A Medical Research Tradition is Born
By: Thomas Wakley
Date: October 05, 1823
Source: The Lancet. Preface. The Lancet. first edition, October 5, 1823, 1-2. Available online at 〈http://www.thelancet.com/about/backfiles〉 (accessed November 5, 2005).
About the Author: Thomas Wakley was a physician and coroner, practicing medicine in the United Kingdom in the early nineteenth century. He was a well-known advocate of medical reform, who made public commentaries regarding his concerns for the need to share information about the developing profession in a consistent and accessible manner, as well as the necessity to advance the professional stature of medicine.
The first edition of The Lancet was published on October 05, 1823. Thomas Wakley, the physician who was The Lancet's creator, sought to provide a forum in which the advances made in the science and practice of medicine could be made easily accessible to the entire medical profession. He also saw the publication as a means of encouraging professional responsibility among his peers. This was accomplished, in part, by highlighting not only advances and new developments, but by offering critiques concerning flaws in the system, and deficits in general medical knowledge and understanding. Wakley covered triumphs and mistakes with equal candor in his journal.
Wakley was the initial editor, as well as the founder and creator of The Lancet. He chose the name as a metaphor for what he hoped to accomplish by the inception of the weekly journal; a lancet is a small, two-edged knife used by surgeons to make small deep cuts or punctures. By disseminating weekly editions of the periodical, the medical profession could be kept apprised of current practice, offered a forum in which lectures and symposia could be listed far enough in advance that medical professionals would be afforded the means for ensuring continuing education, and maintaining state-of-the-art knowledge at a time when developments were occurring in medical academics, science, research, and clinical practice at a rapidly increasing rate. Wakley also intended for individual physicians, as well as those in academia or research, to have a means of sharing case-related information they deemed as having scientific, historical, or social significance.
It was also Wakley's intent to create an avenue for professional disagreement. According to contemporary Lancet editor Richard Horton, "Thomas Wakley … aimed to combine publication of the best medical science in the world with a zeal to counter the forces that undermine the values of medicine, be they political, social, or commercial." In Wakley's own words, from the preface to the first edition of The Lancet, "We shall be assailed by much interested opposition. But, notwithstanding this, we shall fearlessly discharge our duty."
It has long been a subject of surprise and regret, that in this extensive and intelligent community there has not hitherto existed a work that would convey to the Public, and to distant Practitioners as well as to Students in Medicine and Surgery, reports of the Metropolitan Hospital Lectures.
Having for a considerable time past observed the great and increasing inquiries for such information, in a department of science so pre-eminently useful, we have been induced to offer to public notice a work calculated, as we conceive, to supply in the most ample manner, whatever is valuable in these important branches of knowledge;—and as the Lectures of Sir Astley Cooper, on the theory and practice of Surgery, are probably the best of the kind delivered in Europe, we have commenced our under-taking with the introductory Address of that distinguished professor, given in the theatre of St. Thomas's Hospital on Wednesday evening last. The Course will be rendered complete in subsequent Numbers.
In addition to Lectures, we purpose giving under the head, Medical and Surgical Intelligence, a correct description of all the important Cases that may occur, whether in England or on any part of the civilized Continent.
Although it is not intended to give graphic representations with each Number, yet, we have made such arrangements with the most experienced surgical draughtsmen, as will enable us occasionally to do so, and in a manner, we trust, calculated to give universal satisfaction.
The great advantages derivable from information of this description, will, we hope, be sufficiently obvious to every one in the least degree conversant with medical knowledge; any arguments, therefore, to prove these unnecessary, and we content ourselves by merely showing in what directions their utility will be most active: To the Medical and Surgical Practitioners of this city, whose avocations prevent their personal attendance at the hospitals—To Country Practitioners, whose remoteness from the head quarters, as it were, of scientific knowledge, leaves them almost without the means of ascertaining its progress—To the numerous classes of Students, whether here or in distant universities—To Colonial Practitioners—And, finally, to every individual in these realms. Consequently, we shall exclude from our pages the semi-barbarous phraseology of the Schools, and adopt as its substitute, plain English diction. In this attempt, we are well aware that we shall be assailed by much interested opposition. But, notwithstanding this, we will fearlessly discharge our duty. We hope the age of "Mental Delusion" has passed, and that mystery and concealment will no longer be encouraged. Indeed, we trust that mystery and ignorance will shortly be considered synonymous. Ceremonies, and signs, have now lost their charms; hieroglyphics, and gilded serpents, their power to deceive. But for these, it would have been impossible to imagine how it has happened that medical and dietetical knowledge, of all others the most calculated to benefit Man, should have been by him the most neglected. He studies with the greatest attention and assiduity the constitutions of his horses and dogs, and learns all their peculiarities; whilst of the nature of his own he is wholly uninformed, and equally unskilled as regards his infant offspring. Yet, a little reflection and application would enable him to avert from himself and family half the constitutional disorders that afflict society; and in addition to these advantages, his acquirements in Medical learning wold furnish him with a test by which he could detect and expose the impositions of ignorant practitioners.
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.
The nineteenth and early twentieth centuries were times of rapid changes in the scientific and medical realms. Medical education was beginning to change, with the creation of more university- and hospital-affiliated schools. Medical journals began to proliferate, as the professional community sought to broaden and sharpen the accessible means of disseminating information regarding advances and new discoveries in the science of medicine. All formal reports in The Lancet were reviewed by a group of fellow scientists for accuracy, both in the method of collecting data or observations, and for the conclusions presented. This process initiated the peer-review concept that is still standard practice for reporting research results today.
By the middle of the nineteenth century, professional medical organizations were being created, both in the United States and around the world. With improved means of international travel (steamships and safer ocean-going vessels), it became more practical to create international medical congresses, where physicians met for lectures and conference series.
After the American Civil War (1861–1865), with a surge in immigration and the advancing industrial age, came epidemics of deadly infectious diseases, along with problems associated with unsanitary living and working conditions, creating a confluence of events that bespoke the need for a public health system in America. In order to monitor and advance the public health system, it was necessary to create a framework for it, in the form of a system of supporting scientific research laboratories.
Because the shipping industry was America's main venue for import and export of goods and commerce, and because the seaports were the means by which immigrants entered the country before the age of air travel, it was deemed necessary to establish a medical care and monitoring system, called the Marine Hospital Service (MHS). It was responsible for maintaining oversight of the health and well-being of the personnel involved in all aspects of the maritime business. Eventually, it was also given responsibility for ascertaining that passenger ships were not transporting epidemic diseases along with their human cargo. Initially, the only way to carry out that mission was to give each passenger a physical examination and quarantine all those who were visibly ill. Toward the end of the nineteenth century, the germ theory was becoming understood as the key to disease causation, treatment, and prevention. In 1887, the first scientific medical laboratory was opened on Staten Island in New York, and staffed by one scientist, named Joseph Kinyoun, who was an employee of the MHS. He referred to his facility as a "laboratory of hygiene," making a verbal link to the developing public health system in America.
In 1891, the laboratory was relocated to Washington, D.C. and in 1901, the MHS was reclassified in order to give it stature as a public health system; it was renamed the Public Health and Marine Hospital Service (PH-MHS). The research arm of the PH-MHS incorporated new divisions of zoology, chemistry, bacteriology, and pharmacology. The early research program was formalized and given scientific stature and credibility, as it was allocated ongoing funding and tasked with the responsibility for clinical and scientific oversight of pharmaceutical product manufacturing facilities. In 1906, the Pure Food and Drugs Act mandated that the pharmaceutical industry be regulated, this function was also within the purview of the PH-MHS research laboratory facilities.
In 1912, the PH-MHS was again reorganized, and became what it now known as the Public Health Service (PHS), and its research program was again expanded to incorporate the effects of environmental pathogens on the human body, as well as noninfectious (acquired) diseases. In 1930, the laboratory of hygiene was officially renamed the National Institute of Health (NIH), and was afforded sufficient funding to inaugurate the American research education tradition of research and training fellowships and grants. After the end of World War II (1938–1941), there was an explosion in the medical specialty fields, and new research facilities were created to meet the growing knowledge demands. In 1948, the NIH's title was pluralized: it became the National Institutes of Health. By the end of the twentieth century, the NIH had incorporated twenty-seven unique centers and institutes. Its programs continued to grow and expand, due in large measure to successful collaborations across the nation, and around the world.
The Lancet has been continuously published in excess of 180 years. Currently, over one hundred professional peer-reviewed journals report the latest findings from physicians and research institutions around the world. Research is published in many languages, although due in part to The Lancet tradition, English has become the most common and unifying language for reporting the latest news in medical research.
Park, Peter, Mary Brydon-Miller, Budd Hall, and Ted Jackson, eds. Voices of Change: Participatory Research in the United States and Canada. Westport, Conn.: Bergin & Garvey, 1993.
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