the evolution of modern medicine-第26章

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atethe　Moses　who　alone　among　his　contemporaries　saw　the　promised　land。　How　far　Leonardo　was　indebted　to　his　friend　and　fellow　student；　della　Torre；　at　Pavia　we　do　not　know；　nor　does　it　matter　in　face　of　the　indubitable　fact　that　in　the　many　anatomical　sketches　from　his　hand　we　have　the　first　accurate　representation　of　the　structure　of　the　body。　Glance　at　the　three　figures　of　the　spine　which　I　have　had　photographed　side　by　side；　one　from　Leonardo；　one　from　Vesalius　and　the　other　from　Vandyke　Carter；　who　did　the　drawings　in　Gray's　〃Anatomy〃　（1st　ed。；　1856）。　They　are　all　of　the　same　type；　scientific；　anatomical　drawings；　and　that　of　Leonardo　was　done　fifty　years　before　Vesalius！　　Compare；　too；　this　figure　of　the　bones　of　the　foot　with　a　similar　one　from　Vesalius。＇24＇　Insatiate　in　experiment；　intellectually　as　greedy　as　Aristotle；　painter；　poet；　sculptor；　engineer；　architect；　mathematician；　chemist；　botanist；　aeronaut；　musician　and　withal　a　dreamer　and　mystic；　full　accomplishment　in　any　one　department　was　not　for　him！　A　passionate　desire　for　a　mastery　of　nature's　secrets　made　him　a　fierce　thing；　replete　with　too　much　rage！　　But　for　us　a　record　remains　Leonardo　was　the　first　of　modern　anatomists；　and　fifty　years　later；　into　the　breach　he　made；　Vesalius　entered。＇25＇


＇*＇　This　plate　was　lacking　among　the　author's　illustrations；　but　the　Keeper　of　the　Ashmolean　Museum　remembers　his　repeatedly　showing　special　interest　in　the　sketch　reproduced　in　John　Addington　Symonds's　Life　of　Michelangelo；　London；　1893；　Vol。　I；　p。　44；　and　in　Charles　Singer's　Studies　in　the　History　and　Method　of　Science；　Oxford；　1917；　Vol。　I；　p。　97；　representing　Michael　Angelo　and　a　friend　dissecting　the　body　of　a　man；　by　the　light　of　a　candle　fixed　in　the　body　itself。Ed。

＇24＇　He　was　the　first　to　make　and　represent　anatomical　cross　sections。　See　Leonardo：　　Quaderni　d'Anatomia；　Jacob　Dybwad；　Kristiania；　1911…1916；　Vol。　V。

＇25＇　See　Knox：　　Great　Artists　and　Great　Anatomists；　London；　1862；　and　Mathias　Duval　in　Les　Manuserits　de　Leonard　de　Vince：　De　l'Anatomie；　Feuillets　A；　Edouard　Rouveyre；　Paris；　1898。　For　a　good　account　of　Leonardo　da　Vinci　see　Merejkovsky's　novel；　The　Forerunner；　London；　1902；　also　New　York；　Putnam。


HARVEY

LET　us　return　to　Padua　about　the　year　1600。　　Vesalius；　who　made　the　school　the　most　famous　anatomical　centre　in　Europe；　was　succeeded　by　Fallopius；　one　of　the　best…known　names　in　anatomy；　at　whose　death　an　unsuccessful　attempt　was　made　to　get　Vesalius　back。　He　was　succeeded　in　1565　by　a　remarkable　man；　Fabricius　（who　usually　bears　the　added　name　of　Aquapendente；　from　the　town　of　his　birth）；　a　worthy　follower　of　Vesalius。　　In　1594；　in　the　thirtieth　year　of　his　professoriate；　he　built　at　his　own　expense　a　new　anatomical　amphitheatre；　which　still　exists　in　the　university　buildings。　It　is　a　small；　high…pitched　room　with　six　standing…rows　for　auditors　rising　abruptly　one　above　the　other。　The　arena　is　not　much　more　than　large　enough　for　the　dissecting　table　which；　by　a　lift；　could　be　brought　up　from　a　preparing　room　below。　The　study　of　anatomy　at　Padua　must　have　declined　since　the　days　of　Vesalius　if　this　tiny　amphitheatre　held　all　its　students；　none　the　less；　it　is　probably　the　oldest　existing　anatomical　lecture　room；　and　for　us　it　has　a　very　special　significance。

Early　in　his　anatomical　studies　Fabricius　had　demonstrated　the　valves　in　the　veins。　　I　show　you　here　two　figures；　the　first；　as　far　as　I　know；　in　which　these　structures　are　depicted。　It　does　not　concern　us　who　first　discovered　them；　they　had　doubtless　been　seen　before；　but　Fabricius　first　recognized　them　as　general　structures　in　the　venous　system；　and　he　called　them　little　doors〃ostiola。〃

The　quadrangle　of　the　university　building　at　Padua　is　surrounded　by　beautiful　arcades；　the　walls　and　ceilings　of　which　are　everywhere　covered　with　the　stemmata；　or　shields；　of　former　students；　many　of　them　brilliantly　painted。　Standing　in　the　arcade　on　the　side　of　the　〃quad〃　opposite　the　entrance；　if　one　looks　on　the　ceiling　immediately　above　the　capital　of　the　second　column　to　the　left　there　is　seen　the　stemma　which　appears　as　tailpiece　to　this　chapter；　put　up　by　a　young　Englishman；　William　Harvey；　who　had　been　a　student　at　Padua　for　four　years。　　He　belonged　to　the　〃Natio　Anglica；〃　of　which　he　was　Conciliarius；　and　took　his　degree　in　1602。　Doubtless　he　had　repeatedly　seen　Fabricius　demonstrate　the　valves　of　the　veins；　and　he　may　indeed；　as　a　senior　student；　have　helped　in　making　the　very　dissections　from　which　the　drawings　were　taken　for　Fabricius'　work；　〃De　Venarum　Osteolis；〃　1603。　If　one　may　judge　from　the　character　of　the　teacher's　work　the　sort　of　instruction　the　student　receives；　Harvey　must　have　had　splendid　training　in　anatomy。　　While　he　was　at　Padua；　the　great　work　of　Fabricius；　〃De　Visione；　Voce　et　Auditu〃　（1600）　was　published；　then　the　〃Tractatus　de　Oculo　Visusque　Organo〃　（1601）；　and　in　the　last　year　of　his　residence　Fabricius　must　have　been　busy　with　his　studies　on　the　valves　of　the　veins　and　with　his　embryology；　which　appeared　in　1604。　　Late　in　life；　Harvey　told　Boyle　that　it　was　the　position　of　the　valves　of　the　veins　that　induced　him　to　think　of　a　circulation。

Harvey　returned　to　England　trained　by　the　best　anatomist　of　his　day。　In　London；　he　became　attached　to　the　College　of　Physicans；　and　taking　his　degree　at　Cambridge；　he　began　the　practice　of　medicine。　He　was　elected　a　fellow　of　the　college　in　1607　and　physician　to　St。　Bartholomew's　Hospital　in　1609。　　In　1615　he　was　appointed　Lumleian　lecturer　to　the　College　of　Physicians；　and　his　duties　were　to　hold　certain　〃public　anatomies；〃　as　they　were　called；　or　lectures。　　We　know　little　or　nothing　of　what　Harvey　had　been　doing　other　than　his　routine　work　in　the　care　of　the　patients　at　St。　Bartholomew's。　It　was　not　until　April；　1616；　that　his　lectures　began。　Chance　has　preserved　to　us　the　notes　of　this　first　course；　the　MS。　is　now　in　the　British　Museum　and　was　published　in　facsimile　by　the　college　in　1886。＇26＇

＇26＇　William　Harvey：　　Prelectiones　Anatomiae　Universalis；　London；　J。　&　A。　Churchill；　1886。


The　second　day　lecture；　April　17；　was　concerned　with　a　description　of　the　organs　of　the　thorax；　and　after　a　discussion　on　the　structure　and　action　of　the　heart　come　the　lines：

　W。　H。　constat　per　fabricam　cordis　sanguinem　　per　pulmones　in　Aortam　perpetuo　　transferri；　as　by　two　clacks　of　a　　water　bellows　to　rayse　water　　constat　per　ligaturam　transitum　sanguinis　　ab　arteriis　ad　venas　　unde　perpetuum　sanguinis　motum　　in　circulo　fieri　pulsu　cordis。

The　illustration　　will　give　one　an　idea　of　the　extraordinarily　crabbed　hand　in　which　the　notes　are　written；　but　it　is　worth　while　to　see　the　original；　for　here　is　the　first　occasion　upon　which　is　laid　down　in　clear　and　unequivocal　words　that　the　blood　CIRCULATES。　　The　lecture　gave　evidence　of　a　skilled　anatomist；　well　versed　in　the　literature　from　Aristotle　to　Fabricius。　　In　the　MS。　of　the　thorax；　or；　as　he　calls　it；　the　〃parlour〃　lecture；　there　are　about　a　hundred　references　to　some　twenty　authors。　The　remarkable　thing　is　that　although　those　lectures　were　repeated　year　by　year；　we　have　no　evidence　that　they　made　any　impression　upon　Harvey's　contemporaries；　so　far；　at　least；　as　to　excite　discussions　that　led　to　publication。　It　was　not　until　twelve　years　later；　1628；　that　Harvey　published　in　Frankfurt　a　small　quarto　volume　of　seventy…four　pages；＇27＇　〃De　Motu　Cordis。〃　　In　comparison　with　the　sumptuous　〃Fabrica〃　of　Vesalius　this　is　a　trifling　booklet；　but　if　not　its　equal　in　bulk　or　typographical　beauty　（it　is　in　fact　very　poorly　printed）；　it　is　its　counterpart　in　physiology；　and　did　for　that　science　what　Vesalius　had　done　for　anatomy；　though　not　in　the　same　way。　　The　experimental　spirit　was　abroad　in　the　land；　and　as　a　student　at　Padua；　Harvey　must　have　had　many　opportunities　of　learning　the　technique　of　vivisection；　but　no　one　before　his　day　had　attempted　an　elaborate　piece　of　experimental　work　deliberately　planned　to　solve　a　problem　relating　to　the　most　important　single　function　of　the　body。　Herein　lies　the　special　merit　of　his　work；　from　every　page　of　which　there　breathes　the　modern　spirit。　　To　him；　as　to　Vesalius　before　him；　the　current　views　of　the　movements　of　the　blood　were　unsatisfactory；　more　particularly　the　movements　of　the　heart　and　arteries；　which　were　regarded　as　an　active　expansion　by　which　they　were　filled　with　blood；　like　bellows　with　air。　The　question　of　the　transmission　of　blood　through　the　thick　septum　and　the　transference　of　air　and　blood　from　the　lungs　to　the　heart　were　secrets　which　he　was　desirous　of　searching　out　by　means　of　experiment。

＇27＇　Harvey：　　Exercitatio　Anatomica　de　Motu　Cordis　et　Sanguinis　in　Animalibus；　Francofurti；　1628。


One　or　two　special　points　in　the　work　may　be　referred　to　as　illustrating　his　method。　　He　undertook　first　the　movements　of　the　heart；　a　task　so　truly　arduous　and　so　full　of　difficulties　that　he　was　almost　tempted　to　think　with　Fracastorius　that　〃the　movement　of　the　heart　was　only　to　be　comprehended　by　God。〃　　But　after　many　difficulties　he　made　the　following　statements：　　first；　that　the　heart　is　erected　and　raises　itself　up　into　an　apex；　and　at　this　time　strikes　against　the　breast　and　the　pulse　is　felt　externally；　secondly；　that　it　is　contracted　every…way；　but　more　so　at　the　sides；　and　thirdly；　that　grasped　in　the　hand　it　was　felt　to　become　harder　at　the　time　of　its　motion；　from　all　of　which　actions　Harvey　drew　the　very　natural　conclusion　that　the　activity　of　the　heart　consisted　in　a　contraction　of　its　fibres　by　which　it　expelled　the　blood　from　the　ventricles。　These　were　the　first　four　fundamental　facts　which　really　opened　the　way　for　the　discovery　of　the　circulation；　as　it　did　away　with　the　belief　that　the　heart　in　its　motion　attracts　blood　into　the　ventricles；　stating　on　the　contrary　that　by　its　contraction　it　expelled　the　blood　and　only　received　it　during　its　period　of　repose　or　relaxation。　Then　he　proceeded　to　study　the　action　of　the　arteries　and　showed　that　their　period　of　diastole；　or　expansion；　corresponded　with　the　systole；　or　contraction；　of　the　heart；　and　that　the　arterial　pulse　follows　the　force；　frequency　and　rhythm　of　the　ventricle　and　is；　in　fact；　dependent　upon　it。　　Here　was　another　new　fact：　that　the　pulsation　in　the　arteries　was　nothing　else　than　the　impulse　of　the　blood　within　them。　　Chapter　IV；　in　which　he　describes　the　movements　of　the　auricles　and　ventricles；　is　a　model　of　accurate　description；　to　which　little　has　since　been　added。　　It　is　interesting　to　note　that　he　mentions　what　is　probably　auricular　fibrillation。　　He　says：　〃After　the　heart　had　ceased　pulsating　an　undulation　or　palpitation　remained　in　the　blood　itself　which　was　contained　in　the　right　auricle；　this　being　observed　so　long　as　it　was　imbued　with　heat　and　spirit。〃　He　recognized　too　the　importance　of　the　auricles　as　the　first　to　move　and　the　last　to　die。　　The　accuracy　and　vividness　of　Harvey's　description　of　the　motion　of　the　heart　have　been　appreciated　by　generations　of　physiologists。　　Having　grasped　this　first　essential　fact；　that　the　heart　was　an　organ　for　the　propulsion　of　blood；　he　takes　up　in　Chapters　VI　and　VII　the　question　of　the　conveyance　of　the　blood　from　the　right　side　of　the　heart　to　the　left。　　Galen　had　already　insisted　that　some　blood　passed　from