This thesis examines whether and how historians’ reliance on medical treatises has limited the historiography of contagion as it relates to fourteenth through sixteenth century England. It analyses the context, contents, audience, and codicology of six English tractates, four on the plague and two on the sweating sickness. Before the early seventeenth century, most English tractates were translations/adaptations of Continental works, with ‘uniquely English’ content added. Although the plague dominates studies of pre-modern disease, focusing on the plague hinders comparative analyses that can reveal much about contemporary understanding of contagion. The socio-political-professional contexts in which the tractates were written and disseminated affected their contents, circulation and, ultimately, audiences. Although largely ignored by historians, the tractates’ prefatory dedications, together with their codicology, reveals that the texts were likely accessible to non-elite audiences. Rather than being limited to its medical sense, contagion formed part of the larger discourse about the human condition.

À partir de la fin du XVIe siècle, l’acuponcture connut un renouveau au Japon sous l’impulsion de Manase Dôsan (1507-1594) et la mise en place de nouvelles écoles d’acuponcture qui commencèrent à se détacher de la tradition chinoise. Ils représentaient deux tendances qui n’étaient pas nécessairement antinomiques — à savoir d’un côté, une fidélité aux savoirs chinois, et de l’autre côté, l’apparition de nouvelles techniques et théories indigènes — et qui se retrouvèrent tout au long de la période d’Edo (1603-1858). Le développement de l’imprimerie et les stratégies de vulgarisation et de diffusion du savoir médical sino-japonais adoptées par de nombreux médecins lettrés à cette époque favorisèrent par ailleurs la circulation des connaissances. Ainsi, aux traités de médecine importés de Chine ou de Corée, s’ajoutaient leurs rééditions japonaises commentées ou non, les traités de médecine sino-japonaise écrits en chinois classique (avec ou sans signes de lecture) ou en langue vernaculaire et les traités de vulgarisation. Ces livres véhiculaient un savoir issu de différentes traditions, chinoise, coréenne, ou indigène, faisant du Japon pré-moderne un pays à la confluence des savoirs médicaux. Le XVIe et le XVIIe siècles correspondaient aussi à l’arrivée des puissances européennes et aux premières descriptions européennes de l’acuponcture et de la moxibustion, deux pratiques thérapeutiques qui continuèrent d’intéresser les médecins européens en poste à Dejima tout au long de l’époque d’Edo et plus généralement ceux en Europe qui avaient accès à leurs descriptions. Notre travail s’inscrit dans la problématique de la circulation des savoirs en Asie orientale et entre l’Asie orientale et l’Europe. Circulation des savoirs qu’il faut non seulement entendre au sens de transmission et de diffusion des savoirs et des savoir-faire, mais aussi en considérant l’impact de ces savoirs sur le pays récepteur. Nous analysons ainsi la nature des transformations qui se sont opérées au cours des processus de transmission, la manière dont les savoirs ont été compris et décrits par ceux qui ont pu les observer directement et la manière dont ils ont été assimilés par des individus d’un milieu différent de celui dans lequel ils ont été produits. La dynamique médicale de l’époque est restituée par une analyse combinée de la théorie et de la pratique clinique. Ce travail met notamment en lumière l’indissociabilité de la production des savoirs et de leur circulation en montrant comment une pratique se construit à partir des textes transmis. Notre approche méthodologique quantitative et qualitative des sources primaires laisse aussi apparaître le rôle limité de la mobilité humaine dans la transmission des savoirs liés à la pratique de l’acuponcture entre la Chine, la Corée et le Japon. Plus généralement, elle rend compte d’une transmission systématique de tout un système médical de la Chine vers le Japon et d’une transmission parcellaire de ce système du Japon vers l’Europe. L’analyse de la réception de la moxibustion et de l’acuponcture en France à la fin du XVIIIe siècle et au début du XIXe siècle révèle enfin l’importance des institutions médicales dans la soudaine popularité de ces thérapies et la manière dont les médecins français se les approprièrent en ne retenant que le terme (moxa et acuponcture) et le principe (combustion directe sur la peau et insertion d’une aiguille dans le corps). / This dissertation investigates the circulation of acupuncture knowledge between China, Korea and Japan, and between East Asia and Europe in the early modern period (16th century–19th century). In the first part, I analyze the sixteenth and seventeenth century revival of acupuncture focusing on Manase Dôsan (1507-1594) and the emergence of new indigenous theories and techniques. Using the archives of the Nagasaki trade and the transcript of the conversations between Chinese, Korean and Japanese physicians, I also identify the Chinese and Korean acupuncture textbooks transmitted to Japan during the Edo period (1603-1868), their reception by Japanese physicians, and the role geographical mobility played in the transmission of theoretical and tacit medical knowledge. In the second part, I first review the transmission of acupuncture and moxibustion to early modern Europe, and then I analyze their reception in the late eighteenth early nineteenth century France, focusing on the reasons of their sudden vogue in French hospitals, the way French physicians investigated these two therapies, and the reasons of their failure to deeply integrate medical practices. / 本論文では日本の鍼灸医学を研究対象にして、古い伝統をもつ中国医学と近世に発達した日本の医学とを比較軸にしながら、江戸時代の社会、および同時期のフランスにおいて日本医学の知識と技術がどのように形成され、そして普及したかについて、論述している。つまり、当該時期の中国・日本、およびフランスの医学文献・非医学文献に基づき、社会的・政治的な背景に配慮しながら、日本の鍼灸が近世期に入って中国医学から独立した新しい技術と理論を形成した過程を整理・考察し、また日本国内および国外にその日本の医学知識が普及した過程をも検討した。第一部前半では、五世紀以来これまで中国の鍼灸医学が絶対的な尺度であったのに対して、十六世紀後半の安土・桃山時代に入ると、鍼灸の流派が急増し、内容的にも独創的な気運が見え始める。それらは、打針、管針、腹診などのような中国の鍼灸医学に見られない新技術や新理論をともなって登場した。そこで、日本鍼灸の中国からの独立の過程に関して、技術および理論の両面から具体例に基づいて、中国医学・医術の摂取と独自化について述べる。この独立がどの程度のものであったのか、技術のみの独立か、理論のみの独立か、あるいは両方の独立かを明らかにする。例えば、道三流や杉山流のように、理論面では中国鍼灸医学に基づきながら、臨床面では針より灸を頻繁に使う点に日本鍼灸の特徴が見られる流派があった。打鍼流のように、理論・技術ともに中国鍼灸医学を離れ、新しい針術と理論を形成した流派もあった。砭針のように、古代中国医術の名を借りてはいるが、実際の臨床では全く違った技術もあった。第一部後半では、中国や朝鮮からの医書の輸入とその日本における覆刻の問題を取り上げ、併せて長崎経由で来日した中国人や朝鮮人の医師に注目しながら、鎖国といわれる体制のなかで日本と通商を許された限られた国々との医学上の交流を考察する。広く知られているように、江戸幕府は貿易相手国を三国に限定し、日本人の国外渡航を禁じて、出入国を厳重に取り締まる鎖国政策をとっていたが、この閉鎖的な政策にもかかわらず、輸出された医書の量や日本に渡来した医師の数を見ると、医学的・文化的な交流はかなり盛んであったことがわかる。そのうち本研究では、中国からの輸入医書を通した医学知識の摂取と、朝鮮からの来日医師を通した直接的な医術の摂取を明らかにする。特に、朝鮮通信使の参府に際しては、信使一行と接触した日本人の中には医師も含まれ、朝鮮人医師との間に医事に関する質疑も交わされている。その時の筆談記録『医事問答』等を中心に、来日朝鮮人医師、およびその日本への影響に関して検討する。結論としては、江戸時代に輸入された医書は、覆刻によって全国的な規模で医学知識の普及と形成に影響を及ぼしたのに対して、来日医師たちは地域的な規模でしか影響を及ぼさなかった。第三部では、同時代のフランスにおける日本の鍼灸医学の受容過程について論じる。中国由来の東洋医学とは異なる歴史と体系を持つ西洋医学は、十六世紀にポルトガル人の渡来とともに日本に伝えられ、江戸時代には長崎に滞在したオランダ東インド会社の医師たちを通して導入された。そのオランダ人の医師の中では、テン・ライネ、エンゲルベルト・ケンペル、フォン・シーボルトが日本の医学、特に鍼灸医学について興味を持ち、日本人医師に教わった鍼灸医学の理論と技術をヨーロッパの医師たちに紹介した。五世紀における中国医学の伝来以来、日本は常に医学知識の受信国であったが、オランダの医師を媒介として日本が初めて医学知識の輸出国になった。しかしながら、西洋医学に見られない経絡・陰陽のようなヨーロッパ人には理解しがたい理論が多かったので、理論よりも日本独特の管針・打針などの技術が受け入れられた。特にヨーロッパの国々の中でもフランスの医師が日本の鍼灸医学について強い関心を示し、十九世紀初から十九世紀の半ばにかけては『鍼灸極秘伝』などの日本の針灸書がフランス語に翻訳されたり、パリの公的な病院でも鍼灸医学の研究が行なわれたり、日本の鍼灸医学は盛んであった。そこで、フランスで出版された鍼灸医学について書かれた医学書、および大学に提出された博士論文に見える日本鍼灸医学－その拒否感・肯定感・再評価について述べる。

The purpose of this thesis is to prove the existence of the right to adequate healthcare through a critical analysis of the law of obligations, constitutional law and international law framed in the wider focal point of South African medical law. The Constitution only makes provision for the right to access to health care. Conclusively this thesis will have to establish a link between a minimum standard in health care and the Constitution. It is submitted that the most efficacious method of establishing this link is with the duty of care, which is intrinsically linked to the doctor-patient relationship. If a critical analysis of the doctor-patient relationship can establish a clear link between the duty of care and state liability then such a link can successfully be applied to the Constitution. If this link is transposed onto the Constitution, a critical evaluation of the rights in the Bill of Rights will then reveal the most applicable right that can house the right to an adequate standard of health care. Such an analysis is only part of the solution however. In order to make this right effective, the international body of medical laws must be critically analysed and juxtaposed against this adequate standard. This carries the dual purpose of adding normative content as well as determining the current state of South Africa’s obligations under international human rights law, and to what extent those obligations have been discharged. Finally, and most significantly, the right to adequate healthcare, as it was forged in the international legal analysis, will be transposed onto the current South African jurisprudence of socio-economic rights. This practical application will then be reflected onto the new National Health Care Insurance to show conclusively that the current governmental approach of effecting health care is wholly inoperable and will ultimately result in significant harm and extensive human rights violations. This is based on the government only considering access to health care sufficient to discharge its duties and being totally incapable of effectively managing its resources. The core outcome for this thesis is to prove the existence of the right to adequate healthcare. Secondary outcomes are tracing the history of medicine to illustrate the creation and evolution of the doctor-patient relationship, a critical analysis of the application of medical ethics to South African law of obligations, a critical analysis of the Constitution and its fundamentals, an exhaustive evaluation of South Africa’s duties and accomplishments under its international obligations and effectively applying the right to adequate healthcare which is diametrically opposed to the current course South Africa is taking to provide health care. / Dissertation (LLM)--University of Pretoria, 2012. / Public Law / unrestricted

The study addresses from a sociocultural-historical, in particular a missiological and medical perspective the question if Catholic hospitals in Matabeleland, affected by the dramatic down-turn of Zimbabwe’s economy since 2000, did whatever they could to continue offering quality services to their patients. It starts with a portrayal of the emergence of secular modernity in the North-Atlantic World, as regards its view of the world as solely governed by natural laws, and of people as capable of taking destiny into their own hands, unperturbed by spiritual forces. The question is explored how the Christian Occident could end up there, following its development through the Middle Ages, and its expansion by missionary activity, by preaching the Word, but also by military force. Next, the achievements of pre-1900 Western medicine are examined, to identify if/how missionaries in Africa could have benefited. The study describes how professional medicine did not become part of the early Zambesi Mission, not because of its curative shortcomings, but for spiritual reasons, insofar as the Jesuits did not follow the European trend to let worldly well-being take the place of eternal salvation. Vis-à-vis their other-than-modern view of life, suffering, and (self-)sacrifice, the promises of medicine appeared just trivial. Submissiveness to authority, both ecclesiastical and worldly, is identified as the core principle that informed the Jesuits’ educational approach towards Africans in all their efforts at conversions. The missionaries thereby colluded with colonialist thinking, in not attempting to make their pupils grow into self-confident, independent thinkers in their own right. In this educational tradition, grafted onto a pre-modern local culture, the study finds the reason why Zimbabwean medical staff, as managers of their clinics or hospitals, have shown little readiness to proactively prioritise the intrinsic needs of their institutions and push for corrective measures, prepared even to challenge their superiors when encountering aberrations in the health system, locally as well as higher up. The study asks if the Church could have opted for a different educational approach, considering the prevailing socio-economic and cultural framework conditions; finally, which options present-day Zimbabweans have to choose from, regarding their country’s future development. / Christian Spirituality, Church History and Missiology / D. Th. (Missiology)

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Mit der Bekanntgabe der Entdeckung Röntgens 1895 begann nicht nur eine massive Bildproduktion, sondern auch ein reges radiologisches Ausstellungwesen, das sich an ein medizinisch-wissenschaftliches Publikum richtete und parallel zu wissenschaftlichen Kongressen stattfand. Die vorliegende Arbeit geht dieser Praxis des Ausstellens von Röntgenbildern und -apparaten im ersten Drittel des 20. Jahrhunderts nach und bezieht die Ausstellungen auf das im Entstehen begriffene medizinisch-wissenschaftliche Feld der Radiologie. Ausstellungen waren, so die zentrale These, keine dem radiologischen Erkenntnisprozess nachfolgenden Veranstaltungen, sondern Orte, bei denen ein radiologisches Apparate- und Bildwissen kommuniziert und erzeugt wurde. In der Arbeit wird die soziale, technische und expositorische Entwicklung des radiologischen Feldes parallel erzählt und eng miteinander verflochten gedacht. So geraten die engen Kopplungen zwischen Ausstellungsraum und Röntgeninstitut und zwischen technischer Entwicklung und professionellem Selbstverständnis von Radiologen in den Blick. / With the discovery of X-rays in 1895 not only an increased image production can be observed, but also the new format of the X-ray exhibition was created. The exhibitions were mainly aimed at a medical and scientific audience and were organized parallel to scientific congresses. The work traces this practice of exhibiting X-ray images and apparatus in the first third of the 20th century and relates the exhibitions closely to the medical-scientific field of radiology that developed during this period. According to the central thesis, exhibitions were not events that took place after the genesis and development of radiological facts in the clinic or scientific institutes, but spaces where knowledge about the new apparatus and images was communicated and generated. In the work, the social, technical and exhibition-related development of the radiological field is told in parallel and thought of in close relation to each other. Using exhibitions as an example, the close links between exhibition spaces and X-ray institutes and between technical development and the professional self-image of radiologists are brought into focus.

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Increasing time trends in the recorded incidence of childhood cancer have been reported in many different settings. The extent to which these trends reflect real changes in incidence, rather than improvements in methods for diagnosis and registration, is controversial. Using data from the National Registry of Childhood Tumours (NRCT), this thesis investigates time trends in cancer diagnosed under age 15 in residents of Britain during 1966-2005 (54650 cases), and considers potential sources of artefact in detail. Several different methods are used to estimate completeness of NRCT registration. The history of methods for diagnosis and registration of childhood cancers in Britain is described, and predictions are made for effects on recorded incidence. For each of the 12 main diagnostic groups, Poisson regression is used to fit continuous time trends and ‘step’ models to the annual age-sex-standardised rates by year of birth and year of diagnosis. Age-specific rates by period, and quinquennial standardised rates for diagnostic subgroups, are shown graphically. For three broad groups (leukaemia, CNS tumours and other cancer), geographical variation is compared by period of diagnosis. The results of these analyses are discussed in relation to the predicted artefacts. The evidence for a positive association between affluence and recorded incidence of childhood leukaemia is briefly reviewed. A special form of diagnostic artefact, the ‘fatal infection’ hypothesis, is proposed as an explanation of both this association and the leukaemia time trend. This hypothesis is examined in a novel test based on clinical data. The recorded incidence of childhood cancer in Britain increased in each of 12 diagnostic groups during 1966-2005 (from 0.5% per year for bone cancer to 2.5% for hepatic cancer, with 0.7% for leukaemia). Evidence presented here suggests that these increases are probably artefacts of diagnosis and registration. The potential implications for epidemiological studies of childhood cancer should be considered.