Sally Sheard

Developing history of medicine in the University of Liverpool medical curriculum 1995–2005

Context  The University of Liverpool has always been innovative in its approach to medical education. The medical facultys decision to switch to a full problem‐based learning (PBL) medical curriculum from September 1996 represented an opportune moment for history of medicine to put a foot in the curricular door.

The passionate economist: how Brian Abel-Smith shaped global health and social welfare

Brian Abel-Smith was one of the most influential expert advisers of the twentieth century in shaping social welfare. He was a modern-day Thomas Paine, driven by a strong socialist mission to improve the lives of the poorest. This valuable and accessible book is the first biography of Abel-Smith. It takes a historical perspective to analyse the development of health and social welfare systems since the 1950s, exposing the critical impact of long-running debates on poverty and state responsibility, especially in Britain. This book also provides the first comparative study of how developing countries sought better health and social welfare, enabled by the World Health Organisation and other agencies for whom Abel-Smith regularly worked. ,,This book offers an engaging and useful study for students and researchers in health and social policy, history, politics and economics. It will also be essential reading for professionals working in those government ministries and institutions that Brian Abel-Smith helped to shape. LSE Pioneers in Social Policy, This the first book in the LSE Pioneers in Social Policy series. Brian Abel-Smith Richard Titmuss and Peter Townsend were based at the London School of Economics and Political Science and made major contributions to the development of policies on the elderly, health care, law, poverty and welfare in the 20th century. This series of biographies tells the stories of these outstanding individuals: their backgrounds, ideas and work.

History in health and health services: exploring the possibilities

Historical skills—especially the methodologies involved in interpreting a wide range of sources—can provide a useful analysis of the structure and function of health services, and be used as a means of improving public understanding of the expectations and experiences of health and health care. This paper discusses some key examples of different strategies used by historians to show how they can collaborate effectively with health professionals.

Quantifying life: Understanding the history of Quality-Adjusted Life-Years (QALYs)

Quality-Adjusted Life-Years (QALYs) are central to healthcare decision-making in Britain and abroad, yet their history is poorly understood. In this paper, we argue that a more in-depth and political history of the QALY is needed to allow a critical evaluation of its current dominance. Exploiting rich data from archives and 44 semi-structured interviews conducted between 2015 and 2018, we employ Multiple Streams Analysis to construct a complex and dynamic picture of how the idea of QALYs emerged and was adopted within UK health policy. Through its historical and political approach, the paper illuminates the relative roles in the policy-making process of experts (especially economists) and politicians as ‘entrepreneurs’ in the development of new ideas; how these were influenced by negotiation within established and emerging institutional structures; and the role of serendipity and crisis.

History Matters: The Critical Contribution of Historical Analysis to Contemporary Health Policy and Health Care

History is popular with health policymakers, if the regularity with which they invoke historical anecdotes to support policy change is used as an indicator. Yet the ways in which they ‘use’ history vary enormously, as does its impact. This paper explores, from the perspective of a UK academic historian, the development of ‘applied’ history in health policy. It draws on personal experience of different types and levels of engagement with policymakers, and highlights mechanisms through which this dialogue and partnership can be made more efficient, effective, and intellectually rewarding for all involved.

Book Review: Medicine, charity and mutual aid: the consumption of health and welfare in Britain, c.1550–1950.

The principal purpose of the book is to focus on the consumption of medical and social care, charitable assistance, poor relief and mutual aid—specifically to try to give a voice to the users of such services. These twelve case studies form rather a rag-bag of a collection—with broad overviews of educational provision for deaf children sitting alongside accounts of cathedral almsmen; kinship in early modern England; the impact of the enclosure movement on the poors allotment rights; a nineteenth-century private mental health sanatorium, and the Co-operative Mens Guilds preoccupation with social activities in the early twentieth century (to name the most unusual themes). The chapters are arranged in a broad chronological fashion following a brief introductory discussion on potential linking themes, especially those of trust, voices and negotiated relationships. Very few people, apart probably from reviewers, will read this book from cover to cover. Those that do not will miss some striking similarities and discontinuities, which the editors leave readers to discover for themselves. Yet by consciously looking for the patient/client voice, it is possible usefully to balance some of the more traditional institutional and professional histories. Stuart Hogarth exploits one of the best examples of nineteenth-century patient autobiography—that of Joseph Townend at the Manchester Infirmary in 1827. This chapter is a joy to read, and with his fine analysis of the historiography of history of medicine and wider modern British history, will easily earn its place on undergraduate reading lists. Flurin Condrau provides a useful wide-ranging essay on defining “medical success” for tuberculosis patients in British and German sanatoria. The chapter by Pat Starkey examines strategies used by social workers in the post-1945 period to re-voice the “client”. She urges us to consider how interview questions were framed and the responses re-interpreted, and raises pertinent issues on the methodologies required to produce patient-centred history, especially the “decadence of transcription” of interview tapes. As well as exploiting individual case studies, there are also chapters that imaginatively use groups of patients to address the theme of negotiated relationships. Andrea Tanner uses statistics from Great Ormond Street Childrens Hospital to speculate on how parents calculated the wider costs and benefits of accepting in-patient treatment for their children, and Barry Doyle unpicks the tangled relationships between working mens organizations and institutional authorities in the provision of hospital care in Middlesbrough in the early twentieth century. Some chapters, such as that by Jonathan Reinarz on Birminghams charitable hospitals veer towards the provision of health care, and in fact his chapter in Martin Gorsky and Sally Sheards book Financing British medicine since 1750 might be seen as more successful in articulating the individual patients perspective than the one he produces here. This book is full of interesting digressions and anecdotal history. The editorial touch appears to have been too light in some places, and the potentially unifying urban theme has not always been rigorously applied. One would also have liked to see some discussion on how this volume, with its explicit mission to “voice” the “consumption” of charity, health care and mutual aid can be integrated into other, more established, research themes and methodologies.

Book Review: Plague ports: the global urban impact of bubonic plague, 1894–1901

Chinese astrology marked 1900 as the year of the rat. The irony of this was not apparent until six years later, when the rats role in the transmission of bubonic plague finally gained public and scientific acceptance. The third bubonic plague pandemic raged from 1894 into the first quarter of the twentieth century, taking more than 15 million lives. Echenberg has followed its chronological path from its Asian beginnings in Hong Kong and Bombay, to Europe (Alexandria and Porto), South America (Buenos Aires and Rio de Janeiro), America (Honolulu and San Francisco) and finally to what he classifies as the British imperial examples (Sydney and Cape Town). The accumulation of air miles is the smaller part of the reward for his scholarly travels. For each of the ten cities, Echenberg has addressed key questions: how did the disease arrive? How many did it infect and kill? What were the popular and institutional responses? What impact did the changing understanding of plague transmission have on the control strategies? Some of these questions have not been asked of the third plague pandemic before, and certainly not in such a systematic fashion. Echenberg recognizes the enormity of his task, and potential limitations. He seeks to analyse the tension between western cultural imperialism and older indigenous medical responses to disease, but language barriers force him to rely heavily on western interpretations of Confucian, Buddhist, Ayurvedic and Islamic approaches. His second key aim, to analyse the interplay between older sanitarian and newer bacteriological disease strategies, is more attainable, and aided by the books chronological structure. He is able to follow the contested knowledge on the roles of the rat and the flea, and to analyse why some of his case study cities resisted the new bacteriological construction of disease. Considering the speed with which Echenberg moves between these cities, he successfully contextualizes each plague outbreak in 25 to 30 pages. He allows the human factor in the plague responses to shine through the scant statistical information. The cumulative effect of the ten city studies is to impress on the reader some universal themes: fear and victim-blaming; the political economy of infectious disease; that class has more clout than race when fudging sanitary reform strategies; the vastness of the cultural gaps within some cities, and the smallness of the scientific world. Where this book is slightly lacking is in the connections between these fascinating accounts. There are short summaries on each pair of cities, but little sustained comparative analysis. For example, why do the British authorities not learn from the Hong Kong outbreak—a “study in cultural misunderstanding and rumour-mongering”—and apply such lessons in Bombay? Why do the Americans consider a plan to raze San Franciscos Chinatown, when they have already seen the devastating and unproductive results of a similar exercise in Honolulu? The imperial theme, adopted briefly at the beginning and used to order the pairings, is not followed through. Yet the Whitehall gaze must have impacted on how some of these cities reacted to the plague. The fact that Echenberg has travelled in the footsteps of Bruce Low, a British government medical officer sent out in the immediate aftermath of the plague pandemic to report on how it was handled, appears lost on him. The other area that would have benefited from a clearer focus is the “port” aspect of these cities. Echenberg exploits this unifying feature to gain a catchy title for his book, but the explicit maritime aspect subsequently remains undeveloped, apart from a few passing references, for example, to Sydneys role in improving rat-guarding measures on ships, or the tension in Alexandria between the urban and port authorities. Yet one has to admire the sheer range of information packed into this volume, and its accomplished narrative style. In 1996 the World Health Organisation re-classified plague as a “re-emerging” disease. This is an important book that, through its ten city repetition of the threat and reality of epidemic disease, provides inspiration for historians and health authorities alike.

Book Review: Doctors at sea: emigrant voyages to colonial Australia

Through my daily journey along Liverpools Dock Road, I have become the maritime equivalent of a train-spotter. I can recognize familiar ships and I know roughly how often they are in port. There have been some mornings when hitching a ride on one has seemed infinitely preferable to arriving at work. Yet I have realized, through reading Robin Hainess excellent study of oceanic voyages, how little I actually know about what happens in that long interval between ports. This latest book by Haines continues a series of publications on nineteenth-century emigration to Australia. Whereas the focus has previously been on the experiences of the emigrants, especially their morbidity and mortality, this aims at understanding the role and contribution of the doctors, who accompanied every oceanic voyage after 1849. Haines uses a selection of case studies from the 323 emigration voyages made between 1848 and 1885 from Britain to Australia. Most of these were unremarkable, resulting in a mortality of less than 2 per cent. Yet there were several notorious voyages, especially in the 1850s when outbreaks of infectious diseases killed large numbers of passengers, often children. Surgeon superintendents were hired to ensure the implementation of sanitary regimes and to provide medical care during the average 100-day voyages. They appear to have been remarkably successful, particularly given the fact that most voyages started out with a number of emigrants already harbouring infectious diseases such as typhus, whooping-cough and measles. The surgeon superintendents, Haines suggests, need to be seen as early pioneers in preventive medicine. At a time when British sanitary reformers were struggling to impose similar regimes, the complete authority given to these medical men on ships could have served as a useful pilot study. Haines does not seek to examine why the British authorities failed to capitalize on this. The partial nature of archive sources has determined the selection of case studies. Whilst the mortality data can be pieced together from materials in Australia and London, very few of the mandatory surgeons’ journals for each voyage have survived. Haines is well aware of the potential pitfalls, and is confident that the sources used are representative. There is a good balance between describing the normal routines on board ships, and discussing how exceptional circumstances were handled. The inclusion of diary-style case studies, using anecdotes from the handful of surgeons who also left personal journals, makes for gripping reading. Through these personal accounts we learn how surgeon superintendents worked to maintain not only sanitary order, but also the appropriate moral behaviour of the emigrants. Their success in both of these areas was required if Australia was to thrive as a colony, and they were conscious that their supervisory skills were in turn being monitored by the authorities. This book provides an insight into nineteenth-century society, exposing class and sectarian issues. At times the surgeons’ perspective is subsumed by accounts of how “barely civilized” emigrants from Ireland and the Highlands of Scotland struggled to cope with the protein-heavy diet and alien concepts of personal hygiene. Indeed, the emphasis on the experiences of the emigrants has squeezed the space devoted to the history of nautical medicine, apart from a brief acknowledgement of some “great men” such as James Lind, Gilbert Blane and Thomas Trotter. I had hoped to find more discussion of the backgrounds of surgeon superintendents, and some elaboration of Hainess views on ships as floating medical laboratories. This is a slim, beautifully-written volume. One hopes that there is yet more to be gained from such carefully detailed studies.

Book Review: Public health: past, present and future: celebrating academic public health in Edinburgh, 1902–2002

One of the best things about this post-conference publication is a fascinating overview of the next epidemiological transition in the Asia Pacific. What, you may ask, has that got to do with academic public health in Edinburgh? Not a lot, and neither has the bulk of this book. My hackles first rose when reading in the Preface that no other British university can match Edinburghs claim to have founded academic public health. In fact Liverpool created a professorship in public health in 1897—a year before Edinburgh—and earlier post-graduate courses had been established by both Dublin and Cambridge. Although this is a personal whinge, it highlights one of the main weaknesses of the book: its attempt at history is vague, muddled and at times plain wrong. This is not helped by delegating the section on ‘The Past’ to non-historians. There is a sketchy chapter on general ‘Landmarks in the history of public health’;‘Some historical notes on health and public health in Edinburgh’ and ‘Edinburghs contribution to public health’. No one appears to have given any thought to how these would fit together, so they read like verbatim conference presentations, where the speakers have subjected the audience to a sequence of repetitious anecdotes. They are all keen on “gardyloos” but not so keen on analysing (or even describing) how academic public health in Edinburgh has developed with reference to the local or national changes in scientific knowledge, or socio-economic structures. There are already comprehensive accounts of the work of the nineteenth century MOH Henry Littlejohn, his successors, and the development of health in Edinburgh. These disparate hagiographical reminiscences add nothing new. The section entitled ‘The Present’ actually contains reviews of late-twentieth-century developments. Anthony Hedley (Professor of Community Medicine in Hong Kong) presumably features because he at one time worked in Edinburgh, which is fortunate for this volume. His chapter on emerging problems such as SARS and tobacco control in the Asia Pacific is well written and useful. Yet, we are then thrown back again to Littlejohn (and an erroneous claim that he carried out the first epidemiological survey of a city in Britain), and further regurgitations of the history of diseases such as smallpox. There is actually very little about the contributions of Edinburgh academics, if that is what this volume sets out to achieve. Much more could have been said about people like Mary Fulton, who pioneered research on coronary heart disease and lead poisoning in children. Sheila Birds chapter is a welcome relief, and an example of how oral history can illuminate the interface of academic and practical public health. Her account of the development of the CD4 database during Edinburghs HIV crisis in the 1990s is what I had hoped to find in a volume with such an enticing title. She provides an excellent case study in the politics of epidemiology. Helen Zealleys autobiographical approach to Scotlands post-devolution struggle to produce joined-up public health policy is also worthwhile. This volume, produced to celebrate the centenary of academic public health in Edinburgh, unfortunately obscures some of the most interesting aspects of its development in a mire of second-rate historical anecdotes. Despite the claims of Bhopal and others that twenty-first-century public health is now truly inter-disciplinary, it sadly illustrates the pitfalls of failing to engage with historians in a meaningful way. Lets hope that this lesson is learnt in time for the bicentenary.

Book Review: The Spanish influenza pandemic of 1918–19: new perspectives

Like volcanic eruptions, we are told that another large influenza pandemic is expected soon. However, unlike seismic activity readings there are few warning signs which virologists can exploit. This volume illustrates that history can, and should be, a key component in the bureaucratic toolboxes of states and international organizations with responsibility for disease control. There are some excellent papers here which illustrate the potential for this type of expertise. Their focus is a pandemic which is still (just) within living memory, and which claimed the lives of over 30 million worldwide in less than six months.