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This book explores the experiences of the sick poor between the 1750s and through the so-called crisis of the Old Poor Law ending in the 1830s. It provides a comprehensive and colourful overview of the nature, scale and negotiation of medical welfare. At its core stand the words and lives of the poor themselves, reconstructed in painstaking detail to show that medical welfare became a totemic issue for parochial authorities by the 1830s. The book suggests that the Old Poor Law confronted a rising tide of sickness by the early nineteenth century. While there are spectacular instances of parsimony and neglect in response to rising need, in most places and at most times, parish officers seem to have felt moral obligations to the sick. Indeed, we might construct their responses as considerate and generous. To some extent this reflected Christian paternalism but also other factors such as a growing sense that illness, even illness among the poor, was and should be remediable and a shared territory of negotiation between paupers, advocates and officials. The result was a canvas of medical welfare with extraordinary depth. By the 1820s, more of the ill-health of ordinary people was captured by the poor law and being doctored or sojourning in an institution became part of pauper and parochial expectation. These trends are brought to vivid life in the words of the poor and their advocates, such that the book genuinely offers a re-interpretation of the Old Poor Law from the bottom up.

Chronic disease and clinical bureaucracy in post-war Britain

Through a study of diabetes care in post-war Britain, this book is the first historical monograph to explore the emergence of managed medicine within the National Health Service. Much of the extant literature has cast the development of systems for structuring and reviewing clinical care as either a political imposition in pursuit of cost control or a professional reaction to state pressure. By contrast, Managing Diabetes, Managing Medicine argues that managerial medicine was a co-constructed venture between profession and state. Despite possessing diverse motives – and though clearly influenced by post-war Britain’s rapid political, technological, economic, and cultural changes – general practitioners (GPs), hospital specialists, national professional and patient bodies, a range of British government agencies, and influential international organisations were all integral to the creation of managerial systems in Britain. By focusing on changes within the management of a single disease at the forefront of broader developments, this book ties together innovations across varied sites at different scales of change, from the very local programmes of single towns to the debates of specialists and professional leaders in international fora. Drawing on a broad range of archival materials, published journals, and medical textbooks, as well as newspapers and oral histories, Managing Diabetes, Managing Medicine not only develops fresh insights into the history of managed healthcare, but also contributes to histories of the NHS, medical professionalism, and post-war government more broadly.

South Asian doctors and the reinvention of British general practice (1940s– 1980s)

The NHS is traditionally viewed as a typically British institution; a symbol of national identity. It has however always been dependent on a migrant workforce whose role has until recently received little attention from historians. Migrant Architects draws on 45 oral history interviews (40 with South Asian GPs who worked through this period) and extensive archival research to offer a radical reappraisal of how the National Health Service was made.

This book is the first history of the first generation of South Asian doctors who became GPs in the National Health Service. Their story is key to understanding the post-war history of British general practice and therefore the development of a British healthcare system where GPs play essential roles in controlling access to hospitals and providing care in community settings.

Imperial legacies, professional discrimination and an exodus of British-trained doctors combined to direct a large proportion of migrant doctors towards work as GPs in industrial areas. In some parts of Britain they made up more than half of the GP workforce. This book documents the structural dependency of British general practice on South Asian doctors. It also focuses on the agency of migrant practitioners and their transformative roles in British society and medicine.

When physicians gathered in medical societies to present, share, discuss, evaluate, publish and even celebrate their medical studies, they engaged in a community with specific practices, rules and manners. This book explores the formal and subtle ways in which such norms were set. It analyzes societies’ scientific publishing procedures, traditions of debate, (inter)national networks, and social and commemorative activities, uncovering a rich scientific culture in nineteenth-century medicine. The book focuses on medical societies in Belgium, a young nation-state eager to take its place among the European nations, in which the constitutional freedoms of press and association offered new possibilities for organized sociability. It situates medical societies within an emerging civil culture in Ghent, Brussels and Antwerp, and shows how physicians’ ambitions to publish medical journals and organize scientific debates corresponded well to the values of social engagement, polite debate and a free press of the urban bourgeoisie. As such, this book offers new insights into the close relation between science, sociability and citizenship. The development of a professional academic community in the second half of the century, which centered around the laboratory, went hand in hand with a set of new scientific codes, mirroring to a lesser extent the customs of civil society. It meant the end of a tradition of ‘civil’ science, forcing medical societies to reposition themselves in the scientific landscape, and take up new functions as mediators between specialties and as centers of postgraduate education.

Open Access (free)
Mass vaccination and the public since the Second World War

Vaccinating Britain investigates the relationship between the British public and vaccination policy since 1945. It is the first book to examine British vaccination policy across the post-war period and covers a range of vaccines, providing valuable context and insight for those interested in historical or present-day public health policy debates. Drawing on government documents, newspapers, internet archives and medical texts it shows how the modern vaccination system became established and how the public played a key role in its formation. British parents came to accept vaccination as a safe, effective and cost-efficient preventative measure. But occasional crises showed that faith in the system was tied to contemporary concerns about the medical profession, the power of the state and attitudes to individual vaccines. Thus, at times the British public demanded more comprehensive vaccination coverage from the welfare state; at others they eschewed specific vaccines that they thought were dangerous or unnecessary. Moreover, they did not always act uniformly, with “the public” capable of expressing contradictory demands that were often at odds with official policy. This case study of Britain’s vaccination system provides insight into the relationship between the British public and the welfare state, as well as contributing to the historiography of public health and medicine.

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A cultural history of stress in twentieth-century Britain

Drawing on a wealth of sources including self-help books, Mass Observation diaries and directives, oral history interviews, social science research and popular culture, Feeling the strain examines why stress became the ubiquitous explanation for a range of everyday ills by the end of the twentieth century in Britain. It explores the popular, vernacular discourse of nerves and stress to uncover how ordinary people understood, explained and coped with the pressures and strains of daily life and illuminates not only how stress was known, but the ways in which that knowledge was produced.

By focusing on contemporary popular understandings, it reveals continuity of ideas about work, mental health, status, gender and individual weakness, as well as the socio-economic contexts that enabled stress to become the accepted explanation for a wide range of daily experiences. It foregrounds continuities in managing stress and changes in ideas about causation, revealing a vocabulary of ‘nerves’ and ‘nervous disorders’ as precursors to stress but also illustrating the mutability of the stress concept and how its very imprecision gave it utility.

Feeling the strain provides first-hand accounts from sufferers, families and colleagues and offers insight into self-help literature, the meanings of work and changing dynamics of domestic life over the century, delivering a complementary perspective to medical histories of stress and making a significant contribution to histories of everyday life and emotion in Britain during the twentieth century.

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A transatlantic history of English civil law and lunacy

This book reinterprets the history of madness by examining the powerful influence of civil law on understandings of and responses to madness in England and in the North American territory of New Jersey. The influence of civil law on the history of madness has not hitherto been a topic of major academic investigation. Lunacy investigation law (that body of laws encompassing trials in lunacy, chancery court proceedings, proceedings in guardianship and trials of traverse) had its origins in fourteenth-century England. By the eighteenth century, English architects of the civil law had developed a sophisticated legal response to those among the propertied classes who suffered from madness. Lunacy investigation law was also transported successfully along imperial pathways and built into the legal frameworks of several colonies, including New Jersey. In New Jersey a rare and extensive collection of lunacy trials are explored to uncover how customary understandings of and responses to madness were tightly connected to the structures of civil law. The richness of these legal documents allows for an assessment of how civil law, customary responses and institutional alternatives to caring for the mad were balanced in this North American setting before and during the asylum era. Through its analysis of historical precedent, the book also offers insights into on-going contemporary concerns about mental capacity and guardianship.

A history of child development in Britain

This book explains the current fascination with autism by linking it to a longer history of childhood development. Drawing from a staggering array of primary sources, it traces autism back to its origins in the early twentieth century and explains why the idea of autism has always been controversial and why it experienced a 'metamorphosis' in the 1960s and 1970s. The book locates changes in psychological theory in Britain in relation to larger shifts in the political and social organisation of schools, hospitals, families and childcare. It explores how government entities have dealt with the psychological category of autism. The book looks in detail at a unique children's 'psychotic clinic' set up in London at the Maudsley Hospital in the 1950s. It investigates the crisis of government that developed regarding the number of 'psychotic' children who were entering the public domain when large long-stay institutions closed. The book focuses on how changes in the organisation of education and social services for all children in 1970 gave further support to the concept of autism that was being developed in London's Social Psychiatry Research Unit. It also explores how new techniques were developed to measure 'social impairment' in children in light of the Seebohm reforms of 1968 and other legal changes of the early 1970s. Finally, the book argues that epidemiological research on autism in the 1960s and 1970s pioneered at London's Institute of Psychiatry has come to define global attempts to analyse and understand what, exactly, autism is.

Editor: John Cunningham

This collection offers important new insights across a broad range of topics relating to medicine in Early Modern Ireland. Of particular note is the substantial attention devoted to the years before 1750, a period that has been relatively neglected in studies of Irish medicine. The book brings together an exciting selection of established scholars, such as Peter Elmer and Clodagh Tait, as well as a number of early career historians. Their work effectively situates Irish medicine in relation to long-term social and cultural change on the island, as well as to appropriate international contexts, encompassing Britain, Europe and the Atlantic World. The chapters also engage in various ways with important aspects of the historiography of medicine in the twenty-first century. Among the key subjects addressed by the contributors are Gaelic medicine, warfare, the impact of new medical ideas, migration, patterns of disease, midwifery and childbirth, book collecting, natural history, and urban medicine. A common thread running through the chapters is the focus on medical practitioners. The book accordingly enables significant new understanding of the character of medical practise in Early Modern Ireland. This collection will be of interest to academics and students of the history of Early Modern medicine. It also contains much that will be essential reading for historians of Ireland.

This book explores seventeenth- and eighteenth-century Britain’s experiences with and responses to the surgical reconstruction of the nose, and the concerns and possibilities raised by the idea of ‘nose transplants’ in this period. Challenging histories of plastic surgery that posit a complete disappearance of Gaspare Tagliacozzi’s reconstructive operation after his death in 1599, the book traces the actual extent of this knowledge within the medical community in order to uncover why such a procedure was anathema to early modern British culture. Medical knowledge of Tagliacozzi’s autograft rhinoplasty was overtaken by a spurious story, widely related in contemporary literature, that the nose would be constructed from flesh purchased from a social inferior, and would die with the vendor. The volume therefore explores this narrative in detail for its role in the procedure’s stigmatisation, its engagement with the doctrine of medical sympathy, and its attempt to commoditise living human flesh. Utilising medical research and book histories alongside literary criticism, the project historicises key modern questions about the commodification and limits of the human body, the impact of popular culture on medical practice, and the ethical connotations of bodily modification as response to stigma.