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date: 01 December 2022

heartfree

heartfree

  • Julius Rocca

Subjects

  • Science, Technology, and Medicine

The heart (καρδία, κῆρ‎) was one of the most discussed bodily parts in antiquity. This is due, not so much to any assertion that it was the centre of the vascular system, but that it was widely regarded it as the seat of cognition and governor of movement and sensation. From the Hellenistic era onwards, these supposed attributes were set against the counter claim that the brain mediated these functions. This debate remained unsettled, despite Galen’s efforts, and the heart’s association with emotional states persists to this day.

Babylonian medicine possessed terms for the irregularity of the pulse, which served as labels for the heart. Egyptian medicine named the heart (ib, haty), and a vessel system (metu), which transported fluids of the body (including blood and air), as well as pathological and waste products. The connection between the heart beat and the peripheral pulse seems to have been recognised. The Iliad provides vivid examples of fatal wounds to the heart. In the death of Alcathous, the spear in his heart moves synchronously with the beat of its target (Hom. Il. XIII. 442–444). At XVI. 477–481, Sarpedon is fatally wounded in that part of the chest (phrēnes), close to his heart (kēr).

The Hippocratic text On Anatomy (VIII. 538 L) describes the heart as in the middle of the lung, and that it is “rounder” than in other living beings. Two large vessels are associated it; a “large tube” (bronchiē pollē) to the liver, and a “great vessel” (phleps megalē) though which the whole body is nourished. No account of heart function is provided, although its central location may infer some sort of controlling or coordinating role, a notion given expression in Bones (IX. 196 L), where the heart’s position and its relation to the blood vessels is likened to that organ holding the reins from all parts of the body. A specific statement of the heart as a ruler (kardiē basilis) is given in one of the pseudo-Hippocratic Epistles (IX. 396 L), although this is Hellenistic. Places in Man (VI. 282 L) mentions the heart once, in connection with the “hollow vessel” (aorta or vena cava). It is a work that gives priority to describing the blood vessels. The Heart, a Hellenistic work, is devoted entirely to that part (the functional anatomy of which is expressed in teleological terms) and shows familiarity with human material. It places intelligence (gnōmē), which rules over the soul, in the left ventricle (IX. 88 L).

The heart for Plato is the source of blood and the central point of the blood vessels. When affected by the actions of the spirited part of the soul (located in the chest), the heart has a tendency to leap. This motion is reduced by the surrounding lung, which acts both as cushion and thermo-regulator to the heart (Pl. Ti. 70c–d). Aristotle claims that all blooded animals possess a heart, and that it is the source of blood and the vasculature (Part. an. 665b9–666a11). Aristotle argues against what he regards as the communis opinion that the brain is the source of the blood vessels (Hist. an. 513a11–12). For Aristotle, the importance of the heart is underscored by his observation that it is the first organ to appear in the developing embryo, where it is seen as a speck of blood (Hist. an. 561a4–562a21). Aristotle assigned to the heart three chambers or ventricles (left, middle, and right). These chambers communicate with the lung, vena cava (the “great vessel”) and the aorta (Hist. an. 496a19–27). Aristotle assigns to the heart a definite set of functional roles. It is the source of the body’s heat, which is essential to life. This also explains man’s upright posture: the large amount of heat produced in the heart moves upward, causing growth to occur along that path (Part. an. 653a9–32; 669b5). The lung (always regarded as a single bi-lobed structure in antiquity) acts as a mechanism to cool the heart’s innate heat; gills in fish serve the same purpose (Part. an. 668b32–669b12). The heart is also the body’s centre of thought and motion (Part. an. 647a24–31). This cognitive function was also posited by the influential 4th-century physician, Diocles of Carystus (Frr. 72, 80 Van der Eijk). It is appropriate, given the heart’s cognitive status, that it be endowed with many nerves (neura) or sinews (Part. an. 666b14–17). Aristotle also recognised the cord-like structures associated with the heart valves (Hist. an. 496a13), but did not comment on the valves themselves.

The Alexandrian physicians Herophilus and Erasistratus were supported by access to human and animal material in their studies of the heart. The fourth book of Herophilus’s lost Anatomy examined the blood vasculature, the heart, and the blood supply to the brain. He investigated the heart valves, anatomically differentiated between arteries and veins (the former having a tunic six times the diameter of the latter), and maintained that the arteries carried pneuma as well as blood. Veins arose from the right side of the heart, arteries from the left, with the critical exception, followed by others such as Galen, that the relationship of the pulmonary vasculature is opposite to vessels elsewhere. The pulmonary artery, arising from the right ventricle, is the “artery-like vein,” while the pulmonary vein, arising from the left, is the “vein-like artery.” These nomenclatural shifts illustrate not only demands of physiological theory but also the complex vascular relations between heart and lung. One of Herophilus’ lasting innovations lay with his determining that the pulse derived from the heart, not from any innate faculty of the arteries themselves. Further, he maintained the pulse could be used as a diagnostic tool, developing an extensive and influential body of pulse-lore. Erasistratus’ study of the heart seems in part to have been influenced by mechanical engineering principles. His discovery of the four heart valves and their function arguably owes much to the water pump of Ctesibus (cf. Heron Pneum. I.28). The heart valves initiate and regulate the flow of blood and pneuma (there is no system of circulation). These are sent out to the veins and arteries respectively in pulse waves. Erasistratus held that the arteries contained pneuma only; if blood entered the arterial system it was only as a result of inflow from small branches of the veins in communication with similarly sized arteries. That arteries were seen to contain blood when opened was explained by this device, which Galen sought to refute by experiment (An in arteriis sanguis contineatur, IV. 703–736 K).

Galen challenged and consolidated Hellenistic work on the heart, adapting it to his physiological schema. For Galen, the liver is the source (archē) of the veins. Arteries arise from the heart (Erasistratus thought both did). Air entering the lung is converted therein to a “pneuma-like substance” and sent via the pulmonary vein to the left ventricle of the heart. There, in combination with blood and innate heat, it is converted to vital pneuma (pneuma zōtikon). The explanation Galen gives for blood in the left (pneumatic) ventricle is to postulate a series of pores in the inter-ventricular septum allowing passage of some blood from right to left. A portion of vital pneuma is transmitted via the arteries to the brain, where it becomes psychic pneuma (pneuma psychikon), responsible for sensation and motion. Although the heart is no longer a hegemonic organ, its presence is a critical one in Galen’s physiological system.

Primary Texts

  • Van der Eijk, Philip J. Diocles of Carystus: Vol. 1, Text and Translation. Leiden, The Netherlands: Brill, 2000.
  • Van der Eijk, Philip J. Diocles of Carystus: Vol. 2, Commentary. Leiden, The Netherlands: Brill, 2001.

Bibliography

  • Duminil, Marie P. Le Sang, les Vaisseaux, le Coeur dans la Collection Hippocratique: Physiologie et Anatomie. Paris: Les Belles Lettres, 1983.
  • Furley, David J., and James S. Wilkie. Galen on Respiration and the Arteries. Princeton, NJ: Princeton University Press, 1984.
  • French, Roger, “The Thorax in History: From Ancient Times to Aristotle.” Thorax 33, no. 1 (1978): 10–18, 153–166.
  • Geller, Markham J. Ancient Babylonian Medicine: Theory and Practice. Chichester, U.K.: Wiley-Blackwell, 2010.
  • Harris, C. Reginald S. The Heart and the Vascular System in Ancient Greek Medicine. Oxford: Oxford University Press, 1973.
  • Lonie, Ian M. “The Paradoxical Text ‘On the Heart’.” Medical History 17, no. 1 (1973): 1–15; 136–153.
  • Nunn, John F. Ancient Egyptian Medicine. London: British Museum Press, 1996.
  • Scurlock, JoAnn, and Burton R. Anderson. Diagnoses in Assyrian and Babylonian Medicine. Champaign: University of Illinois Press, 2005.
  • Von Staden, Heinrich. Herophilus. The Art of Medicine in Early Alexandria. Cambridge, U.K.: Cambridge University Press, 1989.
  • Wilson, Leonard G. “Erasistratus, Galen, and the Pneuma.” Bulletin of the History of Medicine 33, no. 4 (1959): 293–314.