Jeremy Morris

Quotes

MRC Unit Topics

And they [the MRC] didn’t like the sort of things we did at the beginning and we had great quarrels. The pure scientists couldn’t understand this. […] The first discussion I had there, so every few years you’d turn up at the Council or the Council came down to see you, ‘When did your kind of work ever discover anything?’ Very hostile! So stupidly, the first name I mentioned was Goldberger. Stupidly. […] There’s Florey [the Nobel laureate] and there’s all these other people on the Council and me sitting there. So I said, ‘Goldberger and Snow.’ Neither of which he even knew!

There were three major new, or relatively new, and certainly increasing epidemic diseases: lung cancer, peptic ulcer (bleeding ulcer), and coronary heart disease. And I plunked for coronary heart disease because I was particularly interested in cardiology. . . . it was quite clear that coronary heart disease was what I was going to get into as the third major inquiry of our unit in social medicine. Here is a new disease, a new epidemic disease, a new epidemic, killing disease in which manifestly there must be social factors causing it. About what we virtually had no idea.

There were vague notions about diet, mainly from Russia. . . If there were vague notions about cholesterol we didn’t discuss them. We’re talking about 1946-1947. So I decided to make coronary heart disease as my third major inquiry. For peptic ulcer – the most influential ideas were psychosomatic. And we did, in fact, some studies on that. This was before H. pylori, you see. Years before. Lung cancer was taken over by the smoking people, brilliantly (Doll and Hill). So I was into coronary heart disease

I said, “How do I get into this?” Virtually nothing was known. I read the entire literature in English American in one Saturday afternoon, plus one or two French papers that I managed to struggle through, one or two German papers I got copies of. There was virtually nothing. If there was some other literatures I didn’t cope with them.

So starting out I said, “How shall I tackle this?” It was clear that this was a disease prominent in males rather than females. A disease which increased as middle age advanced. We didn’t know anything about old age. There were some weak suggestions on social class differences in 1930-32, very early. So I decided to go at this through occupations. This seemed to me as good a way as any. I wanted to do large-scale surveys to get some idea of the frequency in the population. Some idea of the rates, but I had very elementary notions on epidemiology. Straight away I started to grapple with the problem of incidence.

Occupational Studies

In December, the same difference we got between the conductors and the drivers we got between the postmen and the clerks. So by now it was something interesting, more than interesting. It is hard to visualize those times. Now-a-days of course, that’s an observation you’d put in the preliminary observation for The Lancet or JAMA or something like that, breathlessly to get in. We were in no hurry at all. We must test this. This is too important. […] The climate of scientific opinion of scientific work was so different.

Being on the Medical Research Council, we were under no pressure. There was no question of funds, you see? But, scientifically we tested and re-tested and now-a-days you’d call it ‘triangulation,’ or you’d point out that Charles Darwin had done this on an infinitely greater scale. We tested this in every way possible. And, of course, this is where my clinical and pathological know-how came in useful. Because unlike so much of modern epidemiology, mine was heavily medical-based. I always had a first-class statistician or team of statisticians with me. But I was a doctor. I was a clinician who had dealt with much coronary heart disease. I was very much into the anatomy of coronary heart disease. But my epidemiology was heavily medical, heavily clinical.

Together with these statisticians who had no blood in their veins, you see, they had water. I’ve always been very fortunate in having first-class statisticians, and an utterly brilliant statistician . . . . I worked with Austin Heady for many years, who is absolutely first class and totally, cold-bloodedly fascinated by the problems, if you know what I mean. I was hot-bloodedly fascinated by the problems. Anyhow, we published at the end of 1953. Jim Watts [Director of the US National Heart Institute] immediately flew over to discuss it and we became good friends.

UK Medical Attitudes:

On my 1947 visit I went specially to see Louis Katz because Louis Katz was unlike British cardiologists, he was interested. Unlike McMichael and Paul Wood, he was interested. Parkinson was polite, he wasn’t interested. . .People like McMichael probably weren’t even polite. But Parkinson wasn’t interested. They wrote the first paper in this country, you know, on clinical myocardial infarction. . .Thomas Lewis, whom I got to know very well, he repeated the Osler story about what we would call the Type A businessman who got angina. They all repeated that. And that was it. And he wasn’t interested in etiology, ecology. Whatever MacKenzie was playing about with Tom, his disciples were all physiologists. But Tom was sufficiently shrewd that his disciples were not only physiologists but very good physicians. Anyhow, Tom wasn’t interested at all and didn’t follow my interest [in epidemiology and social medicine].