- Email: [email protected]
HARVEY AT 400
708
Diuretic intake was equally frequent in the presence or absence of gallstones. On the other hand, chlorothiazide therapy has been as-. sociated with hypertriglyceridaemia,21 a possible aetiological factor in acute pancreatitis. Diuretics can impair’ insulin release from the pancreas,2z and chlorothiazide23 . and bumetanide24 administration have been shown to raise serum-amylase levels. A remaining possibility is that potassium chloride, and not a diuretic, induces pancreatitis. Further clinical and experimental evidence is required before the role of diuretics and/or potassium chloride in causing acute pancreatitis can be determined. A large number of cases of drug-associated liver damage has been reported to the Committee on Safety. of Medicines,2° but there have been few reports of drugassociated pancreatitis. Only 29 reports were made for with frusemide
.
rechallenge.13
’
.
"
. ,. .
the
to June, 1976, compared with 1800 reports for liver injury. Greater awareness among clinicians may result in the diagnosis of more cases of drug-induced pancreatitis.
period July, 1963,
over
We thank the physicians and surgeons of the City and General Hospitals, Nottingham, for allowing us to study their patients.
’
Anniversary
Requests for reprints should be addressed to J. B. B., Department of Surgery, General Hospital, Nottingham NG1 6HA. REFERENCES
1. Banks, S., Marks, I. N. Postgrad. med. J 1970, 46, 576. 2. Davidoff, T., Tishler, S., Rosoff, C. New Engl. J. Med. 1973, 289, 552. 3. Foster, M. E., Powell, D. E. B. Postgrad. med.J. 1975, 51, 667. 4. Murley, R. S. Br. med. J., 1974, i, 161. 5. Graeber, G. M. Archs Surg., Chicago, 1976, 111, 1014. 6. Levitan, A. A. Ann. intern. Med. 1973, 78, 306. 7. Jones, M. F., Caldwell, J. R. New Engl. J. Med. 1962, 267, 1029. 8. Huizenga, K. A., Shorter, R. G., Phillips, S. F. Gastroenterology, 1976, 70, 895. 9. Nogueira, J. R., Freedman, M. A. ibid. 1972, 62, 1040. 10. Coward, R. A. Br. med. J 1977, i, 1086, 11. Gilmore, I. T., Tourvas, E. ibid. p. 753. 12. Johnston, D. H., Cornish, A. L. J. Am. med. Ass 1959, 170, 2054. 13. Jones, P. E., Oelbaum, M. H. Br. med. J. 1975, i, 133. 14. Bourke, J. B. Lancet, 1975, ii, 967. 15. Cox, A. G. ibid. 1977, ii, 632. 16. Imrie, C. W., Whyte, A. S. Br. J. Surg. 1975, 62, 490. 17. Nakashima, Y., Howard, J. M. Surgery Gynec. Obstet. 1977, 145, 105. 18. Pollock, A. V. Br. med. J. 1959, i, 6. 19. Trapnell, J. E., Duncan, E. H. L. ibid. 1975, ii, 179. 20. Committee on Safety of Medicines, Register of Adverse Reactions. London, 1977. 21. Goldner, M. G., Zarowitz, H., Akgun, S. New Engl. J. Med. 1960, 262, 403. 22. Zatuchni, J., Kordasz, F. Am J. Cardiol. 1961, 7, 565. 23. Cornish, A. L., McClellan, J., Johnston, D. H. New Engl. J. Med. 1961, 265, 673. 24. Lynggaard, F., Bjørndal, N. Lancet, 1977, ii, 1355.
continually discarded. So they are-but rarely if the grounds of age. Huge Victorian canvases depicting the Triumph of Virtue or the Fall of Vice may too are
ever on
HARVEY AT 400
,
BuILT-IN obsolescence, not immortal fame, is the hallmark of individual achievement in science. William Harvey was born 400 years ago. His youth coincided with Shakespeare’s maturity. In the year he died Milton began to dictate Paradise Lost. Tintoretto and Rembrandt were his contemporaries on the Continent. The work of these men is as relevant today as it was a hundred or three hundred years ago: they are old masters but no more obsolete than the Bible. The great scientists of the age are mere names or not even that. They are read, if they are read at all, not because they have a message to convey but for quaint antiquarian interest. Even professional historians treat them as an avoidance-worthy embarrassment: they were evidently important, eminent, or at least controversial but what exactly were they important, eminent, or controversial about? And so to young people the composition of yet another essay on Stuart England 1628 means not an anatomical exercise on the movement of the blood and heart in animals but more dreary parliamentary squabbles and the long-overdue assassination of the first Duke of Buckingham.
be trundled off into the cellars; but the Madonna of the Rocks is unlikely to be replaced by coloured bricks or the Fighting Temeraire by a Hockney print. A great work of art is never superseded because it can never be fully assimilated. The greater the work of science the more rapidly it is assimilated; and, as soon as it is assimilated, it ceases to exist in its own right. Of course it is not lost any more than food at a banquet is lost; but once eaten, that food is no longer recognisable as the creation of a master chef. But if individual achievement in science is so evanescent what reasons, other than piety, are there for commemorating individual scientists? One can think of three.
First, it is fun. The
very
difficulty, perhaps impossi-
bility, of attributing and distributing credit is a chal-,,, lenge. Nobody doubts that Shakespeare was a considerable dramatist. But how considerable a scientist was Harvey? Despite all the lofty orations and post-prandial turgidities heaped on him since the day he died, his greatness has not gone unchallenged. William Hunter tried to demolish. him. Comparing him to Columbus and Copernicus (the former a bizarre choice), he concluded low indeed. that "Harvey’s rank (in merit) must be So much had been discovered by others that little more was left for him to do than to dress it up into a system; and that required no extraordinary talent. Yet, easy as it was, it made him immortal. But none of his writings show him to have been a man of uncommon abilities." Fifty years later an American physician, John Redman Coxe, devoted an immensely erudite and surprisingly readable book to an Inquiry into the Claims of Doctor William Harvey and came up with a verdict even more damning than Hunter. And an eminent French physiologist recently suggested that, given the mass of facts available to Harvey, any intelligent schoolboy would ...
The explanation is obvious. Art grows in volume; but, applying the criterion of beauty, it does not advance. Scientific knowledge does not grow in volume; but, applying the criterion of truth, it undoubtedly advances. Of course one hears much about students, medical students especially, having to learn more and more. It is doubtful if they do. Candidates presenting themselves for college examinations in Harvey’s day must have known their Galen backward and in Latin. It was a vast body of supremely coherent knowledge which is no longer required. More important, it would be inaccessible if it were. It could also be argued that works of art
709
have reached the same conclusions. Of course, all these critics miss the point; but, so does Harvey’s champion, Keynes. One hesitates to take issue with one of the great medical biographies of the century; but Keynes’s contention-that Harvey provided experimental proof of what before him had been airy-fairy theories-both overstates and understates the case. Harvey was not an experimental physiologist and what proof he provided would be rejected today by the most somnolent of editors. He searched, he observed, he interpreted, and he expounded. It is true that most of what he saw had been seen before. But nobody had quite understood the function and appreciated the significance of the venous valves. It was the missing bit which made a vast and complex story comprehensible to men of ordinary intelligence. Perhaps it was only an opportune spark; but what else is scientific genius?
The second
reason
for commemoration is the wider
impact made by a few scientists on man’s ideas and institutions. Only by a few. Harvey’s contemporary, Galileo, became the symbol and battle-cry of the Enlightenment. Darwin shattered the faith of his generation. Freud unwittingly grandfathered the permissive society. Harvey’s claim is not nearly so compelling. The discovery of the circulation brought no material benefits to him or to anyone else. It provoked no holy outrage. Its effect even on medical practice was negligible; and it remained negligible for more than two hundred years. Some men in battle continued to bleed to death. Others recovered. It was anything but hot news. And yet Harvey’s career marks a development of minor but real historical significance. For centuries before him the yeoman’s son or the butcher’s boy could rise to the highest position in society -but only in the Church. By the time Harvey was offered the presidency of his College, medicine (though not yet surgery) had become established as one of the great liberal professions. What made it great was neither wealth nor power but independence from both. Of course Harvey did not bring this about single-handed. But he was more than a founding father. He became, as he is still, the new profession’s beau ideal. The
qualities which made Harvey the "compleat physician" were unspectacular. In an age of display, in a country torn by political passion, he remained sober, reticent, proud, and moderate. His attitude today would be described as professional. It was in fact Harveian. And it is reflected in the striking contrast between what is known about him as a person and his legacy as physician. Among a mass of letters, documents, minutes, memoranda, lecture notes, and books there is barely a reference to his closest family, although what reference there is suggests that he was a devoted family man. Nor is anything known about his innermost religious faith. Snippets about his habits and appearance were recorded by Aubrey; but even that perceptive scatterbrain could not pin him down. Steeped in tradition he treated Galen and Aristotle with reverence; but his marginal annotations of the former are replete with terse remarks like "mistake", "arrogant", or simply "no". His references to his own teachers are similarly respectful without being adulatory: there is never any suspicion that he would claim
as
his
own
discoveries that should be cred-
them. He was loyal to his patient, Charles I, but no way besotted by royalty. (James I in one of the monarch’s sillier moods is apostrophised as "that royal baboon".) It seems reasonable to assume that he was offered a knighthood; but of this, very properly, no trace remains. With the new Tudor-Stuart aristocracy (as rapacious a lot as ever made mockery of the name) his relation were devoid of either kind of snobbery. But he relaxed with men of his own stamp-Hobbes., Boyle, Selden. Several asides in his lecture notes show that he was at least educated in music; and the men he chose to paint his portraits were well above the ordinary run of boardroom artists. But such. interests were clearly peripheral to the many-sided pursuit of his profession. A highly successful practitioner, an active fellow and effective officer of his College, a shrewd and seemingly tireless original investigator, he was also, judging by the volume and quality of his lecture notes, a superb teacher. Had he no faults then? Professionally, it seems, only one; and even that became a cherished tradition. His handwriting was appalling.
ited
to
in
The last reason for celebrating scientific anniversaries is that, by a process which defies scientific analysis, they occasionally give rise to works of uncommon merit. The volume which celebrates Harvey’s quatercentenary’ falls into this category. The credit for this must largely go to the editor. He has assembled a galaxy of eminent contributors ; but this alone is no guarantee of success. By hook or by crook-perhaps simply by intoning the name of Harvey-he has persuaded them to give admirably concise and clear accounts of the present state of play in their specialties. Everything is covered, from the microcirculation to the heart (including the lymphatics) and from the simplest to the most sophisticated forms of investigation and treatment. Everything, that is, except perhaps the topics which Harvey might look for in his presentation copy. Underlying causes and basic mechanisms-physical, physiological, and chemicalreceive relatively little attention.
besetting sin of reviewers (and editorial referees) suggest that, good as a book (or paper) may be, it should have been a different book (or paper). Within its clinical compass Circulation of the Blood is a very good book indeed. It is no fault of the authors that threeand-a-half centuries after a revolutionary text their subject is crying out for another. The achievement of Harvey was to show how blood flows. Almost every chapter It is the to
in this commemorative volume describes how it does not. It is, of course, useful to know how the failures can be diagnosed and the consequences mitigated. But any book about the circulation today must be a book about degenerative vascular disease; and what degenerative vascular disease is remains a mystery. It is possible that all the facts required for its solution are now available. It is possible that they are available in this book. But the intelligent schoolboy who could put them in order is nowhere in sight. Whittington Hospital, London N19 5NF
T. L. DORMANDY
1. Circulation of the Blood. Edited by D. GERAINT JAMES, F.R.C.P., Dean, Royal Northern Hospital, London. London: Pitman Medical. 1978. Pp. 495 £25.
Diuretic intake was equally frequent in the presence or absence of gallstones. On the other hand, chlorothiazide therapy has been as-. sociated with hypertriglyceridaemia,21 a possible aetiological factor in acute pancreatitis. Diuretics can impair’ insulin release from the pancreas,2z and chlorothiazide23 . and bumetanide24 administration have been shown to raise serum-amylase levels. A remaining possibility is that potassium chloride, and not a diuretic, induces pancreatitis. Further clinical and experimental evidence is required before the role of diuretics and/or potassium chloride in causing acute pancreatitis can be determined. A large number of cases of drug-associated liver damage has been reported to the Committee on Safety. of Medicines,2° but there have been few reports of drugassociated pancreatitis. Only 29 reports were made for with frusemide
.
rechallenge.13
’
.
"
. ,. .
the
to June, 1976, compared with 1800 reports for liver injury. Greater awareness among clinicians may result in the diagnosis of more cases of drug-induced pancreatitis.
period July, 1963,
over
We thank the physicians and surgeons of the City and General Hospitals, Nottingham, for allowing us to study their patients.
’
Anniversary
Requests for reprints should be addressed to J. B. B., Department of Surgery, General Hospital, Nottingham NG1 6HA. REFERENCES
1. Banks, S., Marks, I. N. Postgrad. med. J 1970, 46, 576. 2. Davidoff, T., Tishler, S., Rosoff, C. New Engl. J. Med. 1973, 289, 552. 3. Foster, M. E., Powell, D. E. B. Postgrad. med.J. 1975, 51, 667. 4. Murley, R. S. Br. med. J., 1974, i, 161. 5. Graeber, G. M. Archs Surg., Chicago, 1976, 111, 1014. 6. Levitan, A. A. Ann. intern. Med. 1973, 78, 306. 7. Jones, M. F., Caldwell, J. R. New Engl. J. Med. 1962, 267, 1029. 8. Huizenga, K. A., Shorter, R. G., Phillips, S. F. Gastroenterology, 1976, 70, 895. 9. Nogueira, J. R., Freedman, M. A. ibid. 1972, 62, 1040. 10. Coward, R. A. Br. med. J 1977, i, 1086, 11. Gilmore, I. T., Tourvas, E. ibid. p. 753. 12. Johnston, D. H., Cornish, A. L. J. Am. med. Ass 1959, 170, 2054. 13. Jones, P. E., Oelbaum, M. H. Br. med. J. 1975, i, 133. 14. Bourke, J. B. Lancet, 1975, ii, 967. 15. Cox, A. G. ibid. 1977, ii, 632. 16. Imrie, C. W., Whyte, A. S. Br. J. Surg. 1975, 62, 490. 17. Nakashima, Y., Howard, J. M. Surgery Gynec. Obstet. 1977, 145, 105. 18. Pollock, A. V. Br. med. J. 1959, i, 6. 19. Trapnell, J. E., Duncan, E. H. L. ibid. 1975, ii, 179. 20. Committee on Safety of Medicines, Register of Adverse Reactions. London, 1977. 21. Goldner, M. G., Zarowitz, H., Akgun, S. New Engl. J. Med. 1960, 262, 403. 22. Zatuchni, J., Kordasz, F. Am J. Cardiol. 1961, 7, 565. 23. Cornish, A. L., McClellan, J., Johnston, D. H. New Engl. J. Med. 1961, 265, 673. 24. Lynggaard, F., Bjørndal, N. Lancet, 1977, ii, 1355.
continually discarded. So they are-but rarely if the grounds of age. Huge Victorian canvases depicting the Triumph of Virtue or the Fall of Vice may too are
ever on
HARVEY AT 400
,
BuILT-IN obsolescence, not immortal fame, is the hallmark of individual achievement in science. William Harvey was born 400 years ago. His youth coincided with Shakespeare’s maturity. In the year he died Milton began to dictate Paradise Lost. Tintoretto and Rembrandt were his contemporaries on the Continent. The work of these men is as relevant today as it was a hundred or three hundred years ago: they are old masters but no more obsolete than the Bible. The great scientists of the age are mere names or not even that. They are read, if they are read at all, not because they have a message to convey but for quaint antiquarian interest. Even professional historians treat them as an avoidance-worthy embarrassment: they were evidently important, eminent, or at least controversial but what exactly were they important, eminent, or controversial about? And so to young people the composition of yet another essay on Stuart England 1628 means not an anatomical exercise on the movement of the blood and heart in animals but more dreary parliamentary squabbles and the long-overdue assassination of the first Duke of Buckingham.
be trundled off into the cellars; but the Madonna of the Rocks is unlikely to be replaced by coloured bricks or the Fighting Temeraire by a Hockney print. A great work of art is never superseded because it can never be fully assimilated. The greater the work of science the more rapidly it is assimilated; and, as soon as it is assimilated, it ceases to exist in its own right. Of course it is not lost any more than food at a banquet is lost; but once eaten, that food is no longer recognisable as the creation of a master chef. But if individual achievement in science is so evanescent what reasons, other than piety, are there for commemorating individual scientists? One can think of three.
First, it is fun. The
very
difficulty, perhaps impossi-
bility, of attributing and distributing credit is a chal-,,, lenge. Nobody doubts that Shakespeare was a considerable dramatist. But how considerable a scientist was Harvey? Despite all the lofty orations and post-prandial turgidities heaped on him since the day he died, his greatness has not gone unchallenged. William Hunter tried to demolish. him. Comparing him to Columbus and Copernicus (the former a bizarre choice), he concluded low indeed. that "Harvey’s rank (in merit) must be So much had been discovered by others that little more was left for him to do than to dress it up into a system; and that required no extraordinary talent. Yet, easy as it was, it made him immortal. But none of his writings show him to have been a man of uncommon abilities." Fifty years later an American physician, John Redman Coxe, devoted an immensely erudite and surprisingly readable book to an Inquiry into the Claims of Doctor William Harvey and came up with a verdict even more damning than Hunter. And an eminent French physiologist recently suggested that, given the mass of facts available to Harvey, any intelligent schoolboy would ...
The explanation is obvious. Art grows in volume; but, applying the criterion of beauty, it does not advance. Scientific knowledge does not grow in volume; but, applying the criterion of truth, it undoubtedly advances. Of course one hears much about students, medical students especially, having to learn more and more. It is doubtful if they do. Candidates presenting themselves for college examinations in Harvey’s day must have known their Galen backward and in Latin. It was a vast body of supremely coherent knowledge which is no longer required. More important, it would be inaccessible if it were. It could also be argued that works of art
709
have reached the same conclusions. Of course, all these critics miss the point; but, so does Harvey’s champion, Keynes. One hesitates to take issue with one of the great medical biographies of the century; but Keynes’s contention-that Harvey provided experimental proof of what before him had been airy-fairy theories-both overstates and understates the case. Harvey was not an experimental physiologist and what proof he provided would be rejected today by the most somnolent of editors. He searched, he observed, he interpreted, and he expounded. It is true that most of what he saw had been seen before. But nobody had quite understood the function and appreciated the significance of the venous valves. It was the missing bit which made a vast and complex story comprehensible to men of ordinary intelligence. Perhaps it was only an opportune spark; but what else is scientific genius?
The second
reason
for commemoration is the wider
impact made by a few scientists on man’s ideas and institutions. Only by a few. Harvey’s contemporary, Galileo, became the symbol and battle-cry of the Enlightenment. Darwin shattered the faith of his generation. Freud unwittingly grandfathered the permissive society. Harvey’s claim is not nearly so compelling. The discovery of the circulation brought no material benefits to him or to anyone else. It provoked no holy outrage. Its effect even on medical practice was negligible; and it remained negligible for more than two hundred years. Some men in battle continued to bleed to death. Others recovered. It was anything but hot news. And yet Harvey’s career marks a development of minor but real historical significance. For centuries before him the yeoman’s son or the butcher’s boy could rise to the highest position in society -but only in the Church. By the time Harvey was offered the presidency of his College, medicine (though not yet surgery) had become established as one of the great liberal professions. What made it great was neither wealth nor power but independence from both. Of course Harvey did not bring this about single-handed. But he was more than a founding father. He became, as he is still, the new profession’s beau ideal. The
qualities which made Harvey the "compleat physician" were unspectacular. In an age of display, in a country torn by political passion, he remained sober, reticent, proud, and moderate. His attitude today would be described as professional. It was in fact Harveian. And it is reflected in the striking contrast between what is known about him as a person and his legacy as physician. Among a mass of letters, documents, minutes, memoranda, lecture notes, and books there is barely a reference to his closest family, although what reference there is suggests that he was a devoted family man. Nor is anything known about his innermost religious faith. Snippets about his habits and appearance were recorded by Aubrey; but even that perceptive scatterbrain could not pin him down. Steeped in tradition he treated Galen and Aristotle with reverence; but his marginal annotations of the former are replete with terse remarks like "mistake", "arrogant", or simply "no". His references to his own teachers are similarly respectful without being adulatory: there is never any suspicion that he would claim
as
his
own
discoveries that should be cred-
them. He was loyal to his patient, Charles I, but no way besotted by royalty. (James I in one of the monarch’s sillier moods is apostrophised as "that royal baboon".) It seems reasonable to assume that he was offered a knighthood; but of this, very properly, no trace remains. With the new Tudor-Stuart aristocracy (as rapacious a lot as ever made mockery of the name) his relation were devoid of either kind of snobbery. But he relaxed with men of his own stamp-Hobbes., Boyle, Selden. Several asides in his lecture notes show that he was at least educated in music; and the men he chose to paint his portraits were well above the ordinary run of boardroom artists. But such. interests were clearly peripheral to the many-sided pursuit of his profession. A highly successful practitioner, an active fellow and effective officer of his College, a shrewd and seemingly tireless original investigator, he was also, judging by the volume and quality of his lecture notes, a superb teacher. Had he no faults then? Professionally, it seems, only one; and even that became a cherished tradition. His handwriting was appalling.
ited
to
in
The last reason for celebrating scientific anniversaries is that, by a process which defies scientific analysis, they occasionally give rise to works of uncommon merit. The volume which celebrates Harvey’s quatercentenary’ falls into this category. The credit for this must largely go to the editor. He has assembled a galaxy of eminent contributors ; but this alone is no guarantee of success. By hook or by crook-perhaps simply by intoning the name of Harvey-he has persuaded them to give admirably concise and clear accounts of the present state of play in their specialties. Everything is covered, from the microcirculation to the heart (including the lymphatics) and from the simplest to the most sophisticated forms of investigation and treatment. Everything, that is, except perhaps the topics which Harvey might look for in his presentation copy. Underlying causes and basic mechanisms-physical, physiological, and chemicalreceive relatively little attention.
besetting sin of reviewers (and editorial referees) suggest that, good as a book (or paper) may be, it should have been a different book (or paper). Within its clinical compass Circulation of the Blood is a very good book indeed. It is no fault of the authors that threeand-a-half centuries after a revolutionary text their subject is crying out for another. The achievement of Harvey was to show how blood flows. Almost every chapter It is the to
in this commemorative volume describes how it does not. It is, of course, useful to know how the failures can be diagnosed and the consequences mitigated. But any book about the circulation today must be a book about degenerative vascular disease; and what degenerative vascular disease is remains a mystery. It is possible that all the facts required for its solution are now available. It is possible that they are available in this book. But the intelligent schoolboy who could put them in order is nowhere in sight. Whittington Hospital, London N19 5NF
T. L. DORMANDY
1. Circulation of the Blood. Edited by D. GERAINT JAMES, F.R.C.P., Dean, Royal Northern Hospital, London. London: Pitman Medical. 1978. Pp. 495 £25.