Since 1974 the National Health Service (NHS) has been subject to successive reorganisations which have shaped and reshaped patterns of administration, clinical care and services. This paper uses two sources of oral evidence: a Witness Seminar with a group of administrators who attended the NHS National Administrators’ Training Scheme in the late 1950s and a collection of interviews with doctors and managers who have played key roles in the health services of Manchester and Salford between 1974 and 2007. It surveys the day-to-day interactions between doctors and administrators/managers in hospital settings and analyses what these reveal about relationships within the broader context of shifting organisational structures and management styles. It suggests that the evidence challenges the historical stereotyping of the two groups and that strong working relationships have been determined as much by the values of respect and association as by changes to structures or management styles.

This article discusses an under-researched group and provides an analytical overview of the comparative experiences of African, Indian and Coloured doctors at South African universities during the apartheid era. It probes diversity of experience in training and practice as well as gendered differentiation amongst black students before going on to discuss the careers and political activism of black doctors as well as the impact of recent transformational change on their position. It briefly assesses how singular this South African experience was.

In the nineteenth century the medicinal leech Hirudo medicinalis evolved into a lucrative commodity in great demand throughout the western world. In less than a century its trade became big business by any measure, involving tens of millions of animals shipped to every inhabited continent. In this context Ireland is particularly instructive in that it was the first country in Europe to exhaust its supply of native leeches. Concomitantly, it was also the first country to import leeches from abroad, as early as 1750. Being an island with manageable border controls, and a clearly definable medical market, Ireland serves superbly as a microcosm of the leech as a worldwide commodity. Being a relative small country it is possible for the first time to gain a balanced perspective of various economic factors underlying this trade, including supply and demand, exploitation of natural resources, and an evolving network of competitive traders.

This paper addresses these and other aspects of the leech trade in Ireland. The principal, and unexpected, finding of this paper is that leeches were unequivocally very expensive in Ireland and became a significant drain on hospital budgets. As such, they found little use amongst the Irish poor. An estimate of several million leeches were imported into Ireland in the nineteenth century, a practice which continued into the twentieth. They were imported initially from Wales and then from France following the defeat of Napoleon, but the bulk came ultimately from Hamburg, via importers in England.

While Jewish ritual circumcision continues to be a controversial issue in Europe and the US, metzitzah b’peh, the addendum to brit milah, which requires the mohel (ritual peritomist) to orally suck blood from the wound immediately following the excision of the foreskin, remains a divisive topic. While medical historians have studied European outbreaks of infectious disease following metzitzah b’peh, no one has assessed the response of the nineteenth century New York Jewry. This paper analyses how this nascent community responded to the thorough report by the New York Board of Health following an alleged and discredited outbreak of syphilis attributed to metzitzah b’peh in 1873, especially in the context of nineteenth century immigration, popular perception of syphilis and American medicine.

This is the first of two related articles in the present volume which examine the recent history of health services management using the case of the British National Health Service (NHS). In the historiography of the NHS the 1980s is widely seen as a watershed, when public policy first sought to introduce market disciplines into its operation. Administrative and managerial reforms were central to this process, and their origins and impact have been the subject of continuing debate. This article examines and evaluates one of the key events in this history, the Griffiths NHS Inquiry of 1983, which put in place the principles of ‘general management’ in the NHS. Drawing on both documentary records and oral evidence it offers fresh perspectives on the reasons why the Conservative government embarked on this reform, on the workings of the inquiry team under the leadership of the businessman Roy Griffiths, and on the uneven course of the implementation of his recommendations. While its initial impact arguably did not meet the expectations of its supporters, it is suggested that several of Griffiths’ key concerns have grown, not diminished, in importance as aspects of subsequent health politics. These include: the need for clinician involvement in NHS management and financing; the conundrum of how to depoliticise the central direction of the service while retaining political accountability; the desirability of measuring and improving performance; and the question of how best to incorporate the wishes of patients and public in the decision-making arena.

In the course of the twentieth century road traffic injuries (RTIs) became a major public health burden. RTI deaths first increased in high-income countries and declined after the 1970s, and they soared in low- and middle-income countries from the 1980s onwards. As motorisation took off in North America and then spread to Europe and to the rest of the world discussions on RTIs have reflected and influenced international interpretations of the costs and benefits of ‘development’, as conventionally understood. Using discourse analysis, this paper explores how RTIs have been constructed in ways that have served regional and global development agendas and how ‘development’ has been (re-)negotiated through the discourse of RTIs and vice versa. For this purpose, this paper analyses a selection of key publications of organisations in charge of international health or transport and places them in the context of (a) the surrounding scientific discussion of the period and (b) of relevant data regarding RTI mortality, development funding, and road and other transport infrastructure. Findings suggest that constructions of RTIs have shifted from being a necessary price to be paid for development to being a sign of development at an early stage or of an insufficiently coordinated development. In recent years, RTI discussions have raised questions about development being misdirected and in need of fundamental rethinking. At present, discussions are believed to be at a crossroads between different evaluations of developmental conceptualisations for the future.