Constitutional Medicine

“Its vogue within the academic medical arena seems to have owed much to a particular cohort of aging ‘great clinicians,’ who attempted to keep the whole patient within the doctor’s gaze. [Walter] Alvarez and [Lewellys] Barker, and to some extent [George] Draper, were among the last of the great clinician-scientists, equally comfortable at the laboratory bench and bedside. At once impressed by the great advances of modern science and depressed by the fragmentation of their profession and its view of the sick person, they articulated a constitutional perspective that not only legitimated the clinician’s sharp diagnostic eye and his or her knowledge of human nature but also reiterated the value of modern laboratory analyses in service to the clinician. In some measure, then, the reappearance of constitutional thinking was a response to the general clinician’s loss of power within an increasingly specialized, research-oriented medical profession” (Tracy, 165). . . . the constitutionalists “shared an intellectual indebtedness to systemically and organismically oriented biologists, physiologists, and psychiatrists such as Ludwig Bertalanffy, Walter B. Cannon, William Child, Edwin Conklin, L. J. Henderson, William Ritter, Charles Sherrington, and Adolf Meyer. Indeed, the aim of uniting the biological and social sciences underlay the interdisciplinary constitutional program; it was an aim shared by funding agencies such as the Rockefeller and Macy Foundations. “On a practical level, Draper, Barker, and Alvarez also advocated the coordination of the medical diagnostic team under the supervision of the internist or generalist. They thus proposed a style of medical investigation and practice that shared the same holistic bent as their view of the individual patients. The three internists were critical of the fragmentation of the patient under the reductionistic lens of an increasingly specialized medical profession” (170-171; cf. Tracy II, 58).