Abstract

For more than 50 years the Guy's Hospital physician Frederick Pavy attempted to discredit the theory of his erstwhile teacher, Claude Bernard, that liver glycogen was broken down to supply sugar to the systemic circulation. His opposition was driven by his clinical perceptions and was based on two assumptions: the first was that the kidney was a simple filter through which small molecules would diffuse, so that sugar had to be prevented from reaching the systemic circulation. For Pavy, the liver was the barrier. The second was teleological: he could not believe that nature would operate in what he saw as a defective way, i.e. converting sugar into glycogen and then back again. At the beginning of his long working life Pavy regarded himself as a physiologist and was critical of the stagnancy of English physiology which was kept afloat by amateurs like himself in whatever time they could spare from busy private practice. At the end he came to see his own view of carbohydrate metabolism as symbolic of the schism between responsible clinicians and irresponsible daydreaming physiologists