Social History of Medicine

Published by Oxford University Press (OUP)
Online ISSN: 1477-4666
Print ISSN: 0951-631X
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A vast range of sources, from chronicles, hagiography and the liturgy to medical manuscripts and charters, is at our disposal for the study of health and healing in Italy between the ninth and eleventh centuries. What is needed in order to exploit this material is a methodology for the careful examination of sources in their regional, social and political context. I focus on what hagiography can contribute to the study of medicine and disease, discussing in detail two ninth—century episcopal hagiographies, the Milanese second Vita Ambrosii, and the Vita Barbati from Benevento in southern Italy. At the same time, however, I stress the limitations of studying texts in isolation, given that one region, city, or community could be simultaneously producing a number of different kinds of evidence, with possibly more than one view of sickness and healing. There is great potential for medical history in further investigation of the archaeological, liturgical, and charter evidence from early medieval Italy. The study of all surviving manuscripts from this period, not just medical works, can provide a bridge between the detailed examination of a particular text and a discussion of the wider literary and cultural traditions into which they fitted
 
This introductory paper has two main themes: first, what can be said about the diseases characteristic of the period in question; second, what generalizations are possible about the medicine that could be deployed against them. After a preliminary discussion of the extent to which the system of dating from Christ's incarnation governed the chronology of those who fall within our scope, the paper raises the question of whether the year 1000 prompted millenial 'fever'. This leads into an account of the concept of 'pathocoenosis', a tableau of the interrelated diseases prevalent at any one place and time. The limitations of the tenth- to eleventh-century evidence available for such a project are examined, philosophical objections to disease history reviewed, and agenda for future research outlined. The paper then turns to the main features of the medical texts on which any investigation of therapeutic practice in the early Middle Ages must depend: features such as amorphousness, mutability, lack of theory, elusive connection with clinical reality. Finally, some wider implications of the special issue are delineated-concerning presumed contrasts between East and West, and, with respect to the relationship of theory to practice, between early and later Middle Ages.
 
The paper begins with the medical practitioners of late Anglo—Saxon England, who were apparently both physicians and surgeons, describing the kinds of ailments they are evidenced as treating. The majority were monastic; whether there were also lay medics is uncertain. Most Anglo—Saxon ecclesiastical foundations appear to have had an infirmary, where sick monks or nuns, or those who were about to die, were looked after. Some infirmaries may have tended lay people, but there do not appear to have been any hospitals in the later medieval sense. The rest of the paper looks at the contents of one manuscript written about the year 1000: London, British Library MS. Harley 585, which contains texts of three compilations in Old English: the Herbarium and the Medicina de Quadrupedibus, both translated from Latin, and the Lacnunga, which is a collection of remedies from diverse sources, some translated from Latin, some of native origin, some wholly rational, some containing Christian or folkloric incantations and rituals, and including four metrical charms. Because of its lack of selectivity and organization, it gives an invaluable insight into the con-dition of and the attitude to, Anglo-Saxon medicine about the end of the first millennium.
 
Historians of medical ethics have found that active euthanasia, in the sense of intentionally hastening the death of terminally-ill patients, was considered unacceptable in the Christian West before the 1870s. This paper presents a range of early modern texts on the issue which reflect a learned awareness of practices designed to shorten the lives of dying patients which were widely accepted among the lay public. Depriving the dying abruptly of their head-rest or placing them flat on the cold floor may strike us as merely symbolic today, but early moderns associated such measures with very concrete and immediate effects. In this sense, the intentional hastening of death in agonising patients had an accepted place in pre-modern popular culture. These practices must, however, be put into their proper context. Death was perceived more as a transition to the after-life and contemporary notions of dying could make even outright suffocation appear as an act of compassion which merely helped the soul depart from the body at the divinely ordained hour of death. The paper concludes with a brief comparison of early modern arguments with those of today.
 
Although it has been widely argued that pre-Enlightenment western medicine ascribed to a one-sex (male) model of the body, this theory has never been evaluated in terms of medical practice. This article seeks to determine the usefulness of such a model for early modern Britain, circa 1600-1740, by examining how medical practitioners responded to three common illnesses that afflicted both male and female patients: venereal disease, smallpox, and malaria. It concludes that, despite a number of similarities, medical treatment of such illnesses was marked by important differences which were based upon the sex of the patient. Due to its unique physiological functions (vaginal discharge, menstruation, pregnancy, and lactation), the female body was considered by practitioners to be capable of manifesting, transmitting, and responding to disease and treatment in ways that the male body could not. This awareness provided practitioners with additional reasons to monitor, and alter, medical treatment in their female patients. In fact, the different constitutions of men and women meant that the patient body was much more complex than the theory of a one-sex model suggests. Furthermore, differences in medical treatment were influenced by age, a variable which was inexorably linked to physiological changes in the 'sexed' body.
 
The literature on the demographic impact of rural industrialization in England has lagged somewhat behind continental inspired historiography. Nowhere is this more apparent than in the sphere of infant mortality, where commentators have failed to balance the effects of rural industry on health and welfare--such as higher earnings and the existance of more dense kinship networks--with the negative effects--proximity of rural industrial areas to rapidly growing towns, poor public health and rapidly increasing population density. Using the results from a very detailed analysis of a proto-industrial township in the West Riding of Yorkshire between 1650 and 1830, this article contends that rural industrial areas had a distinctive experience of infant mortality. In line with much of the existing literature on England, rates of infant mortality in this township were modest. However, concentration on bald figures without wider contextualization, masks the fact that infant mortalitiy visited itself most intensely on a narrow range of families and a narrow range of spatial areas. Those most susceptible were in-migrants living on common land, and the wider linkage of family reconstitution data to poor law evidence suggests that the defining characteristic of concentrated infant mortality was recurrent parental illness, leading to inadequate child care and breast-feeding.
 
The tropical regions of the New World in the early modern era offered European migrants great wealth but were also demographically deadly. This paper presents hard data on white mortality in seventeenth- and eighteenth-century Jamaica and shows that white susceptibility to disease, especially yellow fever, led to appalling white mortality. High white mortality, especially in urban areas in the first half of the eithteenth century, meant that Jamaica did not become a settler society full of native-born whites, as occurred in plantation British North America. The failure of white settlement and continuing high mortality accentuated whites'penchant for fast living, for fatalism, and contributed to slaveowners' callous disregard for the welfare of their slaves. White life chances were not helped by inappropriate medical attention. Although Jamaican doctors' explanations of high white mortality were occasionally correct, their adherence to humoral and miasmic theories of medicine led them to promote remedies that were at best ineffectual, at worst detrimental. Contemporaries, however, refused to accept the facts of white demographic decline, in part because to do so would have been to deny the possibility that Jamaica would become Anglicized rather than Africanized.
 
Based on a collective biography of apothecaries, surgeons, and physicians in Bordeaux between 1690 and 1790, this article offers a counterbalance to the prevailing view of apothecaries. It suggests that, although numbers may have been falling and corporations failing elsewhere in France, the favourable situation of Bordeaux aided the survival of the corporation of apothecaries in that city. It suggests that apothecaries were important in providing a wide range of goods and services to patients, and traces their involvement in retail, wholesale, and international trade. Control of numbers is shown to be linked to a desire to exploit their monopoly of the market, which led to increases in wealth for individual practitioners. A change in traditional inheritance strategies is linked to a new emphasis on merit, and to knowledge obtained through training outside the confines of the apprenticeship system. The 'secrets of the craft' are seen to be undermined by the public nature of the emerging science of chemistry. The corporation of apothecaries in Bordeaux was transformed through its absorption of three new types of practitioner-entrepreneurs, pharmacists, and scientists-yet it survived due to the substantial and continuing presence of traditional, locally born, and locally trained apothecaries.
 
This article is concerned with forensic medical evidence and the several forms in which it was supplied to courts in early modern England. A specific trial is described and interpreted in detail, with particular attention being given to the kinds of information derived from the decomposed body of a young Quaker woman, believed either to have drowned or been murdered. The role of medical and lay evidence is evaluated and attention directed towards the ways in which the proceedings were recounted and recycled in post-trial publications. Major themes include popular attitudes towards dissection, the roles of lay and professional witnesses and the role of women as traditional sources of knowledge about the body.
 
Nineteenth-century views of Georgian medicine were generally uncomplimentary, criticisms it is difficult to refute for apparent lack of original sources on provincial practice and practitioners, especially the range of patients and conditions they actually treated. The data that has been discovered about Bradford Wilmer of Coventry suggests a different picture of a practitioner. His career covered most aspects of eighteenth-century provincial medicine but, quite exceptionally, he was also the author of two works on surgery and one on toxic plants, as well as running a four-man group practice. He participated in two murder trials, one of which, Captain Donellan's, was a contemporary cause célèbre. Politically a high Tory, he became wealthy by speculative investment and four good marriages, as well as by medical practice, but performed poor-law duties throughout his career. He had trained at St Bartholomew's under Sharp and Pott, then practised in Coventry for forty years but maintained an extensive network of professional contacts, corresponding with many British medical contemporaries. His publications have a strongly practical tone and are based chiefly on his midland patients. Not afraid of controversy, he appeared against John Hunter in court in 1781 and disagreed in print with eminent surgical authorities.
 
SUMMARY Between 1720 and 1800, over 30 voluntary hospitals were founded in England, and a further five north of the Border. These ventures were not altruistic projects, divorced from the overall development of eighteenth-century society; on the contrary, they were a clear manifestation of contemporary economic, social, political, and religious values. The focus of this paper is the early years of the General (later Mineral Water) Infirmary at Bath, opened in 1742 to grant the sick and disabled poor access to the city's spa waters. From an examination of the hospital's income and expenditure, and of the arguments used in fund-raising campaigns, there emerges a broader discussion of philanthropy in Hanoverian England. Four principal themes are addressed: mercantilism, status, social control, and religion. As a jewel in the crown' of Georgian elegance and leisure, Bath counted among its visitors the wealthy and powerful. Consequently, the concerns of the country's elite are much illuminated by a study of the city's General Hospital.
 
The Middlesex Hospital was founded in 1745, and opened the first British in-patient lying-in service in 1747. Men-Midwives were instrumental in founding and supporting the service. The hospital's lying-in service featured prominently in its fundraising literature, and the level of demand from benefactors suggests it was popular. From 1764 the hospital also provided domiciliary services, initially to cope with excess demand and later to compete with domiciliary charities. In 1786 it closed the in-patient services, and from this date provided only domiciliary lying-in services. From 1757, in common with the London lying-in hospitals, the Middlesex Hospital faced competition from a domiciliary charity: The Lying-In Charity for Delivering Poor Married Women in Their Own Homes. Later in the century it also faced competition from dispensaries. This paper describes the foundation and evolution of the Middlesex Hospital's lying-in service, including quantitative information about admissions and about the hospitals income and expenditure during the eighteenth century. It compares the characteristics of domiciliary and in-patient services, to analyse why in-patient services were supported by men-midwives and by benefactors.
 
The language of risk, in relation to disease, is usually viewed as having developed in the post-war era, but in fact it has a much longer history. Focusing on the period from the mid-eighteenth century to the mid-twentieth century, this article examines evolving beliefs about what makes women vulnerable to breast cancer and traces the history of certain 'risk factors', such as the presence of benign breast disease, the experience of injury to the breast, the influence of unhappy emotions, the onset of menopause, and a family history of cancer. It situates beliefs about breast cancer within their social and cultural contexts, examining ideas concerning the relationship between mind and body, the impact of new medical knowledge, the social meanings of cancer, definitions of femininity and images of the female body, and women's own views on what places them at risk. It concludes that an historical perspective adds an important dimension to our contemporary understanding of the concept of medical risk.
 
Drawing on the admission records, the medical casebooks and the publications of its director, this article explores how the University of Göttingen's maternity hospital achieved its three official goals: teaching medical students, training female midwives, and providing shelter for needy parturient women. Since educating medical men was the most important aim of the hospital, the paper particularly focuses on how the demands of instruction shaped day-to-day obstetrical practices, especially under the directorship of Professor Friedrich Benjamin Osiander (1792-1822). He was a keen advocate of the forceps, whereas the first director, Professor Johann Georg Roederer (1751-63), had taken a moderate, that is a much less interventionist, approach to obstetrics. Osiander avowedly was determined to subordinate the parturient women to the demands of the clinic and to treat them as 'living manikins'. In spite of that, there is evidence that the pregnant and parturient women, most of whom were unmarried and from the lower classes, made use of the lying-in hospital for their own purposes, and that sometimes they refused to play the role assigned to them. The link between the maternity hospital and the rise of the man-midwife and of 'scientific' obstetrics appears to have been particularly strong in the case of Göttingen and other German university hospitals, compared with lying-in hospitals in other countries where the link was more indirect.
 
In 1792 a slave-ship arrived on the french Indian Ocean island of Ile de France (Mauritius) from South India, bringing with it smallpox. As the epidemic spread, a heated debate ensued over the practice of inoculation. The island was in the throes of revolutionary politics and the community of French colonists were acutely aware of their new rights as 'citizens'. In the course of the smallpox epidemic, many of the political tenisons of the period came to focus on the question of inoculation, and were played out on the bodies of slaves. Whilst some citizens asserted their right, as property owners, to inoculate their slaves, others, equally vehemently, objected to the practice and asserted their right to protect their slaves from infection. Eighteenth-century colonial medicine was largely geared to keeping the bodies of slaves and workers productive and useful, but formal medicine never had a monopoly. Slaves on Ile de France brought with them a rich array of medical beliefs and practices from Africa, India, and Madagascar. We have little direct historical evidence for these, but we do know that many slaves came from areas in which forces of smallpox inoculation were known and practised.
 
SUMMARY In much research into trends in infant mortality in nineteenth-century Europe explanations have recently tended to be focused on changes in infant feeding practices and alterations to the sexual division of labour. Rarely has this research been conducted at the level of individual families within specified communities. Infant mortality in Sweden fell steadily through the nineteenth century from 200 per 1, 000 live births in 1800 to 100 in 1900. This study focuses on two parishes in northern Sweden where infant mortality rates in 1800 were generally in excess of 200 and, in some areas, of 300 per 1, 000 live births. One parish Nedertorneå, inhabited in 1800 primarily by a population of sedentary farmers, whose wives did not breast-feed, experienced infant mortality rates that varied annually from 300 to 500. The other, Jokkmokk, contained a population of nomadic reindeer herders whose women after birth breast-fed their infants for long periods. Over the course of the nineteenth century a campaign by midwives to persuade mothers in Nedertorneå to breast-feed their children led to a dramatic increase in their infant's survival chances although the mothers may well have increased their participation in agricultural work. The mothers of Jokkmokk, while breast-feeding their offspring into their third and fourth year of life, experienced no appreciable fall in the mortality rates of their infants. These women also engaged in demanding and seasonally concentrated labour within the pastoral economy. This study concludes that single-factor explanations for infant mortality decline, especially in societies such as Sweden, where rates were regionally highly varied, have to come to terms with the fact that the explanatory factors never operated alone but functioned interactively with other influences that could register positive and negative effects upon infant mortality.
 
"Physical puritanism", the name given to the popular medical reform movements of early Victorian Britain by the Edinburgh academic Samuel Brown, nicely evokes their links with religious dissent. While historians have examined the formal organization, leadership, and membership of several of these movements, we know very little about the ways of thinking of their ordinary adherents. The diary of John Young (1820-1904), a Sunderland chemist and druggist and local preacher of the Wesleyan Methodist Association, affords unrivalled insights into the mind of one "physical puritan". In particular, Young's reading of the Edinburgh physician and phrenologist Andrew Combe's influential work Principles of Physiology (1834) can be examined in detail. Virginia Smith has argued that such advice books are valuable in providing access to lay ideas about health. Their readership, however, has not been studied. This article offers a case study which calls into question Smith's assertion that the new utilitarian popular physiology of the 1830s and 1840s was valued principally for the physical benefits offered by its therapies, so distinguishing it from its more spiritually-oriented eighteenth-century antecedents. I argue that the natural theology which marks Combe's work was important in helping dissenters like Young to appropriate new ideas (in particular ideas derived from the popular science of phrenology) not only to promote physical health, but also to assist in attaining spiritual goals. For some of their readers, Combe and Wesley were not so far apart.
 
A number of historians have recently suggested that we need to get out of the asylum if we are to fully understand attitudes to insanity in the nineteenth century. Arguing that accounts of the medicalization of madness have ignored the importance of non-medical attitudes to lunacy and idiocy, recent studies have stressed the need to explore family attitudes and responses in more detail. Unfortunately, efforts to escape the asylum have to some extent been hampered by a persistent reliance on institutional records. This institutional dependence is understandable: certificates of insanity, reception orders, case-books, and asylum registers, together with published documents, constitute the major record of historical constructions of the lunatic and idiotic mind. However, there may be more resourceful ways of exploring both medical and non-medical attitudes to idiocy. In this paper, I want to use the records from a contested will case, Ingram v Wyatt, to demonstrate that records from the ecclesiastical courts can provide access to a domain where the definitions and meanings of idiocy and imbecility were routinely considered by lawyers, lay witnesses, judges, and doctors. I shall argue that such cases constitute a fruitful site for excavating lay, professional legal, and medical attitudes to imbecility, for exploring the complex relationship between medical and non-medical understandings of capacity, and for situating those understandings within the context of professional developments in law and medicine and contemporary concerns about inheritance.
 
Takano Chōei (1804-50) was a rangakusha: a scholar of Dutch learning, and a physician of Western medicine. Although he was one of the foremost scholars in his field, his career was cut off in its prime when he became the victim of an intrigue in 1839. As a result, much of his early work has been overshadowed by the political events that followed. This article takes a different approach to the writing of Chōei's history by presenting an example of his work as a physician in the period before his arrest. It examines the responses of Chōei and his colleagues to the famine and pestilence which ravaged the population during the Tempō Famine of the 1830s. The study is based on two short articles: one concerns the precautions people should take against epidemic disease, while the other deals with hardy, rapidly maturing crops thought helpful in warding off starvation. The focus of this article is on the way knowledge from Western sources was 'received'; that is, how it was actively assimilated and transformed, through a process of cultural exchange.
 
In this article we examine the impact of the policies and practices of the Guardians of the New Poor Law Unions on the management of pauper lunatics in four Devon Poor Law Unions in the critical period 1834-84. The central role of the Victorian Poor Law in provision made for the insane has only recently been recognized in the research literature. Scholars have been much more concerned with the activities of professionalizing physicians and the general project of state management than they have with the micro-politics of the local Poor Law and the magistracy who were responsible for the legal disposition of the insane. In this paper we argue that not only were the Guardians of the Poor Law Unions central in the determination of the lunatic's journey through the institutional systems provided in the mid-nineteenth century, but also that there were significant variations within the Poor Law system which made for contrasting systems of disposal of lunatics as between the Unions themselves. These variations in disposal of lunatics in Devon raise important questions of ideology, policy, and practice which, if repeated elsewhere, point to a need to refine significantly our assumptions regarding the disposal of pauper lunatics in England and Wales in the fifty years following the 1834 Poor Law Amendment Act.
 
There are three identifiable phases in comparing vaccination policy in England, Prussia and Imperial Germany. (1) Prior to the 1870's the tradition of medical police in Prussia resulted in the vaccination of the population being treated as a State responsibility earlier than in England and provided an appropriate administrative framework. The administrative pressure that could be exerted persuaded the Prussian authorities that legislation to make vaccination compulsory was unnecessary. In contrast, England and Wales lacked both the tradition and administrative structures of a medical police. Legislation (1840, 1853) for free and universal infant vaccination was followed by radical ideological and administrative innovation. (2) From 1875 to 1889 both countries provided free and compulsory vaccination for all. In England this was limited to infants; in Germany including Prussia, it included the re-vaccination of children. (3) After 1889 England and Germany began to diverge more sharply. In England vaccination rates fell and after 1898 conscientious objectors were excused from having to have their children vaccinated. Germany retained compulsory vaccination and rates in the two countries increasingly diverged. England came to rely on the local public health administration for the surveillance and containment of smallpox, including selective vaccination of contacts. Despite these differences smallpox mortality dropped sharply in both countries, although in Germany somewhat earlier. The English reliance on surveillance and containment prefigures that of the WHO in the eradication of smallpox in the Third World. It suggests that the emphasis on the importance of high levels of mass vaccination in the German literature should perhaps be revised.
 
From its earliest years the GRO developed a twin-pronged publication strategy to maximize both its political and scientific impact in promoting the environmentalist policies of the Public Health movement. Through its weekly and quarterly bulletins of comparative death-rates the GRO fought a relentless campaign to heighten local awareness of the extent of preventable death. The government's chief medical officer also used this information to investigate negligent local authorities. A parallel series of annual and decennial reports offered a more rigorous and scientific analysis of the incidence of the nation's fatal diseases. A relative decline in the GRO's leading position in the public health movement after the retirement of William Farr in 1880 has been misinterpreted as the end of its commitment. But this was only a temporary lull, primarily due to developments beyond its control: the rise of germ theory and also the increasing powers and professional organization of the Medical Officers of Health. The GRO had to adapt to a less glamorous supporting role supplying the country's MOHs with the epidemiological information they required. In the Edwardian period, however, the GRO was to be found once more in the centre of the most significant scientific and political conflict, successfully defending an environmentalist and increasingly state-sponsored public health and welfare policy against the attacks of hereditarian eugenicists.
 
The series of cause of death statistics for England and Wales published by the General Register Office between 1837 and 1920 are a fundamental source for historians studying death and disease in this period. Attention was first drawn to the historical importance of this source, and to its principal shortcomings, by Bill Luckin in 1980. Research by a number of scholars in recent years on mortality and morbidity in the nineteenth century has uncovered further problems, which are outlined in this essay under two heads: general problems, and problems relating to specific cause of death categories.
 
Following the lead of the Lancet's attacks in the 1840s, historians have considered hydropathy and hydropathists in Britain as part of fringe or heterodox medicine. Yet the distance between varieties of orthodox theory and practice and hydropathy was small, and many of the most prominent hydropathists held orthodox views and qualifications. Examining the educational backgrounds and careers of 40 early British hydropathists, the authors suggest that hydropathy and hydropathic establishments, like specialists hospitals, asylums, and spa practice, provided an alternative niche to general practice in the crowded British medical market and a way to 'fame and fortune' for medical men outside the metropolitan élite.
 
Historians have tended to treat the nineteenth- and early twentieth-century censuses of England and Wales as social and economic surveys. In this paper it is argued that they should be seen as part of the General Register Office's overall project of data gathering for the purposes of medical and sanitary research. The populations of defined administrative areas were required for calculating rates search. the populations of defined administraticve areas were required for calculating rates of mortality per thousand. Information on family structure, marital condition, age, sex, and birthplace were used to construct life-tables for insurance purposes, and to study the factors leading to the insanitary overcrowding of cities. Even the classification of occupations was based on a medical model for the purpose of studying the effect of work with particular materials on health. This creates problens for those who wish to use this data for measuring sectoral labour inputs into the economy over time.
 
Public reaction to public health legislation is often assumed to have mirrored that expressed in Parliament or in influential provincial newspapers, yet evidence for the public reaction to public health legislation is elusive. This article, based on an analysis of 871 petitions submitted to Parliament during the 1847 and 1847-8 parliamentary sessions, argues that, during 1847 and 1848, few issues stimulated more interest than public health, and that a geographically and socially diverse constituency embraced national sanitary legislation. It also argues that concerns about centralization did not dominate the petitions, and that the parliamentary interpretation of centralization overlapped but slightly with provincial concerns.
 
Research on sanitary reform in nineteenth-century Britain has focused mainly on the introduction of large-scale sanitary infrastructure, especially waterworks and sewerage systems Other sanitary measures such as the provision of public baths and wash-houses have been ignored, or discussed in the limited context of working-class responses to middle-class samtarianism. Yet by 1915 public baths and wash-houses were to be found in nearly every British town and city A detailed analysis of these ‘enterprises’ can provide a useful way of understanding the changing priorities of public health professionals and urban authorities as well as the changing attitudes of the working classes. Connections between personal cleanliness and disease evolved during the century, particularly after the formation of germ theory in the 1880s. This paper demonstrates how the introduction of public baths and wash-houses in Liverpool, Belfast, and Glasgow was initially a direct response to sanitary reform campaigns It also shows that the explicit public health ideology of these developments was constantly compromised by implict concerns about municipal finance and the potential profit that such enterprises could generate. This city-based analysis shows that this conflict hindered the full sanitary benefit which these schemes potentially offered.
 
During recent decades, great advances have been made in measuring death rates on a number of transoceanic routes over several centuries. This article builds on measurements of mortality on voyages to Australia in the nineteenth century. These have shown that it was on Australia-bound convict and government-assisted vessels, which operated under the auspices of government agencies, that the maritime adult death rate was first brought into line with that on land. The novelty of this article lies in its analysis of a new body of evidence on causes of death on 323 vessels arriving in South Australia between 1848 and 1885. Surgeon-superintendents, working under strict regulations, recorded the cause, age, sex, and date of death of every patient whom they had attended for days or weeks. This is, perhaps, an extraordinary situation that mimics, as it were, the records of a medical practice in a working-class area, over a thirty-seven year period. Surgeons faced intensive scrutiny upon arrival, and were fined if their records, or supervision of the voyage, were considered to be faulty. Hence, severe penalties for inaccurate reportage ensured a high degree of accuracy. Their records allow an assessment of the impact of seasonality on the outcome of the voyage and raise questions about why and how the pattern of deaths over the voyage leaves us with a hump-shaped curve when one might have expected the opposite.
 
Although the shift from a social to a medical function which occurred in nineteenth-century general hospitals has been explored, the occurrence of such a change in maternity hospitals has not been considered. Recent analyses of such institutions have examined particular aspects only, and thus give a somewhat static picture. This paper uses analysis of patient records (themselves an under-exploited resource) to explore the changing function of the Edinburgh Royal Maternity Hospital from a provider of shelter during childbirth to the destitute to a source of skilled medical care. It concludes that, although the Hospital had adopted the outward features of a medical institution by 1890, its casebooks suggest that its purpose only decisively changed in the early twentieth century, and thus can perhaps be more appropriately linked with national anxiety regarding the health of babies and their mothers.
 
Public health concern with food safety and food poisoning emerged in Britain in the 1880s following the first indication that acute gastric illness was caused by a specific organism. Although incidents were for many years only sparsely reported, the central medical department and its scientists were anxious to extend their knowledge of the incidence, specific causal organisms, and epidemiology of the illness. This paper argues for a widespread incidence of food poisoning in Britain in the nineteenth century and traces the social economic, and hygienic contexts within which it occurred. As deadlier infections retreated, food poisoning became an increasing concern of local and national health authorities, who sought both to raise public awareness of the condition as illness, and to regulate and improve food handling practices. Notification of cases was begun in 1939, and this, together with social changes during and after the Second World War, produced an escalating spiral of reported incidents which still continues. This trend, it is argued, is essentially an artefact, whose significance is reduced if considered in its broader historical context.
 
Bacterium coli in London milk 
Diseases which can be caught from contaminated milk 
This paper seeks to adduce evidence on the social consequences of milk consumption in the period 1850-1930. It is shown that the poor quality of supply partly resulted from the nature of the marketing system, with adulteration and the use of chemical preservatives as other factors. Local authority regulation and central government legislation were very slow in controlling the cleanliness of production and sale. Milk was heavily contaminated with bacteria and was responsible for spreading a variety of diseases such as scarlet fever and tuberculosis. Infants not wholly breastfed were particularly vulnerable to diarrhoeal infections. Improvements such as pasteurization and bottling were slow to spread and are unlikely to have had much impact before the 1920s. Overall it is argued that ill-health caused by dirty milk was more serious, and its amelioration much later than previously documented.
 
During the late nineteenth and early twentieth centuries there were two views on the relationship between syphilis and male circumcision: one was that circumcision provided protection against syphilis, another that circumcision was itself a significant source of syphilitic infection. This article reviews this debate, relates the first view to an influential article by Jonathan Hutchinson in 1855 and considers the subsequent use made of his statistics. It is suggested that the original statistics were of dubious value and that the promise of protection against syphilis was an additional argument for doctors who were keen to introduce universal circumcision of male infants for other reasons, the most significant of which was related to the conviction that it would discourage masturbation. The article further considers the controversy over whether Jews were healthier than other peoples, and the interaction among medical, moral, and customary/religious reasons for circumcising boys, and concludes that, while the operation never played any role in the control of syphilis, circumcision was indeed a significant cause of illness and death among male infants before the standardization of aseptic operating techniques.
 
Birth weight remains a major focus of medical research into the relationship between pre-natal growth and life course health, and historians have used mean birth weight to assess women's standard of living. However, there are intrinsic difficulties in inferring maternal health and nutritional status from birth weight, and some of the known data sets produce puzzling results. One rich data set comes from the Melbourne Lying-in Hospital, 1857-83, and the article discusses the complex institutional, social, and economic causes that may underlie its apparently counter-intuitive anthropometric results. This data set reveals the biological effects differential social conditions can inflict, even within an otherwise affluent society.
 
From the first moment of the UMCA's incursion into the African interior, the greatest challenge it faced was the problem of mortality and morbidity. Between 1860 and 1918, over one-third of the mission staff were lost to death, or invalided out due to ill-health. This article tracks the institutional response to the problems of death and disease, and seeks to explain why, from the mid-1890s, there was a notable downward shift, both in the numbers of missionaries dying, and in the numbers forced to retire through sickness. For the first 35 years of the UMCA's existence, it paid little attention to establishing and enforcing a disease-management strategy. Health issues were left to the individual missionaries, and medical policy (in as much as the UMCA can be said to have had a 'policy' before the mid-1890s) was driven by the periphery. A mortality crisis in the 1890s refocused the attention of the Mission authorities on the need to establish more rigorous procedures for overcoming the impact of disease. Control over medical policy was centralized, and structures established for the better enunciation and enforcement of this policy. This institutional response ensured an improvement in the health environment of the missionaries, and consequent reductions in the impact of disease upon the UMCA.
 
As imperialist nations rediscovered leprosy in their colonial world in the late nineteenth century, Colombian physicians found endemic leprosy in their own country. The medical community was interested in constructing a national medicine to conform to 'universal' science. To medicalize leprosy, doctors provoked fears through exaggerating the number of leprosy sufferers to demonstrate that charity was incapable of dealing with the problem. The government approved laws of compulsory segregation of leprosy patients in the 1890s, while the 1897 international conference on leprosy held in Berlin gave international sanction to isolation. Lepers actively resisted segregation as a violation of their individual rights. Dr Juan de Dios Carrasquilla studied the disease, experimented with sero-therapy to cure it, and claimed that the flea was its agent of transmission. He combatted segregation and proposed instead a hygienic programme to improve environmental living conditions, but his approach was defeated. When the early twentieth century saw the consolidation of the Colombian state, modernization of the country became a national priority. The government started to take control of lazarettos, enforcing segregation of lepers, who were confined within an area circumscribed by a sanitary cordon. This strategy was a failure, since patients resisted segregation.
 
Expenditure by Lancashire districts per Thousand on Major Health Services, 1936/7, and Percentage Change From 1922/3 
This article examines the position of the working environment within public health priorities and as a contributor to the health of a community. Using two Lancashire textile towns (Burnley and Blackburn) as case studies and drawing on a variety of sources, it highlights how, while legislation set the industry parameters for legal enforcement of working conditions, local public health priorities were pivotal in setting codes of practice. The complexities entwined with identifying the working environment as a cause of ill health and with improving it were entangled within the local community health context. In addition, the multiple understandings of Medical Officers of Health surrounding the remit of their responsibilities impacted the local health context. These did not always parallel national regulations. Indeed, it was these local, community specific forces that set the public health agenda, determined its path and the place of the working environment within this.
 
This article examines local sanitary policing in extra-metropolitan English and Welsh towns and cities in the period 1873-4. It combines two parliamentary returns, one focusing on the appointments by towns of sanitary officers (inspectors of nuisances and medical officers), the other listing the number of nuisance cases and modes of resolutions. The article uses these databases to examine the identification of nuisances in terms of region, town type, mode of government, population, and salary of inspector. It considers also the effects of tenure and job security on nuisances identification, the effects of town wealth, and differences in the resolution of nuisance allegations by town type and region. The article shows a remarkable and perhaps unexpected sanitary activism, but also a considerable variability by region, town size, and town type.
 
In 1873-4 Sweden suffered its last smallpox epidemic. The disease broke out in epidemic proportions in Stockholm late in the autumn of 1873. The medical corps in the capital city had long been concerned about what they regarded as the failure of the vaccination programme and warned the authorities about the prospects of an epidemic if the disease, which was raging Europe, reached the city. Stockholm was less well protected than the rest of the country, partially because the vaccination system had broken down there. However, there was also resistance to vaccination in various social classes. While some resistance may have been on religious grounds, some reflected the uncertainty that had arisen about the effectiveness of vaccination when the protection proved to be less than lifelong. Publicists also distributed literature emphasizing the right of individuals to make their own decisions rather than being coerced by society. The liberal social policy of the day was reflected in more restrictive policies that shifted responsibility from the collective to the private spheres. Not until faced by a crisis in the form of an epidemic did the municipal government act.
 
Top-cited authors
Javier Silvestre
  • University of Zaragoza
Johan Edman
  • Stockholm University
Anders Ottosson
  • University of Gothenburg
Christoph Gradmann
  • University of Oslo
Leslie Tomory
  • McGill University