a pioneer in the field of Renaissance medicine, playing the role of an eternal skeptic. Whether the "Orioles" in his name came from this role is not known.
Meanwhile, another giant is working in Italy. From 1475 to about 1510, Leonardo da Vinci (1452-1519) performed no less than 30 autopsies on bodies obtained from hospitals in Milan, Rome, Padua, etc. He gained a lot of knowledge about the human body. For example, his famous painting, which uses black and red chalk to accurately depict the shape of the uterus and how blood flows from the mother to the child through the umbilical cord.
In 1477, when a convict was publicly executed, da Vinci, like everyone else present, noticed that this type of execution would result in a sudden erection of the penis. In subsequent autopsies, he accurately depicted the morphology of penile engorgement, while medicine at the time attributed penile erection to changes in the liver in the air mixture that made the penis swell like an inner tube. Later some vicious remarks suggested that da Vinci's interest in male genitalia might be related to his homosexual tendencies. In any case, da Vinci demonstrated for the first time the role of blood on sexual arousal.
Still, detailed sketches of veins and arteries suggest that da Vinci had not yet discovered the secrets of blood circulation. This honor goes to another scientist.
Andreas Vesarius (1514-1564), better known as "Vesarius", was more modest than Paracelsus, but better known for initiating the medical revolution of the 16th century. Although he studied Galen's traditional classical medical theories in Italy, as a contemporary of Leonardo da Vinci, he was influenced by da Vinci's sophisticated human anatomy, Avicenna's Medical Codex, and Paracelsus' critical rebellion.
At the age of 23, Vesalius became a professor at the University of Padua, one of the medical meccas of the time. He probably got the position thanks to his audacity in Leuven, where he stole bodies from Gasburg and performed autopsies – one part at a time, one arm today, one leg the next (by the way, Gasburg is now the hospital of Gasburg).
Vesalius trusts only his eyes and fingers, and does not blindly follow Galen's instructions. From then on, the way medicine is taught will change. Students need to do their own hands on the dissection table, not just in front of the cathedral (according to tradition, the professor stands high above the dissection table, and his assistant can dissect which part he points with the teaching stick and show the students).
Vesarius was quick to refute several axioms proposed by Galen. Perhaps the most important of these is the refutation of Galen's assertion about the heart. Galen believed that there were tiny junctions or pores between the two chambers of the heart through which blood could flow from one side to the other. Vesarius proved that these pores do not exist inside the human heart, and that the two cycles of the heart are separate: one cycle is to receive blood from the large veins of the body and pump it into the lungs; Another cycle is to receive blood pumped from the lungs, which then flows through the arterial system to various organs.
Vesalius took full advantage of the "new" printing press that caused a sensation throughout Europe. He had Jan Stefan van Kacalka, a student of the painter Titian, and other artists make his rough sketches beautifully illustrated, and insert them into his book The Structure of the Human Body (1543). The publication of this book made Vesarius famous at the age of 30. It's puzzling that Vesalius never resisted bloodletting, but you really can't blame a surgical anatomist for having a craving for blood when dissecting... Although Vesarius was able to describe the structure of the human body very accurately, it was not until 1628 that William Harvey of England (1578-1657) revealed the principle of blood circulation in his book "The Theory of the Movement of Hearts".
A still from the documentary In Search of Blood (2015).
Fourteen years after Vesarius' death, Harvey was born into a wealthy family in Folkestone, the eldest of nine children. From an early age, he had the opportunity to learn Latin, the common scientific language in Europe at the time. His talent soon became apparent and at the age of 15 he began his medical studies at Cambridge University. At the age of 19 he began studying in France and Germany, arriving in Padua, then the medical center, in 1599. It is even possible that he met Galileo Galilei there. To be sure, he studied the theories of Vesarius there and studied anatomy under the famous anatomist and surgeon of the time, Fabrichue. Upon his return to London, Harvey married the daughter of Elizabeth I's court physician, which undoubtedly helped him a great boost in his career. He later became the personal physician of Kings James I and Charles I.
Galen's theory was still prevalent in England at the time, but this did not affect Harvey, who brutally dissected living animals (there was no anesthesia at the time), and he was eager to know how blood circulates in living bodies and how blood is transported from one organ to another. The noisy atmosphere of scientific and cultural innovation at the time helped him develop his theories, in which da Vinci's technical sketches, Vesarius' illustrations, the first mining pump appeared, Descartes' philosophical thought "I think, therefore I am" and Shakespeare's works all had a great influence on him.
He quickly came to the conclusion that Galen's theory of the tides of blood movement could not be correct in terms of blood and its circulation. There are indeed valves in the veins, but they only allow blood to flow in one direction; There is really no connection between the left and right atrium; There is no air in the arteries, and the heart contracts coincide with a perceptible pulse. In short, the left and right atria in the heart independently form a system and pump blood, transporting blood to the lungs and other organs separately. The concept of circulation was born, blood is not consumed by organs, but will be recycled, and the heart is like a simple pump that pushes blood flow with each contraction, forming a blood circulation system.
Harvey's theory was not universally accepted because it clearly contradicted the dogmas and theories of the ancient Greek masters. When he began to question the usefulness of bloodletting again, the fierce crusade made him uneasy, and he had to constantly defend himself. His royal "connections" came in handy at this time. In the end, the turmoil was successfully quelled: even before his death, he was honored that most of his colleagues were able to admit his theory. Harvey died peacefully at the age of 79 (probably) from a cerebral hemorrhage, and it was he himself who justified the blood circulation mechanism he discovered.
This article is selected from "Blood Biography", which is abridged and revised from the original text, and has been authorized by the publishing house to publish.
Original author/[Belgium] Marc Bogartz
Excerpt / He Ye
Editor/Zhang Jin
Proofreader/Chen Diyan