This chapter outlines how diabetes re-emerged as a concern of central government during the late 1970s, setting the scene for the move of managed care from clinical settings to policy arenas. It does so by examining the tribulations of efforts to secure Department for Health and Social Security funding for retinopathy screening and photocoagulation treatment trials between 1977 and 1985. The trials were by no means the biggest intervention that central government made into diabetes care during the 1970s and 1980s. Examining their history, however, reveals the ways in which post-war policy networks developed in relation to diabetes, and the shifting ways in which they framed diabetes to garner government attention in a period of considerable economic and political change. Crucially, underpinning debates about the trials were new concepts of risk management, disease prevention, and standard-setting that became central to policy discussions of diabetes care and managed medicine at the end of the century.
This conclusion presents some closing thoughts on concepts discussed in the preceding chapters of this book. The book emphasises how the interconnectedness that has been at the heart of the voyages continued to matter far beyond the time that people spent at sea. It shows that medical knowledge and authority was never a given, and convicts and emigrants actively invested in and shaped the meanings and outcomes of voyages. On an individual level, these voyages were a stepping-stone through a career that might combine service in a British hospital, on a West African patrol, or in an Australian prison. Surgeons' ideas and actions reflected broader assumptions of class and gender, as well as an ethos of nineteenth-century naval medicine as it sought authority and status, particularly under the leadership of William Burnett at the Admiralty.
The history of quarantine stations is a history of what it meant to make the transition from emigrant to immigrant, and it is never just about disease. In a period that lasted 150 years, from 1832 to 1984, thirteen thousand people were quarantined at Sydney's North Head for diseases including typhus, smallpox, plague, cholera, and measles. Compared to diseases such as cholera, smallpox, and yellow fever, typhus has played a minor role in the history of modern quarantine. In a politicised and factious atmosphere, the significance of quarantined immigrants reverberated beyond the medical debates of the quarantine station. As news of the cholera outbreaks in Britain reached New South Wales, the colonial government passed its own quarantine legislation in 1832. As the colonial economy of New South Wales entered the depression of the 1840s, the British government suspended its schemes of emigrant assistance.
This chapter dwells in the tropics, where the experience of calms reinforced and extended preconceptions about the coast of West Africa across the space of the sea. It explores the ways in which passengers used an eclectic range of corporeal, scientific, cultural, medical, and colonial frameworks to evaluate their encounter with the maritime environment. The chapter shows that understandings of health were not just related to being at sea, but also to constant movement through the different regions, environments, and climates of the oceans. In order to understand how medical experience and knowledge evolved over the time and distance of the voyage, it is crucial to appreciate how constant movement through distinct regional maritime climates affected travellers' knowledge of health and illness. Of all these regions, the Atlantic tropics perhaps most define the environmental experience of voyaging to Australia.
During the nineteenth century, over 1.5 million migrants set sail from the British Isles to begin new lives in the Australian colonies. This book follows these people on a fascinating journey around half the globe to give a rich account of the creation of lay and professional medical knowledge in an ever-changing maritime environment. It shows how voyages to Australia partook of colonialism. On leaving the ports, estuaries, and harbours of Britain and Ireland, ships' captains negotiated the adverse winds of the English Channel and the Irish Sea before steering into the Atlantic and heading south-by-south west across the heavy swells of the Bay of Biscay. The book dwells in the tropics, where the experience of calms reinforced and extended preconceptions about the coast of West Africa. It discusses convicts, showing how scurvy became resurgent as British prison committees steadily reduced prison dietary rations during the 1820s and 1830s. Despite their frustrations, the isolation of the ocean and the vulnerability of convicts' bodies offered surgeons an invaluable opportunity for medical experimentation during the 1840s. The book also shows how a series of questions about authority, class, gender, and social status mediated medical relationships as the pressures of the voyage accumulated. Themes of mistrust, cooperation, and coercion emerged in many different ways during the voyage. Australia, where, as emigrants became immigrants, the uncertainties of government responsibility combined with a poisonous political atmosphere to raise questions about eligibility and the conditions of admittance to their new colonial society.
This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book is much about the ideas, priorities, and the worldviews of the medical men who superintended the voyages as it is about the convicts and emigrants under their care. It contributes to tracing the journey, beginning in the ports of the British Isles and ending in Australia. The book introduces debates about the internal spaces of the ship and shows how scurvy became resurgent as British prison committees steadily reduced prison dietary rations during the 1820s and 1830s. Bringing convicts and emigrants back together, it explores how a series of questions about authority, class, gender, and social status mediated medical relationships as the pressures of the voyage accumulated. The book talks about Eliza Baldwinson, a young female convict from London, transported in 1832, whose story we know from penal records.
This chapter charts the changing political, social, and geographical character of Australian departures over the first half of the nineteenth century. It examines the conflicts that emerged in the days around embarkation as medical men sought to assert their understanding of what voyages should be, and who should travel. The existence of debates about the idea of the 'voyage for health' begins to explain why departure was so often a defining moment for naval surgeons as they began to make claims to authority in the first half of the nineteenth century. Wherever surgeons received convicts in Britain and Ireland, they continually requested that emigrant and convict vessels should not be allowed to depart in the autumn and winter. For both convicts and emigrants, the isolated rural terrain and unpredictable weather of Ireland posed particular problems before even getting to sea. Surgeons of convict ships had encountered epidemic cholera in 1831.
This chapter argues that a cumulative ecological interaction defined by a spectrum of moisture extending from human breath to the rolling waves formed the primary basis on which surgeons, commentators, and travellers understood their prospects for health in ships. It provides a brief comment about the advent of steam. In the middle of the eighteenth century, Sir John Pringle explained that the pathological potential of the internal spaces of the sailing ship was exactly analogous to the prisons of land. For surgeons and commentators, these were worryingly unreformed spaces permeated by moistures; sweat, breath, waves, and bilge water poisoned the atmosphere. William Turnbull's influential handbook, The Naval Surgeon, reiterated the dangers of wetness from ill-seasoned wood in new ships, and described the steams, moistures, and emanations of ships and the people in them.
This chapter shows how scurvy became resurgent as British prison committees steadily reduced prison dietary rations during the 1820s and 1830s. Going further still into the voyage, the Cape of Good Hope remained, as it had been in the eighteenth century, intimately linked to surgeons' expressions of regret and of relief about scurvy, but the disease itself seemed to have changed. From the archetypal maritime scourge, scurvy had become a penal disease. Despite their frustrations, the isolation of the ocean and the vulnerability of convicts' bodies offered surgeons an invaluable opportunity for medical experimentation during the 1840s. The first of the Prince George convicts to develop scurvy was a man named George Willett. In 1840, after a decade of intermittent discussions about nitre, William Burnett officially re-opened investigations into scurvy.
This chapter shows how contemporary mistrust of medical authority, so apparent on land among the labouring classes, travelled to sea in respect of practices such as post-mortem examination and vaccination. During the 1830s, when the British government began to provide assistance to emigrants who wished to sail to Australia, vaccination practices at sea also changed. Travelling with vaccine lymph brought naval surgeons into a prestigious global network of medical exchange. For surgeons, voyages provided a space to experiment with remedies, vaccinations, and anatomical examinations. However, these practices also exemplify the questions about compulsion, consent, trust, and medical intervention. While the surgeons' official instructions codified his authority, they could not account for the more intangible elements of medical relationships. Australian voyages bind together the histories of medicine, social power, colonialism, and migration across national borders and geographical space.