The Heart of Leonardo Francis C. Wells The Heart of Leonardo Foreword by HRH Prince Charles, The Prince of Wales Francis C. Wells Department of Cardio-Thoracic Surgery Papworth Hospital NHS Foundation Trust Cambridge United Kingdom ISBN 978-1-4471-4530-1 ISBN 978-1-4471-4531-8 (eBook) DOI 10.1007/978-1-4471-4531-8 Springer London Heidelberg New York Dordrecht Library of Congress Control Number: 2013937956 © Springer-Verlag London 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) For Joanna, Nicholas and Olivia semper proxime ad cor meum........ Foreword by HRH The Prince of Wales vii Foreword by Martin Kemp The twin peaks of Leonardo’s science both involved bodies – the human body and “the body of the earth”, as he called it. The wonderful drawings of the skeleton and muscles from around 1510, when the artist was in his late 50s and his studies of the heart from 1507 onwards yield to no-one in their acuteness of observation, alertness to function and beauty of representation. His hugely innovatory researches into the vast changes undergone by the body of the earth, culminating in the Codex Leicester of the same period, seem to us to belong to a different scienti fi c discipline. However, as Francis Wells deftly demonstrates, Leonardo was never constrained by what we might think of as separate fi elds of visual enquiry. His dissection of the old man – who claimed to be 100 years old – indicated that the centenarian’s “sweet death” was caused by the enfeebling of his blood supply, which had become tortuous and silted up like meandering rivers. The insights are those of a “master of water” as Leonardo was called, that is to say a hydraulic engineer, and came not least from his work on a great canal to bypass the non-navigable reaches of the Arno west of Florence. It was his observations as he traversed the Arno valley that convinced him that it was once the site of two ancient lakes, one high and one low, just as we see in the Mona Lisa . Via his studies of water courses, overground and underground, he comes to de fi ne a cycle of “circulation” in the “veins of water” within the earth’s body that was more radical than his views on the “circulation” of blood in the human body. As we discover, on the course of our journey with the author through the human body as envisaged by Leonardo, anatomy is never just a matter of anatomy as we conceive it. Every drawing by Leonardo is simultaneously an act of analysis as well as description. He cannot draw a form without intuitions about its function. To ascertain how a form works – with no de fi ciency or redundancy – he brings his knowledge of dynamics to bear on his accounts of structures in motion. He knows about weights, levers and pulleys, which he can apply to the functioning of the body. The skeleton and muscles serve as a compound machine, the mathe- matical trajectory of which enables humans to move their limbs with complete freedom in space – across what he calls a “continuous quality”. The complex motion of fl uids, above all water, to which he devoted minute and exhaustive attention, becomes vital to his reading of the actions of the heart valves, which he shows to be miracles of geometrical engineering. He can- not see what blood does in the valves, but he can transfer his knowledge of water vortices. He is a natural bio-engineer. Indeed, his plan to make a glass model of the neck of an aorta to test his notion of the internal currents of blood is entirely novel. He is determined to invent means to determine the “impetus” and “percussion” of the surging torrents of blood, even if he cannot see them fi rst-hand within the heart. We do not have to validate Leonardo’s science in terms of contemporary knowledge, nor do we have to evaluate it by adducing its in fl uence on the history of medicine. His visions of the human body and the body of the earth possess a beauty of insight that are uplifting in their own right, to no lesser degree than his works of art. And they stand as an enduring monument to an unconstrained quest for understanding across disciplines. However, it is thrilling to fi nd that he can still conduct a creative dialogue with a major heart surgeon over the span of 500 years. Francis Wells brings his clinical eye to bear upon drawings we have long admired, and points out major features that we little understood and telling details that we had entirely missed. ix x Foreword by Martin Kemp He shows that no organ had ever been subjected to such remorseless visual enquiry and func- tional interrogation as Leonardo devoted to the heart. The fruits of the dialogue across half a millennium go beyond the clari fi cation of Leonardo’s historical eye. How Leonardo looked and what he saw can still hold surprises for the most professional of specialists. His description of the mitral valve encouraged Francis Wells to look again, to re-ask a question that seemed long since to have been put to bed. The results are wonderful and surprising – even to someone like me who is used to being surprised by Leonardo. It is a privilege to realise that a man who lived so long ago and never brought his scienti fi c works to a published state can still live creatively today in the eyes, mind and hands of someone who really knows the geography of the human body. Martin Kemp Emeritus Professor of the History of Art Trinity College , Oxford , UK Preface The purpose of this book is to bring to a wider audience the astonishing work that Leonardo did in trying to understand the anatomy and physiology of the heart. This work was carried out at the end of his career as an investigator of anatomy. Note that I have referred to him not as an anatomist, but as an investigator of the human form, for his purpose was very different from that of the usual practitioners of this science. Unlike Vesalius and the many great anatomists who followed, Leonardo was a pupil of natural philosophy, interested in all of the natural world and in particular, in man’s place in the microcosm–macrocosm continuum that had exercised the minds of philosophers from Aristotle and Ptolemy to the Renaissance. Like Vesalius, however, he broke new ground in the positioning of the student of anatomy, from one who simply regurgitated the works of Galen to one who thought for himself using the evidence in front of him to describe the human form in new light. Until Vesalius—and here we have to discount Leonardo’s contribution, as he did not publish any of his work—the anatomy professors read from the works of Galen; once a year a body was dissected by a prosector and the parts were demonstrated to the students of medicine by the Demonstrator. Needless to say, the marriage of dictat and observations was not a happy one. Vesalius broke new ground in becoming the dissector, the recorder, and the demonstrator all rolled into one, turning the art into a science. Leonardo did the same thing, but his was work done in private and never released to the academic fraternity at large through publication. We may suppose that even if the work had been published, it would hardly have been accepted from one who lacked a formal educa- tion and was viewed as an artist and engineer. It is even more startling, then, to discover in Leonardo’s works descriptions of form and function of this immensely complex organ that continue to speak to those of us who work with it every day. Many of his insights, such as the description of the closure mechanism of the arterial valves, pulmonary and aortic, hold true today and indeed were unravelled only in the modern era by two Oxford engineers who published their fi ndings in Nature with only one reference—to Leonardo da Vinci! This book includes chapters on Leonardo’s life and times and the state of anatomy in his time.