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 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.

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.

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.

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.

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.

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.

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 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.

This article examines the presence and influence of the work of Swiss psychiatrist Ludwig Binswanger and existential analysis (Daseinsanalyse) in Spanish psychiatry in the central decades of the 20th century. First, and drawing on various printed and archival sources, it reconstructs the important personal and professional ties that Binswanger maintained with numerous Spanish colleagues and describes the notable dissemination of his work in Spain through bibliographical reviews, scientific events, academic reports, university lectures and translations. Next, it reviews the incorporation of the postulates of existential analysis into the discourse of Spanish psychiatrists and assesses their most elaborate and original contributions to the foundations of ‘anthropological–existential’ psychiatry or the ‘existential–analytical’ interpretation of certain disorders or clinical conditions. And, finally, it tries to clarify the assessment according to which the (inevitable) instrumentalisation of existential analysis in the context of Franco’s Spain first compromised the critical recognition of its true possibilities (and limits) and later contributed to the discrediting of psychopathological research among Spanish psychiatrists.

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.

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.

Henry Rider Haggard, the famed author of adventure romances, wrote the novel Dr. Therne (1898) in response to weakening compulsory smallpox vaccination laws, thus entering one of the most heated debates of the late nineteenth century. With Dr. Therne, Haggard aimed to intervene in the lives of the many working-class anti-vaccinationists who, from the 1850s onwards, mobilised to evade what they perceived as a gross – and targeted – extension of state power at the expense of individual rights. Recovering the novel, which has not yet received scholarly attention from historians of medicine, reveals the way fiction was called upon to change minds during a crucial period of Victorian medicine, one that witnessed a climactic shift in public health intervention. This article will examine the reception of Dr. Therne in various print media – middle-class London papers, medical journals and working-class, anti-vaccinationist publications – to consider some new dynamics of the debate which the disagreement over Haggard’s polemic exposes, including the perceived power of fiction (when properly priced and distributed) to change minds, and the contested role of the evangelical press. Additionally, a discussion of the different iterations of Dr. Therne, and a look at an exceptional anti-vaccinationist response in the form of a competing novel, illustrates that pro- and anti-vaccinationists alike contributed to a moment in late Victorian society when the role of fiction was considered a worthy contender in a debate ostensibly about fact.

From the last decades of the twentieth century, above all, in the more service-oriented post-industrial economies, and in a context of debilitation of public health systems, health care became exponentially profitable, thereby attracting new types of investors. In fact, this new stage entails moving from the commercialisation of health care to its financialisation; that is, medical care becomes just one more financial asset and its price and quality are quoted on the stock exchange. This study intends to participate in the debate initiated by historians of medicine and economic historians with the aim of tracing capitalist traits and market participation in the evolution of health coverage, a process initially promoted by professional doctors who converted their consulting rooms into small clinics and larger hospital companies and which, over time, saw the incorporation of financial capital. In particular, this paper has two specific objectives for the case of Spain. First, to analyse the relationship of collaboration and/or competition between public and private hospitals under democracy and the factors that have conditioned this relationship. Second, to make an initial contribution towards understanding how, in this context, the large private hospital groups have been created in Spain during this period, especially in recent decades with concentration in the hands of financial capital, originating from both the traditional banking sector and investment funds.

This work examines the history of smallpox, a highly infectious and epidemic disease, in Argentina, throughout different governments and public health policies from the nineteenth to the twentieth century. The study focuses on the smallpox vaccine and the social and collective significance of universal immunization. It also analyses the relationship between governments of different political orientations and the international community regarding the production of vaccines and vaccination campaigns from their implementation to the eradication of the disease.

In the late Soviet period, a great deal of research was conducted on older people’s health, with the Institute of Gerontology Academy of Medical Sciences (AMN) USSR in Kyiv spearheading a great deal of this. Of particular interest was older people’s ability to work beyond retirement age, the issue of premature ageing, as well as physical activity, diet and living conditions. Many of these interests came under the concept of ‘gerohygiene’, which also reflected the Soviet Union’s prophylactic approach to eldercare (and healthcare more generally). Discussions about older people and Soviet research on gerohygiene are important for furthering our understanding of ideas around healthy ageing and the Soviet project more generally. The Soviet, and indeed socialist, research on gerohygiene sheds light on ideas around active ageing, premature ageing and work practices for older people. It also shows that the role of old people belonged to the wider Soviet effort of contributing to the communist project and shaping society. In this article, I define and examine the broad concept of ‘gerohygiene’ and then assess how gerohygiene applied to older people’s health in relation to both physical activity and labour.

Paul-Louis Simond’s 1898 experiment demonstrating fleas as the vector of plague is today recognised as one of the breakthrough moments in modern epidemiology, as it established the insect-borne transmission of plague. Providing the first exhaustive examination of primary sources from the Institut Pasteur’s 1897–98 ‘India Mission’, including Simond’s notebooks, experiment carnets and correspondence, and cross-examining this material with colonial medical sources from the first years of the third plague pandemic in British India, the article demonstrates that Simond’s engagement with the question of the propagation of plague was much more complex and ambiguous than the teleological story reproduced in established historical works suggests. On the one hand, the article reveals that the famous 1898 experiment was botched, and that Simond’s misreported its ambiguous findings for the Annales de l’Institut Pasteur. On the other hand, the article shows that, in the course of his ‘India Mission’, Simond framed rats as involved in the propagation of plague irreducibly in their relation to other potential sources of infection and not simply in terms of a parasitological mechanism. The article illuminates Simond’s complex epidemiological reasoning about plague transmission, situating it within its proper colonial and epistemological context, and argues for a new historical gaze on the rat as an ‘epidemiological dividual’, which highlights the relational and contingent nature of epidemiological framings of the animal during the third plague pandemic.

This article examines the emergence of modern psychiatric discourse under the culturally Islamic yet radically secular context of the early Turkish republic (1923-1950). To do so, it focuses on the psychiatric publications of Mazhar Osman [Uzman] (1884-1951), the widely acknowledged “father” of modern Turkish psychiatry; and aims to genealogically trace his scientific project of reconceptualizing ruh, an Arabo-Turkish concept that predominantly refers to transcendental soul, rendering it physiologically within the framework of biological-descriptive psychiatry. The article consequently addresses the elusive and multilayered psychiatric language emerged in Turkey as a result of modern psychiatry’s interventions into a field that was previously defined by religion and indigenous traditions. Attempting to contextualize republican psychiatric discourse within the cultural and socio-political circumstances that has produced it, the article sheds light on how the new psychiatric knowledge propagated by Mazhar Osman was formulated in constitutive contradistinction to religious or traditional discourses, explicitly associating them with the Ottoman past and its alleged backwardness, hence reverberating with the Kemalist project of modern Turkish state building. Furthermore, by focusing on the complexities of the Turkish psychiatric language and the contestations it has generated, the article aims to reflect on the ways in which the Turkish psychiatric language was (and presumably still is) haunted by earlier forms of Islamic knowledge and traditions, despite modern psychiatry’s as well as modern secular state’s systematic and authoritative attempts to erase them for good.

In the years 1947–57, following a turbulent retirement, Ugo Cerletti, the father of electroconvulsive therapy (ECT) (1938), invested his energies in a new audacious project conceived as an extension of his ECT research. Forced to leave the direction of the Sapienza University Clinic, he got funds from the National Research Council of Italy to carry out his experimental activities, and founded a ‘Center for the study of the physiopathology of Electro-shock’ in Rome. The Center was aimed at studying liquid substances extracted from electro-shocked animals’ brains that Cerletti named acroagonine and injected into human patients. Inspired by coeval literature, Cerletti believed that electroshock efficacy was due to stimulating some homeostatic processes in the brain, specifically in the meso-diencephalic area (i.e. involving neuroendocrine response in the hypothalamic–pituitary–adrenal axis). Cerletti’s team wished not only to find these effects, but also to reproduce them. With this hypothesis, that proved ineffective, Cerletti anticipated intuitions on the neuroendocrine effects of ECT and the necessity for the development of psychopharmacology. In this article, I cross-combined previously unexplored archival materials stored at Sapienza University of Rome (‘ES Section’) with established bibliographic and archival sources.

The St Petersburg declaration, signed in 1868, is a milestone in the history of warfare and humanitarian law, as it prohibits the use of explosive bullets, which are considered to cause unnecessary suffering. As this article shows, the framing of this declaration that put suffering at its centre, as well as the development of the humanitarian movement, favoured the birth of a new field of expertise: wound ballistics. The wars that broke out after the declaration was signed are the subject of intense scrutiny, while the advances in weaponry, and notably, the creation by the British of a new expansive bullet, provided physicians with new fields of investigation. Numerous experiments have attempted to reproduce the effects of bullets on different materials, including corpses. Based on numerous medical reports and publications, as well as military archives from France and the United Kingdom, this investigation critically examines the notion of pain, its assessment and its use in the monitoring of war violence. It argues that, paradoxically, the greater attention paid to suffering has resulted in a need to objectify pain. This rationalisation and the quest for the quantification of suffering have not been without bias and have shifted attention away from care and treatment.