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Summary
This paper reconceptualizes Thomas Clifford Allbutt's contributions to the making of scientific medicine in late nineteenth-century England. Existing literature on Allbutt usually describes his achievements, such as his design of the pocket thermometer and his advocacy of the use of the ophthalmoscope in general medicine, as independent events; and his work on the development of comparative pathology is largely overlooked. In this paper I focus on this latter aspect. I examine Allbutt's books and addresses and claim that Allbutt argued for the centrality of comparative pathology in the advancement of medical knowledge. He held that diseases should be studied as biological phenomena and that medicine should be made a biological science. He also argued that comparative pathology should be based upon the idea of evolution, and its study should embrace other nineteenth-century sciences including neurology, embryology and bacteriology. Allbutt's writings reveal that his endorsement of comparative pathology (1880s to 1920s), his promotion of the use of the ophthalmoscope and the thermometer in clinical medicine (early 1870s), and his support of the hospital unit system (1910s to 1920s) were part of a single programme. All were grounded in his scientific vision of medicine which emphasized a research culture, a stringent nosological attitude and an integration of laboratory sciences and clinical medicine.
Acknowledgements
I would like to thank Christopher Lawrence and Hasok Chang for their comments and criticisms.
Notes
1See, for instance, T. Clifford Allbutt, ‘Progress of the Art of Medicine’, Lancet, 2 (1870), 37–39; T. Clifford Allbutt, ‘Words and Things’, Lancet, 2 (1906), 1120–25; and T. Clifford Allbutt, ‘Medicine and the People: A Review of Some Latter-Day Tracts’, British Medical Journal, 2 (1919), 763–64.
2See Humphry Davy Rolleston, The Right Honourable Sir Thomas Clifford Allbutt (London, 1929); Burton Chance, ‘Sir Clifford Allbutt, The Apostle of Medical Ophthalmoscopy’, Archives of Ophthalmology, 17, no. 5 (1937), 819–58; Lord Cohen of Birkenhead, ‘The Rt. Hon. Sir Thomas Clifford Allbutt, F.R.S. (1836–1925)’, in Cambridge and its Contribution to Medicine: Proceedings of the Seventh British Congress on the History of Medicine University of Cambridge, 10–13 September, 1969, edited by Arthur Rook (London, 1971), pp. 173–92.
3For recent historical accounts of comparative pathology, see Lise Wilkinson, Animals and Disease: An Introduction to the History of Comparative Medicine (Cambridge, 1992); Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900 (Cambridge, 2000).It should be noted that in his account, Worboys aimed to examine germ theories and their uses in medical practice in late nineteenth-century Britain. Comparative pathology is only a part of his discussion.
4Anonymous (might be from someone at Wakefield), ‘Comparative Pathology—General Remarks upon its Importance: with Reference more especially to Disorders of the Nervous System in Animals’, British Medical Journal, 2 (1869), 371–72 (p. 371).
5Anonymous (might be from someone at Wakefield), ‘Comparative Pathology—General Remarks upon its Importance: with Reference more especially to Disorders of the Nervous System in Animals’, British Medical Journal, 2 (1869), 371–72 (p. 371).
6Henry E. Armstrong, ‘The Importance of the Study of Comparative Pathology’, Public Health, 1 (1888–1889), 164–68 (p. 164).
7Henry E. Armstrong, ‘The Importance of the Study of Comparative Pathology’, Public Health, 1 (1888–1889), p. 167.
8Henry E. Armstrong, ‘The Importance of the Study of Comparative Pathology’, Public Health, 1 (1888–1889), p. 167.
11T. Clifford Allbutt, ‘On the Classification of Diseases by Means of Comparative Nosology’, British Medical Journal, 2 (1888), p. 286.
12T. Clifford Allbutt, ‘On the Classification of Diseases by Means of Comparative Nosology’, British Medical Journal, 2 (1888), p. 286. From John Pickstone's historiographical point of view, Allbutt's exclusion of the Linnean method in favour of the comparative method exemplifies the transition of ways of knowing from an approach dominated by natural history to another dominated by analysis and experimentation. For Pickstone's historiography, see John V. Pickstone, Ways of Knowing: a New History of Science, Technology and Medicine (Manchester, 2000).
9T. Clifford Allbutt, ‘On the Classification of Diseases by Means of Comparative Nosology’, British Medical Journal, 2 (1888), ii: 284–93 (p. 285).
10T. Clifford Allbutt, ‘On the Classification of Diseases by Means of Comparative Nosology’, British Medical Journal, 2 (1888), ii: 284–93 (p. 285).
14T. Clifford Allbutt, ‘On the Classification of Diseases’, p. 285.
13Peter Sedgwick (1973) argued that it was anthropocentric to apply the concept of health and disease to humans and animals. ‘Outside the significances that man voluntarily attaches to certain conditions, there are no illnesses or diseases in nature’, held Sedgwick, ‘… Out of his anthropocentric self-interest, man has chosen to consider as “illnesses” or “diseases” those natural circumstances which precipitate the dealth (or the failure to function according to certain values), of a limited number of biological species: man himself, his pets and other cherished livestock, and the plant-varieties he cultivates for gain or pleasure’ (italics in original). See Peter Sedgwick, ‘Illness—Mental and Otherwise’, in Concepts of Health and Disease: Interdisciplinary Perspectives, edited by Arthur L. Caplan, H. Tristram Engelhardt, Jr and James J. McCartney (Reading, MA, 1981), 119–30 (pp. 120–21).
15T. Clifford Allbutt, ‘The New Birth of Medicine’, British Medical Journal, 1 (1919), 433–38 (p. 437).
16See Roy Porter, ‘Man, Animals and Medicine at the Time of the Founding of the Royal Veterinary College’, in History of the Healing Professions: Parallels between Veterinary and Medical History, edited by A.R. Michell (Wallingford, UK, 1993), pp. 19–30.
17It has been argued that the concentration on pathological anatomy and physical examination in mid-and-late-nineteenth-century English medicine was influenced by Paris medicine. For details, see Knud Faber, Nosography: The Evolution of Clinical Medicine in Modern Times (New York, 1978).However, it should be noted that Othmar Keel has argued that nineteenth-century English pathology was shaped by John Hunter and his followers rather than Paris medicine. Keel held that Paris medicine was in fact influenced by the ‘Hunterian tradition’. For details, see Othmar Keel, ‘Was Anatomical and Tissue Pathology a Product of the Paris Clinical School or Not?’ in Constructing Paris Medicine, edited by Caroline Hannaway and Ann la Berge (Amsterdam, 1988), pp. 117–86.
18Allbutt, ‘On the Classification of Diseases’, p. 286.
19Thomas Clifford Allbutt, ‘Introduction’, A System of Medicine, edited by Thomas Clifford Allbutt, 8 vols (London, 1896) I, xxiv.
20Thomas Clifford Allbutt, ‘Introduction’, A System of Medicine, edited by Thomas Clifford Allbutt, 8 vols (London, 1896) I, xxiv.
21Allbutt, ‘The New Birth of Medicine’, p. 438.
22Allbutt, ‘The New Birth of Medicine’, p. 437.
23T. Clifford Allbutt, ‘The Universities in Medical Research and Practice’, British Medical Journal, 2 (1920), 1–8 (p. 6).
24T. Clifford Allbutt, ‘The Integration of Medicine: President's Introductory Address to the Section of Comparative Medicine of the Royal Society of Medicine’, The Proceedings of the Royal Society of Medicine (London, 1923), 1–3 (p. 1).
25Cited in Penelope Hunting, The History of the Royal Society of Medicine (London, 2001), p. 367.
26See J. Andrew Mendelsohn, ‘“Like All That Lives”: Biology, Medicine and Bacteria in the Age of Pasteur and Koch’, History and Philosophy of the Life Sciences, 24, no. 1 (2002), 1–35.
27For the application of evolution to explanations of infectious diseases changing types, see William F. Bynum, ‘The Evolution of Germs and the Evolution of Disease: Some British Debates, 1870–1900’, History and Philosophy of the Life Sciences, 24, no. 1 (2002), 53–68.
28John Bland-Sutton, Evolution and Disease (London, 1890), p. 2.
29Rudolf Virchow, ‘Transformation and Descent’, The Journal of Pathology and Bacteriology, 1 (1892–93), 1–12 (p. 3).
30George Newman, Some Notes on Medical Education in England: A Memorandum Addressed to the President of the Board of Education (London, 1918), p. 16.
31Allbutt, ‘On the Classification of Diseases’, p. 288.
32Allbutt, ‘On the Classification of Diseases’, p. 285.
34John Hughlings Jackson, ‘Evolution and Dissolution of the Nervous System’, Selected Writings of John Hughlings Jackson, 2 vols (London, 1932) II, 45–75 (p. 46).
33Robert M. Young, Mind, Brain and Adaptation in the Nineteenth Century: Cerebral Localization and its Biological Context from Gall to Ferrier (New York, 1990), p. 151.
35Allbutt, ‘On the Classification of Diseases’, p. 286.
36Allbutt, ‘On the Classification of Diseases’, p. 286.
37Allbutt, ‘On the Classification of Diseases’, p. 286.
38Allbutt, ‘On the Classification of Diseases’, p. 286.
39See William F. Bynum, ‘Cullen and the Study of Fevers in Britain, 1760–1820’ in Theories of Fever From Antiquity to the Enlightenment (Medical History, Supplement No. 1), edited by William F. Bynum and Vivian Nutton (London, 1981), pp. 135–47. Also see Christopher Lawrence, ‘The Nervous System and Society in the Scottish Enlightenment’, in Natural Order: Historical Studies of Scientific Culture, edited by Barry Barnes and Steven Shapin (Beverly Hills, CA, 1979), pp. 19–40.
40See Claude Bernard, Leçons sur la Chaleur Animale, sur les Effets de la Chaleur et sur la Fièvre (Paris, 1876).
41William Coleman, Biology in the Nineteenth Century: Problems of Form, Function, and Transformation (New York, 1971), pp. 48–49.
42George Basalla, William Coleman and Robert H. Kargon, Victorian Science: A Self portrait from the Presidential Address to the British Association for the Advancement of Science (Garden City, NY, 1970), p. 200.
43Allbutt, ‘On the Classification of Diseases’, p. 285.
46Allbutt, ‘On the Classification of Diseases’, p. 290.
44For comparative-pathological research on zoonoses, see Wilkinson, Animals and Disease, ch. 7–11; and Worboys, Spreading Germs, ch. 2, 6 and 7. For the history of animal experimentation, see William F. Bynum, ‘Animal Models and Concepts of Human Disease’, Journal of the History of Medicine, 45 (1990), 397–413.
45Allbutt, ‘The Integration of Medicine’, p. 3.
47The idea of concomitant variation has a long history. It had been included by David Hume in his analysis of causation in A Treatise of Human Nature and was later incorporated by John Stuart Mill into his method of causation, which included (1) the method of agreement (2) the method of difference (3) the mixed method (of agreement and difference) and (4) the method of concomitant variation. It was likely that Allbutt was familiar with Mill's work because George Henry Lewes, Allbutt's close associate, was Mill's associate.
48Allbutt, ‘On the Classification of Diseases’, p. 289.
49Allbutt, ‘On the Classification of Diseases’, p. 291.
50Allbutt, ‘On the Classification of Diseases’, p. 291.
51Bynum, ‘The Evolution of Germs and the Evolution of Disease: Some British Debates, 1870–1900’, pp. 56–57.
52Bynum, ‘The Evolution of Germs and the Evolution of Disease: Some British Debates, 1870–1900’, p. 64.
55Allbutt, ‘On the Classification of Diseases’, p. 288.
53It should be noted that Darwin stood for a variety of theories of evolution, of which his specific mechanism of natural selection was only one among many. This mechanism was remarkable because it did not characterize evolution as a progressive process whereas the majority of nineteenth-century evolutionary theories did. For details, see Peter J. Bowler, The Non-Darwinian Revolution: Reinterpreting a Historical Myth (Baltimore, MD, 1988).
54Allbutt, ‘On the Classification of Diseases’, p. 288.
56See Gerald L. Geison, Michael Foster and the Cambridge School of Physiology (Princeton, NJ, 1978), pp. 191–296.
57See Gerald L. Geison, Michael Foster and the Cambridge School of Physiology (Princeton, NJ, 1978), p. 134.
58Mark Weatherall, Gentlemen, Scientists and Doctors: Medicine at Cambridge 1800–1940 (Rochester, NY, 2000), p. 133.
59Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, p. 109.
60Weatherall, Gentlemen, Scientists and Doctors, p. 133.
61Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, p. 111.
62Weatherall, Gentlemen, Scientists and Doctors, pp. 187–89.
63Weatherall, Gentlemen, Scientists and Doctors, p. 145.
64Weatherall, Gentlemen, Scientists and Doctors, p. 148.
65Weatherall, Gentlemen, Scientists and Doctors, p. 153.
66Weatherall, Gentlemen, Scientists and Doctors, pp. 165–66.
67Weatherall, Gentlemen, Scientists and Doctors, p. 159.
68Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, pp. 180–81.
69Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, pp. 180–81.
70Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, pp. 180–81.
71For the history of the Pathological Society of Britain and Ireland, see James Henry Dible, A History of the Pathological Society of Great Britain and Ireland (London, 1957).
72Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, pp. 201–2.
73Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, p. 202.
74Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, p. 208.
75Anonymous, Annual Report of the Medical Research Committee (London, 1914–1915), p. 8.
76Christopher C. Booth, ‘Clinical Research’, in Historical Perspectives on the Role of the MRC, edited by J. Austoker and L. Bryder (Oxford, 1989), 205–41 (pp. 206–7).
77Christopher C. Booth, ‘Clinical Research’, in Historical Perspectives on the Role of the MRC, edited by J. Austoker and L. Bryder (Oxford, 1989), 205–41 p. 208.
78Weatherall, Gentlemen, Scientists and Doctors, p. 133.
79Thomas Clifford Allbutt, On the Use of the Ophthalmoscope in Diseases of the Nervous System and of The Kidneys; also in Certain Other General Disorders (London, 1871), p. 4.
81Thomas Clifford Allbutt, On the Use of the Ophthalmoscope in Diseases of the Nervous System and of The Kidneys; also in Certain Other General Disorders (London, 1871), p. 4. (my italics).
80Thomas Clifford Allbutt, On the Use of the Ophthalmoscope in Diseases of the Nervous System and of The Kidneys; also in Certain Other General Disorders (London, 1871), p. 4. (my italics).
82Thomas Clifford Allbutt, On the Use of the Ophthalmoscope in Diseases of the Nervous System and of The Kidneys; also in Certain Other General Disorders (London, 1871), p. 4. (my italics).
83Thomas Clifford Allbutt, On the Use of the Ophthalmoscope in Diseases of the Nervous System and of The Kidneys; also in Certain Other General Disorders (London, 1871), p. 5.
84Thomas Clifford Allbutt, On the Use of the Ophthalmoscope in Diseases of the Nervous System and of The Kidneys; also in Certain Other General Disorders (London, 1871), p. 6.
85Thomas Clifford Allbutt, On the Use of the Ophthalmoscope in Diseases of the Nervous System and of The Kidneys; also in Certain Other General Disorders (London, 1871), p. 5.
86Thomas Clifford Allbutt, On the Use of the Ophthalmoscope in Diseases of the Nervous System and of The Kidneys; also in Certain Other General Disorders (London, 1871), p. 6.
87Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, p. 22.
88Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, p. 34.
89Stephen Anning, ‘Clifford Allbutt and the Clinical Thermometer’, The Practitioner, 197 (1966), 818–20 (p. 820).
90T. Clifford Allbutt, ‘Medical Thermometry, Part I’, The British and Foreign Medico-Chirurgical Review, 45 (1870), 429–41 (p. 430).
91Carl Wunderlich, On the Temperature in Disease: A Manual of Medical Thermometry, transl. By W. Bathurst Woodman (London, 1871), p. 51.
92Carl Wunderlich, On the Temperature in Disease: A Manual of Medical Thermometry, transl. By W. Bathurst Woodman (London, 1871), p. 54.
93T. Clifford Allbutt, ‘Medical Thermometry, Part II’, The British and Foreign Medico-Chirurgical Review, 46 (1870), 144–56 (p. 145).
94T. Clifford Allbutt, ‘Medical Thermometry, Part II’, The British and Foreign Medico-Chirurgical Review, 46 (1870), 144–56 (p. 145).
95T. Clifford Allbutt, ‘Medical Thermometry, Part II’, The British and Foreign Medico-Chirurgical Review, 46 (1870), 144–56 p. 146.
96T. Clifford Allbutt, ‘Medical Thermometry, Part II’, The British and Foreign Medico-Chirurgical Review, 46 (1870), 144–56 p. 151.
97T. Clifford Allbutt, ‘Medical Thermometry, Part II’, The British and Foreign Medico-Chirurgical Review, 46 (1870), 144–56 p. 151.
98A. McGehee Harvey, Gert H. Brieger, Susan L. Abrams, and Victor A. Mckusick, A Model of Its Kind: A Centennial History of Medicine at Johns Hopkins, 2 vols (Baltimore, MD, 1989), I, 22.
99Abraham Flexner, Medical Education in Europe: A Report to the Carnegie Foundation for the Advancement of Teaching (New York, 1912), p. 35.
100See O.L. Wade, ‘The Legacy of Richard Burdon Haldane: The University Clinical Units and their Future’, Ulster Medical Journal, 45, part 2 (1976), 146–56.
101See Christopher Lawrence, Rockefeller Money, the Laboratory, and Medicine in Edinburgh, 1919–1930 (Rochester, NY, 2005); also see Donald Fisher, ‘The Rockefeller Foundation and the Development of Scientific Medicine in Great Britain’, Minerva, 16 (1978), 20–41.
102See Christopher Lawrence, Rockefeller Money, the Laboratory, and Medicine in Edinburgh, 1919–1930 (Rochester, NY, 2005); also see Donald Fisher, ‘The Rockefeller Foundation and the Development of Scientific Medicine in Great Britain’, Minerva, 16 (1978), 20–41.
103Allbutt, ‘The New Birth of Medicine’, p. 438.
104Allbutt, ‘The New Birth of Medicine’, p. 438.
105Cited in Rolleston, The Right Honourable Sir Thomas Clifford Allbutt, p. 242.
106T. Clifford Allbutt, ‘Modern Therapeutics’, Practitioner, 2 (1920), 153–64 (p. 163).
107T. Clifford Allbutt, ‘Some Comments on Clinical Units’, Lancet, 2 (1921), 937–40 (p. 937).
108T. Clifford Allbutt, ‘Some Comments on Clinical Units’, Lancet, 2 (1921), 937–40 (p. 937).
109T. Clifford Allbutt, ‘Some Comments on Clinical Units’, Lancet, 2 (1921), 937–40 (p. 937).
110See John Harley Warner, ‘The History of Science and Sciences of Medicine’, Osiris, 10 (1995), 164–93; also see Bruno Latour, ‘For David Bloor … and Beyond: A Reply to David Bloor's “Anti-Latour”’, Studies in History and Philosophy of Science, 30 (1999), 113–29.