The Harveian Oration 1886

Mr. President,

Colleagues, and Gentlemen,—

My instructions are explicit. Once every year, said Harvey, in the deed of conveyance of his patrimonial estate as a gift to the College, some one shall make an oration publickly in the College, "wherein shall be a commemoration of all the benefactors of the said College by name, and what in particular they have done for the benefit of the said College, with an exhortation to others to imitate those Benefactors and to contribute their endeavours for the advancement of the Society, according to the example of those Benefactors, ​and with an exhortation to the Fellows and Members of the said College to search and study out the Secrets of Nature by way of experiment."

Such are the directions, framed nearly two-and-a-half centuries ago, which bring us together here to-day. Himself a munificent benefactor in various ways to the College, and an ardent explorer of nature, Harvey desired that others should be incited to follow in the path that he had trodden. He was not content to quit life without taking steps to encourage others in succeeding generations to pursue the objects which he so strove by his own endeavours to promote. By this oration which he established, and which, notwithstanding the lapse of time that has occurred, may be said, I think, still to elicit as much reverential consideration within the College as at any period, an annual reminder is afforded that keeps his desire alive before us.

Honoured by the invitation of our President this year to deliver the oration, I am here to perform the task. Whilst highly appreciating the mark of distinction conferred, I must however, confess, ​looking at the able hands through which the duty of orator has passed, and the eminence in the profession of many present, that I do not approach the undertaking without a deep sense of the responsibility attaching to it.

The first portion of the duty which has been marked out in such precise terms by the founder of this oration to be performed is to commemorate the benefactions that have fallen into the possession of the College since the last oration was delivered. It is gratifying to me to feel that I do not come empty-handed for the occasion before you.

A new benefaction, which promises to be as useful as it is munificent, has to be recorded, and it belongs to me to mention the manner in which the College has decided to dispose of a recently acquired increased income derivable from one of its ancient benefactions. My immediate predecessor alluded to the augmentation which the income from the endowment for the Croonian lectureship has recently undergone. Dr. Croone, a Fellow of our College in the seventeenth century, left behind him ​a plan for the establishment of a lectureship, but made no provision in his will for its support. His widow, who afterwards married Sir Edwin Sadlier, beqeathed property in the City of London for carrying out the plan that had been thus fruitlessly framed.

It was a gracious act on the part of this lady, and one which showed a noble reverence for her first husband's wishes, to take upon herself in such a manner to give effect to his intention. Through the expiration of a ninety-nine years' building lease the College has come into possession of an income from the Lady Sadlier bequest which raises the amount available for the Croonian lectureship from £10 to £200 per annum. Those present are aware that the consideration of how to turn this twentyfold increase to best account to meet the objects of the Trust, and at the same time secure the advancement of knowledge in a direction likely to produce beneficial results, has anxiously engaged the attention of the Fellows. After passing through the hands of a committee, the subject was discussed at three College meetings, at the last of which, the ​comitia held in June, a resolution expressed in the following terms was passed:—

"That there shall be one or more Croonian lecturers appointed by the College, who shall be required to deliver lectures on one or more subjects in anatomy, physiology, and pathology, with a view to the prevention, control, and cure of disease; and that the College shall devote the funds derived from the Croonian Trust (1) to the payment of such lecturer or lecturers, and (2) to the contribution of such sums as the College may think fit towards the promotion of scientific investigation on the subject of the lectures."

Thus has the College determined to dispose of the increased income that has fallen into its hands through the chance influence that has been wrought by time upon the value of the endowment. The sum to be annually appropriated from the Croonian Trust is now of considerable magnitude, and let it be hoped that the fruit yielded by its application may equal in usefulness what I am sure it is desired by the College it should do. Should this be attained, the benefits issuing from the benefac​tion will immeasurably surpass those that could have been anticipated either by Dr. Croone in planning his design for the lectureship, or Lady Sadlier, his noble-minded widow, in providing an endowment for giving to it a practical shape.

The new benefaction has come into the possession of the College since the commencement of the present year. Not quite recently, but at the same time not long ago, there was to be frequently seen at the College one who, though strikingly quiet and unostentatious in manner, made his presence strongly felt amongst us whenever matters were under consideration bearing on public health. Born and educated in Edinburgh, Gavin Milroy, to whom I refer, became a Fellow of this College in 1853. Never engaged in hospital or private practice, and his mind early drawn to the consideration of questions touching on the prevention of the extension of disease, he devoted himself to the hygienic part of our professional art and became an authority of high repute on social matters affecting health. In such estimation, indeed, was his knowledge held that he was ​employed by Government for carrying out certain special inquiries, and afterwards was granted a life pension of £100 a year in recognition of the services he had rendered. He lived to the ripe age of eighty-one, and what I have said of his life bears upon his benefaction to the College. In his will he said: "I bequeath to the President and Council of the Royal College of Physicians in London for the time being the sum of £2,000 (being a sum of £1,743 which I received from the Colonial Office as remuneration for my services in 1871 and 1872 whilst engaged in my mission to the West Indics, with £257 which I have added thereto), for the purpose of founding and continuing a yearly lectureship of three or four lectures on state medicine and public hygiene, and upon trust to invest the same in the public funds, or in such other investment as they shall in their absolute discretion think fit, and upon trust to pay the income thereof to a lecturer to be appointed from time to time." In another part of his will he directed that the sum bequeathed should be paid free of legacy duty, and further gave the silver ​inkstand which had been presented to him by the College in 1868 in acknowledgment of his services as Honorary Secretary to the Committee on Leprosy, and certain books specifically mentioned by him.

A thorough master in the branch of study to which he devoted himself, no one was in a better position than Dr. Milroy for suggesting the direction in which the attention of those who may hereafter be appointed to carry out his beneficent design may be most advantageously given; and thoughtfully and, doubtless it will be found, most usefully he has left behind him an elaborate code of suggestions for the consideration of the Council of the College in its administration of the trust with which it has been charged. As a preface to these suggestions he remarks: "I would take leave to record some thoughts that have occurred to my mind concerning the subject-matters which, as it seems to me, might be most profitable for investigation at the present time, and possibly for some years to come. I am far from seeking to limit, or in any measure to impede, the free decision of ​the Council in respect of the conduct and arrangement of the lectures themselves; my only desire being how most usefully to promote the advancement of Medical Science along with the interests of philanthropic benevolence and of social welfare."

Could any wiser or more useful form of bequest than this of Dr. Milroy have been bestowed? The College is no longer itself in need of the aid required in former times, but funds placed at its disposal for promoting the acquirement of knowledge constitute a benefaction that confers upon it the power of doing good in a manner standing most in harmony with the wants of the present age. Further, it may be said, the kind of knowledge sought to be advanced by the terms of the Milroy endowment is just that which is most ripe for encouragement at the present moment, and that also which holds a foremost rank in promise of benefit of a wide nature being conferred by its improvement.

I have ventured to consider that such a benefaction as this which it has devolved upon me to commemorate is the best kind of benefaction the ​College could now receive. Probably Harvey had in his mind especially the encouragement of the bestowal of benefactions of a nature calculated in a more direct way to benefit the College. If we carry our thoughts—and looking at the position in which the College stands at the present time it requires a little effort to do so—I say, if we carry our thoughts to what the College was in Harvey's day, we realise that needs then existed which have now disappeared. We have no longer occasion to give ourselves concern about the corporate welfare of the College in the manner that was formerly called for. Founded "with a view to the improvement and more orderly exercise of the art of physic, and the repression of irregular, unlearned, and incompetent practitioners," the College for a long time possessed but very meagre accommodation. A gift by our Founder and first President, Linacre, of the front portion of his private house, "comprising a parlour below and a chamber above, to be used as a council room and library," constituted for many years the only local habitation belonging to the College—a modest beginning ​indeed for the edifice in which we are now assembled. On the announcement towards the end of the sixteenth century by Dr. Caldwell and Lord Lumley of their intention to found a surgery lecture, and to endow it with £40 a year, the Fellows determined to appropriate £100 out of the common stock (and this was nearly all the money the College possessed) to enlarge the building and make it more ornamental and better suited for the meetings of their body and the celebration of the lectures. We next learn that just before Harvey entered upon his tenure of the Lumleian lectureship, contributions from its members and some others were forthcoming which enabled the College to take more suitable premises to which it removed. Subsequently, during the troubled times of the civil wars, the College was brought to the greatest straits. In consequence of the heavy taxes imposed, and the other exactions made, it became unable for a time to pay its rent to the Dean and Chapter of St. Paul's. To add to its distress, its premises were now condemned, as part of the property of the Church, to be sold by public auction. One ​of our Fellows, Dr. Hamey, whose name deserves to be ever remembered, became however their purchaser, and afterwards gave them to his colleagues. Harvey himself contributed munificently to the substantial welfare of the College. A few years before his death "the Fellows," we are told "attended at the College when the doors were thrown open, and Harvey, receiving his assembled colleagues in the new museum, made over to them on the spot the title-deeds and his whole interest in the building," which, says Aubrey, was a noble building of Roman architecture, containing "a great parlour, a kind of convocation room for the Fellows to meet in below, and a library above." This gift preceded that of his patrimonial estate with which the establishment of this oration is connected. From these particulars, drawn from that excellent work, the "College Roll," from the pen of our esteemed colleague Dr. Munk, it is brought home to us how vastly altered the position of the College now is; and I think I shall stand in accord with the opinion of others when I say that I consider the best kind of benefaction that ​can be in the present age bestowed is such as I have had to commemorate to-day—one that confers upon the College the power of contributing towards making us, through the acquisition of increased knowledge, more efficient agents in the exercise of our calling.

The next part of my duty is to exhort the Fellows and Members of this College "to search and study out the secrets of nature by way of experiment." These are the directions I am to follow, and they give me a wide field to select a course of procedure from. The kind of exhortation I shall employ will consist in placing before you a view of the method of work which Harvey himself adopted, and then, as an incentive to follow his example, I will display some of the fruit yielded by recent research conducted upon the lines of his procedure.

The object to be promoted is the acquirement of additional knowledge. It is an old but true saying that knowledge is power. We accept the doctrine which comes to us in definite shape from no less ancient an authority than Aristotle, that there is ​no such thing as innate knowledge, that knowledge of every kind has to be acquired, and that it is based upon perceptions reaching the mind through the senses.

Harvey thus epitomises what was said by Aristotle respecting the manner in which the knowledge appertaining to science is acquired—"The thing perceived by sense remains; from the permanence of the thing perceived results memory; from multiplied memory, experience; and from experience, universal reason, definitions, and maxims or common axioms."

In its elementary form, knowledge consists of simple inferences drawn in a direct manner from impressions. A child once burnt afterwards shuns the fire. From the impression received an inference is framed which forms the foundation for future action.

The same kind of operation determines the conduct of the lower animals. By mental action these simple inferences may be raised into or give rise to knowledge of a higher kind. This is what for science is required to be done. The exercise ​of the intellectual faculties must be brought into operation, in order that what we acquire through perception may be shaped into the knowledge that it is desired to obtain. The object in science is to discover the facts and laws of nature; and to apply the intellect advantageously for the purpose there must be some systematic course, some method or art of reasoning adopted. The system employed up to Harvey's time was the Aristotelian, or syllogistic—a system which, whilst being well adapted for affording proof upon any particular point, is ill adapted for promoting the advance of knowledge. When through the major and minor premises of a syllogism I draw a conclusion, a point is proved, but no real addition is made to our stock of knowledge. For instance, when in accordance with the rules of the syllogistic art I say―

I start with the general proposition in the major ​premise that "all men are mortal," and arrive at the conclusion, through the minor premise, that a particular individual is mortal. A certain attribute—mortality—is asserted to be possessed by a class. A member of the class must also possess the attribute, and this is all the information that my syllogistic conclusion has given me—that the individual, named Thomas, possesses the attribute of mortality, which belongs as a general character to the group of individuals of which he is a member. The two premises of the syllogism already consist of established truths, and for a syllogism to be valid there must be nothing contained in the conclusion beyond what is asserted in the premises. The train of reasoning, therefore, is not adapted to lead us to the acquirement of new knowledge. The essence, indeed, of the system consists in proceeding from generals to particulars. The major premise, with which we start, is, in reality, a general proposition, containing knowledge which has been acquired, not, it is true, by the methodical application of induction; but, nevertheless, after the manner of induction, by observation repeated and confirmed ​until the thing has come to be accepted as an established truth.

Harvey was shrewd enough to perceive that such a system of reasoning, which had continued in use up to the period in which he lived, did not assist in the disclosure of the secrets of nature. He says, "The method of investigating truth commonly pursued at this time is to be held as erroneous and almost foolish, in which so many inquire what others have said, and omit to ask whether the things themselves be actually so or not; and single universal conclusions being deduced from several premises, and analogies being thence shaped out, we have frequently mere verisimilitudes handed down to us instead of positive truths."

Men's minds must have evidently now become occupied with the new system of philosophy set forth by Lord Bacon, in his "Novum Organum," or "true directions concerning the interpretation of Nature." One of the aphorisms of this work clearly exhibits the difference between the new system and the old.

​"There are and can be only two ways of searching into and discovering truth. The one flies from the senses and particulars to the most general axioms, and from these principles, the truth of which it takes for settled and immoveable, proceeds to judgment and to the discovery of middle axioms. The other derives axioms from the senses and particulars, rising by a gradual and unbroken ascent, so that it arrives at the most general axioms last of all." Upon system, or plan of procedure, a great deal depends: look at any undertaking carried out under a good system and a bad. The ancients were a long time in learning the right system to adopt, but it was indeed a great day for science when the method of reasoning by induction was introduced. Starting with particulars or facts which are collected from nature by observation and experiment applied in every available way, it proceeds step by step in the process of generalizing until the largest and widest propositions are obtained. From the proposition which has been formulated out of, it may be, only a few facts, advance is made with the aid of other ​facts to propositions of a more and more general character. The unknown is brought into the domain of the known, and as this domain increases, not only is the position acquired strengthened, but at the same time rendered more advantageous for the attainment of further extension. Thus the march onwards proceeds, and when some general law of nature—like, for instance, gravitation, the correlation of the physical forces, or, even, with a more limited bearing, reflex spinal action—is discovered, a gain is made which, through reflected influence, has the effect of at once immensely enlarging and perfecting the understanding. Truly, it may be said, the explorer by the inductive method does not know whither he may be led. He dedicates himself

and follows simply the direction indicated to be taken by what happens to be revealed. Guided entirely by the facts disclosed by observation and experiment, he brings the instrumental agency of the mind as a reasoning power to bear upon them, ​and draws from them that which adds to the store of knowledge already possessed. He seeks for facts, and interprets their meaning as they come before him.

This was the course pursued by Harvey. Instead of giving himself up, as others had done before him, to arguing out conclusions from accepted axioms, he struck out into the hitherto untrodden path of inquiry—that of induction—and sought knowledge by a direct appeal to nature through the medium of observation and experiment. "It were disgraceful," he says, "with this most spacious and admirable realm of nature before us, did we take the reports of others upon trust, and go on coining crude problems out of these, and on them hanging knotty and captious and petty disputations. Nature is herself to be addressed, the paths she shows us are to be boldly trodden."

In the discovery of the circulation Harvey applied the principles of induction and argued upon them in a strictly logical way. He showed himself to be a good and careful observer, judged even by the ​standard set forth in the following words of John Stuart Mill on the process of observing:—"The observer," says Mill, "is not he who merely sees the thing which is before his eyes, but he who sees what parts that thing is composed of. To do this well is a rare talent. One person, from inattention, or attending only in the wrong place, overlooks half of what he sees. Another sets down much more than he sees, confounding it with what he imagines, or with what he infers. Another takes note of the kind of all the circumstances, but being inexpert in estimating their degree, leaves the quantity of each vague and uncertain. Another sees, indeed, the whole, but makes such an awkward division of it into parts, throwing things into one mass which require to be separated, and separating others which might more conveniently be considered as one, that the result is much the same, sometimes even worse, than if no analysis had been attempted at all. It would be possible to point out what qualities of mind, and modes of mental culture, fit a person for being a good observer: that, however, is a question not of logic, but of the theory ​of education, in the most enlarged sense of the term."

The experiments which Harvey conducted on the arteries and veins, to assist him in his inquiry, were founded upon a well-devised plan. It may be said of experiment that it affords the means of varying the circumstances, and thus aids immensely the acquirement of knowledge by induction. In the application of the faculties to discovery, the mind asks itself what facts are needed to assist in the establishment of a correct conclusion. The fact may be looked for amongst the varied instances presented by nature; or, by an artificial arrangement of circumstances, the required instance may be made,—in other words, experiment may be had recourse to for supplying what is wanted. In the one case we get our fact by observation from the variations in the circumstances spontaneously furnished by nature; in the other we obtain it from experiment, which possesses the great advantage over observation, not only of furnishing us with a much greater number of variations than is to be found naturally presented, but also of enabling us ​to produce the precise form of combination or variation which is needed for our purpose.

Harvey in a true sense adopted the Baconian system of interrogating nature by appeal to observation and experiment and drawing conclusions out of the facts presented, and yet it is evident that the "Novum Organum" was not published till after the discovery of the circulation was made. Bacon's new method of conducting research and discovering the truths of nature was placed before the public in 1620. Harvey's work on the circulation, "Exercitatio anatomica de motu cordis et sanguinis animalibus," was not published till 1628, but it has been generally allowed that his discovery was made known in his first course of Lumleian lectures delivered at the College in 1616; and, thanks to the meritorious labours of a Committee of the College, this has now been rendered open to verification by the very interesting volume just prepared, and on the point of being issued, containing a reproduction in autotype form of his original lecture notes in his own handwriting. Harvey, then, must have been thoroughly in the van of progress taking place in ​his day; and, further, the contemporaries of Bacon must have been acquainted with the new system of philosophy before the "Novum Organum" was published.

Harvey's discovery established a new departure in physiology. Without a knowledge of the circulation nothing really could be known about the various operations taking place within us. It is hard, with the knowledge now possessed, to realise the state existing at the time the circulation was discovered. The passage of blood from the right to the left side of the heart had, it is true, already been recognised, but it was taught that the blood went to the lungs for their nutrition, and "to be elaborated and subtilised by the reception of a spirit from the air in inspiration and the exhalation of a fuliginous matter in expiration." The heart and arteries were supposed to be the seat of the vital spirit, and the liver to be the fountain from whence the body was supplied with blood through the veins, in which there was believed to be a to-and-fro current—a flux and reflux, that was compared to the ebb and flow of the tide in the ​classic straits of Euripus. Truly, indeed, may it be asserted that our ancestors stand in the twofold position of our parents with respect to age, our children with respect to knowledge.

It was not without opposition that Harvey's views were received; and the high position in his profession he had attained did not suffice to prevent his escape from the effect of the prejudice against innovation entertained by the multitude. Aubrey tells us he had "heard him say that after his book on the circulation of the blood came out he fell mightily in his practice; 'twas believed by the vulgar that he was crack-brained, and all the physitians were against him." Harvey lived, however, to see his doctrine generally accepted. But, such are the vicissitudes of time, that in our day an attempt has been made to deprive him of the title of discoverer of the circulation and give it to an Italian physician, Cesalpino, because it has been found that a few words of what he wrote can be construed into suggesting that a conception of the circulation existed in his mind. Most ably and successfully have my predecessors in the delivery ​of this oration, Sir Edward Sieveking and Dr. George Johnson, combatted the claim that has been put forward on behalf of Cesalpino, and maintained the position of Harvey.

Science prepares the ground for the exercise of art. The one—science—is concerned with knowledge as knowledge; the other, with the application of it to a practical end. Our art—our raison d'être as members of the medical profession—is to apply the knowledge of medical science to the prevention of, cure or mitigation of, and alleviation of the sufferings from, disease—to secure, in fact, for man as natural a passage through life as happens to be attainable. We cannot prevent death. Lord Bacon, in his essay "De Morte," said—

True—it is as natural to die as to be born; and, nature's laws must be complied with. Our aim is to avert premature death. A certain power, given to us at starting upon our existence, carries us on, under exposure to the proper conditions or influences for keeping this power going. But, in the ​exercise of its action, although for awhile it shows no signs of a failing tendency, yet assuredly it progresses towards exhaustion and ultimate extinction. Accompanying, and doubtless dependent on, the declining power, and assisting in leading to its becoming extinguished, there is an advancing deterioration of the material organism in which the power is manifested. Such is what is natural, but many circumstances contribute to avert the natural—the ordinary course being run. The power given to start with may not be equal to the standard, and the issue of generation may in consequence present itself under a weak and ill-developed form, easily falling a victim to influences that there ought to be strength enough to resist. There may be a taint in the power derived by generation from the parents—something transmitted by inheritance which may give rise to a tendency to the development of some structural deviation from the natural state or to the performance of one or other functional operation of life in a manner that does not conform with what may be said to be strictly natural. It is a law of nature for the offspring more ​or less closely to assume the likeness of the parent, and likeness in the shape of what is wrong may be assumed as well as in the shape of what is right.

Quitting the quality of the power given to us to start with, we are next dependent upon the influences derived from the external or surrounding conditions to which we become exposed. Light, air, what we eat and drink or what in any way gets into the system, temperature, exercise of mind and body—in short, the conditions under which we live—all exert their influence in favouring or otherwise a natural passage through life. Within us, operations forming a part of the operations of nature proceed, but these operations arc influenced by—owe their activity indeed—to the surrounding conditions, and thus it is that upon these surrounding conditions depends whether a natural course is run or not. Under the same law these surrounding conditions may exert a modifying influence in this or that particular direction upon the operations that are proceeding, and by long continuance in force may lead to the establishment of a more or less modified state as a part of our nature ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/37 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/38 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/39 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/40 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/41 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/42 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/43 ​40 may be chosen and the organic product, whether milk or any other article, remains without under- going change.

The step from the action exerted by bacteria as agents exciting the decomposition of organic products to that which brings them before us as a source of discase is not a great one. In the one case they lead to change which would not otherwise occur, and in the other they disturb the order of changes naturally taking place and thus induce an abnormal state; and although there is nothing in their morphological characters to show the reason, different trains of phenomena-in other words different diseases-are occasioned by different kinds of bacilli.

It is in the group of disorders falling under the denomination of contagious or infectious febrile diseases, a form of disease taken in its entirety constituting one of the greatest scourges besetting the human race, that we are brought most manifestly into contact with bacilli. Very diverse views have been held at different times regarding the nature and mode of production of the affections belonging ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/45 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/46 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/47 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/48 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/49 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/50 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/51 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/52 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/53 ​Page:The Harveian oration (electronic resource) - delivered at the Royal College of Physicians, October 18th, 1886 (IA b2041190x).pdf/54 ​centive, following the words of Harvey, "to search and study out the Secrets of Nature by way of experiment."