"Until the sun of science...the true Apollo of medicine has risen": collective investigation in Britain and America, 1880-1910.

In August, 1880, George Murray Humphry, in his presidential address to the British Medical Association (BMA), called for “collective action” by the country's “eight thousand physicians” to accumulate observations concerning the role of “temperamental, climacteric, and topographical agencies upon disease”. Through participating in organized inquiries, practitioners would “deepen their interest in the science of medicine, and impart the charm of wider usefulness to the daily routine of life”.1 By December 1881, the BMA had funded a Collective Investigation Committee, which over the next eight years would sponsor nearly a dozen inquiries into the natural history of disease.2 Beyond Great Britain, Humphry's appeal would launch an international movement for collective investigation, with physicians in Germany, the Netherlands, Norway, Sweden, and the United States following the British example.3 At first glance, there is little exceptional about the movement for collective investigation. Organized efforts to collect practitioner data on diseases and their treatment go back at least to the eighteenth-century: Felix Vicq d'Azyr led the Societe Royale de Medecine in collecting data from French physicians on meteorological conditions and epidemics, while in England John Jurin surveyed correspondents of the Royal Society concerning their experiences with smallpox inoculation.4 The London Medical-Chirurgical Society, the Clinical Society of London, the BMA, the Massachusetts Medical Society and the American Medical Association (AMA) each attempted analogous inquiries earlier in the nineteenth century with disappointing results.5 Yet the movement for collective investigation provides a unique window into late-nineteenth-century contests over medical science and medical society. The historians Christopher Lawrence, John Harley Warner and George Weisz have analysed the intellectual and political tensions facing late-nineteenth-century elite physicians who sought to incorporate laboratory medicine into clinical practice. Contests over what the laboratory could contribute to diagnosis or treatment were central to a decades-long multinational debate about how future physicians should be trained and how current physicians should practise.6 Historians' emphasis on this “great transformation” has obscured a more immediate divide within the profession, between those practitioners who saw clinical encounters as opportunities for discovery and learning, and the great majority of working physicians who, their attentions focused on earning a living, had little time for new knowledge. The movement for collective investigation, which sought to harvest the experiences of general practitioners for medical science, demonstrates how uninterested such practitioners were in the scientific and social aspirations articulated by medical elites. The present article examines the history of collective investigation in Great Britain and the United States, the two countries where the movement was most vigorous.7 In Great Britain, the sponsors of collective investigation were elite consultants who insisted that the experiences of general practitioners, properly gathered, could transcend the limitations of hospital medicine. Their own background in hospital practice notwithstanding, these consultants articulated a vision of a biographical medicine which might explain the trajectories of disease in ways no study of morbid anatomy could achieve.8 In the United States, collective investigations focused more on therapeutics than on the natural history of disease. Organized collective investigations were taken up by local medical societies, national specialty groups and at least one drug company. Ephemeral as most such efforts were, collective investigation none the less survived two decades longer in the United States than in Great Britain. In both countries, collective investigation ultimately failed as a social movement for achieving professional cohesion and as a legitimate mode of investigation. The movement's failures illuminate the fragility of elite ideals about medical knowledge and medical community in the late nineteenth century.