Making medicine a business in Japan: Shimadzu Co. and the diffusion of radiology (1900-1960).

This contribution focuses on the role of the firm Shimadzu in the marketing of X-ray machines in Japan during the first part of the 20th century, viewed from a business history perspective. It attempts to further understanding of the process of technology diffusion in medicine. In a global market controlled by American and German multinational enterprises, Japan appears to have been a particular country, where a domestic independent firm, Shimadzu, succeeded in establishing itself as a competitive company. This success is the result of a strategy based on both the internalisation of technological capabilities (recruitment of university graduate engineers, subcontracting of research and development activities) and an original communication policy towards the medical world. Finally, the specific structure of the Japanese medical market, composed of numerous and largely privatised small healthcare centres, facilitated the rapid diffusion of X-ray machines, a new technology which conferred a comparative advantage on its holders.

[Vaud regional hospitals from private philanthropy of the to state-province administration (19th-20th century)]. / Les hôpitaux régionaux vaudois de la philanthropie privée à l'Etat-Providence (XIXe-XXe siècle).

In the canton of Vaud (Switzerland), hospitals were originally created within a local philanthropic framework which aimed as much at healing as at controlling the working classes. The practice of medicine was still not very effective, and the generosity of a few well-known people was enough at that time to ensure the viability of small infirmaries, run by deaconesses with just one or two doctors working part-time. Towards the end of the 19th century progress in medicine, particularly in surgery, and the beginning of a greatly improved technical environment following the introduction of X-rays, threatened the operation of these infirmaries. It became necessary to build new hospitals, to engage trained personnel in large numbers, to professionalize the management and to re-examine the organisation of these larger and more complex hospitals in order to meet the increasing demand for hospital treatment. This change of scale put an intolerable strain on the philanthropic framework and eventually led to the increasing intervention of public authorities. In the canton of Vaud after 1945 there was a widespread network of regional hospitals, which were heavily dependent on government funding. From being the principal supporter of a hospital network which had arisen from locally-based groups of infirmaries, the state intervened at the end of the 1970s with the aim of rationalizing the system.