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Discovery in medicine.

To list and describe actual discoveries would be a monumental task; rather, I propose to look at the various ways in which discoveries are made, when they are made, what kind of person makes them, what can be done to facilitate the process, and, finally, what factors determine how discoveries are implemented into clinical practice. I will concentrate particularly on the past five or six decades, in which the pace of discovery has been remarkable. Initially, I would like to spend a few moments on the nature and circumstances of the discovery by William Harvey that "the movement of the blood is constantly in a circle and is brought about by the beat of the heart." Although it was a profoundly important discovery, in truth it is an essentially simple observation, simple in the sense that it is something that can now readily be taught to anyone with the barest rudiments ofbiological knowledge-a concept that the most junior medical students have little difficulty in grasping, a truth so simple that now one wonders why it took so long to be described. But it is important to remember that around the year 1600 medical thought and teaching had been dominated-indeed, petrified-for centuries by the teaching of Galen. As Voltaire was to observe later on the risk of challenging authority, "it is dangerous to be right in matters on which the established authorities are wrong." By the time Harvey arrived in Padua to study medicine in 1600 more enlightened anatomical views than those of Galen were beginning to have credence and these provided important preliminary steps for Harvey's work. He had the supreme good fortune to be the right man in the right place at the right time. Discovery is itself one of the bases for further discovery. We stand on the shoulders of those who have gone before and Harvey, with his lively and questioning mind, was particularly