This article is the first to explore Norwegian HIV/AIDS policy and activism. Drawing on a range of archival material and oral history interviews, it does this along two lines. First, it analyses how AIDS unfolded in the changing political landscape and health bureaucracy of the 1970s and 1980s. The question is addressed of how AIDS challenged and shaped social medicine, an important ‘thought style’ of the postwar health bureaucracy and an important factor in the creation of the welfare state. Second, the article contributes to a growing AIDS historiography tracing the genealogy of AIDS activism in gay and lesbian health activism in the preceding decades. At the advent of AIDS, formal and informal networks already existed between gay and lesbian communities, activist organisations and the authorities. The roles of gay and lesbian medical professionals and activists are traced, together with how they challenged paternalistic and heteronormative notions of social medicine and homophobic attitudes in the public healthcare system. By having one foot in the medico-political world and one in the queer communities, they were able to mediate and translate different kinds of expertise and knowledge to the authorities, the public and the affected communities. This ‘amphibious’ role gave them credibility with both the authorities and the communities when addressing public health issues and preventive work. However, this story demonstrates that gay AIDS activists were not immune to the reproduction of exclusionary or hierarchical mechanisms within the queer communities. It shows how the juggling of different roles sometimes posed difficult dilemmas for the activists and how challenging but important this amphibiousness was to them.

This article examines how international organisations with mandates in health and development interpret global economic crises and respond to disease. It contributes the perspective of World Bank to emerging scholarship on the various factors leading to the decline of the World Health Organization (WHO) and its Health for All (HFA) mission during structural adjustment. It does so by telling a story of collaboration and conflict between WHO and World Bank’s Population, Health and Nutrition (PHN) Department following the ambitious Alma Ata Declaration in 1978 until the initial global AIDS response. As debt crises emerged in Latin America in the early 1980s, WHO tried to find a way forward for HFA. However, the African crisis of 1985 fractured the international community’s support, causing WHO and PHN to dialogue more closely regarding health sector financing. As AIDS became a global crisis, this culminated in their 1987 joint research on the disease’s macroeconomic and demographic impact. However, observing WHO’s continued hesitance regarding financing and its decision to act as a donor gatekeeper, the Bank ultimately opted to work separately in AIDS. Thus, the themes of the Alma Ata versus Selective Primary Health Care debate of the late 1970s continued throughout the 1980s into the early years of the global AIDS response: a perennial conflict of financing within resource constraints and the appropriate role of donors in the grand project of health and development.

Between 1880 and 1920 the medical quest to unearth the causes of disease saw two pathbreaking discoveries. One was the bacteriological revolution – the identification of specific germs as causal agents of specific diseases (anthrax, tuberculosis, diphtheria, cholera and so on), and the simultaneous effort to develop disinfection techniques and immunisation measures to combat these diseases. The other was the rediscovery of Mendel’s laws of heredity and the resulting emergence of medical genetics, where an entire set of medical maladies (deafness, blindness, bodily deformities, haemophilia, Huntington’s chorea, feeble-mindedness and many mental diseases) were identified – rightly or wrongly – as genetically determined. The ‘germ theory of disease’ and the ‘gene theory of disease’ shared striking, all-too-often overlooked similarities. Both theories built on shared epistemological assumptions that influenced their explanatory mechanisms and their overall conceptual frameworks; both mobilised similar visual and linguistic vocabulary; both appropriated – and enforced – prevailing cultural and gender norms; and both enshrined broadly parallel hygienic practices. Reflecting similar social concerns, medical bacteriology and medical genetics acquired kindred scientific and societal configurations, which this paper highlights and scrutinises.

This special issue uses Catholicism as a thread to bring together five contributions to the transnational history of contraception. The articles, which cover examples from Western and East-Central Europe, East Africa and Latin America, all explore the complex interplay between users and providers of birth control in contexts marked by prevalence of the Catholic religion and/or strong political position of the Catholic Church. In the countries examined here, Brazil, Belgium, Poland, Ireland and Rwanda, Catholicism was the majority religion during the different moments of the long twentieth century the authors of this special issue focus on. Using transnationalism as a perspective to examine the social history of the entanglements between Catholicism and contraception, this special issue seeks to underscore the ways in which individuals and organisations used, adapted and contested local and transnational ideas and debate around family planning. It also examines the role of experts and activist groups in the promotion of family planning, while paying attention to national nuances in Catholic understandings of birth control. The contributions shed light on the motivations behind involvement in birth control activism and expertise, its modus operandi, networking strategies and interactions with men and women demanding contraceptive information and technology. Moreover, through the use of oral history, as well as other print sources such as women’s magazines, this collection of articles seeks to illustrate ‘ordinary’ men and women’s practices in the realm of reproductive health.

The twentieth-century history of men and women’s attempts to gain access to reproductive health services in the Republic of Ireland has been significantly shaped by Ireland’s social and religious context. Although contraception was illegal in Ireland from 1935 to 1979, declining family sizes in this period suggest that many Irish men and women were practising fertility control measures. From the mid-1960s, the contraceptive pill was marketed in Ireland as a ‘cycle regulator’. In order to obtain a prescription for the pill, Irish women would therefore complain to their doctors that they had heavy periods or irregular cycles. However, doing so could mean going against one’s faith, and also depended on finding a sympathetic doctor. The contraceptive pill was heavily prescribed in Ireland during the 1960s and 1970s as it was the only contraceptive available legally, albeit prescribed through ‘coded language’. The pill was critiqued by men and women on both sides of the debate over the legalisation of contraception. Anti-contraception activists argued that the contraceptive pill was an abortifacient, while both anti-contraception activists and feminist campaigners alike drew attention to its perceived health risks. As well as outlining these discussions, the paper also illustrates the importance of medical authority in the era prior to legalisation, and the significance of doctors’ voices in relation to debates around the contraceptive pill. However, in spite of medical authority, it is clear that Irish women exercised significant agency in gaining access to the pill.

At the end of the nineteenth century, the northern port of Liverpool had become the second largest in the United Kingdom. Fast transatlantic steamers to Boston and other American ports exploited this route, increasing the risk of maritime disease epidemics. The 1901–3 epidemic in Liverpool was the last serious smallpox outbreak in Liverpool and was probably seeded from these maritime contacts, which introduced a milder form of the disease that was more difficult to trace because of its long incubation period and occurrence of undiagnosed cases. The characteristics of these epidemics in Boston and Liverpool are described and compared with outbreaks in New York, Glasgow and London between 1900 and 1903. Public health control strategies, notably medical inspection, quarantine and vaccination, differed between the two countries and in both settings were inconsistently applied, often for commercial reasons or due to public unpopularity. As a result, smaller smallpox epidemics spread out from Liverpool until 1905. This paper analyses factors that contributed to this last serious epidemic using the historical epidemiological data available at that time. Though imperfect, these early public health strategies paved the way for better prevention of imported maritime diseases.

An expansive, worldwide smallpox eradication programme (SEP) was announced by the World Health Assembly in 1958, leading this decision-making body to instruct the World Health Organization Headquarters in Geneva to work with WHO regional offices to engage and draw in national governments to ensure success. Tabled by the Soviet Union’s representative and passed by a majority vote by member states, the announcement was subject to intense diplomatic negotiations. This led to the formation, expansion and reshaping of an ambitious and complex campaign that cut across continents and countries. This article examines these inter-twining international, regional and national processes, and challenges long-standing historiographical assumptions about the fight against smallpox only gathering strength from the mid-1960s onwards, after the start of a US-supported programme in western Africa. The evidence presented here suggests a far more complex picture. It shows that although the SEP’s structures grew slowly between 1958 and 1967, a worldwide eradication programme resulted from international negotiations made possible through gains during this period. Significant progress in limiting the incidence of smallpox sustained international collaboration, and justified the prolongation and expansion of activities. Indeed, all of this bore diplomatic and legal processes within the World Health Assembly and WHO that acted as the foundation of the so-called intensified phase of the SEP and the multi-faceted activities that led to the certification of smallpox eradication in 1980.

The first major reorganisation of the National Health Service took place in 1974, twenty-six years after the service had been established. It has long been perceived as a failure. This article draws on archival records and a witness seminar held in November 2016 to provide a more nuanced assessment of the 1974 reorganisation and understand more fully why it took the form that it did. In particular it identifies the reorganisation as an important moment in the ongoing story of management consultants engaging with health policymakers, and explores the role of McKinsey and Co. in detail for the first time. Key explanatory factors for their involvement are identified, including the perceived lack of expertise and manpower inside the civil service and the NHS, and perceptions of their impact and effectiveness are discussed. Many debates about the use of management consultants today were directly foreshadowed during the early 1970s. Alongside this, the role of other groups of policy actors, including civil servants, politicians and medical professionals, are established and the extent to which British health policymakers have had to work within existing cultural, political, legislative and practical constraints when trying to initiate change is demonstrated. The fact that many of the ‘mistakes’ that were made have been repeated in the course of subsequent reforms, speaks to the poor institutional memory of Whitehall, and the Department of Health and Social Care in particular. In the run up to 1974 management consultants could make only a limited contribution to an imperfect compromise.

Over the twentieth century, the Lunacy Office (renamed the Court of Protection in 1947) was responsible for appointing ‘receivers’ to manage the property of adults in England who were found incapable of managing their own affairs. Tens of thousands of people were in this position by the 1920s, and numbers continued to grow until after Second World War. This article uses the archives of the Office to examine the evolution of the concept of mental incapacity over the first half of the twentieth century, offering a corrective to the popular impression that the time before the Mental Capacity Act of 2005 was an era of ignorance and bad practice. It examines the changing ways in which being ‘incapable’ was understood and described, with particular reference to shifting ideas of citizenship. I argue that incapacity was not always seen as absolute or permanent in the first half of the century, that models of incapacity began to include perceived vulnerability in the interwar period and that women in particular were seen in this way. From the 1940s, though, the profile of those found incapable was changing, and the growing welfare state and its principles of employment and universality saw the idea of incapacity narrowing and solidifying around knowledge deficits, especially among the elderly. This brings the history of the Lunacy Office into the twentieth century and connects it to current concerns around assessments of mental capacity today.

This paper examines racial science and its political uses in Southeast Asia. It follows several anthropologists who travelled to east Nusa Tenggara (the Timor Archipelago, including the islands of Timor, Flores and Sumba), where Alfred Russel Wallace had drawn a dividing line between the races of the east and the west of the archipelago. These medically trained anthropologists aimed to find out if the Wallace Line could be more precisely defined with measurements of the human body. The paper shows how anthropologists failed to find definite markers to quantify the difference between Malay and Papuan/Melanesian. This, however, did not diminish the conceptual power of the Wallace Line, as the idea of a boundary between Malays and Papuans was taken up in the political arena during the West New Guinea dispute and was employed as a political tool by all parties involved. It shows how colonial and racial concepts can be appropriated by local actors and dismissed or emphasised depending on political perspectives.

The birth of Louise Brown, the world’s first ‘test-tube baby’, has come to signify the moment at which technologically assisted human reproduction became a re ality. This was a highly mediated and visible reality, as this article explores through the example of a British television documentary about Louise Brown broadcast when she was just six weeks old, ‘To Mrs Brown… A Daughter’ (Thames Television, 1978). In the article, I discuss the programme alongside data from an interview with its producer, Peter Williams. Williams sought to convince the public that IVF was morally acceptable and to cultivate sympathy for the infertile through this film. I will consider how he went about this by focusing on the programme’s visual presentation of Louise Brown, Peter Williams’ aims in making the film and his sympathetic relationship with the ‘pioneers’ of IVF, gynaecologist Patrick Steptoe and physiologist Robert Edwards. I will conclude with a discussion of the political implications of this film and how it contributed to the normalisation of IVF at a pivotal moment in its history.

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.

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.

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.

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.

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.

This article examines how a branch of medicine based within the criminal justice system responded to a society which by the 1970s and 1980s was increasingly critical of the prison system and medical authority. The Prison Medical Service, responsible for the health care of prisoners in England and Wales, was criticised by prison campaigners and doctors alike for being unethical, isolated, secretive, and beholden to the interests of the Home Office rather than those of their patients. While prison doctors responded defensively to criticisms in the 1970s and 1980s, comparing their own standards of practice favourably with those found in the NHS, and arguing that doctors from outside would struggle to cope in the prison environment, by 1985 their attitudes had changed. Giving evidence to a House of Commons committee, prison doctors displayed a much greater willingness to discuss how the prison system made their work more difficult, and expressed a pronounced desire to engage openly with the rest of the profession to address these problems. The change of attitude partly reflects a desire by the Home Secretary William Whitelaw to make the Prison Service more open, and an acceptance of a need for greater accountability in medicine generally. Most important, however, was a greater interest in prison health care and appreciation of the difficulties of prison practice among the wider medical profession, encouraging prison doctors to speak out. This provides a case study of how a professional group could engage openly with criticisms of their work under favourable circumstances.

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.