Circulation
Author: Thomas Wright

Overview

This biography of William Harvey is a most enlightening and gripping account of the life of one of medicine’s most illustrious physicians, and of his paradigm-altering discovery of human circulation. The book portrays Harvey’s exposition as a feat that ‘demolished centuries of anatomical and physiological orthodoxy, and introduced a radical conception of the workings of the human body’. Depicting Harvey not just as a physician, but as a seditious ‘natural philosopher‘, the book chronicles the factors that influenced his career and determined his success, and these ranged from his personal characteristics and vision, to his medical education and research methods. With a prose that accurately captured the foundations of his work and the historical contexts of his life, the book projects the seismic shift his work wrought on medicine, and the challenges he faced in advocating for his ideas. Beyond its biographical narrative, the book also covered such related themes as the history and ethics of vivisection, the comparative advantages of the philosophies of Aristotle and Francis Bacon, and the architectural and social milieu of all the settings relevant to Harvey’s life and work (pages xi-xiii, 20-25, 47, 127-131 and 138-146).

Synopsis

The book’s biographical portrait of Harvey explored the factors that fashioned his personality and character, and which influenced his medical practice and research. One of these was his genealogy, and in this regard the book traced his birth in 1578 to ‘a long line of industrious and prosperous sheep farmers‘ who it says were defined by their honesty, integrity, candour, solidity and stolidity. Indeed, it was his father’s determination ‘that his first born advance in the world’ that drove Harvey’s illustrious educational progress from grammar school, where he ‘excelled’, to Cambridge, where he rose to the ‘rank of scholar‘. Also being the son of the English yeomanry, the author argued further that ‘intellectual achievement offered the only accessible route to social progress’ for Harvey. A similarly significant determinant of Harvey’s breakthrough was his education in anatomy at the University of Padua in Italy – a country which the author portrayed as ‘the cradle of the new humanistic learning‘. The author particularly explored how Harvey benefited from Padua’s emphasis on practical experience‘; its advocacy of the Aristotelian philosophy of ‘understanding the “why” of things’; its academic exercises which ‘took the conventional form of disputation and lectures‘; and its highly systematic and performance-based anatomical dissections and teaching (pages xii, 3-14, 41-53 and 61-69).

The concept of circulation that prevailed before Harvey’s time was an important theme of the book as it helped to put in context the magnitude of the change that his seminal discovery provoked. In this regard, the biography described in detail the humoral theories established by Hippocrates and advanced by Galen which ‘continued to hold sway right up to Harvey’s time’. The book illustrated how erroneous these theories were, illustrating this with the example of their dogma that blood was produced in the liver, ‘distributed slowly throughout the veins, and consumed in the tissues‘. Similarly mistaken was their teaching that the heart functioned to distribute ‘humours and spirits within the body’ via the aorta; that it ‘worked like a set of bellows and required air ‘to stay cool’; and that it was ‘transformed into a furnace which heated the blood’ whenever it is activated by emotions. Whilst Galen’s theories were supported and championed by such dominant medical figures as the influential fourteenth century Greek physician Mondino de Luizi, the book also noted that there were later dissenters, and these included the sixteenth century Belgian physician Andreas Vesalius whose anatomy dissections dispelled countless Galenic errors, such as the claim that the heart’s septum contained pores (pages 30-38 and 58).

In his detailed account of the process by which Harvey arrived at his insights on circulation, the author remarked that, because his daytime professional life was ‘a ceaseless cycle of activity’, he had to dedicate his evenings at home for ‘his real work’, but that he did this ‘with all the obsessiveness of his ardent nature’. Whilst this extracurricular research activity began with the dissection of all types of animals, the author explained that it eventually focused on the human circulation. The narrative depicted how Harvey applied the ‘hands-on, human body-centred anatomical style of Vesalius’ to carry out his research, and it illustrated this with his classical vein ligature experiments which demonstrated that the venous valves sustained a one-way perpetual and closed circular motion of blood flow. The book also described how Harvey used similar practical research methods to demonstrate other key aspects of human circulation, such as his observation that ‘blood seemed to enter the right side of the heart via the vena cava‘, and that the heart pumped blood into the lungs via the pulmonary veins. Harvey also demonstrated that ‘the heart’s contraction…appeared to be the cause of the arterial pulse‘; that blood leaving the heart did not ‘gently ebb and flow‘ as previously believed, but that did so forcefully; and that contraction was the heart’s active rather than its passive phase (pages 101-102, 115-123, 124-125, 132-137 and 148-148).

It is not surprising that Harvey’s theory of circulation met with open hostility, and the author explained that this opposition was to the fact that his findings ‘represented an unprecedentedly direct and comprehensive challenge to orthodox views…which had been established in Roman times‘. Whilst ‘some younger anatomists were open to his radical and innovative ideas’, the author nevertheless asserted that the reaction of the medical establishment as a whole was antagonistic, and he supported this by citing the response of the College of Physicians which ‘forbade all criticism‘ of Galen, and which ‘attacked’ Harvey’s theories ‘with all the ardour of undergraduates’. The author even asserted that Harvey published his seminal work, De Motu Cordis, partly in response to the attacks hurled at his ideas. Written in ‘the form of an extended academic disputation‘, the author described how De Motu Cordis countered ‘the hostility of the medical world’, and how it appealed to ‘the broad intellectual culture of the seventeenth century’ which ‘was ripe for it’. The book also explored the consequences of the acceptance of Harvey’s views, such as the way it ‘unwittingly encouraged radical ideas with regard to the body politic, just as it did in the world of natural philosophy‘ (pages xvii, 149-152, 186-188, 193 and 210-218).

Beyond his anatomical research, the biography also comprehensively covered Harvey’s medical career. For example, the author chronicled Harvey’s professional practice at St. Bartholomew’s – ‘London’s oldest hospital’ – after he graduated as a physician from Padua. The book specifically described how he attended to his patients with ‘his courteous manner‘ but treated them conventionally with ‘purging, bloodletting, dieting or medicine‘, and it documented how he ‘drew up strict rules defining the roles and relative importance of staff’. The narrative also detailed his enrolment into the College of Physicians where he ‘rose effortlessly through the college ranks’, and where he demonstrated his leadership skills by embarking on missions to rid society of ‘fraudulent apothecaries‘, and by launching campaigns to limit the independence of surgeons. Also addressed by the book was Harvey’s private practice which opened the way for him to eventually become physician to King James I, and later to his son Charles I (pages 74-95).

Opinion

This biography manages to seamlessly embed the history of a key medical advance within the contexts of the social and medical atmosphere of the time. It not only successfully portrays William Harvey’s seminal achievement, it also highlighted the challenges he faced in establishing its veracity. Evident throughout the account were his single-minded pursuit of his idea, and the hard work he put in to establish it. Although the biography made very little reference to Harvey’s private and family life, the content nevertheless fulfilled the objective of bringing his professional life and research work to life. Some themes, such as the landscape of Harvey’s imagination, seemed irrelevant and uninformative but provided a wider perspective with which to view his philosophy.

Overall assessment

With a focused narrative, this book portrayed the way precise knowledge and high-quality research led William Harvey to one of the most important discoveries in medicine – one that demolished centuries of dogma and tradition and opened the way for those who followed to make revolutionary health care innovations. The book is replete with lessons, from the value of dedicated hard work and the commitment to evidence-based facts, and I recommend it to all doctors.

Book details

Publisher, Place, Year: Vintage Books, London, 2012
Number of chapters: 15
Number of pages: 262
ISBN: 978-0-099-55269-7
Star rating: 5
Price: £25.11