The first major reorganisation of the National Health Service took place in 1974, twenty-six years after the service had been established. It has long been perceived as a failure. This article draws on archival records and a witness seminar held in November 2016 to provide a more nuanced assessment of the 1974 reorganisation and understand more fully why it took the form that it did. In particular it identifies the reorganisation as an important moment in the ongoing story of management consultants engaging with health policymakers, and explores the role of McKinsey and Co. in detail for the first time. Key explanatory factors for their involvement are identified, including the perceived lack of expertise and manpower inside the civil service and the NHS, and perceptions of their impact and effectiveness are discussed. Many debates about the use of management consultants today were directly foreshadowed during the early 1970s. Alongside this, the role of other groups of policy actors, including civil servants, politicians and medical professionals, are established and the extent to which British health policymakers have had to work within existing cultural, political, legislative and practical constraints when trying to initiate change is demonstrated. The fact that many of the ‘mistakes’ that were made have been repeated in the course of subsequent reforms, speaks to the poor institutional memory of Whitehall, and the Department of Health and Social Care in particular. In the run up to 1974 management consultants could make only a limited contribution to an imperfect compromise.

A tropology of moral injury and corruption long framed the plight of the sex crime victim. Nineteenth-century psychiatric acknowledgment of adverse sexual experience reflected general trends in etiological thought, especially on ‘epileptic’ and hysteric seizures, but on the whole remained descriptive, guarded and limited. Various experiential threats to the modern sexual self beyond assault and rape were granted etiological significance, however: illegitimate motherhood, masturbatory guilt, sexual enlightenment, ‘homosexual seduction’ and chance encounters leading to fetishistic fixation. These minor early appeals to medical psychology help us appreciate the multiple nuances of ‘sexual trauma’ advanced in Breuer and Freud’s Studies on Hysteria (1895) and Freud’s subsequent work.

Based on a wide range of historical sources, including published scientific literature and archives (Institut Mérieux, WHO and IMTSSA), this article examines the history of the development of the meningococcal A vaccine between 1969 and 1973. It explores the social factors of vaccine development including various collaborations, informal discussions, the circulation of products and materials, formal meetings, trials and setbacks to highlight the complex reality of the development, production and use of the vaccine. Inscribed in a ‘Golden Age’ of vaccine development and production, this episode not only adds to the scholarship on the history of vaccines, which has tended to focus on a narrative of progress, but also considers the sharing of knowledge through collaborations, and the risks involved in the development of a vaccine. Finally, this perspective reveals the uncertainties and difficulties underlying the production of an effective vaccine.

This paper analyses the shifting images of Chinese medicine and rural doctors in the narratives of literature and film from 1949 to 2009 in order to explore the persisting tensions within rural medicine and health issues in China. Popular anxiety about health services and the government’s concern that it be seen to be meeting the medical needs of China’s most vulnerable citizens – its rural dwellers – has led to the production of a continuous body of literary and film works discussing these issues, such as Medical Practice Incident, Spring Comes to the Withered Tree, Chunmiao, and Barefoot Doctor Wan Quanhe. The article moves chronologically from the early years of the Chinese Communist Party’s new rural health strategies through to the twenty-first century – over these decades, both health politics and arts policy underwent dramatic transformations. It argues that despite the huge political investment on the part of the Chinese Communist Party government in promoting the virtues of Chinese medicine and barefoot doctors, film and literature narratives reveal that this rustic nationalistic vision was a problematic ideological message. The article shows that two main tensions persisted prior to and during the Cultural Revolution, the economic reform era of the 1980s, and the medical marketisation era that began in the late 1990s. First, the tension between Chinese and Western medicine and, second, the tension between formally trained medical practitioners and paraprofessional practitioners like barefoot doctors. Each carried shifting ideological valences during the decades explored, and these shifts complicated their portrayal and shaped their specific styles in the creative works discussed. These reflected the main dilemmas around the solutions to rural medicine and health care, namely the integration of Chinese and Western medicines and blurring of boundaries between the work of medical paraprofessionals and professionals.

This paper aims to critically appraise the incorporation of opium poppy into medical practice in Song-dynasty China. By analysing materia medica and formularies, along with non-medical sources from the Song period, this study sheds light on the role of Chinese Buddhist monasteries in the process of incorporation of foreign plants into Chinese medicine. It argues that Buddhist monasteries played a significant role in the evolution of the use of opium poppy in Song dynasty medicine. This is because the consumption practices in Buddhist monasteries inspired substantial changes in the medical application of the flower during the Southern Song dynasty. While, at the beginning of Song dynasty, court scholars incorporated opium poppy into official materia medica in order to treat disorders such as huangdan  and xiaoke, as well as cinnabar poisoning, this study of the later Song medical treatises shows how opium poppy was repurposed to treat symptoms such as diarrhoea, coughing and spasms. Such a shift in the medical use of the poppy occurred after Chinese literati and doctors became acquainted with the role of the flower in the diet and medical practices of Buddhist monks across China. Therefore, the case study of the medical application of opium poppy during the Song dynasty provides us with insights into how the spread of certain practices in Buddhist monasteries might have contributed to the change in both professional medical practices and daily-life healthcare in local communities in that period.

This article considers the social function of contagious disease as moderator of class relationships in England during the first half of the eighteenth century and takes into account the ways in which the ‘communicability’ of the plague, great pox (syphilis) and smallpox (variola) was used by authors to crystallise social interaction and tension along class lines. The essay begins by examining the representation of the plague, syphilis and smallpox in the medical tradition, before shifting its attention to the practice of maritime quarantine, as laid out by Richard Mead in his Short Discourse Concerning Pestilential Contagion (1720). By foregrounding medical writing on contagion through skin contact, I suggest that pornographic texts such as John Cleland’s The Memoirs of a Woman of Pleasure (Fanny Hill) (1748) had an interventionist function. Cleland is often charged with sanitising the true horrors of sex work in this period. This article proposes that if we take the time to appreciate the way infectious cutaneous diseases were believed to operate and spread we can recognise the moments in which he not only alludes to disease but invokes it for structural and thematic purposes. In proposing this, I am challenging the dominant interpretation that the problematic realities of eighteenth-century prostitution, especially disease, are subordinated to the narrative’s greater interest in erotic pleasure.