the lancet 100 years ago
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I believe that freer movement across these functionalbarriers would solve many of our present difficulties.Some men will do their best work as investigators,some as teachers, and some in applying their labora-tory technique to clinical or public health problems.But it is not always clear at the start where a man’sgifts lie, and a change of work and experience, afew years’ teaching for the research worker, a fewyears’ continuous research for the teacher, and so
on, would keep open paths that are closed by pre-mature limitation to one field of activity.In addition to trying to abolish such barriers as
already exist we must, if we can, prevent the erectionof new ones. To take one example, clinical science,which bears, I take it, the same general relation toclinical practice that academic bears to appliedpathology, is rightly and rapidly developing alonglines of its own. This movement is, perhaps, themost important, and the most hopeful, of the manysigns that the medical sciences are developing thatelusive entity known as a Group Mind. It is not,I think, altogether fanciful to note the growingevidence that the individual mind, for its healthyfunctioning, depends much less than we had supposedon localised and specialised areas of activity, andmuch more on the effective integration of cerebralactivity as a whole. To ensure such integration inthe growing mind of medicine we must ensure thatthe morbid anatomist, bacteriologist, or biochemistwho works, for the time being, in a department ofclinical science, is not separated in any way from hiscolleagues who work in the departments that are
labelled morbid anatomy, bacteriology, or bio-
chemistry.The crux of the matter, I believe, is this. No man
can compass the range of the medical sciences ;but we can, if we choose, develop a common tradi-tion, a common background of knowledge, and acommon way of thought. We can do this best bybreaking down existing barriers and erecting no
new ones ; and by training those who come after usto respect scientific method, which includes accurateand critical observation, rather than to acquire, andthen forget, an arbitrary collection of unrelated factand theory.
I may seem to have gone far beyond the limitedfield of pathology ; but I believe that it is along theselines that pathology itself can best develop, andcan best serve the medical sciences as a whole. Itstretches so far, from the ward and the post-mortemroom to the departments of physiology, biochemistry,and anatomy, that it must exert either an integrativeor disintegrative effect. I have tried to indicate that
pathology, in the course of its development, hasfaced its own problems, and devised its own waysof solving them ; but I believe that we shall bestserve medicine, and ourselves, by not stressing toostrongly the particular technical methods on whichwe have relied in the past, and by a willingness todiscard labels, or disregard them. If no one coulddefine a pathologist except as a person who wasengaged in studying the mechanisms of disease,pathologists would not cease to exist ; nor wouldtheir work decrease in significance or value. Ifinstitutes of pathology housed workers who would,under our present conventions, be regarded as
physiologists, or pharmacologists, or biochemists,as well as morbid anatomists and bacteriologists,and if to these could be added others whose usuallabel would be clinicians, we should, I think, notonly increase the value of the work done in theseinstitutes themselves but provide the personallinks that alone make possible effective cooperation.
For such a development to be fully effective therewould, I think, have to be free and frequent inter-change. It would become a matter of temporaryconvenience whether a man worked in the depart-ment of physiology or the department of pathology,or whether another chose, for the moment, to regardhimself as a bacteriologist or a biochemist. It wouldbe essential that there should be no prescriptiverights to senior posts, that a man should not, becausehe chose to wander between two or more depart-ments, be debarred from normal promotion in anyone of them. I do not think that this is an
impossible solution of our difficulties ; indeed,many of the suggestions I have made are no morethan descriptions of what, in some places, is
happening already.There is one factor on which the success of all such
dreams depends, and that is the personal one.
Cooperation can never be forced, though it can be
encouraged. By Kettle’s death we have lost one ofour number who had the gift of true cooperation atits best. He had the widest interests and the widest
sympathies, and was always able to view his ownproblems in relation to those of others. A masterof his own craft, he loved good work wherever itwas done, and had a wonderful gift for telling goodfrom bad, even in subjects widely separated from hisown. He was always ready to help those who werewilling to help themselves, though be had littlepatience with those whose idea of cooperation wasthat somebody else should do their work for them.His courage, patience, cheerfulness and under-standing made it easy for those who worked withhim to face without boredom or fatigue the dull
patches and the disappointments that come to all
investigators, while any discovery shared with himgained in interest and excitement. He could becritical without any touch of discouragement, andhe was generous to a fault, especially towards youngermen. His last years were spent in laying the founda-tions of the pathological department of the BritishPostgraduate Medical School, and in the last few
days of his life he was thinking of its interests. Hehas left behind him a memory and an example thatnone of us will forget.
THE LANCET 100 YEARS AGO
December 1st, 1838, p. 381.
From the revi,e2u column.
The Medical Annual or, British Medical Almanack,1839. Edited by WiLLran2 FARR. To be continued
annually. London: Sherwood. pp. 224.
WHEN works of this description are executed with
sagacity, research, and industry, they become treasuresof no ordinary value to the members of our profession....In the contents of the present Annual we find a Calendar ;Tables of Heat and Dryness for the last ten years;Information relating to all the chief Hospitals, Infirmaries,Medical Colleges, Boards, Schools, and Societies, the
Universities, and Lunatic Asylums ; a Paper by a Clergy-man on the Misarrangements and Arrangements of
Hospital Staffs ; A History of the Medical Profession ;Statistics of the Kent Hospital ; A Paper on the Pathologyof the Heart; one on American Temperance ; one on
the Mortality of Cholera ; one on the Diseases of the Army ;and one on Private Medical Practice.... vVe shall make from it a few extracts on another
occasion, and in the mean time cordially introduce thevolume to the notice and patronage of the profession.