Richard Lower

English physician and physiologist

• Born: January 29, 1631 (baptized)
• Birthplace: Tremeer, near Bodmin, Cornwall, England
• Died: January 17, 1691
• Place of death: London, England

Lower was one of the first scientists to conduct rigorous studies of injection and blood transfusion and is known for his advances in cardiology, respiratory physiology, neuroanatomy, and medical instrumentation. Working in the tradition of William Harvey and Thomas Willis, he vigorously defended his teacher Willis against all criticism.

Early Life

Richard Lower was baptized at Saint Tudy’s, Cornwall, on January 29, 1631. His parents, Humphry Lower and Margery Billing, were wealthy landowners. As a student from 1643 to 1649 at the prestigious Westminster School in London, Lower earned commendation from the headmaster, Richard Busby. Busby sent Lower on a studentship to his own alma mater, Christ Church College, Oxford University. Lower arrived at Oxford in 1649, matriculated in 1651, and received a B.A. in 1653, an M.A. in 1655, and both a B.Med. and a D.Med. in 1665. In 1666, he married Elizabeth Billing, with whom he had two daughters, Loveday and Philippa.

At Oxford, Lower studied chemistry under Peter Stahl and was the student, assistant, and protégé of Thomas Willis , the leader of the “Oxford physiologists,” investigators in the spirit of William Harvey . With Willis, he studied mostly the nervous system. He also worked closely with Robert Boyle on the circulatory and respiratory systems and on various chemical problems in physiology. Lower’s other research collaborators at Oxford included Ralph Bathurst, Robert Hooke , John Locke , John Mayow, Thomas Millington, Walter Needham, Sir William Petty , Henry Stubbe, John Wallis , John Ward, and Sir Christopher Wren.

Lower was especially skilled as an anatomist. He and his Oxford colleagues performed thousands of postmortem dissections of humans and vivisections of animals. Historians generally agree that Lower performed most of the dissections upon which Willis based his groundbreaking book, Cerebri anatome (1664; The Anatomy of the Brain , 1681). This work was the joint project of Lower, Millington, Wren, and Willis, despite the fact that Willis took primary credit for it.

Life’s Work

Lower’s contributions to medicine and science can best be understood in terms of his discipleship to Willis. In the mid-seventeenth century, a bifurcation existed between bioscientists who were loyal to Galen and those who were persuaded by Harvey’s new physiology, especially his views of circulation. The Oxford physiologists, led by Willis, were all Harveians. In 1665, Edmund Meara, a resolute Galenist, viciously attacked Willis in Examen diatribae Thomae Willisii de febribus (1665; an examination of the discourse of Thomas Willis on fevers). Lower reacted quickly and strongly to defend his mentor, putting out his first publication, Diatribae Thomae Willisii de febribus vindicatio (1666; a vindication of the discourse of Thomas Willis on fevers), only four months after Meara’s book.

Lower’s Diatribae Thomae Willisii de febribus vindicatio did more than just counterattack Meara. It also endorsed Boyle and Harvey, presented new facts and a specific research agenda for blood physiology, and correctly analyzed recent observations on lung function, heart-lung interaction, arterial and venous blood, and the relation of respiration to blood color. In retrospect, the work demonstrates that Lower was among the first properly to understand the cardiac cycle and pulmonary circulation.

Lower moved to London to establish a private medical practice in 1667, following Willis, who had moved there in 1666. The two continued to work together on several projects, but after moving to London, Lower gradually did less research and more clinical work. In 1675, he was elected a fellow of the Royal College of Physicians and succeeded Willis as physician to the king. His opinions upon the heated debate over whether to allow the Roman Catholic James, duke of York, to remain next in succession to the throne, however, soon created political enemies. Lower favored the 1679 attempt to remove James from the line of succession, earning for himself the label of a Whig. As a result, the status he had inherited from Willis as London’s leading physician evaporated as his aristocratic patients abandoned him.

In the 1650’s, the Oxford physiologists, especially Willis, Lower, Wren, and Boyle, experimented with using needles and quills as lancets to inject various substances, not including blood, into animals. Boyle and Lower were particularly interested in analyzing three specific results of injection: the effect on the life and health of the animal, the effect on respiration, and any changes in the color and consistency of the blood.

On the strength of articles published in Philosophical Transactions of the Royal Society between 1665 and 1667, Lower is generally considered to be the first person to perform successful blood transfusions, although early research in this area predated Lower’s work by several generations. From early in the seventeenth century, several surgeons and other medical investigators, mainly on the European continent, had suggested and sometimes tried injecting or transfusing blood to rejuvenate the old, heal the sick, or invigorate the exhausted, either by putting blood from young into old humans or from healthy animals into diseased humans. In 1615, German physician and alchemist Andreas Libavius had specifically advocated transfusion for these purposes. His idea slowly came into practice in the mid-seventeenth century throughout western Europe, especially after Giovanni Colle performed transfusion experiments in the 1620’s. The earliest experiments transfused blood from animal to animal, then from animal to human, and finally from human to human.

Lower improved on these early experiments, refining both the instrumentation and the technique of blood transfusion in the early 1660’s. He published the results of his dog-to-dog transfusions in Philosophical Transactions of the Royal Society in 1665. Meanwhile, Jean Baptiste Denis in Paris and Giovanni Guglielmo Riva in Rome were doing similar research. Denis performed the first blood transfusion into a human in June, 1667, using the blood of a sheep. The patient barely survived, and the experiment was considered unsuccessful.

In November, 1667, Lower and Edmund King, who had duplicated some of Lower’s transfusion results in 1666, successfully performed a sheep-to-human transfusion on Arthur Coga. The plan was that the boisterous Coga would become in temperament more like the lamb, a placid animal, by receiving its blood. Coga did not calm down, but he did not die either and even claimed to feel better. Lower was skeptical about the therapeutic value of just one transfusion and wanted to continue treatments, but Coga refused. Lower’s success in transfusion, though limited, earned him election to the Royal Society in 1667. The following year, however, a man named Antoine Mauroy died after Denis transfused him with the blood of a calf. Even though Denis was acquitted of manslaughter in Mauroy’s death, the adverse publicity generated by the incident effectively ended transfusion research for the next 150 years. The almost universal failure of these experiments led to prohibitions by British scientists in 1668, the Roman Catholic Church in 1669, and the French government in 1678.

Until 1741, however, revised editions of a standard surgical textbook by Johannes Scultetus, Armamentarium chirurgicum (1655; arsenal of surgery), contained an illustrated chapter on transfusion that described the work of Lower and Denis in detail. Although Scultetus himself probably never tried transfusion and died in 1645, before Lower’s first experiments with it, his posthumous editors apparently thought that the technique was important enough for surgeons to learn, despite the bans. Nevertheless, blood transfusion as either serious science or medical therapy was not revived for mainstream medicine until James Blundell invented a practical transfusion apparatus early in the nineteenth century.

Significance

Lower’s contributions to medicine and bioscience consist mostly of minor discoveries and inventions that became the basis of more important discoveries and inventions by later scientists. The new direction that his experiments with subcutaneous and intravenous injections took around 1662 led him to improve the design of syringes and laid the groundwork for the invention of the hypodermic syringe around 1850 by Charles Gabriel Pravaz and Alexander Wood.

Lower’s Tractatus de corde (1669; A Treatise on the Heart , 1932) included the first accurate description of the detailed anatomy of heart muscle, an improvement on Harvey’s account of blood circulation, and theories about why arterial blood and exposed blood are red while venous blood is blue. A Treatise on the Heart is Lower’s greatest work, and made him famous in cardiology. A digressive chapter in it, “Dissertatio de origine catarrhi” (“A Dissertation on the Origin of Catarrh”), demonstrated that mucus drips from inside the nose and not, as had been traditionally thought, into the nose from the brain.

Bibliography

Felts, John H. “Richard Lower: Anatomist and Physiologist.” Annals of Internal Medicine 132, no. 5 (March 7, 2000): 420-423. A clear and accurate outline of the basic facts of Lower’s life and scientific career.

Frank, Robert Gregg. Harvey and the Oxford Physiologists: A Study of Scientific Ideas. Berkeley: University of California Press, 1980. This standard work devotes much attention to Lower and places his life’s work clearly within its historical context.

Lower, Richard. A Treatise on the Heart. Translated by K. J. Franklin. Birmingham, Ala.: Classics of Medicine Library, 1989. A reissue of Franklin’s 1932 critical edition of Lower’s masterpiece.

Moore, Pete. Blood and Justice: The Seventeenth-Century Parisian Doctor Who Made Blood Transfusion History. Hoboken, N.J.: Wiley, 2003. Although its subject is Denis, not Lower, this semifictionalized account of governmental, legal, and religious opposition to blood transfusion in Louis XIV’s France provides an interesting interpretation of the early days of blood transfusion in England as well.