For the World Health Organization (WHO), the 1978 Alma-Ata Declaration marked a move away from the disease-specific and technologically-focused programmes of the 1950s and 1960s towards a reimagined strategy to provide ‘Health for All by the Year 2000’. This new approach was centred on primary health care, a vision based on acceptable methods and appropriate technologies, devised in collaboration with communities and dependent on their full participation. Since 1948, the WHO had used mass communications strategies to publicise its initiatives and shape public attitudes, and the policy shift in the 1970s required a new visual strategy. In this context, community health workers (CHWs) played a central role as key visual identifiers of Health for All. This article examines a period of picturing and public information work on the part of the WHO regarding CHWs. It sets out to understand how the visual politics of the WHO changed to accommodate PHC as a new priority programme from the 1970s onwards. The argument tracks attempts to define CHWs and examines the techniques employed by the WHO during the 1970s and early 1980s to promote the concept to different audiences around the world. It then moves to explore how the process was evaluated, as well as the difficulties in procuring fresh imagery. Finally, the article traces these representations through the 1980s, when community approaches came under sustained pressure from external and internal factors and imagery took on the supplementary role of defending the concept.

Restoration London saw a wave of publications by physicians advocating that the ‘compleat physician’ should be one who experimented and produced his own medicines. Only thus, they argued, could the medical hierarchy be restored and medical authority re-established on a defensible basis. This article seeks to explain the context for this unusual approach, and why it failed to attract mainstream physicians by the end of the century, by considering the sixty-year career of one of its leading advocates, Everard Maynwaring (c.1629–1713), a prolific medical author, and what his own failure to enter the medical establishment may show about the problems inherent in this model for the physician. A university-trained gentleman physician who converted to chymical medicine c.1660, Maynwaring published learned and relatively unpolemical texts to persuade both medical and lay audiences of the superiority of experimental medicine as a mode of learned practice, yet could not easily reconcile this with the advocacy and sale of his own chymical medicines (especially as he focused increasingly on a small group of ‘universal medicines’) without being branded an ‘empirick’. Fragmentary evidence regarding his career suggests he became increasingly marginalised, and as an old man was reduced to advertising his cures like the ‘empiricks’ from whom he had sought to distance both himself and physicians in general.

After his abdication in November 1918, the German emperor Wilhelm II continued to haunt the minds of his people. With the abolition of the lese-majesty laws in the new republic, many topics that were only discussed privately or obliquely before could now be broached openly. One of these topics was the mental state of the exiled Kaiser. Numerous psychiatrists, physicians and laypeople published their diagnoses of Wilhelm in high-circulation newspaper articles, pamphlets, and books shortly after the end of the war. Whether these diagnoses were accurate and whether the Kaiser really was mentally ill became the issue of a heated debate.

This article situates these diagnoses of Wilhelm II in their political context. The authors of these diagnoses – none of whom had met or examined Wilhelm II in person – came from all political camps and they wrote with very different motives in mind. Diagnosing the exiled Kaiser as mentally ill was a kind of exorcism of the Hohenzollern rule, opening the way for either a socialist republic or the hoped-for rule of a new leader. But more importantly, it was a way to discuss and allocate political responsibility and culpability. Psychiatric diagnoses were used to exonerate both the Emperor (for whom the treaty of Versailles provided a tribunal as war criminal) and the German nation. They were also used to blame the Kaiser’s entourage and groups that had allegedly manipulated the weak-willed monarch. Medical concepts became a vehicle for a debate on the key political questions in interwar Germany.

This article examines the changing nature of public health services and their relationship with the public in post-war Britain by an analysis of the exhibitions mounted by Medical Officers of Health (MOsH) in London. Focusing on the period 1948–71, the article explores a time when public health practice, and the problems it faced, were in flux. A decline in infectious disease and an increase in chronic conditions linked to lifestyle required a new role for public health services. Exhibitions were one of several methods that MOsH used to inform the public about dangers to their health, but also to persuade them to change their behaviour. The exhibition, though, offers a unique insight into the relationship between public health authorities and the public, as exhibitions brought MOsH into direct contact with people. It is suggested that in the MOsH exhibitions we can find signs of a new relationship between public health practitioners and the public. Whilst elements of the pre-war, often moralistic ideology of public health services could still be detected, there is also evidence of a more nuanced, responsive dynamic between practitioners and the people. By the end of the 1960s, ‘the public’ was increasingly being thought of as a collection of ‘publics’, including individuals, target groups and vocal respondents.

The presence of children in English voluntary hospitals during the eighteenth century has only recently come under academic scrutiny. This research examines the surviving admission records of the London Hospital, which consistently record inpatient ages, to illuminate the hospital stays of infant and child patients and examine the morbidity of children during the long eighteenth century. Traumatic cases were the most common category of admission. The proportion of trauma cases admitted to the London Hospital was higher than in provincial English child patient cohorts, potentially reflecting the differential risks faced by rural and urban children. In most cases of traumatic injury the inpatients stayed in hospital long enough for significant fracture healing to have occurred. Understanding the conditions surrounding children’s admission to hospital, their length of stay, the result of their stay, and which medical issues drove their parents or guardians to seek medical attention for them are critical to illuminating the morbidity of children during the long eighteenth century.

This article explores the programme of national health planning carried out in the 1960s in West and Central Africa by the World Health Organization (WHO), in collaboration with the United States Agency for International Development (USAID). Health plans were intended as integral aspects of economic development planning in five newly independent countries: Gabon, Liberia, Mali, Niger and Sierra Leone. We begin by showing that this episode is treated only superficially in the existing WHO historiography, then introduce some relevant critical literature on the history of development planning. Next we outline the context for health planning, noting: the opportunities which independence from colonial control offered to international development agencies; the WHO’s limited capacity in Africa; and its preliminary efforts to avoid imposing Western values or partisan views of health system organisation. Our analysis of the plans themselves suggests they lacked the necessary administrative and statistical capacity properly to gauge local needs, while the absence of significant financial resources meant that they proposed little more than augmentation of existing structures. By the late 1960s optimism gave way to disappointment as it became apparent that implementation had been minimal. We describe the ensuing conflict within WHO over programme evaluation and ongoing expenditure, which exposed differences of opinion between African and American officials over approaches to international health aid. We conclude with a discussion of how the plans set in train longer processes of development planning, and, perhaps less desirably, gave bureaucratic shape to the post-colonial state.

The onset of nuclear warfare in Hiroshima and Nagasaki had far-reaching implications for the world of medicine. The study of the A-bomb and its implications led to the launching of new fields and avenues of research, most notably in genetics and radiation studies. Far less understood and under-studied was the impact of nuclear research on psychiatric medicine. Psychological research, however, was a major focus of post-war military and civilian research into the bomb. This research and the perceived revolutionary impact of atomic energy and warfare on society, this paper argues, played an important role in the global development of post-war psychiatry. Focusing on psychiatrists in North America, Japan and the United Nations, this paper examines the reaction of the profession to the nuclear age from the early post-war period to the mid 1960s. The way psychiatric medicine related to atomic issues, I argue, shifted significantly between the immediate post-war period and the 1960s. While the early post-war psychiatrists sought to help society deal with and adjust to the new nuclear reality, later psychiatrists moved towards a more radical position that sought to resist the establishment’s efforts to normalise the bomb and nuclear energy. This shift had important consequences for research into the psychological trauma suffered by victims of nuclear warfare, which, ultimately, together with other research into the impact of war and systematic violence, led to our current understanding of Post-Traumatic Stress Disorder (PTSD).

This article focuses on the consolidation of naval hygiene practices during the Victorian era, a period of profound medical change that coincided with the fleet’s transition from sail to steam. The ironclads of the mid- to late- nineteenth century offered ample opportunities to improve preventive medicine at sea, and surgeons capitalised on new steam technologies to provide cleaner, dryer, and airier surroundings below decks. Such efforts reflected the sanitarian idealism of naval medicine in this period, inherited from the eighteenth-century pioneers of the discipline. Yet, despite the scientific thrust of Victorian naval medicine, with its emphasis on collecting measurements and collating statistics, consensus about the causes of disease eluded practitioners. It proved almost impossible to eradicate sickness at sea, and the enclosed nature of naval vessels showed the limitations – rather than the promise – of attempting to enforce absolute environmental controls. Nonetheless, sanitarian ideology prevailed throughout the steam age, and the hygienic reforms enacted throughout the fleet showed some of the same successes that attended the public health movement on land. It was thus despite shifting ideas about disease and new methods of investigation that naval medicine remained wedded to its sanitarian roots until the close of the nineteenth century.

Never before the nineteenth century had Europeans, especially in the south, adopted cordons sanitaires in such great numbers or at such a fast rate. This article aims to analyse the process of the rationalisation and militarisation of the cordons sanitaires imposed in the fight against epidemics during the nineteenth century on the Mediterranean island of Majorca (Spain). These cordons should be understood as a declaration of war by the authorities on emerging epidemics. Epidemics could generate sudden and intolerably high rises in mortality that the new liberal citizenship found unacceptable. Toleration of this type of measure was the result of a general consensus, with hardly any opposition, which not only obtained the support of scientists (especially in the field of medicine) but also of most of the local and provincial political elite, and even of the population at large.

This article examines the case files of patients diagnosed with Transvestitismus [transvestism] in the Psychiatric Clinic of the Helsinki University Central Hospital in the years 1954–68. These individuals did not only want to cross-dress, but also had a strong feeling of being of a different sex from their assigned one. The scientific concept of transsexuality had begun to take form, and this knowledge reached Finland in phases. The case files of the transvestism patients show that they were highly aware of their condition and were very capable of describing it, even if they had no medical name for it. Psychiatrists were willing to engage in dialogue with the patients, and did not treat them as passive objects of study. Although some patients felt that they had been helped, many left the institution as frustrated, angered or desperate as before. They had sought medical help in the hope of having their bodies altered to correspond to their identity, but the Clinic psychiatrists insisted on seeing the problem in psychiatric terms and did not recommend surgical or hormonal treatments in most cases. This attitude would gradually change over the course of the 1970s and 1980s.

‘Medicalisation’ of same sex relations is a phenomenon that reached its peak in the 1950s and 1960s. The rise of gay liberation produced a divisive political contest with the psychiatric profession and adherents of the orthodox ‘medical model’ in the United States and – to a lesser extent – in the United Kingdom. This socio-historical process occurred throughout the English-speaking world, but much less is known about its dynamics in smaller countries such as New Zealand where the historiography on this issue is very sparse. The methodology situates New Zealand within a transnational framework to explore the circulation of medical theories and the critical responses they were met with. The article is anchored around three key local moments in the 1970s to consider the changing terrain on which ideas about homosexuality and psychiatry were constantly rearranged during this decade. This power struggle took a number of twists and turns, and the drive toward medicalisation alternated with a new impetus to de-medicalise same-sex sexuality.

The increase in road traffic accidents in twentieth-century Britain brought with it a rise in the number of patients admitted to hospital with blunt, non-penetrating head injuries. Patients who had suffered mild to moderate trauma typically complained of a variety of problems, including headaches, dizziness and giddiness. For the neurologists tasked with diagnosing and treating these patients, such symptoms proved difficult to assess and liable to obscure the clinical picture. This article focuses on why neurologists turned to time as a diagnostic-tool in helping to resolve these issues, specifically the measurement of post-traumatic amnesia (PTA). This article argues that PTA became so central to neurological diagnosis owing to a set of epistemic, professional and material factors in the decades prior to the Second World War. It concludes with a call for deeper appreciation of the range of issues that contribute to the shaping of medical theories of head trauma.

Histories of twentieth-century surgery have focused on surgical ‘firsts’ – dramatic tales of revolutionary procedures. The history of tonsillectomy is less glamorous, but more widespread, representing the experience and understanding of medicine for hundreds of children, parents and surgeons daily. At the start of the twentieth century, tonsillectomy was routine – performed on at least 80 000 schoolchildren each year in Britain. However, by the 1980s, public and professional discourse condemned the operation as a ‘dangerous fad’. This profound shift in the medical, political and social position of tonsillectomy rested upon several factors: changes in the organisation of medical institutions and national health care; changes in medical technologies and the criteria by which they are judged; the political, cultural and economic context of Britain; and the social role of the patient. Tonsillectomy was not a mere passive subject of external influences, but became a potent concept in medical, political, and social discourse. Therefore, it reciprocally influenced these discourses and subsequently the development of twentieth-century British medicine. These complex interactions between ‘medical’ and ‘non-medical’ spheres question the possibility of demarcating what is internal from what is external to medicine.

Therapy is not simply a domain or form of medical practice, but also a metaphor for and a performance of medicine, of its functions and status, of its distinctive mode of action upon the world. This article examines medical treatment or therapy (in Russian lechenie), as concept and practice, in what came to be known in Russia as defectology (defektologiia) – the discipline and occupation concerned with the study and care of children with developmental pathologies, disabilities and special needs. Defectology formed an impure, occupationally ambiguous, therapeutic field, which emerged between different types of expertise in the niche populated by children considered ‘difficult to cure’, ‘difficult to teach’, and ‘difficult to discipline’. The article follows the multiple genealogy of defectological therapeutics in the medical, pedagogical and juridical domains, across the late tsarist and early Soviet eras. It argues that the distinctiveness of defectological therapeutics emerged from the tensions between its biomedical, sociopedagogical and moral-juridical framings, resulting in ambiguous hybrid forms, in which medical treatment strategically interlaced with education or upbringing, on the one hand, and moral correction, on the other.

During the Chinese Cultural Revolution (1966–76), Chairman Mao fundamentally reformed medicine so that rural people received medical care. His new medical model has been variously characterised as: revolutionary Maoist medicine, a revitalised form of Chinese medicine; and the final conquest by Western medicine. This paper finds that instead of Mao’s vision of a new ‘revolutionary medicine’, there was a new medical synthesis that drew from the Maoist ideal and Western and Chinese traditions, but fundamentally differed from all of them. Maoist medicine’s ultimate aim was doctors as peasant carers. However, rural people and local governments valued treatment expertise, causing divergence from this ideal. As a result, Western and elite Chinese medical doctors sent to the countryside for rehabilitation were preferable to barefoot doctors and received rural support. Initially Western-trained physicians belittled elite Chinese doctors, and both looked down on barefoot doctors and indigenous herbalists and acupuncturists. However, the levelling effect of terrible rural conditions made these diverse conceptions of the doctor closer during the Cultural Revolution. Thus, urban doctors and rural medical practitioners developed a symbiotic relationship: barefoot doctors provided political protection and local knowledge for urban doctors; urban doctors’ provided expertise and a medical apprenticeship for barefoot doctors; and both counted on the local medical knowledge of indigenous healers. This fragile conceptual nexus had fallen apart by the end of the Maoist era (1976), but the evidence of new medical syntheses shows the diverse range of alliances that become possible under the rubric of ‘revolutionary medicine’.

This article interrogates the complicated understanding of sectarianism in institutional cultures in late-nineteenth-century England through an examination of the practice of religion in the daily life of hospital wards in voluntary hospitals. Voluntary hospitals prided themselves on their identity as philanthropic institutions free from sectarian practices. The public accusation of sectarianism against University College Hospital triggered a series of responses that suggests that hospital practices reflected and reinforced an acceptable degree of ‘tolerable intolerance’. The debates this incident prompted help us to interrogate the meaning of sectarianism in late nineteenth-century England. How was sectarianism understood? Why was it so important for voluntary institutions to appear free from sectarian influences? How did the responses to claims of sectarian attitudes influence the actions of the male governors, administrators and medical staff of voluntary hospitals? The contradictory meanings of sectarianism are examined in three interrelated themes: the patient, daily life on the wards and hospital funding. The broader debates that arose from the threat of ‘sectarianism in hospital’ uncovers the extent to which religious practices were ingrained in hospital spaces throughout England and remained so long afterwards. Despite the increasing medicalisation and secularisation of hospital spaces, religious practices and symbols were embedded in the daily life of voluntary hospitals.

The 1899/1900 arrival of bubonic plague in Argentina had thrown the model status of Buenos Aires as a hygienic city into crisis. Where the idea of foreign threats and imported epidemics had dominated the thinking of Argentina’s sanitarians at that time, plague renewed concerns about hidden threats within the fabric of the capital’s dense environment; concerns that led to new sanitary measures and unprecedented rat-campaigns supported by the large-scale application of sulphur dioxide. The article tells the story of early twentieth-century urban sanitation in Buenos Aires through the lens of a new industrial disinfection apparatus. The Aparato Marot, also known as Sulfurozador was acquired and integrated in the capital’s sanitary administration by the epidemiologist José Penna in 1906 to materialise two key lessons learned from plague. First, the machine was supposed to translate the successful disinfection practices of global maritime sanitation into urban epidemic control in Argentina. Second, the machine’s design enabled public health authorities to reinvigorate a traditional hygienic concern for the entirety of the city’s terrain. While the Sulfurozador offered effective destruction of rats, it promised also a comprehensive – and utopian – disinfection of the whole city, freeing it from all imaginable pathogens, insects as well as rodents. In 1910, the successful introduction of the Sulfurozador encouraged Argentina’s medico-political elite to introduce a new principle of ‘general prophylaxis’. This article places the apparatus as a technological modernisation of traditional sanitary practices in the bacteriological age, which preserved the urban environment – ‘el terreno’ – as a principal site of intervention. Thus, the Sulfurozador allowed the ‘higienistas’ to sustain a long-standing utopian vision of all-encompassing social, bodily and political hygiene into the twentieth century.

This paper examines the experiences of women in one professional organisation – the British Medical Association in Australia – during a significant period in the development of such bodies. In doing so it offers an opportunity to consider the relationship between professional societies and the construction of a gendered profession. For the medical profession in particular the time-frame of this study, from the 1880s to the 1930s, has been regarded by scholars as especially important. In this period various features of medical professionalism came to prominence: the status and authority of doctors, the processes of formally registering medical credentials, and the scope and cohesiveness of professional associations. Taking the third of these themes, the current paper extends previous analyses by uniting gender with history and medicine as the central point of examination, in order to evaluate the changing and contested positions of women within the profession. In this way we not only demonstrate how the history of professional societies can reveal the diverse beliefs and shifting priorities of their members, but also contribute to explaining the remarkable persistence of gendered differences in the medical profession.