Not only laboratory to clinic: the translational work of William S. C. Copeman in rheumatology.

Since the arrival of Translational Medicine (TM), as both a term and movement in the late 1990s, it has been associated almost exclusively with attempts to accelerate the "translation" of research-laboratory findings to improve efficacy and outcomes in clinical practice (Krueger et al. in Hist Philos Life Sci 41:57, 2019). This framing privileges one source of change in medicine, that from bench-to-bedside. In this article we dig into the history of translation research to identify and discuss three other types of translational work in medicine that can also reshape ideas, practices, institutions, behaviours, or all of these, to produce transformations in clinical effectiveness. These are: (1) making accessible state-of-the-art knowledge and best practice across the medical profession; (2) remodelling and creating institutions to better develop and make available specialist knowledge and practice; and (3) improving public and patient understandings of disease prevention, symptoms and treatments. We do so by examining the work of William S. C. Copeman, a dominant figure in British rheumatology from the 1930 through the late 1960s. Throughout his long career, Copeman blended approaches to "translation" in order to produce transformative change in clinical medicine, making his work an exemplar of our expanded notion of TM.

Correction to: Special issue-before translational medicine: laboratory clinic relations lost in translation? Cortisone and the treatment of rheumatoid arthritis in Britain, 1950-1960.

The above-mentioned article has been published online on 7 November 2019 as part of topical collection 'Before Translational Medicine: Laboratory Clinic Relations'.

Lost in Translation? Cortisone and the Treatment of Rheumatoid Arthritis in Britain, 1950-1960. [corrected].

Cortisone, initially known as 'compound E' was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of 'compound E' at a Mayo Clinic seminar, the New York Times reported the drug's promise as a 'modern miracle' in the treatment of rheumatoid arthritis (RA). Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. It arrived at the end of a decade of 'therapeutic revolutions', kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone's introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine (TM). In exploring cortisone's first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone's use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH-AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today.

Phenylbutazone (Bute, PBZ, EPZ): one drug across two species.

In this article we explore the different trajectories of this one drug, phenylbutazone, across two species, humans and horses in the period 1950-2000. The essay begins by following the introduction of the drug into human medicine in the early 1950s. It promised to be a less costly alternative to cortisone, one of the "wonder drugs" of the era, in the treatment of rheumatic conditions. Both drugs appeared to offer symptomatic relief rather than a cure, and did so with the risk of side effects, which with phenylbutazone were potentially so severe that it was eventually banned from human use, for all but a few diseases, in the early 1980s. Phenylbutazone had been used with other animals for many years without the same issues, but in the 1980s its uses in veterinary medicine, especially in horses, came under increased scrutiny, but for quite different reasons. The focus was primarily the equity, economics, and ethics of competition in equine sports, with differences in cross-species biology and medicine playing a secondary role. The story of phenylbutazone, a single drug, shows how the different biologies and social roles of its human/animal subjects resulted in very different and changing uses. While the drug had a seemingly common impact on pain and inflammation, there were inter-species differences in the drug's metabolism, the conditions treated, dosages, and, crucially, in intended clinical outcomes and perceptions of its benefits and risks.

Text Mining the History of Medicine.

Historical text archives constitute a rich and diverse source of information, which is becoming increasingly readily accessible, due to large-scale digitisation efforts. However, it can be difficult for researchers to explore and search such large volumes of data in an efficient manner. Text mining (TM) methods can help, through their ability to recognise various types of semantic information automatically, e.g., instances of concepts (places, medical conditions, drugs, etc.), synonyms/variant forms of concepts, and relationships holding between concepts (which drugs are used to treat which medical conditions, etc.). TM analysis allows search systems to incorporate functionality such as automatic suggestions of synonyms of user-entered query terms, exploration of different concepts mentioned within search results or isolation of documents in which concepts are related in specific ways. However, applying TM methods to historical text can be challenging, according to differences and evolutions in vocabulary, terminology, language structure and style, compared to more modern text. In this article, we present our efforts to overcome the various challenges faced in the semantic analysis of published historical medical text dating back to the mid 19th century. Firstly, we used evidence from diverse historical medical documents from different periods to develop new resources that provide accounts of the multiple, evolving ways in which concepts, their variants and relationships amongst them may be expressed. These resources were employed to support the development of a modular processing pipeline of TM tools for the robust detection of semantic information in historical medical documents with varying characteristics. We applied the pipeline to two large-scale medical document archives covering wide temporal ranges as the basis for the development of a publicly accessible semantically-oriented search system. The novel resources are available for research purposes, while the processing pipeline and its modules may be used and configured within the Argo TM platform.

The Machinery of Authoritarian Care: Dramatising Breast Cancer Treatment in 1970s Britain.

This article examines the professional and public response to the television play Through the Night, which aired on BBC1 in December 1975. One of the first British mass media portrayals of a woman's experience being treated for breast cancer, this play attracted a large audience and considerable attention from both critics and everyday viewers. My analysis of the play draws on sources documenting expert responses to the play in its production stages, as well as critics' and viewers' responses to what the play said about breast cancer treatment in particular, and about Britons' experiences of medical institutions more broadly. Together, I argue, these sources help us see how Through the Night's critique of what one expert called 'the machinery of authoritarian care' reverberated with and supported the efforts of professionals anxious to improve patient experience, and how it crystallised the concerns of activists and everyday viewers.

"Here man learns about himself": visual education and the rise and fall of the American Museum of Health.

When the American Museum of Health (AMH) opened in 1939 at the World's Fair, its popularity convinced its organizers that the AMH was merely the first in a nationwide network of health museums. The AMH's organizers had imported an approach to health education developed in Germany, which promoted health as a positive attribute through interactive, visually impressive displays that relied on clarity and simplicity-as epitomized by the "Transparent Man"-to encourage a feeling of wonder among exhibit goers. However, other museum professionals rejected this approach, and the AMH failed to catalyze a broad health museum movement. Nevertheless, the notion that presenting the body as an object of wonder will improve the public's health has reappeared in the more recent past, as popular anatomical shows claim that exposing the interior of the human body will convince viewers to live healthier lives.

Does bigger mean better? British perspectives on American cancer treatment and research, 1948.

In the summer of 1948, a delegation representing the British Empire Cancer Campaign (BECC) toured North American cancer treatment and research facilities, and reported their observations back to their organization's executive board. This historical article contextualizes the British delegation's observations of US treatment and research, and discusses what the delegation made of the United States' new, "bigger" approaches to cancer surgery and chemotherapeutic research. I argue that the BECC delegation used their observations of US practice to reinforce a positive sense of British distinctiveness, thus reassuring themselves and their colleagues that Britain could still be a leader in the increasingly international field we now call oncology.

"Cancer as the general population knows it": knowledge, fear, and lay education in 1950s Britain.

This article examines British medical debates about cancer education in the 1950s, debates that reveal how those responsible for cancer control thought about the public and their relationship to it, and what they thought the new political economy of medicine introduced by the National Health Service would mean for that relationship. Opponents of education campaigns argued that such programs would add to the economic and organizational pressures on the NHS, by setting in motion an ill-informed, uncontrollable demand that would overwhelm the service. But an influential educational "experiment" devised by the Manchester Committee on Cancer challenged these doubts, arguing that the public's fear was based in their experience with family and friends dying of the disease. The challenge for cancer control, then, was to improve that experience and thus change experiential knowledge.