In August, 1880, George Murray Humphry, in his presidential address to the British Medical Association (BMA), called for “collective action” by the country's “eight thousand physicians” to accumulate observations concerning the role of “temperamental, climacteric, and topographical agencies upon disease”. Through participating in organized inquiries, practitioners would “deepen their interest in the science of medicine, and impart the charm of wider usefulness to the daily routine of life”. By December 1881, the BMA had funded a Collective Investigation Committee, which over the next eight years would sponsor nearly a dozen inquiries into the natural history of disease. Beyond Great Britain, Humphry's appeal would launch an international movement for collective investigation, with physicians in Germany, the Netherlands, Norway, Sweden, and the United States following the British example.

“An effective AIDS vaccine could be found as early as 2012, saving 6 million lives if the world is willing to put £10 bn a year into a new programme, the chancellor, Gordon Brown, said in a speech last night in Tanzania”. Faith in biomedical science; the conviction that new vaccines will be translated into lives saved; belief in the necessity of globally concerted action: the British minister's statement reflects views of vaccine innovation that are widely held today. New and improved vaccines seem our best hope of coping with the scourge of AIDS, of arming ourselves against the unknown threats of emergent diseases and potential bioterrorism, and of tackling the resurgence of old diseases arising once more in Europe. Global coordination, pooling our resources, seems self-evidently necessary, given the international nature of a modern epidemic. Much current discussion of vaccine development and use thus has a global character. That is to say, it is conducted under the banner of global slogans or it seeks to establish globally integrated approaches to vaccine research and development (R&D). Over the past two decades the development and rapid introduction of new vaccines have come to dominate the vaccine agenda worldwide. Social scientists and health policy analysts have been set to work, examining barriers to the implementation of international priorities at the national level. Why, for example, are national responses to the availability of new vaccines often so lethargic? A recent study of the adoption of Hemophilus influenza b (Hib) conjugate vaccine is a good example. It shows policy makers in four countries rationally weighing the burden to public health of the diseases against which the vaccine offers protection (bacterial meningitis and pneumonia), against the high cost of the vaccine. Health policy analysts tend to explain the decision to introduce a new vaccine, or to replace an existing vaccine by a new alternative, in terms of the epidemiology and seriousness of the disease, and of scientific consensus regarding the efficacy and potential risks of the vaccine and (perhaps) their costs. The studies of vaccine diffusion and adoption that they conduct have little or nothing to say about political disagreements, or the influence of commercial interests, national traditions, international relations, or global agendas. Where any attention is paid to vaccine history, it is generally in the attempt to illustrate factors (such as resistance to vaccination) that might cause deviations from the rational deployment of vaccines.

When Henry T Lynch thought that he had discovered the existence of hereditary cancers among Nebraskan families in the 1960s, his hope was that it would lead to more effective means of cancer control. Lynch argued that the identification of such cancers offered tremendous opportunities for improving detection and treatment. If cancer ran in families, he claimed, the discovery of a hereditary cancer in one family member should be an alert to the possibility of cancer in others, and so prompt careful scrutiny for any signs that might indicate the presence of the disease in “healthy” individuals. Lynch hoped that by targeting cancer families it would be possible to catch more cancers at an earlier stage than was hitherto possible. Cancers caught early were often curable, the American Cancer Society (ACS) claimed.

Who was to blame when a labouring woman or her unborn child died during the early modern period? How was responsibility assessed, and who was charged with assessing it? To answer such questions, this article draws on French obstetrical treatises produced by male surgeons and female midwives between 1550 and 1730, focusing on descriptions of difficult deliveries. Sometimes the poor outcome of a labour was blamed on the pregnant woman herself, but more often a particular medical practitioner was implicated. Authors of obstetrical treatises were careful to assign fault when injuries or deaths occurred in cases concerning them. Chirurgiens accoucheurs (surgeon men-midwives) regularly accused female midwives of incompetence, yet also attacked fellow surgeons as well as those male physicians officially superior to them in the medical hierarchy. Female midwives similarly condemned the actions of male practitioners, without hesitating to censure other women when their mismanagement of deliveries had tragic consequences. Part of authors' eagerness to blame others stemmed from the fear of being held accountable for mistakes preceding practitioners had made. Ascribing responsibility usually went hand-in-hand with defensive claims of innocence, or boastful declarations of having saved a suffering woman from the bungling attempts of less skilled birth attendants.

When thinking of spurs to hospital development in the first half of the last century, it would be easy to assume that the greatest watershed was provided by the 1946 National Health Service Act. In this article, however, we focus on an earlier and often overlooked piece of legislation, which had a perhaps equally significant impact on the development of hospitals in England and Wales. This was the 1929 Local Government Act, which changed both the ownership and the focus of many of the largest hospitals in the country. As Robert Pinker has observed, the act “radically altered the percentage distribution of hospital beds in the public sector”. Such observations notwithstanding, municipal medicine in the 1930s has not received the historical attention it deserves, an omission which this article seeks in part to remedy. The terms of the act in respect of hospital development were permissive, and the extent to which local authorities acted had a great effect on the way in which their municipal hospital services developed, and hence the beds and facilities available at the time of the nationalization of the health services. The reaction of local authorities to the act, however, depended partly on their own choices, and partly on constraints over which they had less control.

In 1856 a Parisian physician called Auguste Delpech presented a paper to the French Academy of Medicine in which he described the strange behaviour of workers employed in the production of India rubber. Many of these men, Delpech reported, had symptoms of mental derangement resembling acute alcohol intoxication. They suffered from impaired memory, vague and confused thoughts, restlessness and insomnia. In particular, they exhibited changeable moods of hilarity and manic outbursts followed by drowsiness, apathy and inertia. The source of the problem, accurately identified by Delpech, was the inhalation of large quantities of a highly neurotoxic compound called carbon disulphide. This was used to soften and spread the latex gum in order to produce rubber sheets. Early rubber making was largely a cottage industry, carried out in poorly ventilated workrooms. With the expansion of the industry into larger scale production during the second half of the nineteenth century, further reports of “insanity” associated with rubber manufacture began to appear in the medical literature. In 1902, the physician Thomas Oliver, reporting on the British Committee on Dangerous Trades of 1899, described episodes during the manufacture of mackintoshes in which workers suffered from “an extremely violent maniacal condition whereby, in their frenzy, [they] have precipitated themselves from the top rooms of the factory to the ground”. It was further observed that the windows of rubber vulcanizing rooms were frequently barred as a preventive measure.

In this paper we explore the relationship of modern architecture and modern surgery in the twentieth century. Our central argument is that environments designed for surgery in the modern hospital became more like laboratories at the end of a remarkable metamorphosis, which we explain through three distinct types of spaces in a particularly significant case study, the Royal Victoria Hospital (RVH) in Montreal, Quebec. As the changing design of surgical spaces constitutes our primary evidence, our approach engages the methods of material culture and material history, a methodology infrequently used in the history of science and medicine. In turn, in order to interpret the changes in operating room design, we situate them in the context of the history of surgery. The architecture of health care both illustrates and shapes the identity of patients and doctors, as well as their inter-relationship. It structures surgeons' activities and expresses their status as actors, as well as reinforcing specific scientific theories. Thus, spatial structures like operating rooms can be understood as material evidence of ongoing changes in the status and self-image of surgeons.

Over the last three decades, Norway has experienced two fundamental reforms in hospital organization and direction. In 1970 the nineteen county authorities took over ownership and budget responsibilities for hospitals within their areas, replacing a highly varied and complex structure of ownership, typically generated locally. In 2002 hospitals were transferred to the state and amalgamated into five regional government enterprises. These, in turn, have organized all hospitals in their region under local health enterprises. Both regional and local enterprises are separate legal entities, with their own executive boards and managing directors. The Minister of Health appoints the boards of the regional enterprises, while their directors and the boards of the local enterprises are appointed by the regional boards. Both regional and local enterprises are supposed to have full autonomy for day-to-day operations, while being subject to strategic and political decisions by the Minister of Health as the ultimate authority of the enterprise assembly (foretaksmøte). The “enterprise” concept is, of course, borrowed from private business, modelled on companies of limited liability. The choice of this organizational model must be understood at least partly within the context of a general politico-administrative reform, inspired by the worldwide New Public Management movement. Each enterprise is a separate economic entity with a clear responsibility for balancing its budgets. Privatization (or part-privatization) and bankruptcy, however, are out of the question, as the state in the end retains full economic responsibility.

During 1923, the South African government began to issue free vaccine for the immunization of cattle against anthrax. Five years later, it introduced compulsory annual vaccination in parts of the Transkeian Territories, an area reserved for occupation by Africans. Thereafter, the state sought to extend both compulsory and discretionary vaccination. In 1942, scientists at the government's Onderstepoort Veterinary Institute announced that they had issued 6 million doses of vaccine during the previous year. Approximately half the cattle in the country were being immunized annually with a special product which scientists at the Institute had recently devised. The scale of vaccination was unprecedented within the country and the annual issue of anthrax vaccine far surpassed the amount supplied for any other animal disease. It was a major state intervention in rural society. Nevertheless, vaccination against anthrax in South Africa is absent from the historiography, while published contemporary accounts are few.

The purpose of the Medical Termination of Pregnancy Bill, published on 15 June 1966, was to amend and clarify the law relating to termination of pregnancy by a registered medical practitioner. When David Steel, a young Liberal MP from the Scottish Borders, put this bill forward, some suggested that a Scottish politician had no need to introduce abortion reform since Scots law was already satisfactory in this regard. Certainly, abortion law in Scotland was more flexible than its English counterpart, and the number of prosecutions few. The line between criminal and non-criminal abortion was, however, just as indistinct, with great medical uncertainty in this area. On becoming law, the 1967 Abortion Act was the first piece of abortion-related legislation to cover Scotland, England and Wales collectively. None the less, for a variety of legal and moral reasons, abortion policy and practice continued to differ on either side of the Border.

The early modern era saw important changes in the character of warfare in Europe, including the development of larger, permanent armies and navies. Historians have studied many key aspects of what some call the “military revolution”, whose character and timing have become a matter of debate; but some important features of these emerging military communities remain largely unexplored. One subject which has not attracted the attention it merits is that of the health of soldiers and sailors and of medical provision in the new armies and navies. The issue has not been entirely neglected, either generally, or as it relates to specific states, but focused studies are rare. This is unfortunate, not least because of the importance attached to the issue of sickness and medical provision by contemporaries, and the value of medical provision as a sort of test case by which to measure the effectiveness of medical services and hence to contribute to the “military revolution” debate. For some historians the later seventeenth and eighteenth centuries saw the first significant efforts to develop a structure of military and naval hospitals; for others, however, the extent of illness and the inadequacy of medical support services before the French Revolutionary and Napoleonic era suggests that many states failed to meet the organizational challenge posed by the growth of standing armed forces in the sixteenth, seventeenth and eighteenth centuries. What follows is an investigation of the extent and nature of illness, and the effectiveness of medical provision in the armies and navies of one major player of the period, Spain in the reign of the last Habsburg, Charles II (1665–1700).

Since antiquity, some men have not been considered accountable for their actions when they transgressed the law, and were exempted from legal penalties, or given lesser ones. Why? The rationale for legal exemption has varied over time. So have the labels assigned to such lawbreakers, and even the personnel involved in the labelling process. For centuries, settling the question of deviant mental states of relevance to the court seemed relatively unproblematic. It was thought that personal acquaintance would easily discover such states of mind and the court could then be notified. It was not until the nineteenth century that western society felt a need to regulate this problematique. As a result, or as a precondition for this process of settling the question of legal accountability, the matter came to be construed in part as a medical problem. Physicians, and later psychiatrists, came to be regarded as possessing specific knowledge in this area which qualified them to judge a person's legal accountability. Personal knowledge of the deranged defendant was supplanted by professional knowledge of sanity and insanity as the basis for authority on the matter of accountability.

One of the animating beliefs of British health service reformers in the first half of the twentieth century was that delivery would improve if greater co-ordination was imposed over disparate providers. The fundamental divisions were between the voluntary, public and private sectors. Voluntary provision predominantly meant acute care hospitals, but also included a range of other therapeutic and clinical services. The public sector delivered general practitioner (GP) services to insured workers through the state national health insurance (NHI) scheme, while the remit of local government covered environmental health, isolation and general hospitals and a wide range of personal services addressing tuberculosis, venereal diseases, mental illness, and maternity and child welfare. Finally, the private sector provided nursing homes and GP attendance at commercial rates. Within each area there were tendencies towards independent rather than co-operative working. Voluntary hospitals often lacked any mechanism for conferring with neighbouring institutions and the competitive logic of fund-raising enforced an individualistic ethic. In the public sector health responsibilities were dispersed across various agencies: local authority health committees, advised by the county or borough Medical Officer of Health (MOH), oversaw sanitation, hospitals and personal health services; education committees were responsible for the School Medical Service (SMS), whose remit was the compulsory medical inspection and treatment of elementary schoolchildren; the Poor Law provided institutional care either in workhouses or separate infirmaries, although after the 1929 Local Government Act the boards of guardians were broken up; their powers were then transferred to the public assistance committees of local authorities, however these remained distinct from health committees. GP services accessed through the state NHI system were overseen by local insurance committees separate from local government. Private practice co-existed with NHI and doctors tended to prioritize fee-paying rather than panel patients.

During the late nineteenth and early twentieth centuries the development of bacteriology contributed to a heightened focus on the individual as the carrier of contagious diseases. This raised the question of how the state could shoulder the responsibility of defending public health without infringing on individual civil liberties. How much coercion of the diseased could be tolerated in order to protect the healthy? Pandemics such as plague and cholera had sometimes led to enforced isolation of the diseased; people suffering from leprosy might be confined to special institutions, and tuberculosis could result in long stays in hospitals and sanatoria. In such cases, however, it was also hoped that certain treatments might eventually cure the patients.

The history of the medical and nursing care given to parturient women has been approached in a number of ways. Early studies largely equated it with the development of obstetric technology that occurred from the early eighteenth century onwards, focusing on its potential to save maternal and foetal life, but without examining closely the frequency and significance of its actual use. Thereafter, feminist historians re-interpreted similar evidence to stress what they regarded as the degrading and invasive aspects of such technology, especially as it related to the increasing use of chloroform anaesthesia in the latter half of the nineteenth century. Interest then moved from the technology itself, to its effects on other aspects of care in childbirth, particularly on the eighteenth-century decline of the traditional midwife and the concomitant rise of the man-midwife.