restricted access Medical Innovations in Historical Perspective (review)
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Reviewed by
John V. Pickstone, ed. Medical Innovations in Historical Perspective. New York: St. Martin’s Press, 1992. xv + 288 pp. Ill. $49.95.

Representing what might be called the “Manchester School”—most of the contributors are or have been affiliated with the Wellcome Unit for the History of Medicine there—this collection ranges selectively (idiosyncratically?) across British medical history from antisepsis to cortisone, with one unexpected detour to American pelvimetry. Readers expecting to find conventional case studies of advances in medical technology will be disappointed. Instead, the contributors define innovation broadly, as much a matter of culture and politics as of technology alone. As Pickstone points out, “if decisions on new medical technologies are now taken in a series of institutional and governmental committees, then the processes of innovation must be analysed as politics” (p. 11).

Pickstone’s introduction capably reviews recent scholarship in economic and business history, the history of technology, and innovation and policy studies, and urges historians of medicine to learn from it. Just as other historians have shifted their focus from the sources of innovation to its diffusion and consequences, he says, so medical historians should now pay as much attention to the patient’s perspective on medical innovation as to the physician’s, as much to questions of public perceptions as to professional practice.

In writing chapters of this new social history, Pickstone and his contributors draw far more on the sociology of knowledge than on any other literature, giving the collection a distinctive slant, but also some predictable weaknesses. Like most other studies of the “social shaping” of science, medicine, and technology, this one, for all its talk about the “political aspects of medical choice” (p. 10), often ends up highlighting the local and professional at the expense of the larger issues in political economy. We learn, for instance, why Joseph Lister had so much trouble convincing surgeons to introduce carbolic acid antisepsis in the operating room (Lindsay Granshaw); why physicians ignored oxygen therapy for poison gas victims (Steve Sturdy); why diphtheria serum therapy (Paul Weindling) and [End Page 144] vaccine therapy (Michael Worboys) attracted so much attention, despite questionable clinical trials; and why X-ray pelvimetry screening, for all its early promise, failed to become standard medical practice (Anja Hiddinga). We get little sense, however, of how these stories are connected to one another, or to larger changes in the British health-care system over the past century. No one would quarrel with Sturdy’s claim that medical innovation “must be seen in relation to a much wider programme of innovation aimed at transforming the social organization of bedside medicine” (p. 122). But these cases, valuable though they may be as examples of how innovation created opportunities for new medical specialties and heightened tensions between the laboratory and the clinic, never convincingly link national politics and national policies with day-to-day medical practice.

Pickstone’s essay on psychiatry under the National Health Service, with its focus on the regional market for mental health clinics in Manchester, certainly points in the right direction. So does Roger Cooter’s attention to trade unions as the unlikely allies of orthopedic surgeons in promoting the growth of fracture clinics in major teaching hospitals. What David Cantor, in his history of the introduction of cortisone, calls the “politics of portrayal” (p. 166) likewise is an intriguing perspective on an important public health-care debate over the control of, and access to, the latest wonder drug. But even these essays tend to make professional issues of prestige and profit something of a proxy for politics at large. In following the details of how rheumatologists lobbied for increased funding from the National Health Service, or how orthopedic surgeons fought for space and authority within general hospitals, the authors sometimes lose sight of the bigger picture.

What is missing here is a more sophisticated framework for locating and interpreting innovation. Disappointingly, Worboys’s second contribution to the volume promises to use “Schumpeterian distinctions between the invention, innovation, and diffusion of new products and processes to analyze the development of the sanatorium treatment in Britain” (p. 47), and then essentially ends up retelling, with some fresh insights...