{"id":44629,"date":"2019-05-17T18:44:00","date_gmt":"2019-05-17T17:44:00","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=44629"},"modified":"2019-05-24T14:26:58","modified_gmt":"2019-05-24T13:26:58","slug":"jeffrey-aronson-when-i-use-a-word-desmond-laurences-clinical-pharmacology","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/05\/17\/jeffrey-aronson-when-i-use-a-word-desmond-laurences-clinical-pharmacology\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Desmond Laurence\u2019s Clinical Pharmacology"},"content":{"rendered":"
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Desmond Laurence<\/a>, pictured carrying the documents needed for a meeting of the Committee on Safety of Medicines<\/em><\/figcaption><\/figure>\n

Desmond Laurence (1922\u20132019), one of the founders of UK clinical pharmacology, died this week. Others, better qualified than I am to do so, will write obituaries. But I should like to pay a tribute to Desmond, by highlighting his influential textbook, Clinical Pharmacology<\/span><\/i>.<\/span><\/p>\n

Clinical pharmacology was originally known as \u201cmateria medica\u201d, the Latin translation of the title of a five-volume text by the Greek herbalist and physician Pedanius Dioscorides, written in 50\u201370 AD, called \u03a0\u03b5\u03c1\u03af \u03cd\u03bb\u03b7\u03c2 <\/span>\u1f30\u1fb1\u03c4\u03c1<\/span>\u03b9\u03ba\u03ae\u03c2, literally \u201cabout medical stuff\u201d, \u201cDe materia medica\u201d in Latin. The earliest surviving version is the 6<\/span>th<\/span> century <\/span>Codex Vindobonensis<\/span><\/i><\/a>.<\/span><\/p>\n

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A parallel text edition of the first volume of De materia medica by Dioscorides<\/em><\/figcaption><\/figure>\n

\u201cThe materia medica\u201d in English originally meant \u201cthe remedial substances and preparations used in the practice of medicine [or] a list of these\u201d (OED). It was first recorded in Philip Skippon\u2019s journal, dated 1663, in which he described \u201cfour hundred glass bottles filled with the Materia Medica, chmymically prepared\u201d.<\/span><\/p>\n

Then, in the 18<\/span>th<\/span> century it came to mean \u201cthe branch of medicine that deals with the origins, preparation, and use of the materia medica\u201d, as recorded in Tobias Smollett\u2019s picaresque novel <\/span>Humphry Clinker<\/span><\/i> (1771): \u201cThere are different courses for the theory of medicine, and the practice of medicine; for anatomy, chemistry, botany, and the materia medica, over and above those of mathematics and experimental philosophy.\u201d<\/span><\/p>\n

Textbooks of materia medica started to appear in the late 18<\/span>th<\/span> century. They included <\/span>Methodus Materiae Medicae<\/span><\/i> (1770) by <\/span>Francis Home<\/span><\/a>, the first Professor of Materia Medica in <\/span>Edinburgh<\/span><\/a> (as opposed to Botany and Materia Medica, an earlier chair); <\/span>Materia medica Americana, potissimum regni vegetabilis<\/span><\/i> by Johann David Sch\u00f6pf (<\/span>1787<\/span><\/a>); <\/span>A Treatise of the Materia Medica <\/span><\/i>(<\/span>1789<\/span><\/a>), by William Cullen, Professor of Medicine in Edinburgh; <\/span>Elements of<\/span><\/i> Therapeutics & Materia Medica<\/span><\/i> by Nathaniel Chapman (<\/span>1821<\/span><\/a>); <\/span>Elements of Materia Medica & Therapeutics<\/span><\/i> by Anthony Todd Thomson (two volumes, <\/span>1832<\/span><\/a> and <\/span>1834<\/span><\/a>); and <\/span>Elements of Materia Medica & Therapeutics<\/span><\/i> by Edward Ballard & Alfred Baring Garrod (1845).<\/span><\/p>\n

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An early textbook on materia medica, written in Latin<\/em><\/figcaption><\/figure>\n
\"\"<\/a>
John Mitchell Bruce (1846-1929)<\/em><\/figcaption><\/figure>\n

So when the physician <\/span>John Mitchell Bruce<\/span><\/a> wrote his textbook on the subject, \ufb01rst published in 1884, he called it <\/span>Materia Medica and Therapeutics. An Introduction to the Rational Treatment of Disease<\/span><\/i>. Bruce was joined, in 1912, for the <\/span>9<\/span>th<\/span> edition<\/span><\/a>, by the clinical pharmacologist Walter J Dilling. Dilling became the sole author of the 15th edition in 1939 and continued as such until the 19<\/span>th<\/span> edition, published posthumously in 1951.<\/span><\/p>\n

When Stanley Alstead, Regius Professor of Materia Medica in Glasgow, who taught me materia medica, with his colleague J Gordon MacArthur, produced the 20th edition of Dilling\u2019s textbook in 1960, they called it <\/span>Dilling’s Clinical Pharmacology<\/span><\/i>. Desmond\u2019s Laurence\u2019s textbook, <\/span>Clinical Pharmacology<\/span><\/i>, was first published in 1960. I know of no earlier books similarly titled, although John Taylor Halsey’s translation of a German text as <\/span>Pharmacology, Clinical and Experimental<\/span><\/i> (1914), comes close.<\/span><\/p>\n

As a student at Glasgow University in the 1960s, I used Dilling\u2019s textbook. I learnt about Desmond’s book only when I came to Oxford in 1973 and discovered that the jokes in it were much better than those in Dilling. [Actually, there were no jokes in Dilling.] Peter Kneebone’s illustrations, in the second and later editions of Laurence, added to the fun.<\/span><\/p>\n

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Left<\/strong>: The cover of Desmond\u2019s 1959 publication, in which \u201chuman pharmacology\u201d and \u201cclinical pharmacology\u201d were contrasted by Harry Gold.<\/em>
\nMiddle<\/strong>: The cover of the 21st edition of Clinical Pharmacology (Dilling), the textbook I used as an undergraduate; Stanley Alstead became Regius Professor of Materia Medica in Glasgow in 1948<\/em>
\nRight<\/strong>: The title page of the first edition (1960) of Laurence\u2019s Clinical Pharmacology, co-authored with Moulton; the reviewer in the BMJ, C A Keele, wrote \u201cThis is a very good book. \u2026 I recommend [it] highly\u201d<\/em><\/p>\n

The earliest instance of the term “clinical pharmacology” that I have found is from 1901 in the BMJ, but it became fashionable only many years later.<\/span><\/p>\n

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Pharma in Parma. The earliest instance that I have found of the term \u201cclinical pharmacology\u201d (Burton-Brown FH. Medical Education In Italy. Br Med J 1901 Dec 14; 2(2137): 1751-4); in this survey, the names of the subjects taught in various Italian schools were presumably translated from the Italian<\/em><\/p>\n

Desmond worked in the Department of Applied Pharmacology at University College Hospital in London, and in 1959 he titled the proceedings of a meeting that had been held in London the previous year, <\/span>Quantitative Methods in Human Pharmacology and Therapeutics<\/span><\/i>. However, John Gaddum had titled his 1953 lecture to the Royal Society of Medicine “Clinical Pharmacology”, and Harry Gold, who had been Professor of Clinical Pharmacology at Cornell since 1947, reminded UK pharmacologists of that fact in his paper in Desmond’s 1959 book. Perhaps that’s why Desmond used the term for the title of his new textbook.<\/span><\/p>\n

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John Gaddum\u2019s Walter Ernest Dixon Memorial Lecture (1953): \u201cI propose to discuss some of the clinical implications of pharmacology. I had already decided that the title of my lecture would be \u2018Clinical Pharmacology\u2019 when I found that Dr Harry Gold (1952) had used the same words to describe the same thing\u201d (Proc R Soc Med 1954; 47(3): 195-204)<\/em><\/p>\n

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Harry Gold (1889-1972), First Professor of Clinical Pharmacology, Cornell, 1947; \u201c[At Cornell] we call [the subject] clinical pharmacology. Many of you are probably familiar with Dr Gaddum\u2019s Dixon Memorial Lecture on this subject under the title, \u2018Clinical Pharmacology\u2019 But I believe your term, \u201cHuman Pharmacology\u201d, is a better one, free of the various meanings of the term \u2018clinical\u2019, which tend to identify it with the art of therapeutics, the practical care of patients.\u201d The term \u201cclinical pharmacology\u201d probably prevailed because UK clinical pharmacologists were very much concerned with the practical care of patients.<\/em><\/p>\n

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The growth of clinical pharmacology since the 1960s is reflected in the relevant publications and was partly driven by its textbooks. <\/span>Clinical Pharmacology<\/span><\/i> inspired many students to become clinical pharmacologists, as Dilling\u2019s textbook inspired me.<\/span><\/p>\n

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The numbers of publications listed in PubMed that include the term \u201cclinical pharmacolog*\u201d; the first entry is from 1940, although sporadic instances can be found elsewhere back to 1901; the pattern reflects certain events in the history of clinical pharmacology in the UK: the subject flourished in the 1970s and 1980s, but in the 1990s, with the introduction of research assessment exercises, it stagnated, even though many departments of clinical pharmacology earned 5 or 5* ratings; an instauration began in 2006<\/em><\/figcaption><\/figure>\n

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The earliest paper to feature the term \u201cclinical pharmacology\u201d, listed in the Pubmed database, published in 1940, was called \u201cCalcium gluconate in cardiac failure: clinical pharmacology and therapeutics\u201d (Glasgow Med J 1940; 134(5): 147-62); it was written by Alf Rogen, a cardiologist in Stobhill Hospital, Glasgow, for whom I worked as a Senior House Officer in 1971; the Regius Professor of Materia Medica in 1940, based in Stobhill Hospital, was Noah Morris<\/em><\/figcaption><\/figure>\n

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\"jeffrey_aronson\"<\/a>Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n

Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

Desmond Laurence (1922\u20132019), one of the founders of UK clinical pharmacology, died this week. Others, better qualified than I am to do so, will write obituaries. But I should like […]<\/p>\n

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