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Recovering Irish experiences of VD, 1924–47
Lloyd (Meadhbh) Houston

This chapter discusses a rare exception to the archival silence surrounding the experiences of VD sufferers in the interwar period: the personal correspondence of Dr T.P.C. Kirkpatrick, one of twentieth-century Ireland’s foremost VD specialists. Written by current and former patients, their loved ones and other health professionals between 1924 and 1947, the 120 letters which comprise the Kirkpatrick collection offer an unparalleled insight into the medical, social and emotional experiences of VD sufferers and those who supported them during a formative period in British and Irish state welfare provision. By close-reading these letters through a regional and four-nations history perspective, this chapter contradicts a range of common assumptions about the knowledge, agency and self-understanding of VD sufferers. It charts how, amid the mixed welfare economies of interwar Ireland and Britain, current and former patients sought to leverage the recently established state-funded VD Service to achieve their desired social and healthcare outcomes. It reveals how, in their engagement with medical professionals, sufferers and their loved ones strategically performed their gender, age and class identities to solicit aid and advice. It also explores the transformative effect that treatment for VD had on individuals’ capacity to understand and describe their body in a period in which a cultivated ignorance of sexual matters was the norm. In doing so, it offers a rare and unusually direct view into the intimate lives of Irish people and their attitudes towards sex, sexual health and medical authority during a period of significant social and political upheaval.

in Patient voices in Britain, 1840–1948
The ethical use of historical medical documentation
Jessica Meyer and Alexia Moncrieff

What are the ethics that shape or should shape engagement with historical medical data, particularly archives containing patient voices? This question has come to the fore through the ‘Men, Women and Care’ project, a European Research Council-funded project creating a database of information drawn from the PIN 26 personal pension award records from the First World War. Held by the National Archives, London, these records contain a wealth of personal information, including potentially sensitive details of medical conditions and diagnoses, as well as material concerning stigmatising social situations, such as domestic violence, prostitution and illegitimacy. Using material drawn from ‘Men, Women and Care’, this chapter considers the opportunities presented and challenges posed by this material as sources for historical analysis. It considers issues of both disciplinary practice and theoretical framing to explore the position of the historian in relation to analysing and disseminating the historical patient voice. In doing so, it asks what use historians can and should make of this information and what steps the historical community might consider taking to articulate a code of ethics around practice that is sensitive both to family feeling and academic enquiry.

in Patient voices in Britain, 1840–1948
Mapping the emotional worlds of British VD patients
Anne Hanley

This chapter makes the case for using less traditional sources to access the emotional and psychological experiences of patients who lived with stigmatising venereal diseases. Fears about VD became conflated with and exacerbated by a variety of national and imperial crises. At the same time, however, public discussion of VD (and its perceived association with moral malaise and racial health) was aggressively suppressed. Such tensions were further complicated during the interwar years with growing institutional efforts to bring VD within the remit of preventative medicine. Tension between fear and suppression on the one hand, and fascination and scrutiny on the other, fundamentally shaped patient experiences. But it has also meant that patient-authored records of sexual ill-health are scant. In the absence of more traditional historical archives, works of fiction become especially valuable, laying bare the emotional and psychological costs of living (and dying) with VD. This chapter also considers how historical reflections on such stigmatising illness experiences can help to overcome contemporary inequalities in access to sexual-health services.

in Patient voices in Britain, 1840–1948
Abstract only
Searching for the patient
Anne Hanley and Jessica Meyer

The Introduction lays out the collection’s efforts to reposition the patient at the centre of healthcare histories, providing a model for using new types of sources and reading familiar sources in new ways to draw out patient experiences. It explores a number of the key themes that are addressed throughout the collection, including user-driven medicine and the impact of shame and stigma on health outcomes, and the emergence of vernacular medical knowledge. The Introduction also sets out how the collection aims to help historians locate and develop contemporary healthcare relevance within their work, reflecting on how these historical tensions continue to shape attitudes towards health, illness and the clinical encounter. Each chapter in this collection presents a framework for understanding how this might be accomplished within specific historical case studies and in reference to related, pressing policy issues.

in Patient voices in Britain, 1840–1948
A European perspective
Burkhart Brückner

This comparative study examines the emergence and political significance of lunatics’ rights activism in Europe between 1870 and 1920. In writing the history of the criticism of psychiatry, scholars have so far mainly focused on the second half of the twentieth century. This chapter, however, shows that the decades around 1900 already saw a widespread criticism ‘from below’ accompanying the professionalisation and modernisation of European psychiatry. The comparative analysis of the careers of two key campaign leaders, Louisa Lowe (1820–1901) in England and Adolf Glöklen (1861–c.1935) in Germany, reveals the similarities and differences in their motives, ways of campaigning, mobilisation success and political agency at the individual and collective level. Drawing on concepts from the political sociology of social movements and disability history, the chapter highlights the connections between early lunatics’ rights activism and socio-historical categories like ‘class’, ‘gender’ and ‘body’ and identifies these campaigns as political predecessors of the contemporary consumer/survivor/ex-patient movement.

in Patient voices in Britain, 1840–1948
Sarah Holland

Asylum and hospital farms, the agricultural land managed by psychiatric institutions and on which some patients worked, represented transitional spaces between the institution and the wider community, which are pivotal to understanding nuanced experiences of patients. Patient experiences of work were typically mediated through an institutional lens, which arguably silenced the patient voice. This chapter extrapolates patient experiences of farm work from case notes, demonstrating how patients played an active role in ‘narrating’ their experiences through actions, reactions, behavioural traits and occupational identities and thus ‘navigating’ institutional space. These experiences were nuanced, non-linear and inconclusive, and as such do not coincide neatly with the institutional rhetoric of work and its health and economic benefits.

in Patient voices in Britain, 1840–1948
Michael Worboys

Since Roy Porter’s pioneering work on the ‘patient’s view’, historians have taken up the challenge to rewrite medicine’s past ‘from below’. However, this chapter argues that they have not been radical enough and have neglected a key part of Porter’s agenda for the new social history of medicine. He wrote: ‘We should stop seeing the doctor as the agent of primary care. People took care before they took physick. What we habitually call primary care is in fact secondary care, once the sufferer has become a patient, [and] has entered the medical arena.’ In other words, the beliefs, behaviour and actions of sick people who did not go to the doctor and remained ‘non-patients’. To explore the ‘non-patient’s view’, we have to look beyond self-care and the use of proprietary remedies and alternative medicine. The sociological term of the ‘symptom iceberg’, which refers to the aches and ailments that never reach the doctor, is used as a guide. In turn, historical examples to the following responses to symptoms are discussed: doing nothing; prayer; finding information; looking to family and friends; over-the-counter medicines. The chapter suggests how historians can research the ‘non-patient’s view’, by interrogating familiar sources in new ways and finding novel sources, many of which will have previously been regarded as non-medical. Finally, the chapter considers the policy implications of this work in terms of recent attempts to ease pressures on healthcare systems that encourage people ‘not to see the doctor’ and opt for self-care.

in Patient voices in Britain, 1840–1948
British soldiers as complementary practitioners in the First World War
Georgia McWhinney

The First World War patient is a well-known concept for most medical historians. Soldiers’ healthcare in the Great War has been documented by numerous historians who each present a unique view of the patient. Yet often, these patient studies are a mirror for biomedicine, reflecting on the workings of official healthcare. Distancing the patient from biomedicine allows the historian a new approach. Soldiers in the Great War were not only patients, but also complementary practitioners. Soldiers’ letters, diaries and oral histories provide first-hand accounts of the conditions in the trenches and the diseases they spurred. Men’s accounts convey soldiers’ understanding of their health and bodies as well as their unique medical practices. By re-framing the way in which we approach the patient, we are able to garner new understandings of past healthcare, and ask who is a medical practitioner and what constitutes a healthcare system?

in Patient voices in Britain, 1840–1948
Evidence from the Victorian poor, 1834–71
Paul Carter and Steve King

This chapter challenges the widely held assumption that the voices of the very poorest of the sick are difficult and sometimes impossible to find. Drawing on material from a project which identifies such voices in the central administrative records of the New Poor Law, the chapter shows how often and with what force the sick poor were able to express their views on the medical welfare (broadly defined) offered to or imposed upon them. Few of these paupers and prospective paupers constructed their identities in terms of ‘being a patient’, except perhaps in the titular sense of entering or leaving the infirmary wards of workhouses. Rather, they thought and wrote of themselves as sick fathers, mothers, sons, daughters, citizens and members of the community from which they were drawn. Nonetheless, in a modern sense they were patients and the chapter shows how such people contested aspects of the medical welfare system both at the local level and through correspondence with the national administrative body for the New Poor Law. They were, perhaps surprisingly, often ‘successful’ in their contestation, displaying an agency that is rarely attributed to the very poorest in nineteenth- and early twentieth-century English and Welsh society. More than this, many of the issues that the poor and their advocates contested (who should decide when someone was sick enough to receive treatment; how far might it be reasonable to travel for medical care; and how responsive should healthcare systems be to the wishes of those who used them) have a striking resonance with the sorts of issues raised by and complained about by modern patients and patient groups.

in Patient voices in Britain, 1840–1948
Editors: Anne Hanley and Jessica Meyer

In 1985 Roy Porter called for patients to be retrieved from the margins of history because, without them, our understanding of illness and healthcare would remain distorted. But despite concerted efforts, the innovation that Porter envisaged has not come to pass.

Patient voices in Britain repositions the patient at the centre of healthcare histories. By prioritising the patient’s perspective in the century before the foundation of the National Health Service, this edited collection enriches our understanding of healthcare in the context of Britain’s emerging welfare state. Encompassing topics like ethical archival practice, life within institutions, user-driven medicine and the impact of shame and stigma on health outcomes, its chapters encourage historians to reimagine patienthood. It provides a model for using new sources and reading familiar sources in new ways. And, exploring traditional clinical spaces and beyond, it interrogates what it meant to be a patient and how this has changed over time.

Crucially, the collection also aims to help historians locate and develop policy relevance within their work, reflecting on how these historical tensions continue to shape attitudes towards health, illness and the clinical encounter. Each chapter presents a framework for using history to speak to pressing policy issues.