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1 Introduction NOTES The place of publication is London unless otherwise indicated. The first reference to any printed source within a chapter is given in full; subsequent citations within the same chapter are normally abbreviated to author's sumame and short title. 1 Introduction l. See J. Noble and C. S. B. Galasko (cds), Recent Developments in Orthopaedic Surgery (Manchester, 1987); idem, Current Trends in Orthopaedic Surgery (Manchester, 1988). 2. See D. S. Barrett, 'Are Orthopaedic Surgeons Gorillas?', BMJ, 24-31 Dec. 1989, pp. 1638-9, and Elizabeth Morgan's discussion ofher time in an orthoPaedic department in an American hospital in her The Making of a Woman Surgeon (New York, 1980), pp. 172fT. 3. See Paul Vickers, 'Orthopaedics', in J. Craft et al. (cds) Specialized Futures: essays in honour of Sir George Godber (1975), pp. 1-29; and Royal College of Surgeons of England, Commission on the Provision of Surgical Services, Report of the Working Party on The Management of Patients With Major Injuries (November 1988). 4. See, for example, the special issue of JBJS, 32B (Nov. 1950), 'Half a Century of Progress in Orthopaedic Surgery, 1900-1950', pp. 451-740. Cf. N. E. Vanzan Marchini (ed.), L'ortopedia nella storia e nel costume (Udine, 1989), which brings to light the many interconnecting social, scientific, artistic and cultural features that shaped the development of orthopacdics in Italy. 5. For an overview, see Gerald Larkin, Occupational Monopolyand Modem Medicine (1983), ch. 1: 'Perspectives on Professional Growth'. 6. Rosen, The Specialization of Medicine with Particular Reference to Ophthalmology (New York, 1944), p. 4. 7. Sydney Halpem, American Pediatrics: the social dynamics ofprofession­ alism 188~1980 (Berkeley, 1988), pp. 3-4. See also Andrew Abhott, The System of Professions: an essay on the division of expert labor (Chicago, 1988). 8. Against the latter approach, so far as professions are concemed, see Eliot Freidson, Profession of M edicine: a study ofthe sociology ofapplied knowledge (Chicago, 1970). Freidson's advice, to let the sociological theory of professionalization flow from empirical studies, rather than vice versa, is acted on in Rita Schepers's De Opkomst van het Medisch Beroep in Belgie: tk evolutie van tk wetqeving en tk beroepsorganisaties in tk 19th eeuw (Amsterdam, 1989). 9. See, for example, Glenn Gritzer and Amold Arluke, The Making of Rehabilitation: a political economy of medica/ specialization, 1890-1980 (Berkeley, 1985). For examples of other ways of approaching the history 250 Noles 10 pp. 2-4 251 of specialization in medicine, see Stanley J. Reiser, 'Technology, Specialization, and the Allied Health Professions', J. Al/ied Health, 12 (1983), pp. 177-82; Lester King, 'Medicine in the USA: XXI: special­ ization', JAMA, 9 Mar. 1984, pp. 1333--8; A. B. Davis, 'Twentieth Century American Medicine and the Rise of Specialization: the case of anesthesiology', in F. J. Coppa and R. Harmond (eds), Technology in the Twentieth Century (Iowa, 1983), pp. 73--88; B. E. Blustein, 'New York Neurologists and the Specialization of American Medicine', Bull. Hist. Med, S3 (1979), pp. 170-83; and Joel Howell, 'Tbe Changing Face of Twentieth-Century American Cardiology', Annals of Internal Medicine, 105 (Nov. 1986), pp. 772-4!2. 10. For the USA, see Charles Rosenberg, The Care of Strangers: the rise of America's hospital system (New York, 1987), esp. p. 210; Paul Starr, The Social Transformation of American M edicine (New York, 1982), p. 165 et passim; and Rosemary Stevens, American Medicine and the Public Interest (New Haven, 1971). 11. See Ivan Waddington, The Medical Profession in the Industrial Revolution (Dublin, 1984). 12. For a detailed elaboration ofkey aspects ofthis change within a specific provincial context, see Steve Sturdy, 'Tbe Political Economy ofScientific Medicine: science, education and transformation of medical practice in Sheflield, 189(H922', Med. Hist., 36 (1992), pp. 125-59, esp. pp. 136-7. 13. For the most part, the institutionalization in British hospitals of 'consultant specialists', so called, was post-NHS. Non-consulting, salaried 'surgical specialists' were called for during the First World War and were sometimes appointed to municipal hospitals in the interwar period. See below Chs 8 and 9. 14. On the specialty boards, see Stevens, American Medicine. 15. See Frank Honigsbaum, The Division in British Medicine: a history ofthe separation of general practice from hospital care, 1911-1968 (1979). Among several more or less social-contextual studies of specialisms in Britain recently to appear are: Omella Moscucci, The Science of Woman: gynaecology and gender in England, 1800-1929 (Cambridge, 1990); W. F. Bynum, C. Lawrence and V. Nutton (eds), The Emergence of Modem Cardiology, Med. Hist., Suppt. no. 5 (1985); Lindsay Granshaw, St. Mark's Hospital, London: a social history of a specialist hospital (1985); and Jennifer Beinart, A History of the Nuffield Department of Anaesthetics, Oxford 1937-1987 (Oxford, 1987). Tbe latter three are to some extent triumphalist accounts and it is significant that the latter two are both the result of commissions from the specialist institutions themselves, and, indeed, are as much about those institutions as about specialty formation. Tbere are also historically informed sociological studies of bodies of specialty medical knowledge. Among these is Larkin's OccupationaI Monopoly, which draws heavily on American studies of professionaliza­ tion to iIlustrate how the boundaries were drawn around the 'marginal' medical occupations of ophthalmie opticians, radiographers, phy­ siotherapists and chiropodists. Studies such as these, on boundary formation, owe debts to the sociology of scientific knowledge as 252 Notes to pp. 4--7 pursued in relation to the study of the emergence of scientific disciplines. For exarnple, O. Lemaine and Roy Macleod (eds), Perspecti."es on the Emergence of Scientific Disciplines (Tbe HaguejParis, 1976). See here, in particular, Michael Worboys, 'The Emergence of Tropical Medicine: a study of a scientific speciality'. Sharing this sociological perspective, but extending into the role of economic forces is David Cantor's 'The Contradictions of Specialization: rheumatism and the decline of the spa in inter-war Britain', in Roy Porter (ed.), The Medical Hislory of Waters and Spas, Med. Hist., Suppt. no. 10 (1990), pp. 127-44. 16. Rosemary Stevens, Medical Practice in Modern England: the impact of specialisation and state medicine (New Haven, 1966), p. 11. 17. She reminds us at the outset of her book, that 'in 1939 there was only one specialist to every six or seven OPs, and they were highly concentrated: more than one third ofthem were in London alone', Medical Practice in Modern England, p. 3. However, American comparisons may be exaggerated. As late as 1940, 70 per cent of doctors in the USA were still in general practice. See David Rothman, Strangers at the Bedside (New York, 1991), pp. 113-14. 18. Medical Practice in Modern England, p. 4. 19. Stevens's view of scientific knowledge as a strong determinant in medical relations is shared by Daniel Fox in his Health Policies, Heallh Polilics: the British and American experience, 19lJ-I965 (princeton, 1986). However, compare Daniel Fox, 'The National Health Service and the Second World War: the elaboration of consensus', in Harold L. Smith (ed.), War and Social Change: Brilish society in the Second World War (Manchester, 1986), pp. 32-57 at pp. 32 and 49. For Honigsbaum, too, it appears that 'the advance of knowledge is mainly responsible' for the fact that 'doctors nearly everywhere are divided into two main c1asses, general practitioners and specialists'. Di."ision in British Medicine, p. 1. 20. Sir Harry Platt, interview, 1959. 'But now', he recollected, 'the limelight has shifted to others - arnongst them the plastic surgeons and the cardiac surgeon - and we are finding that the field of orthopaedics is a contracting universe.' 21. 'Corporatism' is used throughout this study to refer to non-individualist, non-class oriented professionalizing activities, which have been informed by and, are themselves expressiolls of, managerial notions of efficiency. This usage, which relates to practice, rather than to political theories of the state, has largely been informed by Harold Perkin, The Rise of Professional Society: England since 1880 (1989), eh. 7: 'Toward a Corporate Society', esp. p. 290. 22. Such is the claim, however, of Ted Bogacz with respect to neurology in his 'War Neurosis and Cultural Change in England, 1914-22: the work of the War Office Committee of Enquiry into "Shell-Shock" " J. Contemp. Hist., 24 (1989), pp. 227-56 at p. 227. 23. However, see Roger Cooter (ed.), In the Name of the Child: health and welfare. 1880-1940 (1992). 24. The point is underlined by Eduard Seidler's 'An Historical Survey of Children's Hospitals', in Lindsay Oranshaw and Roy Porter (eds), The Hospital in History (1989), pp. 181-97. Notes to pp. 8-9 253 25. Among general texts, almost alone in even mentioning the subject of industrial injury as apart of public health is Anthony S. Wohrs Endangered Uves: public health in Victorian Britain (1983). For the few specialist writings, sec below ehs 5 and 7. 26. Among the exceptions are J. V. Pickstone, Medicine and IndustriaI Society: a history of hospital development in Manchester and its region, 1752-1946 (Manchester, 1985), ch. 7, and David Green, Working-Class Patients and the Medical Establishment: seIJ-help in Britainfrom the mid­ nineteenth century to 1948 (Aldershot, 1985). 27. Noel Whiteside in her review of Peter Hennock, British Social Reform and German Precedents: the case of social insurance, 1880-1914 (Oxford, 1987) in Social Hist. Med., 1 (1988), pp. 243-4. But see P. W. J. Bartrip, Workmen's Compensation in Twentieth-century Britain: law, history and social policy (Aldershot, 1987), and Paul Weindling (ed.), The Social History of Oecupational Health (1985). As with so many of these subjects, more research has been conducted in North America than in Britain or Europe.
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