1 - Introduction: Medical Cultures

Summary

In 1933 an officer of the Rockefeller Foundation (RF) of New York, R. A. Lambert, visited the Edinburgh Medical Faculty, into which his institution had poured a great deal of money over the previous ten years. He was struck by the fact that, “For a generation at least, the School has obviously lived to a considerable extent on its reputation and its policies have been determined largely by tradition.” He catalogued what he considered Edinburgh's shortcomings and the changes that might give his paymasters cause for hope that the sort of medicine they wished to see in Scotland was being instituted. One of the sources of optimism was a weakening of the “old individualism.” Lambert could hardly have been plainer: in some medical quarters in Edinburgh, tradition and individualism were highly prized and the RF found them an obstacle to its vision of medical reform.

This is a story of the encounter of two cultures. First a relatively old one, that of a large section of the professional middle class in Scotland, particularly Edinburgh. Much, but by no means all, of this culture was shared with a counterpart in the south of England. Second, a new one which characterized parts of North America (and Britain). It is a history of their striving to harmonize but also of their misunderstandings and mutual manipulation.At times it is a tale of a radical clash between wider historical and moral assumptions. This is the general story but it is one that can be told through the specific meeting (by no means always eye to eye) of two types of medicine.The specific narrative centres on attempts to introduce new medical practices and new ideas about science into old institutions.The general story is more formless, harder to grasp and pin down.The new accounts of medicine and science, however, did not simply detail better ideas and technologies for curing the sick. They challenged older cherished models of the social order. They embodied conceptions of health—well-being—and its relation to social organization. They prescribed a premier place for science in social planning and the management of modern society. Indeed they redefined what constituted a healthy society and who should bring it about and how. Somewhere between the very specific and the very general lies a linkage, a middle level of explanation.