Creating a User-Inventor Community: How Disabled People Innovated and Marketed Disability in Early Nineteenth-Century America.

Early nineteenth-century America's robust trade in medical and health care products is richly documented, yet many scholars have overlooked just what role people with impairments played in that industry as inventors and retailers, forming relationships with clients based on their shared experiences of disability. A study of newspaper advertisements, patents, organizational records, medical accounts, and objects suggests that many impaired and formerly impaired producers marketed products to impaired consumers, creating an organic and unselfconscious network of disabled people who made, sold, and bought knowledge and devices about and for disability. Recovering this world of disabled inventors, retailers, and their clients reveals how disability fueled innovation in early nineteenth-century America, expanding scholarly understandings of who participated in and profited from the burgeoning medical and health care economy. This study also suggests that the market was an early venue of disability community where people came together around their common bond.

Does the history of opening ports and trading influence the long-term business credit environment of cities? Evidence from the Yangtze River Delta region of China.

Based on the China City Commercial Credit Environment Index (CEI), a more scientific spatial DID model was used to examine the long-term impact of the opening of ports and trading in the late Qing Dynasty on the urban commercial credit environment, taking cities above the prefecture level in the Yangtze River Delta as a sample. The study confirms that: (1) the opening of ports and commerce in the late Qing Dynasty had a significant contribution to the urban commercial credit environment, which was conducive to the transformation of production methods and interpersonal relationships from traditional to modern, and to the improvement of the urban commercial credit environment. (2) Before the signing of the Treaty of Shimonoseki, the local forces of the late Qing Dynasty were resistant to the economic aggression of the Great Powers, and the positive impact of the opening of ports and trading on the commercial credit environment of port cities was more significant, but the impact was not obvious after the signing of the Treaty of Shimonoseki. (3) From the history of the opening of ports for trade in the late Qing Dynasty, the economic aggression of the Western powers against the non-patronage areas by means of the buying class objectively strengthened the concept of rule of law and credit awareness in the local market and exerted a long-term influence on the commercial credit environment of the cities, but the impact of the opening of ports for trade on the commercial credit environment of the patronage areas was not prominent. (4) Cities located in the sphere of influence of the common law powers had a more pronounced impact on the commercial credit environment as their institutions and concepts were more easily transplanted, while the impact of the opening of ports and trading on the commercial credit environment of cities in the sphere of influence of the civil law powers was not significant. Policy Insights: (1) Enhance the ability to negotiate with foreign countries on economic and trade matters from a level-headed world perspective, and be bold and adept at fighting unreasonable rules, standards and requirements in order to better optimise the business credit environment; (2) Regulate the use of administrative resources and avoid undue administrative intervention, which is an important prerequisite for improving the basic system of the market economy to enhance the business credit environment; (3) Emphasise both connotative development to follow a Chinese style modernisation path, and (3) emphasising selective cooperation to promote outward development, promoting the interaction, convergence and matching of domestic and foreign regulations, and continuously improving the regional commercial credit environment.

Biomolecular analyses enable new insights into ancient Egyptian embalming.

The ability of the ancient Egyptians to preserve the human body through embalming has not only fascinated people since antiquity, but also has always raised the question of how this outstanding chemical and ritual process was practically achieved. Here we integrate archaeological, philological and organic residue analyses, shedding new light on the practice and economy of embalming in ancient Egypt. We analysed the organic contents of 31 ceramic vessels recovered from a 26th Dynasty embalming workshop at Saqqara1,2. These vessels were labelled according to their content and/or use, enabling us to correlate organic substances with their Egyptian names and specific embalming practices. We identified specific mixtures of fragrant or antiseptic oils, tars and resins that were used to embalm the head and treat the wrappings using gas chromatography-mass spectrometry analyses. Our study of the Saqqara workshop extends interpretations from a micro-level analysis highlighting the socio-economic status of a tomb owner3-7 to macro-level interpretations of the society. The identification of non-local organic substances enables the reconstruction of trade networks that provided ancient Egyptian embalmers with the substances required for mummification. This extensive demand for foreign products promoted trade both within the Mediterranean8-10 (for example, Pistacia and conifer by-products) and with tropical forest regions (for example, dammar and elemi). Additionally, we show that at Saqqara, antiu and sefet-well known from ancient texts and usually translated as 'myrrh' or 'incense'11-13 and 'a sacred oil'13,14-refer to a coniferous oils-or-tars-based mixture and an unguent with plant additives, respectively.

Batavia shipwreck timbers reveal a key to Dutch success in 17th-century world trade.

Ocean-going ships were key to rising maritime economies of the Early Modern period, and understanding how they were built is critical to grasp the challenges faced by shipwrights and merchant seafarers. Shipwreck timbers hold material evidence of the dynamic interplay of wood supplies, craftmanship, and evolving ship designs that helped shape the Early Modern world. Here we present the results of dendroarchaeological research carried out on Batavia's wreck timbers, currently on display at the Western Australian Shipwrecks Museum in Fremantle. Built in Amsterdam in 1628 CE and wrecked on its maiden voyage in June 1629 CE in Western Australian waters, Batavia epitomises Dutch East India Company (Verenigde Oostindische Compagnie, or VOC) shipbuilding. In the 17th century, the VOC grew to become the first multinational trading enterprise, prompting the rise of the stock market and modern capitalism. Oak (Quercus sp.) was the preferred material for shipbuilding in northern and western Europe, and maritime nations struggled to ensure sufficient supplies to meet their needs and sustain their ever-growing mercantile fleets and networks. Our research illustrates the compatibility of dendrochronological studies with musealisation of shipwreck assemblages, and the results demonstrate that the VOC successfully coped with timber shortages in the early 17th century through diversification of timber sources (mainly Baltic region, Lübeck hinterland in northern Germany, and Lower Saxony in northwest Germany), allocation of sourcing regions to specific timber products (hull planks from the Baltic and Lübeck, framing elements from Lower Saxony), and skillful woodworking craftmanship (sapwood was removed from all timber elements). These strategies, combined with an innovative hull design and the use of wind-powered sawmills, allowed the Dutch to produce unprecedented numbers of ocean-going ships for long-distance voyaging and interregional trade in Asia, proving key to their success in 17th-century world trade.

The role of intellectual property rights on access to medicines in the WHO African region: 25 years after the TRIPS agreement.

BACKGROUND: It is now 25 years since the adoption of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the same concerns raised during its negotiations such as high prices of medicines, market exclusivity and delayed market entry for generics remain relevant as highlighted recently by the Ebola and COVID-19 pandemics. The World Health Organization's (WHO) mandate to work on the interface between intellectual property, innovation and access to medicine has been continually reinforced and extended to include providing support to countries on the implementation of TRIPS flexibilities in collaboration with stakeholders. This study analyses the role of intellectual property on access to medicines in the African Region. METHODS: We analyze patent data from the African Regional Intellectual Property Organization (ARIPO) and Organisation Africaine de la Propriété Intellectuelle (OAPI) to provide a situational analysis of patenting activity and trends. We also review legislation to assess how TRIPS flexibilities are implemented in countries. RESULTS: Patenting was low for African countries. Only South Africa and Cameroon appeared in the list of top ten originator countries for ARIPO and OAPI respectively. Main diseases covered by African patents were HIV/AIDS, cardiovascular diseases, cancers and tumors. Majority countries have legislation allowing for compulsory licensing and parallel importation of medicines, while the least legislated flexibilities were explicit exemption of pharmaceutical products from patentable subject matter, new or second use of patented pharmaceutical products, imposition of limits to patent term extension and test data protection. Thirty-nine countries have applied TRIPS flexibilities, with the most common being compulsory licensing and least developed country transition provisions. CONCLUSIONS: Opportunities exist for WHO to work with ARIPO and OAPI to support countries in reviewing their legislation to be more responsive to public health needs.

Exotic foods reveal contact between South Asia and the Near East during the second millennium BCE.

Although the key role of long-distance trade in the transformation of cuisines worldwide has been well-documented since at least the Roman era, the prehistory of the Eurasian food trade is less visible. In order to shed light on the transformation of Eastern Mediterranean cuisines during the Bronze Age and Early Iron Age, we analyzed microremains and proteins preserved in the dental calculus of individuals who lived during the second millennium BCE in the Southern Levant. Our results provide clear evidence for the consumption of expected staple foods, such as cereals (Triticeae), sesame (Sesamum), and dates (Phoenix). We additionally report evidence for the consumption of soybean (Glycine), probable banana (Musa), and turmeric (Curcuma), which pushes back the earliest evidence of these foods in the Mediterranean by centuries (turmeric) or even millennia (soybean). We find that, from the early second millennium onwards, at least some people in the Eastern Mediterranean had access to food from distant locations, including South Asia, and such goods were likely consumed as oils, dried fruits, and spices. These insights force us to rethink the complexity and intensity of Indo-Mediterranean trade during the Bronze Age as well as the degree of globalization in early Eastern Mediterranean cuisine.

The origins of money: Calculation of similarity indexes demonstrates the earliest development of commodity money in prehistoric Central Europe.

The origins of money and the formulation of coherent weight and measurement systems are amongst the most significant prehistoric developments of the human intellect. We present a method for detecting perceptible standardization of weights and apply this to 5028 Early Bronze Age rings, ribs, and axe blades from Central Europe. We calculate the degree of uniformity on the basis of psychophysics, and quantify this using similarity indexes. The analysis shows that 70.3% of all rings could not be perceptibly distinguished from a ring weighing 195.5 grams, indicating their suitability as commodity money. Perceptive weight equivalence is demonstrated between rings, and a selection of ribs and axe blades. Co-occurrence of these objects evidences their interchangeability. We further suggest that producing copies of rings led to recognition of weight similarities and the independent emergence of a system of weighing in Central Europe at the end of the Early Bronze Age.

That "Bulky Commodity, Tobacco".

Tobacco, like other popular commodities, both reflected the rhythms of early modern empires and contributed to them. People, goods, and ideas crossing the Atlantic Ocean often traveled as freight in vessels bound upon other business, and much of that was tobacco business. Using a variety of historical examples, the current article explores tobacco's economic, cultural, and labor-related worlds to show how one plant shaped institutions of human enslavement, altered colonial ecologies, offered new sensory possibilities, and ruined fortunes. Although now perhaps better known within medical contexts as a significant, preventable cause of death, tobacco as it is understood today is also a highly political, economic, and cultural product, characteristics that have shaped human relationships to the commodity over the centuries. The 17th and 18th centuries, for example, saw a dramatic rise in tobacco consumption in Europe alongside an influx of colonial natural products across the continent. The tobacco trade offered power and profit to some, exploitation and enslavement to others. It underwrote the rise of prominent merchant and political families while shaping the daily routines of countless enslaved men, women, and children tasked with growing the plant. Tobacco leaves also offered hopes of medical treatment and trustworthy business dealings, as well as a moment of respite on a long voyage. At every stage of its evolution into a global commodity, tobacco's meanings and roles changed, becoming more fully integrated into European empire and its structures of power and profit in the process.

Mummified baboons reveal the far reach of early Egyptian mariners.

The Red Sea was witness to important events during human history, including the first long steps in a trade network (the spice route) that would drive maritime technology and shape geopolitical fortunes for thousands of years. Punt was a pivotal early node in the rise of this enterprise, serving as an important emporium for luxury goods, including sacred baboons (Papio hamadryas), but its location is disputed. Here, we use geospatial variation in the oxygen and strontium isotope ratios of 155 baboons from 77 locations to estimate the geoprovenance of mummified baboons recovered from ancient Egyptian temples and tombs. Five Ptolemaic specimens of P. anubis (404-40 BC) showed evidence of long-term residency in Egypt prior to mummification, consistent with a captive breeding program. Two New Kingdom specimens of P. hamadryas were sourced to a region that encompasses much of present-day Ethiopia, Eritrea, and Djibouti, and portions of Somalia and Yemen. This result is a testament to the tremendous reach of Egyptian seafaring during the 2nd millennium BC. It also corroborates the balance of scholarly conjecture on the location of Punt.

Strontium is a chemical element that can act as a geographic fingerprint: its composition differs between locations, and as it enters the food chain, it can help to retrace the life history of extant or past animals. In particular, strontium in teeth ­ which stop to develop early ­ can reveal where an individual was born; strontium in bone and hair, on the other hand, can show where it lived just before death. Together, these analyses may hold the key to archaeological mysteries, such as the location of a long-lost kingdom revered by ancient Egyptians. For hundreds of years, the Land of Punt was one of Egypt's strongest trading partners, and a place from which to import premium incense and prized monkeys. Travellers could reach Punt by venturing south and east of Egypt, suggesting that the kingdom occupied the southern Red Sea region. Yet its exact location is still highly debated. To investigate, Dominy et al. examined the mummies of baboons present in ancient Egyptian tombs, and compared the strontium compositions of the bones, hair and teeth of these remains with the ones found in baboons living in various regions across Africa. This shed a light on the origins of the ancient baboons: while some were probably raised in captivity in Egypt, others were born in modern Ethiopia, Eritrea, Djibouti, Somalia and Yemen ­ areas already highlighted as potential locations for the Land of Punt. The work by Dominy et al. helps to better understand the ancient trade routes that shaped geopolitical fortunes for millennia. It also highlights the need for further archaeological research in Eritrea and Somalia, two areas which are currently understudied.

Compositional and provenance study of glass beads from archaeological sites in Mali and Senegal at the time of the first Sahelian states.

The presence of glass beads in West African archaeological sites provides important evidence of long-distance trade between this part of the continent and the rest of the world. Until recently, most of these items came from historical Sub-Saharan urban centers, well known for their role in the medieval trans-Saharan trade. We present here the chemical analysis by Laser Ablation-Inductively Coupled Plasma-Mass Spectrometry (LA-ICP-MS) of 16 glass beads found in three rural sites excavated during the past decade: the funerary site of Dourou-Boro and settlement sites of Sadia, in central Mali, as well as the settlement site of Djoutoubaya, in eastern Senegal, in contexts dated between the 7th-9th and the 11th-13th centuries CE. Results show that the raw materials used to manufacture the majority of the glass most probably originated in Egypt, the Levantine coast and the Middle East. One bead is of uncertain provenance and shows similarities with glass found in the Iberian Peninsula and in South Africa. One bead fragment found inside a tomb is a modern production, probably linked to recent plundering. All of these ancient beads were exchanged along the trans-Saharan trade routes active during the rise of the first Sahelian states, such as the Ghana and the Gao kingdoms, and show strong similarities with the other West African bead assemblages that have been analysed. Despite the remoteness of their location in the Dogon Country and in the Falémé River valley, the beads studied were therefore included in the long-distance trade network, via contacts with the urban commercial centers located at the edge of the Sahara along the Niger River and in current southern Mauretania. These results bring a new light on the relationships between international and regional trade in Africa and highlight the complementarity between centres of political and economic power and their peripheries, important because of resources like gold for eastern Senegal.

Tableware trade in the Roman East: Exploring cultural and economic transmission with agent-based modelling and approximate Bayesian computation.

The availability of reliable commercial information is considered a key feature of inter-regional trade if the Roman economy was highly integrated. However, the extent to which archaeological and historical sources of inter-regional trade reflect the degree of economic integration is still not fully understood, a question which lies at the heart of current debates in Roman Studies. Ceramic tableware offers one of the only comparable and quantifiable sources of information for Roman inter-regional trade over centuries-long time periods. The distribution patterns and stylistic features of tablewares from the East Mediterranean dated between 200 BC and AD 300 suggest a competitive market where buying decisions might have been influenced by access to reliable commercial information. We contribute to this debate by representing three competing hypotheses in an agent-based model: success-biased social learning of tableware buying strategies (requiring access to reliable commercial information from all traders), unbiased social learning (requiring limited access), and independent learning (requiring no access). We use approximate Bayesian computation (ABC) to evaluate which hypothesis best describes archaeologically observed tableware distribution patterns. Our results revealed success-bias is not a viable theory and we demonstrate instead that local innovation (independent learning) is a plausible driving factor in inter-regional tableware trade. We also suggest that tableware distribution should instead be explored as a small component of long-distance trade cargoes dominated by foodstuffs, metals, and building materials.

[Genetic traces of the trans-Atlantic slave trade]. / Les traces génétiques de la traite des esclaves - Chroniques génomiques.

More than 10 million enslaved Africans were transported to the Americas between 1500 and 1900. Recent genetic studies investigate regional African ancestry components in present-day Africa-Americans, and allow comparison with the extensive records documenting these deportations. The genetic evidence generally agrees with the historical records but brings additional insights in this dark episode of human history.

Tobacco industry and public health responses to state and local efforts to end tobacco sales from 1969-2020.

BACKGROUND: In June 2019, Beverly Hills, California, became the first American city in the 21st century to pass an ordinance ending the sale of most tobacco products, including cigarettes, and it is unlikely to be the last. Knowledge of previous efforts to ban tobacco sales in the US, both successful and unsuccessful, may help inform tobacco control advocates' approach to future efforts. METHODS: We retrieved and analyzed archival tobacco industry documents. We confirmed and supplemented information from the documents with news media coverage and publicly available state and local government materials, such as meeting minutes and staff reports, related to proposed bans. RESULTS: We found 22 proposals to end the sale of cigarettes or tobacco products from 1969-2020 in the US. Proposals came from five states, twelve cities or towns, and one county. Most came from elected officials or boards of health, and were justified on public health grounds. In opposing tobacco sales bans, the tobacco industry employed no tactics or arguments that it did not also employ in campaigns against other tobacco control measures. Public health groups typically opposed sales ban proposals on the grounds that they were not evidence-based. This changed with Beverly Hills' 2019 proposal, with public health organizations supporting this and other California city proposals because of their likely positive health impacts. This support did not always translate into passage of local ordinances, as some city council members expressed reservations about the impact on small businesses. CONCLUSION: Tobacco control advocates are likely to encounter familiar tobacco industry tactics and arguments against tobacco sales ban proposals, and can rely on past experience and the results of a growing body of retail-related research to counter them. Considering how to overcome concerns about harming retailers will likely be vital if other jurisdictions are to succeed in ending tobacco sales.

Fear and stock price bubbles.

I evaluate Alan Greenspan's claim that stock price bubbles build up in periods of euphoria and tend to burst due to increasing fear. Indeed, there is evidence that e.g. during a crisis, triggered by increasing fear, both qualitative and quantitative measures of risk aversion increase substantially. It is argued that fear is a potential mechanism underlying financial decisions and drives the countercyclical risk aversion. Inspired by this evidence, I construct an euphoria/fear index, which is based on an economic model of time varying risk aversion. Based on US industry returns 1959-2014, my findings suggest that (1) Greenspan is correct in that the price run-up initially occurs in periods of euphoria followed by a crash due to increasing fear; (2) on average already roughly a year before an industry is crashing, euphoria is turning into fear, while the market is still bullish; (3) there is no particular euphoria-fear-pattern for price-runs in industries that do not subsequently crash. I interpret the evidence in favor of Greenspan, who was labeled "Mr. Bubble" by the New York Times, and who was accused to be a serial bubble blower.

The 20-year impact of tobacco price and tobacco control expenditure increases in Minnesota, 1998-2017.

INTRODUCTION: Tobacco control programs and policies reduce tobacco use and prevent health and economic harms. The majority of tobacco control programs and policies in the United States are implemented at local and state levels. Yet the literature on state-level initiatives reports a limited set of outcomes. To facilitate decision-making that is increasingly focused on costs, we provide estimates of a broader set of measures of the impact of tobacco control policy, including smoking prevalence, disease events, deaths, medical costs, productivity and tobacco tax revenues, using the experience of Minnesota as an example. METHODS: Using the HealthPartners Institute's ModelHealth™: Tobacco MN microsimulation, we assessed the impact of the stream of tobacco control expenditures and cigarette price increases from 1998 to 2017. We simulated 1.3 million individuals representative of the Minnesota population. RESULTS: The simulation estimated that increased expenditures on tobacco control above 1997 levels prevented 38,400 cancer, cardiovascular, diabetes and respiratory disease events and 4,100 deaths over 20 years. Increased prices prevented 14,600 additional events and 1,700 additional deaths. Both the net increase in tax revenues and the reduction in medical costs were greater than the additional investments in tobacco control. CONCLUSION: Combined, the policies address both short-term and long-term goals to reduce the harms of tobacco by helping adults who wish to quit smoking and deterring youth from starting to smoke. States can pay for initial investments in tobacco control through tax increases and recoup those investments through reduced expenditures on medical care.

An Analysis of the United States and United Kingdom Smallpox Epidemics (1901-5) - The Special Relationship that Tested Public Health Strategies for Disease Control.

At the end of the nineteenth century, the northern port of Liverpool had become the second largest in the United Kingdom. Fast transatlantic steamers to Boston and other American ports exploited this route, increasing the risk of maritime disease epidemics. The 1901-3 epidemic in Liverpool was the last serious smallpox outbreak in Liverpool and was probably seeded from these maritime contacts, which introduced a milder form of the disease that was more difficult to trace because of its long incubation period and occurrence of undiagnosed cases. The characteristics of these epidemics in Boston and Liverpool are described and compared with outbreaks in New York, Glasgow and London between 1900 and 1903. Public health control strategies, notably medical inspection, quarantine and vaccination, differed between the two countries and in both settings were inconsistently applied, often for commercial reasons or due to public unpopularity. As a result, smaller smallpox epidemics spread out from Liverpool until 1905. This paper analyses factors that contributed to this last serious epidemic using the historical epidemiological data available at that time. Though imperfect, these early public health strategies paved the way for better prevention of imported maritime diseases.

From achievement to power: David C. McClelland, McBer & Company, and the business of the Thematic Apperception Test (TAT), 1962-1985.

During the 1960s, Harvard psychologist David McClelland focused his research and business endeavors on increasing the need for achievement in small businesspeople, with the goal of fostering economic success in the developing world. However, by the early 1970s, McClelland would focus almost entirely on developing executives' need for power in the United States. In this paper, I argue that underlying this shift was McClelland's dedication to the project of behavioral engineering and a newfound belief that training individuals in the responsible exercise of leadership and managerial power had become the most effective path to achieving his liberal political aims.

L'épidémiologie entre le terrain des épidémies et l'approche populationnelle, XIX-XXe siècle.

TITLE: L'épidémiologie entre le terrain des épidémies et l'approche populationnelle, XIX-XXe siècle. ABSTRACT: L'émergence d'une épidémiologie moderne est fréquemment associée au basculement de la discipline, d'une science des épidémies vers une science des populations. L'avènement et le développement d'une épidémiologie fondée sur une approche statistique et mathématique n'exclut cependant pas la persistance d'une épidémiologie sur le terrain des épidémies, dans le sillage de l'hygiène publique et de la bactériologie triomphante du tournant des XIXe et XXe siècles. De plus, l'histoire de l'épidémiologie ne saurait être cantonnée à une histoire de savoirs scientifiques ou de savoir-faire techniques et organisationnels. Elle doit intégrer, plus sans doute encore que d'autres branches de la médecine, les dimensions économiques et politiques qui participèrent à l'institutionnalisation et au développement de la discipline et à son inscription dans les processus de décision.

The status of imported Barremian-Bedoulian flint in north-eastern Iberia during the Middle Neolithic. Insights from the variscite mines of Gavà (Barcelona).

Barremian-Bedoulian flint from the Vaucluse region (western Provence, SE France), is traditionally considered one of the most significant chrono-cultural markers of the Chasséen culture during the Middle Neolithic (end of the 5th and beginning of the 4th millennium BC). Diffusion of Provençal flints became massive during the first half of the 4th millennium BC, penetrating in several neighbouring cultural spheres such as the Sepulcros de Fosa culture in north-eastern Iberia. The integrated study of the lithic assemblages from the variscite mines of Gavà (Barcelona) and its contextualization within the Sepulcros de Fosa culture in north-eastern Iberia have revealed unexpected complexity in the modes of consumption, use and status of imported Barremian-Bedoulian industries in north-eastern Iberia during the 5th to 4th millennia cal. BC transition. Local communities within this region, already controlling extraction and regional diffusion of variscite ornaments, exerted control over the fluxes of Vauclusian flint south of the Pyrenees, where it had a triple status (functional, symbolic and both). In addition, the results provide complementary data to better understand relevant aspects of the nature and organisation of Barremian-Bedoulian flint exploitation and early supply systems at the Provençal producing sites during the later phase of the Chasséen culture.

McKinsey and the 'Tripartite Monster': The Role of Management Consultants in the 1974 NHS Reorganisation.

The first major reorganisation of the National Health Service took place in 1974, twenty-six years after the service had been established. It has long been perceived as a failure. This article draws on archival records and a witness seminar held in November 2016 to provide a more nuanced assessment of the 1974 reorganisation and understand more fully why it took the form that it did. In particular it identifies the reorganisation as an important moment in the ongoing story of management consultants engaging with health policymakers, and explores the role of McKinsey and Co. in detail for the first time. Key explanatory factors for their involvement are identified, including the perceived lack of expertise and manpower inside the civil service and the NHS, and perceptions of their impact and effectiveness are discussed. Many debates about the use of management consultants today were directly foreshadowed during the early 1970s. Alongside this, the role of other groups of policy actors, including civil servants, politicians and medical professionals, are established and the extent to which British health policymakers have had to work within existing cultural, political, legislative and practical constraints when trying to initiate change is demonstrated. The fact that many of the 'mistakes' that were made have been repeated in the course of subsequent reforms, speaks to the poor institutional memory of Whitehall, and the Department of Health and Social Care in particular. In the run up to 1974 management consultants could make only a limited contribution to an imperfect compromise.