Harveian Oration 2016: Some observations on the causes and consequences of obesity.

21 May 2018

The excitement of clinical science was first made apparent to me through the somewhat theatrical medium of the medical ‘grand round’. In the 1980s, at both Hammersmith Hospital and Oxford, where I undertook postgraduate training, the format was in its heyday. A junior doctor would present the history and clinical and investigative features of a patient with a puzzling illness. This was followed by a scholarly dissection of the key issues by the presenter, after which the chair and a distinguished audience would subject the arguments to forensic dissection. Not infrequently, ongoing research in laboratories within the hospital had actually generated new knowledge directly relevant to the patient and the audience would hear of these discoveries for the first time. It was a powerful vehicle for conveying the thrill of clinical science. It was, moreover, a form of discourse that William Harvey would have understood well. In endowing this lecture, he stipulated that the orator should ‘exhort the Fellows and Members of this College to search and study out the secrets of nature by way of experiment’.1 In the 17th century, non-invasive forms of medical science were limited in scope. Anatomical dissection was the principal tool and, of necessity, the only patients who could be subjected to that form of examination were those no longer alive. In his notes for the Lumleian Lectures, Harvey reminded himself ‘Not to praise or dispraise other anatomists, for all did well, and there was some excuse even for those who are in error’.1 That kind exhortation might bring a wry smile to those who remember the Hammersmith Hospital rounds of the 1980s, where impassioned clashes between the giants of medicine gathered there made the atmosphere more ‘Grand Guignol’ than ‘grand round’.