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“Until the Sun of Science … the true Apollo of Medicine has risen”: Collective Investigation in Britain and America, 1880–1910

Published online by Cambridge University Press:  07 December 2011

Harry M Marks
Harry M Marks
Affiliation:
Institute of the History of Medicine, The Johns Hopkins University, 1900 E. Monument Street, Baltimore, MD 21205, USA; e-mail: [email protected]
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In August, 1880, George Murray Humphry, in his presidential address to the British Medical Association (BMA), called for “collective action” by the country's “eight thousand physicians” to accumulate observations concerning the role of “temperamental, climacteric, and topographical agencies upon disease”. Through participating in organized inquiries, practitioners would “deepen their interest in the science of medicine, and impart the charm of wider usefulness to the daily routine of life”. By December 1881, the BMA had funded a Collective Investigation Committee, which over the next eight years would sponsor nearly a dozen inquiries into the natural history of disease. Beyond Great Britain, Humphry's appeal would launch an international movement for collective investigation, with physicians in Germany, the Netherlands, Norway, Sweden, and the United States following the British example.

Type
Articles
Information
Medical History , Volume 50 , Issue 2 , 01 April 2006 , pp. 147 - 166
Copyright
Copyright © The Author(s) 2006. Published by Cambridge University Press

References

1 George Murray Humphry, ‘President's Address’, Br. med. J., 1880, ii: 241–4, on p. 244.

2 Earlier brief accounts of collective investigation include R M S McConaghey, ‘The B.M.A. and collective investigation’, Br. med. J., 1956, i Supplement (25 February): 59–61; Ernest Muirhead Little, History of the British Medical Association, 1832–1932, London, British Medical Association, 1932, pp. 301–5.

3 William W Gull, ‘On collective investigation of disease’, 8e Congrès périodique international des sciences médicales. Compte-rendu, Copenhagen, Libraries Gyldendal, 1886, vol. 1, pp. 54–66; N S Davis, ‘Report of the Committee on the Influence of Appreciable Meteorological Conditions on the Prevention of Acute Diseases’, Trans. Illinois State Med. Soc., 1889: 41–5.

4 Jean-Pierre Peter, ‘Une enquête de la Société Royale de Médecine (1774–1794): malades et maladies à la fin du XVIIIe siècle’, Annales: E.S.C., 1967, 22: 711–51; Jean Meyer, ‘L'enquête de l'Académie de Médecine sur les épidémies, 1774–1794’, Études Rurales, 1969, 34: 10–59. On Jurin, see Andrea A Rusnock, ‘The weight of evidence and the burden of authority: case histories, medical statistics and smallpox inoculation’, Roy Porter (ed.), Medicine in the Enlightenment, Clio Medica, 29, Amsterdam, Rodopi, 1995, pp. 289–315.

5 Minutes of Council, Medical and Chirurgical Society of London, 30 Sept. 1831; 23 Oct. 1849; 11 Dec., 1849; 8 Jan. 1850, Royal Society of Medicine archives, London. For the Clinical Society, see Christian Baumler, Alfred B Duffin, Berkeley Hill, ‘Report of the Committee on Temperature in Syphilis’, Trans. Clin. Soc. London, 1870, 3: 170–9. On the BMA committee, see ‘An investigation into the effects of remedies’, Br. med. J., 1862, ii: 175–6; ‘Report of the Committee on the Action of Medicines’, Br. med. J., 1862, ii: 177; ‘The therapeutical inquiry’, Br. med. J., 1862, ii: 284–5. For Massachusetts, see Ephraim Cutter, Alonzo Chapin and S A Toothaker, ‘Report of the Committee … in the therapeutical action of medicinal agents’, Boston med. Surg. J., 1863, 68: 342–7. For the AMA, see Worthington Hooker and H D Buckley, ‘Report on the epidemic diseases of New England and New York’, Trans. Am. med. Assoc., 1852, 5: 285–8.

6 Christopher Lawrence, ‘Incommunicable knowledge: science, technology and the clinical art in Britain 1850–1914’, J. contemp. Hist., 1985, 20: 503–20; John Harley Warner, ‘Ideals of science and their discontents in late nineteenth-century American medicine’, Isis, 1991, 82: 454–78; idem, ‘The fall and rise of professional mystery: epistemology, authority and the emergence of laboratory medicine in nineteenth-century America’, in Andrew Cunningham and Perry Williams (eds), The laboratory revolution in medicine, Cambridge University Press, 1992, pp. 110–41; George Weisz, The emergence of modern universities in France, 1863–1914, Princeton University Press, 1983, pp. 359–68.

7 It would, none the less, be useful to have an analysis of the sociology and intellectual programme for collective investigation in Germany, which was initiated by the Berlin Medical Society. See ‘Collective investigation movement’, Br. med. J., 1883, ii: 20–1.

8 John V Pickstone, Ways of knowing: a new history of science, technology and medicine, Manchester University Press, 2000; see also David Armstrong, ‘The emancipation of biographical medicine’, Soc. Sci. Med., 1979, 13A: 1–8.

9 On Mahomed's career, see James F Goodhart and W H A Jacobson, ‘In memoriam: Frederick Horatio Akbar Mahomed’, Guy's Hosp. Rept., 1886, 43: 1–10; Samuel Wilks and George Thomas Bettany, A biographical history of Guy's Hospital, London, Ward, Lock, Bowden, 1892, pp. 306–8. For Humphry, see D'Arcy Power, ‘Sir George Murray Humphry (1820–1896)’, Dictionary of National Biography, ed. Sidney Lee, London, Smith, Elder, 1907, vol. 22 (Supplement), pp. 883–5; Sir Humphry Rolleston, ‘Sir George Murray Humphry, MD, FRS,’ Ann. med. Hist., 1927, 9: 1–11. Rolleston credits Alex Hill, Humphry's demonstrator, with the suggestion for collective investigation, but I have found no corroborating evidence for this claim.

10 Arthur Ransome, ‘On the need of combined medical observation’, Br. med. J., 1864, ii: 405–8; F A Mahomed, ‘Suggestions concerning the scientific work of the Association [letter]’, Br. med. J., 1880, i: 74. Ransome, with a degree in chemistry from the University of Cambridge and clinical training in London and Paris, was not your usual general practitioner. Willis J Elwood, A Félicité Tuxford, Some Manchester doctors: a biographical collection to mark the 150th anniversary of the Manchester Medical Society, Manchester University Press, 1984, pp. 93–7.

11 F A Mahomed, ‘Suggestions concerning the scientific work of the Association,’ Br. med. J., 1880, i: 31–2, p. 31; Ransome, op. cit., note 10 above. As the official organ of the BMA, the British Medical Journal kept much closer tabs on collective investigation than the Lancet, especially when reporting on BMA branch activities.

12 Mahomed, op. cit., note 11 above. On “busy men”, see G M Humphry, ‘Remarks on the collective investigation of disease’, Br. med. J., 1883, i: 145–6, p. 146.

13 Humphry, op. cit., note 1 above. For Humphry's views on the spiritual values of university medical training, see an earlier address to the BMA: G M Humphry, ‘Address on surgery’, Br. med. J., 1864, ii: 175–86, p. 177. See also William W Gull, ‘An address on the collective investigation of disease’, Br. med. J., 1883, i: 141–4, on p. 142; Samuel Wilks, ‘The address in medicine’, Lancet, 1872, ii: 213–16.

14 Prof. Humphry, ‘A short history of the movement’, in The Collective Investigation Record, G M Humphry and F A Mahomed (eds), vol. 1, London, British Medical Association, 1883, pp. 1–6, on p. 2.

15 Remarks of C Macnamara at a meeting of the BMA's Birmingham and Midlands branch, in ‘Collective investigation of disease’, Br. med. J., 1883, i: 32–4, on p. 33.

16 For Acland's role, see Humphry, op. cit., note 14 above, p. 5. As President of the General Medical Council, Acland's support was welcome. Others active in the committee included Walter Cheadle (St Mary's Hospital), Dyce Duckworth (St Bartholomew's Hospital), Octavius Sturges (Hospital for Sick Children), Balthazar Foster (Birmingham), Stephen Mackenzie (London Hospital), I Burney Yeo (King's College Hospital), Sidney Coupland (Middlesex Hospital) and Isambard Owen (St George's Hospital Medical School), who replaced Mahomed as secretary after the latter's death. For a full list of members and local committees, see ‘Organization for the Collective Investigation of Disease’, The Collective Organization Record, vol. 1, op. cit., note 14 above, pp. 160–8.

17 Gull, op., cit., note 13 above, p. 141; Samuel Wilks, A memoir, London, Adlard & Son, 1911, pp. 124–9. Of the group, Wilks was the most strongly committed to morbid anatomy. On the rise of pathological anatomy in the previous generation, see Russell C Maulitz, Morbid appearances: the anatomy of pathology in the early nineteenth century, Cambridge University Press, 1987.

18 Gull, op. cit., note 13 above, p. 141; T Clifford Allbutt, ‘Introductory address delivered at the Leeds School of Medicine’, Lancet, 1871, ii: 531–5.

19 English discussions form part of a broader, trans-European exploration of the relation between local and humoral factors in disease. A history of national pathological traditions, much needed, is beyond the scope of this article. See, however, Pedro Laín Entralgo, La historia clínica: historia y teoría del relato patográfico, facsimile edition, Madrid, Triacastela, 1998; Russell C Maulitz, ‘Rudolf Virchow, Julius Cohnheim and the program of pathology’, Bull. Hist. Med., 1978, 52: 162–82.

20 Samuel Wilks, ‘Some remarks on the nature and causes of disease’, Guy's Hosp. Rept., 1859, 3rd series 14: 15–53, p. 17. Wilks put the blame for localist dogmas not on morbid anatomy but on organ-based specialists motivated by “mercantile” rather than scientific interests. See also James Paget, ‘Notes for the study of some constitutional diseases’, in Clinical lectures and essays, New York, D Appleton, 1875, pp. 353–97; Humphry's discussion of pyaemia in Humphry, ‘Address on surgery’, op. cit., note 13 above, pp. 179–80. For overviews of nineteenth-century constitutional doctrines, see Charles E Rosenberg, ‘The bitter fruit: heredity, disease and social thought’, in idem, No other gods: on science and American social thought, Baltimore, Johns Hopkins University Press, 1976, pp. 25–53; Erwin H Ackerknecht, ‘Diathesis: the word and the concept in medical history’, Bull. Hist. Med., 1982, 56: 317–23; John C Waller, ‘“The illusion of an explanation”: the concept of hereditary disease, 1770–1870,’ J. Hist. Med. Allied Sci., 2002, 57: 410–48.

21 Observing the variation among types was deemed more important than noting the types themselves. James Paget, ‘Some rare and new diseases [1882]’, in Selected essays and addresses, ed. Stephen Paget, London, Longmans, Green, 1902, pp. 352–80, quote on p. 372. On the anti-determinism of constitutionalist thinking, see Rosenberg, op. cit., note 20 above.

22 See Paget's analysis of a nearly fatal septicaemia he developed after conducting an autopsy when he was “overtired” and his body no longer accustomed to the “poisons” encountered during dissection. James Paget, ‘Notes for a clinical lecture on dissection poisons’, Lancet, 1871, i: 735–6, 774–6; idem, ‘On disease of the mammary areola preceding cancer of the mammary gland [1874]’, in Selected essays, op. cit., note 21 above, pp. 145–8. Compare Andrew Mendelsohn, who argues that such an interest in the dynamic role of external factors is a product of the fully realized germ theory. J Andrew Mendelsohn, ‘Medicine and the making of bodily inequality in twentieth-century Europe’, in Jean-Paul Gaudillière and Ilana Löwy (eds), Heredity and infection: the history of disease transmission, London, Routledge, 2001, pp. 21–80.

23 Paget, op. cit., note 21 above, p. 372. See also Wilks, op. cit., note 20 above, p. 50.

24 William Gull, ‘An address on the international collective investigation of disease’, Br. med. J., 1884, ii: 305–8, p. 306. See also Sir William Gull, ‘Address on clinical medicine’, Lancet, 1872, i: 139–40; idem, ‘Presidential address delivered before the Clinical Society of London’, Lancet, 1871, i: 145–7; James Paget to George Paget, 8 March 1880, in Stephen Paget (ed.), Memoirs and letters of Sir James Paget, London, Longmans, Green, 1901, p. 293; Samuel Wilks, ‘An address on collective investigation of disease’, Br. med. J., 1883, ii: 1005; C J P Williams, ‘On the successes and failures of medicine’, Lancet, 1862, i: 345–7; J Magee Finny, ‘Collective investigation of disease’, Dublin J. med. Sci., 1883, 75: 465–76, pp. 467–72.

25 James Paget, ‘An address on the collective investigation of disease’, in The Collective Investigation Record, vol. 1, op. cit., note 14 above, pp. 21–5, on p. 23. See idem, ‘Some rare and new diseases’, and ‘Elemental pathology’, both in Selected essays, op. cit., note 21 above, pp. 240–80. Paget belonged to Darwin's far-flung network of correspondents on natural history but his interests in natural history long proceeded their relationship. See Janet Browne, Charles Darwin, vol. 2: The power of place, New York, Alfred A Knopf, 2002, pp. 203, 286, 359; Paget, Memoirs and letters, op. cit., note 24 above, pp. 25–28, 32–38. See also Gull, op. cit., note 13 above.

26 Paget, op. cit., note 21 above, pp. 369–72, on p. 369. See also Gull, ‘Address on clinical medicine [continued]’, Lancet, 1872, i: 175–7; Wilks, op. cit., note 24 above; idem, ‘The address in medicine’, Br. med. J., 1872, ii: 146–53.

27 W B Cheadle, ‘The progress of medicine’, Fortnightly Rev., 1867, 6: 567–78, p. 576. See also James Paget, ‘Address by the President,’ Trans. Clin. Soc. London, 1870, 3: xxxi–xxxix; William W Gull and Henry G Sutton, ‘Remarks on the natural history of rheumatic fever’, Medico-Chirurgical Trans., 1869, 8: 43–82, pp. 75–82; Samuel Wilks, ‘On the syphilitic affections of the internal organs,’ Guy's Hosp. Repts, 1863, 3rd series 9:1–63, pp. 14–16.

28 Humphry, op. cit., note 14 above, p. 3. Ransome's interests may also be reflected in proposals for topographical and epidemiological inquiries. See Ransome, op. cit., note 10 above. In general, the topics selected reflect the interests of the London consultants in the natural history of disease, not Ransome's interests in therapeutics and epidemiology.

29 ‘The work of the Collective Investigation Committee’, Br. med. J., 1882, i: 355–6, p. 355; ‘Collective Investigation Committee: the function of the local committees’, Br. med. J., 1882, i: 674–6.

30 Sub-committee on phthisis (Dyce Duckworth, Frederick Taylor, W J Tyson, I Burney Yeo, F A Mahomed), ‘A report on the communicability of phthisis’, in The Collective Investigation Record, vol. 1, op. cit., note 14 above, pp. 26–92.

31 These reports, all deemed “preliminary”, were published in The Collective Investigation Record, vol. 1, op. cit., note 14 above, pp. 93–133.

32 Stephen Mackenzie, ‘Report on chorea returns’, The Collective Investigation Record, London, British Medical Association, 1887, vol. 3, pp. 45–56, on p. 45.

33 ‘Report on pneumonia’, The Collective Investigation Record, London, British Medical Association, 1884, vol. 2, pp. 5–71.

34 British Medical Association archives, London (hereafter BMA). Minutes of the Collective Investigation Committee, 14 Jan. 1885, B/74/1/1. All further BMA archival references are to this collection unless otherwise noted.

35 For gout, see Dyce Duckworth, ‘An address on collective investigation of disease’, Br. med. J., 1884, i: 4–5, p. 4. See also the remarks of Dr Saunby (secretary of the local committee) and Dr Rickards at the Birmingham and Midland Counties Branch, ‘Collective investigation of disease’, Br. med. J., 1883, i: 33; remarks of Mr Vincent Jackson, ‘Staffordshire Branch’, Br. med. J., 1885, i: 743; Report of the Collective Investigation Committee, 1 July, 1885, BMA. For a sample of an early and unusually detailed form, see Shirley F Murphy, ‘Memorandum on diphtheria’, Br. med. J., 1882, ii: 1173–75, pp. 1174–75.

36 Wilks, op. cit., note 24 above, p. 1005.

37 T M Dolan, ‘Collective Investigation Committee’, Br. med. J., 1881, ii: 101.

38 Sidney Coupland, ‘Address on collective investigation’, Br. med. J., 1884, i: 1197–99, p. 1198.

39 Minutes, CIC committee, 14 Jan. 1885; Minutes, General Committee, CIC, 14 Oct. 1885, BMA.

40 In its first year of operation (1882), the CIC spent £474 8s 9d, a substantial sum in an organization recently returned to financial health. See Report of the CIC to the Annual Meeting, 3 July 1883, BMA. In 1884, they sought £600 for their second year of operations. See G M Humphry, ‘Report of the Collective Investigation Committee’, The Collective Investigation Record, vol. 2, op. cit., note 33 above, pp. 1–4, on p. 1. On the BMA's finances, see Peter Bartrip, Themselves writ large: the British Medical Association 1832–1966, London, BMJ Publishing Group, 1996, pp. 54–6. On the Berlin expenditures, see Minutes, Committee of Direction (CIC), 8 Apr. 1885, 14 Oct. 1885; Minutes, BMA Council, 8 July 1885, B/55/2/2, Minutes of Council and Subcommittees, 1855–1887, BMA.

41 For branch criticisms, see Minutes, Collective Investigation Committee, 18 Jan. 1885; Minutes, Committee of Direction, 21 July 1886, BMA. For additional criticisms, see ‘The preliminary report of the Collective Investigation Committee on Diphtheria’, Br. med. J., 1884, i: 1111–13. On the complaints of the Section on Therapeutics, see Committee of Direction (CIC), Minutes, 1 July 1885; Joint Meeting of CIC members and President of BMA plus President and officers of sections, Cardiff, 29 July 1885; ‘Investigation of the action of medicines’, Br. med J., 1885, ii: 313. Balthazar Foster, initially a proponent of collective investigation, played a key role in promoting the interests of the Section on Therapeutics within the BMA.

42 On funding, see Minutes, Committee of Direction, 14 April 1886. Relations with the Section on Therapeutics continued to be conflictual, despite a formal agreement. See Joint Meeting of CIC members and President of BMA plus President and officers of sections, Cardiff, 29 July 1885; Minutes, CIC General Committee, 14 Apr. 1886, 21 July 1886.

43 G W Potter [presentation on the dangers of collective investigation], ‘Metropolitan Counties Branch: Northern District’, Br. med. J., 1884, i: 386; see also the criticisms reported in Committee of Direction, Minutes, 19 Jan. 1887, BMA; Octavius Sturges, ‘The Collective Investigation Committee's report on acute pneumonia’, Br. med. J., 1885, i: 348–49, p. 348.

44 Thomas M Dolan, ‘Collective investigation’, Br. med. J. 1884, i: 1249–50, p. 1249.

45 Lawrence, op. cit., note 6 above.

46 ‘The Collective Investigation Movement’, Br. med. J., 1883, ii: 20.

47 ‘Collective investigation’, Br. med. J., 1883, i: 22; see also ‘Collective investigation of disease [Birmingham and Midlands Branch]’, Br. med. J., 1883, i: 32.

48 ‘Report on pneumonia’, op. cit., note 33 above, p. 32; Isambard Owen, ‘Report on the inquiry into the connection of disease with habits of intemperance’, in The Collective Investigation Record, London, British Medical Association, 1888, vol. 4, pp. 100–111.

49 ‘Report on pneumonia’, op. cit., note 33 above, p. 64. See also the anonymous criticism in ‘Preliminary report of the Collective Investigation Committee on Diphtheria’, The Collective Investigation Record, vol. 1, op. cit., note 14 above, pp. 28–33.

50 Memorandum on collective investigation, Dec. 1886. BMA.

51 G M Humphry, ‘Report on aged persons’, The Collective Investigation Record, vol. 4, op. cit., note 48 above, pp. 85–99, on p. 90; Memorandum on collective investigation, Dec. 1886, BMA.

52 ‘Collective investigation’, Br. med. J., 1885, i: 196–7; Finny, ‘Collective investigation’, op. cit., note 24 above, p. 472; Coupland, op. cit., note 38 above, p. 1198; Philip H Kidd, ‘The late Mr Charles Palmer and collective investigation’, Br. med. J., 1885, i: 208. Kidd was none the less critical of collective investigation for not insisting that practitioners record their notes while observing the patient.

53 Memorandum on collective investigation, Dec. 1886, BMA.

54 Sir James Paget, Studies of old case-books, London, Longmans, Green, 1891, pp. v–viii; Duckworth, op. cit., note 35 above; A[rchibald] E G[arrod], ‘Sir Dyce Duckworth, Bart., M.D., 1840–1928’, St. Barthholomew's Hosp. Repts, 1929, 62: 18–41, p. 27.

55 Francis Fowkes to Isambard Owen, 19 Jan. 1887; Quarterly report of the Standing Subcommittee, Jan.–March 1887, BMA.

56 George Murray Humphry, Old age: the results of information received respecting nearly nine hundred persons who had attained the age of eighty years, including seventy-four centenarians, Cambridge, Macmillan and Bowes, 1889. On distribution, see ‘The British Medical Association and collective investigation’, Br. med. J., 1928, ii (Supplement): 245–8, p. 248.

57 Minutes, BMA Council, 18 July 1888, 12 July 1888, b/54/2/4, BMA.

58 F A Mahomed, ‘On medical life-histories’, Br. med. J., 1882, ii: 1295–96; Minutes, Collective Investigation Committee, 20 March 1882, 1 Aug. 1883, 16 Oct. 1883, BMA; Minutes, Collective investigation of disease, Subcommittee Minutebook, 13 Oct. 1885, b/764/2/1, BMA; Karl Pearson, Life, letters and labours of Francis Galton, 3 vols, Cambridge University Press, 1924, vol. 2, pp. 360–7; Charles Roberts, ‘The life-history album [letter]’, Br. med. J., 1884, ii: 1166.

59 Anne Digby, Making a medical living: doctors and patients in the English market for medicine, 1720–1911, Cambridge University Press, 1994. Digby suggests that economic pressures were increasing in the 1880s, see ibid., pp. 136–48. On jealousy and suspicion among practitioners, see Alfred Cox, Among the doctors, London, Christopher Johnson, [1950], pp. 54–6. I am grateful to Dr Andrew Morrice for calling this source to my attention.

60 Dolan, op. cit., note 44 above, p. 1249.

61 The phrase is William Gull's, announcing early plans for collective investigation. Gull, op. cit., note 13 above, p. 141. Chris Lawrence suggests that resemblances between James Mackenzie's work at Aberdeen and collective investigation deserve further exploration (personnal communication); see Jane Macnaughton, ‘The St Andrews Institute for clinical research: an early experiment in collaboration’, Med. Hist., 2002, 46: 549–68. In the 1920s, the BMA used the term “collective investigations” to describe its surveys of hospital consultants' results in using surgery to treat ulcers. Other than the name, these surveys have little in common with the purposes and methods of collective investigation. See Arthur P Luff, ‘Report on collective investigation into the after-history of gastro-enterostomy’, Br. med. J., 1929, ii: 1074–78, 1125–29; Br. med. J., 1930, i: 348–54.

62 Henry B Baker, ‘Scientific collective investigation of disease’, J. Am. med. Assoc., 1887, 9: 486–90.

63 John Shaw Billings, ‘Medicine in the United States, and its relations to co-operative investigation’, Br. med. J., 1886, ii: 299–307, esp. pp. 300–4; William G Rothstein, American physicians in the nineteenth century: from sects to science, Baltimore, Johns Hopkins University Press, 1972, pp. 201–7.

64 Warner, ‘Ideals of science’, op. cit., note 6 above; Toby A Appel, ‘Biological and medical societies and the founding of the American Physiological Society’, in Gerald L Geison (ed.), Physiology in the American context, 1850–1940, Bethesda, American Physiological Society, 1987, pp. 158–62.

65 See the sources cited in note 5 above, and James H Cassedy, Medicine and American growth, 1800–1860, Madison, University of Wisconsin Press, 1986, pp. 44–8.

66 ‘Collective investigation of diseases’, J. Am. med. Assoc., 1883, 1: 216–18, p. 218. See also Davis, op. cit., note 3 above.

67 ‘International collective investigation’, J. Am. med. Assoc., 1884, 3: 442–3, p. 442. On uplift, see also ‘Collective investigation of diseases’, op. cit., note 66 above.

68 James Tyson, Charles K Mills, R H Chase, ‘Report of the Committee on the Collective Investigation of Disease’, Trans. Med. Soc. State Penn., 1885, 17: 66–73; William A Edwards, ‘Report of the Committee on the Collective Investigation of Disease. Report on acute rheumatism’, Trans. Med. Soc. State Penn., 1886, 18: 84–8. For the creation of the committee, see ‘Minutes of the annual meeting’, Trans. Med. Soc. State Penn., 1884, 16: 1–50, pp. 30–1; for dissolution, see ‘Minutes of the annual meeting’, Trans. Med. Soc. State Penn., 1888, 20: 1–33, p. 19.

69 F A Seibert, ‘A collective investigation regarding fibrous pneumonia,’ New York med. J., 1885, 41: 697–8.

70 See Trans. Ohio State Med. Soc., vols 38–42.

71 J F Todd, ‘Report of the Committee on Original Investigation’, Trans. Illinois State med. Soc., 1884, 324–5.

72 B F Hart, ‘Report of Special Committee on Collective Investigation of Disease,’ St. Louis Courier Med., 1886, 16: 1–22. The organization of the Missouri inquiry is unclear; it seems as if questionnaires were sent to the county medical societies, who chose only one physician to reply.

73 See the various ‘Report[s] of the Committee on Matters of Professional Interest in the State’, Proc. Conn. med. Soc., 1883–1905.

74 ‘Report of the Committee on Matters of Professional Interest in the State’, Proc. Conn. med. Soc., 1897, 105: 97–119, p. 102. See similar complaints for the syphilis and appendicitis inquiries: ‘Report of the Committee on Matters of Professional Interest in the State’, Proc. Conn. med. Soc., 1890, 99: 251–69, pp. 251–3; ‘Report of the Committee on Matters of Professional Interest in the State’, Proc. Conn. med. Soc., 1894, 102: 91–111, pp. 91–3.

75 ‘Report of the Committee on Matters of Professional Interest in the State,’ Proc. Conn. med. Soc., 1896, 106: 111–24, p. 111.

76 ‘Report of the Committee on Matters of Professional Interest in the State’, Proc. Conn. med. Soc., 1885, 94: 47–95, p. 60.

77 Ibid., pp. 61–2. See also the inquiry on antipyretics: ‘Report of the Committee on Matters of Professional Interest in the State’, Proc. Conn. med. Soc., 1889, 98: 73–82, pp. 78–9.

78 J E Loveland, ‘The physician as a carrier of the contagion of scarlet fever: a collective investigation’, Proc. Conn. med. Soc., 1904, 112: 173–208, quotes on p. 175.

79 Ibid., pp. 183, 187–8.

80 Ibid., p. 179. See also the discussion of a lack of innovation in typhoid treatment: ‘Report of the Committee on Matters of Professional Interest’, Proc. Con. med. Soc., 1897, 105: 97–119.

81 ‘A collective investigation by the Therapeutic Section of the Philadelphia Polyclinic Medical Society. Sweet-oil in the treatment of Gall-stones’, The Times and Register, 1891, 260–7, p. 265. The committee's idea of collective investigation was capacious: seventeen of the fifty-four cases were from citations to the published literature.

82 Ibid., pp. 265–7.

83 Evelynn Maxine Hammonds, Childhood's deadly scourge: the campaign to control diphtheria in New York City, 1880–1930, Baltimore, Johns Hopkins University Press, 1999, pp. 122–31. See also the discussion of the case-mix issue in William H Welch, ‘The treatment of diphtheria by antitoxin’, Trans. Assoc. Am. Phys., 1895, 10: 312–75.

84 L Emmett Holt, W P Northrup, Joseph O'Dwyer and Samuel S Adams, ‘The report of the American Pediatric Society's collective investigation into the use of antitoxin in the treatment of diphtheria in private practice’, Trans. Am. Ped. Soc., 1896, 8: 21–45, p. 21. Both antitoxin's proponents and critics could point to the non-representative character of hospital studies: John W Branna, ‘A critical analysis of Dr. Winters' clinical observations on the antitoxin treatment of diphtheria’, Med. News, 1896, 48: 691–4; John W Kyger, ‘A protest against accepting the conclusions of hospital physicians as to the value of antitoxine in diphtheria’, New York med. J., 1895, 62: 151.

85 The study also reported cases from 942 cases treated by the New York City Health Department and 1,468 cases treated by the Chicago Health Department. Holt, et al., ‘Report’, op. cit., note 84 above.

86 Ibid. The stratified analysis follows closely the earlier discussion by William Henry Welch concerning factors which had confounded interpretation of the hospital results. Welch, op. cit., note 83 above. It is difficult to compare these results directly with pre-antitoxin experience; in-hospital case-fatality rates could run at 50 per cent or higher but there was limited data on community practice prior to the APS study. The results were universally acclaimed as dramatic, however.

87 Barbara Gutmann Rosenkrantz, ‘Cart before horse: theory, practice and professional image in American public health, 1870–1920’, J. Hist. Med. Allied Sci., 1974, 29: 55–73, p. 70. See also Hammonds, op. cit., note 83, above, pp. 132–6. A second favourable report, on cases involving partial or total blockage of the larynx, was published the following year. W P Northrup, Joseph O'Dwyer, L Emmett Holt and Samuel S Adams, ‘The American Pediatric Society's report on the collective investigation of the antitoxin treatment of laryngeal diphtheria in private practice, 1896–1897’, Trans. Am. Pediatr. Soc., 1897, 9: 32–8.

88 Comments of Dr [Walter Shield] Christopher, in ‘The American Pediatric Society's collective investigation on infantile scurvy in north America’, Arch. Pediatr., 1898, 15: 481–508, p. 500. Nathan Davis made a similarly disparaging analogy to politics, describing collective investigations as like deciding “scientific questions by popular vote”. See Davis, op. cit., note 3 above, p. 44.

89 Ibid. The committee took little note of the fact that fruit juice was included in most (257) of the successfully treated cases. On doctors and “artificial” feeding, see Rima D Apple, Mothers and medicine: a social history of infant feeding, 1890–1950, Madison, University of Wisconsin Press, 1987, pp. 23–34, 53–71.

90 Remarks of Dr [August] Caillé in ‘Collective investigation of infantile scurvy', op. cit., note 88 above, p. 506; for Caillé's minority report, see ibid., p. 500. On the Committee's demurrals, see ibid., pp. 485, 495, 507.

91 Remarks of Dr Griffith, ibid., p. 507.

92 Compare the comments of Drs [Walter Shield] Christopher and [William Perry] Northrup, ibid., p. 500.

93 Remarks of Drs [Samuel S] Adams, [John Lovett] Morse and [Abraham] Jacobi, ibid., pp. 504–5.

94 Ibid., p. 502.

95 Ibid., p. 508.

96 The APS did publish editorial notices of two subsequent collective investigations conducted by other groups: ‘Collective investigation by the Gesellschaft für Kinderheilkunde of Barlow's Disease (Infantile Scurvy)’, Arch. Ped., 1904, 21: 212–14; ‘Collective investigation of anterior poliomyelitis’, Arch. Ped., 1907, 24: 849–50.

97 On George Davis' pioneering use of journals to promote his products, see Tom Mahoney, The merchants of life: an account of the American pharmaceutical industry, New York, Harper & Brothers, 1959, pp. 71–2.

98 ‘Parke, Davis & Co's collective investigation of drugs by the Working Bulletin system’, in Working Bulletin for the Scientific Investigation of Manaca, Detroit, Scientific Department Parke, Davis & Co, 1884, p. iii.

99 ‘Bladder-wrack: clinical reports from private and hospital practice’, in The pharmacology of the newer materia medica, Detroit, George S Davis, 1892, p. 107.

100 See [Issac Ott], ‘The physiological action of Urechites suberecta’, in The pharmacology of the newer materia medica, op. cit., note 99 above, pp. 1195–98.

101 The company also supplied drugs to individuals or organizations conducting collective investigations. See John Aulde, ‘Arsenite of copper—the results of collective investigation’, Trans. med. Soc. State Penn., 1890, 21: 200–2.

102 George L Richards, ‘The present status of the tonsil operation: a collective investigation’, Ann. Otol. Rhinol. Laryngol., 1909, 18: 739–85.

103 Of the 4,000 physicians surveyed, 470 of the 1,100 doctors answering replied that they had seen poliomyelitis cases. Their 752 case reports were then reviewed by the committee, which selectively reported on their findings. Epidemic poliomyelitis. Report on the New York epidemic of 1907 by the Collective Investigation Committee, New York, Journal of Nervous and Mental Disease Publishing Company, 1910, pp. 4–9, 29–54, quote on p. 9.

104 On the subsequent history of such efforts, see Harry M Marks, The progress of experiment: science and therapeutic reform in the United States, 1900–1990, Cambridge University Press, 1997.

105 Mancur Olson, The logic of collective action: public goods and the theory of groups, Cambridge, MA, Harvard University Press, 1965.

106 On the US Army studies, see Cassedy, op. cit., note 65 above, pp. 44–8; see also Peter Mathias' discussion of organized inquiry in the British military in ‘Swords and ploughshares: the armed forces, medicine and public health in the late eighteenth century’, in idem, The transformation of England: essays in the economic and social history of England in the eighteenth century, London, Methuen, 1979, pp. 265–85.

107 John M Eyler, Victorian social medicine: the ideas and methods of William Farr, Baltimore, Johns Hopkins University Press, 1979, pp. 123–49; Simon Szreter, ‘The GRO and the public health movement in Britain, 1837–1914’, Soc. Hist. Med., 1991, 4: 435–63; Graham Mooney, ‘Professionalization in public health and the measurement of sanitary progress in nineteenth-century England and Wales’, Soc. Hist. Med., 1997, 10: 53–8.

108 Graham Mooney, ‘Public health versus private practice: the contested development of compulsory infectious disease notification in late-nineteenth-century Britain’, Bull. Hist. Med., 1999, 73: 238–67. As Mooney notes, opposition to disease reporting was based on more than just the lack of financial incentives. See also Daniel M Fox, ‘Social policy and city politics: tuberculosis reporting in New York, 1889–1900’, Bull. Hist. Med., 1975, 49: 169–95.

109 See the sources cited in note 5 above.

110 Harry M Marks, ‘Notes from the underground: the social organization of therapeutic research, 1920–1950’, in Russell C Maulitz and Diana Long (eds), Grand rounds: one hundred years of internal medicine, Philadelphia, University of Pennsylvania Press, 1988, pp. 297–336; Marks, op. cit., note 104 above, pp. 53–60, 98–128.

111 ‘Report of a Committee of the Clinical Society of London … to investigate the subject of myxoedema’, Trans. Clin. Soc. London, 1888, 21 (Supplement). For background, see Clark T Sawin, ‘Introduction’, Report on myxoedema, facsimile edition, Boston, Francis A Countway Library of Medicine, 1991, pp. 1–14.

112 John Harley Warner, Against the spirit of system: the French impulse in nineteenth-century American medicine, Princeton University Press, 1999; Marks, op. cit., note 104 above.

113 Prescott Gardener Hewett, ‘Address by the President’, Trans. Clin. Soc. London, 1873, 6: xxxv–xliv, p. xxxv.

114 Paget, op. cit., note 20 above, p. 376.

115 For one example of an anthropology of medical labour and knowledge, see Stephen M Stowe, ‘Seeing themselves at work: physicians and the case narrative in the mid-nineteenth-century American South’, Am. Hist. Rev., 1996, 101: 41–79.

116 It is worth noting that John Shaw Billings' call for collective investigation of race and climate in medical geography went unheeded: see Billings, op. cit., note 63 above, pp. 305–6. Nathan Davis' desire to pursue on-going meteorological investigations via collective investigation was similarly disappointed. See Davis, op. cit., note 3 above. On the geographical tradition, see Ronald L Numbers, ‘Medical science before scientific medicine: reflections on the history of medical geography’, in Nicolaas A Rupke (ed.), Medical geography in historical perspective, London, Wellcome Trust Centre for the History of Medicine at UCL, 2000, pp. 217–20.

117 A deeper exploration would be needed to explain why American pathologists did not take up collective investigation with the fervour of British morbid anatomists. Russell Maulitz suggests that by the late nineteenth century, American pathologists had assumed the identity of a specialized scientific discipline whose preoccupations with clinical medicine were no longer central to its mission. Russell C Maulitz, ‘“The whole company of pathology”—pathology as idea and as work in American medical life’, in Teizo Ogawa (ed.), History of Pathology. Proceedings of the 8th International Symposium on the Comparative History of Medicine—East and West, Osaka, Taniguchi Foundation, 1986, pp. 139–61; Russell C Maulitz, ‘Pathologists, clinicians, and the role of pathophysiology’, Physiology in the American Context, 1850–1940, Bethesda, MD, American Physiological Society, 1987, pp. 209–36.

118 On gift cultures and peer review more generally, see Harry M Marks, ‘Local knowledge: experimental communities and experimental practices, 1918–1950’, Paper presented at the conference on Twentieth Century Health Sciences: Problems and Interpretations, University of California, San Francisco, May, 1988.

119 As examples from an enormous literature, see Peter Sahlins, Boundaries: the making of France and Spain in the Pyrenees, Berkeley, University of California Press, 1991; David A Bell, The cult of the nation in France: inventing nationalism, 1680–1800, Cambridge, MA, Harvard University Press, 2001; Gyanendra Pandey, Remembering partition: violence, nationalism and history in India, Cambridge University Press, 2001.