Abstract
Biography generally, and medical/scientific biography in particular, encompasses a wide range of individuals with different roles. Some have made original discoveries while others have become designated pioneers. These are not necessarily one and the same individual; indeed, the pioneer is usually a product of the time and his achievement is frequently not based on his original work but upon that of several individuals. Few pioneers have been original thinkers and the attribution of a major original discovery to an individual is the exception rather than the rule. The entrepreneur has been he who has driven home the pioneering achievement for personal gain – often financial.
The Shorter Oxford English Dictionary (SOED) defines a pioneer as: One who goes before to prepare the way; one who begins some enterprise, course of action, etc., … explorer, or worker; an initiator
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and an originator as an individual … with the power of originating, i.e. that which is not ‘a copy, imitation or representation of it’.
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A pioneer therefore is highly dependent on the ‘climate of the time’, i.e. the precise moment that is ripe for a particular discovery to be widely revealed, and tends to be one who ‘cashes in’ on one or more original discoveries in order to claim a breakthrough; in other words, not far from being an entrepreneur – defined by the SOED as: A contractor acting as an intermediary between capital and labour.
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That these three categories are disparate and distinct is perhaps well illustrated by the better-known work of Edward Jenner (1749–1823) who is widely accepted as the pioneer of smallpox (variola) vaccination. However, the fact that cowpox inoculation prevents smallpox had been well known to country folk in western counties of England, notably Gloucestershire and Dorset (see Benjamin Jesty 1736–1816), for a very long time 2 and the efficacy of vaccination was later established by William Woodville (1752–1815) and George Pearson (1751–1828) in major clinical trials at St Pancras Hospital in London. 3–6 As a result of his ‘discovery’ Jenner was awarded £30,000 by the British Parliament and thus became in effect an entrepreneur as well as a pioneer despite the fact that his personal role as an originator in the matter was minimal!
Medical history therefore encompasses numerous pioneers who never had an original idea or never made an original discovery. However, he has exploited one original discovery, and often more than one, in order to initiate a new historical approach.
The time and whereabouts of observations and research that produced some of the older pioneers is lost in antiquity. Who, for example, first visualized the macroparasites Ascaris lumbricoides and Dracunculus medineses? He was the pioneer of a new discipline – clinical parasitology; it was not until relatively recently, however, that micro-parasites and microorganisms generally were visualized and for that Antoni van Leuwenhoek (1632–1723) rightly is given credit and thus he should be regarded both as a pioneer of an extension of parasitology as well as its originator. 6 Who was responsible for the demonstration that the bark of the cinchona tree was of value in the prevention and cure of malaria? We shall almost certainly never know although the discovery was ‘hijacked’ by later ‘pioneers’ – including Robert Tabor (1642–81) in England. 6 Such individuals were pioneers but again not necessarily originators.
Most of the 17th- and 18th-century individuals currently accepted as pioneers achieved their reputation from an original discovery by other investigators. Edward Jenner is one such. In the Navy James Lind (1716–94) is often given credit and was thus the pioneer in the prevention of scurvy but the original observation was clearly made long before by John Woodall (1556–1643). 7,8 In the 19th century William Jenner (1815–98) is regarded in Britain as the first individual to separate typhoid fever from typhus on clinical grounds despite the fact that William Gerhard (1809–72) had demonstrated the distinction in the USA some 13 years earlier. 6 In the 19th century David Bruce (1855–1931) is usually credited with the discovery of the cause of Malta fever (brucellosis) despite the fact that the Maltese investigator Guiseppe Scicluna (1853–1921) was probably responsible for the discovery. 9 In the late 19th and early 20th century, Patrick Manson (1844–1922) is often given credit for the demonstration of mosquito transmission of lymphatic filariasis but it was George Low (1872–1952) who overturned the widely held view that Homo sapiens is infected by mosquito-contaminated drinking water. 10 Walter Reed (1851–1902) is widely accepted as the pioneer behind the elucidation of the mode of transmission of yellow fever despite the fact that he was not even in the vicinity at the time of the discovery! 9,11
In the field of preventive medicine Sir John Pringle (1707–82) is widely hailed as the pioneer of hygiene in the Army; his classic text Observations on the Diseases of the Army (1752) went to no less than seven editions; however, he was merely utilizing principles discovered by others. 6 Edwin Chadwick (1800–90) is accepted as the pioneer of sanitary reform in the civilian population despite the fact that most of his medical evidence was provided by Southwood Smith (1788–1861), Neil Arnott (1788–1874) and James Kay-Shuttleworth (1804–77). After the Crimean War, Florence Nightingale (1820–1910) was acclaimed as a major pioneer of preventive medicine in the Army and of a revolution in hospital design but, although an accomplished administrator, all of the facts leading to her advances were known already and therefore due to others; she had thus used existing knowledge and in these matters was not herself an original thinker. 12
However, in other cases the accepted pioneer also made the original discovery. Thus, John Snow (1813–58) and William Budd (1811–80) incriminated contaminated water as the underlying cause, respectively, of cholera and typhoid fever; both discoveries were in opposition to orthodox views in their respective eras. 6 Alexandre Yersin (1863–1943) was probably correctly given credit for the cause of plague despite the fact that Shibasaburo Kitasato (1852–1931) possibly got there first! Alexander Fleming (1881–1955) is widely hailed correctly as both the originator and the pioneer of the antibiotic era. The three major proponents of the ‘germ theory’ of infective disease – Louis Pasteur (1822–95), Joseph Lister (1827–1912) and Robert Koch (1843–1910) – are duly recognized as pioneers in their respective fields and as significant contributors to the ‘germ-theory’. 6
However, few originators or pioneers have followed their major discovery with strenuous efforts to capitalize on it in a wider context. Arguably Edward Jenner had this in mind in his attempt at worldwide smallpox prevention but a major figure in this respect was undoubtedly Ronald Ross (1857–1932) who, following his original discoveries, inspired by Manson at Secunderabad and Calcutta, devoted his subsequent career to the prevention of malaria, the transmission of which he had established. 9
But what creates a pioneer? It has much to do with the standing of that individual in the contemporary scene. Frequently he has been part of the contemporary establishment, for example Pringle of the Army and Lind of the Navy. 6 Edward Jenner had worked with John Hunter (1728–93) and was himself something of an establishment figure and there is no doubt that Florence Nightingale was very ‘well-connected’.
But how does one become a pioneer without an establishment background or a personal original observation? The Darwins, both Charles (1809–82) and his grandfather Erasmus (1731–1802), despite original ideas were well connected and influential figures, particularly the former. That doubtless added to their respective pioneer status. In addition to the Darwins, other pioneers have also been relatively wealthy individuals. Others have had good contacts. Support from the ‘old boy network’ clearly has had a major impact in the case of some.
What, though, of the future? As prima donnas decline in numbers, and as heads of departments continue to become lesser figureheads and lose their autocracy, the scenario is rapidly changing. Published articles now contain the names of many more members of a research team than was the case previously; in fact, most scientific and medical papers are now written by a team rather than a domineering leader or departmental head. Thus, the days of the pioneer inevitably are on the decline and in the future originators will hopefully be given greater credit for a discovery than has frequently been the case in the past. The entrepreneur who seeks to make his or another's discovery personally financially rewarding is hopefully an individual of the past!