This article discusses the medicinal remedies consumed at the court of the Yorkist kings of England in the light of a lawsuit in the court of common pleas (edited in an appendix) between John Clerk, king’s apothecary to Edward IV, and Katherine Neville, Duchess of Norfolk, over the partial non-payment of the apothecary’s bills. It argues that the consumption of apothecaries’ wares in large quantities was not merely a direct result of the excessive diet of the late medieval aristocracy, but in itself represented a facet of the conspicuous consumption inherent in the lifestyle of this particular social class. The remedies supplied by Clerk over a period of several years and listed in the legal record are set in the context of contemporary collections of medical recipes, particularly a ‘dispensary’ in the British Library’s Harleian collection generally attributed to the king’s apothecary.

This article provides a new consideration of how Thomas Willis (1621–75) came to write the first works of ‘neurology’, which was in its time a novel use of cerebral and neural anatomy to defend philosophical claims about the mind. Willis’s neurology was shaped by the immediate political and religious contexts of the English Civil War and Restoration. Accordingly, the majority of this paper is devoted to uncovering the political necessities Willis faced during the Restoration of the English monarchy in 1660, with particular focus on the significance of Willis’s dedication of his neurology and natural philosophy to the Archbishop of Canterbury, Gilbert Sheldon. Because the Restoration of Charles II brought only a semblance of order and peace, Willis and his allies understood the need for a coherent defense of the authority of the English church and its liturgy. Of particular importance to Sheldon and Willis (and to others in Sheldon’s circle) were the specific ceremonies described in the Book of Common Prayer, a manual that directed the congregation to assume various postures during public worship. This article demonstrates that Willis’s neurology should be read as an intervention in these debates, that his neurology would have been read at the time as an attempt to ground orthodox worship in the structure of the brain and nerves. The political necessities that helped to shape Willis’s project also help us to better understand Willis’s innovative insistence that philosophical statements about the mind should be formulated only after a comprehensive anatomical investigation of the brain and nerves.

Historical contingency complicates a reading of skill as a self-explanatory and always positive attribute. By focusing on the attempts of the first generation of neurosurgeons to build a community and fashion a collective neurosurgical self, this article highlights the extent to which the relationship between surgical skill and professional judgement is reflected in broader concerns that shape the landscape of medicine at a given time. Some early twentieth-century surgeons expressed concern about the spectacularisation of surgery and the skilful but problematic work of ‘brilliant operators’. The neurosurgeons’ policies of inclusion and exclusion show that in the process of fashioning a neurosurgical persona, this first generation sanctioned specific norms of conduct underwritten by similar moral imperatives, such as self-control. These norms governed the doctors’ work both in the operating room and on the public stage (in their engagement with the press). The meetings of the first neurosurgical society staged a critical encounter between the host neurosurgeon and the members who watched him perform surgery. These technical performances in the operating theatre, followed by discussions, were designed to encourage particular norms, to negotiate surgical knowledge, and to demonstrate the skills and character of the neurosurgeon. The performances acted as a technology of the self that aligned the operator to a community and helped that community refine its norms of surgical conduct. The awkward surgeon with inferior technical ability was preferable to the brilliant but vain operator who lacked the capacity to judge when he should not deploy his spectacular skills.

The introduction and assimilation of chemotherapy to treat pulmonary tuberculosis (TB) during the mid-twentieth century appears at first sight to be a success story dominated by the use of streptomycin in a series of randomised clinical trials run under the auspices of the Medical Research Council (MRC). However, what this standard rhetoric overlooks is the complexity of TB chemotherapy, and the relationship between this and two other ways of treating the disease, bed rest and thoracic surgery. During the late 1940s and 1950s, these three treatment strands overlapped one another, and determining best practice from a plethora of prescribing choices was a difficult task. This article focuses on the clinical decision-making underpinning the evolution of successful treatment for TB using drugs alone. Fears over the risk of streptomycin-resistant organisms entering the community meant that, initially, the clinical application of streptomycin was limited. Combining it with other drugs lessened this risk, but even so the potential of chemotherapy as a curative option for TB was not immediately apparent. The MRC ran a series of clinical trials in the post-war period but not all of their recommendations were adopted by clinicians in the field. Rather, a range of different determinants, including the timing of trials, the time taken for results to emerge, and whether these results ‘fitted’ with individual experience all influenced the translation of trial results into clinical practice.

Between the 1930s and 1960s Puerto Rico was transformed from a marginal United States territory into an industrialised ‘showcase of development’. This article investigates the organisation of milk station programmes on the island during this crucial period and how these reflected the circulation of child welfare knowledge, nutrition expertise and public health practices. During the Depression, these perspectives fostered a recast of the eugenic regeneration ideologies motivating medical assessments of and sanitary interventions with Puerto Rico’s rural poor since the nineteenth century. Innovations in nutrition knowledge and an emerging rural hygiene movement highlighted the negative health effects of the island’s monocrops economy. In this context, the nourishment of children’s bodies assumed symbolic and instrumental significance for the reconfiguration of colonial and developmental models promoted by the new Popular Democratic Party (PPD). The experience of public health professionals in relief work during the 1930s contributed to the articulation of food and nutrition as key elements of this party’s populist discourse. Programmes like milk stations became part of strategies to rear and manage the labour force needed in the industrial development model promoted by the PPD. From the perspective of poor Puerto Ricans, however, they were part of the materialisation of its promise of social justice for the poorer classes.

In its examination of American Medical Aid to Russia, this article shows how the best of intentions can have the potential to go horribly awry. It argues that the competing binary forces of international collaboration and goodwill versus political tensions and uncertainty combined to create an environment wherein actors and agents inhabited an ever changing and unpredictable international stage. Could American philanthropic organisations and individuals overcome political volatility, financial restrictions and ideological barriers? Just what would it take to establish an American hospital in Moscow, the Bolshevik seat of power? The attempt to establish the hospital proved to be an exercise in patience, persistence and prudence (although not always in equal measure). This article shows that international cooperation, while undoubtedly complicated, was certainly possible. The flow of information, materiel and personnel between the United States, Germany and Russia proved that good intentions, trust and a will to help others were valued. The history of American Medical Aid to Russia also demonstrates that the Quaker role of facilitator and interlocutor was vital in establishing a relationship of trust between Soviet Russia and the United States. This article discusses the difficulties that philanthropic organisations faced when navigating the choppy international waters of the early 1920s and highlights the rewards of successfully doing this. It argues that basic human relationships and trust were just as, if not sometimes more, important than ideology in determining the tenor of early US–Soviet relations.

This essay examines the ‘infiltration’ of eugenics into Russian medical discourse during the formation of the eugenics movement in western Europe and North America in 1900–17. It describes the efforts of two Russian physicians, the bacteriologist and hygienist Nikolai Gamaleia (1859–1949) and the psychiatrist Tikhon Iudin (1879–1949), to introduce eugenics to the Russian medical community, analysing in detail what attracted these representatives of two different medical specialties to eugenic ideas, ideals, and policies advocated by their western colleagues. On the basis of a close examination of the similarities and differences in Gamaleia’s and Iudin’s attitudes to eugenics, the essay argues that lack of cohesiveness gave the early eugenics movement a unique strength. The loose mix of widely varying ideas, ideals, methods, policies, activities and proposals covered by the umbrella of eugenics offered to a variety of educated professionals in Russia and elsewhere the possibility of choosing, adopting and adapting particular elements to their own national, professional, institutional and disciplinary contexts, interests and agendas.

This paper examines how, over the course of the nineteenth and early twentieth centuries, the appreciation of skill in surgery shifted in characteristic ways. Skill is a problematic category in surgery. Its evaluation is embedded into wider cultural expectations and evaluations, which changed over time. The paper examines the discussions about surgical skill in a variety of contexts: the highly competitive environment of celebrity practitioners in the amphitheatres of early nineteenth-century Britain; the science-oriented, technocratic German-language university hospitals later in the century; and the elitist surgeons of late nineteenth and early twentieth-century United States with their concerns about distancing themselves from commercialism and cheap showmanship. For analysing the interaction of surgical practices with their various contexts the paper makes use of the concept of ‘performance’ and examines how the rules of surgical performance varied according to the prevailing technical, social, and moral conditions. Over the course of the century, surgical performance looked more and more recognisably modern, increasingly following the ideals of replicability, universality and standardisation. The changing ideals of surgical skill are a crucial element of the complex history of the emergence of modern surgery, but also an illuminating example of the history of skill in modern medicine.

Neuropathologists constituted a small field in post-war England, perched between neurology, psychiatry, neurosurgery and pathology, but recognised as a discrete field of expertise. Despite this recognition, the success of the neighbouring fields of neurosurgery, psychosurgery and neurobiology, and the consultant status granted to pathologists in the National Health Service, neuropathologists struggled to stabilise their field. A discourse of skills, acquired and acquirable, became central to their attempts to situate the field in relation to surgeons’ handicraft, physicians’ diagnostic acumen and the technologies of the biological sciences.

In 1899 the British Medical Journal enthusiastically announced that a new postgraduate teaching college was to open in London. The aim of the Medical Graduates’ College and Polyclinic (MGC) was to provide continuing education to general practitioners. It drew upon emerging specialisms and in so doing built upon the generalist training received at an undergraduate level. Courses were intended to refresh knowledge and to introduce general practitioners to new knowledge claims and clinical practices. The establishment of postgraduate institutions such as the MGC marked an important stage in the development of medical education in England. Yet these institutions, and the emergence of postgraduate medical education more broadly, have been largely overlooked by historians. Moreover the history of venereological training among medical undergraduates and postgraduates alike has been overlooked. The study of such special subjects characterised postgraduate study. This article examines the dissemination of venereological knowledge among subscribers to MGC as an important case study for the development of institutionalised postgraduate medical education in England at the turn of the twentieth century.

A scientific nomenclature of erotic age preferences informed the mid- through late nineteenth century joint appearance of homosexuality and sexual abuse of minors on the medico-legal scene. Yet, even in the twenty-first century, legal, psychiatric and culture-critical dimensions of related terms are rarely cleanly distinguished. Review of primary sources shows the ongoing Western suspension of notions of ‘sick desire’, alongside and beyond the medicalisation of homosexuality, between metaphor, legal interdiction and postulated psychopathology. Virtually all early attention to erotic age preference occurred in the context of emergent attention to erotic gender preference. Age of attraction and age difference centrally animate modern homosexuality’s pre-modern past; its earliest psychiatric nomenclature and typologies (1844–69); its early aetiologies stipulating degrees of sexual differentiation (1890s); its concomitant sub-classification (1896–1914); its earliest psychophysiological tests (1950s); and, finally, its post-psychiatric, social scientific typologies (1980s). Several identifications of ‘paedophilia’ were seen throughout the 1890s but as a trope it gained cultural momentum only during, and as a seemingly intriguing corollary of, the progressive depsychiatricisation of homosexuality across the Anglo-European world (late 1950s through 1980s). Early twentieth century sources varied in having it denote (1) a distinct perversion, thus possible ‘complication’ of sexual inversion (2) a discrete corollary of psychosexual differentiation akin to gender preference (3) a distinct subtype of fetishism, thus a likely imprint of early seduction (4) a more intricate expression of erotic symbolism or psychosexual complex or (5) a taste answering to culture, a lack of it, or a libertine disregard for it.

From its initial development by Carlo Forlanini at the end of the nineteenth century until the advent of antibiotics in the 1940s, artificial pneumothorax was one of the most widely used treatments for pulmonary tuberculosis. However, there were strongly held reservations about this therapy because of its risks and side effects. In the Soviet Union under Stalin, such uncertainties became instruments of political denunciation. The leading Soviet pulmonary physician Volf S. Kholtsman (1886–1941) was alleged to have used the so-called ‘aristocratic therapy’ of artificial pneumothorax to kill prominent Bolsheviks. Drawing on documents from Stalin’s personal Secretariat, this historical study of the pneumothorax scandal contributes to the cultural history of tuberculosis, showing how it was instrumentalised for political purposes.

Writing the recent history of mental health services requires a conscious departure from the historiographical tropes of the nineteenth and twentieth centuries which have emphasised the experience of those identified (and legally defined) as lunatics and the social, cultural, political, medical and institutional context of their treatment. A historical narrative structured around rights (to health and liberty) is now complicated by the rise of new organising categories such as ‘costs’, ‘risks’, ‘needs’ and ‘values’. This paper, drawing on insights from a series of witness seminars attended by historians, clinicians and policymakers, proposes a programme of research to place modern mental health services in England and Wales in a richer historical context. Historians should recognise the fragmentation of the concepts of mental illness and mental health need, acknowledge the relationship between critiques of psychiatry and developments in other intellectual spheres, place the experience of the service user in the context of wider socio-economic and political change, understand the impacts of the social perception of ‘risk’ and of moral panic on mental health policy, relate the politics of mental health policy and resources to the general determinants of institutional change in British central and local government, and explore the sociological and institutional complexity of the evolving mental health professions and their relationships with each other and with their clients. While this is no small challenge, it is perhaps the only way to avoid the perpetuation of ‘single-issue mythologies’ in describing and accounting for change.

This article outlines the history of the commerce in medicinal plants and plant-based remedies from the Spanish American territories in the eighteenth century. It maps the routes used to transport the plants from Spanish America to Europe and, along the arteries of European commerce, colonialism and proselytism, into societies across the Americas, Asia and Africa. Inquiring into the causes of the global ‘spread’ of American remedies, it argues that medicinal plants like ipecacuanha, guaiacum, sarsaparilla, jalap root and cinchona moved with relative ease into Parisian medicine chests, Moroccan court pharmacies and Manila dispensaries alike, because of their ‘exotic’ charisma, the force of centuries-old medical habits, and the increasingly measurable effectiveness of many of these plants by the late eighteenth century. Ultimately and primarily, however, it was because the disease environments of these widely separated places, their medical systems and materia medica had long become entangled by the eighteenth century.

Some ideas return after the briefest of exiles: reductionism is back in vogue. Existential questions – about who we are, about our origins and future, about what is valuable – no longer require difficult soul searching, especially when straightforward answers are expected from the neurosciences. History is being rewritten with the brain as its centrepiece; the search for great men and big ideas of the past begins again. William Cullen (1710–90), whose work on neurosis was once part of the history of psychoanalysis, is now well placed to become part of such a neuro-history. This article attempts to subvert this process, by rebuilding the original meaning of neurosis through Cullen’s physiological and medical works, in comparison with his predecessor, Robert Whytt (1714–66), and illustrating this meaning using one particular neurosis: hypochondriasis. The result is a more complicated version of neurosis which, importantly, carries significant insights into the nature and practice of medicine. Moreover, this article examines how Cullen’s standing fell in the 1820s as British physicians and surgeons turned to an idea which promised to reform medicine: pathological anatomy. When these hopes faded, Cullen became a figure obsessed with the nerves. This image has survived to the present, a blank canvas onto which any theory can be projected. It also values precisely what Cullen warned against: simplistic explanations of the body and disease, and unthinking confidence in the next big idea or silver bullet. Neurosis was not simply a nervous ailment, but it is a warning against reductionism in history making.

During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice.