William Harvey: rebel malgré lui

Abstract

The medical profession has always been conservative. Many individual doctors have broken rank and espoused advanced social or political causes, but they have always been the exceptions, not the rule. Most doctors, needing to earn a living in the medical marketplace, have spoken and behaved in ways that would assure their patients that they were in safe hands.Being a social or political conservative is no bar to having revolutionary ideas. Few medical reformers have been less central pillars of the establishment than William Harvey (1578–1657). Everything about him betrayed his yeoman stock and social ambitions. His father, a prosperous farmer-turned-merchant, reached the pinnacle of his own agenda when he was allowed to have a family coat of arms. All of William Harvey's brothers followed their father into business, and most were successful.Eldest sons are supposed to be the most conservative, to feel the burden of carrying on the family traditions. Younger sons are the rebels. Harvey's younger brothers certainly failed to display any tendency to change the social order. It was left to the eldest, William, to become a rebel malgré lui. Harvey ended up doing for physiology what Vesalius and others had done for anatomy: demonstrating that Galen did not have the last word on matters medical. His discovery of the movements of the heart in systole and diastole, and their role in the circulation of the blood, required a more fundamental rethink of Galenic physiology than the earlier realisation that Galen's anatomical works were done on animals, or were simply incorrect. 1628, the date of Harvey's great Exercitatio anatomica de motu cordis et sanguinis in animalibus, is a key moment in the history of medicine and the life sciences.A generation ago, historians saw Harvey as simply a progressive, central to the Scientific Revolution, and providing an impetus to the mechanisation of the world picture that culminated with Isaac Newton (1643–1727) and his own legacy. To be sure, Harvey did call the heart a pump (which it is), and some of the language in his treatise could be called hydrologic. His younger contemporary, René Descartes (1596–1650), certainly used Harvey's insights into the functions of the heart to further the Frenchman's attempt to establish a science based on matter and motion. He never really understood the nuances of Harvey's own experimental genius, and Descartes's own physiology, important in its own way as it was, mostly inferred function from basic structure, fitting that function rationally into the framework of his idea of animals as merely machines. Harvey would have none of this, calling Descartes and his ilk “shitt-breeches”.Harvey was first and foremost an Aristotelian, steeped in his master's analysis of the nature of biological form and function, and of the Greek's identification of the heart as the master organ of the body. Harvey started from very traditional premises, but his insatiable curiosity and experimental acumen and dexterity led him to see further than anyone had before. As Royal physician, he was aided by having access to King Charles I's menagerie. But Harvey's fascination with a whole range of animals and their functions simply carried on the Aristotelian legacy.Harvey's traditionalism is now widely accepted, thanks to the historical scholarship in the past generation or so. For the facts of Harvey's career and medical practice we all still rely on Sir Geoffrey Keynes' monumental biography of 1966. But Keynes wrote at a time when the simple, linear progress of science and medicine were unquestioned. Keynes' Harvey was an unrepentant modern, mechanistic in his outlook, and doing modern science: experimenting and then interpreting his results.Thomas Wright's Circulation: William Harvey's Revolutionary Idea assimilates the new orthodoxy on his subject. For Wright, Harvey was genuinely a man of his time and class, conservative in his politics and medical practice, if not always in his science. His practice, for instance, was pretty ordinary for a doctor of his time and place, and like his fellow practitioners, he was anxious to earn a good living from his work. He sometimes took patients who didn't pay their bills to court. The gossip John Aubrey (1627–97) reported that Harvey's colleagues in London “would not have given threepence for one of his prescriptions”. The circulation of the blood was, Wright insists, a revolutionary idea, but it came from a man steeped in the London College of Physicians, where Galenism was still strong, and in Harvey's own profound respect for Aristotle. Like Charles Darwin, another great conservative, Harvey simply followed the bent of his own enlarged sense of curiosity. Harvey was an inveterate experimentalist, keeping a menagerie of animals in his own home, and using the larger stock of species made available by the King. It was this drive that set him apart from his medical contemporaries.Function of the valves in the veins in Exercitatio anatiomica de motu cordis (1628)View Large Image Copyright © 2012 Wellcome Library, LondonIt has often been assumed that Harvey discovered the circulation of the blood in the 1610s, and delayed publication because it was such a radical notion. If so, it is curious that there is no mention of it among the doctors (physicians as well as barber-surgeons) to whom Harvey officially lectured during those years. It may be that Harvey originally began to write a book on “the motion of the heart” (that is, the sequence of events in systole and diastole), and then his continuing research led him to the circulation itself, which he patched into his monograph. This would explain the arrangement of the topics that Harvey dealt with in De motu cordis, and the fact that its most revolutionary idea, the circulation, doesn't even get a look-in until half way through the badly produced little volume.Wright offers us an excellent account of Harvey's researches on the heart and circulation, but the real payoff comes from his reconstructions of events in Harvey's life: his days as a student in Cambridge and Padua, his medical practice, or his efforts to defend his work against critics. Wright paints a vivid picture of what it would have been like to be a student at Gonville and Caius College, Cambridge, reading in its cold library stocked with medical volumes bequeathed by John Caius, the great humanist doctor who also studied at Padua, under Vesalius himself. Like Harvey, Caius valued the past even while contributing to the future. Unlike Harvey, Cauis's legacy was scholastic rather than experimental.Our direct access of Harvey's motives and inner thoughts is limited: his London house was sacked and many of his private papers burned during the tumult of the English Civil War, when his Royalist associations told against him. To add insult to injury, the great fire of London in 1666 destroyed the remaining books and papers he left to the Royal College of Physicians. Consequently, Wright has to employ his historical imagination to bring Harvey to life. He does this very well, using Harvey's contemporaries and a judicious supply of quotations. It's a shame that there are no references, so the reader has to take Wright's scholarship on trust. A bit of spot-checking suggests that it is sound, but I for one am a reader who often finds the footnotes the best bits of a book.It's unfortunate, too, that Wright decided to omit Harvey's researches on generation and embryology. While they did not have the lasting impact of his work on the circulation, this work occupied Harvey for two decades, led to a substantial monograph in 1651, and deserves to be better known. Like De motu cordis, De generatione animalium was solidly Aristotelian, even in its most famous aperçu, Ex ovo omnia: all out of the egg. He also spent much time puzzling about the functions of the lungs, a work now lost, but a subject that was taken up after his death by a number of Oxford physiologists, including John Mayow (1640–79) and Richard Lower (1631–91), who saw themselves as following in Harvey's footsteps. Although a Cambridge man himself, Harvey would not have been disappointed to see his tradition perpetuated in Oxford, where he spent time during the Civil War. Oxford had more Royalist associations than his alma mater. For Harvey, the heart was the centre of the body, just as the King was the centre of the body politic.Contemporary portraits of Harvey depict him as a man with sharp features, a touch of choleric, and an air of melancholy. He certainly doesn't seem to have been a convivial dinner companion. Instead, he was a man who knew his own worth, and whose real passion was trying to understand the living world. Harvey's investigations helped place experimental physiology on a sound footing. De motu cordis is that rare scientific classic: still fresh after almost 400 years.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The medical profession has always been conservative. Many individual doctors have broken rank and espoused advanced social or political causes, but they have always been the exceptions, not the rule. Most doctors, needing to earn a living in the medical marketplace, have spoken and behaved in ways that would assure their patients that they were in safe hands. Being a social or political conservative is no bar to having revolutionary ideas. Few medical reformers have been less central pillars of the establishment than William Harvey (1578–1657). Everything about him betrayed his yeoman stock and social ambitions. His father, a prosperous farmer-turned-merchant, reached the pinnacle of his own agenda when he was allowed to have a family coat of arms. All of William Harvey's brothers followed their father into business, and most were successful. Eldest sons are supposed to be the most conservative, to feel the burden of carrying on the family traditions. Younger sons are the rebels. Harvey's younger brothers certainly failed to display any tendency to change the social order. It was left to the eldest, William, to become a rebel malgré lui. Harvey ended up doing for physiology what Vesalius and others had done for anatomy: demonstrating that Galen did not have the last word on matters medical. His discovery of the movements of the heart in systole and diastole, and their role in the circulation of the blood, required a more fundamental rethink of Galenic physiology than the earlier realisation that Galen's anatomical works were done on animals, or were simply incorrect. 1628, the date of Harvey's great Exercitatio anatomica de motu cordis et sanguinis in animalibus, is a key moment in the history of medicine and the life sciences. A generation ago, historians saw Harvey as simply a progressive, central to the Scientific Revolution, and providing an impetus to the mechanisation of the world picture that culminated with Isaac Newton (1643–1727) and his own legacy. To be sure, Harvey did call the heart a pump (which it is), and some of the language in his treatise could be called hydrologic. His younger contemporary, René Descartes (1596–1650), certainly used Harvey's insights into the functions of the heart to further the Frenchman's attempt to establish a science based on matter and motion. He never really understood the nuances of Harvey's own experimental genius, and Descartes's own physiology, important in its own way as it was, mostly inferred function from basic structure, fitting that function rationally into the framework of his idea of animals as merely machines. Harvey would have none of this, calling Descartes and his ilk “shitt-breeches”. Harvey was first and foremost an Aristotelian, steeped in his master's analysis of the nature of biological form and function, and of the Greek's identification of the heart as the master organ of the body. Harvey started from very traditional premises, but his insatiable curiosity and experimental acumen and dexterity led him to see further than anyone had before. As Royal physician, he was aided by having access to King Charles I's menagerie. But Harvey's fascination with a whole range of animals and their functions simply carried on the Aristotelian legacy. Harvey's traditionalism is now widely accepted, thanks to the historical scholarship in the past generation or so. For the facts of Harvey's career and medical practice we all still rely on Sir Geoffrey Keynes' monumental biography of 1966. But Keynes wrote at a time when the simple, linear progress of science and medicine were unquestioned. Keynes' Harvey was an unrepentant modern, mechanistic in his outlook, and doing modern science: experimenting and then interpreting his results. Thomas Wright's Circulation: William Harvey's Revolutionary Idea assimilates the new orthodoxy on his subject. For Wright, Harvey was genuinely a man of his time and class, conservative in his politics and medical practice, if not always in his science. His practice, for instance, was pretty ordinary for a doctor of his time and place, and like his fellow practitioners, he was anxious to earn a good living from his work. He sometimes took patients who didn't pay their bills to court. The gossip John Aubrey (1627–97) reported that Harvey's colleagues in London “would not have given threepence for one of his prescriptions”. The circulation of the blood was, Wright insists, a revolutionary idea, but it came from a man steeped in the London College of Physicians, where Galenism was still strong, and in Harvey's own profound respect for Aristotle. Like Charles Darwin, another great conservative, Harvey simply followed the bent of his own enlarged sense of curiosity. Harvey was an inveterate experimentalist, keeping a menagerie of animals in his own home, and using the larger stock of species made available by the King. It was this drive that set him apart from his medical contemporaries. It has often been assumed that Harvey discovered the circulation of the blood in the 1610s, and delayed publication because it was such a radical notion. If so, it is curious that there is no mention of it among the doctors (physicians as well as barber-surgeons) to whom Harvey officially lectured during those years. It may be that Harvey originally began to write a book on “the motion of the heart” (that is, the sequence of events in systole and diastole), and then his continuing research led him to the circulation itself, which he patched into his monograph. This would explain the arrangement of the topics that Harvey dealt with in De motu cordis, and the fact that its most revolutionary idea, the circulation, doesn't even get a look-in until half way through the badly produced little volume. Wright offers us an excellent account of Harvey's researches on the heart and circulation, but the real payoff comes from his reconstructions of events in Harvey's life: his days as a student in Cambridge and Padua, his medical practice, or his efforts to defend his work against critics. Wright paints a vivid picture of what it would have been like to be a student at Gonville and Caius College, Cambridge, reading in its cold library stocked with medical volumes bequeathed by John Caius, the great humanist doctor who also studied at Padua, under Vesalius himself. Like Harvey, Caius valued the past even while contributing to the future. Unlike Harvey, Cauis's legacy was scholastic rather than experimental. Our direct access of Harvey's motives and inner thoughts is limited: his London house was sacked and many of his private papers burned during the tumult of the English Civil War, when his Royalist associations told against him. To add insult to injury, the great fire of London in 1666 destroyed the remaining books and papers he left to the Royal College of Physicians. Consequently, Wright has to employ his historical imagination to bring Harvey to life. He does this very well, using Harvey's contemporaries and a judicious supply of quotations. It's a shame that there are no references, so the reader has to take Wright's scholarship on trust. A bit of spot-checking suggests that it is sound, but I for one am a reader who often finds the footnotes the best bits of a book. It's unfortunate, too, that Wright decided to omit Harvey's researches on generation and embryology. While they did not have the lasting impact of his work on the circulation, this work occupied Harvey for two decades, led to a substantial monograph in 1651, and deserves to be better known. Like De motu cordis, De generatione animalium was solidly Aristotelian, even in its most famous aperçu, Ex ovo omnia: all out of the egg. He also spent much time puzzling about the functions of the lungs, a work now lost, but a subject that was taken up after his death by a number of Oxford physiologists, including John Mayow (1640–79) and Richard Lower (1631–91), who saw themselves as following in Harvey's footsteps. Although a Cambridge man himself, Harvey would not have been disappointed to see his tradition perpetuated in Oxford, where he spent time during the Civil War. Oxford had more Royalist associations than his alma mater. For Harvey, the heart was the centre of the body, just as the King was the centre of the body politic. Contemporary portraits of Harvey depict him as a man with sharp features, a touch of choleric, and an air of melancholy. He certainly doesn't seem to have been a convivial dinner companion. Instead, he was a man who knew his own worth, and whose real passion was trying to understand the living world. Harvey's investigations helped place experimental physiology on a sound footing. De motu cordis is that rare scientific classic: still fresh after almost 400 years.