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Harvey En Zijn Circulatietheorie Van Natuurfilosoof Tot Medisch Empirist PERSPECTIEF Frank J

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Harvey En Zijn Circulatietheorie Van Natuurfilosoof Tot Medisch Empirist PERSPECTIEF Frank J Geschiedenis Harvey en zijn circulatietheorie VAN NATUURFILOSOOF TOT Medisch EMPirist PERSPECTIEF Frank J. Wolters In 1628 publiceert de Engelse arts William Harvey (1578- n 1605 stelt filosoof Francis Bacon in TheAdvance- 1657) zijn revolutionaire theorie dat bloed in het lichaam ment of Learning,dat ‘de geneeskunde in de moderne rondgaat, aangedreven door het hart. Hiermee bekritiseert Itijd weinig tot geen vooruitgang heeft geboekt’.1 Vol- hij de eeuwenlang in ere gehouden ideeën van Hippocrates gens Bacon ligt de oorzaak hiervan in een exceptioneel en Galenus, aangaande 4 verschillende lichaamssappen en vertrouwen in autoriteiten, terwijl proefondervindelijk hun stroming in van elkaar gescheiden arteriële en veneuze onderzoek noodzakelijk is. Een belangrijke bijdrage in vaatstelsels. Harvey vergaart in de loop van zijn carrière het doorbreken van dit paradigma wordt in de daaropvol- veel maatschappelijke invloed als lid van het prestigieuze gende decennia geleverd door een landgenoot van Bacon, Royal College of Physicians te Londen, alsook binnen het Hof die tevens zijn behandelend arts is. Dr. William Harvey als lijfarts van koning James I en Charles I. Met anatomische publiceert in 1628 een idee dat een revolutie in de kennis demonstraties en vivisecties streeft Harvey een meer empi- over het menselijk lichaam veroorzaakt.2 Nog geen 100 risch gestoelde vorm van geneeskunde na. Ondanks de vele jaar nadat Copernicus de wereld heeft opgeschud met kritiek die hij te verduren krijgt, weet hij in de loop van zijn zijn heliocentrisch model, openbaart Harvey zijn theorie leven zijn visie te verspreiden onder de invloedrijke univer- dat ook het bloed een rondgang maakt. siteiten van Europa. De navenante verandering in praktijk- Net als Copernicus had Harvey af te rekenen met eeu- voering blijft dan echter nog uit; pas decennia na Harveys wenlang aangehangen theorieën van filosofen uit de dood zouden Galenistische behandelingen als aderlating Oudheid. Geneeskundige theorieën en behandelingen worden losgelaten. waren hoofdzakelijk gebaseerd op beschrijvingen van Hippocrates en Galenus, meer dan 1500 jaar eerder. Ook het belangrijkste handboek voor de middeleeuwse arts, de Canon der Geneeskunde van Avicenna (980- 1037) –ook bekend onder zijn Perzische naam Ibn Sīnā – was gebaseerd op deze klassieke leer waarin de natuurfilosofie centraal stond. De door Hippocrates gedefinieerde 4 ‘humores’, ofwel lichaamssappen, stroomden volgens Galenus door 2 gescheiden vascu- laire systemen: de venen die hun oorsprong vonden in de lever, en de arteriën met hun oorsprong in het hart. Het bloed werd gesynthetiseerd in de lever, waarna een deel door een poreus interventriculair septum in het hart werd overgeheveld naar de arteriële circulatie. Tij- dens de relaxatiefase van het hart – die men indertijd als de actieve fase zag – werd het bloed vanuit de venen weggezogen naar het arteriële systeem, om als voeding te dienen voor de afzonderlijke organen.3 De beweging van het bloed werd in deze theorie mede mogelijk gemaakt door zelfstandig pulserende arteriën en veneuze kleppen die de bloedstroom naar organen en ledematen reguleerden. Harvey deed al vroeg in zijn loopbaan waarnemingen die hem ertoe brachten deze theorie te weerleggen.4 John Radcliffe Hospital, Nuffield Department of Clinical Hoe werd deze jonge arts een sleutelfiguur in de medisch- Neurosciences, University of Oxford, Oxford, Verenigd Koninkrijk. wetenschappelijke ontwikkeling in de periode na de mid- Drs. F.J. Wolters ([email protected]). deleeuwen? NED TIJDSCHR GENEESKD. 2013;157: A6715 1 NATUURFiloSooF EN empiriST de juiste connecties een plek aan het hof van koning William Harvey wordt op 1 april 1578 geboren in Fol- James I en diens opvolger Charles I te bemachtigen kestone in het Engelse graafschap Kent. Hoewel zijn (figuur 1).5 Deze maatschappelijke positie geeft hem de vader Thomas Harvey als handelaar kapitaal heeft ver- financiële armslag om onderzoek uit te voeren zoals gaard, staat de familie niet bijzonder hoog in aanzien in hem goeddunkt. Koning Charles I stimuleert Harveys 5 PERSPECTIEF de geldende klassenmaatschappij. Thomas Harvey werk onder meer door hem voor zijn experimenten de heeft echter grootse plannen met zijn oudste zoon en beschikking te geven over de kadavers van de jacht. wendt daartoe een aanzienlijk deel van zijn vermogen Het onderzoek waar Harvey zich op toelegt, behelst dis- aan om Williams studie aan het Caius College van de sectie en vivisectie van dieren in zijn eigen anatomisch Universiteit van Cambridge mogelijk te maken. Con- laboratorium (figuur 2). Deze experimenten vormen de necties binnen de invloedrijke sociale kringen spelen in basis voor zijn stapsgewijze weerlegging van de denk- die tijd een belangrijke rol bij het verwerven van acade- beelden van Galenus. Zo neemt Harvey – in navolging misch succes. De bachelorfase van Harveys studie in van Vesalius – onder meer waar dat het harttussenschot Cambridge opent de eerste deuren daartoe en is boven- niet poreus is, wanneer hij water injecteert in het rech- dien de sleutel tot zijn verdere geneeskunde-opleiding ter atrium na onderbinding van de arteria pulmonalis in Padua – op dat moment de tempel van de anatomie, en vena cava. Ook laat hij zien dat de hoeveelheid bloed met een anatomisch theater dat heden ten dage nog die het hart verlaat veel te groot is om dagelijks door de altijd in volle glorie te bewonderen is. lever te worden aangevuld – een opmerkelijk standpunt In deze Italiaanse stad ontwikkelt Harvey met Fabricius in een tijd dat kwantitatieve methoden nog allerminst als leermeester een stijl waarin de natuurfilosofie van geaccepteerd zijn.2 Tevens onderzoekt Harvey de func- Aristoteles samenkomt met empirische bewijsvoering. tie van de veneuze kleppen. Hij bindt bij proefpersonen Het belang dat Harvey aan beide scholen toekent, lezen de arm af en belemmert zo de doorstroming van de vena we terug in het voorwoord van de Engelse uitgave van brachialis. Harvey beschouwt het opzwellen van de dis- zijn Exercitationes de generatione animalium:6 tale venen als teken dat het bloed zijn normale gang niet ‘Whatever notable and approved thing we have in Philo- kan volgen, oftewel geen weg richting het hart kan vin- sophy, it all is derived onto us by the pains and industry den. Dat hij bij het strakker afbinden van de arm – en of ancient Greece. Yet when we content our selves with daardoor ook de dieper gelegen arterie – de distale arm their discoveries, and calmly believe (which is mere slee- niet ziet opzwellen maar bleek ziet worden, sterkt zijn piness) that there is now no more place for new inventi- overtuiging. Harvey besteedt geruime tijd aan het ver- ons, the spritely edge of our own wit languishes, and we fijnen van deze circulatietheorie, alvorens deze in 1628 extinguish the lamp which they lighted to our hands. te publiceren in De Exercitatio Anatomica de Motu And certainly he alone will grant, that the whole truth Cordis et Sanguinis in Animalibus – kortweg De motu was engrossed by the Ancients, who is ignorant of the cordis genoemd.2 many noble discoveries […] lately found out in the busi- ness of Anatomy. And this was chiefly done by […] those, who following Nature’s conduct with their own eyes […] attained to the highest pitch of Truth.’ Ondanks deze duidelijke erkenning van het belang van waarneming en experiment, maakt Harvey niet de over- stap naar het empirisme zoals Bacon in die tijd wed- ijvert. Op grond van de leer van Aristoteles is Harvey van mening dat elk experiment moet dienen ter bevesti- ging van teleologische redenatie. De drijfveer van Har- veys werk blijft de filosofie, getuige ook zijn veelvuldige verwijzingen naar Aristoteles.2,6 In 1602 promoveert Harvey in Padua tot ‘doctor medicinae’, waarna hij terugkeert naar zijn thuisland.7 DE circULATieTheorie FIGUUR 1 Een speciale postzegeluitgave uit 2010 ter ere van het House of Eenmaal terug in Engeland, vestigt Harvey zich in Lon- Stuart, waar William Harvey als lijfarts van koning James I en Charles I een den. Hier verwerft hij, met hulp van zijn schoonvader prominente plaats innam. Afgedrukt met toestemming van Stamp Design Royal dr. Lancelot Browne, een lidmaatschap van het prestigi- Mail Group Ltd. euze Royal College of Physicians.5 Tevens weet hij door 2 NED TIJDSCHR GENEESKD. 2013;157: A6715 later afvragen, hoe het mogelijk was dat een groots observator als Fabricius de waarheid niet zag, terwijl er ogenschijnlijk zovele aanwijzingen voor waren.15 Het is mogelijk dat onder invloed van de gewelddadige inquisi- tie in die tijd mannen als Fabricius en Lusitanus – die Joods was – in geschriften niet het achterste van hun PERSPECTIEF tong lieten zien. Tegelijkertijd was het dogma van Gale- nus zo diep geworteld, dat het een bijzonder frisse blik en groot vertrouwen in empirische waarnemingen moet hebben vereist om tot de nieuwe circulatietheorie te komen. VerSpreiding VAN de circULATIETheorie Ondanks zijn volwaardige alternatief voor de theorie van Galenus, ondervindt Harvey veel weerstand van de conservatieve academische wereld. De manier waarop hij zijn theorie presenteert, is dan ook van groot belang. Harvey deelt zijn waarnemingen veelvuldig met acade- FIGUUR 2 Harvey demonstreert met een hertenhart zijn circulatietheorie aan mische collega’s en studenten tijdens anatomische koning Charles I. Robert Hannah, 1848, olieverf op canvas, 80,6 X 91,4 cm, demonstraties.5 Het steevast daaropvolgende debat afgedrukt met toestemming van het Royal College of Physicians of London. geeft hem de gelegenheid
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