How is the American Congress of Rehabilitation Medicine like the building of a gothic cathedral?

ACRM PRESIDENTIAL ADDRESS

How is the American Congress of Rehabilitation Medicine Like the Building of a Gothic Cathedral? Robert H, Meier, III, MD

Preamble Before I begin my swan song or presidential address, I must take this opportunity to thank you for the extreme honor and privilege of serving as your President during this year. In addition, I must express my heartfelt thanks to the help and understanding provided by my wife, Martha and our son, Christian. My work was made easier with the assistance of my faculty and staff at the University of Colorado Health Sciences Center. It has been a distinct privilege to work with an extraordinarily capable Board of Governors. Congress members, I hope, will also extend their thanks for all the time and effort expended by each Board member. I finally wish to acknowledge the fresh leadership, hard work, and the attention to detail that has been provided by Dick Muir, our Executive Director, Amy Rogers, Cynthia Porter, and the whole staff at the Association Management Center in Skokie, IL. “People in those old times had convictions; we moderns only have opinions. And it needs more than a mere opinion to erect a Gothic cathedral. ”

Heinrich Heine- 1837 While traveling the dirt roads from town to town in 1 lth and 12th century France, the traveler would witness an unusual social phenomenon. The traveler would be passed by carts loaded with large blocks of granite and marble being pulled by persons from all stations of life who labored side by side without regard to class. Often they would be singing and praying together, a countess next to a peasant pulling a heavy load. What strange labor was this that juxtaposed the high and the low? What goal would bring these unlikely parties together? All over western Europe at this time, huge buildings were being built to honor their deity (fig 1). The great period of Gothic cathedral building spanned 300 years from 1050 to 1350, concluding with the onset of the Black Plague and the Hundred Years’ War. During this time, more stone was quarried in France than was used to build the great pyramids in Egypt. Master architects borrowed designs and geometric knowledge from the East to transform important buildings from the heavy Romanesque to the ever lighter Gothic style. The Gothic style evolved over the centuries, building higher and allowing more light to flood the interiors with walls of more glass and less stonework (fig 2). Presented at the71st Annual Meeting of the American Congress of Rehabilitation Medicine, Minneapolis, June 9, 1994. 8 1994 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation oc@3-9993/94/7510-3190$3.00/0

Why did these people sacrifice their money and effort to construct something that most of them would not live to see completed? Their personal commitment and investment provided an assurance that their labors would be rewarded by their God. They also knew that their work would live on for future generations who would continue to honor and remember the builders. Some of these workers and builders are memorialized in the stone sculptures and the stained glass.

GOTHIC CATHEDRAL DESIGN The design and building of these magnificent edifices often occurred by trial and error. The arts and crafts employed in the building evolved over centuries. Craftspeople formed groups or guilds that promoted their skill and enhanced their working conditions. The money for the fabric of the cathedral was gathered and managed by the “chapter,” a group of priests and prominent citizens in the local community. The chapter hired the architect to oversee the design and construction of the cathedral. Sometimes there was plenty of money to build and the construction went quickly. At other times, money might become scarce and the cathedral works would be slowed or even stopped. The bishop, whose throne was to be positioned in the cathedral, might have some say over the governing of the diocese but often did not have direct control over the construction of the building. A western cathedral is designed usually in a cruciform plan, with the choir and its rounded end facing east. The long nave for the congregation was strung out in a westerly direction. Therefore, the choir pointed to the Holy City of Jerusalem. It housed the altar, the holy of holies, where the mysteries of the Christian faith were enacted so that the body and blood of Christ were present in the sacrament of Eucharist. Here, the main service of the Church was celebrated by the priests and their attendants with a full view of the congregation from the nave. Gothic design was intended to lighten the interior of the church by decreasing the stonework of the upper walls and replacing the masonry with leaded, stained-glass windows that flooded the interior with a multicolored mysterious light (fig 3). This light was violet, provided by the predominant use of ruby-red and sapphire-blue stained glass. The walls of these cathedrals went higher and higher as the Gothic period progressed. The solution to supporting the weight of these higher walls with less stone was the flying buttress (fig 4). This was an exterior architectural element that took the forces from the upper walls, the vaulted ceiling, and the roof and transmitted them to the ground. What types of journeymen did it take to build these magnificent monuments of the Middle Ages? Besides the architect, there were stonemasons, carpenters, sculptors, glaziers,

Arch Phys Med Rehebil Vol75, October 1994

ACRM PRESIDENTIAL ADDRESS, Meier

Fig 1-Canterbury Cathedral. Built 1174 to 1502. Fig 2-York Minster. Nave looking east. Fig 3-Washington National Cathedral. Nave showing arcade and clerestory stained-glass windows. (Reprinted with permission from Washington National Cathedral.) Fig 4-Flying blIttreMe& wasbington National CathedraL (Reprinted witb pelIl&&n fhml Wasllington National Cathdral.) Fig 5-&tail of west rose window. Washington National Cathedral. (Reprinted with -on from Washington National Cathedral.1 Arch Phys Mod Rahabil Vol75,

October 1994

1071

ACRM PRESIDENTIAL ADDRESS, Meier

blacksmiths, mortar makers, quarrvmen, and roarers: ‘AB~~%%t%4l~n of constructing the rehabilitation cathedral themselves. We must have the able member workers assume these were banded together into their specific guilds. responsibility for contributing to the framework and the structure. We must have members who will pull the carts CATHEDRAL BUILDING AS A METAPHOR with the building blocks. We must have carpenters, blackFOR ACRM smiths, masons, and roofers, members of all rehabilitation How is our American Congress of Rehabilitation Mediguilds, if we are to spread the gospel of rehabilitation in cine (ACRM) like a Gothic cathedral and its workforce of these times of health care change. All guilds must contribute builders? First, we have built the sanctuary to protect the to construct a harmonious, complete structure. Imagine a body and blood of our patients who lie in their beds, a cathedral without stained-glass windows, stone statuary, or type of altar for the human spirit. We act as the priests and carved doors. Each guild has an important contribution to attendants who minister to the needs of the patient. Medical make, without which, the cathedral does not convey the rehabilitation could be viewed as the Gothic cathedral that message for which its construction was intended. If we has been constructed to provide shelter for the person with do not have the participation of more workers and more a disability. We have formed our guilds of various profesguilds, we cannot build a unified but multifaceted strucsionals who through craft and science contribute to specific ture. This carefully designed project can proclaim the imfacets of the building process. The carpenters might be the portance of interdisciplinary involvement as the building physical therapists, the glaziers, the occupational therapists. takes shape. The speech and language pathologists might be the brickWe finally come to the altar of our patients for whom the makers. The stonemasons could be the physicians while the cathedral was principally designed. As we approach the holy mortar makers are the rehabilitation nurses. In this schema, of holies, have we prepared ourselves to serve? Have we the sculptors are the psychologists, the quarry workers are made our offerings and prepared our bodies and minds to the social workers, the roofers are the vocational counselors, be more worthy of the trust placed in us as care providers? and the bioengineers are the blacksmiths. The chapter, the Or have we gotten too caught up in the acquisition of external group that oversees the design and the building while having trappings? Have we worked in our fine garments next to the responsibility for the funds of its construction, is the Board peasant in the mud to pull the carts of building blocks to of Governors. the building site? Have we mixed the mortar or chiseled a The Gothic cathedral, in its design, reached for the ideal statue? What have our personal contributions been? There in lightness of weight and the maximum of light. It needed is much more work to do. You can help strengthen our to be of sufficient size to allow the local citizens to worship foundation by adopting the new bylaws that are recombut also to conduct the business of the town. It served many mended to make our cathedral stronger. You can help build purposes, even recreation. However, as each cathedral the walls by adding the stones represented by new members. reached higher and higher, some eventually collapsed beYou can let in more light by actively pursuing new research cause there was insufficient knowledge to build the supportquestions that demonstrate the truths of rehabilitation sciing structure to accommodate the weight. ence. You can contribute to the mortar that holds the stones We are attempting to build a cathedral organization that together by participating actively in the committees, interdisneeds all the trades represented in the process of rehabilitation. The art and science of rehabilitation, in my view, ap- ciplinary special interest groups (ISIGS), task forces, and the leadership of the Congress. You can influence the chappears to parallel the art and science of cathedral building. Some physical principles are known but much is left to the ter, your Board of Governors, as it moves forward with the architect’s imagination, using empiricism and trial and error. plans of the cathedral. Let the Board Members know your We try to provide more light through our research and inves- thoughts and concerns regarding the construction process. I do not apologize if I sound like a religious zealot. tigation. We plan for the walls to rise higher and higher but Frankly, most of the people I would like to exhort with this risk that, without an adequate foundation, the walls and roof address are not here to hear it. They can read it in the will collapse. Archives! I hope those of you who are present will proselytize. Convert others in the fundamental belief that the ConMEMBER INVOLVEMENT IN BUILDING gress is essential for the future of interdisciplinary medical THE ACRM rehabilitation. We have arrived at a crucial point in the plan of our cathedral, the ACRM. Can we recruit more experienced proACRM AND FUTURE MEDICAL fessionals as we plan for the cathedral organization to beREHABILITATION come larger? How do we educate our apprentices so they When we lay down our tools and blueprints, will we be can add to the fabric of the cathedral? We have a new group of assumptions and goals for the Congress. But you, the proud of the result? Will the ACRM have relevance for professionals, must help develop the strategic plan so that rehabilitative care in the 21st Century? Will future generaour building can progress for future generations to benefit tions come to worship at the shrine of interdisciplinary rehabilitation? Years from now will people marvel at what we from our labors. We have tried to lay a strong foundation accomplished with less information and experience than they with our chapter, the Board of Governors, an industrious, hard-working, freethinking group. But they cannot carry the will have? We are working from a new blueprint for an

Arch Phys Med Rehabil Vol75,

Octobetr 1994

1072

ACRM PRESIDENTIAL ADDRESS, Meier

uncertain health care future. We must build with the conviction that interdisciplinary medical rehabilitation will provide the best structure for the disabled person. Today, we only “see through a glass darkly” and trust that, as Robert Louis Stevenson said, “Mankind was never so happily inspired as when it made a cathedral.” Friends and colleagues, let us inspire others to this great adventure of building. Only then can our cathedral of medical rehabilitation be built higher and become flooded with brighter light (fig 5). Thank you again for the privilege of serving as your president.

References 1. Adams H. Mont Saint Michel and Chartres. Dunwoody, GA: Norman S. Berg, Publisher, 1978. 2. Clifton-Taylor A. The Cathedrals of England. London: Thames and Hudson, 1980. 3. Follett K. The Pillars of the Earth. New York: William Morrow, 1989. 4. Gimpel J. The Cathedral Builders. New York: Harper Perennial, 1992. 5. Grodecki L. Gothic Architecture Milan: Electa/Rizzoli, 1978. 6. Jantzen H. High Gothic. The Classic Cathedrals of Chartms, Reims and Amiens. Hamburg: Minerva Press, 1957. I. Male E. Chartres. New York: Harper & Row, 1983. 8. Swaan W. The Gothic Cathedral. London: Omega Books, 1988.

NOTICE TO AUTHORS The Archives of Physical Medicine and Rehabilitation is changing its address effective December 10, 1994. Manuscripts and correspondence should be addressed to: Editorial Board Archives of Physical Medicine and Rehabilitation Suite 25 10 330 North Wabash Avenue Chicago, IL 6061 l-3604 Telephone (3 12) 464-9550

Arch Phys Mad Rehabil Vol75, October 19B4