Free Heart: An American Medical Odyssey by Dick Cheney, Jonathan Reiner

and vital spirits; blood was propelled by inspiration; and the pulse was caused by contraction of the arteries.
    Even Leonardo da Vinci, whose detailed dissections and subsequent drawings so elegantly depicted the anatomy of the heart, could not break with the Aristotelian and Galenic view of the purpose of the heart, though he came close to articulating its role in circulation when he wrote, “The heart is the seed which engenders the tree of the veins.”
    William Harvey, an English physician born in Folkestone, Kent, on April 1, 1578, had a different idea, and in 1628 he published a ninety-page book, On the Motion of the Heart and Blood in Living Beings (De Motu Cordis) . In the introduction to an 1889 English translation from the original Latin, Alexander Bowie succinctly summarizes Harvey’s theory:
    That there is one blood stream, common to both arteries and veins; that the blood poured into the right auricle, passes into the right ventricle;that it is from there forced by the contraction of the ventricular walls along the pulmonary artery through the lungs and pulmonary veins to the left auricle; that it then passes into the left ventricle to be distributed through the aorta to every part of the animal body; and that the heart is the great propeller of this perpetual motion, as in a circle; this is the great truth of the motion of the heart and blood, commonly called the circulation, and must forever remain the glorious legacy of William Harvey.
    Although Harvey describes for the first time the physiology of the circulatory system, he does not refute the heart’s incorporeal role:
    The heart of animals is the foundation of their life, the sovereign of everything within them, the sun of their microcosm, that upon which all growth depends, from which all power proceeds.
    Until the twentieth century, entry to the heart, be it accidental, intentional, or surgical, was believed to lead to certain death. In 1902, the surgeon Harry Sherman described the heart:
    An organ . . . particularly vulnerable—in fact, so vulnerable that any interference, even for surgical purposes, might be followed by immediate fatal results.
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    In 1929, Werner Forssmann, a German physician, set out to challenge the dogma that declared the heart sacrosanct. Forssmann, twenty-five years old at the time, was interested in finding a safe route into the chambers of the heart. Although studies in cadavers demonstrated the technical feasibility of his idea, Forssmann’s hospital chief forbade him from performing the experiment on a patient. Undeterred, Forssmann decided to perform it on himself. In a now legendary and visionary display of both arrogance and bravery, a colleague placed a large-bore needle into the brachial vein of Forssmann’s right arm and then advanced a well-lubricatedureteral catheter a short distance. A week later, now without assistance, Forssmann anesthetized his own left arm, punctured a vein, and inserted the catheter its entire sixty centimeters length. In a 1929 paper describing his experiment, Forssmann wrote:
    I checked the catheter position radiologically, after having climbed stairs from the OR to the radiology department. A nurse was holding a mirror in front of the X-ray screen for me to observe the catheter advance in position. The length of the catheter did not allow further advancement than into the right atrium. I paid particular attention to the possible effects on the cardiac conduction system, but could not detect any effect.
    Forssmann’s maverick work proved that an intrusion into the heart need not be deadly and thus unlocked the door to the heart.For the next quarter-century, other physicians, including Dr. André Cournand and Dr. Dickinson Richards of Columbia University (who would share the Nobel Prize with Forssmann in 1956), refined Forssmann’s technique, conducting hemodynamic and dye studies within the cardiac chambers that exponentially expanded knowledge of the structure and