FEATURE ARTICLE 2

Kunde Hospital: Nepal

WORK IN PROGRESS 4

Public Health in Ceylon

Medical research in western India

Buddhist medicine in Angkor

CONFERENCE REPORTS 8

NEW PUBLICATION 9

RESEARCH RESOURCE 11

The Bombay University Library

RESEARCH REPORT 13

India and the USA:A researcher’s reflections

BOOK REVIEWS 15

RESEARCH GROUP NEWS 20

London, Birmingham, Manchester

CALENDAR 24

WellcomeHistoryISSUE 27 WINTER 2004

In 1966, New Zealander Sir EdmundHillary, who with Tenzing Norgayhad first stood on the summit ofthe world’s highest mountain in1953, built a small hospital in theSherpa village of Kunde at the footof the region’s sacred mountain,Khumbu-yul-lha.

Surrounded by the snowy peaks of this rugged, high-altitude region the hospital was part of Hillary’s wideraid programme to assist the people of the Mt Everestarea in Nepal who have played such an important rolein Himalayan mountaineering. It was set up to provideWestern medical services which it has done, but it hadto learn how to function among people who did notbelieve that Western medicine was inherently superiorto other systems of beliefs and practices.

The Sherpa of Khumbu are an ethnically Tibetan peoplewho came over the mountain passes of the Himalaya inthe early 16th century into what was then an uninhabitedarea. In the 18th century the region became incorporatedinto the Gorkha kingdom that now forms the modernnation of Nepal. The new rulers were Hindu while theSherpa, like a number of small groups living along theHimalaya, were Buddhist. Both the geographic locationof the Sherpa near Nepal’s border and their low positionin the Nepali social and political structure contributedto them largely being left alone, apart from the paymentof taxes. Sherpa lived in villages and generally managedtheir own affairs, with their livelihood based on amixture of agriculture and pastoralism, and supplementedby trade as the area was located on a long-distance traderoute between northern India and China.

Although Nepal’s borders were generally closed toWestern visitors until 1949, Western medicine hadhad a limited presence within the country since the18th century. In the late 19th and early 20th centurieshospital services expanded, as in other countries, andin 1933 the government’s newly formed Departmentof Health Services promoted both Western and Ayurvedicmedicine. During the 1950s further expansion occurred,particularly with the increasing presence of foreign aid,but in the early 1960s services were still very limited,or non-existent, in rural areas where most people lived.Many people in remote Khumbu would only haveheard of the type of medicine offered by Kunde Hospital,although some, particularly those people employed bythe mountaineering expeditions, may have used it.

Western medical practice did not enter a vacuum, butSherpa beliefs and practices about sickness revolvedaround a different system to that of the New Zealandvolunteers brought in to run the hospital. Sherpainhabited a world that was full of various types ofbeings that could be dangerous if offended or ignored,but could also be appeased through appropriate measures.Sherpa could employ a number of strategies to deal withsickness, including prevention, self-help or consulting alama or lhawa (spirit medium). Finding out the causetook precedence over dealing with the symptoms,although the perceived severity could influencewhether or not the patient or family sought assistance.People made a preliminary decision on which to call,but when a person was very sick they often used both.

Early documents reveal the complexityof the encounter between Sherpabeliefs and practices, and those ofWestern medicine.

Cover andabove:

Mount Everest.Image courtesy

of author

Kunde HospitalSir Edmund Hillary and the Sherpa of theMt Everest area of Nepal

Sherpa also had another option – the use of an amchi,the practitioner of Tibetan medicine. Oral sourcesindicate that prior to 1950 Khumbu did not have itsown amchi. Sherpa recognised amchi medical practiceas different, but because of their shared Tibetan originnot as different as Western medicine.

Kunde Hospital has been the major provider ofbiomedical services in the area since its opening.It has been run by the Himalayan Trust in New Zealand,which Hillary established to run a large number ofeducation, health, forestry and community projectsthat since their inception in the early 1960s havehad an enormous impact on the region and its people.Today this small hospital offers a range of mainlyprimary and some secondary services to about 3500people in the immediate locality of Khumbu and asimilar number from adjacent districts, as well asbeing available to tourists when they are sick.

The hospital has become part of the global fascinationwith the area and its people. Many people have beentreated as out-patients. Rising numbers from 1924during 1967 to 7224 in 1996, without a correspondingrise in the resident population, show increasing usebeing made of the hospital. It also provided in-patientfacilities for serious cases or for people who lived a longdistance from the hospital. The area has no roads andsome patients may walk, or are carried, for several daysto reach Kunde. Early documents reveal the complexityof the encounter between Sherpa beliefs and practices,and those of Western medicine; the uncertainty of thevolunteer doctors at Kunde Hospital as to the outcome,and the importance of proving the efficacy of Westernmedical treatment. People were both pragmatic andselective in their use. They were keen, for example,to have smallpox vaccinations, but less enthusiasticabout other prophylactic measures.

Reviewing Kunde Hospital’s first nine months ofoperation, John McKinnon, the first doctor, wroteof the mixed response to ‘modern medicine’, butthought: “The passage of several years, with exposureto modern medical practice and local publicationof therapeutic successes, will lead to even greateracceptance.” He believed three main successes gavepositive initial publicity for the hospital: the decreasein the size of the goitres as a result of iodized oilinjections; the treatment of tuberculosis which waswidespread with high mortality rates; and the freedomfrom years of pain with the extraction of rotten teeth.

Five years later Dr Lindsay Strang wrote in his annualreport that “Western medicine continues to be acceptedonly slowly and still traditional forms are often resortedto initially especially for serious conditions.” Dr SelwynLang had written around 1970–71 how he and his wifeAnn, also a doctor, “have ligated a spurting artery atone end of the patient while the spirit mediumsprinkled water on the other”. Already the overseasstaff were becoming used to offering Western medicinein a setting where its anticipated inherent supremacywas not accepted and advice and treatment oftenignored. The use of biomedical services did increase,but within a plural system.

Persuading patients to return for follow-up monitoringor treatment was a recurrent problem. For example, thelength of treatment for TB – despite now being muchshorter – was a constant frustration for hospital staff.Annual reports frequently noted patient refusal.Attempts were made to encourage attendance ortreatment compliance through highlighting cases ofcured individuals, health education talks, or enlistingthe support of the Hospital Advisory Committee orthe local district committee.

Staff were becoming used to offeringWestern medicine in a setting whereits anticipated inherent supremacywas not accepted.

Obstetrics was another area where the hospital has metresistance. The Langs reported in an analysis of the firstfive years of the hospital’s work that of 74 women whocame in for antenatal care only nine were subsequentlydelivered by the doctor.

While part of understanding the nature of medicalpractice at Kunde Hospital lies in the medical encounter,part also relates to the wider relationship between thehospital and the community. The community has hadconsiderable influence on the way Western medicine hasbeen practised or offered from Kunde Hospital. KundeHospital did not exist in isolation; it was part of the widerHimalayan Trust programme with its philosophy ofworking with and respecting the local people. Hospitalstaff, local and overseas, learned how to respond to theway people regarded their services and often had to adapttheir practice accordingly.

After 37 years hospital and community have becomeused to each other. The local hospital staff, who are mostlySherpa, have played a key role in ‘educating’ both thevolunteers about living and working in Sherpa societyand the patients about being at the hospital. The smallnumber of staff know the community well, and while theoverseas volunteers changed generally every two years,there has been considerable local staff stability since 1980.

The history of Kunde Hospital, therefore, allows us toexamine the spread of Western medicine into theEverest region of the Himalaya of Nepal providing bothcomparison and contrast with other areas. Its relativelyrecent history with available archival and oral sourcesalso allows a closer look at the encounter between localbeliefs and practices and incoming Western medicalservices. With international medical aid programmesproviding such a major role in health in many countriesthe close relationship between Kunde Hospital,Sir Edmund Hillary and the Sherpa people of the Mt Everestarea of Nepal offers some pertinent thoughts for thoseinvolved with aid in the Third World.

Susan Heydon is a PhD student in the Departmentof History, University of Otago, Dunedin, New Zealand.She was a volunteer at, Kunde Hospital, from 1996 to1998. (E heydon.family@xtra.co.nz).

3Wellcome History Issue 27 Feature article

Opposite above:

Jones’s bookargues that

the record ofthe colonial

government’shealth policy was mixed.

Right:

The colonialmedical service in

Ceylon wascomposed mainly

of indigenouspractitioners.

4 Work in progress Wellcome History Issue 27

MARGARET JONES

The role of Western medicine incolonial societies has been thesubject of a vigorous historiographicaldebate. Viewed at the time as oneof the positive benefits of colonialism,it is now frequently seen as a keyaspect of its oppression.

My recently published book provides a case study forexploring these controversies in relation to colonialSri Lanka. It was called a model colony in the 19th centurybecause it set the pattern for crown colony governance.Again, in the 20th century, somewhat ironically giventhe current tensions in the island, it provided a modelfor a relatively conflict-free process of decolonisationwith the granting of independence in 1948.

With regard to health policy, colonial Sri Lanka isparticularly interesting for three reasons. First, fornearly two decades preceding independence thecolony was virtually self-governing. The legislature,the State Council, was elected on universal suffrageand the executive, the Board of Ministers, was chosenfrom these elected representatives. Although theimperial government kept some reserve powers, policymaking was essentially in the hands of indigenouspoliticians. Responsibility for the direction andimplementation of health policy therefore lay with anelected Ceylonese Minister of Health. It was generallyaccepted by contemporaries and by historians thatthis elected government paid much more attentionto questions of health and welfare than previouscolonial governments.

The second important feature is that the colonialmedical service was composed mainly of indigenouspractitioners, products of the colony’s medical schoolestablished in 1870. It was Ceylonese doctors who ranand staffed the colony’s hospitals, the preventivemedical and public health facilities. The Ceylonisationof the medical service was completed in 1936 whena Sinhalese, S T Gunasekera, became the first non-British Director of the Medical and Sanitary Services.

Thirdly, the record of Sri Lanka (a relatively poorcountry) in quality of life indicators, such as infant andmaternal mortality and life expectancy is exemplaryand requires some explanation. It has been argued thatthis is partly due to the embryonic welfare state whichwas in place by 1948, one of the pillars of which wasthe colonial healthcare system. Does this case studyprovide evidence that on balance Western medicinein the colonial context was beneficial?

My book argues that the record of the colonialgovernment’s health policy is in fact a mixed one.Before 1948 Ceylon’s epidemiological profile nevermade the transition to a modern one. Communicablediseases remained the principal causes of death.Deaths from dysentery, diarrhoea and respiratorydiseases continued at a high level. Pure water suppliesand water-borne sewage disposal were not supplied,and a safe urban environment not ensured. The reasonsfor these failures are explored fully in the book andattributed, among other factors, to the reluctanceof the imperial and colonial governments as well asthe ratepayers to accept the necessary financialresponsibility. Malaria and ankyolostomiasis continuedto debilitate the population. The 1934 – 35 malariaepidemic, which claimed the lives of nearly 100 000people, is testament to the failure to control theravages of such communicable diseases.

Alongside these failures, however, there were unquestionedsuccesses. Infant and maternal mortality had declinedby 1948 and even malaria was being brought undercontrol, if only temporarily. These achievements canbe attributed in part to the adoption of preventivehealthcare services which by 1948 covered the wholeisland. These included infant and maternal welfareservices, a health unit system whose primary functionwas to provide preventive healthcare services, schoolmedical inspection and treatment, and free schoolmeals after 1935. There was also an extensive island-wide hospital system staffed by indigenous doctors.After 1941 the government also supported the indigenoussystem of medicine. An Ayurvedic training college,hospital and dispensaries were funded by centraland local governments.

How does the example of Ceylon contribute to the debatesabout colonial medicine? If it is accepted that good healthis a necessary basis for the wellbeing of individuals then

Public health in Britain’s modelcolony of Ceylon

real improvements in health, as seen in Ceylon, must beacknowledged as a positive gain.

This does not necessarily rebut the charge that the colonialmedical services were a tool of imperialism. They couldindeed be oppressive. But at the same time they could alsobe beneficial for indigenous populations.

Furthermore, there is a very real conflict in any societybetween the needs of the community, as defined bythe government, and the freedom of the individualin collective public health provision. The impositionof such measures on colonial populations whereconsent was at best dubious does bring this dilemmainto sharp relief. But was the imposition any greater,say, than on working class men and women in Britain?Moreover, in Ceylon the indigenous population wasable to contest and negotiate their relationship withthe medicine of their colonial rulers. The government’ssupport of Ayurveda is just one illustration of this.It could be argued that the situation in Ceylon wasunique within the imperial system, but its healthrecord does reinforce what is increasingly apparentin recent literature on the subject that simplisticgeneralisations are suspect. The impact and legaciesof colonial medicine, as indicated in the experienceof Ceylon, are both contradictory and variable.

Dr Margaret Jones is Unit Research Officer at theWellcome Unit for the History of Medicine, Oxford(E spring@mjones40.fsnet.co.uk). Her book was publishedin November 2004, by Orient Longman Ltd as part of itsNew Perspectives in South Asian History series. ContactMs Priti Anand at (E editor@pol.net.in) for details.

5Wellcome History Issue 27 Work in progress

Right:

Sir Leonard Rogers

SHIRISH KAVADI

India, as British and Indian medicalcircles noted, was “the largestdisease laboratory in the BritishEmpire” offering large opportunitiesfor “scientific exploitation”.

Yet the British Indian Government appears to havedone little to encourage medical research apart fromsetting up bacteriological laboratories, which became“mere bottling centres for standard vaccines and sera”.The research structure that evolved, R Ramasubbanobserves, was shaped by piecemeal and ad hoc responseto sudden epidemic outbursts. Studies conducted by theAll India Institute of Medical Sciences in 1991 and 1996conclude that India lacks a strong medical researchtradition suggesting that little has changed sinceindependence.

Indian Medical Service officials and eminent researchersSir Leonard Rogers, Lt Col. Megaw and Sir S S Sokhey inthe 1920s and 1930s lamented the utter neglect ofmedical research in India and criticised the governmentfor its lack of concern. Rogers exhorted Indian industrialists

and philanthropists to come forward to support thecause of medical research and stated that India needed an“Indian Rockefeller” to create a medical research institute.

Private support and initiatives were not lacking.Ramasubban points out, Indian elites were “eager to laythe foundations for the growth of medical science inwhich Indians could participate and benefit”.

State policy, philanthropy, and medicalresearch in western India,1898–1962

The Indian Research Fund Association and the CalcuttaSchool of Tropical Medicine received generous supportfrom Indian princes and businessmen. The most notablephilanthropic efforts to advance the cause of scientificmedicine in India were made by Jamsetji Tata and hisson Sir Dorab Tata with their proposals for a Schoolof Tropical Medicine (1918) and a cancer researchcentre (Tata Memorial Hospital – 1932). Internationalphilanthropy, namely the Rockefeller Foundation,was not lagging behind. From the 1930s the RockefellerFoundation supported the setting up of various medicalinstitutes in the country such as the All India Instituteof Public Health in Calcutta (1932), the Virus ResearchCentre at Pune (1952) and the All India Instituteof Medical Sciences in New Delhi (1954).The focusof this study is on the two Tata schemes and theRockefeller Foundation’s virus centre.

RESEARCH FOCUSWhat was the State response to these initiatives?What motivated the Tatas and the RockefellerFoundation to undertake the institutionalisingof medical research? What were their concerns?Were these concerns merely philanthropic or basedon a world view reflecting larger social concerns?How did the Tatas’ thinking and approach compareand contrast with that of the Rockefeller Foundation?This study aims to examine State policy both duringthe colonial and post-colonial periods towards privatephilanthropic initiatives to institutionalise medicalresearch. It attempts to examine the interactionfocusing on areas of conflict and on compromisebetween the State and the private philanthropy inthe public sphere. Both the Tatas and the Rockefeller

Foundation believed that science was central to humanwellbeing and were eager to invest in institutes thatwould provide training to Indians and inculcate thespirit of scientific medicine in them. However, the politicalleadership and the bureaucracy appeared unwilling toconcede space as conflict centred on location, recruitmentpolicy, composition of governing bodies, and funding.The study proposes to examine, at the general level,State policy with respect to the development of medicalresearch from 1898 to 1962 and, at the specific level,the efforts of Tata and Rockefeller philanthropy toinstitutionalise medical research. The study is restrictedto medical institutes in the Bombay province. The studyfurther examines the role of the various actors andtheir perceptions and interests as areas of conflictand cooperation.

RELEVANCEMuch of the discourse on the history of medicine inIndia covers preventive policy, disease control, Indianresponse and the missionary role. David Arnold andHelen Power have studied certain aspects of medicalresearch policy and the role of philanthropy in organisingand institutionalising medical science in India. The presentstudy of the philanthropic role of Tata and Rockefellerin the institutionalising of medical research is significantfor examining continuity and discontinuity in Statepolicy from the colonial to post-independent period.The study focuses on a neglected but vital aspect in thediscourse on development of medical science in India,namely the interaction between State policy andphilanthropy with specific reference to medical research.

Shirish N Kavadi is a doctoral scholar attached to theRoyal Asiatic Society, Mumbai, India.

6 Work in progress Wellcome History Issue 27

RETHY K CHHEM

Tantric Buddhism has had asignificant influence on the theoriesand practices of medicine in Angkorat the end of the 12th century CE.

Three notable historical situations are fundamental tothe discussion of this paper. First, the foundation stelaeof the temple of Lolei shows that Ayurvedic medicinewas known and practised in Angkor from at least thetenth century CE. Second, Jayavarman VII was crownedKing in 1181 CE, after his victory of the Cham who hadoccupied Angkor for four years. In his efforts to rebuildhis shattered kingdom, he ordered the construction of

temples, hospitals, resthouses and a dense network ofroads to link them together. Third, by 1200 CE, Muslimraids destroyed major Buddhist centres in northernIndia triggering an unprecedented exodus of learnedmonks from famous Tantric Buddhist universities likeVikramisila, who took refuge in Tibet, Nepal, China,Pegu, Pagan, Champa and Angkor.

The arrival of those monks in Khmer kingdom, along withthe adoption of Mahayana Buddhism by King JayavarmanVII, contributed to the prodigious development ofmonastic universities, hospitals and hostels for pilgrims.

Medicine is one of the five major subjects of the Buddhistcurriculum that also includes philology, logic, fine arts andmetaphysics. Among the major innovations developed byTantric Buddhism are the use of pulse examination as adiagnostic tool and alchemy as a way to treat disease.

Buddhist medicine in12th-century Angkor

MEDICAL ALCHEMYChurning of the milk ocean, by both demons and godsleading to the formation of the nectar (Tuk amret) oflongevity is a well-known legend in ancient Cambodia.This translated into a wonderful architectural designat four of the five gates of the city of Angkor – made oftwo rows of demons and gods, holding a Naga (mythicalsnake), to churn the ocean.

Epigraphical sources strongly support the practice ofmedical alchemy in Angkor. The Ta Prohm stelaenumerates several metals and alchemical apparatus asroyal donations from King Jayavarman VII to temples,including mercury, sulphur and a golden cauldron.Zhu Da Guan, a Chinese visitor who stayed in Angkorin 1296, mentioned in his diary that mercury andsulphur were imported from China.

In addition to these written sources, chemical analysisof Angkorian bronze had shown that the Khmer had agood command of metal technology. The transmutationof metal, especially mercury into gold is the processtowards the making of the elixir of longevity thatprevents the decay of human body and thereforeallowing human to become immortal. Althoughthe use of mercury is known in Vedic medical treatiseslike Susruta Samhita, it is only with the development oftantric cults that alchemy has become a major therapeuticmethod. Also tantric alchemy was an integral part of theBuddhist curriculum in monastic universities of northernancient India such as Nalanda and Vikramasila. A KhmerShivaite sect, the Pasupatas were active and influentat Angkor royal court. In ancient India, they were theforerunners of the Siddhas, also called Yogis, well-knownexperts in alchemy. According to the inscriptions,Yogis were present in Angkorian Buddhist universities.

All the above evidence strongly supports that alchemicalremedies were used in Angkorian medicine. We alsoknow that from the fifth century onward Indian rasa-cikitsa (mercurial medicine) was exported, alongwith Buddhism and Ayurvedic medicine, to Tibet,China, South-east Asia and Sri Lanka. Therefore, a longtradition of alchemical practices has been alreadyestablishedin Angkor, but in the late 12th century,refugee-monks from Vikramisila may have beeninstrumental to further development of this field inAngkorian medical institutions, because many metalswere used in Angkor monastic universities and hospitals.

PULSE DIAGNOSISPulse examination was one of the major diagnostic andprognostic techniques used in Buddhist medicine. Thetechnique has been described in detail in the main Tibetanmedical treatise, the Rgyud Bzi, translated from the Sanskrittext developed by the Buddhist monks of Vikramasila.Although there is no known similar text in Cambodia,many other ancient Buddhist manuscripts from Indiahave been translated to Tibetan, Cambodian or Chinese.This ancient clinical method has been passed down tomodern practitioners of traditional Khmer medicine. It istherefore reasonable to suggest that Khmer pulse diagnosistreatises derive from old Indian manuscripts and havebeen introduced by Buddhist monks from India.

On the other hand, Bhaisajyaguru, one of the mainfigures of the Mahayana Buddhist pantheon had beenthe source of inspiration for the writing of the Tibetan‘Four Tantra’. He is also the major divinity sitting in thechapel of the 102 Angkorian hospitals, which numbersymbolises twice as much as the 51 mandala of theBhaisajyaguru, because Jayavarman VII ‘doubled’ all hisfoundations in order to worship his parents. Apart fromthe inscriptions, there is iconographical evidence tosuggest the practice of pulse diagnosis in Angkorianhospitals. A bas-relief on the pediment of the Chapel ofthe Angkor Thom’s East Hospital displays a scene of adoctor taking a pulse at the wrist of a patient. Coedesinterpreted this bas-relief as a representation of a healermassaging the leper King’s forearm, in the context ofulnar nerve paralysis (Coedes, 1940, 345). There are twomain reasons for revisiting this interpretation.

The first is the use of biomedical concepts to explain thepathogenesis of leprosy neuropathy not yet known toboth Angkorean and Western doctors in the late 12thcentury. To the contrary, in ancient Cambodia, leprosyis rather attributed to humoral disturbance, and thetreatment is made of herbal medicine mixed with cow’surine, not massage (Susruta Samhita, 2000, vol II, 375).Second, the patient represented on this bas-relief is nota king as he lacks all the royal attributes such as parasols,banners, peacock feather, etc. This ‘overinterpretation’is a common pitfall when one wishes to establish adiagnosis of disease based on an ancient representationof the human body. On the other hand, a definiteargument supports the theory that this bas-reliefactually displays a ‘pulse diagnosis scene’ and thereforesupports the role of the Bhaisajyaguru as the centraldivinity in the shrine of Angkor hospitals, and who isdescribed as the divine founder of pulse diagnosis inBuddhist medical manuscript. What could be morepowerful evidence than a scene of pulse diagnosis ina hospital’s chapel in honour to a divinity who hadbeen the supreme teacher of this technique?

Professor Rethy K Chhem is in the Faculty of Medicineat the University of Western Ontario, Canada(E rethy.chhem@lhsc.on.ca).

7Wellcome History Issue 27 Work in progress

Top right:

Bhaisajyaguru(the medicine buddha),

the central divinityin the shrine of Angkor

hospitals.

8 Conference reports Wellcome History Issue 27

ALISON BASHFORD

Stranded one day at LA airport –all flights to Toronto were cancelledbecause of SARS – a conferencebegan to materialise in my notebook.It turned into ‘Medicine at the Border:the history, culture and politics ofglobal health’, held at the Universityof Sydney 1–3 July 2004.

If, to use contagion/causation metaphors in a slightlyunusual way, the ‘proximate cause’ of the conferencewas SARS, the ‘predisposing cause’ was the wave ofrecent scholarship on public health, nationalism andborders. And the ‘remote cause’ was the intriguing talkat various papers, dinners and coffee breaks at MickWorboys and Flurin Condrau’s tuberculosis conferencein Sheffield some years ago.

The Australian government was kind enough to grantvisas for a number of historians and sociologists fromthe UK – Richard Coker, Sally Sheard, Ian Convery,John Welshman, Sanjoy Bhattacharya and others.But for speakers from other nations, this was not thecase. The opening irony of the conference, which forme gave great import to our talks and exchange, wasthat several speakers from India, Senegal, Cambodia,Taiwan and Indonesia were subject to Australia’snotoriously rigid health criteria for entry visas (fromcertain nations categorised as high TB risk). In severalcases, entry visas were either not granted, or theexpense and difficulty of undertaking the various chestX-rays and tests were prohibitive or simply not worththe hassle. A carefully planned ‘global’ program wasflattening out into a conference dominated by US, UK,Australian and New Zealand speakers. And fabulousthey were but the exercise was a clear object-lesson inthinking about how the net effect of such ostensiblyneutral risk-based epidemiology and security structuresis remarkably close to the old white Australia. And I offerthat not flippantly or even provocatively, but strictlyhistorically: the legal basis of the white Australia policysimilarly never explicitly discriminated, or evenmentioned ‘race’ either.

Thus when Richard Coker, London School of Hygieneand Tropical Medicine, opened the conference with hisassessment of contemporary migration screening andinfectious disease control, the issues were immediatelypressing. Current British official interest in ‘theAustralian model’ of rigid pre-entry screening, made iteven more so. The conference was well placed to discussthe histories which had produced current medico-legalborder control, to compare histories and processes ofregulation, and to think in a really informed way about

moments and places where this was not the case. For me,one strand which emerged was the more acute senseof national ‘hospitality’ and global responsibility in theimmediate post-World War II period, than the globalsituation now. And Heather Worth, speaking of HIV-positive refugees, offered a fascinating politicaltheorisation of ‘hospitality’ in precisely this context.

One of the most interesting lines of inquiry to emerge,I thought, was the question of the place aspect of theprocess of screening. Hans Pols offered a paper onEllis Island mental hygiene screening, John Welshmanspoke of TB screening more recently at Heathrow.These ‘onshore models’ were/are vastly different to thetradition of ‘offshore’ pre-entry screening (in London)for intending emigrants, which Australian governmentshad long insisted upon. Indeed in what ways are varioushistories of onshore/offshore health screening relatedto current (vastly different) national practices ofscreening people for refugee status? Several papers tookup links between refugee issues and health issues, andthe conference drew considerable attendance fromclinicians and public health policy makers in that field.

A carefully planned ‘global’ programwas flattening out into a conferencedominated by US, UK, Australianand New Zealand speakers.

I think that public health historians and epidemiologistsare temperamentally twinned. We both want to knowand explain (if differently) what happens over timeand over place. This was certainly one of the successfulemphases at the Sheffield tuberculosis conference,and I hoped to replicate such fruitful interdisciplinaryexchange in Sydney. While that is for others todetermine, my sense is that interest from the statehealth department, the Commonwealth quarantineservice, and public health academics, both localand international, came to shape much of theconference discussion.

The other strand of inquiry which emerged for me, wasrather more about the ‘global health’, than the ‘border’aspect of the conference title, although the two areobviously related. Elizabeth Fee detailed a broad shiftfrom the use of ‘international health’ to ‘global health’,and offered analysis of why this might be the case, andwhat its effects may be. Sociologist Lorna Weir took upquestions of contemporary global communication ofinformation on communicable disease, and the newmedia used for surveillance, information retrieval anddispersal. Such communication often works outsidenational systems altogether. A fascinating 20th-centuryhistory emerged from intense use of public healthrationales in post World War I national borderarrangements (Patrick Zylberman) to colonialism,

Medicine at the Border

internationalism and disease eradication (SanjoyBhattacharya) to globalisation and disease (LornaWeir). And that was before we got onto SARS. CarolynStrange’s semiotic analysis of Toronto’s touristicrepackaging of its image during and post-SARS,examined a peculiar, desperate and (it has to be said)daggy attempt to make itself insistently not ‘thirdworld’. The complicated and important links betweenculture, commerce and communicable disease in the21st century were skilfully laid out before us.

Finally, for me the conference opened up morefascinating questions about the relationship betweencolonial networks and international networks. Paperson colonial public health in India (Mridula Ramanna,Jo Robertson, Jane Buckingham) and on 19th-century

ocean-oriented networks of health, quarantine andports (in particular Sally Sheard’s paper) were veryinteresting indeed to place against scholarship onthe emerging world health logic of the 20th century.The question of how tropical medicine functionedas a hinging discourse between the 19th and the20th century, between ‘imperial’ and ‘world’ is,I think, an open one.

A conference report from the conference organiseris a peculiar thing. Nonetheless, at least it givesme another chance to heartily thank the participants(and indeed those who couldn’t make it) for theircontributions.

Dr Alison Bashford, University of Sydney, Australia.

9Wellcome History Issue 27 Conference reports

The History of Dreamsand Altered States, Part IIMELANIE CLEWS

In the second of two symposiaon ‘The History of Dreams andAltered States’, Rhodri Haywardand Michael Neve put togetheran excellent group of speakersfor this cross-disciplinary event.

Forming a rich investigation on the theme of dreamsand altered states, each paper differed in approachand perspective. In addition to an examination of theircontent, their differences also identified broaderquestions about historiography and methodology andthe complexity involved in an historical analysis ofwhat is primarily a private, introspective experience.The rationale behind this second symposium was,according to Hayward, “a desire to create an alternativehistory to the Freudian studies that had been donemany times before. The idea was to engage with scientificstudies that would include an examination of theimpact of modern technology on dreams and dreaming”.

Sonu Shamdasani opened the event with an impressivepaper that traced a ‘genealogy’ of contemporary dreamculture, touching upon analogies of dreams to madness,and the 19th-century annexation of discourses ondreams by psychology. Sonu ranged his longitudinalhistory of dreams within modern European thoughtacross the philosophical ideas of Descartes, Kant andLocke on the nature of identity and the meaning ofsleep and function of dreaming.

While an alternative historical discourse to that of thepsychoanalytic framework formed a basis for this

conference, a total omission of Freudian psychoanalysiswould have resulted in an uneven discourse.

It was thanks to John Forresters’s interesting andenjoyable paper ‘“I’ll let you be in my dreams if I canbe in yours” Bob Dylan: Freud’s Place in TwentiethCentury Dreams’, that this didn’t occur! Citing a greatselection of examples, including the Bob Dylan songin the paper’s title, Forrester argued that “Dylan’sjostling with the psychiatrist-at-the-end-of-the-worldis emblematic of many cultural responses to theinvasion of the interior life by Freud”. Forresteralso explored “the means by which Freud’s theoryof dreams insinuated itself into the dreamworld ofthe twentieth century”. Picking up on the themeof the impact of modern technology on our interiorlife, John Forrester suggested that dream analysisand film production could be regarded as parallelcultural forms because “cinema, like psychoanalysis,is constitutionally disposed towards ignoring thedistinction between reality and fantasy, between reality

Right:

The child’s dreamof pantomime

Wood engraving byArthur Crowquill

and dream”. This theme of dreams in relation tochanges in both technology and analytic technique wasexpanded in Antonio Melechi’s paper ‘Lucid Dreams’.Melechi traced the development of practical techniquesof ‘lucid dreaming’ beginning with the work ofStephen La Berge.

Whereas Antonio Melechi offered a narrative reconstructionof the evolution of new dream techniques, Joanna Bourkedrew out the methodological implications of suchstudies, arguing that they must include an explorationof the lived, bodily experience of the dreamer. Herpaper, ‘Nightmares: A History’, suggests an historicalapproach to people in the past “that acknowledgesthe history of bodily and emotional reactions to theworld”. Through examination of archival accountsof nightmares, Bourke asks “what nightmares aredoing” historically?

In Douwe Draaisma’s paper, ‘Panoramic memory:a brief history of the metaphor “I saw my life flashbefore me”’, different metaphors are examined to locatethe historical constancy, should there be one, of the‘near-death experience’. The fact that research indicatesthat the near-death experience is consistently reportedas something outside ordinary experience has meantthat, according to Draaisma, recollection usuallyresorts to metaphor, and closer investigation revealsthat the metaphors used are historically specific. In theage of cinema, such experiences usually take the formof a projected film. Draasisma’s analysis echoed themesfrom the papers of Forrester and Bourke – Joannasuggested that changes in the narration of nightmaresaltered the subjective experience of dreaming; Jung’snightmares were embedded with Jungian theory filledwith Jungian symbols, and Freud’s, Freudian imagery.

The final two papers from Kenton Kroker and John Geigerboth demonstrated the central role of technology inmediating our dream experiences. Kroker focused onthe development of the ‘sleep laboratory’ and discoveryof REM, showing how this prototypically subjectiveexperience of dreaming was turned into an object ofscientific investigation. His political account traced thelinks between private experience and public enterprise,an approach which was paralleled in John Geiger’slecture on Flicker and the History of the DreamMachine. Geiger explored the “intersection of artand science within the transcendental worlds evokedby stroboscopic light”. He traced the evolution ofthe dream machine from the first discovery of ‘flickerpotentials’ by the Bristol neurophysiologist, GreyWalter, through its development into a hallucinationgenerator by beatniks such as Brion Gysin and IanSomervillle, into its eventual development into the‘Dream Machine’, which the electronics company Pyehad hoped to install in every suburban living room.

This was a convincing and engaging symposium, withexcellent papers. As already mentioned the historicalmethodology embedded in some of the papersraised further questions. Although the papers wereaddressing, in different ways, a history of what isessentially a subjective experience, this only revealedthe need for more inter-paper discussion to challengesome of the assumptions and problems of historiography.I would have like to have seen extra session at the endof the day to bring the papers together on the theme of methodology. This was, otherwise, an excellent,enjoyable and different approach to a history ofdreams and altered states.

Melanie Clews, Queen Mary and Westfield College at theUniversity of London, UK.

10 Conference reports Wellcome History Issue 27

JOHN STEWART

A two-day workshop on municipalmedicine was held at St Edmund’sHall, Oxford, 1– 2 July 2004.

It was convened by Martin Powell (University of Bath),John Stewart, Alysa Levene and Becky Taylor (OxfordBrookes University).

The workshop was part of a wider project onmunicipal medicine in interwar England and Walesfunded by the Wellcome Trust. The convenors aimedto bring together some key voices working in the fieldof municipal medicine, as well as disseminating workfrom their current project.

Contributors to the workshop were Anne Crowther,Martin Gorsky, Greta Jones, Pam Michael, John Mohan,

Chris Nottingham, Martin Powell, John Stewart andBecky Taylor. Bernard Harris, Anne Hardy and VirginiaBerridge chaired the sessions. The papers covered awide range of quantitative and qualitative aspects ofthe high period of municipal medicine. These includedexplorations of specific municipal health systems –with examples from Gloucestershire, Eastbourne,Glasgow, Wales and The Netherlands – and of particularservices, and the structural and local factors affectinglocal authority health services. Other papers took amore quantitative approach in order to explain thepattern of hospital appropriation following the 1929Local Government Act, and the distribution ofvoluntary and state service provision.

It was a very productive two days, and in the roundtable discussion chaired by Kier Waddington there wasthe opportunity to explore a number of inter-relatedthemes, which had emerged from the papers.

Municipal Medicine

One of the key threads running through many of thepapers was how the diversity of municipal solutionsto provision of personal health services was reflectedin the diversity of localities. Therefore a variety oflocal influences must always be factored into anyconstruction of interwar service development. In thiscontext participants discussed the respective role ofeconomic determinism during the economic crisesof the interwar period; politics and the rise of Labour;the role of the Ministry of Health; and the existenceof progressive institutions and individuals in shapingservice provision. Other factors which came to the forewere the impact of civic pride and civic competition,and the influence of class and gender in steering theamount of investment and the direction of localhealth service development. Consequently the ideaof boundaries emerged as a key to understanding theperiod – not simply geographical boundaries, but also

institutional ones and between the voluntary andmunicipal sectors. Boundaries could isolate particularservices within their particular municipal authorityor divide one authority from another; equally theycould be blurred through strong inter-departmentalcooperation, joint schemes between local authorities,or by close coordination of the municipal andvoluntary sectors.

The discussion closed by exploring the relationshipbetween failures and strengths of municipal medicineand the emergence of the NHS.

The convenors would like to thank everyone whoparticipated, and the Wellcome Trust for their financialsupport. To find out more about the project on interwarmunicipal medicine, please contact John Stewartor Martin Powell at (E jwstewart@brookes.ac.uk) or(E hssdmp@bath.ac.uk).

11Wellcome History Issue 27 New Publication

J LOURDUSAMY

This book gives a flavour of the Indian responseto modern science by analysing the lives andcareers of four scientifically influential personalitiesin Bengal. It throws light on some of the complexand paradoxical issues attending India’sengagement with modern science in the contextof colonialism. While explicating the nuancesof the response, this work also contests somebroad generalisations which have a bearingon the subject.

Lourdusamy uses this study to emphasise theimportance of a prosopographical approach. Hisanalysis of the careers of two scientists, J C Bose andP C Ray, and two institution builders, MahendralalSircar and Asutosh Mookerjee, brings to light theissues related to science at a time of colonialism andnationalism. Scientists often had to depend on Britishinstitutions for legitimation and funding, while alsosupporting the nationalist cause for greater autonomy.One of the central claims of this book is that theprotagonists aimed to contribute to a modern worldscience, one based on a strong sense of universalism.They did not aim to construct any ‘alternative’ sciences,though they did express and apply their work bydrawing on their cultural heritage. This makes Scienceand National Consciousness a work of particularrelevance today, when a homogenous, instrumentalistand totally Western conception of science is beingglobally accepted.

J Lourdusamy is Assistant Professor in the Departmentof Humanities and Social Sciences at the Indian Instituteof Technology Madras, which he joined after his doctoralstudies at Oxford. His broad areas of interest includehistory of science and the interaction of scienceand religion.

For purchase information, contact Orient Longman(E editor@pol.net.in)

Science and National Consciousnessin Bengal,1870 –1930

Top right:

The clock towerof the Bombay

University LibraryImage courtesy of

Sanjoy Bhattacharya

12 Research resource Wellcome History Issue 27

MRIDULA RAMANNA

The University of Bombay was established in 1857. In 1864,Premchand Roychand, a rich merchant, offered a donationof Rupees 200 000 “towards the erection of universitylibrary which may be an ornament to the city, and bybecoming a storehouse of the learned works not only ofthe past but of many generations to come, may be themeans of promoting the high ends of the University.”

This was followed by another gift of Rupees 200 000 for a clock tower to be erected in memory of Roychand’smother, Rajabai. Designed by Sir Gilbert Scott, thefoundation stone of the structure was laid in 1869, andcompleted in 1878.The clock tower rises to a height of280 feet and with the library building is a landmark inMumbai (Bombay). Among the building’s many uniquefeatures are the stained glass windows and the sculptures,above the first gallery in the niches, representing thevarious communities of Mumbai, including the Parsi,Memon, Maratha, Gujarati and Kathiawari. Maclean’sGuide to Bombay (1880) recorded with pride: “A noticeablefeature in the work and one which speaks volumes forthe way in which it has been managed is that duringthe whole time of the construction not a single accidenthas occurred.”

The library opened, in 1880, with a conversazione,when eminent medical men conducted experiments.At the time, it had an odd assortment of historicaland biographical books, presented by the government,when the library of the East India Company was removedto the India Office and some books were divided amongIndian universities. In 1876, the university purchasedthe books owned by Dr John Wilson, founder of WilsonCollege, and university vice-chancellor between 1868and 1870. These were on ‘oriental’ interests, traveland theology. Initially, Rupees 400 was providedannually for the purchase of books and soon eventhis was discontinued. In 1888, there were only tworeaders, the additions that had been made to the librarybeing official publications of the government and someschool and college books, presented by publishers.As a result by the end of the 19th century, the library had4504 books and 214 manuscripts. Gradually the librarycame into its own, with an annual grant, the amountvarying, according to circumstances. The windfallcame in 1930, when a non-recurring grant of Rupees60 000 was given to strengthen the library for post-graduate work. Thereafter, funds kept flowing, andby 1956, the library had 125 000 books, and 1190manuscripts in Arabic, Urdu and Persian and 7418 inSanskrit and other allied languages. This source materialhas been growing in subsequent years.

Descriptive catalogues of manuscripts list the treatiseson medicine. Among the interesting titles are Ajirnamanjari,a treatise on indigestion and its remedies; Anjananidana,

which deals with eye diseases; Yogatarangini, a manualof dietetics and therapeutics; Jvaraparajaya, whichdiscusses fevers; Asta Pariksha, which gives theeightfold method of diagnosing diseases; and workson materia medica and on the preparation of syrups,powders and oxides. The Arabic manuscripts includea dictionary of medical terms, and Al Hikmatu’ T-Tibb,describing the symptoms and treatment of diseases.

Of particular value are the library’s rich collection onMumbai. It has all the census reports, annual reports ofthe sanitary commissioner, public health, civil hospitalsand dispensaries, administration of the BombayPresidency, the municipal commissioner, city of Bombay,the Grant Medical College, proceedings and debates ofthe legislative councils, Bombay University calendars,with the lists of graduates, and extracts from Indiannewspapers published weekly (invaluable forunderstanding Indian responses to colonial policy).The library also has reports from other presidencies,and proceedings of medical and sanitary conferences,little-known works, of the 19th and early 20thcenturies, by Indian doctors, besides those by Britishhealth officials, Andrew Leith, Charles Morehead,T G Hewlett and J A Turner. There are specific recordspertaining to plague, cholera, smallpox, leprosy andmalaria. Of particular interest are the issues of thedelightful Pickings from the Hindi Punch, whichcarried cartoons on issues of health.

Together with the even richer Maharashtra State Archivesand the library of the Asiatic Society of Mumbai, thecity is a treasure trove for medical history researchers.

Dr Mridula Ramanna is Reader and Head of Departmentof History SIES College at Mumbai, India(E mridularamanna@hotmail.com).

The BombayUniversity Library

Right:

Shops inChamba Town

Image courtesy of author

13Wellcome History Issue 27 Research report

ALEX MCKAY

There are many similarities between India and theUSA. Both are vast countries with a wealth ofcultures and landscapes, extremes of climate andbeliefs, and fractured, turbulent histories that stillchallenge their futures.

They are both democracies where the everyday practiceof religion exists amidst a secular framework andpersonal proclamations of faith are unblushinglymade by politicians and passers-by alike. Both providethe visitor with an intense encounter, fully engagingthe mind and body. But for the academic researcherit is the differences between the two lands that aremost immediately apparent.

You don’t get body-searched going into the Libraryof Tibetan Works and Archives in the Himalayanfoothills above Dharamsala, north India. Nor do youhave to pass through a metal detector and wait whileuniformed guards rummage through your bag andcheck your shoes for explosives, as you now do toenter the Library of Congress in Washington DC.You don’t even need to apply for a reader’s card. Butthe collections of the Library of Congress reflect allthe wealth and splendour of a 20th-century superpower,while for all its efforts the Tibetan library reflects thestruggle for resources in an exile community.

I recently carried out research in archives and universitiesin India and the USA as part of a Wellcome-fundedproject to trace the history of the introduction ofbiomedicine into the Indo-Tibetan Himalayas. ThusI came to reflect on the different research strategiesrequired in the two countries.

The most obvious difference perhaps, is that of time.Research can be done at pace in the USA. Librarians,themselves pressed for time, dispense crucial informationquickly and efficiently with the minimum of notice.Broadband computer connections and comprehensiveonline catalogues enable relevant material to be quicklyordered. Study areas are spacious and equipped withcomputer connections. Work proceeds at pace. In theHimalayas, however, the pace is somewhat different.Tibetan etiquette, for example, demands a preliminarycall on the relevant official, an outlining of the proposedwork and a discussion over how best it might be done.Commencing the actual work is politely left untila subsequent date. The researcher following suchconventions will lose time, but in return gains socialacceptance, and may thus be informed of sources thatmight not be revealed to less sensitive enquirers.

Information is power, and whereas in the USA a keeperof archives is a facilitator, in India the researcher oftenenters into a power relationship. In return for access to

sources there are expectations of mutual benefit.A library may need assistance with an application forsponsorship from a Western benefactor, or the librarianmay need assistance in locating a suitable Europeanuniversity for his son to apply to. Contributing to therelationship takes time, and perhaps even money.

Locating sources can be similarly time-consuming.There are few archives in the USA that cannot be quicklylocated via an internet search. Academic resources inIndia, however, are less systemised. Records of a periodmay still be in the possession of a local Maharajah.The records of the state are for them family records,accounts of a period in which their forefathers werethe government. Thus the creation of anunderstanding of the local historical context of medicaldevelopment requires an appointment with the Maharajah,whose perspective provides new insights not givenin the records of the British colonial state. But onedoes not simply turn up at a Maharajah’s door at9 a.m. ready to start work. They invariably have manybusiness interests and social commitments, and theresearcher must join the queue.

In India the researcher often entersinto a power relationship.

The need to see specific individuals can be particularlylabourious. Both the nature of interviewing and thehierarchal nature of bureaucracy is such that certainofficials are recommended by all as ‘the person to see’.But that officer is invariably ‘engaged at court’ or‘out of station’ at any time in the immediate future.Days pass with frequent cups of tea proffered byfriendly lesser officials, along with assurances thatthe subject will eventually return.

India and the USA:A researcher’s reflections.

One church official I sought, reputedly the key to allknowledge of the early medical missionaries in thatdistrict, proved particularly tardy. I filled in one daysearching for an alternative voice; a relative of theabsent ecclesiastic who was said to have fallen out withhim many years before. When I eventually found hishouse in the back streets of the bazaar, I was solicitouslyinformed by his neighbours that he had actuallydied some months previously. And when the missingchurch official finally returned a week late, he provedto actually know very little about the missionaries.But he did know a considerable amount about themission’s house and the land they had had, becausehe now occupied it, and hoped to gain my support inthe long-running lawsuit over its disposal.

Travel in India takes up considerable time. India’sinfrastructure has greatly improved in recent years,but it can still take hours to buy a train ticket, andreservations for a particular day can be impossibleto find. Similarly Himalayan roads are subject tolandslides, and the wear and tear on vehicles onmountain roads means breakdowns are frequent.What is scheduled as a morning’s drive is liable totake all day. Planning ahead can thus be difficult,if not impossible.

Nor can one put in long hours at the archives. The mainlibrary of the University of Chicago is open at least14 hours a day, and sometimes overnight. In India,however, an eight-hour day is usually the maximumeven in theory, while the inevitable power cuts mayreduce that time still further, and also prevent‘catching up’ work in the evenings at one’s hotel.

There is also a different culture of historical preservation.In the USA records are recognised as a resource; thepapers of even a minor historical figure may fetch aconsiderable sum at auction. But medical history ishardly a priority in India, where scant resources canbarely cope with the present. Many Indian hospitalsdestroy all records after a few years, and even those filesthat are stored are often kept in unsuitable locations.A monsoon season or two, and the attentions of insectsand rodents, means they are soon unusable.

Even when local medical records are retained ingovernment archives they are not necessarily safe.Most of the colonial-era records kept in Simla, theBritish imperial summer capital, were destroyed ina fire in the 1950s, and the Simla archives are thus oflittle value to the imperial historian.

What can be found is often revealed by chance. WhileI waited a week for my churchman, I often chatted toan elderly man living near my hotel. He talked to afriend who worked at the local hospital, where I hadbeen told that no records were kept of the colonial era.But purely as a curiosity, the friend had kept a 1920shospital pay-book he had found behind a cupboard,and that pay-book turned out to be a useful primarysource for me.

Such personal discoveries, and the joy of working inthe beauty of the Himalayas, are more than adequatecompensation for the difficulties of research there.

Dr Alex McKay is a Wellcome Research Fellow at theWellcome Trust Centre for the History of Medicine at UCL(E: dungog@hotmail.com).

Top right:

Chamba TownImage courtesy of author

14 Research reports Wellcome History Issue 27

15Wellcome History Issue 27 Book reviews

ALAN SHIEL

When Roy Porter published his book calledMadness: A brief history, I told him that ithad been reviewed in a major broadsheet.He enquired about the review and I said thatthe reviewer had said it was quite good butrather brief. Somewhat uncharacteristically Royreplied, “Bloody fool, hasn’t he read the title?”

Well, I have read the title of Roy Porter’s latest bookBlood and Guts: A short history of medicine. Apart fromthe inference that it might be somewhat demotic instyle, it is a totally accurate description of the contents.It is an extraordinary tour de force taking the readerthrough the history of medicine from mankind’sarrival on earth to the current state of the NationalHealth Service in the UK. It is certainly not the lastword on the history of medicine but I think that formany readers it may be the first word. It is an idealintroduction: informative, fascinating without anysuggestion of ‘dumbing down’.

The book is based on a series of lectures which hegave and that allows him to provide complete stand-alone chapters on such topics as ‘Disease’, ‘Doctors’,‘The Body’, ‘The Hospital’, and so on. It is not todenigrate the content of the main part of the book ifI say that possibly the most important section comes atthe end, in his list of further reading where, informallybut thoroughly, he sets out in 17 pages a list of furtherbooks. In the rare use of an exclamation mark he notesthat Jackie Duffin’s A History of Medicine: A scandalouslyshort history is “actually 430 pages long!” By way ofcomparison Blood and Guts runs to just 199 pages; justhow scandalous is that? For those of whom this is theirfirst book in the history of medicine this is aninvaluable resource.

Roy Porter’s lecturing style is evident in the way eachchapter is written. Full of information, anecdote, humourand challenging theory, it is not hard to imagine Roystanding before a class and telling his spellboundaudience about ‘Lily the Pink’ (whom I had previouslysupposed to be the invention on the 1960s pop groupThe Scaffold) and the early uses of amyl nitrate! Thebook sadly but inevitably fails to include the hilariousand possibly scandalous asides and digressions thatwould have followed from a discussion of such matters.

Roy Porter’s lifelong scepticism about the efficacy ofmuch medical treatment is never better highlightedthan by his account of the function of prescribing pillsat the close of a brief consultation: “It’s a nice way ofgetting rid of a patient, you scribble something outand rip the thing off the pad. Doctors can now cure asnever before: the public may doubt whether they care.”

Although continuing to be wary of ‘quacks’ (e.g. the“electrified Celestial Bed” provided by James Grahamat his Temple of Health, which promised long lifeand sexual regeneration), Roy is not unsympatheticto alternative approaches to healing per se, nor tothose who turn to them. He describes how alternativehealing philosophies often mirrored religiousdissenting sects and sociopolitical radicals: “Artisansdistrustful of princes and prelates were no more disposedto swallow the medicines of privileged Colleges.”

Roy has seldom used his books to regale his readers withhis political opinions (a brief and effective exceptionappears in London: A social history) but he leaves littledoubt in the mind of his readers that he considers thecurrent attitudes in and towards the National HealthService unhelpful. He does not coin the slogan ‘over-management kills’ but there is little doubt that he wouldsubscribe to such a view. It would not be a wild flight offancy to imagine he felt the same about other leadingBritish institutions such as the BBC and the universitysector of higher education. In the face of current trendsat most seems almost quaint his plea for the return of the‘personal touch’ approach in medical care.

Is an ideal introduction: informative,fascinating without any suggestionof ‘dumbing down’.

In The Human Effect in Medicine by Michael Dicksonand Keiran Sweeney (also recently published) there is acomplaint that “modern medicine has lost its heart andsoul and become mechanistic. The new GP contract talksabout measuring cholesterol and blood pressure but whatpatients want is a doctor who will listen, talk with themand understand them.” I doubt that Roy Porter wouldhave dissented from such a statement.

Blood and Guts

16 Book reviews Wellcome History Issue 27

ANN DALLY

Anyone who knew ‘Bing’ Spear well in hisprofessional capacity will know that, behindhis bureaucratic even-handedness as acivil servant, lay passion and strong beliefs.He was Chief Inspector of Drugs at the HomeOffice, with more than 35 years’ experienceof the drug scene in Britain. He had seen itdevelop and he knew it intimately.

As a civil servant, he could not express his views publiclybut he often said that, when retired, he would revealall. This he has now done. Unfortunately he died beforehe finished the story, which he tells up to two yearsbefore his retirement. Those two years were full ofincidents but nevertheless he has covered most of itand the manuscript has been ably edited by a formercolleague of his, Joy Mott.

Spear believed, as do many others, that the British(following the American) policies concerning heroinhave failed. Prohibition has led to ever-increasingaddiction and to a vast amount of crime and suffering.The situation was made much worse because thetreatment centres, set up in the 1960s when heroinwas becoming a problem, were, according to Spear,“an unmitigated disaster”.

This was “not because the basic idea was wrong butbecause of the way in which that idea was developedand implemented”.

For this Spear blamed “a small group within themedical establishment”, and “psychiatrists in particular”,led by the late Dr Philip Connell. These doctors, withlittle experience of treating addiction, imposed theirown views on the situation and took steps to ensurethat other doctors and GPs, who traditionally treatedaddicts, were kept out of the scene, and often that all

addicts, whether they had been addicted for threeweeks or 30 years, should be treated the same. In lifeSpear was vociferous in his condemnation of thisgroup of “drug dependency mafia”, and he sets outhis arguments here.

The book is authoritative and quite different fromwhat anyone else has written. It is an invaluableaddition to the history of heroin in Britain.

Spear H B (2002) Heroin Addiction: Care and control:the British system, edited by Joy Mott, London:Drugscope. pp.362, £35.

Ann Dally is at the Wellcome Trust Centre for the Historyof Medicine at UCL.

Heroin Addiction Care and Control:The British system

Roy Porter was never gloomy let alone apocalyptic;it was not in his nature to be. We should thereforetake serious notice of his view that drug abuse anddependency – by no means only in the guise of illegalnarcotics – means there is an urgent problem formedicine and society alike. Roy Porter concludes hisbook with the warning that medicine may be on thebrink of one of the greatest transformations in its longand chequered history but the public climate is not oneof optimism but of new millennium anxiety.

If anyone continues to doubt that ‘history matters’or that the lessons of the future are to be found in a

study of the past then they would do well to read thisbook. I am sure it will be widely read by newcomersto the subject and by accomplished historians ofmedicine. In writing this review I became consciousof the danger of being part of a ‘Death of Roy PorterIndustry’. In life Roy hated sycophants and flatterers;in death he may have to put up with us!

Blood and Guts: A short history of medicine ispublished by Penguin Allen Lane at £12.99.

Alan Shiel is at the Wellcome Trust Centre for the Historyof Medicine at UCL

17Wellcome History Issue 27 Book reviews

PRATIK CHAKRABARTI

This highly interesting book engages with variousareas of modern scholarship: ecology, modernity,cultural imperialism and post-colonialism. The mainargument is that the USA role in shaping Indianecology since independence needs to be seenas one of collaboration, distinct from the Britishcolonial one.

US scientists like S Dillon Ripley did not carry the‘colonial burden’ in interacting with Indian naturalistslike Salim Ali. The book discusses contributions ofGeorge Schaller and Juan Spillett who came to Indiaas part of the diasporas of US ecologists throughoutthe world from the 1940s in search of wilderness andsolitude, with the urge to expand a new disciplinebeyond the ‘frontiers’. They and others formed stronglinkages with Indian scientists and institutions leadingto the emergence of an ecological science for Indianecosystems, where Indians like Madhav Gadgil,Raghavendra Gadagkar and Raman Sukumar, actively‘localised’ US biological concerns.

The book reads like a delightful travelogue describingthe author’s intellectual journeys with WorldlifeInstitute of India (WII) researcher Christy Williamsin Rajaji Park. As a historical monograph its study ofthe contribution of the pioneer Salim Ali, establishmentof Bombay Natural History Society and its linkages withIndian nationalism provides a much richer reading ofIndian ecological history than that by Gregory A Barton(Empire Forestry and the Origins of Environmentalism,Cambridge University Press, 2002).

Despite its detailed study of ecological debates, Lewisprovides a rather ahistorical explanation for complexhistorical processes like the evolution of ecologicalideas in the USA, as well as the early 20th-centurydevelopment in German physics, Italian Renaissance,and Indian nationalist thinking, which according tohim were “an unexpected outpouring of brilliance”(pp.338–9). In regards to ecological thinking in theUSA, it must be pointed out that key historical worksin that field (e.g. Donald Worster, Nature’s Economy:The roots of ecology) get unmentioned.

Lewis tends to over-simplify theissue of ‘cultural imperialism’

Coming back to collaboration and the emergence ofnew knowledge, Lewis distances himself from ArjunAppadurai’s notion of public culture to set out a deeperproject, the study of “… the role of power relations inwhat knowledge is accepted and codified, versusrejected or marginalised” (p.26).

Lewis provides a rather ahistoricalexplanation for complex historicalprocesses like the evolution ofecological ideas in the USA

But the narrative gets embroiled in a debate with ‘culturalimperialism’, which limits its scope. Lewis tends toover-simplify the issue of ‘cultural imperialism’ whichaccording to him, “assumes that all global exchangesare trumpets – fairly inflexible products of one culture”,(p.335), and in another instance, “The idea of culturalimperialism implies that things have pure origins”(p.337). Few scholars working on imperialism andculture would make such claims. Notably neither ofthese statements are attributed to any book or scholar.Lewis elsewhere has engaged with Shiv Visvanathan’scritic of Western science, but one of Visvanathan’sarticles that Lewis has discussed in fact sets a verydifferent tone:

“India today stands as one of the world’s greatclearing houses and compost heaps for ideas…This is best seen in the attitude to its three greatestimports: democracy, the English language, andmodern Western science. For Indians these werenot alien ideas to be handled with suspicion butcelebrations, which they had to internalize andreinvent for themselves. Indeed, the confidenceand openness with which India greeted andscrutinized science constitutes one of the mostfascinating chapters in the encounter betweenscience and democracy”.

Thus Lewis ends up denouncing what is quite indefensible.His conclusion that: “it is difficult to imagine howIndian ecology would have developed in the absence of

Inventing Global Ecology: Tracking thebiodiversity ideal in India,1945 –1997

18 Book reviews Wellcome History Issue 27

KAI KHIUN LIEW

Aside from official accounts, newspapers, poetry,novels and autobiographies are all alternativeand legitimate sources in framing the discourseson the history of medicine.

From a broad compilation of articles spanning acrossthe Early Modern period to the present, the contributorsof Framing and Imagining Disease seek to demonstratethe fluctuating interpretations of health and diseasesthrough the articulations of historically acclaimed literalpersonalities and ordinary subjects outside the medicalprofession. Such accounts cover areas ranging frompsychiatry to epidemiology, from New York to India.

While their efforts are commendable, questions remainon the extent to which this work is capable of steeringresearch directions and paradigms within the increasinglyrelated fields of history, medicine, culture and society.

Framing and Imagining Disease is one of the concreteoutcomes of ongoing multidisciplinary dialogues from‘a consortium’ of scholars interested in the culturalunderstanding of illness. To begin with, readers arefaced with a lengthy introduction by George Rousseau,the editor, on the basis and background of theirapproach in deciphering diseases through literatureand poetry. In this respect, Rousseau identifies twofundamental approaches in the historiography.They are the dominant ‘Rosenbergian’ (from

Charles Rosenberg’s works) enterprise of viewing the

discipline through macro-social arrangements and

the emerging ‘Rousseauvian’ group that gravitates

its research towards individual voices. The volume is

divided into four main sections, namely, on framing

and imagining diseases, madness and psychiatry, the

narratives of the patients, as well as the poetics and

metaphorics of diseases.

In the first part, Caterina Albano dissociates the

contemporary understanding of anorexia with the

the USA, so intertwined are the two nations’ ecologicalsciences, but at the same time it is clear that Indianecology developed along its own lines, fulfilling thegoals of Indian actors, be they scientists, activistsor bureaucrats” (p.340) is hard to distinguish fromAppadurai’s theme of negotiations in public betweenthe cultural producer and the consumer.

While Lewis has successfully argued that US participationin Indian ecology cannot necessarily be seen as animperialist project, other issues remain, like theone with which he started, that do synthesis andsyncretion exclude the question of power? Lewiseffectively critiques Ramchandra Guha’s suggestionsof US dominance in Indian ecological thinking butintriguingly avoids engaging with the importantliterature on the subject which has suggested a morenuanced understanding of the production andabsorption of ecological expertise, while specifyinghow power and politics continue to play their roles inthe struggle for resources in the diminishing forests.

Christy Williams’ comment, “everyone else has a voice,and the elephants have only the biologists” (p.15)reveals the dichotomy that exists between scientists andhuman rights activists in Indian ecological debates.

US ecological science, while sympathetic towards Indianflora and fauna, has been found inadequate to tacklethe unique problem of Indian forests which often havedense human settlements. The issue is as much ecologicalas sociological. But a quick look at the faculty of WIIreveals that it still comprises people from biology,botany or zoology backgrounds, while social activistscontinue to oppose a science which they claim doesnot reflect their concerns. Lewis refers to this problemas a gap between the rural and the urban understandingof forest management (p.110) but does not elaborate onit. One breakthrough from this impasse might lie in adeeper interaction between these sociological concernsand ecological science towards a more compositeunderstanding of the forest and its inhabitants, andthus an integration of ‘Indian’ concerns within thescience of ecology, one of the key themes of the book.

Lewis M. Inventing Global Ecology: Tracking theBiodiversity Ideal in India, 1945 –1997.New Delhi: Orient Longman; 2003; pp. xi + 369; Rs. 675,ISBN 81 250 23771.

Dr Pratik Chakrabarti is the Deputy Director and UnitResearch Officer at the Wellcome Unit for the History ofMedicine, Oxford, UK.

Framing and Imagining Disease in Cultural History

notions of self-starvation as a continuation of themedieval traditions of religious piety and asceticismin the 17th-century case of Martha Taylor, otherwiseknown as ‘Derbyshire Damosell’. Basing on thepoetries and treatises on smallpox in the same period,David Shuttleton discusses the relationship betweenthe notions of inherited sin and disfigurement withthat of self-dignity of facially scarred survivors of thedisease. Moving to 19th-century New York, Jane Weisshighlights the complexities of the responses to thecholera outbreak in 1832 by tracing the shifting ofjournalistic paradigms from casual dismissal tofeverish distress. Across the world in colonial India,Pamela K Gilbret equates the attempts by Britishcolonial officials in the subcontient to map out itsmedical cartography as both epidemiological tools,and, as arguments for pushing for social developmentand modernity to the ‘backward natives’.

Overall, the organisation andquality of the contributions in thevolume are pleasing.

Moving forward to 20th-century Germany, Malte Herwighighlights, through Thomas Mann’s The Tragic Mountain,the varied responses from the medical establishment toalternative interpretations from otherwise lay sources.In the second part of dealing with psychiatry, MirandaGill laments the absence of any attention paid toeccentricity in French historical accounts. Still onFrench literature of the same century, Michael Finndemonstrates the failed attempts at a medicalreformulation of the popular understanding ofstrongly embedded historical concepts of possessionand hypnosis. What was meant to be treated asnarratives of scientific progress became inverted topublic imaginations of fetish behaviours. Anotherattempt to demystify the march of biomedical progressin mental health is highlighted in the experience of thedevelopment of Hungarian psychiatry. Emese Laffertonconcluded that late 19th-century Hungarian literatureexpressed fears of the functioning of asylums asinstitutions that reinforces rather than liberate existingrepressive social structures.

Resounding the late Roy Porter’s call for historiansto view the patient’s perspective and his role as anactive social player instead of a passive object, PhilipReider, in the third part of the volume, focuses on theunderstanding of lay medical cultures through theaccounts of 18th-century writers like Jean-JacquesRousseau and Isabelle de Charriere. This is followedby Rousseau and David Boyd Hancock’s contributionon the anaylsis of the English poet, Samuel TaylorColeridge’s rich but troubled and conflicting accountsof mapping symptoms of illness within his body,even none seemed to be found by doctors. To theauthors, he personified the legacy of poetry,melancoholy and hypochondriasis, or what istermed as ‘diseased imagination’.

Finally, on the section concerning metaphors ofdiseases, Agnieszka Steczowicz explains the 16th-century terminology of ‘paradox’ to the difficultiesof categorising new diseases through the vocabularyof existing medical traditions. Hence, the wordpromised controversy and departure from acceptednorms, and embraces discovery and innovation.From her study of Victorian culture, Kristie Blairtouches on matters of the heart in her chapter onthe enduring cultural significance of the heart inspite of the pressures of the rising influences ofbiomedical ideas of it as a functional physical organ.Lastly, Stephan Besser draws light to Henry Wenden’scolonial novel Tropenköller in 1904 as a text that circulatesbetween different frames of politics, literature andmedicine. The title, a compound of the Germandialect of both ‘tropics’ and ‘choleric’, assumed themetaphor of the German contempt for, and its atrocitiesin, its African colonies in the early 20th century.

Overall, the organisation and quality of the contributionsin the volume are pleasing, reflecting on both thecommitments of individual authors and editors.This is demonstrated in the long discussions in theintroductory chapter to the detailed elaboration ofthemes and events. Rousseau has even pre-emptedcritical reviewers by both acknowledging previousworks on culture and medicine, and also apologisingfor the lack of a larger representation of topics andcoverage on larger sociological themes. Nonetheless,questions remain about the ambiguous place ofFraming and Imagining Diseases in the interdisciplinaryframework that he eagerly embraces. Even as theacademic focus of culture and medicine has beenrelatively recent, this publication is neither a novelproject, nor is it tailored to break into new conceptualgrounds. The aims of the authors in offering alternativeinterpretations by different frames to counteractthe absolutist claims of modern biomedicine cannotbe considered to be radical. On the contrary, it seemsthat the editors are more successful in attemptingto institutionalise and reassert the dichotomy betweenthe traditional Roserbergian and the ‘newly established’Rousseauvian schools of thought. Last but not least,Rousseau has yet to reconcile the fact that, in spiteof its claims of multidisciplinarity, the field ofculture and medicine has evolved into a distinctstudy, instead of one that could move freelybetween cultural studies, history and medicine.

George Sebastian Rousseau, with Miranda Gill,David Haycock and Malte Herwig (eds).Framing and Imagining Disease in Cultural History(New York: Palgrave, 2003) 329 pp.

Mr Kai Khiun Liew is a doctoral candidate at theWellcome Trust Centre for the History of Medicineat University College London, UK.

19Wellcome History Issue 27 Book reviews

20 Research group news Wellcome History Issue 27

VISITORS AND EVENTS

Visitors to the Wellcome Trust Centre for the Historyof Medicine at University College from June throughDecember 2004 have included:

Prof. Rima Apple* (University of Wisconsin-Madison),Science + Love.

Dr Luc Berlivet (CNRS-CERMES), The impact ofthe smoking/lung cancer controversy on the globalsetting of British biomedical research.

Dr Carmen Caballero (University of Granada),The Hebrew written production on women’shealthcare.

Lucia Candelise (EHESS, Paris), Chinese medicinein France and Italy.

Dr Che-Chia Chang (Academica Sinica, Taiwan),Rhubarb as a medicine and Sino-British relations,via British Academy award.

Dr Michael Clark* (ex-Wellcome Library), Anglo-Irishmedico-legal relations from the Act of Union toindependence, and archival medical film and history.

Dr Esté Dvorjetski* (University of Haifa), Leisure,pleasure and therapy in Roman-Byzantine Palestineand Jordan.

Dr William Gallois* (American University of Sharjah/Mellon Fellow, SOAS), A history of medical ethics inAlgeria and Morocco, 1800-2000.

Dr Debabrata Ghosh (All India Institute of MedicalSciences, New Delhi ), Ideas and concepts about issuesrelated to human fertility in pre-Mughal India.

Prof. Sander Gilman* (University of Illinois-Chicago),Vocabularies of good diagnostic practice.

Dr Geoff Hudson (McMaster University), The Englishmilitary hospital, 1644 –1790.

Dr David Israel* (BC’s Children’s Hospital, Vancouver),Medical specialisation in the second half of the20th century.

Prof. Amarjit Kaur (University of New England ona British Academy Visiting Professorship), MigrantIndian labour in Malaya and Burma, 1880 – 1940:Workers’ health and health services in plantationand industrial/urban sectors.

Dr Jennifer Keelan (Toronto), Late 19th centurymedical calculating and risk assessment.

Prof. Steven King (Oxford Brookes University),The sick poor.

Dr Shang-Jen Li (Academica Sineca, Taiwan),Healing bodies, saving souls: Medical missions to19th-century China.

Dr Anita Magowska (Karol Marcinkowski Universityof Medical Sciences, Pozna, Poland), Charity and itsimpact on healthcare in the 20th century.

Prof. Janet McCalman (University of Melbourne),A social history of the underclass in Australia.

Prof. Ian McDonald* (formerly Harveian Librarianat the RCP), The views of central nervous systemmechanisms held by clinicians and physiologists inthe latter half of the 19th century and a history of thecontributions of the National Hospital of Neurology,London in the second half of the 20th century.

Dr Arouna Ouedraogo (INRA, Paris/EHESS, Paris),The social history of vegetarianism.

Dr Christiane Sinding (CERMES/CNRS, Paris),A history of diabetes mellitus and insulin.

Dr Chris Waters (Williams College, Williamstown,MA), Psychiatry, the state and sexual selfhood inmodern Britain.

Sally Bragg, Visitor and Programmes Administrator(apologies to those of our visitors whose plans were notfinalised at the time of providing copy).

* Are at the Centre at the time of publication.

From 20 December 2004 the Centre’s new addressis 210 Euston Road, London NW1 2BE, UK

Wellcome Trust Centre for the Historyof Medicine at University College London

21Wellcome History Issue 27 Research group news

ROBERT ARNOTT

The Centre for the History of Medicine, a HEFCE-funded academic department within the MedicalSchool of the University of Birmingham, wasestablished in December 2000 to support andpromote teaching and research in the history ofmedicine and help develop the rapidly expandingreputation in this field in one of the UK’s topresearch universities.

The Centre, uniquely located in a medical school,continues to grow very quickly and is now looking atways of developing its research potential.

TEACHINGUnlike many other similar centres, devoted exclusivelyto research and some limited postgraduate teaching,the principal core function of the Centre is to undertakeits extensive programme of undergraduate teachingin the history of medicine and healthcare, mainly tostudents of medicine, dentistry and professions allied tomedicine. The history of medicine has a significantplace in a number of undergraduate degree programmes.

For example, in the last five years, over 700 medicalstudents have now studied the subject at differentlevels, from our continually expanding IntercalatedBMedSc Degree in the History of Medicine. Ourprogramme also admits a number of students frommedical schools outside Birmingham, onto the six-week special study modules.

Outside the undergraduate sphere, the Centre isexpanding its taught postgraduate degree programmes,which will be resourced from within the School andthe Centre. These include a mixed taught/researchMPhil (History of Medicine) degree programme, which isalready running, an internationally unique MSc (Historyof Military Medicine and Healthcare) degree programmeavailable from 2005 and organised in collaborationwith the Royal Centre for Defence Medicine.

We are also looking at starting an MSc programmein disease and medicine in the ancient world withintwo years. Some modules that are associated with theintercalated degree are available to students from theSchool of Historical Studies and all of our modulessince September 2004 are also available as continuingprofessional development (CPD) stand-alone courses,which will bring in considerable financial resources.

SEMINARS AND CONFERENCESRegular fortnightly meetings of the Centre’s Historyof Medicine and Health Research Seminar, which hasan average attendance of 22, including both cliniciansand historians, and a series of conferences andworkshops supplement the research of the Centre.

Since the foundation of the Centre we have organised15 conferences, many in conjunction with other bodies,such as the Society for the Social History of Medicine.

EXPANDING RESEARCHMuch of our work, located in a School where all theRAE scores are either 5* or 6* and where the historyof medicine is a recognised research discipline, supportsan active programme of research funded by a numberof bodies including: the University itself, the UniversityHospital Birmingham Charities, the Wellcome Trust,the Institute for Aegean Prehistory, the Arts and HumanitiesResearch Board and the Sir Arthur Thomson CharitableTrust. Part of the Centre’s strategy is to consolidate andexpand its principal research themes: (a) The history ofmedicine and healthcare in Birmingham and the BlackCountry, especially its voluntary hospitals; (b) medicaleducation in provincial England, 1800–1948; and(c) ancient medicine and palaeodisease. In the latterresearch theme within the field of bioarchaeology, theCentre is now internationally recognised as having thelead in research in palaeodisease, health and medicinein the Bronze Age cultures of the Aegean and Anatolia.Members of the Centre are currently developingadditional research foci, particularly the history ofoccupational health and medicine and the historyof military medicine and healthcare. The staff, both coreand other, produces a steady stream of books and articles,many as the result of our conferences and meetings.

The Centre brings together scholars not only within theSchool of Medicine (and the Royal Centre for DefenceMedicine), but also on a collaborative basis with scholarsfrom other different schools of the university, whichtouch upon the history of disease, medicine, nursingand historical demography. Internationally, the Centrenow has very close links with the University of Salzburgin Austria, and Lund and Uppsala Universities inSweden, with whom we are developing research linksand student exchange programmes.

The Centre will be greatly enhanced with the imminentmove of the Birmingham Medical Institute, founded in1875, into the Medical School, which will lead to thecreation of a substantial history of medicine library(The Sampson Gamgee Library in the Historyof Medicine).

As well as being a centre of excellence in the teachingof the history of medicine to medical undergraduateand postgraduate students, plenty of opportunitiesexist for postgraduate research students to undertakeresearch based upon the Centre’s research strengthsand current projects. It is possible to work towards thedegree of MPhil, MLitt and PhD by research, and forsome clinicians, MD by research. By the autumn of2004, the Centre had 14 postgraduate research studentswho have now forged themselves into a vibrantresearch and social community.

Centre for the Historyof Medicine at Birmingham

22 Research group news Wellcome History Issue 27

Right:

Children at theManchester Unit’s

first outreach eventin March.

Image courtesy of authors

JULIE ANDERSON, EMM BARNES, NEILPEMBERTON AND DUNCAN WILSON

In March 2004 our first outreach event was heldat the Eureka! Science Museum over two days.Organised by Dr Emm Barnes the days wereorganised to widen the exposure of history ofscience technology and medicine, and offeredhands-on learning experience about disabilityboth in the past and the present.

In describing reasons for planning and organising thisparticular event, Emm Barnes said, “We felt that thehistory of medicine was a great way to increasechildren’s interest in science and technology. The stresson hands-on learning at Eureka enabled us to get awayfrom more formalised learning environments andbring aspects of our work to life with real objects andpersonal experiences. Once children see the many waysin which human ingenuity has improved health andwellbeing over time, they see the point in learning moreabout science and may grow up to consider careers inscience, technology and medicine”.

The event was organised into three separate sections,‘Design Your Own Body Part’, ‘CommunicatingWithout Sound’ and ‘Games Disabled People Play’.In ‘Design Your Own Body Part’, Julie Anderson makethe history of medicine come alive for the participantswith a combination of play-acting, demonstration andactivities. As expected, the children intimated thathistory was dull and boring. Julie and Emm enacteda scene from the turn of the century: Emm, was the

patient and had her arm removed with an amputationkit and without the benefit of anaesthesia. This quicklyaltered the children’s view that history of medicine wasdull and boring! Different artificial limbs and internalprostheses were shown to the children, leaned kindly forthe event by Dr Peter Mohr at the University ofManchester Medical School. The children tried to guesswhat all the prostheses were for and were encouraged toask questions and touch the items that were on show.

In his session ‘Games Disabled People Play’, DuncanWilson concentrated on sport for disabled people – withparticular emphasis on the game of blind football. Thechildren were initially incredulous when told that loss,or impairment, of sight was no barrier to participation in

STAFFDr Jonathan Reinarz’s Wellcome University Award,which will convert into a permanent Lectureship inthe History of Medicine, and the appointment ofDr Anne Spurgeon as a part-time Senior Lecturer,have greatly strengthened the work of the Centrewith the addition of modern medical historians onour core staff. They join the Director, Robert Arnott,recently promoted to Reader in the History of Medicineand leading specialist in palaeodisease and ancientmedicine, and Hilary Morris, a Teaching Fellow whospecialises in the social history of medicine from the18th to the 20th centuries. Together with the supportstaff, many of whom undertake teaching as wellas research, we have a superb base with which tocontinue our work and expands our activities.

THE FUTUREAt the Centre, we have a clear strategic plan and anumber of objectives. They are based around the

consolidation of the Centre’s existing research basein its key research areas, expanding the researchcapacity of existing staff by attracting major researchgrants in these areas and further permanent academicappointments. We aim to forge stronger interdisciplinarylinks within the university, especially with the Schoolof Historical Studies. On the international front, weplan to develop existing international contacts andcollaborative research.

Going back to our core activity, the developmentof research-led teaching, particularly in the field oftaught postgraduate programmes and CPD, andthe training of Master’s and PhD students is ofparamount importance. Finally, we hope to improvedissemination of our research and develop our publicengagement activities.

Robert Arnott is a Reader in the History of Medicine,Sub-Dean of Medicine and Director of the Centre for theHistory of Medicine in the University of BirminghamMedical School (E R.G.Arnott@bham.ac.uk).

A historic day: Manchester WellcomeUnit’s outreach event

football. All believed that sight-impairment was totallyrestrictive in this respect. The aim of this session gave thechildren first-hand experience of the skills required topartake in these activities.

All participants were made aware of blind sports andthe heightened skills required for participation. Somechildren expressed admiration for those who played inblind football, and clearly saw blindness as less limitingthan they did initially.

In the workshop ‘Communicating Without Sound’Neil Pemberton aimed to highlight the diversity ofnon-verbal communication. All children were giventhe opportunity to learn some basic sign language andcreate a sign name, as well as working with each otherin a fun-based activity. By giving children first-handexperience of nonverbal communication, the activitysought to question any commonsense views childrenhad of non-verbal communication.

Helen Barraclough for Eureka! said, “The Challenge Dayswere a huge success with the children and the teachers.The activities provided enrichment opportunitiesfor the children to develop their problem-solving skills,whilst raising awareness of the challenges faced by peoplewith disabilities. It was also a wonderful opportunity for

the children to meet real-life academics and beintroduced to the possibilities of higher education.”

First of these outreach events was a great success andthe two days were fun and educational for both theparticipants and the group leaders.

23Wellcome History Issue 27 Research group news

Top right:

Children playinga game of

‘blind football’.Image courtesy of authors

Right:

Florence Nightingale.

Previously unknown recording ofFlorence Nightingale’s famous speech,made in support of the Light BrigadeRelief Fund, 30 July 1890.

In May 1890 a public scandal erupted when it wasdiscovered that many veterans of the Charge of theLight Brigade were destitute. The Secretary for Warstated in Parliament that he could not offer assistanceand in response the St James’s Gazette set up the LightBrigade Relief Fund.

Colonel Gouraud, Edison’s representative in Britain,arranged to make three sound recordings to supportthe fund:

• Alfred Lloyd Tennyson reading The Charge ofthe Light Brigade on 15 May 1890.

• Martin Lanfried, trumpeter and veteran,sounding the charge as heard at Balaclava,on 2 August 1890.

• Florence Nightingale, delivering a message to theveterans, recorded on 30 July 1890 at her homeon 10 South Street, Park Lane, London.

This original wax cylinder features two recordingsmade by Nightingale reading the same speech.The second reading was first produced commercially

in 1935 on a 78rpm disc but it did not feature herfirst attempt where she stumbles on her words andthere is a long pause between the sentences. The waxcylinder is extremely fragile and each time it isplayed the recording becomes even more indistinct.The British Library Sound Archive technical teamhas now restored the recording and made it audible,using digital technology. The original will be preservedby the British Library, who have also featured it ontheir recently published Voices of History CD.

Florence Nightingale remastered

Calendar ofevents TO ADD AN EVENT TO THE CALENDAR PAGE,

PLEASE SEND DETAILS TO THE EDITOR,sanjoy.bhattacharya@ucl.ac.uk

JANUARY 2005

20 History in Public Health seminar series: Global biopolitics and world health London School of Hygiene and Tropical Medicine, 12.45–14.00Speaker: Alison Bashford (Sydney)

26 Workshop: Tuberculosis, migration and health screening:Comparative historiesLondon School of Hygiene and Tropical Medicine, 12.45–14.00Speakers: John Welshman (Lancaster), Alison Bashford (Sydney),Richard Coker (LSHTM)

FEBRUARY 2005

17–19 Health and History: International perspectivesUniversity of Auckland, New ZealandContact: Linda Bryder (E l.bryder@auckland.ac.nz)

24 History in Public Health seminar series: Christian witness through medical service: the American Mission Hospitals in Ceylon, 1850–1960London School of Hygiene and Tropical Medicine, 12.45–14.00Speaker: Margaret Jones (Oxford)

MARCH 2005

11 UK History of Nursing Research ColloquiumGreen College, University of OxfordContact: Helen Sweet (E helen.sweet@wuhmo.ox.ac.uk)

21–23 Health, Heredity and the Modern Home, 1850–2000Centre for Medical History, University of ExeterContact: Claire Keyte (E cfmh@exeter.ac.uk)

APRIL 2005

16–17 Sex Education of the Young: A cultural historyUniversity of DurhamContact: Lutz Sauerteig (E l.d.sauerteig@durham.ac.uk)

SEPTEMBER 2005

1– 4 21st Congress of the British Society for the History of Medicine Institute of Arab and Islamic Studies, University of ExeterContact: Claire Keyte (E cfmh@exeter.ac.uk)

7– 10 Cultural History of Health and Beyond. Joint conference of the Society for the Social History of Medicineand the European Association for the History of Medicine and Health Ministère de la Recherche, Paris, FranceContact: Patrice Bordelais (E bordela@ehss.fr)

JUNE 2006

28 – 30 Practices and Representations of Health: Historical perspectivesContact: Robert Arnott (E R.G.Arnott@bham.ac.uk)

APRIL 2007

18 – 21 The History of Work, Environment and HealthContact: Robert Arnott (E R.G.Arnott@bham.ac.uk)

For a fuller listing of lectures, seminars, conferences and other events relatingto the history of medicine, visit http://medhist.ac.uk/events

SubmitThe next issue of Wellcome History isdue out in spring 2005. Please sendyour contributions to the Editor,Sanjoy Bhattacharya (details below).Guidelines for contributors are available atwww.wellcome.ac.uk/wellcomehistory

Preferably, contributions should bepasted into an email and sent to theeditor (E sanjoy.bhattacharya@ucl.ac.uk).

Copy deadline for spring 2005 issue:30 December 2004.

Dr Sanjoy BhattacharyaWellcome Trust Centre for the Historyof Medicine at UCL

210 Euston RoadLondon NW1 2BET +44 (0)20 7679 8155F +44 (0)20 7679 8192E sanjoy.bhattacharya@ucl.ac.uk

SubscribeWellcome History is published three timesa year and is free of charge. To subscribe(or to change any subscription details),please contact:

Publishing DeptThe Wellcome Trust215 Euston RoadLondon NW1 2BE, UKT +44 (0)20 7611 8256F +44 (0)20 7611 8242E publishing@wellcome.ac.uk

www.wellcome.ac.uk/wellcomehistory

The views and opinions expressed by writers withinWellcome History do not necessarily reflect thoseof the Wellcome Trust or Editor. No responsibility isassumed by the publisher for any injury and/or damageto persons or property as a matter of products liability,negligence or otherwise, or from any use or operationof any methods, products, instructions or ideascontained in the material herein.

All images are from the Wellcome Trust MedicalPhotographic Library unless otherwise indicated.Designed and produced by the Wellcome TrustPublishing Group. The Wellcome Trust is a charitywhose mission is to foster and promote researchwith the aim of improving human and animal health(registered charity no. 210183). Its sole Trustee isThe Wellcome Trust Limited, a company registeredin England, no. 2711000, whose registered officeis 215 Euston Road, London NW1 2BE.

ML-3300.p/3K/12-2004/PM

WellcomeHistory