Andrew Hull

War of words: the public science of the British scientific community and the origins of the Department of Scientific and Industrial Research, 1914–16

In late 1916 the British Government finally bowed to pressure from scientists and sympathetic elements of the public to organize and fund science centrally and established the Department of Scientific and Industrial Research (DSIR). Since just before the turn of the century state funding for science had steadily increased: the National Physical Laboratory was established in 1899, the Development Commission in 1909 and the Medical Research Committee in 1913. The establishment of the DSIR marked an end to piecemeal support and it was therefore a watershed when the state finally accepted its responsibility to fund science properly, to develop a coherent science policy and thus recognise that science and scientists were crucial components of modern national life; not just in wartime, but in the development of the peacetime economy as well. At least this is how the history of the DSIR is currently still represented. The following analysis is more sensitive than previous treatments as it points out that the states organization of a centrally planned and funded national policy for science began before the DSIR, and that this new body (in its support of pure research) reflected priorities established before the outbreak of the war. In previous accounts the DSIR was presented as a total break with the laissez-faire past. So, as historians we no longer follow the special pleading of the contemporary science lobby in arguing that the state was deaf to the needs of modern science. However, I want to argue that we are still deaf to the wider concerns of this contemporary pro-science rhetoric, which argued not only for centrally planned and funded science, but also often that scientists themselves should make policy for science.

Hector's house: Sir Hector Hetherington and the academicization of Glasgow Hospital Medicine before the NHS.

ImagesFigure 1Figure 3Figure 4

Fictional father?: Oliver Sacks and the revalidation of pathography

This paper is a revalidation of Oliver Sackss role in the development of medicines narrative turn and, as such, a reinterpretation of the history of narrative in medicine. It suggests that, from the late 1960s, Sacks pioneered in his ‘Romantic Science’ a new medical mode that reunited the seemingly incommensurable art and science of medicine while also offering a way for medical humanities to shape clinical reasoning more effectively.

Glasgow's 'sick society'?: James Halliday, psychosocial medicine and medical holism in Britain c.1920-48

James Lorimer Halliday (1897–1983) pioneered the development of the concept of psychosocial medicine in Britain in the 1930s and 1940s. He worked in Glasgow, first as a public health doctor, and then as part of the corporatist National Health Insurance scheme. Here he learned about links between poverty, the social environment, emotional stress and psychological and physical ill-health, and about statistical tools for making such problems scientifically visible. The intellectual development of his methodologically and epistemologically integrated medicine – a hybrid of biomedical and psychological approaches – was embedded in the context of this practice with its particular medical culture and socio-economic circumstances. Halliday’s ideas are part of the wider, heterogeneous turn towards medical modernism and holism within mainstream medicine in Britain, western Europe and the United States in the inter-war period, and their evolution underlines the varied nature of contemporary anti-reductionist thinking in medicine. It also points to the diversity of the sources of holism and the many routes by which psychological and especially psychosocial discourses about health and illness entered professional and public arenas in Britain in this period.

Jonathan Reinarz, Health Care in Birmingham: The Birmingham Teaching Hospitals 1779–1939 (Woodbridge: Boydell Press, 2009), pp. xii + 276, £60.00, hardback, ISBN: 978-1-84383-506-6.

Commissioned by the main local NHS Trust, supervised over six years by a steering committee of medical practitioners and academics, and informed by a penumbra of practitioner interviewees, Jonathan Reinarz’s history of Birmingham voluntary teaching hospitals might be a classic poisoned chalice cum curate’s egg. Books like this, as many of us will know, can lose points with the academic community by trying to appeal to a broader public. Balancing the very different interests and demands of these disparate audiences is hard, if not impossible. Reinarz goes for a lively, engaging style and begins in a patient-centred way appealing to both constituencies, vividly describing the serious hand injury sustained by William Jones, labourer and first patient at the town’s General Hospital in 1779 (a surprisingly late date). The rest of this chapter, however, is more traditionally focused, with much about the buildings, visiting staff, gradually expanding annual reports, illnesses treated, and expenditure, but with surprisingly little on income. We hear about lucrative musical concerts, but nothing about who the main subscribers were (manufacturers or farmers, middle class or gentry/aristocracy?). Is this the first sign that key historiographical themes will be lost in the attempt to hold the attention of more general readers? As if anticipating such concerns, Reinarz storms back with fine-grained analyses (nearly four chapters) of the gradual growth of specialist hospitals, cannily using published works to supplement thin archival material, and thus revealing fascinating details of treatment (for example, of ear afflictions). As well as linking specialist developments to restricted career-development opportunities for ambitious practitioners at the General, he also cautions that, ‘the origins of medical specialties in towns like Birmingham almost always pre-date the foundation of a specialist hospital’ (p. 72). It seems churlish to suggest that there are no towns exactly like Birmingham, yet Reinarz tells us little about its social, political or medical distinctiveness. Following the first specialist chapter, is a detailed analysis of the School of Medicine’s early years (plagued by local versions of the characteristic intense intra-professional and university-hospital rivalries). After two more specialist chapters we return to the medical school, via an analysis of specialist hospital contributions to the unified (after 1892) Birmingham University (after 1900) medical school based around the General and Queen’s Hospitals. This deliberately fragmented structure underlines that there is more to a provincial medical school than its core general teaching hospital; yet it turns out that specialties occupied a very small part of the curriculum by the 1910s, and few students went to the smaller hospitals. It seems that, rather than serving the argument, this fragmented structure is trying to serve a fragmented audience. Similarly, we learn little about local responses to the ultimately irresistible trend toward laboratory science. Just as the context of Birmingham’s distinctive social and cultural politics is largely missing, so is a characterisation of the local medical elite and the dominant medical culture. We are told that laboratories and laboratory research come slowly to Birmingham (mid-1920s) but not why. The argument that routine service work was too valuable a source of funding for medical school development is interesting, but is not clearly enough utilised as an explanation of late development. Reinarz suggests briefly (p. 183) that Medical Faculty staff supported old-school empirical vocational training over academic laboratory-based medicine, and mentions the importance of university-hospital relations – eg., full-time clinical chairs – for integrating bedside and bench, but does not fully follow through these key academic themes into the crucial 1918–39 period. It often seems that nothing much happens until after the move to the academic Mecca of the new Edgbaston campus in c.1941 – by which time the book has ended. In fact, a lot of research went on previously and it would have been useful to know more about it. We learn of Howard Collier’s broad collaborations on industrial noxia, but only very little about what the radium research beds were used for and by whom, what kinds of co-operative work were carried on between laboratory workers and clinical staff on carbon monoxide, rheumatism, gastric contents, diabetes, or sulphur metabolism in cataract patients. Yet such teamwork was characteristic of the development of scientific medicine and laboratory-orientated clinical research in other medical schools. Closer analysis of such activities would have enabled a better characterisation of the nature of scientific medicine in England’s second city. No doubt this thoroughly researched history, which at least touches on very many of the important themes in the history of voluntary hospitals, will satisfy much of the project’s target audience, but it will leave medical historians wishing for more in certain key areas.

Graham Mooney, Jonathan Reinarz (eds), Permeable walls: historical perspectives on hospital visiting, Wellcome Series in the History of Medicine, Clio Medica 86, Amsterdam and New York, Rodopi, 2009, pp. vi, 352, €70.00 (hardback 978-90-420-2599-8).

Most of our experiences of the hospital world come from visiting friends or relatives; not so “patient visitors” (p. 8) we awkwardly enter the alien sick world, breathe its disinfected air, perch uncomfortably on the edge of its universe of medicalized order and control over bodies too sick to retain their own, and leave sooner rather than later, grateful that we still can. However, as the very title of this excellent and timely collection reminds us, so many other (overlapping) types of visitor have crossed this line—most similarly historiographically invisible—that the boundaries between the realms of sickness and health seem porous and fluid. In fact from c.1750 until c.1920s (arguably longer) the busy social relations between the outside community and the hospital reflected and shaped both the nature of society and of the institution. The articles here first cover charitable institutions: general, then specialist childrens hospitals. The emphasis then changes to state provision: infectious disease, and mental hospitals. All hospitals emerge as inextricably connected to their communities and wider societies in so many ways, sometimes to the point of co-constitutiveness. Visiting emerges as about governance, citizenship, and the nature of civil society; as such it partakes in, and contributes to, the same changes that that society goes through in the changing mixed economy of health care. Extending Charles Rosenbergs analysis, all types of visitors helped to make up a highly ordered and moralized community, which covered everyone in the building, and linked them with the socio-economic and moral order of the community and society in which they were embedded. Patient visitors were increasingly closely regulated and delimited as potential sources of moral and physical contamination, as the hospital became increasingly medicalized. Contributing governors with business backgrounds—“house visitors” (p. 8)— practised “deep philanthropy”, giving not only money but time. They inspected for economic efficiency and moral rectitude—a remit which included “medical” matters. These eminent gentlemen spun a surveillance web in which patients reported on staff, nurses on doctors and doctors on nurses. Meanwhile eminent Lady Visitors, as befitting their socially prescribed gender roles and public sphere contributions, became more involved in the patient experience—a limitation that again demonstrates the interlinking of hospital and wider community. These survivals of medieval and early-modern ecclesiastical visitations of charitable bodies remind us that the moral backbone of the hospitals power/knowledge regime was upheld by strong lay support while voluntary hospitals remained plugged into donations from the philanthropic socio-economic system. House visitors helped to maintain the standards necessary to provide a steady stream of funding from “public visitors” taking part in the “gift-relationship” of conspicuous giving in the new public sphere of bourgeois civil society; and to make sure the hospital did not fall foul of “official visitors” from charitable or state bodies. Such official visits increased as the expanding state took on more social roles and as charities were co-opted into the greater web of governance. In a large collection highlights include Jonathan Reinarzs detailed investigation of these trends for hospitals in nineteenth-century Birmingham, and Andrea Tanners study of their relationship to the development of Great Ormond Street Childrens Hospital. Kevin Siena shows how especially careful stage-management of visiting was necessary to secure funding for the London Lock Hospital, since venereal disease was a far less attractive charitable funding opportunity than the foundlings, orphans, impoverished mothers and acutely ill respectable working people with whom the Lock vied in the highly competitive London charity market. Switching to local authority infectious disease isolation hospitals, Graham Mooney argues convincingly that visitors were seen as having compromised their status as respectable and healthy citizens. Visiting left them teetering on the precipice of disease, and thus also vulnerable to strong public health regulation of their behaviours, both inside and outside the hospital, to recover full citizenship. Leonard Smith shows how the official visitations of the Lunacy Commissioners became the vehicle by which the central direction of insanity provision was gradually established, and how they succeeded in raising standards in both public and private asylums. The other chapters on mental hospitals finally dissolve any lingering impressions of such intuitions as socially isolated: entertainers visited, balls were held, and staff sports teams toured, while patient visits, though often (increasingly) closely regulated, were sometimes viewed sympathetically as having a therapeutic purpose. The warmth of the welcome visitors received depended on the types of visitors and patients being visited, as well as the type and financial security of the hospital, and many other socio-economic variables. This very diversity, though strengthening the argument about the historiographical importance of attention to visitors, does make it hard to unify these essays. Arguably the most important conclusion—that these studies show that Foucaults view of institutional power/knowledge regimes needs to be revised to incorporate more fluid relationships with civil society—is rather hidden under a bushel. In addition, inevitably some potentially fruitful new areas for investigation can only be touched upon: for example the roles of hospitals in knowledge transfer via administrative and medical staff educational visits. Until direct participation of donors in hospital administration waned with increasing reliance on patient contributory schemes and local authority contracting of services, leading to a shift to professional administrators, visiting and visiting policy were integrally bound up with the socio-economic survival of hospitals. Official visitation regimes, though also becoming more formalized and professionalized, maintained the link between evolving patterns of social governance in hospital and civil society. Who came in, what they did and what they saw were key to securing funding and regulating social environments, and thus visiting was tightly controlled and often stage-managed to create the illusion of an idealized physical environment and moral universe. While there is some variation in quality and some contextual repetition between essays, and while the collection does not (as the editors acknowledge) cover military hospitals, these are very valuable contributions that develop the Porterian reorientation of medical history away from the profession and towards a wider social history of health care. As Catherine Colebornes final article argues, the institution needs to be historiographically decentred: the meanings of illness and its treatment are not fully captured in analyses of the institution and its staff, but also lie in the multiple points of contact and interaction among the hospital world and family, lay and official visitors.

Book Reviews: Medicine, madness and social history: essays in honour of Roy Porter.

Visiting Glasgow in 1997, Roy Porter was asked by an awestruck colleague the mortifyingly pretentious question, “Are you the real ‘Roy Porter’ or a simulacrum?” Sadly, of course, that is all we can now have: a copy for which no original ever existed, refracted through our own perceptions. However, this collection does a tremendously good job of summoning an image of Porters interests and methods in the social history of medicine and their impact. In addition, personal recollections show the lasting impression a generous human being made on many hearts, minds, and careers. That stress on the contribution of the individual is, of course, also central to Porters intellectual legacy. His focus was on people, their thoughts and activities. As Hal Cook argues in his candid historiographical appraisal, Porter was “neither the founder of a school of history nor an aspirant for such a role. His analyses were rooted in persons and moments rather than in structures” (p. 15). Porter, Cook suggests, was really a social historian of thought rather than of medicine. The mind of the age was centre stage: Porter was interested in how people conceived of themselves and their worlds, in the range of human experience, and in the emergence of ideas from “a variety of people and processes” (pp. 16–17). He wished to break down artificial and anachronistic divisions between medical ideas and other areas of social and cultural life. His trademark commitment to bringing neglected voices into the historical narrative—giving ordinary people back agency, rescuing them from victim status—made him seem part of a wider movement that became associated with socio-economic causal explanations. The essays here certainly reflect these interests, in a Porterian parade of colourful outsider-individuals: past social historians, medical reformers, educational democratizers, dentists, cucumber-forcing gardeners, pension-seeking disabled soldiers, anxious working-class mental patients, sexual utopians, blood donors, murderers, mesmerists and great men in crisis. In all this variety, certain common Porterian themes re-occur: the importance of market relationships, of artisan knowledge, of professional self-creation, the meanings of class, the social power of ideas, the historiographical challenge of outsider voices, and the interconnection between the arts and sciences. The essays are of much higher quality (as well as diversity) than in many a festschrift, and in most edited collections, and often employ innovative styles of historical writing. Moreover, many of the pieces (notably Geoffrey Hudson on disabled ex-servicemen, Akihito Suzuki on male anxiety and lunacy, Kim Pelis on the early history of the Blood Transfusion Service, Mary Lindemann on insanity pleas, Emese Lafferton on hypnosis) are genuinely ground-breaking: effectively deploying new archival sources to reveal striking challenges to existing understandings. Elsewhere Adrian Wilson contributes an extremely valuable study of Porter versus Foucault on Paris medicines differences from Morgagni (a shame, however, that the differences between Porter and Foucault on the modern patient were not explored). The collection ends, grandly, with two thoughtful pieces on the Porterian themes of psychiatry and the common intellectual context. Daniel Pick explores how Freudianism threatened the already receding Victorian certainty of the autonomy of the will. Mark Micales equally stimulating final piece focuses on the post-Romantic continuation of the interpenetration of the discourses of science and art. Does Roy Porter, a largely empirical historian, remain more of a historiographical challenge than more theoretically inclined writers? As Flurin Condrau has argued, the history of medicine has still not satisfactorily responded to Porters call for full integration of the patients perspective (‘The patients view meets the clinical gaze’, Soc. Hist. Med., 2007, 20: 525–40). Would this mean unpicking just too many assumptions about what medical history is, or should be, about? Porters aim, “to see history through people and to allow people to see themselves through history” (p. 13) involves—in its seeming acceptance of actors categories—a challenging redefinition of the role of the historian and of the nature and scope of history itself. Perhaps it is as such a thorn in the historiographical side—a continual reminder of the purpose and potential value of history (if historians conscientiously reflect on what history is and why)—that Porters influence will be most keenly felt. In the meantime, let us make do with this excellent collection, which shows that his intellectually thorny legacy is very much alive and pricking.

Book Review: A history of the Royal College of Physicians of London, vol. 4, 1948–1983

The writing of institutional histories is a notorious poisoned chalice. The unfortunate author is caught in a no-win situation between the Scylla and Charybdis of the expectations of the eminent Members and Fellows and those of academic historians about what constitutes an effective historical treatment. Briggs, as one would expect with his experience and talents, makes a good stab at a readable history (and it is actually possible to read this book all the way through—quite an achievement in itself given the subject matter). However, Briggs is no medical historian and has not attempted to read himself into the literature very far, apart from the standard historiography on the NHS (although there is no Rudolf Klein, no Nicholas Timmins, no Michael Foot and no Bernard Harris). This means that, while the Comitia might be happy with this volume, which is much less full of dry and dusty administrative details than its predecessors by George Clark and Alexander Cooke, it is very unlikely to satisfy any academics. Briggss attempts to associate this work with academic conventions notwithstanding (see bottom of p. 1373), it addresses none of the key themes in the history of twentieth-century medicine that occupy the academic history of medicine community. Moreover, since Briggs has gone for readability, it is also of limited use as a reference work (the one great strength of those earlier impenetrable volumes). The other main problem with institutional history is what to write about. The RCPL is a medical examining body, but it is also the voice of the metropolitan medical elite and thus carries great weight within medicine and has some policy influence. Briggs does not examine the social/professional/epistemological basis/bases of College power or how it was maintained. He notes the clinical bias but does not comment on the Colleges position(s) on the relationship between clinic and laboratory. He notes (in the case of George Godber) the interpenetration of government by Members and Fellows, but fails to explore adequately the ramifications of this point. Briggs organizes his material in two ways: specific broad contextual themes (for example, the NHS 1946–68 and 1968–84, ‘Smoking and health’, although in this last there are no references to the work of Virginia Berridge), and catch-all general chapters like ‘Five Presidents’ or ‘Munks Roll’. These latter are entertaining and methodologically justifiable as prosopography, but are rather anecdotal and break up the flow of the narrative. In the former, Briggs seems to err too much on the side of general context of medical politics, rather than focusing on the role of the College. One can sometimes forget one is reading a history of the College at all, so infrequently is it mentioned. Briggs is cleverly insightful in choosing to dedicate a chapter to “communicating”, although, again there is little acknowledgement of the existing secondary literature (Anne Karpf, Virginia Berridge, Kelly Loughlin, etc.). In general there is a frustrating lack of references for large swathes of text, and a concerning tendency to cite the Presidents annual addresses rather than detailed minutes of the council and its committees. Surely the latter provide a better way into the day-to-day concerns of such an institution. However, once again these criticisms reflect Briggss compromises on the book he has chosen to write: it is for the Members and Fellows and not academic historians. Briggss best chapter is perhaps that on the Colleges core activity: examining, training, educating. However, here, because of his lack of familiarity with the medical history literature, Briggs, rather ironically, given his over-attention to contextualization elsewhere, does not adequately explain how and why the Colleges developed greater roles in postgraduate medical education and examination. Most obviously lacking is any discussion of the centrality of the Goodenough Report to the evolution of British medical education, and the way it was synchronized with the new NHS to produce a regional educational structure for academic medicine based around the local intellectual powerhouses of universities and university hospitals. There is also no adequate exploration of the way the Colleges responded to specialization. This is dealt with in the literature on postgraduate medical education in the UK, and in some of the more recent histories of UK Royal Colleges. However, there is little evidence in the footnotes that Briggs has read anything about non-London Colleges, and they are certainly exceedingly rarely mentioned and never in any detail. This lack of a comparative perspective is disappointing, but will probably not unduly trouble his core audience. Briggss book, then, falls between two stools. Such are the perils and potential pitfalls of institutional history; but then Briggs should know that as he has written a well-received history of the BBC, another pillar of the institutional establishment. Could it be that being a famous, readable, popular historian is not the best qualification for writing the history of medical institutions?