Rockefeller Money, the Laboratory, and Medicine in Edinburgh 1919-1930: New Science in an Old Century (review)

Logan Turner, the ear, nose, and throat surgeon and historian who wrote or edited histories of the Royal Infirmary and the University of Edinburgh in the 1930s, disposed of the Rockefeller Foundation's contribution to Edinburgh medicine in each of these volumes in three bland paragraphs. Turner, one of whose 1920s medical papers is cited in Rockefeller Money as an example of the difficulty of distinguishing between routine and research procedures in the laboratory, gave no hint of the political and personal turmoil that underpinned the Rockefeller story. Christopher Lawrence has rent this veil with a compelling account of the issues and challenges faced by Edinburgh in the 1920s.

In chapters 1 and 2—"Medical Revolutions" and "Medical Cultures"—Lawrence sketches the background to the period covered by the book, dealing with themes such as the distinctions between routine and research in clinical work and the changing face of academic medicine. In the next three chapters, he discusses the relationship between the Rockefeller Foundation and British medical culture, the structure and ethos of Edinburgh medicine, and the differences among the Edinburgh, London, and North American medical communities. Lawrence deals with the complex, even Byzantine, politics of Rockefeller's efforts to establish a presence in Edinburgh in chapters 5–7 and examines what happened in the laboratory in the 1920s and its impact on clinical care in the last two chapters. (However, as Lawrence freely admits on p. 208, many of the conclusions in this section are speculative because of the difficulty of distinguishing routine from research in the patient case notes.)

The strength of Lawrence's work lies in the detail, which has produced what one reviewer described as a marvelous example of the value of institutional micro-history. The account of the interactions among Rockefeller, the London-based Medical Research Council, and the main Edinburgh protagonists provides some fascinating insights into the tensions between academic and clinical doctors in this era. Central to this clash were such issues as Rockefeller's desire to create a "true university clinic," the concept of full-time academic chairs, the right to private practice, the relationship between bedside and laboratory medicine, and the reluctance of some clinicians to acknowledge the laboratory practitioners.

Richard Pearce, director of the Rockefeller Foundation Division of Medical Education, regarded Edinburgh as a key player in extending the Rockefeller model throughout the British Empire. As late as 1931, his successor still believed Edinburgh to be the most important influence on medicine within the Empire (p. 326). Lawrence accepts and endorses this perception but offers no evidence to support it. New Zealand and Australian records suggest that while there may have been some truth in this assertion during the nineteenth century, Edinburgh's influence was considerably diminished after World War I with the emergence of the Australasian medical colleges and the increasing desire for London or American postgraduate experience.

The author's absorption with Edinburgh, and perhaps an overreliance on Rockefeller Foundation and Medical Research Council records, leads to a lack of context in some other regards. Pearce believed that Principal Ewing of Edinburgh University knew nothing about the medical school, but Lawrence does not explore this theme. He might profitably have compared this situation with that of Glasgow, whose principal throughout this period was a highly respected medical man and chair of the General Medical Council. It would also have been useful to set the Edinburgh developments alongside those in Glasgow, where the university received funds to endow chairs in bacteriology and biochemistry in 1919, along with a number of other endowed medical chairs and lectureships in the 1920s.

In fairness, there were few secondary sources on which Lawrence could draw for such comparisons. This emerges very clearly in the discussion of Scottish professionals and of interwar "patrician" ideology (pp. 107...