Eyewitness—Agents of Change in Medical Biology Over Sixty Years

EYEWITNESS—AGENTS OF CHANGE IN MEDICAL BIOLOGY OVER SIXTY YEARS R. A. CLEGHORN* When asked to address an annual meeting of psychiatric research workers and their interested clinical associates in 1983, I had doubts about my qualifications until I realized that the committee's hope was to bridge the gap of experience from the horse and buggy days, and on this score I qualified. My childhood home was lit by gas light. In the yard there were a cow, chickens, and a horse-drawn vehicle called a democrat. On calls the local doctor would hitch his mare to a ring on a green post before the house. Now, doctors rarely visit homes, alas, but in contrast the advances and discoveries in medicine and psychiatry in the past 50 years have been so startling and rewarding that progress has been greater perhaps than that in any other half century. This is the period during which I have lived and worked in several medical disciplines. It is fair to say that on this journey I have been more like the early Canadian voyageurs who travelled to a variety of trading posts by rivers and lakes, often by scantily marked routes. Sometimes the canoe leaked. As an utterly naive first-year medical student in Toronto in 1922, I was unaware of the excitement of the discovery of insulin in that year. The lurid news reports of the academic quarrels over priority and credit went practically unnoticed by most of us and did not interfere with campus activities or arouse any scientific interest. Years later I met the four principals in that discovery and got a feel for the tensions and rivalries that arose at that time, a drama that has recently been brilliantly described by Professor Michael Bliss [I]. During my stint as an intern in 1928 and 1929 at the Toronto General This paper is an expanded version of a lecture given on Annual Research Day of the Department of Psychiatry, University of Toronto, Canada, September 21, 1983. ?Emeritus professor of psychiatry, McGiIl University; consultant, Department of Psychiatry , Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4H 3M5.© 1985 by The University of Chicago. AU rights reserved. 0031-5982/86/2901-0467$01.00 132 I R. A. Cleghorn ¦ Medical Biology Hospital the reality of medical practice, as I saw it, was desperately short of specific therapies. Doctors' treatments achieved more by their solicitousness than by their prescriptions. Medical diseases were still distressingly confined to the narrow aetiological viewpoint of single causes. There was scant recognition of social factors, and the appearance of emotion was dismissed in cavalier fashion. Psychological medicine was practically nonexistent. On the other hand, the hospital facilities were good, medical diagnosis was shrewd, surgical care was competent, and public health achievements were notable. Hope for further progress in medical therapy had been aroused in the mid-1920s by the transforming effect of insulin therapy for diabetes and by liver therapy for pernicious anemia. However, these therapeutic marvels were far too inscrutable and impersonal to evoke a sense of participation and responsible involvement in tyros like me. Involvement there was in the rotating internship, especially on the emergency service or on the fine brain-surgery service of K. G. McKenzie , whose advent in Toronto preceded Penfield's in Montreal [2] and whose last great paper deflated the value of prefrontal lobotomy [3]. Obstetrics was a gratifying experience, and history taking on the medical service was like listening to life. The common denominator linking these enthusiasms seems to have been that of participant observer. Intellectually , medicine was in a static phase, awaiting a new paradigm or model. While this serves to give recognition in retrospect, one must also appreciate that there were stimuli encouraging new psychological thinking, such as that which came from Bernard Hart's psychoanalytically oriented The Psychology of Insanity [4], prescribed in our early medical course. It was a lucid, psychodynamically oriented account of mental mechanisms by a highly respected British psychiatrist; but this was not widely welcomed in Britain or Canada, for Freud's ideas were unacceptable in psychiatric circles; so Hart ultimately returned to the respectability of Harley Street. Continuation in clinical work at...