Social Skills: Adolf Meyer’s Revision of Clinical Skill for the New Psychiatry of the Twentieth Century

Adolf Meyer (1866–1950) exercised considerable influence over the development of Anglo-American psychiatry during the first half of the twentieth century. The concepts and techniques he implemented at his prominent Phipps Psychiatric Clinic at Johns Hopkins remain important to psychiatric practice and neuro-scientific research today. In the 1890s, Meyer revised scientific medicine’s traditional notion of clinical skill to serve what he called the ‘New Psychiatry’, a clinical discipline that embodied social and scientific ideals shared with other ‘new’ progressive reform movements in the United States. This revision conformed to his concept of psychobiology – his biological theory of mind and mental disorders – and accorded with his definition of scientific medicine as a unity of clinical–pathological methods and therapeutics. Combining insights from evolutionary biology, neuron theory and American pragmatist philosophy, Meyer concluded that subjective experience and social behaviour were functions of human biology. In addition to the time-honoured techniques devised to exploit the material data of the diseased body – observing and recording in the clinic, dissecting in the morgue and conducting histological experiments in the laboratory – he insisted that psychiatrists must also be skilled at wielding social interaction and interpersonal relationships as investigative and therapeutic tools in order to conceptualise, collect, analyse and apply the ephemeral data of ‘social adaptation’. An examination of his clinical practices and teaching at Johns Hopkins between 1913 and 1917 shows how particular historical and intellectual contexts shaped Meyer’s conceptualisation of social behaviour as a biological function and, subsequently, his new vision of clinical skill for twentieth-century psychiatry.     

‘To Preserve the Skin in Health’: Drainage,Bodily Control and the Visual Definition of Healthy Skin 1835–1900

The concept of a healthy skin penetrated the lives of many people in late-nineteenth-century Britain. Popular writings on skin and soap advertisements are significant for pointing to the notions of the skin as a symbolic surface: a visual moral ideal. Popular health publications reveal how much contemporary understanding of skin defined and connected ideas of cleanliness and the visual ideals of the healthy body in Victorian Britain. Characterised as a ‘sanitary commissioner’ of the body, skin represented the organ of drainage for body and society. The importance of keeping the skin clean and purging it of waste materials such as sweat and dirt resonated in a Britain that embraced city sanitation developments, female beauty practices, racial identities and moral reform. By focusing on the popular work by British surgeon and dermatologist Erasmus Wilson (1809–84), this article offers a history of skin through the lens of the sanitary movement and developments in the struggle for control over healthy skin still in place today.     

‘Just a Quack Who Can Cure Cancer’: John Braund,and Regulating Cancer Treatment in New South Wales,Australia

In 1948 the New South Wales government instituted an inquiry into the claims of John Braund – a 78-year-old self-described ‘quack’ – that his secret treatment had cured 317 cancer sufferers. The ‘Braund controversy’, as it became known, was one of Australia’s most prominent cases of medical fraud. This paper examines that controversy and its effects on cancer philanthropy, medical research, and especially on legislation regulating treatment providers up to the present. With the Braund controversy in mind, the New South Wales (NSW) parliament struggled to develop legislation that would protect patients and punish quacks but also allow for serendipitous, unorthodox discoveries. Recent decades saw new elements added to this calculus – allowing a wide-ranging health marketplace, and allowing patients to choose their therapies. This paper argues that the particular body of law legislatures used in regulating cancer treatment and how regulations were framed reflected the changing context of healthcare and illustrates the calculus legislatures have undertaken in regulating the health marketplace, variously factoring in public safety, serendipitous discovery, the authority of orthodox medicine, patient choice, and economic opportunity. Keywords and phrases : John Braund, Cancer Treatment Regulation and Legislation, New South Wales, Quackery, Medical FraudIt started with an article in the Sun in 1947. The newspaper – cautiously warning readers not to accept any claims until proven – suggested that its reporter had found medical gold: ‘this man says he can cure cancer’. ¹ The man in question was John Braund, a 78-year-old self-described ‘quack’, living in a villa in suburban Sydney, who said he had treated 318 cancer patients, and cured all but one of them. The Sun’s journalist had also interviewed an anonymous ‘cancer specialist’ who said he was baffled by Braund’s successes. Braund kept the details of his method secret, but revealed that he gave no medicine and ‘use[d] no knife’ to achieve his spectacular cures.The ‘Braund controversy’, as the saga provoked by the Sun’s coverage came to be known, was one of Australia’s most prominent cases of medical fraud, sharing features with the growing number of scholars’ accounts of medical charlatans in other countries and deserves historical investigation from that aspect alone. ² But the controversy also had repercussions beyond its immediate interest. For one, it initiated a cascade of legislation in New South Wales (NSW) regulating cancer treatment. After describing the Braund controversy in the first half of the paper, I then examine the nature of those legislative changes, and the reasoning behind them. Parliamentary discussions show that legislatures grappled with balancing competing priorities in the treatment of cancer, but that those priorities were changed over the ensuing sixty years. When the NSW parliament first debated legislation restricting cancer treatment, their concern was to protect the public while allowing the possibility that unorthodox approaches might happen upon a cure. I refer to this as ‘the Sister Kenny problem’. (Sister Elizabeth Kenny – then, and now, an ‘Australian icon’ – was a self-taught nurse who developed a treatment for polio and whose example was much in the minds of the NSW legislature.) In contrast, the idea that laws ought to balance protecting the public against a patient’s right to chose his or her therapy, or with the economic desirability of having a vibrant health sector, is a recent framing of the issue. The Braund controversy and its legislative aftermath, therefore, helps illustrate the calculus that legislatures have undertaken in regulating the health marketplace, variously factoring in public safety, serendipitous discovery, the authority of orthodox medicine, public choice, and economic opportunity.For another, the Braund controversy speaks to the issue of professionalisation in medicine – that process of developing specialised group knowledge and association, self-regulation, and control. Legislation that restricts provision of cancer treatment to registered practitioners only satisfies the requirements of Abbott’s ‘professionalisation event’, meaning a milestone achievement in the course of professionalisation. ³ But contrary to the usual framing of professionalisation as a process prompted and shepherded by the profession itself, the Braund controversy shows that, in rarer instances, the professionalisation of medicine can be achieved without the medical profession’s involvement. ⁴   Professionalisation can be the by-product of other organisations’ and individual’s actions.     

��Looking as Little Like Patients as Persons Well Could��: Hypnotism, Medicine and the Problem of the Suggestible Subject in Late Nineteenth-Century Britain

During the late nineteenth century, many British physicians rigorously experimented with hypnosis as a therapeutic practice. Despite mounting evidence attesting to its wide-ranging therapeutic uses publicised in the 1880s and 1890s, medical hypnosis remained highly controversial. After a decade and a half of extensive medical discussion and debate surrounding the adoption of hypnosis by mainstream medical professionals – including a thorough inquiry organised by the British Medical Association – it was decisively excluded from serious medical consideration by 1900. This essay examines the complex question of why hypnosis was excluded from professional medical practice by the end of the nineteenth century. Objections to its medical adoption rarely took issue with its supposed effectiveness in producing genuine therapeutic and anaesthetic results. Instead, critics’ objections were centred upon a host of social and moral concerns regarding the patient’s state of suggestibility and weakened ‘will-power’ while under the physician’s hypnotic ‘spell’. The problematic question of precisely how far hypnotic ‘rapport’ and suggestibility might depart from the Victorian liberal ideal of rational individual autonomy lay at the heart of these concerns. As this essay demonstrates, the hypnotism debate was characterised by a tension between physicians’ attempts to balance their commitment to restore patients to health and pervasive middle-class concerns about the rapid and ongoing changes transforming British society at the turn of the century.     

Cullen,a Cautionary Tale

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

Psychotherapy and Moralising Rhetoric in Galen’s Newly Discovered Avoiding Distress (Peri Alypias)

In this article, I examine Galen’s credentials as an ethical philosopher on the basis of his recently discovered essay Avoiding Distress (Peri alypias). As compensation for the scholarly neglect from which Galen’s ethics suffers, I argue that his moral agenda is an essential part of his philosophical discourse, one that situates him firmly within the tradition of practical ethics of the Roman period. Galen’s engagement with Stoic psychotherapy and the Platonic-Aristotelian educational model affirms his ethical authority; on the other hand, his distinctive moralising features such as the autobiographical perspective of his narrative and the intimacy between author and addressee render his Avoiding Distress exceptional among other essays, Greek or Latin, treating anxiety. Additionally, I show that Galen’s self-projection as a therapist of the emotions corresponds to his role as a practising physician, especially as regards the construction of authority, the efficacy of his therapy and the importance of personal experience as attested in his medical accounts. Finally, the diligence with which Galen retextures his moral advice in his On the Affections and Errors of the Soul – a work of different nature and intent in relation to Avoiding Distress – is a testimony to the dynamics of his ethics and more widely to his philosophical medicine.

The philosopher’s lecture room is a ‘hospital’: you ought not to walk out of it in a state of pleasure, but in pain; for you are not in good condition when you arrive. Epictetus, Discourses 3.23.30

     

Negotiating South–South cooperation for mental health: the World Health Organization and the African Mental Health Action Group, 1970s–90s

This article explores the African Mental Health Action Group (AMHAG), one of the earliest examples of the World Health Organization’s (WHO) attempts to promote ‘ownership’ over development through the South–South cooperation envisaged in Technical Cooperation in Developing Countries. Formed in 1978, the AMHAG was intended to guide national and regional policy on mental health, while also fostering national and collective self-reliance. For a short period, between the late 1970s and the early 1990s, it was central to the WHO’s strategy for promoting policies of mental health in primary healthcare in Africa. It was a largely ineffective tool, with national governments having different opinions on the value of mental health, and poor coordination between AMHAG countries. Approaching the AMHAG as a regional project and transnational network, however, the article provides explores the importance of regions and regionalism in international health cooperation, as well as the inequities of participation in health development. Drawing on WHO archival material spanning over twenty countries and two national liberation movements, it argues that participating countries were differently positioned not only to navigate relationships between countries, but also to contend with the shifting landscape of international assistance, as well as – for some – contexts of war, violence and political and economic instability. The article not only serves as a case study of power imbalances in a failed development initiative, but also sheds light on the WHO’s engagement with mental health during a period that historians of psychiatry in Africa have tended to overlook.     

Origin of Lee Quedae’s Knowledge of Artistic Anatomy

Art in medicine, especially in anatomy, is the creative expression of the structural form of life, specifically life as manifested in human anatomy. Artists and anatomists together produced images of the body that combined medical knowledge and an artistic vision. In Korea, the pioneer of artistic anatomy was Lee Quede (1913–1965). During the Korean War (1950-1953), in the Geoje prisoner of war camp, he produced anatomical drawings and notes about the human body to teach artistic anatomy to his fellow refugee Lee Ju-yeong. Human anatomy, physiognomic differences among races, and phrenology are explained in those drawings. His drawing notes relied upon his own memories of what he had learned at Teikoku Art School in Japan, where he obtained knowledge on artistic anatomy from Nishida Masaaki (1894–1961). Seventy-four drawings and their explanations were produced. The table of contents was ordered starting from body proportions, followed by the skeleton, the muscles, and the head. The essential forms, proportions and movement were included. In École Supérieur des Beaux Arts in France, Kume Geichiro (1866–1934) was a pupil of Mathias Duval (1844–1907) and Paul Richer (1849–1933). In Teikoku Art School, Kume lectured on art anatomy using the books written by Duval and Richer. Kume handed over his lectures to Nishida, and Lee Quede learned from Nishida. Thereafter, Lee Quede’s anatomical knowledge was based on the French artistic anatomy of the 19^th century, succeeded by Kume and Nishida. Lee Quede’s drawing notes are valuable documents for assessing the influence of Japanese artistic anatomy on Korean artistic anatomy.     

‘I have been obliged to Send Nassaw’: an enslaved healer’s medical labour and skill in eighteenth-century Virginia

This article examines the medical career of an enslaved physician in Virginia named Nassaw from the mid eighteenth-century until the period of the American Revolution. I develop a taxonomy of Nassaw’s labours as a nurse caring for the sick, a healer administering medicines at the behest of his enslaver and as a doctor in his own right making medical judgements as he treated his patients. Nassaw is in some ways comparable to other enslaved healers of African descent in the Atlantic world, including well-known Mohanes and ritual specialists in Brazil and Latin America. However, due to his role as a physician employed by his slaveholder to principally heal other enslaved people, Nassaw struggled to find satisfaction in his labours as a healer as other enslaved people rightly perceived him as an agent of their enslaver whose medical work healed their bodies while extending their oppression. I argue that Nassaw became frustrated and depressed, and turned to drinking because of his inability to pursue or experience what Sharla M. Fett terms a ‘relational vision of health’ in the Chesapeake. Moreover, I interpret his drinking as a rebuke to the racist pretensions of his enslaver – who instructed him in pharmacy and surgery – who aimed to transform Nassaw into an Enlightened ‘black exhibit’ by training him to be a doctor. I conclude by returning to how precisely different Nassaw was from other enslaved healers in the Chesapeake like Tom of Nomini Hall or Romeo, and make the case that Nassaw deserves a place in histories of slavery and medicine precisely because he was an enslaved plantation doctor rather than a popular healer or conjuror.     

A Web-Based Telehealth Training Platform Incorporating Automated Nonverbal Behavior Feedback for Teaching Communication Skills to Medical Students: A Randomized Crossover Study

BackgroundIn the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students’ awareness of their nonverbal communication.ObjectiveThis study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students.MethodsWe conducted a 2-group randomized crossover trial between February and June 2016. Participants were second-year medical students enrolled in a clinical communication skills course at an Australian university. Students were randomly allocated to complete online EQClinic training during weeks 1–5 (group A) or to complete EQClinic training during weeks 8–11 (group B). EQClinic delivered an automated visual presentation of students’ nonverbal behavior coupled with human feedback from a standardized patient (SP). All students were offered two opportunities to complete face-to-face consultations with SPs. The two face-to-face consultations were conducted in weeks 6–7 and 12–13 for both groups, and were rated by tutors who were blinded to group allocation. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at 2 time points and also by an SP (n=83). Tutor-rated clinical communications skill in face-to-face consultations was the primary outcome and was assessed with the SOCA. We used t tests to examine the students’ performance during face-to-face consultations pre- and postexposure to EQClinic.ResultsWe randomly allocated 268 medical students to the 2 groups (group A: n=133; group B: n=135). SOCA communication skills measures (score range 4–16) from the first face-to-face consultation were significantly higher for students in group A who had completed EQClinic training and reviewed the nonverbal behavior feedback, compared with group B, who had completed only the course curriculum components (P=.04). Furthermore, at the second face-to-face assessment, the group that completed a teleconsultation between the two face-to-face consultations (group B) showed improved communication skills (P=.005), and the one that had teleconsultations before the first face-to-face consultation (group A) did not show improvement.ConclusionsThe EQClinic is a useful tool for medical students’ clinical communication skills training that can be applied to university settings to improve students clinical communication skills development.     

The Impact of Social Media on Medical Professionalism: A Systematic Qualitative Review of Challenges and Opportunities

Background

The rising impact of social media on the private and working lives of health care professionals has made researchers and health care institutions study and rethink the concept and content of medical professionalism in the digital age. In the last decade, several specific policies, original research studies, and comments have been published on the responsible use of social media by health care professionals. However, there is no systematic literature review that analyzes the full spectrum of (1) social media–related challenges imposed on medical professionalism and (2) social media–related opportunities to both undermine and improve medical professionalism.

Objective

The aim of this systematic qualitative review is to present this full spectrum of social media–related challenges and opportunities.

Methods

We performed a systematic literature search in PubMed (restricted to English and German literature published between 2002 and 2011) for papers that address social media–related challenges and opportunities for medical professionalism. To operationalize “medical professionalism”, we refer to the 10 commitments presented in the physicians’ charter “Medical professionalism in the new millennium” published by the ABIM Foundation. We applied qualitative text analysis to categorize the spectrum of social media–related challenges and opportunities for medical professionalism.

Results

The literature review retrieved 108 references, consisting of 46 original research studies and 62 commentaries, editorials, or opinion papers. All references together mentioned a spectrum of 23 broad and 12 further-specified, narrow categories for social media–related opportunities (n=10) and challenges (n=13) for medical professionalism, grouped under the 10 commitments of the physicians’ charter.

Conclusions

The accommodation of the traditional core values of medicine to the characteristics of social media presents opportunities as well as challenges for medical professionalism. As a profession that is entitled to self-regulation, health care professionals should proactively approach these challenges and seize the opportunities. There should be room to foster interprofessional and intergenerational dialogue (and eventually guidelines and policies) on both challenges and opportunities of social media in modern health care. This review builds a unique source of information that can inform further research and policy development in this regard.     

In search of lost fleas: reconsidering Paul-Louis Simond’s contribution to the study of the propagation of plague

Paul-Louis Simond’s 1898 experiment demonstrating fleas as the vector of plague is today recognised as one of the breakthrough moments in modern epidemiology, as it established the insect-borne transmission of plague. Providing the first exhaustive examination of primary sources from the Institut Pasteur’s 1897–98 ‘India Mission’, including Simond’s notebooks, experiment carnets and correspondence, and cross-examining this material with colonial medical sources from the first years of the third plague pandemic in British India, the article demonstrates that Simond’s engagement with the question of the propagation of plague was much more complex and ambiguous than the teleological story reproduced in established historical works suggests. On the one hand, the article reveals that the famous 1898 experiment was botched, and that Simond’s misreported its ambiguous findings for the Annales de l’Institut Pasteur. On the other hand, the article shows that, in the course of his ‘India Mission’, Simond framed rats as involved in the propagation of plague irreducibly in their relation to other potential sources of infection and not simply in terms of a parasitological mechanism. The article illuminates Simond’s complex epidemiological reasoning about plague transmission, situating it within its proper colonial and epistemological context, and argues for a new historical gaze on the rat as an ‘epidemiological dividual’, which highlights the relational and contingent nature of epidemiological framings of the animal during the third plague pandemic.     

Undergraduate teaching in UK general practice: a geographical snapshot

Background

Learning in general practice is an essential component of undergraduate medical education; currently, on average, 13% of clinical placements in the UK are in general practice. However, whether general practice can sustainably deliver more undergraduate placements is uncertain.

Aim

To identify the geographical distribution of undergraduate teaching practices and their distance from the host medical school.

Design and setting

National survey of all medical schools in the UK.

Method

All 33 UK medical schools were invited to provide the postcodes of their undergraduate teaching practices. These were collated, de-duplicated, and mapped. The distance in kilometres and journey times by car and public transport between each medical school and its teaching practices was estimated using Transport Direct (www.transportdirect.info). The postcodes of every practice in the UK were obtained from the UK’s health departments.

Results

All 33 UK medical schools responded; 4392 practices contributed to teaching, with a median (minimum–maximum) of 142 (17–385) practices per school. The median (minimum–maximum) distance between a school and a teaching practice was 28 km (0–1421 km), 41 (0:00–23:26) minutes’ travel by car and 1 hour 12 (0:00–17:29) minutes’ travel by public transport. All teaching practices were accessible by public transport in one school and 90–99% were in a further four schools; 24 schools had >20% of practices that were inaccessible by public transport.

Conclusion

The 4392 undergraduate teaching general practices are widely distributed and potentially any practice, no matter how isolated, could contribute to undergraduate education. However, this is, at the price of a considerable travel burden.     

The making of the ‘useless and pathological’ uterus in Taiwan, 1960s to 1990s

During the 1960s and 1970s, the notion that the uterus is a useless and pathological organ after a woman has had ‘enough’ children emerged alongside news reports of excessive hysterectomy in Taiwan. This notion and hysterectomy became two sides of the same coin, the former pointing to the burden of birth control and cancer risk, and the latter to sterilization and removing cancer risk. I explore how, in post-war Taiwan, the notion became commonplace through the intersection of three historical formations: the medical tradition of employing surgery to manage risk (such as appendectomy for appendicitis), American-dominated family planning projects that intensified the surgical approach and promoted reproductive rationality, and cancer prevention campaigns that helped cultivate a sense of cancer risk. The gender politics operating in the family planning and cancer prevention projects were apparent. The burden of birth control fell mainly on women, and the cancer prevention campaign, centring almost exclusively on early detection of cervical cancer, made cancer into a woman’s disease. I argue that the discourses of reproductive rationality and disease risk were parallel and, in several key ways, intersecting logics that rendered the uterus useless and pathological and then informed surgeons’ practice of hysterectomy. Exploring the ways in which the uterus was envisioned and targeted in the history of medicine in Taiwan, this paper shows overlapping bio-politics in three strands of research in an East Asian context – namely women’s health, family planning and cancer prevention – and offers a case for global comparison.     

Typhoid Fever in Nineteenth-Century Colombia: Between Medical Geography and Bacteriology

This paper analyses how the Colombian medical elites made sense of typhoid fever before and during the inception of bacteriological ideas and practices in the second half of the nineteenth century. Assuming that the identity of typhoid fever has to be understood within the broader concerns of the medical community in question, I show how doctors first identified Bogotá’s epidemics as typhoid fever during the 1850s, and how they also attached specificity to the fever amongst other continuous fevers, such as its European and North American counterparts. I also found that, in contrast with the discussions amongst their colleagues from other countries, debates about typhoid fever in 1860–70 among doctors in Colombia were framed within the medico-geographical scheme and strongly shaped by the fear of typhoid fever appearing alongside ‘paludic’ fevers in the highlands. By arguing in medico-geographical and clinical terms that typhoid fever had specificity in Colombia, and by denying the medico-geographical law of antagonism between typhoid and paludic fevers proposed by the Frenchman Charles Boudin, Colombian doctors managed to question European knowledge and claimed that typhoid fever had distinct features in Colombia. The focus on paludic and typhoid fevers in the highlands might explain why the bacteriological aetiology of typhoid fever was ignored and even contested during the 1880s. Anti-Pasteurian arguments were raised against its germ identity and some physicians even supported the idea of spontaneous origin of the disease. By the 1890s, Pasteurian knowledge had come to shape clinical and hygienic practices. Keywords : Typhoid Fever, Medical Geography, Bacteriology, Colombia, History of Medicine, Fevers     

Franco-British responses to chemical warfare 1915–8, with special reference to the medical services,casualty statistics and the threat to civilians

This dual-focussed examination will critically compare and contrast the British Royal Army Medical Corps and the French Medical Service’s involvement in the Western Front chemical campaign between 1915 and 1918. Because the Anglophone historiography has tended to marginalise the French contribution to the allied chemical war, this article will attempt to re-balance the historical narrative by emphasising the collective nature and importance of this joint Franco-British enterprise. By interrogating a raft of under-utilised primary evidence in the French and British archives, this investigation will contribute to the ‘alliance literature’ by arguing that when it comes to aspects of the Franco-British chemical war such as the co-operation of the medical services, the appellation ‘together but alone’ does not fully hold. The article will explore avenues of the two national armies evolving process of mutual medical assistance, material exchange and scientific collaboration. The striking similarity of French and British gas casualty statistics is highlighted with reference to the overall congruence of their anti-gas strategies – notwithstanding the problematic nature of these statistics. In addition to enhancing soldiers’ resistance to the poison gas threat on the battlefield, the Medical Services were also responsible for the protection of local civilians in the war zones. With reference mainly to France, this investigation will discuss the significance and implications of the poison gas threat to the home front. Finally, the impact of chemical weapon production upon civilian war workers in France and Britain will be commented upon.     

‘The Hospital was just like a Home’: Self,Service and the ‘McCord Hospital Family’

For more than a century, McCord Hospital, a partly private and partly state-subsidised mission hospital has provided affordable health-care services, as well as work and professional training opportunities for thousands of people in Durban, a city on the east coast of South Africa. This article focuses on one important aspect of the hospital’s longevity and particular character, or ‘organisational culture’: the ethos of a ‘McCord Family’, integral to which were faith and a commitment to service. While recognising that families – including ‘hospital families’ like that at McCord – are contentious social constructs, with deeply embedded hierarchies and inequalities based on race, class and gender, we also consider however how the notion of ‘a McCord family’ was experienced and shared in complex ways. Indeed, during the twentieth century, this ethos was avidly promoted by the hospital’s founders and managers and by a wide variety of employees and trainees. It also extended to people at a far geographical remove from Durban. Moreover, this ethos became so powerful that many patients felt that it shaped their convalescence experience positively. This article considers how this ‘family ethos’ was constructed and what made it so attractive to this hospital’s staff, trainees and patients. Furthermore, we consider what ‘work’ it did for this mission hospital, especially in promoting bonds of multi-racial unity in the contexts of segregation and apartheid society. More broadly, it suggests that critical histories of the ways in which individuals, hospitals, faith and ‘families’ intersect may be of value for the future of hospitals as well as of interest in their past.     

‘No “Sane” Person Would Have Any Idea’: Patients’ Involvement in Late Nineteenth-century British Asylum?Psychiatry

In his 1895 textbook, Mental Physiology, Bethlem Royal Hospital physician Theo Hyslop acknowledged the assistance of three fellow hospital residents. One was a junior colleague. The other two were both patients: Walter Abraham Haigh and Henry Francis Harding. Haigh was also thanked in former superintendent George Savage’s book Insanity and Allied Neuroses (1884). In neither instance were the patients identified as such. This begs the question: what role did Haigh and Harding play in asylum theory and practice? And how did these two men interpret their experiences, both within and outside the asylum? By focusing on Haigh and Harding’s unusual status, this paper argues that the notion of nineteenth-century ‘asylum patient’ needs to be investigated by paying close attention to specific national and institutional circumstances. Exploring Haigh and Harding’s active engagement with their physicians provides insight into this lesser-known aspect of psychiatry’s history. Their experience suggests that, in some instances, representations of madness at that period were the product of a two-way process of negotiation between alienist and patient. Patients, in other words, were not always mere victims of ‘psychiatric power’; they participated in the construction and circulation of medical notions by serving as active intermediaries between medical and lay perceptions of madness.