The development of clinical science in Britain.

Abstract

Clinical science is the study of man in health and disease. It also entails the use of experimental studies in animals when it is not possible to proceed further with human studies. As Sir Thomas Lewis claimed in his famous Harveian Oration on clinical science, its father was William Harvey.1 Harvey had a free-ranging curiosity and liberality of mind that owed much to the freedom of thought encouraged at the Univer sity of Padua at the beginning of the seventeenth century. An Anglican, he could have graduated from no other Italian univer sity, where it was then necessary to be a Catholic to receive the university's degree. But Padua, enjoying the patronage of the Venetian Republic, was able to confer degrees that were not given by papal or ecclesiastical authority. It was this freedom from the authority of religion that made Padua the intellectual centre of Europe. Galileo was lecturing at Padua while Harvey was a student, but he probably never heard him, nor is it likely that he ever believed that the earth went round the sun.2 Harvey graduated in 1602, returning to England and to a lifetime of practice in London. A year later the old queen died, to be succeeded by the first of the Stuarts, who arrived in London in May 1603. Harvey's experimental approach established for the first time the importance of experiment in medical research. Yet during the seventeenth century, little notice was taken by clinicians of the experimental method he had introduced, even after his death in 1657. Thomas Sydenham's descriptions of disease established a tradition of clinical observation in London medicine that was to last for over two centuries, but he was contemptuous of the new approach. Sir Hans Sloane, future president of both the Royal Society and the Royal College of Physicians, was intro duced to him when a young man as a good botanist and skilful anatomist, the basic sciences of those days. Thomas Sydenham told him: Anatomy, botany, nonsense?no, young man go to the bedside; there alone can you learn disease.3 This conversa tion illustrates clearly the antithesis between the experimentalist and the experienced clinician?a conflict that sadly inhibited the development of academic medicine in medical schools in London until the twentieth century. In the second half of the seventeenth century, however, other developments began to influence clinical science. In 1663 the Royal Society was founded by Charles II, a forum for scientific discussion and debate of the first importance in this country. Within two years it began the publication of its Philosophical Transactions, and here can be read the work of those who were to extend the horizons of Harvey's discoveries. The founder