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Richard Cabot

Richard Cabot Richard Clarke Cabot (May 21, 1868-May 7, 1939) was a physician, philosopher, educator, and social work pioneer. He was a meticulous scientific observer and record keeper, a talented speaker, a prolific writer, and an outspoken commentator on medical, moral, and ethical issues. He saw his calling as the integration of empirical knowledge with spiritual belief.

The fifth of seven sons, Richard Cabot was born in Brookline, Massachusetts to James Elliot Cabot and Elizabeth Dwight Cabot. Richard's grandfather began as a common sailor. He married one of Thomas Handasyd Perkins's daughters, joined Perkins's trading firm, and eventually took command after Perkins retired. Richard's father, James, studied philosophy at Göttingen, Heidelburg, and Berlin. He was a member of the Agassiz expedition to Lake Superior and practiced architecture before settling down as an independent philosopher. He published articles, presented lectures, attended the Cambridge Metaphysical Club, and was a Harvard Overseer. A close friend of Ralph Waldo Emerson, he served as Emerson's editor, biographer, and literary executor.

Nurtured in a rich spiritual and intellectual home environment, Richard at first resolved to become either a Unitarian minister or a philosopher. But the influences of his cousin, Joseph Lee, a social work pioneer who led a campaign to establish urban playgrounds, and Dr. Edward Livingston Trudeau, a tuberculosis survivor who, in 1884, established the first sanatorium, were in the end more decisive.

As a youth Cabot attended the private Noble & Greenough school and worshipped at the First Parish (Unitarian) in Brookline. At Harvard University, he studied under William James, George Herbert Palmer, and Josiah Royce. Royce, at that time considered the preeminent philosopher in the United States, became Cabot's long-time mentor. After graduating summa cum laude in 1889 with a B.A. in philosophy, Cabot decided to pursue a graduate degree in medicine, rather than philosophy or the ministry, because he believed that practicing medicine would enable him to employ his religion in the practical care of patients.

In 1892 Cabot received an M.D. degree from Harvard Medical School. Following a one-year internship he won a Dalton Fellowship for leukemia research at the Massachusetts General Hospital (MGH). At this time his parents asked him to take over the diabetes treatment and care of his older brother Ted, whom he had always admired for his keen philosophical abilities. Since there was then no viable treatment for diabetes, his brother Ted died while under his care. This affected him deeply.

While an undergraduate Cabot met Ella Lyman (1866-1934), of a prominent Boston family which attended King's Chapel (Unitarian). After attending private high schools, Ella went to Radcliffe and Harvard where she studied logic and philosophy. In 1894 Richard and Ella were married at the Swedenborgian Church in Waltham, Massachusetts. Like her husband, Ella attended Josiah Royce's seminars, lectured in his classes, and attended the weekly ethics seminars at his home. Ella wanted to have children, but Richard opposed the idea, believing that resisting bodily instincts would lead to a "more abundant life," focused on service to God and society. Although the couple enjoyed an intimate spiritual and intellectual partnership, they later regretted not having children.

Richard and Ella Cabot shared lofty goals. Writing to her in 1894 he said, "The reconciliation of religion and science, of religion and art, of science and the outlook from the point of view thus to be obtained, seems to me as true a statement of our vocation as I can make in so few words." Both wanted to put their superior education and inherited wealth to public benefit. Richard said, "I feel that not to do something really great will be for me to have failed entirely. I have never heard or read of anyone with such advantages." His plan was to "practice medicine until 45 or until I can live on my income, then I will cultivate other fields."

Cabot began his clinical work at MGH in 1895. His first book was A Guide to the Clinical Examination of the Blood for Diagnostic Purposes, 1896. In 1897 he opened a private medical practice and in 1898 he served as the pathologist on the hospital ship, Bay State, which traveled to Puerto Rico during the Spanish-American War. He also served on the Board of Directors of the Boston Children's Aid Society, 1894-1902; the governing committee of the Massachusetts Civic League, 1901; and as Chairman of the Advisory Committee on Hygiene for the Boston Public Schools, 1895-1901. He did volunteer work as the consulting physician to the Westboro School for Boys and the Lancaster School for Girls.

In his medical career Cabot juggled a number of overlapping and interrelated positions. At MGH he started as the house officer on the East Medical Service; then moved up to direct the Out-Patient Department; and finally was promoted to Chief of the West Medical Service. In 1905 he established at MGH the nation's first in-hospital social service department, with Ida Maud Cannon as one of it's first social workers.

From 1897 to 1926 Cabot saw patients in private practice at his Boston home. In addition to the traditional medical tools of the time—stethoscope, reflex hammer, and blood pressure cuff—his office had a microscope to do white blood cell counts and chemical equipment to do urinalysis. He had X-rays (recently discovered) taken by a specialist, often referred patients to other local physicians and specialists, and consulted with doctors at the Harvard Medical School. He took meticulous notes detailing symptoms, diagnosis, prescribed treatments, and follow-up results. These indexed and cross-referenced case records, which eventually came to 36 bound volumes, were a source of data that he used in his classes, writings, and presentations.

Cabot used the results of laboratory research findings in his clinical work to improve the accuracy of his diagnoses. He presented his case method in Physical Diagnosis, 1905, which became the standard textbook on the subject, going through ten editions.

While teaching at the Harvard Medical School, 1899-29, Cabot introduced case analysis as a teaching method. It was soon adopted as the standard for medical education. Believing that diagnosis was the first step in medical intervention, he developed at MGH "clinicopathological conferences," where a physician would present his "differential diagnosis" of a patient based on symptoms, laboratory test results, and observation. At the conclusion a pathologist would reveal the actual cause of death, based on autopsy findings. As these conferences were popular, he produced a written format that lived on as a regular feature in the New England Journal of Medicine. Later he adapted the clinicopathological conference to hospital social work, instituting weekly case conferences. He gained national acclaim for his landmark article in the Journal of the American Medical Association, "The Four Common Types of Heart Disease," 1914, in which he drew connections between autopsy results and patient case histories in order to determine the causes of heart disease.

The medical social service program that Cabot introduced at MGH was widely imitated by hospitals across the country. He delivered talks on medical social service to hospitals and social service organizations throughout the nation. By 1913 there were 100 hospital social service departments in the United States. He also taught medical social work classes at Simmons College School of Social Work, 1912-34.

In 1916 Richard and Ella toured the United States to rouse Americans to support the Allies in World War I. Cabot's younger brother Hugh, also a doctor, enlisted in the British medical service before the United States entered the war. Seeing nobility in combat, Richard joined the United States Army Medical Reserve Corps and served in France, 1917-19. Sobered by hospital work at the front, he regretted having believed prewar patriotic propaganda. He wrote that he "came home from France after the war branded with the conviction that non-ethical education was just as apt to be a curse as a blessing."

In 1919, as he had predicted 20 years earlier, Cabot switched careers. He resigned from MGH and the Harvard Medical School faculty to become Professor of Social Ethics—a combination of philosophy and sociology—at the Harvard Divinity School. By accepting the position, which had been empty since Francis Greenwood Peabody retired in 1913, he hoped to spark a rebirth of ethical thought. He thought that the progressive movement was being swept aside by cynicism and reactionary thought and he wanted to reinvigorate ethics by applying it to real human problems, thereby strengthening the character of his students. By this time a new generation of philosophers had come to Harvard. He studied and worked with Ernest and Agnes Hocking and Alfred North Whitehead. During the 1920s he participated in a Christian Pilgrimage group that included the Hockings and a number of social work leaders.

Cabot envisioned Social Ethics as a graduate level school of social work, like law, medicine, and theology. He wanted to train professional executives, a new generation of social reformers, like Hull House founder Jane Addams. In 1924 he developed a clinical year for theology students where they practiced pastoral counseling in medical institutions.

Cabot felt that social work needed new directions. At the 1931 National Association of Social Workers convention he was pessimistic about the ability of social work to alleviate problems brought on by the stock market crash, comparing the effect of the use of social workers to that of "attacking a granite fortress with a pea shooter." He had found funding for and had supported a study of juvenile recidivism by Sheldon and Eleanor Glueck that led to a similar conclusion about the effectiveness of social work. He wanted to redefine social work with an emphasis on 1) honesty, 2) developing channels of communication, and 3) lightening and simplifying the social worker's workload. He wanted social workers to help clients help themselves rather than fixing their problems for them.

Throughout his career Cabot was a popular speaker and writer. His topics included the school hygiene movement, Christian Science cures, the ethics of animal experimentation, the place of women in medicine, group medical practice, animal rights, health insurance, the improvement of church music, the ethics of spying on our neighbors in times of peace, alcohol, civil liberties, carillons, Freud, Gandhi, Communism, corporate spying, Christmas caroling, and Christianity and sex.

Cabot retired from Harvard at 65. His wife Ella died that year. She had put much of the wealth she had inherited into a trust to support personal projects in art, religion, and related areas.

Continuing to work, Cabot became Professor of Sociology and Applied Christianity at Andover-Newton Theological School. He soon gained a strong following of students in his Clinical Pastoral Education (CPE) classes. He also worked on the Cambridge-Somerville Youth Study with Eleanor Glueck, seeking to identify social and psychological factors that contributed to childhood delinquency; wrote a book, with Russell Dicks, about CPE called The Art of Ministering to the Sick, 1936; and wrote a grand synthesis of his personal theology, "The Creative Power of God," which was never completed. He died in 1939. He directed that his wealth be added to that of his wife in the Ella Lyman Cabot Trust.

To friends and foes Cabot was controversial. They called him quixotic, tangential, unreliable, hasty, a saint, blunt, unusual, complicated, a medical muckraker, and a cracker-barrel moralist. He believed that "Ethical action is what we do while we are building up our chance to voice somewhere and sometime our thankfulness that we were born and reared on a planet that can show us such wonder, such beauty, such devotion."

Collections of Cabot papers are housed in Harvard's Countway Medical Library and in the Archives at Harvard University in Cambridge, Massachusetts. Additional material is in the Archives of Simmons College, in Boston, and in the Archives of the Massachusetts General Hospital, in Boston. Books by Cabot, not mentioned above, include Case Histories in Medicine (1906), Case Teaching in Medicine (1906), Social Service and the Art of Healing (1909), The Christian Approach to Social Morality (1913), What Men Live By: Work, Play, Love, and Worship (1914), A Layman's Handbook of Medicine (1916), Training and Rewards of the Physician (1918), Facts of the Heart (1926), Adventures on the Borderland of Ethics (1926), The Goal of Social Work (1927), Christianity and Sex (1937), and Honesty (1938).

Ian S. Evison's three volume University of Chicago doctoral dissertation, "Pragmatism and Idealism in the Professions: The Case of Richard Clarke Cabot" (1995), contains a comprehensive bibliography, an in-depth exploration of his career and thought, and a wealth of biographical information. Although no full-length biography of Cabot has been published, there are a number of works that explore a single facet of his life. One of the best is Private Practice in the Early Twentieth-Century Medical Office of Dr. Richard Cabot (2005), by Christopher Crenner. There is an entry "Richard Cabot: Medical Reformer during the Progressive Era (1890-1920)," in the History of Medicine (1993) and entries in the Dictionary of American Biography and in the Encyclopedia of World Biography.

Article by Amy Dahlberg Chu - posted April 21, 2007


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