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Psycho-​Oncology
Psycho-​Oncology
FOURTH EDITION

EDITED BY

William S. Breitbart, MD, FAPOS

Phyllis N. Butow, BA(Hons), DipEd, MClinPsych,
MPH, PhD
Paul B. Jacobsen, PhD
Wendy W. T. Lam, RN, PhD, FFPH
Mark Lazenby, APRN, PhD
Matthew J. Loscalzo, MSW, LCSW, FAPOS

1
3
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2021
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
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by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Names: Breitbart, William S., 1951– editor.
Title: Psycho-oncology / [edited by] William S. Breitbart, Phyllis N. Butow, Paul B. Jacobsen, Wendy W. T. Lam,
Mark Lazenby, Matthew J. Loscalzo ; senior editor, William Breitbart.
Other titles: Psycho-Oncology (Holland)
Description: 4th edition. | New York, NY : Oxford University Press, [2021] |
Includes bibliographical references and index.
Identifiers: LCCN 2020029603 (print) | LCCN 2020029604 (ebook) |
ISBN 9780190097653 (hardback) | ISBN 9780190097677 (epub) | ISBN 9780190097684
Subjects: MESH: Neoplasms—psychology | Risk Factors | Neoplasms—prevention & control |
Neoplasms—therapy
Classification: LCC RC262 (print) | LCC RC262 (ebook) | NLM QZ 260 |
DDC 616.99/40019—dc23
LC record available at https://lccn.loc.gov/2020029603
LC ebook record available at https://lccn.loc.gov/2020029604
DOI: 10.1093/​med/​9780190097653.001.0001
This material is not intended to be, and should not be considered, a substitute for medical or other professional
advice. Treatment for the conditions described in this material is highly dependent on the individual
circumstances. And, while this material is designed to offer accurate information with respect to the subject
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Printed by LSC Communications, United States of America
Dedication: Jimmie C. Holland, M.D. (1928–2017)
Psycho-​Oncology, 4th edition is solemnly dedicated to Professor Jimmie C. Holland, MD (1928–​2017), internationally recognized as the founder
of the field of psycho-​oncology. Dr. Holland, who was affectionately known by her first name, “Jimmie,” had a profound global influence on the
fields of psycho-​oncology, oncology, supportive care, psychiatry, behavioral medicine, and psychosomatic medicine. At the time of her passing,
Dr. Holland was the Attending Psychiatrist and Wayne E. Chapman Chair at Memorial Sloan Kettering Cancer Center (MSK) and Professor of
Psychiatry, Weill Medical College of Cornell University in New York.
In 1977, Jimmie was appointed Chief of the Psychiatry Service in the Department of Neurology at MSK, by Jerome Posner, MD, then Chairman of
Neurology at MSK. The Psychiatry Service at MSK was the first such clinical, research, and training service established in any cancer center in the
world. In 1996, Dr. Holland was named the inaugural Chairwoman of the Department of Psychiatry and Behavioral Sciences at MSK—​again,
the first such department created in any cancer center in the U.S. or the world. Dr. Holland had over a 40-​year career at MSK.
Jimmie created and nurtured the field of psycho-​oncology, established its clinical practice, advanced its clinical research agenda, and, through
her pioneering efforts, launched the careers of the leaders of a worldwide field who continue to work in what has become a shared mission to em-
phasize “care” in cancer care. Dr. Holland founded the International Psycho-​Oncology Society (IPOS) in 1984 and the American Psychosocial
Oncology Society in 1986. Over 25 years ago, Jimmie founded the international journal Psycho-​Oncology and coedited the journal for 30 years.
Dr. Holland received many awards recognizing her achievements over the course of her career. Some of her notable awards include the Medal
of Honor for Clinical Research from the American Cancer Society, the Clinical Research Award from the American Association of Community
Cancer Centers, the American Association for Cancer Research Joseph H. Burchenal Clinical Research Award, the Marie Curie Award from the
Government of France, the Margaret L. Kripke Legend Award for contributions to the advancement of women in cancer medicine and cancer
science from the MD Anderson Cancer Center, the T. J. Martell Foundation 2015 Women of Influence Award, and the Distinguished Alumnus
Award from Baylor College of Medicine in 2016. She served as President of the Academy of Psychosomatic Medicine (APM) in 1996 and was the
recipient of the APM’s Hackett Lifetime Achievement Award in 1994. She was the inaugural recipient of the Arthur Sutherland Award for Lifetime
Achievement from IPOS.
This 4th edition of Psycho-​Oncology is the first edition of this text that has not been edited by Dr. Holland. In 1989, Dr. Holland edited the
Handbook of Psychooncology: Psychological Care of the Patient with Cancer, the first major textbook in our field. This landmark book was no-
table for several reasons; it established our “new” field, and it was the first use, in a text, of the term “psychooncology” to name our field (thankfully
the hyphen was soon added). Psycho-​oncology was thus born and named with the publication of this textbook. Subsequently, Dr. Holland edited,
with a group of dedicated coeditors, several editions of what became known as the “Bible” of psycho-​oncology or, in many circles, the “Holland
Textbook of Psycho-​oncology.” The textbook Psycho-​Oncology was published in 1998 and represented the most comprehensive, multidiscipli-
nary, and international encyclopedia of a field entering its adolescence. The year 2010 saw the publication of the 2nd edition, followed by the 3rd
edition in 2015, both published by Oxford University Press in collaboration with IPOS and APOS. Every card-​carrying “psycho-​oncologist” in
over 60 countries with national psycho-​oncology societies around the world had to have the latest edition in their library. For many it represented
a valued link to Jimmie Holland. The task of editing this 4th edition of Psycho-​Oncology without Jimmie’s firm guidance and wise counsel was
daunting for all of us, but we were all deeply inspired to do so because of our loving debt to Jimmie. The torch has been passed.
Dedication: Ruth McCorkle, PhD, RN, FAAN (1941–​2019)
In January 1975, a 33-​year-​old Ruth McCorkle, a newly minted PhD from the University of Iowa and a new assistant professor at the University of
Washington, met Jimmie C. Holland at a conference on the behavioral dimensions of cancer that was organized by the National Cancer Institute
in San Antonio, Texas. This meeting began a lifelong friendship and collaboration, not least of which was this book.
Ruth McCorkle died on August 17, 2019, in her home in Hamden, CT, from cancer. At the time of her death, she was the Florence Schorske Wald
Professor of Nursing Emerita at Yale University.
From the earliest days of her career, Ruth was interested in the lived experiences of people diagnosed with cancer, including the effects of touch on
the seriously ill and how the attachments and goals of patients undergoing treatment for lung cancer—​and their families—​changed over time. At
the University of Washington, she and Jeanne Quint-​Benoliel developed the first multidisciplinary cancer unit in which patients and their families
would be seen from the time of diagnosis through the dying experience by an interprofessional team.
It was on this unit, in the mid 1970’s, that she developed the first scale that measured the distress cancer patients experienced, the Symptom
Distress Scale. As a student of history, she learned of how Sir William Osler had taken field notes on his dying experience, in which he wrote that,
because he had “no actual pain,” he felt “singularly free from mental distress” as he was dying. In the early 1970’s, when Ruth had gone to London
to study with Dame Cicely Saunders at St. Christopher’s Hospice, she was introduced to the British psychiatrist J. M. Hinton and his now justly
famous qualitative work on associations between dying patients’ physical and mental distress. From Saunders and Hinton, and from Osler’s field
notes, Ruth began to see that patients’ mental distress could be related to their physical symptoms. She thus became interested in the points at
which a physical symptom becomes emotionally unbearable. Hence, her scale measured the presence of a symptom as well as how distressed a
patient was by it. The development of the Symptom Distress Scale led to her intervention.
She developed and tested in 7 National Institutes of Health-​funded clinical trials the Standardized Nursing Intervention Protocol, an intervention
in which an advanced practice cancer nurse helped patients and families learn to manage distressing symptoms. In a breakthrough, one of those
trials resulted in a 7-​month survival benefit.
We will read much about distress in this 4th edition of Psycho-​Oncology. For the importance of identifying and intervening on the sources of
cancer patients’ distress—​and even for the presence of the word “distress” in the psycho-​oncologic lexicon—​we have Ruth—​and Jimmie—​to thank.
Ruth ended the last article she wrote with this: “. . . patients’ physical needs must be addressed before their psychosocial problems are identified. It
is not just about taking care of their physical needs first. Rather, it is that we may be creating distress by not doing so.” Over the last 6 weeks of her
life, she instructed her hospice care providers on how to manage her physical needs, and her close friends and family provided the physical touch
she knew would comfort her emotionally. In this experience, one can find the truth of Ruth’s entire scientific career.
In this 4th edition of Psycho-​Oncology, you will find this truth woven into the science the book reports on: For Ruth, psycho-​oncology was not
just about how to support patients and families living with cancer. It was also about enabling them to have deaths “singularly free from mental
distress.” It is thus fitting that, along with Jimmie C. Holland, we dedicate this edition to Ruth McCorkle.
Contents

Section editors xiii 8 Cervical Cancer Screening and HPV

Contributors xv Vaccination: Multilevel Challenges to Cervical
Cancer Prevention 61
Introduction: Our Past, Our Future—New Richard Fielding, Samara Perez, Zeev Rosberger, Ovidiu Tatar,
Frontiers in Psycho-​Oncology 1 and Linda D. L. Wang
William S. Breitbart (Senior Editor)
9 Breast Cancer Screening 68
Gabriel M. Leung, Irene O. L. Wong, Ava Kwong, and
Joseph T. Wu
SECTION I
10 Prostate Cancer Screening 74
Behavioral and Psychological Factors in Michael A. Diefenbach, Daniel Nethala, Michael Schwartz, and
Cancer Risk and Prevention Simon J. Hall
Paul B. Jacobsen (Section Editor) 11 Lung Cancer Screening 78
1 Tobacco Use and Cessation 7 Lisa Carter-​Harris and Jamie Ostroff
Thomas H. Brandon, Vani N. Simmons, Úrsula Martínez, and 12 Skin Cancer Screening 87
Patricia Calixte-​Civil Jennifer L. Hay and Stephanie N. Christian
2 Diet and Cancer 13
Marian L. Fitzgibbon, Lisa Tussing-​Humphreys, Angela Kong,
and Alexis Bains
SECTION III
3 Physical Activity, Sedentary Behavior, and Screening and Testing for Germ Line and
Cancer 21
Somatic Mutations
Christine M. Friedenreich, Chelsea R. Stone, and Jessica McNeil
Paul B. Jacobsen (Section Editor)
4 Sun Exposure and Cancer Risk 30
Suzanne J. Dobbinson, Afaf Girgis, Bruce K. Armstrong, and 13 Psychosocial Issues in Genetic Testing for
Anne E. Cust Breast/​Ovarian Cancer 95
Mary Jane Esplen, Jonathan Hunter, and Eveline M. A. Bleiker
5 Psychosocial Factors 36
Anika von Heymann and Christoffer Johansen 14 Psychosocial Issues in Genetic Testing for
Hereditary Colorectal Cancer 102
6 Viral Cancers and Behavior 43 Sukh Makhnoon and Susan K. Peterson
Susan T. Vadaparampil, Lindsay N. Fuzzell, Shannon M. Christy,
Monica L. Kasting, Julie Rathwell, and Anna E. Coghill 15 Psychosocial Issues in Genomic Testing, Including
Genomic Testing for Targeted Therapies 110
Megan Best
SECTION II 16 Psychosocial Issues Related to Liquid Biopsy for
Screening for Cancer in Normal and At-​Risk ctDNA in Individuals at Normal and Elevated
Populations Risk 116
Jada G. Hamilton, Amanda Watsula-​Morley, and
Wendy W. T. Lam (Section Editor)
Alicia Latham
7 Colorectal Cancer Screening 53
Caitlin C. Murphy and Sally W. Vernon
viii Contents

29 Head and Neck Cancer 215

SECTION IV Loreto Fernández González, Jonathan Irish, and Gary Rodin
Screening and Assessment in Psychosocial 30 Central Nervous System Tumors 221
Oncology Alan D. Valentine
Wendy W. T. Lam (Section Editor) 31 HIV Infection and AIDS-​Associated
17 Screening and Assessment for Distress 121 Neoplasms 226
Alex J. Mitchell Joanna S. Dognin and Peter A. Selwyn

18 Assessment, Screening, and Case Finding

for Depression and Anxiety in People with
Cancer 130
Kristine A. Donovan and Paul B. Jacobsen
19 Screening for Delirium and Dementia in the
Cancer Patient 137
Christian Bjerre-​Real, James C. Root, Yesne Alici,
Julia A. Kearney, and William S. Breitbart
20 Screening and Assessment for Cognitive
Problems 146
Alexandra M. Gaynor, James C. Root, Elizabeth Ryan, and
Tim A. Ahles
SECTION V
Psychological Issues Related to Site of
Cancer
Mark Lazenby (Section Editor)
21 Melanoma 155
Nadine A. Kasparian and Iris Bartula
SECTION VI
Management of Specific Physical
Symptoms
William S. Breitbart (Section Editor)
32 Cancer-​Related Pain 235
R. Garrett Key, Dustin Liebling, Vivek T. Malhotra,
Steven D. Passik, Natalie Moryl, and William S. Breitbart
33 Nausea and Vomiting 255
Laura J. Lundi and Kavitha Ramchandran
34 Cancer-​Related Fatigue 265
Daniel C. McFarland, Christian Bjerre-​Real, Yesne Alici, and
William S. Breitbart
35 Sexual Problems and Cancer 276
Jeanne Carter, Ashley Arkema, Andrew J. Roth, Sally Saban, and
Christian J. Nelson
36 Neuropsychological Impact of Cancer and Cancer
Treatments 283
Alexandra M. Gaynor, James C. Root, and Tim A. Ahles

22 Lung Cancer 162 37 Sleep and Cancer 291

Marianne Davies Amy E. Lowery-​Allison and E. Devon Eldridge-​Smith

23 Breast Cancer 169 38 Weight and Appetite Loss in Cancer 298

M. Tish Knobf and Youri Hwang Yesne Alici and Victoria Saltz

24 Colorectal Cancer 176 39 Body Image—​An Important Dimension in Cancer

Anne Miles and Claudia Redeker Care 303
Mary Jane Esplen and Michelle Cororve Fingeret
25 Prostate Cancer and Genitourinary
Malignancies 182
Andrew J. Roth and Alejandro Gonzalez-​Restrepo

26 Gastrointestinal Cancers 189

Daniel C. McFarland and William S. Breitbart
27 Gynecologic Cancers 196
Heidi S. Donovan and Teresa H. Thomas
28 Hematopoietic Dyscrasias and Stem Cell
Transplantation/​CAR-​T Cell Therapy 203
Jesse R. Fann and Nicole Bates
SECTION VII
Psychiatric Disorders
William S. Breitbart (Section Editor)
40 Adjustment Disorders in Cancer 313
Froukje de Vries, Sarah Hales, Gary Rodin, and Madeline Li
41 Depressive Disorders in Cancer 320
Christian Schulz-​Quach, Madeline Li, Kimberley Miller, and
Gary Rodin

42 Suicide and Medical Aid in Dying 329
Hayley Pessin, Elie Isenberg-​Grzeda, Reena Jaiswal, and
Monique James
43 Anxiety Disorders 338
Ashley M. Nelson, Chelsea S. Rapoport, Lara Traeger, and
Joseph A. Greer
44 Delirium 345
Yesne Alici and William S. Breitbart
45 Substance Use Disorders 355
Sameer Hassamal, Adam Rzetelny, and Steven D. Passik
46 Posttraumatic Stress Disorder Associated with
Cancer Diagnosis and Treatment 363
Matthew Doolittle and Katherine N. DuHamel
47 Psychiatric Toxicities of Cancer Therapies: Focus
on Immunotherapy and Targeted Therapy 374
Daniel C. McFarland, Mehak Sharma, and Yesne Alici
SECTION VIII
Evidence-​Based Interventions
William S. Breitbart and Phyllis N. Butow (Section Editors)
Models of Care Delivery
48 Delivering Integrated Psychosocial Oncology
Care: The Collaborative Care Model 385
Jesse R. Fann, Julia Ruark, and Michael Sharpe
49 The Engaged Patient: The Cancer Support
Community’s Comprehensive Model of
Psychosocial Programs, Services, and
Research 393
Mitch Golant, Alexandra K. Zaleta, Susan Ash-​Lee,
Joanne S. Buzaglo, Kevin Stein, M. Claire Saxton,
Marcia Donziger, Kim Thiboldeaux, and Linda Bohannon
50 The Role of Implementation Science in
Advancing Psychosocial Cancer Care 400
Paul B. Jacobsen and Wynne E. Norton
Interventions During Active Treatment
51 Supportive Psychotherapy in Cancer 409
Rosangela Caruso, Maria Giulia Nanni, and Luigi Grassi
52 Cognitive and Behavioral Interventions 416
Barbara L. Andersen, Nicole A. Arrato, and Caroline S. Dorfman
53 Metacognitive Approaches 424
Louise Sharpe and Leah Curran
Contents ix
54 Mindfulness-​Based Interventions 429
Linda E. Carlson
55 Acceptance and Commitment Therapy (ACT) for
Cancer Patients 438
Nicholas J. Hulbert-​Williams, Ray Owen, and Christian J. Nelson
56 Supportive-​Expressive and Other Forms of Group
Psychotherapy in Cancer Care 445
David W. Kissane
57 Emotion-​Focused Therapy 452
Sharon Manne
58 Interpersonal Psychotherapy and Cancer 459
Jennifer Sotsky, Hayley Pessin, and John C. Markowitz
59 Integrative Oncology 470
Santhosshi Narayanan, Gabriel Lopez, Jun J. Mao, Wenli Liu,
and Lorenzo Cohen
Interventions for Families and Couples
60 Psychosocial Interventions for Couples and
Families Coping with Cancer 481
Talia I. Zaider and David W. Kissane
Interventions for Advanced Cancer/​End of
Life/​Bereavement
61 Meaning-​Centered Psychotherapy 489
Melissa Masterson Duva, Wendy G. Lichtenthal,
Allison J. Applebaum, and William S. Breitbart
62 Dignity Therapy 495
Harvey Max Chochinov and Maia S. Kredentser
63 Managing Cancer and Living Meaningfully
(CALM) Therapy 502
Sarah Hales and Gary Rodin
64 Bereavement Interventions in the Setting of
Cancer Care 509
Wendy G. Lichtenthal, Kailey E. Roberts, Holly G. Prigerson, and
David W. Kissane
Interventions for Cancer Survivors
65 Meaning-​Centered Group Psychotherapy for
Cancer Survivors 521
Nadia van der Spek, Wendy G. Lichtenthal, Karen Holtmaat,
William S. Breitbart, and Irma M. Verdonck-​de Leeuw
66 Physical Activity and Exercise Interventions in
Cancer Survivors 528
Chloe Grimmett, Rebecca J. Beeken, and Abigail Fisher
x Contents
Digital Health Interventions
67 e-Health Interventions for Cancer Prevention
and Control 537
Kelly M. Shaffer, Elliot J. Coups,† and Lee M. Ritterband
68 Digital Health Interventions for Psychosocial
Distress (Anxiety and Depression) in Cancer 543
Lisa Beatty and Haryana Dhillon
69 e-​Health Interventions for Physical Symptom
Control 550
Robert Zachariae
70 e-​Health Interventions for Tobacco
Cessation 561
Chris Kotsen, Jamie Ostroff, and Lisa Carter-​Harris
SECTION IX
Psychosocial Issues at the Time of Diagnosis
Matthew J. Loscalzo (Section Editor)
71 Treatment Decision Making 573
Allison Marziliano and Michael A. Diefenbach
72 The Family Meeting: Communication across the
Continuum of Cancer Care 578
Stefanie N. Mooney and Marinel Olivares
SECTION X
Palliative and Supportive Care
Mark Lazenby (Section Editor)
73 Psychological and Psychiatric Aspects of Palliative
and End-​of-​Life Care: Synergies between Psycho-​
Oncology and Palliative Care 589
Scott A. Irwin, Nathan Fairman, Chase Samsel, Jeremy M. Hirst,
Jason A. Webb, and Manuel Trachsel
74 Prognostic Understanding in Advanced Cancer
Patients 599
Laura C. Polacek, Leah E. Walsh, Allison J. Applebaum, and
Barry Rosenfeld
SECTION XI
Diversities in the Experience of Cancer
Matthew J. Loscalzo (Section Editor)
75 Cancer, Culture, and Health Disparities 609
Marjorie Kagawa-​Singer and Annalyn Valdez-​Dadia
76 Financial Toxicity in Cancer Treatment 616
Victoria Blinder and Francesca M. Gany
77 The Experience of Cancer as an Immigrant 621
Francesca M. Gany and Jennifer Leng
78 Sexual and Gender Minority Health in
Psycho-​Oncology 627
Charles Kamen and Jennifer M. Jabson Tree
SECTION XII
Bio-​Behavioral Psycho-​Oncology
William S. Breitbart and Mark Lazenby (Section Editors)
79 Psycho-​Oncology, Stress Processes, and Cancer
Progression 637
Michael H. Antoni, Jennifer M. Knight, and Susan K. Lutgendorf
80 Depression, Inflammation, and Cancer 644
Daniel C. McFarland, Leah E. Walsh, and Andrew H. Miller
81 Biobehavioral Psycho-​Oncology
Interventions 654
Michael A. Hoyt and Frank J. Penedo
SECTION XIII
Geriatric Psycho-​Oncology
Matthew J. Loscalzo (Section Editor)
82 The Older Cancer Patient 663
Barbara A. Given and Charles W. Given
83 Geriatric Psycho-​Oncology Assessment Issues
and Interventions 671
Kelly M. Trevino, Rebecca M. Saracino, Andrew J. Roth,
Yesne Alici, and Christian J. Nelson
84 Communicating with the Older Adult Cancer
Patient 678
Patricia A. Parker, Smita C. Banerjee, and Beatriz Korc-​Grodzicki
SECTION XIV
Pediatric Psycho-​Oncology
William S. Breitbart (Section Editor)
85 Screening and Assessment in Pediatric
Psycho-​Oncology 687
Darcy E. Burgers, Sarah J. Tarquini, Anne E. Kazak, and
Anna C. Muriel
 Contents xi

86 Psychiatric Disorders in Pediatric Psycho-​

Oncology: Diagnosis and Management 696 SECTION XVII
Julia A. Kearney, Meredith E. MacGregor, and Maryland Pao
Building Supportive Care/​Psycho-​Oncology
87 Evidence-​Based Psychosocial Interventions in Teams
Pediatric Psycho-​Oncology 703 Phyllis N. Butow (Section Editor)
Lori Wiener, Marie Barnett, Stacy Flowers, Cynthia Fair, and
Amanda L. Thompson Building Supportive Care Teams: Working
88 Adolescent and Young Adult Patients 715 Together and Self-​Care
Christabel K. Cheung, Sheila J. Santacroce, and Bradley J. Zebrack
96 Integrating Interdisciplinary Supportive Care
Programs: Transforming the Culture of Cancer
Care 775
SECTION XV Matthew J. Loscalzo, Karen L. Clark, Barry D. Bultz, and
Psychological Issues for the Family and Juee Kotwal

Caregivers 97 Occupational Stress in Oncology Staff: Burnout,

Phyllis N. Butow (Section Editor) Resilience, and Interventions 782
Fay J. Hlubocky and Daniel C. McFarland
89 Including Family Members in Caring for
the Patient with Cancer: A Family-​Centered Health Provider/​Patient Communication
Approach 723
Douglas S. Rait 98 Principles of Communication Skills Training
in Cancer Care across the Life Span and Illness
90 Couples Facing Cancer 729
Trajectory 791
Hoda Badr and Courtney Bitz
David W. Kissane and Carma L. Bylund
91 Cancer Caregivers 737
Allison J. Applebaum, Erin Kent, Kristin Litzelman, Betty Ferrell,
J. Nicholas Dionne-​Odom, and Laurel Northouse
SECTION XVIII
92 Addressing the Needs of Children When a Parent Psycho-​Oncology in Health Policy
Has Cancer 745
Cynthia W. Moore, Greer J. Dent, and Paula K. Rauch Wendy W. T. Lam (Section Editor)

99 Distress, the Sixth Vital Sign: A Catalyst for

Standardizing Psychosocial Care Globally 801
Barry D. Bultz, Matthew J. Loscalzo, Alex J. Mitchell, and
SECTION XVI
Jimmie C. Holland†
Survivorship
100 Implementation of Clinical Practice Guidelines
Phyllis N. Butow and Wendy W. T. Lam (Section Editors)
for Psychosocial Cancer Care 806
93 Fear of Cancer Recurrence 755 Jane Turner and Nicole Rankin
Allan B. Smith, Joanna E. Fardell, and Phyllis N. Butow
101 Emerging International Directions for
94 Implementing the Survivorship Care Plan: A Psychosocial Care: Perspectives from Asia and
Strategy for Improving the Quality of Care for Low-​Middle-​Income Countries 813
Cancer Survivors 760 Jeff Dunn, Melissa Henry, and Maggie Watson
Erin E. Hahn and Patricia A. Ganz
Index 819
95 Adult Survivors of Childhood Cancer 767
Lisa A. Schwartz, Claire E. Wakefield, Jordana K. McLoone,
Branlyn Werba DeRosa, and Anne E. Kazak
Section editors
William S. Breitbart, MD, FAPOS
The Jimmie C. Holland Chair in Psychiatric Oncology
Chairman
Department of Psychiatry and Behavioral Sciences
Memorial Sloan Kettering Cancer Center
Professor of Clinical Psychiatry
Vice-Chairman
Department of Psychiatry
Weill Cornell Medical College
President Emeritus, International Psycho-oncology Society
Phyllis N. Butow, BA(Hons), DipEd, MClinPsych, MPH, PhD
Professor of Psychological Medicine
NHMRC Senior Principal Research Fellow
Founding Chair, PoCoG
School of Psychology
University of Sydney
Paul B. Jacobsen, PhD
Associate Director
Healthcare Delivery Research Program
Division of Cancer Control and Population Sciences
National Cancer Institute
Wendy W. T. Lam, RN, PhD, FFPH
Associate Professor, Head, Division of Behavioural Sciences,
School of Public Health
Director, Jockey Club Institute of Cancer Care, Li Ka Shing
Faculty of Medicine
Director, Centre for Psycho-oncology Research and
Training (CePORT)
The University of Hong Kong
Mark Lazenby, APRN, PhD
Associate Dean for Faculty and Student Affairs
Professor of Nursing and Philosophy
University of Connecticut School of Nursing
Matthew J. Loscalzo, MSW, LCSW, FAPOS
Liliane Elkins Professor in Supportive Care Programs
Administrative Director, Sheri and Les Biller Patient and Family
Resource Center
Executive Director, Department of Supportive Care Medicine
Professor, Department of Population Sciences
City of Hope National Medical Center
Contributors

Tim A. Ahles, PhD Hoda Badr, PhD

Attending Psychologist Associate Professor
Director, Neurocognitive Laboratory Department of Medicine
Psychiatry Service Baylor College of Medicine
Department of Psychiatry and Behavioral Sciences Houston, TX, USA
Member Alexis Bains, BSc Nutrition
Memorial Sloan Kettering Cancer Center Research Assistant
New York, NY, USA Department of Kinesiology and Nutrition
Yesne Alici, MD The University of Illinois at Chicago (UIC)
Associate Attending Psychiatrist Chicago, IL, USA
Clinical Director, Smita C. Banerjee, PhD
Co-​Director, Bio-​Behavioral Brain Clinic Associate Attending Behavioral Scientist
Psychiatry Service Behavioral Sciences Service
Department of Psychiatry and Behavioral Sciences Co-​Director, Comskils Laboratory
Memorial Sloan Kettering Cancer Center Department of Psychiatry and Behavioral Sciences
New York, NY, USA Memorial Sloan Kettering Cancer Center
Barbara L. Andersen, PhD New York, NY, USA
Distinguished University Professor Marie Barnett, PhD
Department of Psychology Assistant Attending Psychologist
Ohio State University Psychiatry Service
Columbus, OH, USA Department of Psychiatry and Behavioral Sciences &
Michael H. Antoni, PhD Department of Pediatrics
Professor Memorial Sloan Kettering Cancer Center
Department of Psychology New York, NY, USA
University of Miami and Sylvester Comprehensive Cancer Center Iris Bartula, DCP
Miami, FL, USA Head of Research Psychology
Allison J. Applebaum, PhD Melanoma Institute Australia
Assistant Attending Psychologist Senior Lecturer
Director, Caregiver’s Clinic Northern Sydney Medical School
Psychiatry Service Faculty of Medicine and Health
Department of Psychiatry and Behavioral Sciences University of Sydney
Memorial Sloan Kettering Cancer Center Sydney, NSW, Australia
New York, NY, USA Nicole Bates, MD
Ashley Arkema, MS Acting Assistant Professor
Nurse Practitioner Department of Psychiatry and Behavioral Sciences
Female Sexual Medicine University of Washington Attending Psychiatrist
Brooklyn, NY, USA Department of Psychosocial Oncology
Bruce K. Armstrong, BMedSci(Hons), MBBS(Hons), DPhil(Oxon), FRACP, FAFPHM Seattle Cancer Care Alliance
Retired Seattle, WA, USA
School of Population and Global Health Lisa Beatty, PhD
The University of Western Australia Senior Research Fellow
Perth, WA, Australia College of Medicine and Public Health
Nicole A. Arrato, MA Flinders University
Graduate Research Assistant Adelaide, SA, Australia
Department of Psychology Rebecca J. Beeken, PhD
Ohio State University Associate Professor of Behavioural Medicine
Columbus, OH, USA Leeds Institute of Health Sciences
Susan Ash-​Lee, MSW, LCSW University of Leeds
Vice President Leeds, Yorkshire, UK
Clinical Services Program
Cancer Support Community
Denver, CO, USA
xvi Contributors

Megan Best, PhD, MAAE, BMed(Hons), GradDipQHR Darcy E. Burgers, PhD

Senior Lecturer Psychologist
Department of Psycho-​Oncology Co-​operative Research Group Division of Pediatric Psychosocial Oncology
University of Sydney Department of Psychosocial Oncology and Palliative Care
Broadway, NSW, Australia Dana-​Farber Cancer Institute
Courtney Bitz, MSW, LCSW, OSW-​C Boston, MA, USA
Director of Clinical Social Work Phyllis N. Butow, BA(Hons), DipEd, MClinPsych, MPH, PhD
Department of Supportive Care Medicine Professor of Psychological Medicine
City of Hope NHMRC Senior Principal Research Fellow,
Duarte, CA, USA Founding Chair, PoCoG
Christian Bjerre-​Real, MD, MMCI School of Psychology
Research Fellow University of Sydney
Department of Psychiatry and Behavioral Sciences Sydney, NSW, Australia
Memorial Sloan Kettering Cancer Center Joanne S. Buzaglo, PhD
New York, NY, USA Executive Director, PRO Solutions
Eveline M. A. Bleiker, PhD Outcomes Sciences
Professor ConcertAI
Department of Psychosocial Research and Epidemiology Rydal, PA, USA
Netherlands Cancer Institute Carma L. Bylund, PhD
Amsterdam, The Netherlands Professor
Victoria Blinder, MD, MSc College of Journalism and Communications
Associate Attending Oncologist University of Florida
Associate Member Newberry, FL, USA
Immigrant Health and Cancer Disparities Service Patricia Calixte-​Civil, MA
Department of Psychiatry and Behavioral Sciences Doctoral Student
Breast Medicine Service Department of Psychology
Department of Medicine University of South Florida, Moffitt Cancer Center
Memorial Sloan Kettering Cancer Center Tampa, FL, USA
New York, NY, USA Linda E. Carlson, PhD
Linda Bohannon, MSM, BSN, RN Professor
President Department of Oncology
Global Headquarters University of Calgary
Cancer Support Community Cumming School of Medicine
Washington, DC, USA Calgary, AB, Canada
Thomas H. Brandon, PhD Jeanne Carter, PhD
Department Chair and Program Leader, Attending Psychologist
Health Outcomes and Behavior Director, Female Sexual Health Clinic
Moffitt Distinguished Scholar Gynecology Service
Director, Tobacco Research and Intervention Program Department of Surgery
Moffitt Cancer Center Psychiatry Service
Professor Department of Psychiatry and Behavioral Medicine
Departments of Psychology and Oncologic Sciences Memorial Sloan Kettering Cancer Center
University of South Florida New York, NY, USA
Tampa, FL, USA Lisa Carter-​Harris, PhD, APRN, ANP-​C , FAAN
William S. Breitbart, MD, FAPOS Associate Attending Behavioral Scientist
Jimmie C. Holland Chair in Psychiatric Oncology Behavioral Sciences Service
Chairman Department of Psychiatry and Behavioral Sciences
Department of Psychiatry and Behavioral Sciences Memorial Sloan Kettering Cancer Center
Member New York, NY, USA
Attending Psychiatrist Rosangela Caruso, MD, PhD
Supportive Care Service Doctor
Department of Medicine Biomedical and Specialty Surgical Sciences
Memorial Sloan Kettering Cancer Center University of Ferrara
Vice Chairman and Professor of Clinical Psychiatry Ferrara, Emilia Romagna, Italy
Department of Psychiatry
Christabel K. Cheung, PhD, MSW
Weill Cornell Medical College
Assistant Professor
New York, NY, USA
University of Maryland School of Social Work
Barry D. Bultz, AOE, PhD Member
Professor and Head, Division of Psychosocial Oncology University of Maryland Greenbaum Comprehensive Cancer Center
Daniel Family Leadership Chair in Psychosocial Oncology Baltimore, MD, USA
Department of Oncology
Harvey Max Chochinov, OM, OC, PhD, MD, FRCPC, FRSC, FCAHS
Cumming School of Medicine
Distinguished Professor
Department of Psychosocial Oncology
Department of Psychiatry
Tom Baker Cancer Center
University of Manitoba
University of Calgary
Winnipeg, MB, Canada
Calgary, AB, Canada
 Contributors xvii

Stephanie N. Christian, MPH Haryana Dhillon, BSc, MA(Psych), PhD

K. Leroy Irvis Fellow Associate Professor
Department of Behavioral and Community Health Sciences Centre for Medical Psychology and Evidence-​based Decision-​making,
University of Pittsburgh Graduate School of Public Health School of Psychology, Faculty of Science
Pittsburgh, PA, USA The University of Sydney
Shannon M. Christy, PhD Camperdown, NSW, Australia
Department of Health Outcomes and Behavior Michael A. Diefenbach, PhD
Division of Population Science H. Lee Moffitt Cancer Center and Research Professor
Institute Departments of Medicine, Urology and Psychiatry
Department of Oncologic Sciences Northwell Health
Morsani College of Medicine University of South Florida Manhasset, NY, USA
Center for Immunization and Infection Research in Cancer J. Nicholas Dionne-​Odom, PhD, RN, ACHPN
Lee Moffitt Cancer Center and Research Institute Assistant Professor
Tampa, FL, USA School of Nursing
Karen L. Clark, MS University of Alabama at Birmingham
Manager of Supportive Care Programs Hoover, AL, USA
Department of Supportive Care Medicine Suzanne J. Dobbinson, BSc, MSc, PhD
City of Hope National Medical Center Senior Research Fellow
Duarte, CA, USA Centre for Behavioural Research in Cancer
Anna E. Coghill, PhD, MPH Cancer Council Victoria
Assistant Member Kensington, VIC, Australia
Cancer Epidemiology Joanna S. Dognin, PsyD
Moffitt Cancer Center Psychologist
Tampa, FL, USA Department of Veterans Affairs
Lorenzo Cohen, PhD NYU Langone Medical Center
Professor and Director, Integrative Medicine Program White Plains, NY, USA
Department of Palliative, Rehabilitation and Integrative Medicine Heidi S. Donovan, PhD, RN
The University of Texas MD Anderson Cancer Center Professor
Houston, TX, USA Co-​Director National Rehabilitation Research and Training Center
Elliot J. Coups, PhD† on Family Support
Member Department of Health and Community Systems
Rutgers Cancer Institute of New Jersey University of Pittsburgh
Department of Medicine Pittsburgh, PA, USA
Rutgers Robert Wood Johnson Medical School Kristine A. Donovan, PhD, MBA
Rutgers, The State University of New Jersey Associate Member
New Brunswick, NJ, USA Department of Supportive Care Medicine
Leah Curran, DCP Moffitt Cancer Center
Clinical Psychologist Tampa, FL, USA
Department of Psychology Marcia Donziger, BA
The University of Sydney Vice President
Camperdown, NSW, Australia Digital Strategy and Business Development
Anne E. Cust, PhD, MPH(Hons), BSc, BA Cancer Support Community
Professor of Cancer Epidemiology Denver, CO, USA
Sydney School of Public Health Matthew Doolittle, MD
And the Melanoma Institute Australia Assistant Attending Psychiatrist
The University of Sydney Psychiatry Service
Camperdown, NSW, Australia Department of Psychiatry and Behavioral Sciences
Marianne Davies, DNP, ACNP, AOCNP Memorial Sloan Kettering Cancer Center
Associate Professor Yale School of Nursing New York, NY, USA
Department of Oncology Nurse Practitioner Caroline S. Dorfman, PhD
Smilow Cancer Hospital Assistant Professor
New Haven, CT, USA Department of Psychiatry and Behavioral Sciences
Greer J. Dent, BA Duke University Medical Center
Clinical Research Coordinator Durham, NC, USA
Department of Cancer Center Katherine N. DuHamel, PhD
Massachusetts General Hospital Director
Boston, MA, USA KND Consulting
Branlyn Werba DeRosa, PhD New York, NY, USA
Research Director Jeff Dunn, PhD, AO
Department of Research and Training Institute Professor
Cancer Support Community Department of Research and Innovation
Ardmore, PA, USA University of Southern Queensland
Toowoomba, Queensland, Australia
xviii Contributors

E. Devon Eldridge-​Smith, PhD Marian L. Fitzgibbon, PhD

Assistant Professor Professor
Department of Medicine Department of Pediatrics
National Jewish Health University of Illinois
Denver, CO, USA Chicago, IL, USA
Mary Jane Esplen, PhD Stacy Flowers, PsyD
Professor and Vice-​Chair Associate Professor
Department of Psychiatry Director of Behavioral Science
Faculty of Medicine Department of Family Medicine
University of Toronto Wright State University
Toronto, ON, Canada Columbus, OH, USA
Cynthia Fair, LCSW, MPH, DrPH Christine M. Friedenreich, PhD, FCAHS, FRSC
Professor and Department Chair Scientific Director
Department of Public Health Studies Department of Cancer Epidemiology and Prevention Research
Elon University Alberta Health Services
Elon, NC, USA Arnie Charbonneau Cancer Institute
Nathan Fairman, MD, MPH Adjunct Professor
Associate Clinical Professor The Faculties of Medicine and Kinesiology
Department of Psychiatry and Behavioral Sciences University of Calgary
UC Davis School of Medicine Calgary, AB, Canada
Sacramento, CA, USA Lindsay N. Fuzzell, PhD
Jesse R. Fann, MD, MPH Applied Research Scientist I
Professor Health Outcomes and Behavior
Department of Psychiatry and Behavioral Sciences Moffitt Cancer Center
Adjunct Professor Tampa, FL, USA
Departments of Rehabilitation Medicine and Epidemiology Francesca M. Gany, MD, MS
University of Washington Attending Physician
Medical Director Chief, Immigrant Health and Cancer Disparities Service
Department of Psychosocial Oncology Department of Psychiatry and Behavioral Sciences
Seattle Cancer Care Alliance Clinical Research Division Member
Fred Hutchinson Cancer Research Center Seattle, Washington Memorial Sloan Kettering Cancer Center
Seattle, WA, USA Professor
Joanna E. Fardell, PhD, MClinNeuropsych, BSc Department of Medicine and Department of Healthcare Policy & Research
Research Fellow Weill Cornell Medicine
Department of Behavioural Sciences Unit, Discipline of Paediatrics, New York, NY, USA
School of Women’s and Children’s Health, Faculty of Medicine Patricia A. Ganz, MD
University of New South Wales Distinguished Professor
Randwick, NSW, Australia Schools of Medicine and Public Health
Loreto Fernández González, BA, BSc, MPH University of California, Los Angeles (UCLA)
PhD Student and Connaught Scholar Los Angeles, CA, USA
Social and Behavioural Health Sciences Alexandra M. Gaynor, PhD
Dalla Lana School of Public Health Post-​Doctoral Neuropsychology Research Fellow
University of Toronto Department of Psychiatry and Behavioral Sciences
Toronto, ON, Canada Memorial Sloan Kettering Cancer Center
Betty Ferrell, RN, PhD, FAAN New York, NY, USA
Professor Afaf Girgis, PhD, BSc(Hons)
Nursing Research Professor
City of Hope National Medical Center Director, Psycho-​Oncology Research Group
Duarte, CA, USA University of New South Wales
Richard Fielding, BA(Hons), CPsychol, PhD, FFPH, FHKPsyS Sydney, Australia
Clinical Lead Barbara A. Given, PhD, RN, FAAN
Jockey Club Institute of Cancer Care, Li Ka Shing Faculty of Medicine University Distinguished Professor, Associate Dean Emeritus
Honorary Professor, School of Public Health College of Nursing
The University of Hong Kong Michigan State University
Hong Kong, China Okemos, MI, USA
Michelle Cororve Fingeret, PhD Charles W. Given, PhD
Fingeret Psychology Services Professor Emeritus
Houston, TX, USA College of Nursing
Abigail Fisher, PhD Michigan State University
Associate Professor Okemos, MI, USA
Department of Behavioural Science and Health Mitch Golant, PhD
University College London Senior Consultant, Strategic Initiatives
Bloomsbury, London, UK Research and Training Institute
Cancer Support Community
Los Angeles, CA, USA
 Contributors xix

Alejandro Gonzalez-​Restrepo, MD Melissa Henry, PhD

Attending Psychiatrist Associate Professor
Hartford Hospital/​Institute of Living Department of Oncology
Hartford Healthcare Faculty of Medicine
Simsbury, CT, USA McGill University
Luigi Grassi, MD Montreal, QC, Canada
Professor and Chair of Psychiatry Anika von Heymann, MSc, Psych, PhD
University of Ferrara Postdoctoral Fellow
Chairman of the Department of Biomedical and Specialty Surgical Sciences Department of Oncology
University of Ferrara Rigshospitalet
Ferrara, Italy København, Denmark
Joseph A. Greer, PhD Jeremy M. Hirst, MD
Associate Professor of Psychology Clinical Professor of Psychiatry; Palliative Care Psychiatry
Department of Psychiatry Department of Psychiatry; Palliative Medicine
Harvard Medical School UC San Diego School of Medicine
Program Director, Center for Psychiatric Oncology & La Jolla, CA, USA
Behavioral Sciences Fay J. Hlubocky, PhD, MA, CCTP
Massachusetts General Hospital Cancer Center Clinical Health Psychologist
Boston, MA, USA Research Project Professor
Chloe Grimmett, PhD Department of Medicine
Senior Research Fellow University of Chicago Medicine
School of Health Sciences Chicago, IL, USA
University of Southampton Jimmie C. Holland, MD†
Hampshire, UK Wayne E. Chapman Chair in Psychiatric Oncology
Erin E. Hahn, PhD, MPH Attending Psychiatrist
Research Scientist Psychiatry Service
Department of Research and Evaluation Department of Psychiatry and Behavioral Sciences
Kaiser Permanente Southern California Member
Pasadena, CA, USA Memorial Sloan Kettering Cancer Center
Sarah Hales, MD, PhD New York, NY, USA
Assistant Professor Karen Holtmaat, MSc, MA
Division of Psychosocial Oncology Assistant Professor in Psychosocial Oncology
Department Supportive Care Department of Clinical, Neuro-​and Developmental Psychology
Princess Margaret Cancer Centre Vrije Universiteit Amsterdam
Centre for Mental Health Amsterdam, NH, The Netherlands
University Health Network Michael A. Hoyt, PhD
University of Toronto Associate Professor
Toronto, ON, Canada Chao Cancer Center
Simon J. Hall, MD UC Irvine
Zucker Professor of Urologic Oncology Irvine, CA, USA
Smith Institute of Urology Nicholas J. Hulbert-​Williams, BSc, PhD, CPsychol, APBPsS, FHAE
Hofstra Northwell School of Medicine Professor of Behavioural Medicine
Lake Success, NY, USA School of Psychology
Jada G. Hamilton, PhD, MPH University of Chester
Assistant Attending Psychologist Chester, UK
Behavioral Sciences Service Jonathan Hunter, BSc, MD, FRCPC
Department of Psychiatry and Behavioral Sciences; Department of Medicine Professor
Assistant Member Department of Psychiatry
Memorial Sloan Kettering Cancer Center University of Toronto
New York, NY, USA Toronto, ON, Canada
Sameer Hassamal, MD Youri Hwang, MSN, RN, FNP-​C
Assistant Professor PhD Student
Department of Psychiatry School of Nursing
Arrowhead Regional Medical Center Yale University
Colton, CA, USA New Haven, CT, USA
Jennifer L. Hay, PhD Jonathan Irish, MD, MSc, FRCSC, FACS
Attending Psychologist Professor and Head
Behavioral Sciences Service Division of Head and Neck Oncology and Reconstructive Surgery
Department of Psychiatry and Behavioral Sciences Department of Otolaryngology-​Head and Neck Surgery
Member Princess Margaret Cancer Centre, University of Toronto
Memorial Sloan Kettering Cancer Center Toronto, ON, Canada
New York, NY, USA
Another random document with
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mankind, which is still obliged to make the same sacrifice of time and
labour to obtain a product which henceforth nature partly realises. If
this state of things should continue with every invention, a principle
of indefinite inequality would be introduced into the world. Not only
we should not be able to say, value is in proportion to labour; but we
should no more be able to say, value has a tendency to be in
proportion to labour. All that we have said of gratuitous use, of
progressive community, would be chimerical. It would not be true
that labour [les services] is given in exchange for labour [des
services] in such a manner that the gifts of God pass from hand to
hand, par-dessus le marché, on the man intended [destinataire], who
is the consumer. Each one would always exact payment for not only
his labour, but also for that portion of the natural forces which he had
once succeeded in applying. In a word, humanity would be
constituted on the principle of a universal monopoly, in place of the
principle of progressive community.”—Harmonies Economiques, Vol.
vi., p. 354.
We think, with Bastiat, that the use of natural agents ought to be
gratuitous, and that no one has the right to artificially monopolise in
such a way as to exact royalties [prélever des redevances], which
are not due, and which often are obstacles almost as insurmountable
as those which invention ought naturally to remove.
T. N. Benard.

[5] Unfortunately, this is not true of British law. The illustration

founded on it is (like the rest of these papers) admirable.—R. A.
M.
 SPEECH OF MICHEL CHEVALIER,
AT THE MEETING OF THE “SOCIÉTÉ
D’ÉCONOMIE POLITIQUE,” ON THE
5TH JUNE, 1869.
(From the June Number of the Journal des Economistes.)
M. Michel Chevalier, Senator, proposed to consider Patents in
their relation to freedom of labour [la liberté du travail], a corner-
stone of modern political economy, and to the principle of the law of
property, which is greatly respected by economists and which serves
them as guide.
Does the principle of freedom of labour accommodate itself to that
of Patents? It may be doubted. All Patents constitute a monopoly;
now, it is indisputable that monopoly is the very negation of freedom
of labour.
In the case of Patents, it is true, monopoly has a limited duration;
but in France this duration generally extends, if the Patent is worth it,
to fifteen years; which makes a long time in our day when the
advances of manufacturers are so rapid and so quickly succeed one
another. A hindrance or an obstacle which lasts fifteen years may
greatly damage and seriously compromise important interests.
It would be easy to exhibit by examples the extent and the
importance of these disadvantages.
In France the manufacturer to whom a new apparatus or a new
machine is offered is always in uncertainty whether the invention
proposed is not already the subject of some Patent, the property of a
third party, in which case he would be exposed to the annoyance of
a law-suit at the instance of this third party. It follows that he
frequently hesitates about adopting a machine, apparatus, or method
of work, which would be an advantage not only to the manufacturer,
but to the community at large, whom he might supply better and
cheaper. Another case which occurs to us is that of a manufacturer
in whose factory an improvement has suggested itself. He is forced
to take out a Patent, and consequently to observe formalities and
undertake expenses with which he would rather dispense; he is
obliged, and becomes a patentee, whether he will or no; because, if
he did not, it might happen that the improvement might come under
the observation of one of the numerous class of Patent-hunters. This
man might take out a Patent, which is never refused to the first
comer; and once patented, he might annoy and exact damages from
the manufacturer with whom the invention, real or pretended,
actually had its birth.
In France the annoyances which Patents may occasion are very
serious. It is well known that, by the French law, the patentee may
seize not only the factory of the maker, but also, wherever he may
find it, the machine or apparatus which he asserts to be a piracy of
that for which he has taken a Patent. He may take it away or put it
under seal, which is equivalent to forbidding the use of it. M. Michel
Chevalier thinks that this is a flagrant attack on the principle of the
freedom of labour.
It can also be shown how, in another way, labour may be deprived
of its natural exercise by the monopoly with which patentees are
invested. When an individual has taken out a Patent for an invention,
or what he represents to be such, no one is allowed to produce the
object patented, or use it in his manufacture, without paying to the
patentee a royalty, of which he is allowed to be the assessor, and
which sometimes assumes large proportions. The result is, that the
produce manufactured can only be offered in foreign markets at a
price so augmented that the foreigner refuses it if some other
producer, residing in a country where the Patent is not
acknowledged, establishes competition. Thus, for instance, France,
which worships Patent-right, cannot export the “Bessemer” steel to
Prussia, because there this product is not patented; whereas in
France, on the contrary, it is subject to a heavy royalty, on account of
the Patent.
 The same thing may be said of velvets, which have been very
much in fashion, and for which a French manufacturer took out a
Patent. The effect of this Patent was, that French manufacturers of
this stuff were shut out from the foreign markets, because outside
France they had to encounter the competition of Prussia, whose
manufacturers were not subject to any royalty, the Patent not being
acknowledged there.
In our day, when export trade excites so great an interest among
all manufacturing nations, and has so much influence on the
prosperity of internal commerce, M. Michel Chevalier believes that
the observation he is about to make ought to be taken into serious
consideration. At least it follows, according to him, that before
approving and continuing the present system of Patents, it would be
necessary that they should be subjected to uniform legislation in
every country. Now there are manufacturing nations—Switzerland,
for instance—which absolutely refuse; there are others where
Patents are subjected to so many restrictions that it is as if they did
not exist; such is Prussia.
From the point of view of the right of property, it is contended that
Patent-right should be respected, since it only assures property in
invention in the interest of him to whom the community is debtor. M.
Michel Chevalier sees in this argument only a semblance of the
truth. We must first inquire whether an idea may really constitute an
individual property—that is, exclusive personal property. This
pretension is more than broached. A field or a house, a coat, a loaf,
a bank-note, or credit opened at a banker’s, readily comply with
individual appropriation, and can hardly even be otherwise
conceived of; they must belong to an individual or to a certain fixed
number of persons; but an idea may belong to any number of
persons—it is even of the essence of an idea that once enunciated,
it belongs to every one.
Besides, is it certain that the greater part of patentees have had an
idea of their own, and that they have discovered anything which
deserves this name? Of the great majority of patentees this may be
doubted, for various reasons.
 The law does not impose on the individual who applies for a
Patent the obligation of proving that he is really the inventor.
Whoever has taken out a Patent may very easily turn it against the
real inventor; this has occurred more than once.
Besides, the law lays it down as a principle that it is not an idea
that is patented, and constitutes the invention valid; and thus it
excludes from the benefit of patenting the savants who make the
discoveries, of which Patents are only the application.
It is by the advancement of human knowledge that manufactures
are perfected, and the advancement of human knowledge is due to
savants. These are the men prolific in ideas; it is they who ought to
be rewarded, if it were possible, and not the patentees, who are
most frequently only their plagiarists.
M. Michel Chevalier does not desire systematically to depreciate
patentees. Among them there are certainly many honourable men.
The inventions, real or pretended, which they have patented are
supposed to be new and ingenious uses or arrangements
[dispositions], by help of which we put in practice some one or more
specialities of manufacture; true discoveries are always due to the
savants. But in general these arrangements, represented as new,
have no novelty.
In the detailed treatises on Mechanics, Physics, and Chemistry, in
books of technology, with their accompanying illustrations, such as
are now published, we find an indefinite quantity of combinations of
elementary apparatus, especially of mechanical arrangements, and
very often the work of professional patentees consists in searching
through these so numerous collections for uses and arrangements,
which they combine and group. What right of property is there in all
this, at least in the greater number of cases?
Against the pretended right of property alleged by the defenders of
Patents there will be much more to say. There exists in the greater
number of cases much uncertainty about the inventors, even when
true and important discoveries are in question. Is it known with
certainty who invented the steam-engine, who invented the aniline
dyes, or photography, even? Different nations are at variance on
these points, as formerly they were on the birthplace of Homer. The
fact is, that the majority of inventions are due to the combined
working [collaboration] of many men separated by space, separated
by great intervals of time.
On this subject M. Michel Chevalier repeats what he heard from
an eminent man who was Minister of Finance at the time when
Daguerre received the national recompense which had been
awarded him with the acclamations of all France. One of the
Government clerks brought to this eminent personage proof that he
too had made the same invention; and also there were the labours of
M. Niepce de Saint Victor, analogous to those of M. Daguerre.
[M. Passy, the chairman of the meeting, confirmed the statement
of M. Michel Chevalier on this fact.]
M. Michel Chevalier, in continuation, remarked that in our time
industrial arts are subject to great changes in the details of their
operations.
Independently of the general alterations which from time to time
completely change the face of any given manufacture, there is no
important workshop where some useful notion is not occasionally
suggested by some mechanic or overseer, which leads to minor
improvements [un perfectionnement de détail]. It would be an abuse
to grant, during a term of fifteen years, or even a much shorter,
exclusive use of any particular improvements to any single
individual. It would not be just, for it is quite possible that the idea
might have occurred to another at the same time, or that it might
occur the next day. It would even be against the general interest, for
it would fetter competition, which is the chief motor in the progress of
the useful arts.
But it is said inventors are useful to society; we must therefore
recompense them. To this M. Michel Chevalier answers that it may
be too liberal to confer the flattering title of inventor on men who,
when a veritable discovery has been made by savants, push
themselves forward to appropriate the profits, in securing by Patents
the various special applications which may be made of it. Besides,
there are different sorts of recompenses; there are other than
material rewards, and these are not the least coveted. The savants
who are the greatest discoverers are satisfied with these immaterial
rewards—honour, glory, and reputation. The example is worthy of
recommendation; not but it is quite allowable for a man to extract
from his labour [travaux] whatever material recompense he can. But,
in many cases at least, the Patent is not necessary for this purpose.
The authors of some useful discovery would often have the resource
of keeping their secret and working the invention themselves. That
would last for a time. Even under the system of Patents several
inventors have thus sought and found an adequate remuneration.
Thus the famous Prussian steel manufacturer, M. Krupp, has
taken out no Patent, and yet has made a colossal fortune; also M.
Guimet, of Lyons, inventor of French blue. Their secret remained in
their own hands for more than fifteen years, the maximum duration
that their Patent would have had in France.
Lastly, in the case of some truly great discovery it would be natural
to award a national recompense to the inventor. If James Watt, for
instance, had received from the British Parliament a handsome sum,
every one would have applauded it. These rewards would not
impoverish the Treasury, since similar cases are of rare occurrence.
In recapitulation, Patent-right may have been allowable in the
pasts when science and manufactures had not yet formed so close
and intimate a union. It was advisable to attract towards
manufactures, by means of exceptional inducements, the attention of
those who made a study of the sciences. But now that the union is
consummated, Patent-right has ceased to be a useful auxiliary to
industry. It is become, instead, a cause of embarrassment and an
obstruction to progress. The time is come to renounce it.
Another speaker at the meeting, M. Paul Coq, thought that, on a
question so delicate and controverted history furnishes instruction
which directs to a right solution. Notably Franklin, a genius eminently
practical, declared himself unwilling to avail himself, as to his
numerous discoveries, of any Patent. The refusal of this great man is
founded upon the principle that every one receives during his whole
life ideas and discoveries from the common fund of knowledge by
which all profit, and therefore ought, by reciprocation, to let the public
freely benefit by every invention of his. This, with Franklin, was not a
mere sentimental truth, but a practical conviction, based upon
reasons worthy of the author of “Poor Richard.” There is in the
bosom of society a constant exchange of beneficial thoughts and
services. Every one stimulated by the efforts of others ought, in the
spirit of equity, to make the community participants of the
improvements and useful applications for which he has in a manner
received payment in advance. On this system, equality, competition,
and freedom of industry find their account in the law of reciprocity;
whereas, on the footing of privilege established and defined by the
theory of Patents, there is created an artificial property, along side of
that rightful property which has in it nothing arbitrary or conventional,
and depends simply for its existence on civil law. These circles,
thereby traced round the inventor and his discovery, are so many
hindrances and so many obstacles to the expansion of forces, in the
way of continuous progress. Under pretext of maintaining individual
rights, improvement is in reality paralysed by superimposed
difficulties, and especially litigation without end, on account of which
nobody dare touch, either far or near, what has been appropriated.
The numerous actions at law, raised with a view to ascertain whether
such and such a process constitutes a perfectionation, a new
application, or merely an imitation, are my proof. There is another
proof in the distinction attempted to be made between matters
patentable and methods scientific which may not be patented. All
this, as it affects progress, the free expansion of forces, is infinitely
grave. Franklin has found for his precepts, already alluded to, more
than one adept pupil. One modest savant, whose name deserves to
be better known among us for his numerous services rendered to
science as well as to the arts—Conté—honoured to replace in
France the pencils of England, the importation of which was not
possible in time of war—not only supplied by his new process the
want of plumbago with success, but made it better than the English.
To him are due, besides black-lead pencils, which make his name
celebrated, the crayons of various colours, which have been so
serviceable in the arts of design. Well, like Franklin, he presented his
process to industry, and contented himself with being first in the new
manufacture. It must be remarked that he who thus opens the way
easily maintains the first rank which the date of his invention assigns
him, and which public confidence assures him....
Before concluding, M. Paul Coq adverted to the distinction
between the right of property generated by a creation of a work of art
or of literature, and factitious property decreed in the interests of
industry. The skilful painter, who should copy faithfully line for line,
tint for tint, a chef d’œuvre like the picture of Ingres, which every one
knows, “The Source,” in order to expose it for sale and pocket the
advantages, not merely lays hold of the property of a great artist who
lives by the fruit of his talent, but perpetrates, in all points of view, an
action mean and vile. To inventions in the domain of the useful arts,
processes and operations do not carry the stamp of personality,
which is the glory of the artist and author, and which of itself
constitutes a protection equal to that which protects right of property.
The invention is something impersonal, like a service rendered
and returned, which is not exchanged or paid by services of
equivalent weight and description. There is, therefore, no plausible
objection to maintaining unimpaired the common right, which, by its
freedom of movements, its equality, and its reciprocations, alone
efficaciously favours the result of which these are the indispensable
corollaries.
 EXPERIENCE IN FRANCE.
The following observations were published in the Avenir
Commercial, November 1, 1862, and June 28, 1863, have been
kindly translated and presented by the Author:—

THE RESULTS OF A BAD LAW.

I.

When you walk along a public road, if you find a watch, a

diamond, a note of a hundred or a thousand francs, and, far from
seeking the owner to give it back, you apply it to your own use, moral
law and civil law take hold of you and condemn you without
hesitation. It matters not whether he who lost what you found be rich
or poor, his carelessness, his negligence, or the accident that
caused his loss, give you no sort of right to use it and make it yours.
There are not two opinions on that point: the laws of all countries
condemn the man who enriches himself with what chance throws in
his way.
But if a scientific man—seeking some impossible discovery, finds
a clue to an idea—meets with an interesting phenomenon—
indicates, in some way, new properties belonging to some bodies—
announces the results of some new chemical combination—it is only
a scientific research. This or that other skimmer of inventions can get
a Patent for the application of the idea, of the discovery, of the
method; and the law guarantees his pretended right not only against
all reclamations of the scientific man who has discovered the whole,
but against the whole world, deprived of all possibility of making use
of the discoveries of science!
 And not only the law forbids every one to use this or that produce,
except if made by the patentee, but it also prohibits the use of any
similar produce made by different means.
Then, to prevent all inventors to approach the ground that the
patentee has chosen, he takes immense care to have his Patent
made of formulas so wide and elastic, that all inventions in the same
course of ideas will be infringements in the eye of the law.
To these observations it is answered that industrialists or scientific
men are equal before the law, that all have an equal right to its
protection, but on the express condition that the invention be put in
use.
We see very well where is the privilege of the chance patentee,
who has made the discovery of the scientific man his own, but we do
not see where is its justice or equality.
We see very well where is the privilege of the man who has had
nothing to do but to apply the idea deposited in a book by a scientific
man—an idea that, in fact, was at the disposal of the public, since
the discoverer did not claim its proprietorship; but we do not see why
the law gives a monopoly to him who has only borrowed that idea.
But we are told, the law is quite equitable, for it, says, “To every
man his due. The scientific man discovers a body, glory be to him. If
he will add to it some profit, let him indicate the properties that may
be used industrially, and let him take a Patent for his discovery. But
he must hurry, because if industry forestalls him, industry will get the
profit.”[6] It is exactly as if this was the law: A millionaire drops a 100-
franc note. It will not make him much poorer. If he wants to get it
back, let him return where he came from and seek along the road.
Let him hurry, for if this note is found, he who will have got it may
keep it.
Common sense and equity would join to say that when a scientific
man indicates a discovery or an invention, that invention or discovery
remains at the disposal of every one if the finder does not claim the
exclusive right to work it. But the law is different, and the results are
soon made apparent.
 In 1856 an English chemist, of the name of Perkins, was seeking
the way to make artificial quinine. In the course of his experiments
he discovered in the laboratory of M. Hofmann the property residing
in aniline of producing a violet colour by the action of bi-chromate of
potass.
Perkins got a Patent for this discovery. The attention of the
scientific and industrial classes being called to this property of
aniline, and to the possibility of extracting from it divers colouring
matters, several French and other chemists and manufacturers got
Patents for many more new processes.
In 1858, Hofmann, continuing to study aniline, discovered the red
colour. He sent a memoir to our Académie des Sciences, in which he
gave the exact method to produce this magnificent crimson red.
Hofmann took no Patent; it seemed as if he wanted to present
gratuitously to tinctorial industry a new and beautiful produce.
Six months after, a manufacturer, who as early as 1857 had tried
to get patented in France the patented discovery of Perkins, sold to a
manufacturer of chemical produce a process copied from the
discovery of Hofmann, by which the red of aniline could be
manufactured by the reaction of the bi-chloride of tin. The Patent
was granted, and the produce manufactured. But very soon after, in
France and abroad, more advantageous and more scientific
methods, preferable to the patented one, were found.
All the French manufacturers who tried to use any of these new
processes were prosecuted and condemned for infringement on the
right of the patentee. It then followed that one kilogramme of red of
aniline was sold abroad for £12, and the monopolisers sold it for £40
in France.
This could not last, particularly after the treaty of commerce, by
which printed and dyed goods could be introduced. Manufacturers
threatened to give up work, and the patentee thought proper to
reduce his prices.
But another result, no less fatal to French interests, soon followed.
 The most intelligent manufacturers of colouring-stuffs, those who
were at the head of that branch of industry, and had concentrated in
Paris, Lyons, and Mulhouse the fabrication of the finest and most
delicate dyes for the home and foreign market, went to establish new
factories across the frontiers.
The existing Patent prevented them from satisfying the demands
of their customers abroad, who required some aniline colours, and
they were obliged to carry their industry to foreign parts.
The following is the list of the manufacturers who have founded
new establishments beyond the reach of the monopolising Patent:—
A. Schlumberger, of Mulhouse, new factory at Bâle (Switzerland);
Jean Feer, of Strasburg, new factory at Bâle; Peterson and Seikler,
of Saint Denis, new factory at Bâle; Poirrier and Chappal, of Paris,
new factory at Zurich; Monnet and Dury, of Lyons, new factory at
Geneve.
Five other establishments, raised by Swiss people but under the
direction of Frenchmen, are being founded at Bâle, Zurich, Glaris,
and Saint Gall. Then there are still to be founded, the factory of M. A.
Wurtz, brother to Professor Wurtz at Leipsic; another, by M. O.
Meister at Chemnitz; a French factory at Elberfeld; three, also
French, in Belgium; and three others in Switzerland.
It is, in fact, a general expatriation, like the one that followed the
revocation of the Edict of Nantes. It is worthy of remark that in
Germany there are twelve Patents for making colours or dyes from
aniline; in England there are fourteen, in France (thanks to the
interpretation given to the law) there is one. “Et nunc caveant
consules.”
T. N. Benard.

[6] Extract of a paper on the subject in the Propriété

Industrielle.

II.
 In our number of November 1, 1862, we published on this very
same question an article in which we stated that about twenty
French manufacturers had been forced to go abroad to escape the
unheard-of exigencies of the law of Patents. We were answered by
insults that we disdained; but the facts that we had revealed were
not contested.
A volume just published on the legislation and the jurisprudence of
the law of Patents enables us to show another side of the question,
and to prove how injurious it is to manufacturers and inventors, and
how profitable to certain gentlemen of the Bar who have the
speciality of cases for infringement on Patents. We say it openly and
fearlessly, if it was not for the lawyers who swim freely amongst the
windings of that law, it would not have a supporter. Manufacturers
and inventors are shamelessly made a prey to a group of pleaders
who defend right and wrong with the same deplorable alacrity.
What an immense number of law-suits have arisen from the 54
articles of that law! The volume we have in hand has been written
with the intention of giving to the public a view of the jurisprudence
adopted by the Courts in the interpretation of each paragraph. A
summary of the trials that have taken place since its promulgation in
1844 follows each article of the law.
Article I. is as follows: “Every new discovery or invention, in all
kinds of industry, ensures to its author, under the conditions and for
the time hereafter determined, the exclusive right to work for his
benefit the said discovery or invention. This right is established by
documents granted by the Government, and called Patents.”
The first trial that we find in the list took place in 1844. The
question was, Whether the words all kinds of industry could be
applied to things that are not in trade? The Court’s decision was for
the affirmative.
The second trial was raised to know if, when a working man is only
executing the orders given to him by another party, with the
indications and in the interest of this last, the working man may be
reputed the inventor, and if the results of his labour may have the
character of an invention, so that he may claim [revendicate] its
ownership by a Patent. The Court decided for the negative.
We pass four other suits running on the interpretation of this first
article, that seems so innocent, so inoffensive, and come to the
eleventh trial. In conferring by Article I., under the conditions that it
determines, on the author of new discoveries or inventions the right
of working them exclusively for his own benefit, did the law intend to
deprive of all rights those who were using the same means of
fabrication prior to the delivery of the Patents? The question was, in
other terms, to know whether the Patent is good and legal against
every one except against the party who, having worked it for a
certain period anterior to the granting of the Patent, might be kept in
possession of his industry? On March 30, 1849, the Court of
Cassation decided for the affirmative in the case of “Witz Meunier
versus Godefroy Muller.” You fancy, perhaps, that the affair is all right
and settled; the Court of Cassation has spoken, and every inventor
who will not have taken a Patent may work out his invention without
fear of prosecution from a patentee coming long after. You are
greatly mistaken. You do not know how keen, and ardent, and clever,
and anxious are the seekers of Patents. Previously to that the Court
Royal of Paris had declared in May, 1847, in the case of “Lejeune
versus Parvilley,” that the Patent can be put in force against the
manufacturer working the invention before it was patented, if he has
not published it before the patentee, and if the patentee is the first
who has introduced it in commerce. But in 1847 the Court Royal of
Paris did not know the opinion given in 1849 by the Court of
Cassation. We see how unsafe are the things of this world. Say if
you can ever be sure of holding and knowing the truth.
On August 19, 1853, the same question was brought again before
the Court of Cassation in the case of “Thomas Laurent versus Riant,”
and the Court decided that the Patent can be put in force against
whoever possessed the invention before it was patented. There is at
Lyons a manufacturer who for a great many years fabricated a dye
for which he has not taken a Patent, but the secret of which he
carefully keeps to himself. If, by some manœuvring, by some
doubtfully moral means, an industrialist—as there are too many
amongst the patentees—contrived to worm out this secret, and got a
legal Patent, he could work the discovery and oblige the Lyonese
manufacturer to cease all productions of the same kind. Would it not
be an admirable example of legality?
The contradiction that we have just noted between two verdicts
given by the same Court upon the same question gives us the right
to say that the magistrates ought to show a little more indulgence to
those they condemn. When there is a law like that relative to
Patents, common mortals are very excusable if they make a mistake
in interpreting in a wrong way this or that expression, since we see
the highest Court in the country giving sometimes one interpretation
and sometimes another.
The first article of the law has given rise to fifteen different suits,
inscribed in the pages of the volume we hold. These fifteen suits
have been tried before the Civil Courts or the Court of Cassation.
People may well be frightened at the mountain of papers that must
have been used and destroyed by the attorneys, counsel, barristers,
&c., before the public could have any clear notion of what the
legislators meant.
The second article is as follows: “Will be considered as new
inventions or discoveries—the invention of new industrial produce;
the invention of new methods or the new application of known
methods to obtain an individual result or produce.” This article, we
may say, is the main beam of the edifice, consequently it has given
occasion to no less than 104 suits. One might fancy that the
multitude of judicial decisions given by the Courts has thrown the
most brilliant light on the interpretation to be given to the three
paragraphs forming the second article. Alas! these paragraphs are
just as obscure as before. For instance, the Imperial Court of Paris
decided on August 13, 1861, that the “change in the form of a
surgical instrument, even when there may result an advantage or
greater facility to the operator, cannot be patented.” But on July 26 of
the same year it had decided that “a production already known—a
straw mat, for instance—may be patented when its form, its size,
and its length are new.” So, again, the Court of Cassation decided,
on February 9, 1862, that “the production of a new industrial result is
an invention that may be patented, even if it is only due to a new
combination in the form and proportions of objects already known.”
On the contrary, the Correctional Court of the Seine decided on
December 24, 1861, that a modification of form, even when it
procures an advantage, is not of a nature to constitute a patentable
invention. Can we not say with the poet:

“Deviner si tu peux, et choisis si tu l’oses?”

The lawyers of Great Britain are accustomed to celebrate certain

anniversaries by a professional dinner. The President of the party,
after having proposed the health of the Queen and the Royal Family,
calls upon his brethren to join in a toast to the prosperity of the
profession they follow. This traditional toast is characteristic enough.
It is as follows: “The glorious uncertainty of the law!” We think the
facts we have related give to this toast a right of citizenship on this
side of the Channel.
T. N. Benard.
 IMPORTANT MESSAGE FROM THE
SECRETARY OF THE
CONFEDERATION, COUNT VON
BISMARCK, TO THE NORTH GERMAN
FEDERAL PARLIAMENT.
Berlin, December 10, 1868.
In the presence of the manifold and well-founded complaints
concerning the defective state of legislation on Patents in Prussia
and Germany, the Royal Prussian Government deems it important to
have considered without any further delay what course might best be
adopted in the matter.
At the same time, however, and with a view to the position long
since taken by Government in regard to the question, it must not be
omitted in the first place to decide whether henceforth Patents
should be granted at all within the boundaries of the Confederation.
The frequent polemics on the principles of Patent-Laws, to which the
repeated attempts at reform have given birth during the last ten
years, and more particularly the discussions in the late German
Federal Assembly, have enhanced the questionability of the
usefulness of Patents.
After taking the opinion of the Chambers of Commerce and the
mercantile corporations, the Prussian Government, on the occasion
of the German Federal Assembly Session of 31st December, 1863,
gave utterance to the doubt whether under present circumstances,
Patents for inventions may be considered either necessary or useful
to industry. Since then the Royal Prussian Government has taken
the question once more into serious consideration, and feels bound
to answer it in the negative on the strength of the following
arguments.
From a theoretical point of view, it may be taken for granted that
the conferring of an exclusive right to profits which may be derived
from industrial inventions, is neither warranted by a natural claim on
the part of the inventor which should be protected by the State, nor is
it consequent upon general economical principles.
The right of prohibiting others from using certain industrial
inventions, or bringing certain resources and profitable means of
production into operation, constitutes an attack upon the inalienable
right which every man has, of applying each and every lawful
advantage to the exercise of his profession, which is the more
obvious, as there exists a prevailing tendency to free industrial
pursuits from all artificial restrictions adherent to them, and the time-
honoured practice can only be upheld by a thorough vindication and
a practical proof of its fully answering the purpose. To demonstrate
this should be the chief aim of all arguments against abolition.
To an argument which has repeatedly been urged—i.e., that the
granting a temporary exclusive right is indispensable (so as to
secure for the meritorious inventor a reward adequate to the mental
labour and money expended, as well as risk incurred, in order that
there be no lack of encouragement to the inventive genius)—the
objection may be raised that the remarkably developed system of
communication and conveyance now-a-days, which has opened a
wide field to real merit, and enables industrial men promptly to reap
all benefit of production by means of enlarged outlets for their
articles, will, generally speaking, bring those who know how to avail
themselves before others of useful inventions to such an extent
ahead of their competitors, that, even where no permanent privilege
is longer admissible, they will make sure of a temporary extra profit,
in proportion to the service rendered to the public.
It is, in fact, in the peculiar advantage produced by the early
bringing into operation of a fresh suggestion of their minds, that the
remuneration of those lies, who, through cleverness and steadiness
of purpose, succeed in satisfying existing wants in a manner less
expensive and superior to what previously was the case, and
notwithstanding do not obtain any monopoly. Not of less account are
the practical impediments which stand in the way of every effort to
bring about an improvement of the Patent-Law.
It is generally admitted by the promoters of Patent-right, that the
system of inquiry or examination, as it is now working in Prussia,
cannot possibly remain in its present condition, and the experienced
officers appointed to decide upon Patent matters and make the
necessary inquiries, unanimously confirm that opinion. Though
provided with relatively excellent means of ascertaining, the Prussian
Technical Committee for Industry had to acknowledge as early as
1853 (Vide Prussian Trade Archives of 1854, Vol. ii., page 173, ff.)
that the question whether an invention submitted for being patented
might not perchance already have been made or brought into
operation elsewhere, was almost an unsolvable one. Since then,
inventions have augmented yearly in steadily increasing proportion.
The main difficulty, however, not only rests in the impossibility of
mastering the matter submitted, but equally so with the upholding of
firm principles relating to the criterion of originality. If the inquiry do
not altogether deviate from its primitive object by patenting any and
every innovation in construction, form, or execution, which is
presented, we fall into such uncertainty when sifting actual
inventions from the mass of things which are not to be considered as
undeniable improvements—owing to the continually increasing and
diversified combinations of generally known elements or material
and altered constructions or modes of application—that it is hardly
possible not to be occasionally chargeable with injustice. Every day
shows more clearly how annoying a responsibility grows out of such
a state of affairs, and it is highly desirable that the authorities no
longer be conscious of doing injustice in their duties on account of
rules which cannot properly be put into practice.
As for the often much-commended so-called “application system,”
it would by no means really answer the purpose; even without
considering the theoretical objections which might be raised against
it. Its practical results have been far from giving satisfaction
wherever it has been adopted. The complaints of the abuses and