Amongst Canadian historians, the “Laurentian thesis” (named for the St Laurence river) is an argument for master narratives rooted in a purportedly national experience. Amongst medical historians, the writings of Christopher Lawrence add up to a “Lawrentian thesis” of their own, but one that debunks national and master narratives. Lawrence's earlier, much-cited works identify a group of “patrician” London consultants who resisted scientific specialization in medicine. While Lawrence provided brilliant insight into these groups, he did not tell us much about how modernity actually occurred. This new book carries the story a little further. It brings the debunking spirit of the “Edinburgh strong programme” of science studies to Edinburgh medicine. Rockefeller money, the laboratory, and medicine in Edinburgh 1919–1930 examines the impact that American philanthropic money earmarked for scientific research had upon a very old and distinguished Scottish university. The juxtaposition of “new science” and “old country” lets Lawrence explore the larger cultural confrontation between British, and more especially Scottish, ways and those of an expansionist America. Rockefeller men and their allies in Britain (usually from Cambridge) found extant British medical institutions primitive, like those of the United States three decades earlier, and exclaimed, “we can completely revolutionize the teaching of medicine and surgery at very little cost” (pp. 95, 119). They tried to lure British medical schools to hire scientists with good research credentials to work as full-time salaried scholars, rather than as honorary consultants with private incomes (the status quo). The results were mixed across Britain and especially mixed in Edinburgh, as Lawrence shows. The Rockefeller funded a research chair in therapeutic medicine because the Canadian in that position, J C Meakins, was a serious scientist working on oxygen intake. Meakins wrote co-authored papers, brought in keen young researchers himself, and founded a good research school. But he soon left for McGill, his alma mater, and the modernization project stuttered to a not-quite halt. His replacement, David Murray Lyon, was more interested in clinical than laboratory observations, and so the keen young men left. The reorganization of the rest of the medical departments was blocked by rivalries and by the obstacle of Murray Lyon himself, until he reverted to an honorary consultant position in 1929. In surgery, the chair was filled only because the incumbent was permitted a private practice, a concession made, according to the university president, by a “hard and fast plan” to “wise and progressive change” (p. 146). The first half of the book describes, sometimes in excessive detail, administrative rivalries and cultural distrust. The second half describes the new laboratory practices. Lawrence can show how quickly or slowly some “modern” techniques were taken up. Under Meakins, investigations into blood gases and especially oxygen saturation and alkali reserves proliferated but they lapsed after his departure. Edwin Bramwell, a patrician consultant appointed in 1908, never ordered an alkali reserve or a Wassermann. Lawrence has good clinical records for Bramwell and shows that the consultant—or perhaps his junior staff—did order an increasing number and variety of laboratory tests for patients. Every one of his diabetic patients had at least one blood-sugar reading, though not the serial readings that some specialists demanded. There was movement, but no “complete revolution”. Lawrence sometimes overplays the argument for the sake of narrative neatness and drama. This was as much a conversation amongst Britons as it was a confrontation between Britain and America. The Rockefeller's mouthpiece, Richard Pearce, virtually disappears from the story as British modernizers become the key intermediaries. Other influences like German practices and practitioners, are neglected. Moreover, the spectre of American medicine remains a hollow spectre—there is almost no information about how modern the modernizers had managed to make it and one suspects that the British were not alone in their local resistances. But Lawrence knows all this. He introduces enough backdrop to the local story to make his substantial point, which he does splendidly. Scientific development was not linear: it advanced and it regressed. Moreover, it is wrong to insist on polar oppositions between science and non-science. Departmental rivalries are part of the picture, not its antithesis. Bramwell too participated in the whole modernizing enterprise. Science was not a monolithic juggernaut. The review began with a Canadian geographical metaphor and will finish with a geological one. Lawrence's Edinburgh resembles the Burgess Shale: it reveals the wonderful diversity around the early development of modern scientific medicine.
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Jun 20, 2007
António Gomes De Menezes + 1
Open Access
