Ideas of heredity,reproduction and eugenics in Britain, 1800–1875

In this paper I begin by arguing that there are significant intellectual and normative continuities between pre-Victorian hereditarianism and later Victorian eugenical ideologies. Notions of mental heredity and of the dangers of transmitting hereditary ‘taints’ were already serious concerns among medical practitioners and laymen in the early nineteenth century. I then show how the Victorian period witnessed an increasing tendency for these traditional concerns about hereditary transmission and the integrity of bloodlines to be projected onto the level of national health. Tracing the gradual emergence of eugenical thought, I also highlight some of the more fundamental social, political and intellectual factors that promoted this predilection for extrapolating from the individual lineage to the nation and race. In doing so I argue that fully fledged eugenical thought was always unlikely to emerge prior to the early Victorian period. However, I am also able to show that Francis Galton's 1865 eugenical proposals were far from innovative and that identifying him as the ‘father’ of the eugenics movement is highly misleading.     

Asian traditions of knowledge: the disputed questions of science,nature and ecology

The search for ‘ecological insights’ in venerable Asian traditions of thought prompts questions about how such traditions understood humans in relation to nature. Answers which focus on philosophical and religious ideas may overlook culturally important understandings of people and places articulated within scientific and medical thinking. The paper tentatively explores the prospects for gleaning a form of ethics of place from the study of traditional Hindu and Chinese medical sources. Although there are serious problems with the idea that any unadulterated assimilation from other traditions can take place, these sources can be thought of as incorporating a place-centred (topocentric) ethic. By looking closely at Francis Zimmerman’s study of Hindu medicine, it is argued that a poetics of place can be ascribed to Ayurvedic discourses on health and disease. It may be possible to associate a similar poetics with classical Chinese medical worldviews, these being reconcilable with—though not the same as—contemporary ecological understandings of humans in relation to the world. Although no pristine reconstruction of Asian traditions of medical thought can be made, the conclusion of the present paper is that it would be wrong to dismiss these traditions as ‘antienvironmental’, based purely on the study of philosophical and religious texts.     

Applied psychophysiology and biofeedback of event-related potentials (brain waves): Historical perspective,review, future directions

This paper reviews the efforts of workers in the 1960s–1980s to demonstrate voluntary control of exogenously evoked (event-related) potentials in visual, somatic sensory, and auditory systems in rats, cats, and humans. The first part of the paper reviews the conceptual foundation and development of the work — it actually arose from traditional sensory coding and neural correlates of behavior studies. The second part summarizes recent applications of the method in the area of pain control. In reviewing these matters, the major effort is directed at revealing how the ideas unfolded in very human, day-to-day, anecdotal terms. There is not much of an attempt to formally review the literature, which is cited for consultation elsewhere. In the same spirit, many possible future experiments are suggested by way of elucidating the key remaining questions in the area.Some of the research reported here was supported by NIH grants DE05204 and GM23696. I have tried to make this material of interest to the general readership of this journal by emphasizing how, on a day-to-day basis, we thought about and planned our studies. Thus, I've tried to tell a true story of where the ideas came from and how some of them got executed, rather than write a formal review (several of which can be found in the references for this paper). I would really appreciate your comments. If nothing else, a postcard from you will give me an idea about how many people are reading this paper, and I'd like to know.     

The problematization of medical tourism: a critique of neoliberalism

The past two decades have seen the extensive privatisation and marketisation of health care in an ever reaching number of developing countries. Within this milieu, medical tourism is being promoted as a rational economic development strategy for some developing nations, and a makeshift solution to the escalating waiting lists and exorbitant costs of health care in developed nations. This paper explores the need to problematize medical tourism in order to move beyond one dimensional neoliberal discourses that have, to date, dominated the arena. In this problematization, the paper discusses a range of understandings and uses of the term 'medical tourism' and situates it within the context of the neoliberal economic development of health care internationally. Drawing on theory from critical medical anthropology and health and human rights perspectives, the paper critically analyzes the assumed independence between the medical tourism industry and local populations facing critical health issues, where social, cultural and economic inequities are widening in terms of access, cost and quality of health care. Finally, medical tourism is examined in the local context of India, critiquing the increasingly indistinct roles played by government and private sectors, whilst linking these shifts to global market forces.     

News media reports of patient deaths following 'medical tourism' for cosmetic surgery and bariatric surgery

Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer-reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article identifies and describes twenty-six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer-reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of 'medical tourism' will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel.     

Quackery versus professionalism? Characters,places and media of medical knowledge in eighteenth-century Hungary

This essay discusses the question of health in the Kingdom of Hungary during the Age of Enlightenment. It explores the relationships and tensions between central theories of medical police and the local expectations of government administrators, as well as those between academic or official knowledge and implicit or alternative knowledge about health. The reigns of Maria Theresia and Joseph II marked the moment at which particular kinds of folk and practical knowledge about healing became visible and above all legible. This is to be seen in the enormous rise in book production, which in itself represented an 'approved knowledge' that found legitimation in new academic and bureaucratic institutions, such as the reformed medical faculty of the University of Vienna, the newly-founded medical faculty at Tyrnau, the establishment of a health department within the Hungarian Statthalterei, as well as in the emission of royal legislation supporting the agendas of the new enlightened science of 'medical police'.     

Transgressing community: the case of Muslims in a twenty-first-century British city

Abstract

This paper draws on ethnographic research carried out in Birmingham, UK – a city significant for its sizeable Muslim population and its iconic role in the history of minority ethnic settlement in Britain – to consider how associations of place and ethnicity work in different ways to inform ideas about ‘Muslim community’ in twenty-first-century Britain. The paper charts happenings around a local event in an area of majority Asian settlement and how representations of the area as a place of Muslim community were used to implicate it in the ‘war on terror’. The paper goes on to show how this sensibility is disrupted by Muslims themselves through alternative engagements with space and ethnicity. The paper argues that these offer a ground for making Muslim community in ways that actively engage with histories and patterns of ethnic settlement in the city rather than being determined by them.     

Havelock Ellis, eugenicist

This article examines the contributions made towards eugenic thought in the late nineteenth and early twentieth centuries by Havelock Ellis (1859-1939). Ellis was a significant social reformer who worked on the problems of sexuality from a scientific-naturalist secular perspective. In the later phases of his work, after he had completed much of his writing on sexuality, Ellis concentrated on issues of feminism and eugenics--problems he thought were interlinked. In this paper, I integrate his ideas about these subjects, and consider the ways in which Ellis and other liberal social reformers created a 'eugenic subject' in order to frame their arguments about social problems.     

JUSTICE, STIGMA, AND THE NEW EPIDEMIOLOGY OF HEALTH DISPARITIES

Recent research in epidemiology has identified a number of factors beyond access to medical care that contribute to health disparities. Among the so-called socioeconomic determinants of health are income, education, and the distribution of social capital. One factor that has been overlooked in this discussion is the effect that stigmatization can have on health. In this paper, I identify two ways that social stigma can create health disparities: directly by impacting health-care seeking behaviour and indirectly through the internalization of negative interpersonal judgments. I then argue that social arrangements that foster self-respect can reduce the impact of stigmatization on health disparities. I conclude by showing how John Rawls' conception of justice can be used to address the intersection of stigma, health, and self-respect, in contrast to critics of his position, who have seen him as excessively focused on the allocation of material goods.     

Specialization and medical mycology in the US, Britain and Japan

This paper attempts to bring new insights to a long-standing historical debate over medical specialization by analyzing the formation of medical mycology, a somewhat marginal biomedical discipline that emerged in the mid-twentieth century around studies of fungal disease in humans. The study of fungi predates that of bacteria and viruses, but from the 1880s it became eclipsed by bacteriology. However, in the postwar period, there were moves to establish medical mycology as an independent speciality. I trace the processes that led to the launch of professional societies in the United States, Britain and Japan, three major players in medical mycology, and more broadly in biomedicine. The analysis of the three different national contexts illustrates how geographical, medico-technological, epidemiological, political and social conditions gave the specialty a distinctive character in each country; this was further complicated by the different and changing medical fields in which fungal diseases were studied and treated. The three case studies show medical specialization as a process that is not simply cumulative but responds to specific historical events and developments.     

Misunderstanding as therapy: Doctors,patients and medicines in a rural clinic in Sri Lanka

In this paper I want to draw attention to the integration of Western medicine into therapeutic choices among patients in rural Sri Lanka. These patients' interpretation and use of Western pharmaceuticals is discussed in relation to the Ayurvedic theory of balance. The influence of this theory on people's ideas of health and illness is highlighted in encounters where laymen and professionals alike use Western medicines according to context and their respective perspectives. Such therapeutic encounters are used to describe how the meaning of therapy is negotiated and communicated. The modes of perception used by doctors and patients seem to be mutually exclusive but each has its own logic. Western medicines are used as a symbolic means which help the patients and the practitioners of Western clinical medicine in a rural health unit to communicate through — rather than despite — misunderstandings based on their differing cultural assumptions about the body, about disease and about therapy. This argument is raised in relation to recent theoretical discussions among medical anthropologists concerning doctor-patient relationships, asymmetric medical relations and the analysis of meaning systems     

The legitimacy of elite gatekeeping

Natasha Warikoo’s study of how students at Harvard, Brown, and Oxford Universities view race and fairness highlights the vast differences between the U.S. and Britain with respect to perceptions of meritocracy by these winners in the competition for places in elite institutions. The strict enforcement of uniform standards for admission is seen as critical and legitimate at Oxford, whereas a more holistic approach in the U.S. – one that sees racial diversity as an important and desirable part of the institution’s culture and identity – is seen as critical to a “diversity bargain”. I question the sources of students’ ideas about race and the diversity bargain, suggesting that they may be rooted more in their pre-college experiences than in their life at university. I also raise questions about whether and how an admissions lottery would work to address some of Warikoo’s concerns.     

‘Aching to be a boy’: A preliminary analysis of gender assignment of intersex persons in India in a culture of son preference

Intersexuality, particularly in the global South, remains an under-researched field of study. In my in-progress doctoral research project, I explore the cultural, social, and medical discourses that influence how key stakeholders such as healthcare providers make decisions about the sex and gender assignment of the intersex child in India. In this paper I interrogate some of these ideas around gender assignment of intersex people in India, paying particular attention to the context of son preference. I am interested in exploring how decisions of gender assignment by medical professionals are guided by ideas of son preference. Focusing on four qualitative, semi-structured, in-depth interviews across two cities with medical doctors from different specializations, this paper is a preliminary attempt to examine some of the factors that guide medical professionals in making decisions about gender assignment of intersex children and explore the dynamics of the decision-making process. Specifically, I explore the factors that inform doctors’ decision-making and locate these decision-making processes within the broader socio-cultural context of India.     

Aspects of audit. 1. The background.

Methods of reviewing health care already exist in Britain, but the debate continues about how practical and acceptable such a review is. The many different terms used to describe review only confuse the issue. "Audit" is a useful term for describing the review of medical work by medical people. This can be divided into "internal audit," or peer review, and "external audit"--that is, review by organisations outside hospital and general practice. The concepts of internal and external audit have a great impact upon the attitudes held by the medical profession about audit. The shortcomings of audit by the professional standards review organisations in the United States are not inevitable in Britian.     

Purinergic Receptors,Past and Future (Closing Remarks)

Abstract

At the end of a symposium, it is useful to look back, both at the symposium itself and the developments that led up to the symposium. In this spirit, I thought it would be appropriate to tell the story of how I first became interested in purinergic receptors. I am recounting this story not because I believe that my audience has a burning interest in the history of my intellectual development, but rather because it illustrates the power of ideas.     

Range size, dispersal and niche breadth in the herbaceous flora of central England

1 It has been suggested that rare species differ from related common species in a variety of traits, including (among others) niche breadth and dispersal ability. We set out to test these ideas in the flora of central England.
2 We used two measures of range: number of hectads in Britain (national range) and number of 1 km² in a 3000-km² area of central England (local range). In each case we regressed phylogenetically independent contrasts in geographical range against contrasts in range of germination temperature (one aspect of fundamental niche breadth), terminal velocity of dispersule (a measure of wind dispersal capacity), seed weight and specialism index (a measure of the diversity of habitats exploited in central England). Seed weights and germination temperature were known for 263 species, specialism index for 261 and terminal velocity for 178.
3 Specialism index explained by far the largest part of the variance in local and national range. Seed weight, terminal velocity and germination temperature each explained only 2–4% of the variation in local range, and none of the variation in national range.
4 Most previous attempts to relate niche breadth and dispersal ability to range have concerned animals. There is little convincing published evidence for plants, and in the British herbaceous seed plants studied here the best predictor of range was diversity of habitats exploited. This pattern was independent of phylogeny.     

Medical Humanitarianism Under Atmospheric Violence: Health Professionals in the 2013 Gezi Protests in Turkey

During the 2013 Gezi protests in Turkey, volunteering health professionals provided on-site medical assistance to protesters faced with police violence characterized by the extensive use of riot control agents. This led to a government crackdown on the medical community and the criminalization of “unauthorized” first aid amidst international criticisms over violations of medical neutrality. Drawing from ethnographic observations, in-depth interviews with health care professionals, and archival research, this article ethnographically analyzes the polarized encounter between the Turkish government and medical professionals aligned with social protest. I demonstrate how the context of “atmospheric violence”—the extensive use of riot control agents like tear gas—brings about new politico-ethical spaces and dilemmas for healthcare professionals. I then analyze how Turkish health professionals framed their provision of health services to protestors in the language of medical humanitarianism, and how the state dismissed their claims to humanitarian neutrality by criminalizing emergency care. Exploring the vexed role that health workers and medical organizations played in the Gezi protests and the consequent political contestations over doctors’ ethical, professional, and political responsibilities, this article examines challenges to medical humanitarianism and neutrality at times of social protest in and beyond the Middle East.     

'Yes:--no:--I have been sleeping--and now--now--I am dead': undeath, the body and medicine

In this paper I propose that, since the mid-eighteenth century medical science has simultaneously generated and disavowed 'undead' bodies, suspended between life and death. Through close analysis of three examples of 'undeath' taken from different moments in medical history, I consider what these bodies can tell us about medicine, its history, cultural meaning, scientific status and its role in shaping ideas of embodiment, identity and death. My first example is Edgar Allan Poe's story 'The facts in the case of M. Valdemar' which imagines the possibility of a man mesmerised at the point of death. I read this story as a response to the rise of professional, scientific medicine in the 1840s. I then look at the recurring issue of brain death in order to consider tensions within twentieth-century medical hegemony. Finally I read the Alder Hey scandal as a reactivation of undead anxiety in response to the emergent culture of medical consumerism at the end of the twentieth century.     

Claiming respectable American motherhood: homebirth mothers, medical officials, and the state

Based on ethnographic research regarding public policy and grassroots organizing for midwifery in Virginia, this article explores how medical discourses around appropriate health care practices intersect with state discourses about what practices are considered "respectable" versus "pathological" for its citizens. In recent legislative debates about the legalization of direct-entry midwifery, medical officials have extended their criticism of midwifery and homebirth to mothers who resist state-sanctioned childbirth practices. This article examines how medical officials challenge the respectable mothering practices of homebirthers by linking them with women they deem pathological--child abusers, negligent mothers, and drug users--and placing them outside the cadre of "normal" American mothers who acknowledge the "logical" and "natural" superiority of biomedical childbirth practices. I also address homebirth mothers' responses, which assert that their political advocacy for midwives is a respectable mothering practice because they are responsible citizens who desire what they deem the best care for their children.     

Is infertility a disease and does it matter?

Claims about whether or not infertility is a disease are sometimes invoked to defend or criticize the provision of state‐funded treatment for infertility. In this paper, I suggest that this strategy is problematic. By exploring infertility through key approaches to disease in the philosophy of medicine, I show that there are deep theoretical disagreements regarding what subtypes of infertility qualify as diseases. Given that infertility’s disease status remains unclear, one cannot uncontroversially justify or undermine its claim to medical treatment by claiming that it is or is not a disease. Instead of focusing on disease status, a preferable strategy to approach the debate about state‐funded treatment is to explicitly address the specific ethical considerations raised by infertility. I show how this alternative strategy can be supported by a recent theoretical framework in the philosophy of medicine which avoids the problems associated with the concepts of health and disease.