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

Among historians of biology, the medical school at University of Edinburgh may be best known as the institution where a sixteen-year-old Charles Darwin began (and ended) his brief career in medicine. A few years later, his vocational ambitions having shifted to the church, Darwin began reading William Paley and collecting beetles at Cambridge. At that time, Cambridge was in most respects a scientific backwater compared to Edinburgh, whose medical faculty members (such as Robert Grant) were conversant in Continental philosophical anatomy. Christopher Lawrence's Rockefeller Money, the Laboratory and Medicine in Edinburgh, 1919-1930 takes stock of the same medical school in transition a century later, by which time Edinburgh was no longer a scientific trend-setter. However, the point of comparison by the 1920s was not Oxbridge or even London so much as the new institutions of American medical research, with their lavishly funded laboratories. The American style of biomedical research had itself been inspired by a certain vision of European excellence—the Rockefeller Institute for Medical Research in New York was modelled on the celebrated institutes named (or renamed) for Pasteur, Koch, and Lister—yet the American interpretation was large-scale, with a heavy emphasis on standardization, instrumentation, and entrepreneurship. The publication in 1910 of the Flexner Report set a course for reforming American medical education to be more scientific, laboratory-based, and standardized. Lawrence inquires into the results as American philanthropy, specifically the Rockefeller Foundation, sought to export this laboratory-based understanding of medicine to an Old World antecedent, the Medical Faculty at Edinburgh.

The result of Lawrence's inquiry is a tightly-focused case study. At the same time, he offers as background a panoramic view of the profound changes to medical education and practice between the world wars. The conflict over reform at Edinburgh had undeniably mythic resonances, a confrontation between the moderns and the ancients (where 'ancient' refers to the nineteenth century), the Old World and the New World, science versus 'tradition'. The Rockefeller Foundation's involvement with modernizing the medical school played into a broader but contested shift in Britaintowardsacademic medicineandassociatedlaboratoryfacilities.Membersof the Edinburgh medical establishment resisted the erosion of individualism in patient care, the depreciation of their reliance on clinical insight rather than technology, and the American presence in British life more generally. While one senses some inevitability at play, Lawrence resists the temptation to side with the harbingers of modernity, and conveys a respect for the local culture and healing traditions that medical education in Edinburgh thrived upon. In this sense, the book maintains (even as it analyzes) an Anglo-European ambivalence about American cultural imperialism.

This schema of a grand transatlantic confrontation does not erase the distinctly Scottish character of the story. Lawrence argues (persuasively, to this reader) that Scottish medicine was 'home-grown' the same way as its law and established church. In medicine as in elite society generally, the university had a long-standing role in defining and perpetuating civic values. The social roots of Scottish clinicians were more urban and less aristocratic than those of their English counterparts. Scottish elite clinicians did not embrace the 'laboratory revolution' of nineteenth-century medicine. They remained proud of their pathological-anatomical approaches to disease and resisted the notion that these methods had been superseded by physiology and biochemistry. The institutionalization of medical education also strengthened the clinical orientation. A highly inbred system of staffing at the Edinburgh School of Medicine and the Royal Infirmary of Medicine reinforced the strong sense of local culture and loyalty. To Scottish medical teachers, 'tradition' was 'a force for good' (p. 107); for American program officers, this devotion to tradition stood in the way of scientific progress.

The real drama of the book is political—as leading lights in Edinburgh wrestled with colleagues, rivals, patrons, and institutional inertia itself...