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Rockefeller Money, the Laboratory and Medicine In Christopher Lawrence is Professor of the History Lawrence In the first half of the twentieth century, reformers of Medicine at the Wellcome Trust Centre for the attempted to use the knowledge and practices History of Medicine, University College London. of the laboratory sciences to transform medicine He is a Fellow of the Royal College of Physicians radically. Change was to be effected through of Edinburgh. Rockefeller Money, medicine’s major institutions; hospitals were to be turned into businesses and united to university- the Laboratory and Medicine based medical schools. American ideas and in Edinburgh 1919–1930 money were major movers of these reforms. The “A marvelous demonstration of the value of institutional microhistory. This study Rockefeller Foundation supported these changes of the constructive yet in some ways less than idyllic marriage between the worldwide. Reform, however, was not always Rockefeller Foundation and the Edinburgh medical establishment sheds fundamental welcomed. In Britain many old hospitals and light on the evolution of biomedicine in the twentieth century as well as the New Science in an Old Country medical schools stood by their educational and relationship between England and the United States.” healing traditions. Further, American ideals were —Charles E. Rosenberg, Ernest E. Monrad Professor in the Social Sciences, often seen as part of a larger transatlantic threat Harvard University to British ways of life. In Edinburgh, targeted by reformers as an important centre for training “Christopher Lawrence shows how broad cultural trends and the perceived interests doctors for the Empire, reform was resisted on of historical actors played out in changing (or failing to change) medical institutions the grounds that the city had sound methods of in 1920s Edinburgh. At the same time, he clearly indicates that the daily practice education and patient care matured over time. of doctors and scientists—and thus the knowledge they used and produced—were This resistance was part of an anxiety about a based in those doctors’ and scientists’ understanding of the resources of those wholesale invasion by American culture that institutions. His fine-grained empirical monograph thus demonstrates how institutions was seen to be destroying Edinburgh’s cherished serve as connectors between larger social forces and the activities of individuals; values and traditions. These latter in turn were it is an exemplary study in the historical sociology of biomedical science.” seen to stem from a distinct Scottish way of life. This book examines this culture clash through — Edward T. Morman, Director, F.C. Wood Institute for the History of attempts to introduce the laboratory sciences, Medicine, the College of Physicians of Philadelphia particularly biochemistry, into the Edinburgh medical world of the 1920s. ISBN 1-58046-195-6 University of Rochester Press 668 Mt. Hope Avenue Rochester, NY 14620, USA P.O. Box 9, Woodbridge Suffolk IP12 3DF, UK Christopher Lawrence Jacket design: Lisa Mauro www.urpress.com 9 781580 461955 RMM_Prelims.qxd 7/1/05 11:31 AM Page i ROCKEFELLER MONEY,THE LABORATORY, AND MEDICINE IN EDINBURGH 1919–1930 RMM_Prelims.qxd 7/1/05 11:31 AM Page ii Rochester Studies in Medical History Senior Editor:Theodore M. Brown Professor of History and Preventive Medicine University of Rochester ISSN 1526–2715 The Mechanization of the Heart: Harvey & Descartes Thomas Fuchs Translated from German by Marjorie Grene The Workers’ Health Fund in Eretz Israel Kupat Holim, 1911–1937 Shifra Shvarts Public Health and the Risk Factor: A History of an Uneven Medical Revolution William G. Rothstein Venereal Disease, Hospitals and the Urban Poor London’s “Foul Wards,”1600–1800 Kevin P.Siena Rockefeller Money, the Laboratory, and Medicine in Edinburgh 1919–1930: New Science in an Old Country Christopher Lawrence RMM_Prelims.qxd 7/1/05 11:31 AM Page iii ROCKEFELLER MONEY, THE LABORATORY,AND MEDICINE IN EDINBURGH 1919–1930 New Science in an Old Country Christopher Lawrence RMM_Prelims.qxd 7/1/05 11:31 AM Page iv Copyright © 2005 Christopher Lawrence All Rights Reserved. Except as permitted under current legislation, no part of this work may be photocopied, stored in a retrieval system, published, performed in public, adapted, broadcast, transmitted, recorded or reproduced in any form or by any means, without the prior permission of the copyright owner. First published 2005 University of Rochester Press 668 Mt. Hope Avenue, Rochester, NY 14620, USA www.urpress.com and of Boydell & Brewer, Limited PO Box 9,Woodbridge, Suffolk 1P12 3DF, UK www.boydellandbrewer.com ISBN 1–58046–195–6 Library of Congress Cataloging-in-Publication Data Lawrence, Christopher, 1947- Rockefeller money, the laboratory, and medicine in Edinburgh, 1919-1930 : new science in an old country / Christopher Lawrence. p. ; cm. – (Rochester studies in medical history, ISSN 1526-2715 ; 5) Includes bibliographical references and index. ISBN 1-58046-195-6 (hardcover : alk. paper) 1. Rockefeller Foundation–History. 2. University of Edinburgh Faculty of Medicine–History. 3. Medicine–Scotland–Edinburgh–History–20th century. 4. Medical colleges–Scotland–Edinburgh–History–20th century. 5. Medical education–Scotland–Edinburgh–History–20th century. 6. Medical education–Scotland–Edinburgh–Endowments–History–20th century. 7. Medicine–Research–Scotland–Edinburgh–History–20th century. 8. Medicine–Research–Scotland–Edinburgh–Endowments–History–20th century. 9. Medical laboratories–Scotland–Edinburgh–History–20th century. [DNLM: 1. Rockefeller Foundation. 2. Royal Infirmary of Edinburgh. 3. University of Edinburgh. Faculty of Medicine. 4. Hospitals, University–history–Scotland. 5. Schools, Medical–history–Scotland. 6. Foundations–history–Scotland. 7. History, 20th Century–Scotland. 8. Laboratories, Hospital–history–Scotland. 9. Social Change–history–Scotland. WX 28 FS2 L419r 2005] I.Title. II. Series. R497.E34L39 2005 610Ј.71Ј14134–dc22 2005010469 A catalogue record for this title is available from the British Library. Designed and typeset by Mizpah Publishing Services Private Limited This publication is printed on acid-free paper. Printed in the United States of America. RMM_Prelims.qxd 7/1/05 11:31 AM Page v CONTENTS List of Figures and Graphs vi Acknowledgments vii Abbreviations ix 1 Introduction: Medical Cultures 1 2 Medical Revolutions 11 3 The Rockefeller Foundation and the Culture of British Medicine 25 4 The Organization and Ethos of Edinburgh Medicine 63 5 Edinburgh, London, and North America 93 6 The Departments of Surgery and Medicine 140 7 A Hospital Laboratory 186 8 A University Laboratory in a Hospital 225 9 Bench and Bedside 269 10 Conclusion: Modern Times 326 Bibliography 335 Index 351 v RMM_Prelims.qxd 7/1/05 11:31 AM Page vi FIGURES AND GRAPHS Figures 7.1 A side room, RIE, 1920s 189 7.2 The Clinical Laboratory and laboratory staff, RIE, no date 197 9.1 Glucose tolerance curve from the case notes of William C 274 9.2 The glucose test meal 279 9.3 Temperature chart of Catherine B 281 9.4 Temperature chart of Angus M. showing start of insulin therapy, June 26, 1923 294 9.5 Hand-drawn graph from the case notes of Janet H 303 Graphs 7.1 Specimens and examinations 1921–30 198 7.2 Total examinations of blood and urine 1921–30 199 7.3 Basal Metabolic Rate estimations 1921–30 200 7.4 Cerebrospinal fluid examinations 1921–30 201 7.5 Total examinations of nitrogenous substances in blood and urine 1921–30 203 7.6 Blood sugar estimations 1921–30 206 7.7 Tests for blood cholesterol and van Den Bergh reactions 1921–30 207 7.8 Blood chloride determinations 1921–30 215 7.9 Tests related to the biochemistry of respiration and acid–base balance 1921–29 216 vi RMM_Prelims.qxd 7/1/05 11:31 AM Page vii ACKNOWLEDGMENTS To three people I owe major debts. I have talked endlessly to Mike Barfoot and Steve Sturdy who know this material as well as (and a lot of it better than) I do.They have been tireless critics and good friends.We by no means agree on all the interpretations that follow, for which I take responsibility, but I could not have arrived at them without their engage- ment. I owe immeasurable thanks to Helen Coyle who was research assistant on this project for two years. Helen was both an assiduous researcher when directed but also had tremendous initiative and could turn up new sources with ease. She was also a wonderfully organized record keeper (as I continue to discover as I look through the files). For reading and commenting on the manuscript or individual chap- ters I am grateful to Andrew Doig, Bill Bynum, Harry Marks, George Weisz and two anonymous referees. I presented some of what follows at a seminar at the Wellcome Centre for the History of Medicine where the now late Roy Porter made a characteristically off-the-cuff remark that prompted me to think about this material in a new way.Thanks to Martin Edwards for useful discussions about control and to Stephen Casper for being provocative and for alerting me to Edwin Bramwell’s diaries. A great number of people assisted with research in various ways. Some of the following may be surprised to find themselves here. I did not meet them but Helen Coyle found their help invaluable. Thanks to Mr Ian Milne, Librarian, and all the library staff at Royal College of Physicians of Edinburgh; Mr Arnott Wilson, Archivist, University of Edinburgh Library, Special Collections; Dr Murray Simpson, Miss Jean Archibald, and staff at the Special Collections Department, University of Edinburgh Library; Julie Hutton, John Simmons
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