Reproductive health in state socialism is usually viewed as an area in which the broader contexts of women’s lives were disregarded. Focusing on expert efforts to reduce premature births, we show that the social aspects of women’s lives received the most attention. In contrast to typical descriptions emphasising technological medicalisation and pharmaceuticalisation, we show that expertise in early socialism was concerned with socio-medical causes of prematurity, particularly work and marriage. The interest in physical work in the 1950s evolved towards a focus on psychological factors in the 1960s and on broader socio-economic conditions in the 1970s. Experts highlighted marital happiness as conducive to healthy birth and considered unwed women more prone to prematurity. By the 1980s, social factors had faded from interest in favour of a bio-medicalised view. Our findings are based on a rigorous comparative analysis of medical journals from Hungary, Poland, Czechoslovakia and East Germany.

The theory that the people of the early modern period slept in well-defined segments of ‘first’ and ‘second’ sleeps has been highly influential in both scholarly literature and mainstream media over the past twenty years. Based on a combination of scientific, anthropological and textual evidence, the segmented sleep theory has been used to illuminate discussions regarding important aspects of early modern nocturnal culture; mainstream media reports, meanwhile, have proposed segmented sleep as a potentially ‘natural’ and healthier alternative to consolidated blocks of sleep. In this article, I re-examine the scientific, anthropological and early modern literary sources behind the segmented sleep theory and ask if the evidence might support other models of early modern sleep that are not characterised by segmentation, while acknowledging that construction of such models is by nature limited and uncertain. I propose a more diverse range of interpretations of early modern texts related to sleep, with important implications for medical and social history and literary scholarship.

This article advances historical understandings of health, veterinary medicine and livestock agriculture by examining how, in mid-twentieth-century Britain, the diseases of livestock were made collectively knowable. During this period, the state extended its gaze beyond a few, highly impactful notifiable diseases to a host of other threats to livestock health. The prime mechanism through which this was achieved was the disease survey. Paralleling wider developments in survey practices, it grew from small interwar beginnings into a hugely expensive, wide-ranging state veterinary project that created a new conception of the nation’s livestock as a geographical aggregation of animals in varying states of health. This article traces the disease survey’s entanglements with dairy cows, farming practices, veterinary professional politics and government agendas. It shows that far from a neutral reflection of reality, surveys both represented and perpetuated specific versions of dairy cow health, varieties of farming practice and visions of the veterinary professional role. At first, their findings proved influential, but over time they found it harder to discipline their increasingly complex human, animal and disease subjects, resulting in unconvincing representations of reality that led ultimately to their marginalization.

Our contributions examine the Norwegian Karl Evang's (1901-1981) and the Dane Halfdan Mahler's (1923-2016) participation in international health co-operation facilitated by the World Health Organization (WHO) in India in the 1950s. While Evang’s was a hectic, but relatively short visit as part of a WHO visiting team of medical scientists in 1953, Mahler’s spanned the entire decade on assignments as WHO medical officer to tuberculosis control projects. Mahler’s name should be familiar to researchers of international health as the Director-General of the WHO 1973-88, and for his promotion of primary health care through the 1978 Alma-Ata Declaration. Evang, Norway’s Director of Health 1938-72, was also a key figure in international health in the mid-twentieth century as one of the original instigators of the WHO, and a participant in much of its early work.

A core theme is the place of social medicine, both in Evang’s and Mahler’s work, and within the WHO and its navigation of complex postcolonial settings in the 1950s. Investigating cross-regional encounters and circulations of social medicine ideas between Evang and Mahler and their Indian interlocutors as well as international WHO staff members, we ask what the role of social medicine was in international health in the early post-war period. Researchers have found that social medicine had its heyday during the 1930s and 1940s, and that a technology-focused, vertical approach became dominant soon after the war. In contrast, we suggest that continued circulation of social medical ideas points towards a more complicated picture.

This article investigates how World Health Organisation (WHO) Director-General Halfdan Mahler’s views on health care were formed by his experience in India between 1951 and 1961. Mahler spent a large part of the 1950s in India assigned as WHO medical officer to tuberculosis control projects. It argues that Mahler took inspiration from the official endorsement of the doctrine of social medicine that prevailed in India; even if it was challenged by an increasing preference for vertical, techno-centric campaigns. It shows how, from the outset, Mahler was remarkably hostile towards the highly skilled, clinically oriented doctors, but embraced prevalent ideas of community participation. It suggests that Mahler – although he remained silent on the issue – was impressed by the importance and resilience of indigenous traditions of medicine, despite hostility from leading political figures. In this way, the article attempts to establish links to Mahler’s advocacy of primary health care in the 1970s. A broad approach to health, scepticism toward clinically oriented doctors, preference for simple technologies and community participation, as well as an accommodating attitude towards indigenous practitioners, were all features of primary health care, which correlate well with views developed by Mahler as he negotiated social medicine in India between 1951 and 1961.

During the interwar period, France put unprecedented efforts into public health measures targeting the colonised populations of sub-Saharan Africa. This investment in health was seen as crucial to ensuring the renewal of the African labour force needed for the economic development of the colonies. Syphilis, although less deadly than other endemic or epidemic diseases such as yellow fever, sleeping sickness and bubonic plague, was one of the most widespread infections in France’s sub-Saharan colonies. This article demonstrates the contradictory nature of the colonial medicine approach to this disease during the interwar years. The negative impact of syphilis on population growth in Africa made it a major threat to the colonial project, and France put significant, costly investment into tackling the disease, focusing its efforts on maternal and child health. However, a closer look at syphilis control in sub-Saharan Africa reveals that the disease was also minimised as a public health issue, under-resourced and downplayed by colonial doctors and administrators. This neglect was embodied in the invention of a new colonial disease, ‘exotic syphilis’, which was presented as being a relatively benign skin disease among the African populations. It was also reflected in care practices, via a form of mass medicine based on the use of blanchiment, which consisted of knowingly limiting treatment to a superficial effect.

The late eighteenth and early nineteenth century witnessed a dramatic increase in the number of pauper lunatics being admitted to institutions and many mentally-ill paupers found their way into workhouses. The range of options existing for the admission of paupers, who at the time were described as lunatics or insane, included private madhouses, charitable asylums, public asylums as well as workhouses. Legislation relating to transfer from a workhouse to a one of these other institutions was ambiguous and depended on the concept of dangerousness and whether a workhouse inmate was manageable, rather than the nature of their illness. Because demand exceeded the space available because of overcrowding, workhouses and public asylums continually needed to increase provision by means of converting existing facilities or erecting new buildings. Nevertheless, the transfer of patients between asylums was commonplace and extensive. This article will explore the interface between two urban workhouses in the West Midlands of England and their local asylums from the late eighteenth until the end of the nineteenth century. It will demonstrate that, although local circumstances at any one time may have contributed to decisions on transfer, the overriding difficulty in the correct placement of pauper lunatics throughout the time period was institutional overcrowding, mainly driven by the increasing numbers of pauper lunatics.

Imagery is an overarching feature of Maximus of Tyre’s Orations which has never been the subject of systematic investigation. This paper provides a starting point by focusing exclusively on medical imagery, one of the most pervasive and instrumental types of imagery in Maximus’ work that has gone entirely unnoticed in the literature to date. This paper shows that Maximus uses medicine (especially its scientific basis and historical development), the physician (e.g. his skill, provision and sensitivity towards the patient), the body (its physiology and workings) and notions of health and disease with considerable diversity and creativity, in ways that make his examples stand out in relation to earlier (Platonic) or contemporary applications of the medical parallel. It argues that the use of the medical imagery in the pedagogical context in which Maximus’ Orations were performed facilitated not just clarity but also concept formation and the shaping of a moral outlook as well as the familiarisation with the proper literary references and verbal and conceptual topoi for admission into the group of the educated elite. Another main thesis is that medical imagery valorises Maximus’ philosophical status and his claims to Imperial-period acculturation, thus functioning as a trademark for the rhetorical philosophy he wished to promote.

In February and March 1953, a WHO Visiting Team of Medical Scientists worked in India, collaborating with local medical students and professionals. This article studies the complexities of early postcolonial international health work and the relations between the young WHO and the newly independent countries, from the position of the team’s vice chairman, Norwegian doctor Karl Evang. While the WHO aimed to create dialogue and interaction, also learning from the host country, the article finds that an equal exchange of views between visitors and hosts was not achieved. The topic pertains to discussions on power and influence in international organisations and governance, development and health work, within a South Asian setting. Studying intellectual exchanges between Evang and his Indian interlocutors sheds light on India’s role as both receptive and generative site of ideas and political practice, contributing to broader debates on the appropriation, refashioning and application of political ideas in independent India. Also, at a time of new directions in international health, and considering Evang’s social medicine conviction, an additional question concerns the role of social medicine. The article underlines the existence of multiple, parallel tracks in international health work, and argues the need to portray international health as a complex mosaic, rather than a step-by-step development. The case has relevance as historians endeavour to make international and global history more diverse, as through Evang we capture parts of a broader international involvement of people and nation states in the WHO and its work in the early post-war period.

In contrast to the well-known stories of the embryotoxic drug, thalidomide, in countries where it was responsible for large numbers of birth defects, there is limited information on its history in India. Its presence before 2002, when the country issued the first marketing licence for a thalidomide-containing preparation, is assumed to be negligible. This article challenges this view by showing that the drug entered the Indian subcontinent through the former Portuguese territory of Goa around 1960. We examine the subsequent development of its distribution, use and regulation in India from the mid-1960s up to the present situation. Colonial legacies are a crucial explanation for the early appearance of thalidomide on the Indian subcontinent. They also influenced its re-emergence as drug for treating leprosy reactions in India after 1965. We identify key actors in this process: the original German producer that delivered thalidomide free of charge, European doctors who worked for international non-governmental organizations, the World Health Organization (WHO), which supported clinical trials and later discouraged the use of the drug, and finally the Indian state institutions that limited its distribution and later quickly opened the way for the private sector to produce and market thalidomide and its analogues. Finally, we discuss the risk of thalidomide-induced birth defects by casting a critical look on the present state of regulatory provisions and the monitoring of birth defects in India.

This article explores missionary medical discourses in three Telugu journals published in the early twentieth century, to analyse how caste pivoted denunciations of alcohol, especially toddy and arrack, in the Madras Presidency and the Hyderabad state. It argues that one women’s missionary journal, Vivekavathi, deployed medical knowledge to formulate subtle and occasionally explicit condemnations of toddy and arrack as unclean and unhealthy substances. The journal relied on universal medical and missionary, British and American knowledge frameworks to mark out Dalits and other marginalised castes as consumers of these local beverages. This stigma was conjured through medical narratives of marginalised castes as lacking in the knowledge of alcohol’s relation to digestion, toddy’s role in ruining maternal and child nutrition, the unhygienic environment of arrack shops and their propensity to ‘alcoholism’. However, this article also traces counter-caste voices who too invoked ‘the power of the universal’ to dispel caste stigma against marginalised castes. While both sets of voices deployed medical ‘enslavement’ to alcohol as an interpretive move, they differed in their social imperatives and political imaginaries, defined in caste terms. This article explores a third set of implications of the term ‘universal’ by analysing global medico-missionary narratives of alcohol in two other Telugu journals. On a methodological plane, this article also pushes for a hybrid reading of what counts for ‘scientific instruction’, where hymns, catechisms, parables and allegories are considered alongside conventional scientific experiments. In that sense, it upholds vernacular missionary publications as an invaluable resource for the social history of medicine.

Nineteenth-century physicians increasingly favoured leeching – the placing of a live leech onto a patient’s skin to stimulate or limit blood flow – as a cure for numerous ailments. As conviction in their therapeutic properties spread, leech therapy dominated European medicine; France imported over fifty million leeches in one year. Demand soon outpaced supply, spawning a lucrative global trade. Over-collection and farming eventually destroyed leech habitats, wreaked environmental havoc and forced European merchants to seek new supply sources. Vast colonies of leeches were found to inhabit the immense wetlands of the Ottoman Empire, which soon became a major exporter of medicinal leeches. Following the Treaty of Balta Liman (1838), the Ottoman state moved to exert control over the lucrative trade, imposing a tax on leech gathering and contracting with tax-farmers (mültezim) to collect the taxes. British diplomats, merchants and other stakeholders protested the imposition of the tax, as had previously happened with the commodification of wildlife; their pursuit of profit led collectors and farmers to over-gather leeches, with catastrophic consequences. By the end of the century, so great had their worth climbed that the leech population faced extinction. This paper situates medicinal leeches as therapeutic actors of history and adopts an interscale approach in formulating the human-leech interaction. It offers a substantive contribution to the history of medicine, in revealing the centrality of leeches to the rise of modern medicine and global trade, but also by making visible their role in shaping imperial diplomacy and worldwide economic markets.

John A. Ryle was Britain’s first professor of Social Medicine. In the 1930s and 1940s, at the peak of his influence, he was a vigorous proponent of social medicine, then a relatively new, if contested, field. This article examines Ryle’s views and activities under three broad headings: What was social medicine? What were Ryle’s politics? Why prioritise medical education? We conclude with the apparent failure of the social medicine project, at least as envisioned by Ryle.

The paper examines the introduction of trained female nurses for the British army men in colonial India between 1888 and 1920. It discusses the genesis of the Indian Nursing Service (INS), including the background and negotiations leading up to its formation, terms of employment, duties and working conditions of the nursing sisters. The memoir of Catharine Grace Loch, who served as the first Chief Lady Superintendent of the service is used extensively to trace the early experiences and challenges of the nursing sisters. The paper primarily argues that the INS being a new service, the colonial government maintained tight control over its functioning, and extreme conservatism in spending, thus retarding the growth of professional army nursing in India. Secondly, in examining the relations between the sisters and the (male) nursing orderlies, sub-medical and medical officers, the paper argues that the inadequate delineation of the nursing sisters’ position in the military medical hierarchy was an important reason for the undermining of their expertise and status. Thirdly, the paper contends that as an all-women service, nursing constituted an important avenue of female agency within the patriarchal colonial establishment, which subjected the sisters to scrutiny both professionally and socially. The paper analyses the resultant conditions and regulations imposed on the sisters – most of them determined by gender and class notions. Finally, the paper discusses the gradual establishment and recognition of the service as an important cornerstone for the health of the army, while highlighting the shortcomings that yet persisted up until 1920.

Guinea worm disease (dracunculiasis) is a debilitating waterborne disease. Once widespread, it is now on the brink of eradication. However, the Guinea Worm Eradication Programme (GWEP), like guinea worm itself, has been under-studied by historians. The GWEP demonstrates an unusual model of eradication, one focused on primary healthcare (PHC), community participation, health education and behavioural change (safe drinking). The PHC movement collided with a waterborne disease, which required rapid but straightforward treatment to prevent transmission, creating a historical space for the emergence of village-based volunteer health workers, as local actors realigned global health policy on a local level. These Village Volunteers placed eradication in the hands of residents of endemic areas, epitomising the participation-focused nature of the GWEP. This participatory mode of eradication highlights the agency of those in endemic areas, who, through volunteering, safe drinking and community self-help, have been the driving force behind dracunculiasis eradication. In the twenty-first century, guinea worm has become firstly a problem of human mobility, as global health has struggled to contain cases in refugees and nomads, and latterly a zoonotic disease, as guinea worm has shifted hosts to become primarily a parasite of dogs. This demonstrates both the potential of One Health approaches and the need for One Health to adopt from PHC and the GWEP a focus on the health of humans and animals in isolated and impoverished areas. Guinea worm demonstrates how the biological and the historical interact, with the GWEP and guinea worm shaping each other over the course of the eradication programme.

This essay aims to situate the emergence of Siddha medicine as a separate medical system in the erstwhile Madras Presidency of colonial India within a broader socio-economic context. Scholars who have worked on Siddha medicine have stressed more on political dimensions like nationalism and sub-nationalism with inadequate attention to the interplay of various (other) factors including contemporary global developments, changes in the attitude of the colonial State and especially to the new promises held by the greater deference shown to indigenous medical systems from the 1920s. If the construction of ‘national medicine’ based on the Sanskrit texts and the accompanying marginalisation of regional texts and practices were the only reasons for the emergence of Siddha medicine as presented by scholars, it leaves open the question as to why this emergence happened only during the third decade of the twentieth century, though the marginalisation processes started during the first decade itself. This paper seeks to find an answer by analysing the formation of Siddha medical identity beyond the frameworks of nationalism and sub-nationalism. Further, it explicates how material factors served as immediate cause along with the other, and more ideational factors related to the rise of the Dravidian political and cultural movement.

The fear of the malingering soldier or veteran has existed in Australia since its first nationwide military venture in South Africa. The establishment of the Repatriation Department in 1917 saw the medical, military and political fields work collectively, to some extent, to support hundreds of thousands of men who returned from their military service wounded or ill. Over the next decades the medical profession occasionally criticised the Repatriation Department’s alleged laxness towards soldier recipients of military pensions, particularly those with less visible war-related psychiatric conditions. In 1963 this reached a crescendo when a group of Australian doctors drew battle lines in the correspondence pages of the Medical Journal of Australia, accusing the Repatriation Department of directing a ‘national scandal’, and provoking responses by both the Minister for Repatriation and the Chairman of the War Pensions Assessment Appeal Tribunal. Although this controversy and its aftermath does allow for closer investigation of the inner workings of the Repatriation Department, the words of the doctors themselves about ‘phony cronies’, ‘deadbeats’ and ‘drongoes’ also reveal how the medical fear of the malingering soldier, and particularly the traumatised soldier-malingerer, lingered into the early 1960s and beyond. This paper will analyse the medical conceptualisation of the traumatised soldier in the 1960s in relation to historical conceptions of malingering, the increasingly tenuous position of psychiatry, as well as the socio-medical ‘sick role’, and will explore possible links with the current soldier and veteran suicide crisis in Australia.

Though the Hippocratic text On the Heart has garnered significant attention in the twentieth and twenty-first centuries from classicists, physicians and historians of medicine alike, no commentary on this important work currently exists. There remain, however, central questions of interpretation concerning a number of important points: in particular, how the author understands the structure and functioning of the heart.

The significance of this text for the history of cardiovascular medicine can be found first in its position as being radically advanced in its portrayal of the inner structure of the heart when compared with any other Hippocratic text. At the same time, the text falls dramatically short of the discoveries of the Alexandrian researchers who studied during the Hellenistic period—that is, around the same period as this text’s likely composition. In addition, this work contains the first extant description of the valves of the heart, and its detailed descriptions of a cuspid valve and the chordae tendineae have led several scholars to imagine that this text even contains evidence of either a systematic dissection of an animal heart or—what seems impossible outside of Alexandria, Egypt at that time—evidence of the dissection of a human heart.

This article intends to provide a full commentary on the text by consolidating, and in some cases correcting, previous interpretive attempts to understand an often referenced, and at times misinterpreted, ancient medical treatise.

Intermittent fever is a historical diagnosis with a contested meaning. Historians have associated it with both benign malaria and severe epidemics during the Early Modern Era and early nineteenth century. Where other older medical diagnoses perished under changing medical paradigms, intermittent fever ‘survived’ into the twentieth century. This article studies the development in how intermittent fever was framed in Denmark between 1826 and 1886 through terminology, clinical symptoms and aetiology. In the 1820s and 1830s, intermittent fever was a broad disease category, which the diagnosis ‘koldfeber’. Danish physicians were inspired by Hippocratic teachings in the early nineteenth century, and patients were seen as having unique constitutions. For that reason, intermittent fevers presented itself as both benign and severe with a broad spectrum of clinical symptoms. As the Parisian school gradually replaced humoral pathology in the mid-nineteenth century, intermittent fever and koldfeber became synonymous for one disease condition with a nosography that resembles modern malaria. The nosography of intermittent fever remained consistent throughout the second half of the nineteenth century. Although intermittent fever was conceptualized as caused by miasmas throughout most of the nineteenth century, the discovery of the Plasmodium parasite in 1880 led to a change in the conceptualization of what miasmas were. The article concludes that the development of how intermittent fever was framed follows the changing scientific paradigms that shaped Danish medicine in the nineteenth century.