Part 1

Doctor and Patient

Papers on the Relationship of the Physician to Men and Institutions

BY FRANCIS WELD PEABODY, M.D.

Professor of Medicine, Harvard Medical School; Director of the Thorndike Memorial Laboratory; Visiting Physician and Chief of the Fourth Medical Service, Boston City Hospital 1921 to 1927

NEW YORK THE MACMILLAN COMPANY 1930

Copyright, 1930, By THE MACMILLAN COMPANY.

All rights reserved--no part of this book may be reproduced in any form without permission in writing from the publisher.

Set up and printed. Published June, 1930.

SET UP BY BROWN BROTHERS LINOTYPERS PRINTED IN THE UNITED STATES OF AMERICA BY THE FERRIS PRINTING COMPANY

Three of the papers in the collection have already appeared in print; “The Care of the Patient” is reprinted by permission from the Journal of the American Medical Association, Volume 88, pages 877 to 882, and The Harvard University Press. “The Physician and the Laboratory” is reprinted by permission from The Boston Medical and Surgical Journal (now The New England Journal of Medicine), Volume 187, Number 9. An expression of appreciation is also due the Journal of the American Medical Association for permission to reprint “The Soul of the Clinic,” which appeared in Volume 90.

CONTENTS

PAGE Introduction by Hans Zinsser, M.D. ix

The Public and the General Practitioner 1

The Care of the Patient 27

The Physician and the Laboratory 58

The Soul of the Clinic 72

INTRODUCTION TO COLLECTED PAPERS OF FRANCIS W. PEABODY

The writer of these papers, composed at different times for specific occasions, without thought at their writing, of eventual collective publication, was beloved by his friends for qualities of heart and mind that were not associated by them with his professional achievements. Yet as one thinks of him in retrospect, appraising him as a physician, one becomes more and more convinced that his great significance for American medicine sprang from those very qualities which endeared him in his personal relations, applied to and interwoven with his professional life. Intellectual and emotional sanity and integrity, from which wisdom, kindness and courtesy are derived, were the natural endowments which brought him distinction as a human being and which gave him an importance for American medicine possessed by very few of his contemporaries.

In the history of medicine there are many names associated with the discovery of facts, with learned treatises and with technical achievements of one kind or another; there are relatively few of whom we think especially as physicians in the sense in which this word is used in regard to Suydenham, for instance. It is a rare blending of learning and humanity, incisiveness of intellect and sensitiveness of the spirit, which occasionally come together in an individual who chooses the calling of Medicine; and then we have the great physician.

His professional life fell into a period of reorganization and unparalleled expansion in the medical world in which public attention quite naturally was focused on the material phases of these changes. Fundamental to these, however, and far more permanently significant, there was an intellectual reorganization and expansion which demanded the development of new leaders who might accomplish for our generation what men like Neusser, Nothnagel, McKenzie, Osler, Delafield, Shattuck and James had accomplished for the one just past. Of these young standard-bearers of the new Medicine he had become an affectionately acknowledged leader. As he grew in maturity and authority his interests were forced, almost in spite of himself, beyond his immediate work in laboratory and wards, into the more general problem of the relations of his profession to education, public health, sociology and, we may call it, its moral and philosophical bearing upon community life. In the educational phases of his work, the clinic which he headed at the Boston City Hospital represents a contribution to the constructive coördination of teaching, investigation and the care of the sick which solved many difficult problems and has already exerted a profound and lasting influence upon medical organization. This was his chief work at the end of his life and here he was continuing the studies which had already made him a noteworthy investigator and teacher.

But the imagination and critical faculties which had given value to his investigations were equally fertile in the more general aspects of his interests. Sought as a member of the most important scientific bodies of our country, he was capable of impersonal judgments and retained, as he would have indefinitely, that combination of the young heart and the old head in which the passage of time makes little difference and which, together, are the essentials of true understanding.

Of all his valuable contributions to the development of modern medicine, these short papers are the ones which deal most directly with the problems forced upon medicine by its own rapid development and by the increased opportunities and responsibilities which involved it with educational, social and economic changes. They deal with questions many of which are still unsolved, and their publication will serve to continue the influence of a voice that American medicine could ill afford to lose--one of clear-headedness, unsentimental idealism and the great wisdom of affectionate optimism.

Hans Zinsser.

Francis Weld Peabody

Born--November 24, 1881; died, October 13, 1927.

Degrees--A.B., Harvard, 1903. M.D., Harvard, 1907.

Positions--

Intern, Massachusetts General Hospital, 1907-08.