Mr. Thornton's Experiments: Transformations in Culture and Health

We have chosen to reproduce as closely as possible the oral rhetoric and "experience" of the following text, for its power derives from its generic nature as manifesto and examination of conscience. We have listed all works cited in the bibliography, but we have neither tampered with the tempo, the grammar, or the stream-of-consciousness texture of the piece nor inserted endnotes into the lecture manuscript. By probing the traditions and past performance of the journal he now edits, Dr. Horton indeed seems to us to be performing his own "experiments" in conceptualizing the responsibilities of text—and of journals—today. As a follow-up of interest, we see that the Lancet has announced a Call for Stories in preparation for a December 2007 special issue of fiction on any aspect of medical science or health. Please see http://ees.elsevier.com/thelancet for information on submission.

—the Editors-in-Chief

I

"A fermenting sewer"! "Sad proof of the folly of our carelessness"! "The feculence rolled up in clouds so dense that they were visible at the surface"!

Michael Faraday, "The State of the Thames: The Public Health and the Cholera"

Michael Faraday had taken a steamboat on the river Thames one afternoon in July 1855. The water was a putrescent pale brown. Vapors from excrement forced themselves through the nostrils of a man rather more accustomed to the rarefied airs of the Royal Institution than the sewage pits of London.

He tried an experiment. He took white cards, tore them into tiny pieces, wetted them to make them sink, and threw the fragments into the river each time the steamboat passed a pier. Despite the bright sun, as soon as the pieces of card dipped beneath the surface of the water, they vanished into the opaque effluent that then passed for the water of the river Thames. St Paul's Wharf, Blackfriar's Bridge, Temple Wharf, Southwark Bridge, Hungerford—the dense and morbid consistency of the water flowed unabated.

Faraday charged "those who exercise power" to take note of the river's condition. He swore to the truth of his observations. He argued that the river's present exceptional state was "rapidly becoming" its "general condition." Neglect now, in the era of the fearsome cholera, risked disaster.

This was the moment when medicine was beginning to find its place in the wider circumference of society, when doctors were coming to understand that their interests extend beyond the immediate confines of the hospital or clinic and that ill health might be tied to the circumstances as well as the activities of life. But this self-awareness was not without its own appreciation of medicine's prior indifference and treachery. This awakening of conscience was at times painfully evident. In one Lancet editorial of 1853, the writer contrasts two aspects of human development: the moral and intellectual advance of the mind against the improvement of our physical frame.

This "duplex movement of vitality" conferred a symmetry to human progress. But the cycle of our interests swung too frequently to extremes. On the one hand, there is an emphasis on bodily satisfaction at the expense of moral improvement, which leads to "the slothful effeminacy of a regal luxury." On the other hand, there is the exaltation of the mind, which creates the conditions for a psychic self-indulgence, allowing the passive observation of hunger, thirst, and corporeal disintegration.

A bias toward either interest arrests human development. In a thought experiment, the editorialist invites the reader to consider taking a citizen of ancient Greece, whose life had been one of comfort, equanimity, and philosophical reflection, on a journey through the habitations of London's poor. Here he would find "the dark, unventilated dens in which the present generation die and the future are reared"; "the faint and disgusting odours which surround his fellow-mortals for a whole life-time"; "the offensive faecal refuse which even animals bury out of sight"; and "the black oozings from the drains and cesspools seething up through the rotten boarding where he stands."

But doctors simply saluted what they...