It has become commonplace in accounts of medicine in the second half of the twentieth-century to ascribe an “antibiotic revolution” to the years when penicillin became widely available from the early 1950s. However, to date there have been hardly any studies that demonstrate a major discontinuity in medical practices after mid-century, let alone that go on to specify their character. There would seem to be two key features of any “antibiotic revolution”: first and foremost that the treatment of diseases was transformed as doctors were able to cure illness caused by infections with specific drugs that eliminated causative bacteria; and second that the ambition of doctors to intervene with drugs in a number of diseases grew, as did the ability of the pharmaceutical industry to supply an increasing range of targeted and effective remedies. In this article we contribute towards an assessment of the first of these key features by discussing the changing management of acute bronchitis from the mid-1940s to the early 1960s. The disease was amongst the most prevalent and important of that period in Britain, being the single largest cause of consultations with general practitioners (GPs) through much of the 1950s. Bronchitis was also the subject of many high profile debates among doctors and health care agencies as concerns about its morbidity and mortality touched on such issues as smoke pollution, the costs of the National Health Service (NHS) and changes in the doctor–patient relationship. The evidence of contemporary studies shows that the treatment of acute bronchitis changed radically after the introduction of antibiotics, such that by the mid-1950s over 80 per cent of patients diagnosed with the condition were prescribed penicillin or another antibacterial drug—a shift that was not supported by any clinical trials or systematic evidence. How and why this change occurred are the questions we set out to answer.

This paper introduces simulation-based re-enactment (SBR) as a novel method of documenting and studying the recent history of surgical practice. SBR aims to capture ways of surgical working that remain within living memory but have been superseded due to technical advances and changes in working patterns. Inspired by broader efforts in historical re-enactment and the use of simulation within surgical education, SBR seeks to overcome some of the weaknesses associated with text-based, surgeon-centred approaches to the history of surgery. The paper describes how we applied SBR to a previously common operation that is now rarely performed due to the introduction of keyhole surgery: open cholecystectomy or removal of the gall bladder. Key aspects of a 1980s operating theatre were recreated, and retired surgical teams (comprising surgeon, anaesthetist and theatre nurse) invited to re-enact, and educate surgical trainees in this procedure. Video recording, supplemented by pre- and post-re-enactment interviews, enabled the teams’ conduct of this operation to be placed on the historical record. These recordings were then used to derive insights into the social and technical nature of surgical expertise, its distribution throughout the surgical team, and the members’ tacit and frequently sub-conscious ways of working. While acknowledging some of the limitations of SBR, we argue that its utility to historians – as well as surgeons – merits its more extensive application.

During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain’s leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient’s military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria.