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September 9, 1974

The New Orchestration

JAMA. 1974;229(11):1476. doi:10.1001/jama.1974.03230490064034

Reflecting on the nature of the relationships between organs, Lord Russell Brain1 made the following comment:

Transaction is the characteristic feature of our present epoch in medicine. Many of the most important things that happen in the body can no longer be explained simply as the result of interaction of two or more organs, but require the conception of a dynamic transaction which itself integrates the activities of the organs.... In these processes the constituents are themselves affected by what goes on. We are dealing, therefore, not with the interaction of unchanging objects like billiard balls, but with events that can only be expressed in transactional terms. In other words, though physiology and pathology have to take account of what is happening in individual organs, the transaction as a whole is the more important and unifying factor.

It is 20 some years since these lines had been written. We