¹ Robert A Aronowitz, ‘Do not delay: breast cancer and time, 1900–1970’, Milbank Quarterly, 2001, 79: 355–86.

² On cancer control, see ibid.; Barron H Lerner, The breast cancer wars: hope, fear, and the pursuit of a cure in twentieth-century America, New York, Oxford University Press, 2001; and Lester Breslow, et al., A history of cancer control in the United States, with emphasis on the period 1946–1971, prepared by the History of Cancer Control Project, UCLA School of Public Health, pursuant to Contract no. N01-CN-55172, Division of Cancer Control and Rehabilitation, National Cancer Institute, Bethesda, MD, Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health, National Cancer Institute, Division of Cancer Control and Rehabilitation, 1977. See also James T Patterson, The dread disease: cancer and modern American culture, Cambridge, MA, and London, Harvard University Press, 1987.

³ Robert N Proctor, Cancer wars: how politics shapes what we know and what we don't know about cancer, New York, Basic Books, 1995; Stephen P Strickland, Politics, science and dread disease: a short history of United States medical research policy, Cambridge, MA, Harvard University Press, 1972.

⁴ Ilana Löwy and Jean-Paul Gaudillière, ‘Disciplining cancer: mice and the practice of genetic purity’, in Jean-Paul Gaudillière and Ilana Löwy (eds), The invisible industrialist: manufactures and the production of scientific knowledge, Basingstoke, Macmillan, 1998, pp. 209–49; Jean-Paul Gaudillière, ‘Circulating mice and viruses: the Jackson Memorial Laboratory, the National Cancer Institute, and the genetics of breast cancer, 1930–1965’, in Michael Fortun and Everett Mendelsohn (eds), The practices of human genetics, Dordrecht, Kluwer Academic Publishers, 1999, pp. 89–124; Jean-Paul Gaudillière, ‘Making heredity in mice and men: the production and uses of animal models in postwar human genetics’, in Jean-Paul Gaudillière and Ilana Löwy (eds), Heredity and infection: the history of disease transmission, London and New York, Routledge, 2001, pp. 181–202; Jean-Paul Gaudillière, ‘Mapping as technology: genes, mutant mice, and biomedical research (1910–1965)’, in Hans-Jörg Rheinberger and Jean-Paul Gaudillière (eds), Classical genetic research and its legacy: the mapping cultures of twentieth-century genetics, London and New York, Routledge, 2004, pp. 173–203; Karen A Rader, Making mice: standardizing animals for American biomedical research, 1900–1955, Princeton and Oxford, Princeton University Press, 2004, esp. chs 4 and 5.

⁵ For one of the few exceptions to the dismissal of hereditarian explanations of cancer, see Paolo Palladino, ‘Between knowledge and practice: on medical professionals, patients, and the making of the genetics of cancer’, Soc. Stud. Sci., 2002, 32: 137–65. See also Paolo Palladino, ‘Speculations on cancer-free babies: surgery and genetics at St. Mark's Hospital, 1924–1995’, in Gaudillière and Löwy (eds), Heredity and infection, op. cit., note 4 above, pp. 285–310; and Paolo Palladino, Plants, patients and the historian: (re)membering in the age of genetic engineering, New Brunswick, NJ, Rutgers University Press, 2003.

⁶ Aronowitz, op. cit., note, 1 above, esp. pp. 370–5.

⁷ Jeremy A Greene, ‘Therapeutic infidelities: ‘noncompliance’ enters the medical literature, 1955–1975’, Soc. Hist. Med., 2004, 17: 327–43.

⁸ For the background of post-war enthusiasm for psychology, see Nathan G Hale Jr, The rise and crisis of psychoanalysis in the United States: Freud and the Americans, 1917–1985, New York, Oxford University Press, 1995; Ellen Herman, The romance of American psychology: political culture in the age of experts, Berkeley, University of California Press, 1995; Eva S Moskowitz, In therapy we trust: America's obsession with self-fulfillment, Baltimore, Johns Hopkins University Press, 2001; Joel Pfister and Nancy Schnog (eds), Inventing the psychological: toward a cultural history of emotional life in America, New Haven, Yale University Press, 1997.

⁹ I am grateful to Dr Lynch for a copy of his CV. An earlier version of his CV is available at <http://tobaccodocuments.org/ctr/CTRMN011133-1160.html> (accessed 18 July 2003). Details of his career are also obtained from <http://www.whonamedit.com/doctor.cfm/1970.html> (accessed 18 July 2003), and from Eugene P DiMagno, ‘Lifetime Achievement Award Henry T. Lynch, MD. International Symposium on Inherited Diseases of the Pancreas’, in Peter Durie, Markus M Lerch, Albert B Lowenfels, Patrick Maisonneuve, Charles D Ulrich and David C Whitcomb (eds), Genetic disorders of the exocrine pancreas: an overview and update, Basel, Karger, 2002, pp. 149–53; ‘Henry Lynch's family affair: on the trail of inherited cancers’, Coping Magazine, May 1987, pp. 50–4; Mary McGrath, ‘Dr. Henry T. Lynch’, Sunday World Herald [Omaha], 28 Nov. 1999, Section R, p. 24. Details of his career are also from an interview I conducted with Henry Lynch, 12th December 2003, in his office at Creighton University, hereafter ‘Lynch interview, 12th December 2003’.

¹⁰ Oliver moved to Austin in 1946, where he established a human genetics programme at the University of Texas and served as chair of the department of zoology. Clarence P Oliver, ‘Human genetics program at the University of Texas’, Eugenical News, 1952, 37: 25–31. It is possible that Lynch's first contact with human or medical genetics was during his time at Oklahoma where Lawrence H Snyder and Paul R David provided genetic advice to families referred to them. Snyder had been professor in medical genetics at Ohio State University before moving in 1947 to become Dean of the Graduate College of the University of Oklahoma. David was the Professor of Zoology also at the University of Oklahoma. Daniel J Kevles, In the name of eugenics: genetics and the uses of human heredity, Cambridge, MA, Harvard University Press, 1995, pp. 209–10. For a listing of North American counselling centres in the 1950s, see Lee R Dice, ‘Heredity clinics: their value for public service and for research’, American Journal of Human Genetics, 1952, 4: 1–13. A shorter version of this article is available in Lee R Dice, ‘Counseling centers on human heredity in North America’, Eugenical News, 1952, 37: 32–34.

¹¹ These positions were: Medical Genetics Consultant and Lecturer, Department of Orthodontics, University of Nebraska College of Dentistry, Lincoln (1962–1965), and Lecturer in Human Genetics, Graduate and undergraduate students, Department of Zoology, University of Nebraska, Lincoln (1962–1964).

¹² Lynch notes that he was invited to Creighton by the medical school dean, Richard Egan. ‘Lynch interview, 12th December 2003’, op. cit., note 9 above. On Lynch's appointment, see Wayne B Leadbetter, ‘Dr. Lynch takes over’, The Beat, SMA, The Creighton University, Nov. 1967, 1 (2): 1, 7; ‘Two new department heads named’, Creighton Faculty Newsletter, Nov. 1967: 3; John M McBride, ‘Boxing, research in cancer both part of doctor's career’, The Creightonian, 27 Oct. 1967: 9; ‘Noted cancer researcher heads medical department’, The Creightonian, 17 Nov. 1967; ‘Named head at Creighton’, Diagnosis News, March 1968, 1 (3): 24; ‘Authority on cancer genetics to head Creighton's preventive medicine unit’, West Omaha and Dundee Sun, 2 Nov. 1967.

¹³ Kenneth M Ludmerer, Genetics and American society: a historical appraisal, Baltimore and London, Johns Hopkins University Press, 1972, pp. 190–3. See also Kevles, op. cit. note 10 above; Diane B Paul, The politics of heredity: essays on eugenics, biomedicine, and the nature–nurture debate, Albany, State University of New York Press, 1998, pp. 133–56. For British and Canadian perspectives, see, respectively, Peter Coventry and John Pickstone, ‘From what and why did genetics emerge as a medical specialism in the 1970s in the UK?’, Soc. Sci. Med., 1999, 49: 1227–38; William Leeming, ‘Ideas about heredity, genetics, and “medical genetics” in Britain, 1900–1982’, Stud. Hist. Phil. Biol. & Biomed., 2005, 36: 538–58; and William Leeming, ‘The early history of medical genetics in Canada’, Soc. Hist. Med., 2004, 17: 481–500. In addition on human genetics, see Fortun and Mendelsohn, op. cit., note 4 above.

¹⁴ For details of this clinic, see the note in Robert L Tips, George S Smith, Henry T Lynch and C Wallace McNutt, ‘The “whole family” concept in clinical genetics’, Am. J. Dis. Child., 1964, 107: 67–76, p. 67. For a history of the University of Texas Medical Branch, see Chester R Burns, Saving lives, training caregivers, making discoveries: a centennial history of the University of Texas Medical Branch at Galveston, Austin, Texas State Historical Association, 2003.

¹⁵ In 1964, Tips listed his affiliation as Department of Pediatrics, Baylor Medical School, Houston.

¹⁶ Lynch's CV at <http://tobaccodocuments.org/ctr/CTRMN011133-1160.html>, op. cit., note 9 above. On the Bar Harbor course, see Ludmerer, op. cit., note 13 above, p. 191.

¹⁷ H T Lynch, Anne Krush and Rose Faithe, ‘Medical genetics in Nebraska’, Nebr. State Med. J., 1964, 49: 406–11. On the establishment of a genetics clinic, see H T Lynch, ‘Heredity, cancer, and the genetics clinic’, Texas Medicine, 1967, 63: 57–61.

¹⁸ Among the sixteen types of diseases the team studied were Dercum's disease, transposition of the great vessels, osteogenesis imperfecta, cystinosis, dwarfism, diabetes, hypothyroidism, pulmonary emphysema, and several (unspecified) forms of cancer.

¹⁹ Lynch, Krush and Faithe, op. cit., note 17 above, p. 411. Contrast this with the secrecy that McKusick found a problem among the Amish. M Susan Lindee, ‘Provenance and the pedigree: Victor McKusick's field work with the old order Amish’, in Alan H Goodman, Deborah Heath and M Susan Lindee (eds), Genetic nature/culture: anthropology and science between the two-culture divide, Berkeley, University of California Press, 2003, pp. 41–57. A revised version of Lindee's article on McKusick has been published as chapter 3 of her Moments of truth in genetic medicine, Baltimore, Johns Hopkins University Press, 2005, pp. 58–89. On the history of rural Nebraska families, see Deborah Fink, Agrarian women: wives and mothers in rural Nebraska, 1880–1940, Chapel Hill and London, University of North Carolina Press, 1992.

²⁰ Lynch, Krush and Faithe, op. cit., note 17 above, esp. p. 407.

²¹ Ibid. Biographical information on Krush is taken from, ‘The Anne J. Krush Fund for Education and Research in Hereditary Colorectal Cancer Syndromes’, <http://hopkins-gi.nts.jhu.edu/pages/latin/giving/annekrush.cfm> (accessed 17 April 2005).

²² Anne J Krush, Henry T Lynch and Charles Magnuson, ‘Attitudes toward cancer in a “cancer family”: implications for cancer detection,’ Am. J. Med. Sci., 1965, 249: 432–8. One of the clues to the identification of his first cancer family came from his first CFS patient, who explained that he drank excessively because he knew he would one day die of cancer, like all members of his family. Henry T Lynch, Thomas Smyrk, and Jane F Lynch, ‘Molecular genetics and clinical-pathology features of hereditary nonpolyposis colorectal carcinoma (Lynch syndrome): historical journey from pedigree anecdote to molecular genetic confirmation’, Oncology, 1998, 55: 103–8, p. 104.

²³ Krush, Lynch and Magnuson, op. cit., note 22 above.

²⁴ Ibid., p. 433.

²⁵ Ibid., p. 434. See also the movie, The family tree. Cancer genetics: guide to early diagnosis, University of Texas M D Anderson Hospital and Tumor Institute at Houston and the Richardson Foundation, produced by Medical Communications, Houston, University of Texas, 1967. Copy available in National Library of Medicine (QZ 241 VC no.2 1967).

²⁶ Lindee, op. cit., note 19 above.

²⁷ Lynch's interest in collecting such information led him to criticize the common hospital practice of destroying old medical records, see Henry T Lynch and Anne J Krush, ‘The life and death of medical records’, JAMA, 7 December 1970, 214: 1890.

²⁸ Lynch, Krush and Faithe, op. cit., note 17 above, p. 410.

²⁹ Henry T Lynch, ‘Skin, heredity and cancer’, Cancer, 1969, 24: 277–88, p. 286.

³⁰ Lynch, Smyrk, and Lynch, op. cit., note 22 above; Alan G Thorson, Joseph A Knezetic and Henry T Lynch, ‘A century of progress in hereditary nonpolyposis colorectal cancer (Lynch Syndrome)’, Diseases of the Colon and Rectum, 1999, 42: 1–9. Details of the work can be found in the ‘Family register’ compiled by Lynch for members of Family N. in 1978, Papers held by Henry Lynch at the Creighton University (hereafter Lynch archives). The register states that the first patient was referred in 1964, the others state 1962.

³¹ On FAP, see Palladino, ‘Between knowledge and practice’, op. cit., note 5 above. See also Palladino, ‘Speculations on cancer-free babies’ and Palladino, Plants, patients and the historian, both op. cit., note 5 above.

³² H T Lynch, M W Shaw, C W Magnuson, A L Larsen, and A J Krush, ‘Hereditary factors in cancer: study of two large midwestern kindreds’, Arch. Intern. Med., 1966, 117: 206–12.

³³ Ibid. Lynch described CFS as a pedigree involving a high occurrence of adenocarcinomas of multiple anatomical sites (most frequently in the endometrium and colon), multiple primary malignant neoplasms, an early age at onset, and autosomal dominant inheritance. He contrasted this with familial occurrences of malignancy, which by and large were concerned with cancer of specific anatomic sites such as the breast, stomach, prostate, and colon.

³⁴ The term “hereditary nonpolyposis colon cancer” was used by Lynch in 1981. Henry T Lynch, William Albano, James Recerbaren, Patrick M Lynch, and Jane F Lynch, ‘Prolonged survival as a component of a hereditary breast and nonpolyposis colon cancer’, Medical Hypotheses, 1981, 7: 1201–9, p. 1202; H T Lynch, G J Voorhees, S J Lanspa, P S McGreevy and J F Lynch, ‘Pancreatic carcinoma and hereditary nonpolyposis colorectal cancer: a family study’, Br. J. Cancer, 1985, 52: 271–3.

³⁵ On animal research and human genetics, see Gaudillière, ‘Circulating mice and viruses’, and ‘Making heredity in mice and men’, both op. cit., note 4 above. But see Palladino for earlier studies of human cancers, ‘Between knowledge and practice’, op. cit., note 5 above. See also Palladino, ‘Speculations on cancer-free babies’, and Plants, patients and the historian, op. cit., note 5 above.

³⁶ C P Oliver, ‘Studies on human cancer families’, Ann. N. Y. Acad. Sci., 1958, 71: 1198–212; Clarence P Oliver, ‘Genetic factors in breast cancer’, Proceedings of the National Cancer Conference, 1964, 5: 133–42; Clarence P Oliver, ‘Formal discussion of: cancer in man’, Cancer Research, 1965, 25: 1327–29.

³⁷ Lynch, Krush and Faithe, op. cit., note 17 above. This was his first published account in which he indicated that cancer was one of the many hereditary conditions he was studying that deserved more focused attention.

³⁸ For a discussion of proximate, remote, predisposing and exciting causes, see Christopher Hamlin, ‘Predisposing causes and public health in early nineteenth-century medical thought’, Soc. Hist. Med., 1992, 5: 43–70. Michael Worboys, Spreading germs: disease theories and medical practice in Britain, 1865–1900, Cambridge and London, Cambridge University Press, 2000. See also Robert Olby, ‘Mendelism and the theory of hereditary diathesis’, Proceedings of the Symposium on the History of Human Genetics, International Congress of Human Heredity, Washington DC, 1991, published in K R Dronamraju (ed.), The history and development of human genetics, Singapore, World Scientific, 1992, pp. 256–65; W F Bynum, ‘Darwin and the doctors: evolution, diathesis, and germs in 19th-century Britain’, Gesnerus, 1983, 40: 43–53.

³⁹ H T Lynch and A J Krush, ‘Heredity and breast cancer: implications for cancer control’, Med. Times, 1966, 94: 599–605, p. 602.

⁴⁰ V Elving Anderson, Harold O Goodman, Sheldon C Reed, Variables related to human breast cancer, Minneapolis, The University of Minnesota Press, 1958. For a history of the risk factor, see William G Rothstein, Public health and the risk factor: a history of an uneven medical revolution, Rochester, NY, University of Rochester Press, 2003.

⁴¹ For a statement of such arguments in relation to other hereditary cancers and that no genotype seemed to lead to all cancers in general, see Curt Stern, Principles of human genetics, 2nd ed., San Francisco and London, Freeman, 1960, p. 566.

⁴² Lynch, Smyrk, and Lynch, op. cit., note 22 above. I have been unable to find any records of this visit in NIH or NCI records or archives. For a discussion of statisticians' attempts to eliminate bias in clinical trials, see Harry M Marks, The progress of experiment: science and therapeutic reform in the United States, 1900–1990, Cambridge University Press, 2997, esp. pp. 144–6.

⁴³ In interview Lynch is very reluctant to name his critics, and they seem to have been equally reluctant to put their doubts about him into print. Lynch noted that he did not wish to embarrass his former critics by naming them. ‘Lynch interview, 12th December 2003’, op. cit., note 9 above.

⁴⁴ Lynch, Smyrk, and Lynch, op. cit., note 22 above, p. 105.

⁴⁵ Lynch and Krush, op. cit., note 39 above, pp. 600–601. Lynch's comment was itself a quotation from Oliver, ‘Formal discussion’, op. cit., note 36 above, p. 1327. Note that Oliver's comment refers to lay misunderstandings of genetics, while Lynch's comment can be read to refer to medical misunderstandings. On the importance of Mendelism to medical genetics, see Jean-Paul Gaudillière, ‘Mendelism and medicine: controlling human inheritance in local contexts, 1920–1960’, Comptes Rendus de l'Académie des Sciences. Série III, Sciences de la Vie, 2000, 323: 1117–26. Olby, op. cit., note 38 above.

⁴⁶ Lynch, Smyrk, and Lynch, op. cit., note 22 above, p. 104.

⁴⁷ Lynch and Krush, op. cit., note 39 above, p. 603. The original comments are in Oliver, ‘Studies on human cancer families’, op. cit., note 36 above. Then again, in the case of CFS, the non-Mendelian character of the segregation ratio in some sibships led Lynch to suggest other factors at work besides autosomal dominant inheritance, such as cytoplasmic inheritance or virus factors or both. Lynch, Shaw, Magnuson, Larsen, and Krush, op. cit., note 32 above. H T Lynch, Henry M Lemon and Anne J Krush, ‘A note on “cancer-susceptible” and “cancer-resistant” genotypes’, Nebr. State Med. J., 1966, 51: 209–11.

⁴⁸ H T Lynch, P G Rigby, C W Magnuson, A L Larson and A J Krush, ‘Etiology of carcinoma: genetic determinism’, Nebr. State Med. J., 1966, 51: 8–10, p. 9.

⁴⁹ Lynch and Krush, op. cit., note 39 above, p. 603.

⁵⁰ In his view, susceptibility and resistance worked as a continuum within the population. At one end of the continuum were “cancer families” that had emerged by “selection” with an apparently strong hereditary determinism to cancer. At the other end, were families with little or no cancer, which might indicate hereditary determinism against malignant neoplasia—“resistance” he called it, with inverted commas. Lynch, Lemon and Krush, op. cit., note 47 above; Lynch and Krush, op. cit., note 39 above.

⁵¹ Many of Lynch's publications were in Nebraska's state medical journal. However, he also published in, among other journals, JAMA, Cancer, and the Archives of Internal Medicine. See other notes in this article. Lynch may also have sought to bolster support by, for instance, building alliances with the insurance industry. For example, in a 1971 paper he argued that the life insurance industry should begin to take family histories of cancer seriously in assessing risk. Henry T Lynch, ‘Genetic predictability in certain forms of cancer’, Transactions of the Association of Life Insurance Medical Directors of America, 1971, 55: 172–90.

⁵² ‘Lynch interview, 12th December 2003’, op. cit., note 9 above.

⁵³ On the history of fraternal societies, see David Beito, From mutual aid to the welfare state: fraternal societies and social services, 1890–1967, Chapel Hill, University of North Carolina Press, 2000. Jason Kaufman, For the common good? American civic life and the golden age of fraternity, New York, Oxford University Press, 2002. On the Nebraska branch or “aerie” of the Fraternal Order of Eagles, see its website <http://www.foe.com/nebraska/> (accessed 18 July 2003).

⁵⁴ Lynch, Krush and Faithe, op. cit., note 17 above, p. 411.

⁵⁵ Anne J Krush, ‘Heredity, emotions, and carcinoma: delay in cancer detection’, in Henry T Lynch, Hereditary factors in carcinoma, New York, Springer, 1967, 141–53, p. 146.

⁵⁶ Lynch and Krush, op. cit., note 39 above, p. 603. For another example of a patient delaying after witnessing the effect of cancer in another family member, see H T Lynch, T P Krush and Anne Krush, ‘Psychodynamics in cancer detection: a patient with advanced cancer of the lip’, Psychosomatics, 1966, 7: 152–7.

⁵⁷ Aronowitz, op. cit., note 1 above.

⁵⁸ See, for example, the dismissal of hereditarian explanations of cancer in the following ACS movies: The traitor within, John Sutherland Productions, 1946; and Man alive, produced by UPA, United Productions of America, 1952, both presented by the American Cancer Society. Copies of both are available in the National Library of Medicine. For early critiques of hereditarian explanations, see ‘A war department lecture on cancer’, Campaign Notes. American Society for the Control of Cancer, September 1918, 1 (6): [pp. 2–3]. This does not deny that heredity may play a role, but suggests it is only a small factor in the onset of disease. For this reason, it claims that it is not a hereditary disease. George R White, ‘The control of cancer’, Campaign Notes. American Society for the Control of Cancer, October 1918, 1 (7): [pp. 2–3]; Francis Carter Wood, ‘What every woman should know about cancer’, Campaign Notes. American Society for the Control of Cancer, January 1919, 1 (9): [pp. 1–4]; Eugene Lyman Fisk, ‘A deadly foe routed’, Campaign Notes. American Society for the Control of Cancer, February, 1919 1 (10): [pp. 1–4].

⁵⁹ This is not to say that cancer education always ignored the subject of heredity. Some educational pamphlets highlighted animal experiments that suggested a hereditarian component to cancer, only to raise questions about the applicability of such experiments to human cancer. See, for example, Lester Grant, The challenge of cancer: a research story that involves the secret of life itself, Bethesda MD, Federal Security Agency, Public Health Service, National Institutes of Health, 1950; Clarence C Little, The fight on cancer, New York, Public Affairs Committee, 1939, p. 18; and Dallas Johnson for the American Cancer Society and the National Cancer Institute, Facing the facts about cancer, New York, Public Affairs Committee, 1947, pp. 21–3. See also C C Little, ‘Research’, in Clarence C Little (ed.), Cancer: a study for laymen, New York and Toronto, Farrar & Rinehart, 1944, pp. 3–46, on pp. 43–4.

As Karen Rader notes, C C Little, head of the ASCC and the Jackson Memorial Laboratory, promoted animal genetic research in his popular publications from the 1930s, but was cautious in applying this work to humans. Anxious that an emphasis on familial cancers might discourage efforts to promote cancer control, Little urged people with cancer in the family to be alert, cautious and intelligent in detecting and reporting cancers, and not to worry. (Rader, op. cit., note 4 above, pp. 194–6.) Such caution is well illustrated by the two pamphlets (above) Little published in 1939 and 1947, the second a revised version of the 1939 pamphlet by Dallas Johnson, an NCI publicity official. Both these pamphlets included accounts of animal experimentation and heredity. But both also included the following caption prominently displayed on the cover: “Did you know: That cancer is NOT hereditary or contagious?” The text inside the 1939 edition warned readers that while a tendency to form cancer might be inherited in humans, it was so indirect that there need not be a source of worry to anyone (p. 18). The discussion inside the 1947 edition was perhaps more cautious about the applicability of mouse experiments to humans. Unlike the 1939 edition, it contained no warnings to people not to worry if cancer in the family was discovered, and the section on heredity (p. 21) concluded with a discussion of mouse experiments that suggested that a virus in the mother's milk might be the cause of cancer. On virus research, see Angela N H Creager and Jean-Paul Gaudillière, ‘Experimental platforms and technologies of visualisation: cancer as viral epidemic’, in Gaudillière and Löwy (eds), Heredity and infection, op. cit., note 4 above, pp. 203–41; and Gaudillière, ‘Circulating mice and viruses’, op. cit., note 4 above.

⁶⁰ For Lynch and Krush's discussions of emotive responses to cancer, see Krush, Lynch and Magnuson, op. cit., note 22 above; Lynch and Krush, op. cit., note 39 above; Krush, op. cit., note 55 above.

⁶¹ On the creation of such referral systems, see David Cantor, ‘Cancer’, in Dominique Lecourt, François Delaporte, Patrice Pinell, Christiane Sinding (eds), Dictionnaire de la pensée médicale, Paris, Presses Universitaires de France, 2004, pp. 195–201.

⁶² See, for example, the movie Lynch released in 1967 (during his time in Houston) designed to educate family physicians about hereditary cancers and their role in detecting it. The family tree, op. cit., note 25 above.

⁶³ Thus, he instituted a programme to introduce medical students to the reality of disease as it affected people in their homes, and so to encourage empathy with patients. Henry T Lynch, Anne J Krush and Joseph M Holthaus, ‘Teaching comprehensive medicine in the home setting: a preliminary report’, Nebr. State Med. J., 1969, 54: 454–7, 516–18.

⁶⁴ Henry T Lynch and Anne J Krush, ‘Early cancer detection is not just the patient's problem’, Consultant, 1971, 11 (4): 58–60, p. 59.

⁶⁵ Henry T Lynch, ‘A note on cancer control’, Nebr. State Med. J., 1971, 56: 99–100; Lynch and Krush, op. cit., note 64 above.

⁶⁶ Tips, Smith, Lynch and McNutt, op. cit., note 14 above; Robert L Tips and Henry T Lynch, ‘The impact of genetic counseling upon the family milieu’, JAMA, 20 April 1963, 184: 183–6; R L Tips, Henry T Lynch and C Wallace McNutt, ‘Genetic counseling’, Texas State Journal of Medicine, 1964, 60: 650–3; Henry T Lynch, Robert L Tips, Anne Krush and Charles Magnuson, ‘Family centered genetic counseling: role of the physician and the medical genetics clinic’, Nebr. State Med. J., 1965, 50: 155–9; H T Lynch, T P Krush, A J Krush and R L Tips, ‘Psychodynamics of early hereditary deaths. Role of the medical genetics counselor’, Am. J. Dis. Child., 1964, 108: 605–10. See also R L Tips, ‘Dynamics of genetic counseling’, Eugenics Quarterly, 1962, 9: 237–40; Robert L Tips, George Smith and Donald L Meyer, ‘Reproductive failure in families of patients with idiopathic developmental retardation’, Pediatrics, 1964, 33: 100–105.

⁶⁷ Henry T Lynch, ‘Cancer and genetic counseling’, in Lynch, Hereditary factors in carcinoma, op. cit., note 55 above, pp. 154–68. On the dominance of physicians in genetic counselling during this period, see Regina H Kenen, ‘Genetic counseling: the development of a new interdisciplinary occupational field’, Soc. Sci. Med., 1984, 18: 541–9. See also Ludmerer, op. cit., note 13 above, pp. 174–93.

⁶⁸ On integrative psychological support, see Henry T Lynch, Dynamic genetic counseling for clinicians, Springfield, IL, Charles C Thomas, 1969, esp. ch. 2.

⁶⁹ Philip Reilly, ‘State supported mass genetic screening programs’, in Aubrey Milunsky and George J Annas (eds), Genetics and the law, New York and London, Plenum Press, 1976, pp. 159–94.

⁷⁰ P F, ‘Cancer week’, Nebr. State Med. J., 1921, 6: 290–1; P F, ‘Cancer week’, Nebr. State Med. J., 1921, 6: 324–5; Palmer Findley, ‘The cancer problem’, Nebr. State Med. J., 1922, 7: 384–5; ‘The 1923 cancer campaign’, Nebr. State Med. J., 1923, 8: 412. On the status of cancer control in Nebraska in the 1930s, see Frank Leslie Rector and Clarence Cook Little, ‘Report of a cancer survey of Nebraska’, Nebr. State Med. J., 1935, 20: 409–42.

⁷¹ ‘Progress in the control of cancer’, Nebr. State Med. J., 1939, 24: 138–9, p. 139.

⁷² John Baldwin, ‘History of the eugenic movement’, Nebr. State Med. J., 1962, 47: 458–65.

⁷³ Sheldon R Reed, Counseling in medical genetics, Philadelphia, Saunders, 1955, pp. 14–15. On Reed and the Dight Institute for Human Genetics, see Paul, op. cit., note 13 above, pp. 133–56. See also Molly Ladd-Taylor, ‘“A kind of genetic social work”: Sheldon Reed and the origins of genetic counselling’, in Georgina D Feldberg, Molly Ladd-Taylor, Alison Li, and Kathryn McPherson (eds), Women, health and nation: Canada and the United States since 1945, Montreal, McGill-Queen’s University Press, 2003, pp. 67–83.

⁷⁴ Lynch, op. cit., note 67 above, p. 154.

⁷⁵ Lynch and Krush, op. cit., note 64 above.

⁷⁶ Krush, Lynch and Magnuson, op. cit., note 22 above, p. 437.

⁷⁷ The importance of physician (and family) intervention to Lynch is well illustrated by his account of one of his early cancer patients, an unnamed farmer-cum-mill worker who came to him and his team around 1965. Lynch, Krush and Krush, op. cit., note 56 above.

⁷⁸ Comments in Henry T Lynch, Jane Lynch and Patrick Lynch, ‘Management and control of familial cancer’, in John J Mulvihill, Robert W Miller and Joseph F Fraumeni Jr (eds), Genetics of human cancer, progress in cancer research and therapy, volume 3, New York, Raven Press, 1977, pp. 235–56, on p. 255.

⁷⁹ H T Lynch interview with Raul Necochea 7 July 2003, Raul Necochea, report 2, additional or enriched issues in HTL's works based on more recently obtained literature, on literature that links the work of HTL and that of other researchers, on Raul Necochea's field notes from his first trip to Omaha, and on his first interview with HTL July 2003.

⁸⁰ Ibid.

⁸¹ Rosemary A Stevens, ‘The Americanization of family medicine: contradictions, challenges, and change, 1969–2000’, Family Medicine, 2001, 33: 232–43.

⁸² Michael J Haller (Director of the Family Practice Section of Lynch's Department of Preventive Medicine and Public Health), ‘The role of the family physicians in the diagnosis and treatment of cancer’, in Henry T Lynch (ed.), Cancer and you, Springfield, IL, Charles C Thomas, 1971, 216–25.

⁸³ Lynch, ‘Cancer and genetic counseling’, op. cit., note 67 above, p. 157.

⁸⁴ Ibid., pp. 165–6.

⁸⁵ Lynch, Krush and Krush, op. cit., note 56 above. The children in this case were repulsed by the sight and touch of the massive lip lesion, and became fearful and anxious.

⁸⁶ Lynch, op. cit., note 67 above pp. 155–6.

⁸⁷ Deborah F Weinstein, ‘Culture at work: family therapy and the culture concept in post-World War II America’, J. Hist. Behav. Sci., 2004, 40: 23–46; Deborah Fran Weinstein, ‘The pathological family: a cultural history of family therapy in post-World War II America’, PhD thesis, Harvard University, 2002.

⁸⁸ Henry T Lynch and Anne J Krush, ‘Attitudes and delay in cancer detection’, CA: Cancer Journal for Clinicians, 1968, 18: 287–93.

⁸⁹ For example, he speculated that the western tradition of independence and self-reliance among the white Nebraskan rural population encouraged excessive feelings and beliefs of self-sufficiency. All too often, he noted, Nebraskans used their own resources to defray the costs of illness, even to the point of destitution. Traditions of self-reliance, he noted, contributed to a lack of knowledge of the resources available through state, federal and community agencies. Krush, Lynch and Magnuson, op. cit., note 22 above, p. 436.

⁹⁰ There are strong parallels between Lynch's critique of narrow specialization and that of early twentieth-century holists, see Christopher Lawrence and George Weisz (eds), Greater than the parts: holism in biomedicine, 1920–1950, New York and Oxford, Oxford University Press, 1998.

⁹¹ On surveillance medicine, see David Armstrong, ‘The rise of surveillance medicine’, Sociology of Health and Illness, 1995, 17: 393–404.

⁹² Henry T Lynch, Gabriel M Mulcahy, and Anne J Krush, ‘Genetic counseling and the physician’, JAMA, 1970, 211: 647–51, p. 651. On Lynch's view of the role of the physician in genetic counselling, see also Henry T Lynch and Anne J Krush, ‘Genetic counseling and cancer: implications for cancer control’, Southern Medical Journal, 1968, 61: 265–9; Henry T Lynch, Gabriel M Mulcahy, and Anne J Krush, ‘Genetic counseling (A scientific exhibit)’, Nebr. State Med. J., 1970, 55: 209–16. Regina Kenen has noted that genetic counselling in the 1950s and 1960s was dominated by physician practitioners: Lynch vigorously argued that this was a desirable state of affairs. Kenen, op. cit., note 67 above.

⁹³ Lynch, op. cit., note 67 above p. 155.

⁹⁴ Ibid.

⁹⁵ On clinical attitudes to language in the British context, see David Cantor, ‘The NAME and the WORD: Neo-Hippocratism and language in inter-war Britain’, in David Cantor (ed.), Reinventing Hippocrates, Aldershot, Ashgate, 2001, pp. 280–301; Christopher Lawrence, ‘Incommunicable knowledge: science, technology and the clinical art in Britain 1850–1914’, J. Contemp. Hist., 1985, 20: 503–20.

⁹⁶ On the identification of cancer genes, see Kevin Davies and Michael White, Breakthrough: the race to find the breast cancer gene, New York, John Wiley, 1996. For an account of longer history of the molecularizing of cancer research, see Jean-Paul Gaudillière, ‘The molecularization of cancer etiology in the postwar United States: instruments, politics and management’, in Soraya de Chadarevian and Harmke Kamminga (eds.), Molecularizing biology and medicine: new practices and alliances, 1910s–1970s, Amsterdam, Harwood, 1998, pp. 139–70. On the impact of molecular genetics on HNPCC, see Raul Antonio Necochea, ‘From cancer families to HNPCC: Henry Lynch and the transformations of hereditary cancer, 1975–1999’, Bull. Hist. Med., in press.

⁹⁷ Nevertheless, there remained a complex relationship between molecular biological and older notions of genetics. For example, in the 1990s, molecular biologists began to conceptualize HNPCC not as a disease that ran in families, but one with specific genetic components that could be detected by genetic testing. However, the search for HNPCC genes was in part dependent on the prior identification by means of family studies of entities called “cancer families”, and the diagnosis of HNPCC required that mutated genes be found within a kin group identified as a “cancer family”. Genetic testing did not do away with older notions of the “cancer family”. See Necochea, op. cit., note 96 above.

⁹⁸ Three syndromes are named after him: Lynch's syndromes I and II (syndromes involving a familial predisposition to colorectal cancer), and Lynch–Wiersma syndrome (a combination of ichtyosis congenita and secondary male hypogonadismus).

⁹⁹ Raul Antonio Necochea is working on Lynch's involvement with the molecular genetics of cancer. See Necochea, op. cit., note 96 above.