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Thomas D’haeninck, Jan Vandersmissen, Gita Deneckere, and Christophe Verbruggen

"The medicalisation of society was strongly intertwined with both the overall scientification of society and the rationalisation of dealing with the social question on a pan-European scale. This chapter reassesses the history of Belgian public health by looking at the social activism of physicians and ‘hygienists’ as part of a global field of discourse and practice. In doing so, it nuances the image of the nineteenth-century state as a ‘nightwatchman’, and in particular for the twentieth century, considers the Belgian Congo as an integral component of Belgian health policies.

The chapter consists of four parts that are structured chronologically. The first part starts in the late eighteenth century and focuses on the emergence of scientific medicine and the growing awareness that the study of many diseases could not be separated from the socio-economic context in which they originated. The second part discusses the bacteriological revolution in the 1870s and its impact on public health questions, linking social medicine more closely to applied sciences and preventive healthcare. Social medicine became increasingly entangled with other reformist movements. The third part deals with the further development of social hygiene and the rise of eugenics, national health protection and improvement policies in the interwar period. Finally, the fourth part re-evaluates the period after 1960 when national public health systems were strongly questioned, local community health centres emerged and medical activism went increasingly beyond borders. For each time period, representative players are highlighted, including Adolphe Burggraeve, Victor Desguin, Gustave Dryepondt, Peter Piot and Marleen Temmerman.

in Medical histories of Belgium
Open Access (free)
Renaud Bardez and Pieter Dhondt

Although medical knowledge has been produced in different forms and locations over the past two centuries, the modern university was certainly its primary locus. The medical faculties of leading educational institutions evolved into the central spaces of scientific research ‒ an evolution that in turn had an impact on the medical curriculum. In Belgium, this ‘scientification’ occurred along the ideological dividing lines between Catholics and liberals, between the Flemish- and French-speaking communities, and was influenced by the competition between state and private universities. Its principal driving force was the development of laboratory science. However, this dominant form of scientific medical knowledge was often contested. Engaging in the age-old debate between medicine as a science and an art, nineteenth-century practitioners claimed to have practical knowledge, rooted in everyday observations, that was just as ‘scientific’. Their knowledge originated primarily around the bedside, what contributed to the changing position of the hospital as an additional professional training site.

This chapter presents the development of medical education at the medical schools and later the faculties of medicine in the southern Netherlands/Belgium from the end of the eighteenth century up until today. It focuses on the shifts in the balance between general education, vocational training and scientific schooling, and on the continuous tension between medical specialisation and (the perceived need of offering) a more holistic approach. The process of professionalisation in general followed a similar line of development in Belgium as in most other European countries, yet many specific circumstances also created a unique situation.

in Medical histories of Belgium
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
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
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
Coreen McGuire, Jaipreet Virdi, and Jenny Hutton

This chapter explores the interrelationships between embodied knowledge and assistive technology. Its primary focus is on interwar developments to respiratory technologies in Britain, but explores more broadly the extent to which consideration of users and user involvement has featured in the design of various technologies to facilitate breathing. The chapter uses under-utilised primary sources from the National Archives and the Royal Institution to examine mechanical respirators such as the Bragg-Paul Pulsator, then develop this user-focused framework to consider the later rise of ambulatory oxygen for home use. Considering how users have mattered in respiratory assistive technology highlights the problems with prosthetic designs which fail to consider the full social worlds of the user. Understanding these problems necessitates awareness of the longer history of their development and the longer-term problems inherent to ownership of the air. This relates to the politics of nationalised healthcare because ambulatory oxygen was outsourced from NHS pharmacy control in 2006. The chapter therefore concludes with a discussion of how standardised technology currently affects diverse users’ ability to engage with assistive technologies.

in Patient voices in Britain, 1840–1948
Reinventing medieval leprosy for the modern world, 1850–1950
Kathleen Vongsathorn and Magnus Vollset

By the nineteenth century, most Europeans considered leprosy a matter of the past. When it was ‘rediscovered’ in Europe and the tropical world, people looked to history to inform contemporary understandings of the disease. Using medical journals and textbooks, leprosy histories, policy documents, newspaper articles, and philanthropic publications, this chapter discusses modern perceptions of medieval leprosy. First, it shows how medieval leprosy gained and lost relevance as medical and scientific debates changed over time. The past was reinvented to correspond with the present, in which leprosy’s contagiousness and the supposed efficacy of segregation in medieval Europe were cast as models for modern action. Next, the chapter explores popular conceptions of leprosy. When Europeans began encountering leprosy again in the nineteenth century, writers and medical practitioners drew parallels between medieval Europe and the contemporary tropics, while differentiating them from modern Europe. The contrast drawn between ‘civilised’ modern Europe and its ‘primitive’ medieval past was part of an attempt to preserve the superior, ‘civilised’ identity of Britain, in particular. Leprosy has long been a disease of contradictions, and while modern Europeans were casting medieval Europeans in a negative light, they were also looking to their ancestors for positive inspiration towards philanthropy. Overall, this chapter explores the tension between ‘old’ and ‘new’ ideas about leprosy, showing how perceptions of leprosy’s history, if conflicting, became deeply ingrained in the conceptualisation and management of leprosy in the modern world.

in Leprosy and identity in the Middle Ages
Constructing population in the search for disease genes
Steve Sturdy

Numerous studies describe the genetic make-up of populations living outside Europe and North America. Many of these tackle human genetic variation with the explicit aim of identifying gene variants of medical significance for the populations studied. However, the chapter points to rather different motivations, showing how recent studies documenting the genetic constitution of non-Western populations have grown out of, and serve the purposes of, efforts to identify genetic factors which influence the health of populations in Europe and North America. Analysing the past thirty-five years of medical research literature, the chapter shows how, in this context, efforts to identify genetic variants of possible significance for disease aetiology have shifted to include large-scale association studies in populations rather than families. It discusses how research with local concerns must nonetheless take into account the global distribution of genes and genotypes, thus making studies of the genetic causes of disease, wherever conducted, increasingly global in their purview. The chapter also argues that this recent knowledge of human population genomics has developed in a way which reinscribes ideas of racial difference into biomedical understanding of human populations, and creates tools for excluding supposedly non-Western populations from research oriented towards the concerns of Western institutions.

in Global health and the new world order
Coreen Anne McGuire

This chapter begins by showing how the First World War improved the technology used in amplified telephony while simultaneously creating the conditions of mass deafening that made such technology necessary. It then argues that the telephone was used as an arbitrator of normal hearing and that the data used to create apparently normal hearing levels in the British interwar telephone system featured a ‘disability data gap’. This disability data gap was embedded in the British Post Office’s ‘artificial ear’, which represented ideal hearing (eight normal men with good hearing) as normal, to the detriment of those at the outer edges of a more representative average curve. Subsequently, those with less than perfect hearing agitated to demand the Post Office supply telephones that could be used by the majority of the population. The Post Office responded by creating its ‘telephone service for the deaf’, and the subsequent user appropriation and modification of this service vividly demonstrates the fluid categorisation of deafness that the telephone enabled. This history reveals how aspirational users employed a variety of strategies to ensure equitable access to telephony and how users with hearing loss created modified devices so that they could access telephony.

in Measuring difference, numbering normal
Coreen Anne McGuire

This chapter shows how the standardisation of sound was perfected and pursued in the interwar years as the ‘telephone as audiometer’ was embraced as an objective tool to define noise limits and the thresholds of normal hearing. In this way, the audiometer was elevated as a tool for testing hearing loss and prescribing hearing aids because it provided an objective numerical inscription, which could be used to guard against malingering and to negotiate compensation claims for hearing loss. Simultaneously, the ‘telephone as hearing aid’ exploded into the interwar medical market as hearing aid moderation and prescription were complicated by conflicts over categorisation, the status of hearing aids as medical devices and the question of which institutional bodies were responsible for the ‘problem of hearing loss’. Finally, this chapter ends with analysis of the ending of the Post Office’s amplified telephone service and argues that failure to consider user input or the reality of hearing aid usage from the perspective of the ‘deaf subscriber’ led to failure to provide an NHS adjunct for telephony.

in Measuring difference, numbering normal