October 19, 1893] 



NATURE 



60; 



his discoveries ; it was here that he found his disciples and his 

 friends. Here he was urged to take the presidential chair ; and 

 here his statue was erected, five years before his death, with the 

 inscription, " Viro mottumenlis suis immortali." It would have 

 been a poor compliment to his elaborate demonstrations, and 

 unworthy of a liberal profession, if so startling a revolution as 

 Harvey proposed had been accepted without inquiry. It was 

 considered, it was discussed, and, without haste but without 

 timidity, it was at last accepted— the very way in which Dar- 

 win's theory was received and criticised, and finally adopted by 

 Lyell and by Hooker. Let then no scientific impostor or medical 

 charlatan quote Harvey to console him under merited censure. 



II. Of Harvey's writings, the second, and by far the longer 

 treatise, is that upon Generation. This formed the subject of a 

 valuable criticism in the Harveian Lecture by the late Sir 

 Arthur Farre. It [is [full of interest and contains many 

 observations that remain true for all times, many acute 

 criticisms, and a few broad and true generalisations, such as the 

 famous dictum — "Omnia anirnalia ex ovo progigtti." 

 Perhaps, however, what most strikes the reader of this treatise 

 is the learning of the writer. He is familiar with his Aristotle, 

 and quotes from Fabricius and other writers with much greater 

 freedom than in the succinct and almost sententious treatise, 

 " De Motu Cordis ct Sanguinis." Some would have us believe 

 that here, as in other cases, erudition was a clog upon genius. 

 This question has been often discussed, and it has even been 

 maintained that he is most likely to search out " the secrets of 

 Nature by way of experiment " who comes fresh to the task 

 with his faculties unexhausted by prolonged reading, and his 

 judgment uninfluenced by the discoveries of others. This, how- 

 ever, is surely a delusion. Harvey could not have discovered 

 the circulation of the blood had he not been taught all that was 

 previously known of anatomy. True, no progress can be made 

 by mere assimilation of previous knowledge. There must be 

 intelligent curiosity, an observant eye, and intellectual insight. 



" D:)ctrina sed vim promovet insitam," 



and few things are more deplorable than to see talent and in- 

 dustry occupied in fruitless researches, partially rediscovering 

 what is already fully known, or stubbornly toiling along a road 

 which has long ago been known to lead nowhither. We 

 must then instruct our students to the utmost of our power. 

 Whether they will add to knowledge we cannot tell, but at least 

 they shall not hinder its growth by their ignorance. The strong 

 intellect will absorb and digest all that we put before it, and 

 will be the better fitted for independent research. The less 

 powerful will at least be kept from false discoveries, and will 

 form (what genius itself requires) a competent and appreciative 

 audience. Even the dullest scholars will be respectable from 

 their learning, and if they cannot make discoveries themselves, 

 can at least enjoy the delight of intelligently admiring the dis- 

 coveries of others. 



HI. There is, however, a third phase of Harvey's intellectual 

 work of which, unfortunately, the records have for the most 

 part perished, and which has not, perhaps, been duly ap- 

 preciated. What I believe Harvey contributed, or would, but 

 for adverse fate, have contributed to medicine as distinct from 

 physiology, was a systematic study of morbid anatomy. In the 

 following passage he speaks of the great benefit that would 

 ensue from the regular observation of the structural changes 

 produced by disease : — 



" Sicut enim sanorum et boni habitus corporum dissectio 

 plurimum ad philosophiam et rectam physiologiam facit, ita 

 corporum morbosorum et cachecticorum inspectio potissimum ad 

 pathologiam philosophicam." 



Now this was a new notion. It was not uncommon for the body 

 to be opened after death, especially in the case of great person- 

 ages, either for the purpose of embalming or for discovering (as 

 it was supposed) the fact of poison or other foul play ; and 

 occasionally a physician would obtain permission for a like in- 

 spection when something unusual in the symptoms had excited a 

 laudable curiosity to ascertain their cause. But the records of 

 such inspections in the seventeenth century by Bartolinns, or 

 Tulpius, or Bonetus, or, in our own country, by Mayerne, or 

 Bate, or Morton, are fragmentary, their object being limited to 

 the individual case. There was no attempt to search out the 

 secrets of nature in disease by a systematic observation of the 

 state of the organs after death, nor was there for more than a 

 century after Harvey's death. Morgagni in Italy ; the French 



NO. 1 25 I, VOL. 48] 



anatomists of the early part of this century, Corvisart and 

 Laennec, Broussais and Cruveilhier ; in Germany Meckel 

 and Rokitansky, and in England Baillie, Abercrombie, Cars- 

 well and Bright — these were the founders of scientific 

 pathology on a sure anatomical basis almost within living 

 memory. 



Not only had Harvey the prescience to recommend the study 

 of morbid anatomy for itself, but he had himself carried it out 

 by recording a large number of dissections, or, as we should now 

 call them, inspections, of diseased bodies. Unfortunately most 

 of these post-mortem reports, with his observations on the gen- 

 eration of insects, and other manuscripts were destroyed, or 

 irrevocably dispersed, when his house in London was searched 

 while he was with the King at Oxford. If the records of 

 these inspections had been published, may we not asssume 

 that Harvey's great authority would have set the fashion, and 

 that the systematic study of morbid anatomy would have begun 

 a century and a half earlier than it did ? And think what this 

 would have meant. With the exception of a few shrewd ob- 

 servations, a few admirable descriptions, and here and there a 

 brilliant discovery, such as the origin and prevention of lead 

 colic and of scurvy and the introduction of vaccination, it may 

 be said that medicine made no important progress between the 

 time of Harvey and that of Laennec. The very notion of 

 diagnosis in our modern sense of the word depends upon morbid 

 anatomy. The older physicians seldom attempted to determine 

 the seat of an ailment. Disease was looked upon not as a con- 

 dition depending upon disordered physiological functions, but 

 as something external, attacking a previously healthy person, 

 disturbing, and, if not expelled by art, finally destroying him ; 

 while any structural changes which were found after death were 

 regarded rather as the effects than the causes of the symptoms 

 during life. 



Now, the ambition of every intelligent student — and in 

 medicine we are life- long students^ — is to fix upon the most 

 objective, certain, and important of the symptoms of a patient, 

 to follow out this clue, to determine the organ affected and the 

 nature of the affection, so that in his mind's eye the tissues 

 become transparent and he sees the narrow orifice for the blood- 

 stream and the labouring muscle behind it ; or the constricted 

 loop of intestine with violent peristalsis above and paralysis 

 below, the blood-current stopped and congestion passing hour 

 by hour into gangrene ; or, the spinal cord with grey induration 

 of a definite region, and the motors, sensory and trophic changes 

 which physiologically ensue. 



Sometimes this minute search to fix upon the locality and 

 exact nature of a lesion has been ridiculed ; and we are asked 

 what benefit to the patient such knowledge when attained can 

 bring. We answer, that in medicine, as in every other practical 

 art, progress depends upon knowledge, and knowledge must be 

 pursued for its own sake, without continually looking about for 

 its practical application. 



Harvey's great discovery (which we physicians rightly cele- 

 brate this day) was a strictly physiological discovery, and had 

 little influence upon the healing art until the invention of 

 auscultation. So also Dubois Reymond's investigation of the 

 electrical properties of muscle and nerve was purely scientific, 

 but we use the results thus obtained every day in the diagnosis 

 of disease, in its successful treatment, and in the scarcely less 

 important demonstration of the falsehoods by which the name 

 of electricity is misused for purposes of gain. 



It is true that Bernard's discoveries of the diabetic puncture 

 and of the digestive function of the pancreas have not yet 

 received their practical application. He was right when he said, 

 " Nous venous les mains vides, mais la boucht pleine d'esperances 

 legitimes " — but he should have spoken for himself alone. 



The experiments on blood-pressure begun by Hales, and 

 carried to a successful issue in our own time by Ludwig, have 

 already led to knowledge which we use every day by the bed- 

 side, and which only needs the discovery of a better method of 

 measuring blood -pressure during life, to become one of our 

 foremost and most practical aids in treatment. 



Again, we can most of us remember using very imperfect 

 physiological knowledge to fix, more or less successfully, the 

 locality of an organic lesion in the brain. I also remember such 

 attempts being described as a mere scientific game, which 

 could only be won after the player was beaten, since when the 

 accuracy of diagnosis was established, its object was already 

 lost ; but who would say this now, when purely physiological 



