This investigation sheds light on the social history of pathogenic dirt and its significance for shaping medical practices during the nineteenth century. It consists of an analysis focusing on Swedish medicine, using 8800 yearly reports written 1820–1900 by Swedish provincial doctors for the National Board of Health in Stockholm. The main argument is that the provincial doctors’ perceptions of the relationship between dirt and health during this century can be better understood by focusing on similarities in the handling of different kinds of pathological dirt over the course of many decades, rather than seeing interest in cleanliness as something mostly unprecedented. A novel cleanliness regime became dominant during the latter third of the century, meant to counter a new hybrid between everyday dirt – bodily emanations from healthy bodies – and matter believed to have caused miasmatic and contagionistic disease. New ideas about filth and its impact on health played a crucial role in the development of public health and sanitation movements, and were a precondition for everyday dirt becoming a central medical problem around the turn of the twentieth century, but as is shown, they built on old precedents. Thus, the miasmatic and contagionistic approach to disease shaped conceptions of hygiene and cleanliness.

Between 1903 and 1952, there was a Jesuit and French university in Shanghai called l’Aurore. This article focuses on its medical faculty, which operated from 1912 to 1952. It shows that, in a precarious political and military context, l’Aurore simultaneously benefited from Jesuit missionary activity and the French quest for imperial influence, without fully identifying with either. The faculty was not an official missionary institution, and most of its hundreds of students were not Christians. However, the Jesuit administration kept a record of baptisms among the students and, based on Catholic principles, encouraged opposition to birth control through courses on ‘medical ethics’ and a special oath that medical graduates had to take. Nor was the medical faculty an overtly imperial institution. It was part of a concession and the result of an alliance between Jesuit missionaries and anti-clerical diplomats of the French Third Republic. Yet, the faculty was key to a French policy of imperial influence designed to compete with other imperial, religious, and private foreign powers active in medical education in China. During the years of war between China and Japan (1937–1945), the faculty consolidated its influence by increasing student numbers and building new infrastructure, whereas its Chinese staff assumed a more prominent role, reinforcing the importance of Chinese medicine in teaching and research. Doctors trained at l’Aurore who stayed in China remained active in public health until well into the second half of the twentieth century, even after the medical faculty was abolished by the Communist regime.

I would like to thank Professor Ekirch for his reflections on ‘Have we lost sleep?’, which contain several points that I have already responded to within the paper following his peer review of my original submission to Medical History in 2023 (Professor Ekirch having voluntarily identified himself as a reviewer in a normally double-blind process). I acknowledge that the focus of my paper was on Ekirch’s original work from 2001; if I did not engage as he would have wished with his subsequent publications, this was simply because I do not perceive the same substantial developments in his thinking and research on the subject that he does. Indeed, the present critique by Ekirch amounts essentially to more of the same: a long list of references and quotes but little detailed discussion of any individual source. As my paper demonstrates, seemingly unambiguous evidence from a brief quotation can become less clear-cut when placed in context. I am sorry if I deploy the word ‘might’ more than Ekirch would like. This reflects, I hope, a healthy degree of uncertainty and intellectual humility in my approach to the complex issue of pre-industrial sleep. To extend Ekirch’s metaphor, if the jigsaw puzzle that both he and I are trying to assemble can take the form of a cat or a dog, it is possible that its true form is neither animal. The extent to which people woke in the night in pre-industrial Europe, the duration of such awakening, and the predominant cultural attitude towards this—concern, acceptance, or indifference—are topics about which it would seem wise to avoid sweeping statements and generalisations, given the relatively long period covered and the social, cultural, and individual diversity that must be taken into consideration. I can only repeat that I think amassing more brief references, and selectively citing relatively small physiological studies and anthropological evidence from global settings, is unlikely to provide much clarity, let alone definitive answers. I welcome Professor Ekirch’s contribution to this discussion as an indication that the question of segmented sleep in early modern Europe is by no means settled but is a matter of ongoing debate.

This article focuses on the circulation of knowledge about epilepsy in Sweden between 1915 and 1940. During the period medical research on epilepsy increased, which simultaneously brought a new degree of specialisation and distinction between branches of medicine. The aim of this article is to study the impact of new medical knowledge about epilepsy on the treatment and education of children with epilepsy in Sweden. In order to concretise the aim, the study focuses on the asylum Margarethahemmet. The key source material consists of Margarethahemmet’s annual reports and yearbooks. The minutes of the meetings of the Swedish General Association for the Care of the Feebleminded and Epileptic for the period 1915–1938 have been used as supplementary material. In order to trace the impact of medical discoveries on Margarethahemmet’s operations, contemporary scientific articles, mostly from Germany, have also been used. The article demonstrates how new research and new knowledge was sought internationally and nationally, to provide doctors and special teachers at the asylum with a proper knowledge about education, care and treatment for children with epilepsy. The increased understanding of the disease directly impacted the ability of a stigmatized group – people with epileptic disorder – to actively participate in society on the same terms as others.

Medical practitioners, inevitably scattered across the country, need frequent periodicals to communicate the latest medical information. Journals are an essential component of the infrastructure of modern medicine, yet they were slow to achieve firm roots in Britain during the eighteenth century, with few sustained quarterly periodicals and the only attempt at a monthly lasting a year. Then in 1799, Richard Phillips, owner of the Monthly Magazine, published the Medical and Physical Journal, the first sustained monthly medical journal, which lasted for thirty-four years. Ever since, Britain has never been without a monthly or weekly general medical journal. Responding to the need for a strong commercial focus, the Journal used a magazine format which blended reviews and abstracts of already published material with original contributions and medical news, and it quickly achieved a national circulation by close engagement with all types of practitioners across the country.

Contrary to the historiography, the Journal was distinctly different from the contemporaneous monthly science journals. The key to success was two-way communication with all practitioners, especially the numerous surgeons and surgeon-apothecaries who were increasingly better trained and confident of their status. Much of the content of the Journal was written by these readers, and with rapid, reliable distribution and quick publication of correspondence, controversial topics could be bounced back and forth between all practitioners, including the distinguished. Initially, the editors tried to maximise circulation by avoiding any controversy, but this started to change in the first few years of the next century.

In this textual comparison of seventeenth-century herbals, I show in detail that most of the descriptions and medicinal uses of English herbs included in Culpeper’s small folio The English Physitian (1652) and its enlargement of the following year were lifted straight out of the works of John Parkinson, apothecary. This was a deliberate act by Culpeper, to make available to the people of England the best information on native plant medicines for use in treating their illnesses. He attacked the College of Physicians of London, whom the great majority of the population could not afford to engage, for trying to keep this knowledge secret. Among later historians of the herbal tradition, Culpeper’s work was not accorded the same status as the great English herbals of William Turner, John Gerard, and John Parkinson, not because this borrowing was recognised but because its astrological content worked to divert attention from the quality and source of much of its guidance on treatment. Even contemporaries of Culpeper did not recognise the extent of the borrowing. Comparisons also reveal the limitations of Culpeper’s powers of plant description and his lack of interest in the developing science of botany. The editorial decisions Culpeper made to reduce a great folio herbal to a much smaller book to be sold for 3d touch on domestic and other non-medical uses, while points of discussion common to both authors such as the doctrine of signatures and superstitious beliefs about plants are explored.

Premodern medicine used a variety of mineral substances for therapeutic purposes. The present article deals with pitch-asphalt, and, in particular, a precious kind of it called mūmiyāʾ originating in Persia. It was first described in detail in the Arabic pharmacological tradition, and its fame spread throughout the medieval Mediterranean, including Byzantium. By editing and examining for the first time a previously unexplored medieval Greek text on mūmiyāʾ, this study offers new insights into the medicinal uses of this substance. It also significantly increases our understanding of the intense cross-cultural transfer of medical knowledge from the Islamicate world to Byzantium by showing that this was not merely based on the translation of a few Arabic medical works into Greek, but was a multifaceted phenomenon involving a complex nexus of sources that require further investigation.

The article, ‘Have we lost sleep? A reconsideration of segmented sleep in early modern England’, Medical History, 67, 2 (2023), 91–108, by Niall Boyce is devoted to criticising my historical research pertaining to 1) the predominance of segmented sleep in the pre-industrial Western world and 2) the nineteenth-century transition of sleep to today’s pattern of continuous slumber that most people in modern societies seek to achieve, albeit not always successfully. This response addresses Boyce’s reinterpretation of the evidence and indicates whether this is erroneous or selective. My analysis thereby reasserts the predominance of segmented sleep in pre-modern Western Europe. Boyce’s assessment rests not on his original investigation of primary sources but on my first study relating to segmented sleep, published in 2001. Not least of the flaws of ‘Have We Lost Sleep?’ is its surprising inattention to my subsequent works that have expanded, modified, and bolstered this initial publication.

This article reconstructs the first outbreak of epidemic dropsy recorded in documentary evidence, which occurred in Calcutta, Mauritius, and northeastern India and Bengal in 1877–80. It uses current medical knowledge and investigations into the wider historical contexts in which the epidemic occurred to re-read the colonial medical literature of the period. It shows that colonial policies and structures in the context of variable enviro-climatic conditions increased the likelihood that an epidemic would break out, while also increasing the vulnerability of certain populations to infection and mortality. Additionally, it shows how the trans-regional nature of the epidemic contributed to varying understandings of the disease between two colonial medical establishments, which influenced each other in contradictory ways. The article’s core contributions are to recent trans-regional perspectives on disease transmission and colonial medical knowledge production in the Indian Ocean World.

This article provides an overview of the historiography of medical education and calls for greater attention to the connections between medical schools. It begins by reviewing research on medical education in imperial metropoles. Researchers have compared medical schools in different national contexts, traced travellers between them or examined the hierarchies that medical education created within the medical profession. The article then shows how historians have emphasised the ways in which medicine in colonial empires was shaped by negotiation, exchange, hybridisation and competition. The final part of the article introduces the special issue ‘Medical Education in Empires’. Drawing on a variety of sources in English, French, Dutch and Chinese, the special issue builds on these historiographies by juxtaposing cases of medical schools in imperial contexts since the eighteenth century. It considers who funded these medical schools and why, what models of medicine underpinned their creation, what social changes they contributed to, what life was like in these schools, who the students and teachers were and what graduates did with their medical careers. This special issue thus contributes to clarifying the role of medical education in empires and the long-term impact of empires on the medical world.

While larger British colonies in Africa and Asia generally had their own medical services, the British took a different approach in the South Pacific by working with other colonial administrations. Together, colonial administrations of the South Pacific operated a centralised medical service based on the existing system of Native Medical Practitioners in Fiji. The cornerstone of this system was the Central Medical School, established in 1928. Various actors converged on the school despite its apparent isolation from global centres of power. It was run by the colonial government of Fiji, staffed by British-trained tutors, attended by students from twelve colonies, funded and supervised by the Rockefeller Foundation, and jointly managed by the colonial administrations of Britain, Australia, New Zealand, France and the United States. At the time of its establishment, it was seen as an experiment in international cooperation, to the point that the High Commissioner for the Western Pacific called it a ‘microcosm of the Pacific’. Why did the British establish an intercolonial medical school in Oceania, so far from the imperial metropole? How did the medical curriculum at the Central Medical School standardise to meet the imperial norm? And in what ways did colonial encounters occur at the Central Medical School? This article provides answers to these questions by comparing archival documents acquired from five countries. In doing so, this article will pay special attention to the ways in which this medical training institution enabled enduring intercolonial encounters in the Pacific Islands.

In the early nineteenth century, medical schools became a growing means of regulating medicine in the British Empire, both in the metropole and in two colonies: India and Canada. By examining the establishment of medical schools in Calcutta, Bombay, Madras, Quebec City, Montreal and Toronto between the end of the Seven Years’ War and the beginning of the Victorian era, this article argues that the rise of the British Empire was a key factor in the gradual replacement of private medical apprenticeships with institutional medical education. Although the imperial state did not implement a uniform medical policy across the British Empire, the medical schools established under its jurisdiction were instrumental in devising a curriculum that emphasised human dissection, bedside training in hospitals and organic chemistry as criteria of medical competence.

Doctors have played an important role in the development of health institutions in Latin America. However, they are not the only profession that has had a voice in these matters. There are also other factors influencing the development of ministries of health. This issue has gone unnoticed in the literature. This article suggests that it is possible to identify two distinct trends in the creation of health ministries in Latin America. The first, of an early nature, was seen principally in Central America and the Caribbean in countries dependent on or under the influence of the United States which, from the 1880s, promoted health Pan-Americanism. The second trend, which became apparent from 1924, was characterised by the emergence of ministries in a context of institutional breakdown and the appearance of new actors (military or populist leaders). This second trend was first seen in Chile in 1924. This article analyses the creation of the Ministerio de Higiene, Asistencia y Previsión Social (Ministry of Hygiene, Assistance and Social Security) in Chile in 1924 and its subsequent development through to 1931. The analysis looks at the health measures adopted, the context in which this occurred and the debates triggered by the ministry’s process of institutional development, based on parliamentary discussions, presidential speeches, official statistics, legislation, documents prepared by key actors and the press of the time.

This paper reexamines the sources used by N. Fancy and M.H. Green in “Plague and the Fall of Baghdad (1258)” (Medical History, 65/2 (2021), 157–177). Fancy and Green argued that the Arabic and Persian descriptions of the Mongol sieges in Iran and Iraq, and in particular, in the conquest of Baghdad in 1258, indicate that the besieged fortresses and cities were struck by Plague after the Mongol sieges were lifted. This, they suggested, is part of a recurrent pattern of the outbreak of Plague transmitted by the Mongol expansion across Eurasia. Fancy and Green concluded that the primary sources substantiate the theory driven by recent paleogenetic studies indicating that the Mongol conquests of the thirteenth century set the stage for the massive pandemic of the mid-fourteenth century. The link between the Plague outbreak and the Mongol siege of Baghdad relies on three near-contemporaneous historical accounts. However, our re-examination of the sources shows that the main text (in Persian) has been significantly misunderstood, and that the two other texts (in Syriac and Arabic) have been mis-contextualized, and thus not understood properly. They do not support the authors’ claim regarding Plague epidemic in Baghdad in 1258, nor do other contemporary and later Arabic texts from Syria and Egypt adduced by them, which we re-examine in detail here. We conclude that there is no evidence for the appearance of Plague during or immediately after the Mongol conquests in the Middle East, certainly not for its transmission by the Mongols.

Existing scholarship on prison diets has emphasised the role of food and its restriction as a key aspect of the deterrent system of prison discipline introduced in the 1860s. Here we suggest that a strong emphasis was placed on dietary regulation after the establishment of the reformist, but also ‘testing’, separate system of confinement in the mid-nineteenth century. While the impact of diet on the physical health of prisoners was a major concern, we argue that the psychological impact of food was also stressed, and some prison administrators and doctors argued that diet had an important protective function in preserving inmates’ mental wellbeing. Drawing on a wide range of prison archives and official reports, this article explores the crucial role of prison medical officers in England and Ireland in implementing prison dietaries. It highlights the importance and high level of individual adaptations to dietary scales laid down centrally, as a means of utilising diet as a tool of discipline or as an intervention to improve prisoners’ health. It examines the forays of some prison doctors into dietary experiments, as they investigated the impact of different dietaries or made more quotidian adjustments to food intake, based on local conditions and food supplies. The article concludes that, despite central policies geared to establishing uniformity and interest in new scientific discourses on nutrition, a wide range of practices were pursued in individual prisons, mostly shaped by practical rather than scientific factors, with many prison medical officers asserting their autonomy in making dietary adjustments.

In 1851, the colonial administration of the Dutch East Indies established a two-year program to educate young Javanese men to become vaccinators in Batavia (today’s Jakarta). During the following sixty years, the medical curriculum was expanded several times; in 1913, it consisted of a ten-year program. In 1927, the Batavia Medical School, granting degrees equivalent to those of Dutch university-affiliated medical schools, commenced operations. Consequently, a steadily increasing number of Indonesian physicians with various credentials were employed by the colonial health service, plantations, sugar factories and mines, or established private practices. They became a social group that occupied an ambiguous and even paradoxical position somewhere between Europeans and the indigenous population. During the 1910s, this inspired these physicians to obtain credentials and professional recognition equal to those of their European colleagues. Several of them became active in journalism, politics and social movements. During the 1920s, several became radicalised and criticised the nature of colonial society. In the 1930s, following the increasingly repressive nature of colonial society, most of them remained active in the public sphere while a small group dedicated itself to improving medical research and health care. After the transfer of sovereignty from the Netherlands to Indonesia on 27 December 1949, this small cadre reestablished medical education and health care, and built the Indonesian medical profession.

This article examines the care provided for the welfare of soldiers by the three combatant countries – China, Korea and Japan – during the East Asian War of 1592–8. Also known as the Imjin War, this large-scale military conflict can also be understood as an encounter between different state cultures and strategies of military medicine. This study focuses on cold-induced injuries, epidemic outbreaks and external wounds suffered during the war. I illuminate provision of prophylactic measures against cold by the Ming state, as well as attempts by the Sino-Chosŏn medical alliance to manage epidemics and treat wounded soldiers. I contrast these measures with the lack of similar centralised support for the Japanese forces, and examine the effect these differences had upon on military outcomes during the war. The difference in the amount of time, efforts and resources that the three combatant states devoted to sick and injured soldiers has implications not only for our understanding of the war but also for illuminating the early modern history of military medicine in East Asia. By exploring East Asian military medicine during and after the Imjin War, this article responds to recent calls for more detailed examination of histories of military medicine in premodern periods and non-European regions.

This article examines some of the racist features of nineteenth-century medical school curricula in the United States and the imperial networks necessary to acquire the data and specimens that underpinned this part of medical education, which established hierarchies between human races and their relationship to the natural environment. It shows how, in a world increasingly linked by trade and colonialism, medical schools were founded in the United States and grew as the country developed its own imperial ambitions. Taking advantage of the global reach of empires, a number of medical professors in different states, such as Daniel Drake, Josiah Nott and John Collins Warren, who donated his anatomical collection to Harvard Medical School on his retirement in 1847, began to develop racial theories that naturalised slavery and emerging imperialism as part of their medical teaching.

This article is the first scholarly research focusing exclusively on the history of Jews with disabilities in the Kingdom of Poland from the 1860s to 1914. It analyses sources drawn from the Jewish press in Yiddish, Polish, and Hebrew. Areas of investigation include the hierarchy of attitudes towards different categories of individuals with disabilities, spiritual perspectives on disability, and the portrayal of disabilities within Jewish literature. The study places particular emphasis on the Jewish deaf community, given the proliferation of available source material. Drawing on the broad conceptual framework of disability studies, the authors examine the phenomenon of medicalisation, tracing its influence on Jewish public discourse over the latter half of the nineteenth century and the early decades of the twentieth.