The Man Who Touched His Own Heart

by Rob Dunn

  3. Few of the details of da Vinci’s childhood were directly recorded, and so most, including exactly where he was born and when he moved, are subject to debate.

  4. It is likely that da Vinci’s father paid Verrocchio a modest sum to train da Vinci, but Verrocchio would have had to house and feed da Vinci, both of which were possible only because of the demand by the wealthy for great and ambitious art.

  5. Da Vinci was aware he was doing a better job than anyone else; for instance, he described Michelangelo’s nudes as “nutcracker men” and begged other artists not to copy Michelangelo’s poor understanding of the body.

  6. At least in the context of a book about the heart.

  7. M. Kemp, “Dissection and Divinity in Leonardo’s Late Anatomies,” Journal of the Warburg and Courtauld Institutes 35 (1972): 200–25. See also Keele’s beautiful treatise on da Vinci titled Leonardo da Vinci on the Movement of the Heart and Blood (London: Harvey and Blythe, 1952).

  8. Francis Wells, “The Renaissance Heart,” in J. Peto, ed., The Heart (London: Wellcome Collection, 2007).

  9. It was a sentiment that would cause tensions with the Church. The Church allowed dissections but based on the premise that the body was just a vessel for the Holy Spirit. The vessel was all right to study, but inasmuch as da Vinci thought the actual forces of the body could be understood, his work was at odds with the Church’s teaching, sacrilegious even.

  10. Keele, “Leonardo da Vinci’s Views on Atherosclerosis.”

  11. B. J. Bellhouse and F. H. Bellhouse, “Mechanisms of Closure of the Aortic Valve,” Nature 217 (1968): 86–87.

  12. Da Vinci’s science stemmed from his art, but his art was also constantly influenced by his science. In his deluge drawings of the flooded river Arno, da Vinci drew eddies in the river, and I have the sense that he drew them with both the river and the heart in mind.

  13. Artists, including da Vinci’s mentor, had been dissecting human bodies across southern Europe at this time, but they were focused on the muscles and bones. They did not typically even approach the organs with their knives, much less consider their functions.

  14. For a nice summary of our modern perspective on da Vinci’s contributions to the heart, see M. M. Shoja et al., “Leonardo da Vinci’s Studies of the Heart,” International Journal of Cardiology 167 (2013): 1126–38. Among the hypotheses advanced in this work is the idea that da Vinci was prevented from discovering the circulation of the blood not by some intellectual barrier but instead because he was a bit flaky and incredibly busy. The authors reference Stefan Klein, who wrote, in Leonardo’s Legacy, “Leonardo was pursuing so many interests that he could rarely take full advantage of his chance to solve any particular problem; he simply lacked the time to do so. In cases where an additional experiment would have given him more precise information, he was already moving on to the next unknown territory. And because he was working for himself, rather than for others, he did not devote much time to the issue of publishing his findings.”

  15. See K. D. Keele, “Leonardo da Vinci’s Influence on Renaissance Anatomy,” Medical History 8 (1964): 360–70.

  16. It is possible that in the Mona Lisa’s face, there lurks something else germane to this book—a genetic defect. The Mona Lisa’s eyes are yellowed, unusually so, even among depictions of the time. It has been argued that the model for the Mona Lisa had such yellow eyes because she suffered from familial hypercholesterolemia, a genetic disorder in which cholesterol levels are many times higher than in most humans. If so, this was just one more truth da Vinci’s paintbrush recorded, a truth he recorded without even being aware of it.

  4. Blood’s Orbit

  1. J. Sawday, The Body Emblazoned: Dissection and the Human Body in Renaissance Culture (New York: Routledge, 1995). See also K. Park’s gruesomely fascinating article “The Criminal and the Saintly Body: Autopsy and Dissection in Renaissance Italy,” Renaissance Quarterly 47 (1994): 1–33.

  2. Vesalius was very avid. Hallam says of Vesalius and his friends, “They prowled by night in charnel-houses, they dug up the dead from the graves, they climbed the gibbet, in fear and silence to steal the mouldering carcase of the murderer; the risk of ignominious punishment, and the secret stings of superstitious remorse, exalting, no doubt, in the delight of these useful but not very enviable pursuits.”

  3. It was to be one of the three great books published between 1543 and 1546 by scholars trained in medicine in Padua. The other two were Nicolaus Copernicus’s De Revolutionibus Orbium Coelestium, in which the author argued the earth circled the sun, and Hieronymus Fracastorius’s De Contagione et Contagiosis Morbis, one of the first substantive works on pathology.

  4. A. Castiglioni, “Three Pathfinders of Science in the Renaissance,” Bulletin of the Medical Library Association 31 (1943): 301–7.

  5. This includes his work on anatomy, which survived thanks to just three copies, one of which Harvey appears to have seen.

  6. A botanist/anatomist from Pisa, Cesalpino (1524–1603), had already done the reverse of this experiment, pinching veins and observing that when he did so, the vein below (away from the heart) rather than above the pinch swelled, suggesting that the blood in veins was moving toward the heart.

  7. In truth, the average body contains 5.2 liters of blood, five big soda bottles’ worth. Every minute, nearly all of this blood passes through the heart, and this rate (5 liters/minute) goes up sixfold during exercise, to about 30 liters/minute.

  8. This is part but not all that moves, thanks to the heart, through blood. Blood is composed of plasma (which is mostly water), red blood cells (which carry oxygen and carbon dioxide), and a variety of necessary substances and features. Hormones travel through the blood, bearing messages from one part of the body to another. Heat moves through the body via blood, which is warmer than the rest of the body. Nutrients also move in the blood, whether sugars, fats, vitamins, or minerals, as do wastes such as urea and valuable proteins that aid in the immune response. The blood is the body’s road of many uses.

  9. Just when the first life turned up is actively debated. For the most recent salvo in the debate, see S. Moorbath, “Paleobiology: Dating the Earliest Life,” Nature 434 (2005): 155.

  10. R. E. Blankenship, “Early Evolution of Photosynthesis,” Plant Physiology 154 (2010): 434–38.

  5. Seeing the Thing That Eats the Heart

  1. Which, as often as not, is atherosclerosis.

  2. In 1879, three French physiologists had done an experiment in which they inserted a catheter through the jugular vein of a horse, up through the vein, and into the horse’s enormous heart. At its tip, the catheter had a balloon that could be inflated. The pressure on the balloon due to the horse’s contracting ventricle was then used to test whether or not the ventricle contracted actively, which it did. In and of itself, this story is amazing, not least because it means that in 1879, people still did not understand the rough dynamics of the heart’s pump. One of these physicians, Bernard, published a book on it, Leçons de Physiologie Opératoire. It was in this book that Forssmann saw the drawing.

  3. This detail comes from Renee and Don Martin’s The Risk Takers. Like much about Forssmann, it is a bit hard to confirm. Forssmann seemed uncomfortable in his skin and as a consequence told different versions of stories on different occasions. The most common version of his story derives from his published paper, and in later years, he claimed that this version (which made him look less reckless than he really was) had been a lie. I suspect that Forssmann was telling the truth later on and was lying in his youth, though it is possible it is the other way around.

  4. Coronary artery disease was first described in 1768 by William Heberden, an English physician who, upon doing an autopsy on his good friend John Fothergill, another physician, observed his diseased coronary arteries and linked them to the chest pain, angina, Fothergill had felt just before his death of what we now call a heart attack. But it wasn’t until Forssmann’s generation that people began to realize just how common the
disease was.

  5. Two decades later, Forssmann did try his experiment on rabbits and when he did, it killed them. They went into immediate cardiac arrest. Had he begun with rabbits, the lesson he would have learned was that heart catheterization was always dangerous, deadly even.

  6. W. Forssmann, Experiments on Myself: Memoirs of a Surgeon in Germany (New York: St. Martin’s Press, 1974).

  7. H. C. Orrin published a breathtaking book titled The X-ray Atlas of the Systemic Arteries of the Body. In it, he showed the blood vessels through x-ray photos. His was an update to Vesalius’s drawings of the body, but one based purely on observations. Here it is, revealed, the images announced. One could do nothing but look on with awe.

  8. M. C. Truss, C. G. Stief, and U. Jonas, “Werner Forssmann: Surgeon, Urologist and Nobel Prize Winner,” World Journal of Urology 17 (1999): 184–86.

  9. Yes, he really said this. He is actually the one who put it in print.

  10. Quotes come from Forssmann, Experiments on Myself.

  11. Roentgen discovered x-rays in 1895, but for the first years, it proved more useful as a tool of discovery in the study of cadavers than as a diagnostic tool in hospitals. With x-rays, the seemingly invisible could be made visible, especially, as in the case of cadavers, if the “patient” could hold still for the many minutes the early x-rays took. In 1920 a book by Orrin, The X-ray Atlas of the Systemic Arteries of the Body, was published in England, showing x-rays of cadavers who’d had dye injected into their blood vessels. The resulting imagines were arguably the first significant progress in depicting the arteries and veins since the work of Harvey and Malpighi in the late 1600s. Suddenly, the secret passages of the body were revealed, layered on top of one another. The book, like many advances in our understanding of the cardiovascular system, was as much art as science.

  12. What exactly happened in the x-ray room has been retold in many different ways. Certainly the x-ray was taken. Romeis was present and angry. Forssmann might have kicked Romeis; he might not have. The x-ray technician might have objected; she might not have. Forssmann might have let out a barbaric yowl when he saw the catheter in his heart, a groaning yelp of accomplishment; he might not have. Whatever happened, the catheter made it to his heart, and a picture was snapped.

  13. In this paper, Forssmann would fabricate a series of stories about the procedure in order to make it seem less radical than it really was.

  14. Somewhat ironically, beginning in the 1930s, the first efforts to build on Forssmann’s successes used his method to study cardiac output in human patients, just as had been done in the study that led to Forssmann’s cherished image of the catheterized horse.

  15. Forssmann would work to save Nazi soldiers and then, when he began to realize the full horrors of the war, those threatened by the same soldiers. Forssmann witnessed and, by his own account in his autobiography, tried to stop the shooting of six hundred Russian peasants on Whitsunday in 1942.

  16. Forssmann’s Nobel Prize acceptance speech can be read on the Nobel Prize website.

  17. Interestingly, Forssmann had an even more ignored antecedent. In 1831, Johann Dieffenbach put a catheter into the heart of a patient dying of cholera to drain away excess blood. Or so he says. Without producing an x-ray, Dieffenbach receives little credit for being first. It was also difficult for him to inspire his own colleagues to believe that such an endeavor was possible or reasonable.

  18. Sones seems to have been all these things from an early age. He studied medicine at the University of Maryland, where his professor informed him cardiology was “a nothing specialty” in which there would “never be any great discoveries.” This convinced Sones to study cardiology and to make great discoveries.

  19. According to David Monagan’s Journey into the Heart: A Tale of Pioneering Doctors and Their Race to Transform Cardiovascular Medicine (New York: Gotham Books, 2007), Sones was sometimes so eager to dictate case reports that he would kick in the ladies’ room door and yell to the secretaries (who might or might not have been inside), “Type, type, type.”

  20. For more on the personality of Sones, see Monagan, Journey into the Heart.

  21. From a chapter on Sones, “The Way to a Human’s Heart,” in D. Robinson, The Miracle Finders: The Stories Behind the Most Important Breakthroughs of Modern Medicine (New York: David McKay, 1976).

  22. By all accounts, Sones’s disregard for rules and social norms was equaled only by his regard for rigorous work and for doing that work oneself. Sones started his career at Cleveland Clinic in a small, third-floor office but before long his territory had greatly expanded, in part because he worked when everyone else was sleeping, pushed out of the way anyone who was in the way, and, by force of will, did things right. Young doctors in training often admired Sones but seldom could keep up with him. See, for example, W. C. Sheldon, “F. Mason Sones Jr.—Stormy Petrel of Cardiology,” Clinical Cardiology 17 (1994): 405–7. Sheldon also reports on Dr. William Proudfit’s summary of the rules by which Sones lived, which were:

  Be honest

  Nothing is good enough

  Find an expert

  Don’t read (or write)—if you must write don’t use semicolons

  Don’t calculate

  Don’t rely on gadgets

  Don’t watch the clock

  Don’t repeat experiments indefinitely

  Concentrate on the problem

  Simplify the problem

  Make a decision

  Communicate

  23. F. M. Sones, “Cine Coronary Arteriography,” Modern Concepts in Cardiovascular Disease 31 (1962): 735–38.

  24. G. A. Lindeboom, “The Story of a Blood Transfusion to a Pope,” Journal of the History of Medicine and Allied Sciences 9 (1954): 455–59.

  25. There had been attempts at more ambitious surgeries. In 1925, London surgeon Henry Souter attempted a valve repair. He cut through the pericardium, through the heart, and into the atria. Once in, he put his finger into the patient’s inflamed mitral valve (and through into the left ventricle). As he began to sew up the valve, the heart started to flutter. It spat blood. Everything went wrong. In a panic, somehow Souter sewed the heart back up (without fixing anything), and the girl lived, but this story chastened many of those who imagined undertaking ambitious surgery.

  26. There has always been someone willing to oppose progress on the heart, so it is perhaps understandable that voices of reason were ignored.

  6. The Rhythm Method

  1. The full quote, which is worth a read for its unusual earnestness in a scientific paper, can be found in J. H. Gibbon, “The Development of the Heart-Lung Apparatus,” Review of Surgery 27 (1979): 231–44.

  2. Gibbon appears to have been liked by nearly everyone. Rudolph Camishon said of him, “This gem of a man glistens most radiantly.” He was kind and eager to do good in the world. As David Cooper wrote, he was “the tabloid press’s nightmare, the paparazzi’s despair, for it almost impossible to find anyone who has any criticism of him. To a large extent, he seems faultless and unblemished.” D. K. C. Cooper, Open Heart: The Radical Surgeons Who Revolutionized Medicine (New York: Kaplan Publishing, 2010).

  3. John’s great-great-grandfather was John Hannum Gibbons (with an s). Gibbons was born in Chester County, Pennsylvania, but educated in Edinburgh, Scotland, the site of the most notorious body snatching in history in later years, all in the name of anatomy. In addition to his direct line of descent from doctors, Gibbon had physicians scattered around his family more generally: uncles, great-uncles, and the like. One of John Gibbon’s nephews is now a doctor. It is what the Gibbons did and do. It seems unlikely he ever had a chance of convincing his parents to let him write, though it seems as though he had a great deal to write about.

  4. Many details of Gibbon’s life derive from the National Academy biography found here: http://www.nasonline.org/publications/biographical-memoirs/memoir-pdfs/gibbon-john.pdf.

  5. J. H. Gibbon, “The Maintenance of Life During Experimental Occlusion of t
he Pulmonary Artery Followed by Survival,” Surgery, Gynecology and Obstetrics 69 (1939): 602.

  6. F. D. A. Moore, A Miracle and a Privilege: Recounting a Half Century of Surgical Advance (Washington, DC: John Henry Press, 1995). At about this time, a group of scientists that included Francis Moore visited the lab. Moore described a scene that was probably similar to how Jack and Maly had spent much of the last ten years of their professional life: “We were ushered into the operating room… The pump oxygenator was approximately the size of a grand piano. A small cat, asleep on one side, was the object of all this attention. The cat was connected to the machine by two transparent blood-filled plastic tubes. The contrast in size between the small cat and the huge machine aroused considerable amusement among the audience… we began to sense that we were not walking on a dry floor. We looked down. We were standing in an inch of blood. ‘Oh, I’m sorry,’ said Gibbon, ‘the confounded thing has sprung a leak again.’ ”

  7. For more on Alibritten, a hero in his own right, see K. D. Hedlund, “A Tribute to Frank F. Alibritten Jr.: Origin of the Left Ventricular Vent during the Early Years of Open-Heart Surgery with the Gibbon Heart-Lung Machine,” Texas Heart Institute Journal 28 (2001): 292–96.

  8. Gibbon met Watson because he was the father-in-law of one of his colleagues.

  9. Equivalent to about $255,581 in 2013, accounting for inflation.

  10. Replicating a human lung is not trivial. The capillaries in the lungs absorb oxygen (and release carbon dioxide) over a surface area of six hundred square feet (above the size of a tennis court) but do so in a volume no larger than a small loaf of bread. More generally, the body has layer upon layer of maximized internal surface area. The surface area of the lungs is immense, thanks to branching bronchi. The surface area of the capillaries is immense, thanks to their own branching. But even inside cells, surfaces are expansive. Mitochondria, those creatures within our cells, are built of folded membranes that allow each individual mitochondrion to have a surface area manyfold greater than would be the case for a sphere of the same diameter, in order to better allow them to burn oxygen. A similar convolutedness is found in other organs, including the kidneys, liver, and intestines, where having more surface area is beneficial.