Teamwork, clinical research, and the development of scientific medicines in interwar Britain: The "Glasgow school" revisited

Bulletin of the History of Medicine

Volumn 81, Issue 3, 2007, Pages 569-593

  Hull, Andrew J ^a  

^a SWANSEA UNIVERSITY   (United Kingdom)

Author keywords

Academic medicine; Acidosis; Clinic; Clinical research; Clinician; Glasgow; Laboratory; Medical scientist; Scientific medicine; Teamwork

Indexed keywords

CLINICAL MEDICINE; COOPERATION; HISTORY; HUMAN; INTERDISCIPLINARY COMMUNICATION; LABORATORY; MEDICAL RESEARCH; REVIEW; SOCIOLOGY; UNITED KINGDOM; UNIVERSITY HOSPITAL; WAR;

ACADEMIC MEDICAL CENTERS; BIOMEDICAL RESEARCH; CLINICAL MEDICINE; COOPERATIVE BEHAVIOR; HISTORY, 20TH CENTURY; HUMANS; INTERDISCIPLINARY COMMUNICATION; LABORATORIES; SCOTLAND; SOCIOLOGY, MEDICAL; WORLD WAR I; WORLD WAR II;

EID: 34848843480     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (114)

1. See, e.g., Christopher Lawrence, "Incommunicable Knowledge: Science, Technology and the Clinical Art in Britain, 1850-1914,"J. Contemp. Hist., 1985, 20: 503-20;
2. Lawrence, "Still Incommunicable: Clinical Holists and Medical Knowledge in Interwar Britain," in Greater than the Parts: Holism in Biomedicine, 1920-1950, ed. Christopher Lawrence and George Weisz (Oxford: Oxford University Press, 1998), pp. 94-113;
3. L. S. Jacyna, "The Laboratory and the Clinic: The Impact of Pathology on Surgical Diagnosis in the Glasgow Western Infirmary, 1875-1910," Bull. Hist. Med., 1988, 62: 384-406.
4. American work has also been influential on British historiography: see Gerald L. Geison, "Divided We Stand: Physiologists and Clinicians in the American Context," in The Therapeutic Revolution, ed. Morris J. Vogel and Charles E. Rosenberg (Philadelphia: University of Pennsylvania Press, 1979), pp. 67-90;
5. Russell C. Maulitz, "'Physician Versus Bacteriologist': The Ideology of Science in Clinical Medicine," ibid., pp. 91-107.
6. See, inter alia, Gerald L. Geison, "Social and Institutional Factors in the Stagnancy of English Physiology, 1840-1870," Bull. Hist. Med., 1972, 46: 30-58;
7. Geison, Michael Foster and the Cambridge School of Physiology: The Scientific Enterprise in Late Victorian Society (Princeton: Princeton University Press, 1978);
8. Terrie Romano, Making Medicine Scientific: John Burdon Sanderson and the Culture of Victorian Science (Baltimore: Johns Hopkins University Press, 2002);
9. Robert E. Kohler, From Medical Chemistry to Biochemistry: The Making of a Biomedical Discipline (Cambridge: Cambridge University Press, 1982);
10. William Coleman and Frederic L. Holmes, eds., The Investigative Enterprise: Experimental Physiology in Nineteenth-Century Medicine (Berkeley: University of California Press, 1988).
11. See, e.g., W. F. Bynum, "Sir George Newman and the American Way," in The History of Medical Education in Britain, ed. Vivian Nutton and Roy Porter (Amsterdam: Clio Medica, 1995), pp. 37-50;
12. George Graham, "The Formation of the Medical and Surgical Professorial Units in the London Teaching Hospitals," Ann. Sci., 1970, 26: 1-22;
13. Donald Fisher, "The Rockefeller Foundation and the Development of Scientific Medicine in Great Britain," Minerva, 1978, 16: 20-41;
14. Steve Sturdy, "The Political Economy of Scientific Medicine: Science, Education and the Transformation of Medical Practice in Sheffield, 1890-1922," Med. Hist., 1992, 36: 125-59;
15. Steve Sturdy and Roger Cooter, "Science, Scientific Management, and the Transformation of Medicine in Britain c. 1870-1950," Hist. Sci., 1998, 36: 421-66.
16. See also Christopher Lawrence, "Clinical Research," in Science in the Twentieth Century, ed. John Krige and Dominique Pestre (Amsterdam: Harwood Academic Publishers, 1997), pp. 439-60.
17. See Christopher Lawrence, "A Tale of Two Sciences: Bench and Bedside in Twentieth-Century Britain," Med. Hist., 1999, 43: 421-49;
18. but more especially the following: Helen Valier, "The Politics of Scientific Medicine in Manchester, c. 1900-1960" (Ph.D. thesis, University of Manchester, 2002);
19. Christopher Lawrence, Rockefeller Money, The Laboratory, and Medicine in Edinburgh, 1919-1930 (Rochester, N.Y: University of Rochester Press, 2005).
20. See also Mark Weatherall, Gentlemen, Scientists and Doctors: Medicine at Cambridge 1800-1940 (Woodbridge, U.K.: Boydell Press, 2000), pp. 142-311;
21. David Smith, "The Use of 'Team Work' in the Practical Management of Research in the Inter-War Period: John Boyd Orr at the Rowett Research Institute," Minerva, 1999, 37: 259-80.
22. Christopher Lawrence, Medicine in the Making of Modern Britain: 1700-1920 (London: Roudedge, 1994), pp. 74-87 passim.
23. MRC Report 1928-29 (London: HMSO, 1930), p. 23. In fact, Lewis wrote most of the controversial pp. 22-29:
24. see "Private and Confidential for Members of the MRC only. Draft for a Section of the Introduction to the Annual Report," 26 December 1929, Lewis Papers, PP/LEW/D.4/1, Wellcome Library, London.
25. See esp. N. D.Jewson, "The Disappearance of the Sick-Man from Medical Cosmology, 1770-1870," Sociology, 1976, 10: 225-44.
26. David Smith and Malcolm Nicolson, "The 'Glasgow School' of Paton, Findlay and Cathcart: Conservative Thought in Chemical Physiology, Nutrition and Public Health," Soc. Stud. Sci., 1989, 19:195-238;
27. Smith and Nicolson, "Chemical Physiology versus Biochemistry, the Clinic versus the Laboratory: The Glaswegian Opposition to Edward Mellanby's Theory of Rickets," Proc. Roy. Coll. Physicians Edinburgh, 1989, 19(1): 51-60.
28. Their analysis supported Jacyna, "Laboratory and the Clinic" (n. 1).
29. Smith and Nicolson, "Chemical Physiology" (n. 8), p. 51 (emphasis added).
30. Smith and Nicolson, "'Glasgow School'" (n. 8), p. 196.
31. Ibid., p. 210.
32. Ibid., p. 197.
33. Neil Morgan, "The Strategy of Biological Research Programmes: Reassessing the 'Dark Age' of Biochemistry, 1910-1930," Ann. Sci., 1990, 47: 139-50, on p. 141.
34. Ibid., p. 150.
35. Smith and Nicolson, "'Glasgow School'" (n. 8), p. 208.
36. See Andrew Hull, "Hector's House: Sir Hector Hetherington and the Academicization of Glasgow Medicine before the NHS," Med. Hist., 2001, 45: 207-42.
37. Geison, "Social and Institutional Factors" (n. 2);
38. Kohler, From Medical Chemistry (n.2).
39. Steve Sturdy, "Medical Chemistry and Clinical Medicine: Academics and the Scientisation of Medical Practice in Britain, 1900-1925," in Medicine and Change: Historical and Sociological Studies of Medical Innovation, ed. Ilana Löwy et al. (London:John Libbey Eurotext, 1993), pp. 371-93, on p. 372.
40. Malcolm Nicolson and David Smith, "Science and Clinical Scepticism: The Case of Ralph Stockman and the Glasgow Medical Faculty" (paper presented at Science and Technology Dynamics Internal Progress Conference, Amsterdam, September 1997), p. 18. I am grateful to the authors for a copy of this paper.
41. John V. Pickstone, "Ways of Knowing: Towards a Historical Sociology of Science, Technology and Medicine," Brit. J. Hist. Sci., 1993, 26: 433-58;
42. Pickstone, Ways of Knowing: A New History of Science, Technology and Medicine (Manchester: Manchester University Press, 2000).
43. Pickstone also pioneered the importance of the local context: see, esp., Pickstone, "Psychiatry in District General Hospitals: History, Contingency and Local Innovation in the Early Years of the National Health Service," in Medical Innovations in Historical Perspective, ed. Pickstone (London: Macmillan, 1992), pp. 185-99.
44. Valier, "Politics" (n. 4); Sturdy, "Political Economy" (n. 3).
45. Valier, "Politics" (n. 4), p. 98.
46. See D. N. Paton, "The Relationship of Science and Medicine," Edinburgh Medical J., 1928, 35: 1-11, on p. 10
47. cited in Smith and Nicolson, "'Glasgow School'" (n. 8), p. 206.
48. See Hull, "Hector's House" (n. 16).
49. See Graham, "Formation" (n. 3); Weatherall, Gentlemen (n. 4).
50. See A. Flexner, Medical Education in Europe, Carnegie Foundation for the Advancement of Teaching, Bulletin no. 6 (New York: Carnegie Foundation, 1912), p. 131.
51. Paton was in charge of General or Experimental Physiology and Histology, and Cathcart of Physiological Chemistry.
52. See R. Y. Thomson and R. M. S. Smellie, "Biochemistry," Proc. Roy. Soc. Edinburgh, Sect. B, 1983, 84: 21-35, on p. 24;
53. Elliott Simpson, People Who Made Scottish Clinical Biochemistry (Glasgow: Association of Clinical Biochemists, 1995), pp. 25-60.
54. The proximate cause for this was the 1922 MRC decision to discontinue the free supply of insulin: hospitals now needed somebody on staff to provide it, and to perform blood-sugar tests. Clinicians could not do the biochemistry, and the new biochemists had to be medically qualified to take blood. Thanks to Malcolm Nicolson for help on this point.
55. See Munk's Roll (London: RCPL, 1968), pp. 130-31;
56. B. S. Veeder, "Leonard Findlay," in Paediatric Profiles, ed. Veeder (St. Louis: Mosby, 1957), pp. 189-92.
57. See Archibald Young, The Limitations of Surgery, Past and Present, Presidential Address, Royal Medico-Chirurgical Society of Glasgow, 3 October 1924 (Glasgow: MacDougall, 1925), p. 31.
58. Sturdy and Cooter, "Science, Scientific Management" (n. 3). See also Roger Cooter, Surgery and Society in Peace and War: Orthopaedics and the Organization of Modern Medicine, 1880-1948 (Manchester: Manchester University Press, 1993).
59. Smith, "Use of Team Work" (n. 4).
60. Leonard Findlay, "Work Done by the Glasgow School on the Aetiology of Rickets," Lancet, 1922, 199: 825-31, on p. 826.
61. Royal Society of Medicine, Section of Medicine meeting, 28 October 1930, discussion on "Research in Medicine," Lancet, 1930, 216: 966-67, on p. 966 (emphasis added).
62. Edna Robertson, The Yorkhill Story (Glasgow: Yorkhill Hospital Board of Management, 1972).
63. Donald MacAlister, Chairman of Governors and Patron of Hospital, moving adoption of Annual Report at Annual Meeting, 14 March 1923, RHSC Annual Report (1924), p. 11, Yorkhill Archives, Glasgow, YH 3/1/8.
64. See, e.g., ibid., pp. 11-12.
65. Directors' Meeting, 14 July 1930, pp. 159-66, RHSC, Minutes of Board of Management, Yorkhill Archives, YH 1/2/10. For Findlay's later career, see Lawrence Weaver, "From the Appliance of Science to an Alliance with Science: Leonard Findlay and the Making of a Modern Medical Unit" (paper delivered at Wellcome Trust Regional Forum on the History of Medicine in Scotland, Glasgow, October 2003).
66. See E. MacAlister, Sir Donald MacAlister of Tarbet (London: Macmillan, 1935), pp. 341-42;
67. RHSC, Minutes of Board of Management, for the years 1918-27, Yorkhill Archives.
68. RHSC, Annual Report (1928), p. 21.
69. See Meeting of Directors, 9 January 1928, p. 216, in RHSC, Minutes of Board of Management (1925-29)
70. Yorkhill Archives, YH 1/2/9 (hereafter RHSC Minutes), where this aim is explicitly stated in relation to the new University/Hospital posts.
71. Blacklock continued as Hospital Pathologist, a post he had held since 1924.
72. See Meetings of Directors on 10 January 1927, 8 August 1927, and 14 August 1927, esp. pp. 203-5, "Memorandum of Agreement between the University Court of the University of Glasgow and the Royal Hospital for Sick Children," RHSC Minutes. Morris's salary (£350 from the University as Lecturer; £200 from the Hospital as Clinical Biochemist) reflects his intended role.
73. Meeting of Directors, 9 January 1928, pp. 216-17, RHSC Minutes. Blacklock's salary also reflected his role: £600 from the University for the Lectureship, and a further £350 from the Hospital as Pathologist (ibid., p. 217).
74. Directors' Meetings on 9 January, 8 October, 12 November 1928, RHSC Minutes.
75. Directors' Meeting, 10 December 1928, supplement, "Memorandum by the Directors, November 1928," pp. 336-46, on p. 338, RHSC Minutes.
76. Ibid., pp. 342-43 (emphasis added).
77. "University of Glasgow Regius Chair of Materia Medica. Application with Testimonials in Favour of Noah Morris," 1937, Glasgow University Archives and Business Records Centre, HP, DC 8/888, pp. 1-2.
78. See MRC Reports, 1928-48, passim.
79. Noah Morris, "The Cause of Increased Electrical Excitability," Glasgow Med. J., 1922, 98: 329-37, on pp. 336-37
80. citing L. Findlay and M. Ferguson, A Study of Social Factors in the Causation of Rickets, MRC Special Report Series, no. 20 (London: MRC, 1918).
81. See Noah Morris, "Metabolic Studies in Disorders of Acid-Base Equilibrium of Infancy and Childhood" (D.Sc. thesis, University of Glasgow, 1935), acknowledgments section, where he thanks them for access to their patients.
82. Noah Morris and Stanley Graham, "The Regulation of the Acid-Base Balance of the Body," Glasgow Med. J., 1928, 109: 239-60, on p. 247 (emphasis added).
83. Noah Morris and Stanley Graham, "Observations on the Action of Acetone," Arch. Dis. Childh., 1927, 2: 212-19;
84. Morris and Graham, "Regulation of the Acid-Base Balance of the Body," Trans. Roy. Med.-Chirurg. Soc Glasgow, 1927-28, 22: 97-118;
85. Morris and Graham, "Carbon Dioxide Dissociation Curve of Blood in Infancy and Childhood," Arch. Dis. Childh., 1929, 4: 299-305;
86. Morris and Graham, "Changes in Blood Chemistry in Congenital Hypertrophic Pyloric Stenosis and Their Clinical Significance," ibid., pp. 335-46;
87. Graham and Morris, "Changes in Blood Density in Congenital Hypertrophic Pyloric Stenosis and Their Clinical Significance," ibid., 1930, 5: 207-28;
88. Morris and Graham, "The Theoretical Carbon Dioxide Dissociation Curve in Acid-Base Disturbance of Childhood," Brit. J. Exp. Path., 1930, 11: 322-28;
89. Morris and Graham, "Observations on Chloride Metabolism in Congenital Pyloric Stenosis," Arch. Dis. Childh., 1931, 6: 27-36.
90. Morris and Graham, "Regulation of the Acid-Base Balance" (n. 53), p. 257.
91. Ibid.
92. Ibid, (emphasis added).
93. Lawrence, "Incommunicable Knowledge" (n. 1), p. 515.
94. Morris and Graham, "Regulation of the Acid-Base Balance" (n. 53), p. 259.
95. Stanley Graham and Noah Morris, Acidosis and Alkalosis (Edinburgh: Livingstone, 1933), p. vii.
96. Morris, "Metabolic Studies" (n. 52), pp. 1-2.
97. On triangulation, see Susan Leigh Star, "Triangulating Clinical and Basic Research: British Localizationists, 1870-1906," Hist. Sci., 1986, 24: 29-48.
98. Morris, "Metabolic Studies" (n. 52), pp. 11-12.
99. D. N. Paton, "Physiology in the Study of Disease," in Physiology and National Needs, ed. W. D. Halliburton (London: Constable, 1919), pp. 75-101, on p. 80.
100. Ibid., pp. 81-82, 99.
101. This scientific holism is very clearly expressed in the introduction to Morris's D.Sc. thesis, "Metabolic Studies" (n. 52), pp. 2-5.
102. See also Noah Morris, "The History of Therapeutics," Proc. Roy. Phil. Soc. Glasgow, 1944-45, 69: 13-34, on pp. 27-29.
103. See L. Findlay, "The Study and Teaching of Paediatrics. Abstract of a Lecture to the Belgrade Faculty of Medicine and Medical Association, Yugoslavia," Brit. Med. J., December 1929, 28: 1185-88.
104. Noah Morris, "Prolegomena to the Study of Therapeutics," Glasgow Med. J., 1937, 7th ser., 128 (4): 137-51, on p. 138.
105. Morris, "Metabolic Studies" (n. 52), p. 4.
106. Morris, "History of Therapeutics" (n. 66), p. 33.
107. Noah Morris, "The Significance of Plasma Phosphatase in Bone Disease and Jaundice" (summary of a paper given to the Royal Medico-Chirurgical Society of Glasgow, 4 December 1936), Glasgow Med. J., 1937, 7th ser., 127: 25-26;
108. Noah Morris and Olive D. Peden, "Plasma Phosphatase in Disease: A Review," Quart. J. Med., n.s., 1937, 6: 211-30;
109. Noah Morris, M. M. Stevenson, O. D. Peden, and J. M. P. Small, "Significance of Plasma Phosphatase in the Diagnosis and Prognosis of Rickets," Arch. Dis. Childh., 1937, 12: 45-58.
110. The names of both the department and the chair were changed to Biochemistry in 1958: see Thomson and Smellie, "Biochemistry" (n. 28).
111. Morris, "Significance of Plasma Phosphatase in Bone Disease and Jaundice" (n. 71), pp. 25-26 (emphasis added).
112. Morris, Stevenson, et al., "Significance of Plasma Phosphatase" (n. 71), p. 45 (emphasis added).
113. Morris and Peden, "Plasma Phosphatase in Disease" (n. 71), p. 221 (emphasis added).
114. See Findlay's remarks at the Royal Society of Medicine in 1930, as reported in Proc. Roy. Soc. Med., 1930-31, 24 (1): 152-68, on pp. 166-67.