By the 1990s, a consensus was emerging in British medicine about the need for new instruments of professional management and clinical regulation. In the four decades after the 1950s, professional, political, and public anxieties about standards of medical practice had grown inexorably. Critiques of variations and evidence in medical care had joined with concerns about cost and professional accountability to produce a ‘crisis’ over quality. Locally, some practitioners responded by intensifying projects for structured care, creating more
physiology – in exploration and sport – in the long twentieth century.
Mark Jackson's essay on the making of the midlife crisis in Chapter 9 considers how new subject positions were formed – and imbalances were regulated – through the different modalities of text and counselling in twentieth-century Britain and America. It became commonplace during the twentieth century to regard the age of 40 (or later 50) as a tipping point in the life cycle, a moment when many people could begin to shed the financial, domestic, parental and occupational worries of
political change, financial constraints, and new understandings of prevention enhanced political interest in diabetes and reshaped policy around its management. Following the creation of regional standards for clinics in 1953, diabetes failed to generate substantial political interest in subsequent decades, certainly in comparison to other chronic diseases and risk factors with higher mortality rates or more influential lobbying interests. 1 Various aspects of diabetes care – from prescription charges to special foodstuffs – had been raised in Parliament during the 1960
adoption of a tax-funded service removed most direct financial obstacles to accessing pharmaceuticals, self-care equipment, and clinic services. In fact, as will be noted in the next chapter, GPs were almost incentivised to refer patients diagnosed with diabetes to hospital. Clinics also became more accessible as the number of clinics grew (from 40 in 1940 to over 190 in 1955), and the regional machinery of the NHS provided a possible means for planning clinic placement. 43
This regional focus was, in many ways, the result of the Diabetic
In 1933, the German lawyer Friedrich Franz König published an essay on medical negligence.
He pointed out that the number of negligence cases in Germany had risen to unprecedented heights in recent times. The years 1927–29 had seen an increase of close to 50% of negligence cases, as the insurance statistics demonstrated. König suggested that such a rise was due to the global economic crisis that had hit Germany hard.
As a second argument for
introduced to a receptive public. Indeed, for the high-profile ones (such as Salk's poliomyelitis vaccine) there was active demand from citizens. But such demand was also tempered by concerns about other risks, such as vaccine damage, convenience and financial sustainability.
Thus, the public played a key role in shaping public health authorities’ priorities. The general trend was toward the increased use of vaccination, in terms both of the number of vaccines available and of percentage uptake among the population. This relationship between the
with the vaccine. The medical deliberations over the relative risks of vaccine damage and infectious disease were clearly the catalyst for the crisis. More importantly, however, these debates were rooted in anxieties about the role of the welfare state. The most prominent discussions were over the provision of financial compensation to the victims of vaccine damage. This was a product of renewed political interest in groups whose risks of poverty had not been successfully managed by the 1948 welfare state. 8 The public demanded protection from the risks of vaccine
Disease, conflict and nursing in the British Empire, 1880–1914
frequently reiterated goal had always been to teach the
Chinese to care for their own people. However, in locations administered to a greater or lesser extent by European powers, concerns
surrounding the preservation of professional standards and racial
boundaries, alongside an apparent commitment to improving local
sanitary conditions, often took precedence over cost. Crisis provided
an opportunity to ignore financial restrictions and justify longstanding objectives. It was perhaps internalised concerns surrounding cost,
as well as a desire to capitalise on the associated
cases could be counted on one hand, but the vaccination programme that achieved this decline did not eliminate polio overnight; nor was it without significant financial and logistical difficulties.
This chapter focuses on the theme of demand. This was not unique to polio. As has been seen in previous chapters, the British public had come to demand health and other welfare protections from the government, particularly since the 1940s. There was active demand for emergency vaccination during smallpox epidemics. What set polio apart is that we see
foreign travel and laboratory accidents were a not-uncommon problem for post-war MOHs. The way in which these decisions were taken says much about the government's approach to the relative medical, financial and political risks of vaccination and disease. It also showed that the modern British vaccination system was forged by decisions not just about which vaccines to include, but also about which ones should be taken away.
The recurring theme in debates and policy decisions about smallpox was the nation. The discursive relationship between the public and the nation