Tuesday, December 27, 2011

Human Well-Being .

Richard Cabot's (1868-1939) decision to leave full-time medical work in 1920 to teach social ethics illustrates some of the tensions inherent in twentieth-century medicine's transformation from clinical practice to a biomedical science. Cabot, then one of America's best known physicians, practiced medicine in an era in which science redefined medical practice and thinking. Although a champion of medical science, Cabot's primary concerns were clinical and humanistic. He emphasized the importance of ambulatory medicine, advocated group practice, founded hospital social work, did clinical epidemiologic research, lobbied for preventive medicine, created the Clinical-Pathologic Conference, and wrote extensively on medical ethics. In 1912, despite Cabot's great talents, a top professorship at Harvard Medical School was instead given to David Edsall, a clinician with more extensive basic science training. Cabot's efforts to define the physician's, as well as the health care system's, role in human well-being, however, presaged medicine's current attempts to emphasize the social context of the patient.
He is also credited with discovering Cabot rings(1), and for describing, along with his colleague, Locke, the eponymous Cabot-Locke murmur, a diastolic murmur occasionally heard in severe anemia, unrelated to heart valve abnormalities.
Paul Dudley White, the distinguished cardiologist, wrote of Richard Cabot after his death:
In every generation there are restless souls who cannot be made to fit the common mold. A few of these are valuable in keeping their communities and professions in a ferment by their constant challenge to the existing order of man's thought and action. But when, in addition to possessing these attributes, a rare individual is endowed with the divine fire and makes important contributions to the pioneering progress of humanity, then indeed we recognize a great leader. In the thick of the fray such recognition comes slowly but as soon as the smoke of the battle clears the acclaim is universal. (1939)

[1] Cabot rings are thin, red-violet staining, threadlike strands in the shape of a loop or figure-8 that are found on rare occasions in erythrocytes. They are believed to be microtubules that are remnants from a mitotic spindle. Cabot rings have been observed in a handful of cases in patients with megaloblastic anemia, lead poisoning and other disorders of erythropoiesis. They were first described in 1903 by American physician, Richard Clarke Cabot.
Cabot addressed the seventh annual New Thought conference as did Royce in 1907.

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