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Specialization without the Hospital: The Case of British Sports Medicine

Published online by Cambridge University Press:  17 May 2012

Vanessa Heggie
Vanessa Heggie
Affiliation:
Vanessa Heggie, PhD, Department of History and Philosophy of Science, University of Cambridge, Free School Lane, Cambridge CB2 3RH, UK; e-mail: [email protected]
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Abstract

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Type
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Information
Medical History , Volume 54 , Issue 4 , October 2010 , pp. 457 - 474
Copyright
Copyright © The Author(s) 2010. Published by Cambridge University Press

References

1 George Rosen, The specialization of medicine with particular reference to ophthalmology, New York, Froben Press, 1944. For alternative models, see G Gritzer and A Arluke, The making of rehabilitation: a political economy of medical specialization, 1890–1980, Berkeley, University of California Press, 1985; Sidney A Halpern, American pediatrics: the social dynamics of professionalism, 1880–1980, Berkeley, University of California Press, 1988; Frank Honigsbaum, The division in British medicine: a history of the separation of general practice from hospital care, 1911–1968, London, Kogan Page, 1979; Gerald Larkin, Occupational monopoly and modern medicine, London, Tavistock, 1983; Barbara Bridgman Perkins, ‘Shaping institution-based specialism: early twentieth-century economic organization of medicine’, Soc. Hist. Med., 1997, 10: 419–35; Rosemary Stevens, Medical practice in modern England: the impact of specialization and state medicine, New Haven, Yale University Press, 1966; Geoffrey Stuart Taylor and Malcolm Nicolson, ‘The emergence of orthodontics as a specialty in Britain: the role of the British Society for the Study of Orthodontics’, Med. Hist., 2007, 51: 379–98. Rosen's case study, offering an interesting reconsideration of ophthalmology, can be found in L Davidson, “‘Identities ascertained”: British ophthalmology in the first half of the nineteenth century’, Soc. Hist. Med., 1996, 9: 313–33.

2 Lindsay Granshaw, “‘Fame and fortune by means of bricks and mortar”: the medical profession and specialist hospitals in Britain, 1800–1948’, in Lindsay Granshaw and Roy Porter (eds), The hospital in history, London, Routledge, 1989, pp. 199–220.

3 George Weisz, ‘The emergence of medical specialization in the nineteenth century’, Bull. Hist. Med., 2003, 77: 536–75; idem, Divide and conquer: a comparative history of medical specialization, Oxford University Press, 2006.

4 Erwin Ackerknecht, Medicine at the Paris hospital, 1794–1848, Baltimore, Johns Hopkins Press, 1967.

5 “Le processus de division en sous-espaces spécialisés est en partie déterminé par l’état existant des connaissances, des techniques, des institutions et de la structure des rapports de position des agents au sein du champ médical”. P Pinell, ‘Champ médical et processus de spécialisation’, Actes de la Recherche en Sciences Socials, 2005, 1/2 (156–57): 4–36, p. 4.

6 Peter A Coventry and John V Pickstone, ‘From what and why did genetics emerge as a medical specialism in the 1970s in the UK? A case-history of research, policy and services in the Manchester region of the NHS’, Soc. Sci. Med., 1999, 49: 1227–38; Carsten Timmermann and Julie Anderson (eds), Devices and designs: medical technologies in historical perspectives, London, Palgrave Macmillan, 2006.

7 Halpern, op. cit., note 1 above; John Grimley Evans, ‘Geriatric medicine: a brief history’, Br. Med. J., 1992, 315: 1075–7; John E Morley, ‘A brief history of geriatrics’, J. Gerontol., 2004, 59A: 1132–52.

8 Andrology has yet to be embraced as a full medical specialism in most countries, although it has had specialist journal coverage (in German) since 1969, while the American Society of Andrology was founded in 1975, the British Andrology Society in 1977, and the International Society of Andrology in 1981.

9 Vanessa Heggie, A history of British sports medicine, Manchester University Press, 2010.

10 The phrase “and exercise” was added in 1999; the adding of “exercise” to sports medicine is discussed in more detail below. Papers of the British Association of Sport and Exercise Medicine (hereafter, BAS(E)M Papers), Annual General Meeting, 27 Feb. 1953. These papers have been deposited in Archives and Manuscripts, Wellcome Library, under the classmark SA/BSM. I would like to thank Dr Neil Carter for providing me with copies.

11 Archives of the British Olympic Association, BOA Headquarters, Wandsworth (hereafter, BOA Archives), 34.2 MED INJUR, Proceedings of meetings held at Loughborough Training College, June 1961.

12 See, for example, this affirmation of the rights of “non-medical members” to sit on BAS(E)M's executive committee, vote, and hold official positions. BAS(E)M Papers, SA/BSM/A/2/2, minutes of the executive committee, 25 Sept. 1968.

13 On the public health changes, see V Berridge, ‘Medicine and the public: the 1962 report of the Royal College of Physicians and the new public health’, Bull. Hist. Med., 2007, 81: 286–311; idem, ‘Medicine, public health and the media in Britain from the nineteen-fifties to the nineteen-seventies’, Hist. Res., 2009, 82: 360–73.

14 Vanessa Heggie, ‘A century of cardiomythology: exercise and the heart c.1880–1980’, Soc. Hist. Med., 2009 (online preview).

15 The second two justifications, an appeal to equity and to public interest, are of course familiar approaches to boundary formation in professions; they are particularly highlighted in M J D Roberts, ‘The politics of professionalization: MPs, medical men, and the 1858 Medical Act’, Med. Hist., 2009, 53: 37–56.

16 The Sports Council in the period 1965–1972 is sometimes referred to as the Advisory Sports Council, to differentiate it from the Executive Sports Council, which it became in 1972. Since the Council's own records consistently use the phrase “Sports Council”, this is the one I use. Centre for Sports Science and History, Birmingham University, Papers of the Sports Council (hereafter, Sports Council Papers).

17 Vanessa Heggie, “‘Only the British appear to be making a fuss”: the science of success and the myth of amateurism at the Mexico Olympiad, 1968’, Sport in History, 2008, 28: 213–35.

18 Wolfenden Committee on Sport, Sport and the community, London, CCPR, 1960–1, p. 1.

19 Taken from the Sports Council's own review of expenditure: Sports Council Papers, SC(IR)(72)1.

20 Sports Council Papers, SC(RS)(67)17, ‘Sports injuries—a general background to the position in Britain’.

21 Ibid.

22 See various oral history accounts in L A Reynolds and E M Tansey (eds), The development of sports medicine in twentieth-century Britain: the transcript of a Witness Seminar held by the Wellcome Trust Centre for the History of Medicine at UCL, London, on 29 June 2007, London, Wellcome Trust, 2009.

23 Sports Council Papers, Appendix A to SC(RS)(67)17, ‘The Middlesex Hospital Athletes’ Clinic’.

24 Sports Council Papers, SC(RS)(67)17.

25 National Archives, Kew (hereafter NA), MH166/1394, the Sports Council Pilot Study of Sport Injury Clinics.

26 H Justin Evans, Service to sport: the story of the CCPR, 1935–1975, London, Pelham for the Sports Council, 1974; Barrie Houlihan, The government and politics of sport, London, Routledge, 1991, pp. 86–91.

27 The Institute of Sports Medicine was founded in 1963 as the “academic” wing of British sports medicine by the BAS(E)M, the British Olympic Association and the Physical Education Association.

28 Berridge, op. cit., note 13 above.

29 Sports Council Papers, SC(RS)(68)3, note of a meeting held at the Ministry of Health, 19 Nov. 1967.

30 Sports Council Papers, SC(RS)(69), Research and Statistics Committee Minutes, 8 July 1969.

31 Sports Council Papers, SC(RS)(71)22, ‘A proposal from the Nuffield Department of Industrial Health … for an extension of the pilot study on sports injuries’, 11 June 1971.

32 NA, MH166/1394, letter from Roger Bannister to George Godber, 27 Oct. 1971; Notes of a meeting re. Sports Injuries, 26 Nov. 1971.

33 It is not clear from the archive material exactly who was involved in this group, which appears [10pt] to have been put together relatively informally. Correspondence about the issue is shared between four doctors: Dr M J Prophet, Dr Catherine N Dennis, Dr Archibald and Dr Yellowlees.

34 NA, MH166/1394, letter from Dr C N Dennis to Drs Archibald, Yellowlees and M J Prophet, 3 Dec. 1971.

35 NA, MH166/1394, letter from Dr M J Prophet to Dr C N Dennis, n.d. (early 1972). See also a handwritten note from Dr M J Prophet to Dr Laylock, 20 Dec. 1973, “The politics, the suggestion of rivalry among the groups associated [with] Sport is incredible. We must proceed [with] care + caution”.

36 NA, MH166/1394, letter ‘Special clinics for athletes’ from Dr M J Prophet to Drs Archibald and Yellowlees, 4 May 1972.

37 NA, MH166/1394, letter from Dr M J Prophet to Dr C N Dennis, n.d. (c.1972).

38 Ibid.

39 Sports Council Papers, draft copy of the annual report 1972–3.

40 Sports Council Papers, SC(IR)(73)6.

41 NA, MH166/1394, letter from B J Rees (Sports Council) to Dr Ower (DHSS), 25 June 1973.

42 Of a list of just over 450 BAS(E)M members from 1968, of those whose qualifications are stated, over 150 were physicians, and between twenty and twenty-five either surgeons or members of the Association of Chartered Physiotherapists. Anon., ‘List of members’, British Journal of Sports Medicine (hereafter BJSM), 1968, 3: 96–104.

43 Mr J Buck (Brook General Hospital), Dr H Burry (Guy's), Dr I Curwen (Queen Mary's), [10pt] Mr A McDougal (Victoria Infirmary, Glasgow), Dr K Lloyd (United Cardiff Hospitals), Dr J Blonstein (Amateur Boxing Association), Dr P Sperryn, Dr J G P Williams. NA, MH166/1394, letter from Dr M J Prophet to Dr C N Dennis, 14 June 1972.

44 Sports Council Papers, SC(IR)(73)6.

45 NA, MH166/1394, ‘The Sports Council pilot study of sport injury clinics’, p. 58.

46 Ibid., p. 61.

47 Ibid., p. 68.

48 Ibid., p. 62.

49 NA, MH166/1394, letter from Dr Jane Richings to Miss P M C Winterton, 28 Jan. 1976.

50 NA, MH166/1394, letter from Dr Nichols to Dr Jane Richings, 1 March 1976.

51 The attitude of the Department of the Environment, and particularly of Denis Howell, Minister of Sport and Recreation, 1974–9, to the SIC scheme was quite different to that of the DHSS. Howell's advocacy of the NHS's role in providing sports medicine (and not just sports injuries care) did not always match the line taken within the DHSS itself. See, for example, NA, MH166/1394, letter from Dr Archibald to Dr J Richings, 24 June 1976, and the various materials relating to the Department of the Environment's records on Research into Sport, Exercise and Health: NA, AT60/65.

52 NA, MH166/1394, letter from Miss P M C Winterton to Mr Hertzmark, 10 May 1976.

53 Anne Digby, The evolution of British general practice, 1850–1948, Oxford University Press, 1999; Granshaw, op. cit., note 2 above; Honigsbaum, op. cit., note 1 above; C Lawrence, ‘Incommunicable knowledge: science, technology and the clinical art in Britain, 1850–1914’, J. Contemp. Hist., 1985, 20: 303–20.

54 The vision of the Sports Council and the BAS(E)M was more successfully drawn together in the late 1970s; see NA, AT60/65.

55 P N Sperryn and J G Williams, ‘Why sports injuries clinics’, Br. Med. J., 1975, 3: 364–5, on p. 364, emphasis added.

56 BAS(E)M papers, SA/BSM/A/2/1, minutes of the executive committee, 29 April 1957.

57 The records that remain of the Middlesex Hospital do not contain any reference to Woodard's clinic in 1947 or 1948, but accounts from those who worked there in later years suggest that it was running in the late 1940s. University College London NHS Foundation Trust Archives, minutes of the Board of Governors.

58 D F Featherstone, ‘Medicine and sport’, Practitioner, 1953, 170: 299–302; W G S Pepper, A T Fripp and W E Tanner, ‘Injuries to the professional association footballer’, Practitioner, 1950, 164: 298–305.

59 M Randal Roberts, ‘A footballers’ hospital’,Windsor Magazine, March 1899: 511–16.

60 John King (ed.), Sports injury clinic, London, Pelham Books, 1987.

61 Anon., ‘How to find a sports injury clinic’, Running Magazine, 1986, 68: 46.

62 P Sperryn, ‘Editorial: BASM's clinic register’, BJSM, 1993, 27: 219.

63 C S B Galasko, et al., ‘University of Manchester Sports Injury Clinic’, BJSM, 1982, 16: 23–6.

64 NA, FD23/4515, ‘Medical research and sport’, outline proposals for the Cambridge project, n.d.

65 Personal papers of Dr Malcolm Read, letter from New Allied Medical Insurance Co. to Malcolm Read, 19 Jan. 1984. I would like to thank Dr Read for allowing me access to his collection of materials relating to sports medicine.

66 J E Davies, ‘Sports injuries and society’, BJSM, 1981, 15: 80–3.

67 R G Pringle, ‘Dangerous, meddlesome, wasteful … sports medicine is a pseudo-specialty’, World Medicine, 22 March 1980: 29–30.

68 J Jones, ‘Sports medicine and soft tissue lesions’, in Hedley Berry, Eric Hamilton and John Goodwill, Rheumatology and rehabilitation, London, Croom Helm, 1983, pp. 127–38, on p. 137.

69 BAS(E)M Papers, SA/BSM/A/2/2, minutes of the executive committee, 12 Jan. 1981.

70 Members of the Association of Chartered Physiotherapists in Sports could become associate members.

71 P Sperryn, ‘Secretary's column: unity or fragmentation?’, BJSM, 1981, 15: 88–9.

72 Reynolds and Tansey (eds), op. cit., note 22 above; see the evidence of Dr Davies in particular.

73 BAS(E)M Papers, SA/BSM/A/2/2, minutes of an executive committee meeting, 23 June 1982.

74 BAS(E)M Papers, SA/BSM, ‘The case for BASEM to become a membership organisation in sport and exercise medicine for doctors’ by Malcolm Read and Nick Webborn.

75 Centre for Sports Science and History, Birmingham University, NCLA II.M203. N McGuinness, ‘A study of the temporal and regional aspects of the English marathon between 1908 and 1985, with suggested explanations for trends uncovered’, Birmingham, Social Sciences dissertation, n.d. [6pt]

76 Sperryn and Williams, op. cit., note 55 above.

77 See, in particular, Roberts, op. cit., note 15 above.

78 P Sperryn, ‘Sport for all—or all for sport?’, BJSM, 1994, 28: 219.

79 Heggie, op. cit., note 14 above.

80 Weisz, op. cit., note 3 above, p. xxi.

81 Anon., ‘Diploma in sports medicine (Society of Apothecaries)’, BJSM, 1989, 23: 61–2.

82 NA, MH166/1394, letter from W M Hollyhock to McGregor, 9 Nov. 1971.

83 Donald A D Macleod, ‘Intercollegiate Board for Sport and Exercise Medicine’, BJSM, 2000, 34: 235.

84 It is a sub-specialty in the larger fields of emergency medicine, family medicine, internal medicine, orthopaedic surgery, paediatrics and physical medicine and rehabilitation.

85 Editorial, ‘Sports medicine and national fitness’, BJSM, 1993, 27: 3. [6pt]

86 Coventry and Pickstone, op. cit., note 6 above.

87 Especially since even recent studies on specialty formation in the sciences eschew references to material from specialization in medicine; see K Brad Wray, ‘Rethinking scientific specialization’, Soc. Stud. Sci., 2005, 35: 151–64.