Rockefeller Money, the Laboratory and Medicine in Edinburgh 1919-1930:

Rockefeller Money, the Laboratory and Medicine in Edinburgh 1919-1930:: New Science in an Old Country

Christopher Lawrence
Copyright Date: 2005
Edition: NED - New edition
Published by: Boydell and Brewer,
Pages: 384
https://www.jstor.org/stable/10.7722/j.ctt14brr6h
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  • Book Info
    Rockefeller Money, the Laboratory and Medicine in Edinburgh 1919-1930:
    Book Description:

    In the first half of the twentieth century, reformers attempted to use the knowledge and practices of the laboratory sciences to radically transform medicine. Change was to be effected through medicine's major institutions; hospitals were to be turned into businesses and united to university-based medical schools. American ideas and money were major movers of these reforms. The Rockefeller Foundation supported these changes worldwide. Reform, however, was not always welcomed. In Britain many old hospitals and medical schools stood by their educational and healing traditions. Further, American ideals were often seen as part of a larger transatlantic threat to British ways of life. In Edinburgh, targeted by reformers as an important center for training doctors for the empire, reform was resisted on the grounds that the city had sound methods of education and patient care matured over time. This resistance stemmed from anxiety about a wholesale invasion by American culture that was seen to be destroying Edinburgh's cherished values and traditions. This book examines this culture clash through attempts to introduce the laboratory sciences, particularly biochemistry, into the Edinburgh medical world of the 1920s. Christopher Lawrence is Professor of the History of Medicine at the Wellcome Trust Centre for the History of Medicine, University College London. He is a fellow of the Royal College of Physicians of Edinburgh.

    eISBN: 978-1-58046-644-8
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-v)
  3. List of Figures and Graphs
    (pp. vi-vi)
  4. ACKNOWLEDGMENTS
    (pp. vii-viii)
  5. ABBREVIATIONS
    (pp. ix-x)
  6. 1 INTRODUCTION: MEDICAL CULTURES
    (pp. 1-10)

    In 1933 an officer of the Rockefeller Foundation (RF) of New York, R. A. Lambert, visited the Edinburgh Medical Faculty, into which his institution had poured a great deal of money over the previous ten years. He was struck by the fact that, “For a generation at least, the School has obviously lived to a considerable extent on its reputation and its policies have been determined largely by tradition.” He catalogued what he considered Edinburgh’s shortcomings and the changes that might give his paymasters cause for hope that the sort of medicine they wished to see in Scotland was being...

  7. 2 MEDICAL REVOLUTIONS
    (pp. 11-24)

    The Edinburgh Medical School was founded in 1726 and the RIE in 1729. Two hundred years later medicine could be said to have undergone one revolution and to be undergoing another. These revolutions are best described in terms of ideal types, for the spectrum of theories, assumptions, practices, and institutions that they embraced varied widely. The first revolution, often called hospital medicine, occurred in the early nineteenth century and involved the gradual transformation of a medicine based largely on the patient’s narrative to one based on physical examination and the use instruments, famously the stethoscope. Clinicians, on hospital wards and...

  8. 3 THE ROCKEFELLER FOUNDATION AND THE CULTURE OF BRITISH MEDICINE
    (pp. 25-62)

    RF perceptions of Britain require understanding within two wider frameworks, one encompassing the other. First is RF global policy and strategy. Perceptions of, and interventions in, British medicine were not simply local but very much a part of a panoramic view. Second, RF global policy itself needs situating within America’s social, political, economic, and cultural relations with Europe, and indeed much of the world, in the first decades of the twentieth century. To deal with the latter first: in a valuable corrective to the thesis of American exceptionalism, Daniel T. Rodgers has argued that in areas of social policy (poor...

  9. 4 THE ORGANIZATION AND ETHOS OF EDINBURGH MEDICINE
    (pp. 63-92)

    In London most of the medical schools had been created within the great old hospitals and were based in them. Qualification was traditionally achieved not by university degree but by examination at the Royal Colleges of Physicians and of the Surgeons, or the Society of Apothecaries. London University was a relatively late addition to medical education in the capital and, even in the 1920s, still not regarded as important in some quarters. London University was an umbrella organization: administering, degree awarding, and examining. In Edinburgh the situation was quite different. The University was the principal seat of medical education and...

  10. 5 EDINBURGH, LONDON, AND NORTH AMERICA
    (pp. 93-139)

    Rockefeller attempts to transform Edinburgh medicine in the 1920s turned out to be no means as easy and as successful as Pearce had probably anticipated. In the early 1920s American visitors to the city recorded, sometimes with dismay, local opinion on what constituted sound medical practice, the most productive ways to teach, and the best means to advance medical knowledge. In London there was suspicion of American ways in doing things because of the hospital-based nature of London medical schools and the relative marginality of London University. More generally the rural ideology of the London doctors and their association of...

  11. 6 THE DEPARTMENTS OF SURGERY AND MEDICINE
    (pp. 140-185)

    The RF’s concentration on the Biochemistry Laboratory and the Department of Therapeutics was a product of considerable institutional history and Rockefeller strategy. As usual the RF picked out its man, in this case Meakins (that he held the therapeutics chair was coincidental). Although there were problems in London the RF had been able to support new medical and surgical units there, notably because they were unencumbered by the burden of history. In Edinburgh it tried to create units using the premier medical and surgical professorships but these were long-standing chairs with intricate relations with the Infirmary and with incumbents who...

  12. 7 A HOSPITAL LABORATORY
    (pp. 186-224)

    Biochemical testing in laboratories as an adjunct to patient care (clinical biochemistry) appeared in Britain chiefly in the 1920s. Before the Biochemistry Laboratory opened in Edinburgh in 1921 the Infirmary had two laboratory services: that of the Pathology Department and a socalled clinical laboratory which was mainly devoted to electrocardiography.¹ The surgeons had their own laboratory facilities and did not call much on the Pathology Department.² There were also ward “side rooms” for carrying out simple tests and microscopy.

    During the nineteenth century, chemistry was increasingly held to be an important example of a basic science with the power to...

  13. 8 A UNIVERSITY LABORATORY IN A HOSPITAL
    (pp. 225-268)

    The Department of Therapeutics used the lab to achieve high academic visibility in three ways: through the “pure” research of basic scientists, through the studies of clinicians who combined bedside observations with bench research, and through the joint investigations of both groups. By the 1920s a background in research was essential to constructing a career in academic medicine. It could also be used to further a future in private medical practice since it might enhance the possibility of obtaining a hospital appointment and hence a higher public profile. Creating a prestigious academic department of medicine in Britain was not easy...

  14. 9 BENCH AND BEDSIDE
    (pp. 269-325)

    How did physicians who were not laboratory researchers use the lab? This question does not admit of a full answer. Original case records for the medical wards do not exist except for the physician Edwin Bramwell. There is an almost full set of his patient records for the period 1919–1935. In addition a complete register of all of Bramwell’s in-patients exists, so it is usually possible to know the names, diagnoses, admission, and discharge (or death) dates of those few patients whose notes are missing. Further, in surgery, there is virtually a complete set of case notes from 1524...

  15. 10 CONCLUSION: MODERN TIMES
    (pp. 326-334)

    After assisting the reconstruction of the Medical Department, the RF pulled out of all further projects related to teaching and research in medicine in Edinburgh. This was a policy decision made before Pearce’s death and which he talked about with Fletcher who agreed with it.¹ The decision seems to have resulted from a combination of factors, notably experience and general policy change. At the end of the 1920s at the Foundation headquarters the Division of Medical Education was dissolved and a new Medical Sciences division was created. Policy was changed from supporting schools to assisting individual research projects. Psychiatry, worldwide,...

  16. BIBLIOGRAPHY
    (pp. 335-350)
  17. INDEX
    (pp. 351-374)
  18. Back Matter
    (pp. 375-375)