Projects like the SMD-funded retinopathy screening trials reflected the British state's growing engagement with diabetes during the 1980s. In that specific instance, the DHSS's hopes for generating organisational guidance for the NHS were disappointed. Central state interest in diabetes management, however, remained undimmed, and much more extensive standards for diabetes care would be produced by the new millennium.
The work of elite practitioners and specialists proved integral to maintaining state interest in both
Although mandated by British health departments, these activities were to remain predominantly professionally led. Local committees comprising hospital clinicians, GPs, and technical staff would support audit activity, whilst the Royal Colleges and elite specialist organisations produced national care guidelines and minimum datasets to inform local developments. Crucially, in terms of diabetes management, these bodies intended their standards to be used by hospital doctors as much as by primary care teams, and they stressed the need for local systems to bridge the
precise protocols and undertaking institutional audits. Nationally, elite professional bodies and leading specialists produced guidelines to inform local developments, and sought to establish national datasets and audit systems. Through these changes, previously informal measures regulating clinical activity became explicit, and the rhythms and content of care became subject to new forms of structure and review.
The Conservative governments of the 1980s and 1990s had also become interested in guidelines and medical audit. Motivated by historic
, in specific instances specialists pushed for new forms of work out of scepticism about GPs. Nonetheless, the new arrangements also reflected a shared sense within the diabetological community – and, evidently, within elite British medicine more broadly – that quality care depended upon bureaucratising instruments: tools that formally codified work processes and responsibilities and held up actions of team members for review. 5 GPs themselves designed new systems, and once enrolled, all practitioners would find their work patterns reoriented, their
the temporality and content of clinical activity in order to integrate dispersed labour. Amid professional and popular anxiety about the quality of British medical practice, elite specialists and GPs also developed the first national guideline and audit systems, designed to inform local care and structure national provision. In doing so, these practitioners incorporated previously academic tools for research and healthcare assessment into routine care. Moreover, acting through statutory bodies associated with the NHS and the standard-setting bodies of the Royal
Narratives of balance and moderation at the limits of human
health and dynamic equilibrium, can be experimented on without danger and can repeat their performances exactly again and again’.
The use of explorers and elite sports performers as subjects had a significant effect on the study of extreme physiology, as it reinforced the erasure of the female body. Even where scientists acknowledged that women's physiology was poorly understood, they made little effort to rectify their ignorance. For example, in 1959 a major symposium on Polar
Cancer, modernity, and decline in fin-de-siècle Britain
of medical and surgical elites founded a cancer hospital just off Tottenham Court Road.
Both institutions served the local, urban, plebeian population, but people also travelled in from the surrounding countryside.
These two hospitals provided clinical evidence for a flurry of publications, and various familiar figures – urban surgical elites like John Abernethy, Everard Home, Charles Bell, and Thomas Denman – wrote tracts and treatises on the disease, derived from their new encounters with
-ground position in practice. Here, they combined a desire to ‘do no harm’ – striving for near-normal glycaemia levels where possible – with a pragmatic acknowledgement that any regimen had to be simple enough to be reasonably followed, and generous enough not to generate resentment or provoke hypoglycaemia. 13 Patients, moreover, approached their prescriptions in similar ways, adjusting diets according to different priorities and structural constraints. 14
The continued emphasis on laboratory oversight into the 1940s meant that elite hospital doctors (and
The French human sciences and the crafting of modern subjectivity,
The people were susceptible to the voice of reason, but they also listened to those who wanted to inflame unjust passions – they were, ultimately, dependent on the whims of the elite.
Sicard believed that sourds-muets represented a perfect natural state prior to the onset of education. They were therefore ideal objects for an ‘experimental metaphysics’, which he believed could demonstrate how, from the raw, natural state of humanity, an enlightened educational practice would produce enlightened and peaceful citizens
, from major literary works such as Charlotte Brontë's Jane Eyre (1847) and Walt Whitman's Leaves of Grass (1855), to the educational reforms of Horace Mann, and the workings of the criminal justice systems of both countries. If the scientific and intellectual elite were sceptical of phrenology by the mid-century, the ‘doctrine served as a cohesive cultural factor’,
and in the second half of the nineteenth century, it ‘became in many ways more deeply entrenched than ever in everyday thought and expression