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Da Descoberta Da Circulação Sanguínea Aos Primeiros Factos Hemorreológicos (1.ª Parte) § [99]

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Da Descoberta Da Circulação Sanguínea Aos Primeiros Factos Hemorreológicos (1.ª Parte) § [99] ARTIGO DE REVISÃO Da descoberta da circulação sanguínea aos primeiros factos hemorreológicos (1.ª Parte) § [99] J. M ARTINS E SILVA Faculdade de Medicina de Lisboa, Lisboa, Portugal Rev Port Cardiol 2009; 28 (11): 1245-1268 RESUMO ABSTRACT Neste artigo, o primeiro de duas partes sobre From the discovery of the circulation o mesmo tema, procede-se a uma breve of the blood to the first steps in revisão histórica sobre os conceitos que hemorheology: Part 1 prevaleceram, relativamente à natureza do sangue e circulação sanguínea, desde a In this article (the first of two on the subject) Antiguidade e até à resolução do problema a brief historical review is presented of the por William Harvey, no século XVI. Pela prevailing ideas on the nature of the blood vivissecção de diversos tipos de animais, pôde and its circulation from antiquity to the 16th Harvey definir um modelo geral e lógico para century, when the problem was solved by toda a circulação sistémica que contradizia William Harvey. On the basis of vivisection conceptualizações anteriores, designadamente of various types of animals, Harvey con- as que haviam sido definidas por Galeno, structed a general and logical model for the cerca de catorze séculos antes. A influência whole systemic circulation, which contradict- que Galeno ainda exercia sobre, virtualmente, ed previous concepts, mainly those that had todos os assuntos médicos terá justificado as been put forward by Galen fourteen centuries hesitações e escrúpulos de Harvey, que publi- before. The influence that Galen still exer- cou somente as suas conclusões treze anos cised on virtually all areas of medicine depois de as ter obtido. Também explica a justified Harvey’s hesitations and scruples, polémica estabelecida com colegas sobre o forcing him to delay publishing his assunto, que se manteve até ao seu falecimen- conclusions for thirteen years. It also to. Todavia, através de cuidadosa observação explains the controversy with fellow e investigação perseverante, Harvey de- physicians on the subject, which continued monstrou claramente que o coração era o until his death. However, through careful órgão central do sistema, de que dependia a observation and painstaking investigation, propulsão do sangue para as artérias e, depois Harvey demonstrated clearly that the heart o seu retorno por vasos diferentes, as veias, was the central organ of the circulatory até ao ponto de partida. O sangue proveniente system, on which depended the propulsion of do coração seria diferente do que regressasse the blood to the arteries and its subsequent aquele órgão, atribuindo essa diferença (em return by different vessels, the veins, to its cor e fluidez) à presença de conteúdos starting point. The blood coming from the próprios, nutritivos para o organismo por ele heart was different from that which returned 1245 Recebido para publicação: Julho de 2009 • Aceite para publicação: Setembro de 2009 Received for publication: July 2009 • Accepted for publication: September 2009 Rev Port Cardiol Vol. 28 Novembro 11 / November 11 irrigado. Caracterizou a pulsação sanguínea to the organ, the difference (in color and como resultante do enchimento das artérias fluidity) being attributed to the presence of pelo sangue arterial veiculado a cada con- constituents which nourished the organism it tracção cardíaca. Revelou que o sangue arte- irrigated. Harvey characterized blood pulsa- rial saía do coração pela contracção do ven- tion as the result of the arteries filling with trículo esquerdo, a qual ocorria em simultâ- arterial blood during each heart contraction. neo com a do ventrículo direito e, em ambos, He demonstrated that the arterial blood left depois da contracção das aurículas. the heart by contraction of the left ventricle, Confirmou que o sangue passava do ventrícu- which happened simultaneously with lo direito para a aurícula esquerda e, desta, contraction of the right ventricle and, in both, para o ventrículo esquerdo, através da circu- after the contraction of the atria. He lação pulmonar. Pelo cálculo do volume de confirmed that blood passed through the lung sangue debitado diariamente pelo coração, circulation from the right ventricle to the left considerou que o sangue não poderia ser con- atrium and from there to the left ventricle. By sumido pelo corpo e teria de circular continu- calculating the volume of blood pumped daily amente pelo coração e rede vascular. Ainda by the heart, Harvey reasoned that the blood que não tenha confirmado completamente a could not be consumed by the body and continuidade da rede circulatória, não deixou would have to circulate continually through de considerar a existência de passagens the heart and vascular network. Although minúsculas ou imperceptíveis entre as Harvey did not confirm the continuity of the artérias e veias, que seriam posteriormente circulatory network, he went so far as to confirmadas, por Marcello Malpighi, sob a hypothesize the existence of minuscule forma de redes capilares. O sentido unidirec- imperceptible passages between arteries and cional do fluxo sanguíneo era assegurado tam- veins, which was later confirmed by Marcello bém por válvulas presentes no coração e nas Malpighi, in the form of networks of veias. O modelo estabelecido por Harvey para capillaries. The one-way direction of blood a circulação sanguínea foi extrapolado para o flow was ensured by valves in the heart and Homem sendo corroborado nos séculos veins. The model established by Harvey for seguintes. Malpighi e, depois, Van blood circulation in animals and extrapolated Leeuwenhoek contribuíram, em especial, para to humans was confirmed in the following um melhor esclarecimento da composição e centuries. Malpighi and van Leeuwenhoek, in características do sangue e a importância particular, helped clarify the composition and exercida sobre a respectiva perfusão através characteristics of blood and their importance dos diferentes vasos da rede circulatória. for its perfusion of the different vessels of the circulatory network. INTRODUÇÃO INTRODUCTION constituição e funções genéricas da cir- he general constitution and functions of Aculação sanguínea são do conhecimento Tthe blood circulation have been common comum desde o século XVII. Para esse conhe- knowledge since the 17th century. The contri- cimento foi decisiva a contribuição de bution of William Harvey was fundamental to William Harvey, culminando um conjunto de this understanding, which was the culmina- hipóteses e modelos elaborados a partir da tion of a series of hypotheses and models that Antiguidade. go back to ancient times. Cerca de dezasseis séculos antes da Sixteen centuries before Harvey, the 1246 descoberta de Harvey já se afirmava no Huangdi Neijing , the Inner Canon of Huangdi, João Martins e Silva Rev Port Cardiol 2009; 28: 1245-1268 “Huangdi Neijing ” ( Canon da Medicina de stated that “all the [movement of the] blood is Huangdi ) i que “ todo o (movimento do) sangue controlled by the heart; the blood flows in é controlado pelo coração; o sangue flui con- never-ending circles... some blood vessels tinuamente em círculos sem nunca parar… transport the air that is necessary to life” (1) . alguns vasos sanguíneos transportam o ar The next step was taken in ancient Greece, necessário à vida ” (1) . when dissection of human cadavers showed A etapa seguinte ocorreu na Grécia Antiga, that the blood circulated in special vessels of ao ser comprovado, pela dissecção de two types; one, which was thought to transport cadáveres humanos, que o sangue circulava air, was called “artery” (meaning tube for air; em canais próprios de dois tipos; um dos tipos, this gas was also known as pneuma , or vital ii que transportaria ar, foi denominado arteria spirit), while the other type, which contained (significava tubo de ar, sendo este gás blood, was termed “vein” (from the Greek designado também por pneuma ou “espírito phleps , phlebos , tube carrying blood). vital”), enquanto os do outro tipo, que According to Aristotle and his disciples at iii continham sangue , recebiam a designação de the school of Alexandria, Erasistratus and veias ( phleps ou phebos , tubo transportador de Herophilus (4th-3rd century BC), the blood sangue). was formed in the liver from food, and was Segundo Aristóteles, e depois com os seus thence transported to the heart, which distri- discípulos da escola de Alexandria, Erasis- buted it throughout the body, where it was tratus e Herofilus (séc. IV-III aC), admitia-se consumed. Arteries and veins emanated from que o sangue era formado no fígado a partir the heart. By contrast, according to Hippo- dos alimentos, donde seria transportado para o crates (5th-4th century BC), the blood circu- coração, que o distribuiria para todo o corpo, para consumo. As artérias e veias emanariam lated in a single vessel that branched through- (1, 2) do coração. Pelo contrário, para Hipócrates out the body, in a closed circuit . (séc. V-IV aC) o sangue circularia num só vaso Claudius Galenus, known as Galen (em circuito fechado) que se ramificava por (131-201?AD), adopted the concepts of the todo corpo. (1, 2) Alexandria school and altered them in accor- Claudius Galenus, conhecido simples- dance with his own anatomical observations. mente por Galeno (131-201? A.C.), adoptou According to him, as well as air, the arteries os conceitos originais da escola de carried blood (as also proposed by Hero- Alexandria, alterando-os de acordo com as philus) of a different composition and color suas próprias observações anatómicas. Desde from venous blood. The two types of blood modo, as artérias não transportariam somente were distributed throughout the body and con- ar mas também sangue (como Herofilus sumed as and when required, but their origin propusera) de composição e cor distintas das and transport system were different. The darker *Primeira de duas partes. §Professor Catedrático (aposentado) da Faculdade de Medicina da Universidade de Lisboa. NB- As transcrições de parte de textos originais citados foram adaptados à grafia actual. i Compêndio médico chinês atribuído ao Imperador Amarelo (Huang di), cerca de 2400 aC, foi transmitido oralmente durante muitos séculos.
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