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The Lancet: the first to last

1998; Elsevier BV; Volume: 352; Linguagem: Inglês

10.1016/s0140-6736(98)90291-4

1474-547X

WF Bynum,

Medical Coding and Health Information

WF Bynum received his MD from Yale University in 1969, where he became intrigued with medical histoty. He then went to Cambridge University, where in 1974 he earned a PhD in the history of science. Since 1973 he has been at University College London and the Wellcome Institute for the History of Medicine. London, where he is now professor. His Science and the Practice of Medicine {Cambridge: Cambridge University Press. 1994) has just been transIated into Chinese. Since 1980, Professor Bynum has been co-editor of a quarterly journal, Medical History, which gives him much sympathy for Thomas Wakley. Medical textbooks and monographs become outdated or "classics". Journal titles, when they cease to be published, become "dead". Antiquarian booksellers do not know what to do with them, especially if the journals are unbound, and they are often reduced to searching for some worthy paper, or a minor one by a famous figure, which happened to have appeared in the journal and selling the volume under its author's name. Few bibliophiles take a shine to periodicals. Modern medicine would be unthinkable without its journals, however. For some two centuries, they have participated in the exponential growth of just about everything associated with medicine and health care. And, despite their high infant mortality rate, journals enjoy such a healthy birth rate that the number of current titles continues to grow. As the founder of Index Medicus, John Shaw Billings (1838–1913), wrote late last century, it is "as useless to advise a man who was determined to do so not to start a medical journal as it is to advise him not to commit suicide"1Loudon J Loudon I Medicine, politics and the medical periodical, 1800–50.in: Bynum WF Lock S Porter R Medical journals and medical knowledge. 2nd edn. Historical essays. Routledge, London1992Google Scholar Billings did not have modern electronic methods of indexing at his disposal, but he obviously shared the modern perception that new knowledge—-new facts, at least—-was exploding all about him. One should not forget that the father of Index Medicus was himself a bibliophile (as well as a doctor, designer of the Johns Hopkins Hospital, and first librarian of the New York Public Library).2Chapman CB Order out of chaos: John Shaw Billings and America's coming of age. Boston Medical Library, Boston1994Google Scholar There is no word, or at least not a polite one, to describe an avid collector of old journals; undoubtedly such individuals exist, but they must be very its journals rare. I have certainly never met one. And, for every historian of the journal, there aye a hundred historians of the book. The invention of the printing press transformed western culture, including its medical and scientific cultures. Gutenberg (1400–68) lived a century before Vesalius, Copernicus, and the other giants of the Scientific Revolution, and books printed with moveable type predated journals by even longer.3Eisenstein EL 2nd edn. The printing as an agent of change. 2 vols. Cambridge University Press, Cambridge1979Google Scholar The first two learned journals were scientific ones, started a few months apart in 1665. The first, Journal des Scavans, established what was to be a common pattern and proved to be mortal. The second, Philosophical Transactions, continues to be published by its parent body, the Royal Society of London, and is thus the oldest current periodical in the world.4Kronick DA A history of scientific and medical periodicals: the origins and development of the scientific and technical press, 1665–1790.2nd edn. Scarecrow Press, Metuchan, NJ1976Google Scholar Physicians were well represented among the Society's early Fellowship, and papers on medical topics were a regular feature, even though half a century later James Jurin, a successful London physician and Secretary of the Royal Society during part of Isaac Newton's long Presidency, complained that its Fellows then were resistant to medical topics being aired at the Society's meetings.5Rusnock AA The correspondence of James Jurin (1684–1750). Rodopi, Amsterdam1996Google Scholar Similar stories can be told about other national scientific academies in France and Italy, established about the same time but with agendas that increasingly squeezed out the practical concerns of practising doctors from their published proceedings. Dedicated medical journals were not slow in appearing, however, although most of them were short-lived and of limited intellectual or professional impact. The first to be published in the vemacular was established by an entrepreneurial rogue, Nicolas de Blegny (16547–1722), who was at one time an apothecary, a surgeon, a pill pedlar, a venereologist, a court physician, a truss manufacturer, a chemist, an obstetrician, and, frequently, a defendant or litigant in court. He flouted the Parisian Medical Faculty by refusing to take its examinations, by dedicating one of his books to provincial doctors (of which he was originally one), and by publishing his medical journal in a vulgar tongue. It was entitled Nouvelles Découvertes sur Toutes les Parties de la Mddécine. Members of the Faculty hated its populist appeal and managed to get his licence to publish his journal revoked, with the consequence that Blegny's brainchild, the first issue of which appeared in 1679, had to be taken abroad. It survived for just over 6 years, during which time it had six different titles, two editors, and, as a final indignity for a man of Blegny's radical sympathies, ended its life in the language of learned medicine, Latin. Blegny's journal was said to have had 6 months of life, 3 years of lethargy, and a couple more years of existence.6Brockliss L Jones C The medical world of early modern France. Clarendon Press, Oxford1997Google Scholar, 7Thornton JL Medical books, libraries and collectors.2nd edn. Andre Deutsch, London1966Google Scholar, 8Kronick DA Nicolas de Blegny.in: Medical journalist. revised edn. Bull Cleveland Med Library. 7. 1960: 47-56Google Scholar The first English-language medical journal, Medicina Curiosa: or a Variety of New Communications in Physick, Chirurgery, and Anatomy, managed only two issues between June and October, 1684, a fate not unlike that of the other eight 17th-century medical periodicals appearing in Europe. The ten journals of the 17th century contrast with some 436 new medical periodical titles in the 18th, over half of them from the German-speaking lands, though with Latin as the favoured language. By contrast, most French and English periodicals appeared in the vernacular, and the two patterns gingerly established earlier were perpetuated: journals were either the work of some enterprising entrepreneur like Blegny, or the collective activity of members of the medical societies and institutions that were founded in such profusion in the age of Enlightenment. The former were invariably short-lived: The British Physician appeared in five numbers in 1716; Medical Miscellany also came and went in a single year—1768. Unusually Samuel Foart Simmons' London Medical Journal lasted 19 years, with only one change in title. The latter category of periodical, with collective input, generally survived longer and achieved greater visibility. A prototype is offered in the Medical Essays and Observations, published in Edinburgh in six volumes between 1733 and 1744. It went into a second edition and a two-volume abridgment as well as translations into French and German, and was resurrected, albeit less successfully, in 1754. It was also imitated by London doctors, with a periodical entitled Medical Observations and Inquiries. Its sponsoring "Society of Physicians" took 27 years to put together its six volumes, but the various volumes went into multiple editions and were translated into German. Even the Physicians was stung into action, Transactions appearing with decreasing frequency in six volumes between 1768 and 1820.9LeFanu WR Loudon J British periodicals of medicine, 1640–1899. revised edn. Wellcome Unit for the History of Medicine, Oxford1984Google Scholar These and several other late 18th-century examples were largely the productions of medical elites operating within an unregulated medical marketplace and therefore concerned to differentiate themselves from medical low-life, which they defined as quacks, impostors, empirics, and ignorant purveyors of secret and dangerous remedies. Publication represented a way of opening up medicine, reporting new results or observations, and subjecting them to the criticism of one's peers. These high-minded periodicals thus placed a premium on the solid fact, multiple case reporting, identification of the ingredients of remedies, and recording of observations made in the dissecting room or chemical laboratory. At the same time, publication is a form of self-advertising and can help an author in getting on in the cut-throat business of what Thomas Beddoes called the "sick trade".10Porter R The rise of medical journalism in Britain to 1800.in: Bynum WF Lock SP Porter R Medical journals and medical knowledge. 2nd edn. Historical essays. Routledge, London1992Google Scholar The more we dissect medical behaviour in the 18th century, the harder it is to define precisely what it was that set the "regulars" and "irregulars" apart, even if "quacks" tended to resort to the pamphlet or cheap volume, replete with consulting address or instructions where the remedies could be purchased, to communicate with the public.11Porter R Health for sale: quackery in England, 1660–1850. Manchester University Press, Manchester1989Google Scholar In the 18th century, however, irregulars were almost always individualists, and the collective and generally coopt activity that produced many of the medical Periodicals of the period can be 'd out as one important bute of emerging medical professionalism. None of the collective endeavours mentioned re has survived, but two journals that, rang from medical societies have, and ire among the oldest current English language medical periodicals. The elder, Medico-Surgical Transactions of the Medical and Surgical Society of London, was assimilated into the Proceedings of the royal Society of Medicine in 1907, ten a number of ldon medical societies merged to form the Royal Society of Medicine, and: an be said to live on in spirit in the pages of the Journal of he Royal Society of Medicine.;actions of the Medical Society of London continues to appear annually under that title and has been described as "the first strictly medical journal that still appears today".12Lock SP Medical journals.in: Walton J Barondess J Lock S The Oxford Medical Companion. 2nd edn. Oxford University Press, Oxford1994Google Scholar An early American imprint with staying-power offers another example of collective medical endeavour. The New England Journal of Medicine & Surgery & the Collateral Branches of Science (to give it its original title) was founded in 1812 by two prominent Boston medical men—-the surgeon John Collins Warren (who 34 years later conducted the first recorded operation with anaesthesia) and James Jackson. It survived changes of name, editor, and publisher for over a century until being rescued from bankruptcy in 1921 by the Massachusetts Medical Society; it turned out to be an exceptionally shrewd move on the Society's part. Although Warren and Jackson edited the early volumes of their journal, the masthead proclaimed that it was "Conducted by a Number of Physicians".13Garland J A voice in the wilderness: the "New England of Journal of Medicine" since 1812.BMJ. 1962; 1: 105-108Crossref PubMed Google Scholar There was safety as well as responsible behaviour in numbers, even if the recent demise of several venerable medical journals reminds us that no journal can be safe from the evolutionary pressures of social and technological change. The Lancet should not have survived. Nothing appeared right about it. It was a commercial enterprise, founded by a marginal medical man with no reputation and a left-of-centre agenda witlain a conservative profession. The radical journalist William Cobbett may have inspired Thomas Wakley about the capacity of a vigorous press to catalyse reform, but Waldey's own crusading spirit took a while to mature. Mrs Wakley's desire for a better London address, and for a husband who did not keep a dispensary, may have had as much to do with Wakley's initiative as any burning desire to transform his profession and, eventually, the society within which it existed.14Sprigge SS The life and times of Thomas Wakley. Robert E. Krieger Publishing Company, Huntington, NY1974Google Scholar Certainly Wakley's career would have been different had the medical practice he established in fashionable Argyll Street, London, succeeded. He was newly married with a house stuffed with wedding presents when word got around that he had been the masked surgeon who beheaded the executed members of the Cato Street Conspiracy Gang, one of g number of informal republican groups that sprung up in the turbulent years after the end of the Napoleonic Wars. Threatening letters followed, as well as an incident that changed the course of his life, incidentally reminding us that blood-letting could save lives. One August evening in 1820, Wakley felt indisposed and applied leeches to his temples, bandaging his head to keep the leeches in place. Answering a knock on his door led to a sharp blow on the head and a vicious assault by unknown men. The surgeon who attended him was certain that the blow would have been fatal save for the swaddling he had placed around the leeches. QED. The incident, and the fire in his house that same evening, led to the first of Wakley's many appearances in court, since the insurance company suspected him of starting the fire and refused to honour his policy. He won his case, though the stigma came back to haunt him later. More particularly, it destroyed his promising practice and led, after 3 desultory years, to a new career in journalism. The Lancet began inconspicuously enough on Oct 5, 1823, a Sunday. From the beginning, Wakley's aim was to entertain, instruct, and reform. Entertainment was provided by the racy, even bombastic, style that the journal adopted for a number of years; in the first few issues, there was additional interest through political comment and theatre reviews, as well as the world's first regular feature of a chess problem. Wakley obviously hoped his weekly would act as a kind of medical newspaper, although these novel features were dropped fairly soon. Medical politics remained, and remains, part of the journal's brief. Instruction concentrated initially on the verbatim transcription and reproduction of the lectures of the consulting elite of London's teaching hospitals. In a period before published textbooks had become routine aids to medical study, and when students had to present certificates of attendance at lectures before offering themselves for examination by the London medical corporations, the lectures of medical and surgical leaders were great public occasions. They were also sources of good income for the lecturers, which was one reason why many were reluctant to publish their lectures in textbooks. This defined Wakley's targeted readership at the medical student or young practitioner, but it also alienated Wakley from In conclusion — we respectfully observe, that our Columns will not be restricted to Medical Intelligence, but on the contrary we shall be indefatigable in our exertions to render "THE LANCET" a complete Chronicle of current Literature. From the Preface of the first issue of The Lancet. many of the lecturers and landed him in court when John Abernethy, surgeon to St Bartholomew's, challenged his right to publish transcripts of his spoken words, complete with grammatical infelicities, rambling sentences, and extraneous matter. It took a decade for Wakley to achieve some sort of truce with the medical teachers, and hospital administrators and the medical corporations continued to feel the prick of his sharp pen for much longer. In conclusion – we respectfully observe, that our Columns will not be restricted to Medical Intelligence, but on the contrary we shall be indefatigable in our exertions to render "THE LANCET" a complete Chronicle of current Literature. From the Preface of the first issue of The Lancet. The legal tilt with Abernethy was one of ten that Wakley's rambunctious style landed him with. He lost as often as he won, though his opponents generally were awarded only a fraction of the damages they sought, and these and Wakley's costs were generally met by public subscription. The Lancet soon made Wakley a public man, something he hardly expected, since he initially edited his journal anonymously. The Lancet should not have survived; instead it thrived. It is both easy and impossible to explain historical contingencies, but three brief reasons may be offered why Wakley was able to leave to his son a journal that had become more than even a national institution. THE DRAMA.DRURY LANE—Notwithstanding the immense and beautiful alterations that were made in this Theatre last year, the enterprising Manager, during the summer recess, has added more comforts, and even more fascinations: indeed, a spirit of landable rivalship appears to stimulate those who have the direction of both our Winter Theatres: we confess that we are glad of it; but we sincerely hope that their exertions will not be confined to house decorations; we wish to see the stage well decorated—not with foloage ornaments or gilded columns—but with intellectual genius and classical refinement. And we are delighted to observe that the Play-bill of this Theatre contains a list of Performers, who ensure to the lovers of the Drama many a rich treat during the ensuing theatrical campaign.This Theatre opened on Wed THE DRAMA. DRURY LANE—Notwithstanding the immense and beautiful alterations that were made in this Theatre last year, the enterprising Manager, during the summer recess, has added more comforts, and even more fascinations: indeed, a spirit of landable rivalship appears to stimulate those who have the direction of both our Winter Theatres: we confess that we are glad of it; but we sincerely hope that their exertions will not be confined to house decorations; we wish to see the stage well decorated—not with foloage ornaments or gilded columns—but with intellectual genius and classical refinement. And we are delighted to observe that the Play-bill of this Theatre contains a list of Performers, who ensure to the lovers of the Drama many a rich treat during the ensuing theatrical campaign. This Theatre opened on Wed First, Wakley himself. He began rather quietly as a reforming editor, but he soon became a crusading one, certainly the first within medicine. So successful was his journal that he used the position it gave him to further his own personal and professional ambitions, especially as coroner for Middlesex and as a Member of Parliament. He wrote English in a style that soon went out of fashion and he made no significant contributions to medical knowledge. He used humour and sarcasm effectively if not always in good taste. We would no longer expect our medical editors to publish a series of exposes entitled "Hole and Corner Surgery"; to describe three eminent consultant surgeons as "The Three Ninny-hammers"; to predict that the necropsy of another equally respected surgeon would reveal that his liver was in his cranium, his mouth having performed "the office of a ductus communis choledochus"; or announce that rival medical journals emitted "a little foetor". Nonetheless, he took himself and his power seriously and was never afraid to make mistakes, or to fight for what he deemed right. He was an ordinary man who became an extraordinary editor. With Ernest Hart, the later but equally great editor of the British Medical Journal, Wakley created modem medical journalism.12Lock SP Medical journals.in: Walton J Barondess J Lock S The Oxford Medical Companion. 2nd edn. Oxford University Press, Oxford1994Google Scholar, 15Bartrip PWJ Mirror of medicine.in: A history of the BMJ. Clarendon Press, Oxford1990Google Scholar Theatre review From the first issue of The Lancet Second, Wakley gambled successfully on his journal's format. The Lancet was not the first weekly medical periodical, but it was the first to last, and it gave the journal both an advantage over its monthly or quarterly rivals, and its own special character. It made it possible to comment on the minutiae of medicine and of medical politics, made correspondence and news items an essential feature, and required its tone to be engaging rather than stately and Olympian. It facilitated the path along which Wakley chose to take his journal, from a periodical of news and record to a force of social change. He reached the latter goal without losing the former. Last, Wakley was shrewd in deliberately seeking to or three-quarters of a century, The Lancet was a Wakley family business. It still is an anomaly. reach the widest possible audience. By appealing to medical students and the rank and file of the profession (whence Wakley himself came), he made a deliberate statement, not simply about his ideal readership but also about the desirable nature of the profession itself, in which all members mattered. Some of his campaigns in this direction failed—-for example, his call for a single national college, with a single entrance examination for all. Nevertheless, Wakley and his journal must be counted as among the most important formative forces during the middle third of the 19th century, when modern British medical structures and values were established, between the Apothecaries Act of 1815 and the Medical Act of 1858.16Peterson MJ The medical profession in mid-Victorian London. University of California Press, Berkeley1979Google Scholar, 17Loudon I Medical care and the general practitioner, 1750–1860. Clarendon Press, Oxford1986Google Scholar For three-quarters of a century, The Lancet was a Wakley family business. It still is an anomaly. The Lancet is a commercial journal without affiliation to a medical or scientific organisation. It exerts its influence by attracting important contributors and by fiercely guarding its independence, attributes that sustained it in Wakley's day and that, we may hope and expect, will guarantee its continued rude health.