Rockefeller attempts to transform Edinburgh medicine in the 1920s turned out to be no means as easy and as successful as Pearce had probably anticipated. In the early 1920s American visitors to the city recorded, sometimes with dismay, local opinion on what constituted sound medical practice, the most productive ways to teach, and the best means to advance medical knowledge. In London there was suspicion of American ways in doing things because of the hospital-based nature of London medical schools and the relative marginality of London University. More generally the rural ideology of the London doctors and their association of American reform with other features of modernism played a part.Things were ostensibly different in Edinburgh where there was a university-based medical school and two Royal Colleges committed to modernizing medicine through the Lister scheme. In the appointment of Meakins to a full-time chair there was an indication of a commitment of some sort to the American ideal.

Edinburgh, then, on the face of it, looked an obvious Rockefeller target. In fact, throughout the decade, there were sometimes deeply different perceptions in Edinburgh and New York of medicine and strategies for its promotion.What is noteworthy is that the features of Edinburgh medicine that the city was particularly proud of—tradition, and the collaboration of the Colleges, the Medical School, the University, and the RIE—were those that Pearce found most tiresome. Edinburgh physicians valued all the very things that frustrated their transatlantic cousins. Institutional collaboration, which was a virtue in Scotland, was seen an obstacle to progress in Manhattan. Tradition, which was a hallowed word in Edinburgh, savoured of backwardness across the Atlantic. In Edinburgh, medical institutions were seen as having been founded by wise ancestors whose foresight had been borne out by time. These institutions needed gradual change in conformity with their historical development. At a dinner in 1926, celebrating the 200th anniversary of the founding of the Faculty of Medicine, it was observed by Lorrain Smith that, “The Colleges, the Faculty, and the Hospitals were three measures of medical service devised and set up for the healing of the nation. Subsequent developments proved the wisdom of the founders and the soundness of the principles on which they acted.”