Osiris, Volume 36: Therapeutic Properties: Global Medical Cultures, Knowledge, and Law

By Helen Tilley

This volume of Osiris takes as its point of departure a simple premise: we have yet to fully flesh out the complex historical interplay between medicine and law across the globe. Therapeutic Properties takes an inventive look at the issue, presenting welcome insights on the worldwide ascendancy of biomedicine, the persistence of nonofficial and unorthodox approaches to healing, and the legal contexts that have served to shape these dynamics.

The contributions draw upon source material from the Americas, Africa, Western Europe, the Caribbean, and Asia to trace the influence of penal and civil codes, courts and constitutions, and patents and intellectual properties on not only health practices but also the very foundations of state-sanctioned medicine. The authors explore, too, how institutions of global governance, including those underpinning empires and trade, have historically created feedback loops that enabled laws and regulatory regimes to spread, amplifying their effects and standardizing approaches to diseases, drugs, professions, personhood, and well-being along the way. Highlighting the payoff of interdisciplinary and transnational analyses, this volume adroitly teases apart how different actors fought to write the rules of global health, rendering certain approaches to life and death irrelevant and invisible, others pathological and punishable by law, and others still, normal and natural.

• Language: English
• Publisher: University of Chicago Press Journals
• Release date: Aug 19, 2021
• ISBN: 9780226911915

Book preview

OSIRIS v36n1 coverOSIRIS_titleOSIRIS_editors

Acknowledgments

Introduction

Helen Tilley:

Medical Cultures, Therapeutic Properties, and Laws in Global History

Rebellious Spirits and Medical Imaginations

Paul Christopher Johnson:

Translating SpiritsMedical-Ritual Healing and Law in Brazil and the Broader Afro-Atlantic World

Kate Ramsey:

Powers of Imagination and Legal Regimes against Obeah in the Late Eighteenth- and Early Nineteenth-Century British Caribbean

Hannah-Louise Clark, Dr:

Of Jinn Theories and Germ TheoriesTranslating Microbes, Bacteriological Medicine, and Islamic Law in Algeria

Constitutive Laws and Unprecedented Traditions

Projit Bihari Mukharji:

Subaltern SurgeriesColonial Law and the Regulation of Traditional Medicines in the British Raj and Beyond

Laurence Monnais:

The Reinvention of an Appropriate Tradition or the Colonial Birth of Vietnamese Medicine

Helen Tilley:

Traditional Medicine Goes GlobalPan-African Precedents, Cultural Decolonization, and Cold War Rights/Properties

Bodies of Law and Laws of Bodies

Susan L. Burns:

Sexual Assault and the Evidential BodyForensic Medicine and Law in Modern Japan

María Carranza Maxera:

Enabling RestrictionsFemale Sterilization, Physicians, and the Law in Costa Rica, 1960–1999

Jaimie Morse:

The Geopolitics of Rape Kit ProtocolsHistorical Problems in Translation as Humanitarian Medicine Meets International Law

Redefining Properties and Patenting Powers

Mario Biagioli and Alain Pottage:

Patenting Personalized MedicineMolecules, Information, and the Body

Laura G. Pedraza-Fariña:

The Intellectual Property Turn in Global HealthFrom a Property to a Human Rights View of Health

Anna Winterbottom:

Becoming TraditionalA Transnational History of Neem and Biopiracy Discourse

Stacey Langwick:

Properties of (Dis)PossessionTherapeutic Plants, Intellectual Property, and Questions of Justice in Tanzania

Judiciary Magic and Legal Therapies

João Biehl:

The Pharmaceuticalization and Judicialization of HealthOn the Interface of Medical Capitalism and Magical Legalism in Brazil

Emilie Cloatre, Nayeli Urquiza-Haas, and Michael Ashworth:

Legalities of HealingHandling Alterities at the Edge of Medicine in France, 1980s–2010s

Notes on Contributors

Index

Osiris vol. 36 (2021): v–v.

Acknowledgments

This volume grew out of a multiyear collaboration on Global Medical Cultures and Law that sought to bring together historians, anthropologists, sociologists, and legal scholars to explore a shared set of historical questions. We received generous support from the Buffett Institute for Global Studies and the Science in Human Culture Program at Northwestern University. I am especially grateful to the Buffett Institute’s then director, Bruce Carruthers, and to my collaborators: Carol Heimer, Laura Pedraza-Fariña, Rebecca Seligman, Jeannette Colyvas, and, most recently, Adia Benton. For their unflagging encouragement, I am indebted to Ken Alder and Steve Epstein; and for their advice and thoughts before the project got off the ground, my thanks to Mitra Shirafi and Heinz Klug. Natasha Dennison and Janet Hundrieser provided terrific administrative assistance, while the indomitable Shan Chen Pu did helpful background research. My coordinating role was supported in part by a Buffett Institute Faculty Fellowship and my research by a Scholars Award from the National Science Foundation (Award #1456984).

Several scholars enriched our conversations along the way by taking part in events that led to this volume, including Mark Harrison, Linda Barnes, Kaushik Sunder Rajan, Rosemary Coombe, Chidi Oguamanam, Madhavi Sunder, Siri Suh, Guillaume Lachenal, Bridie Andrews, Noelle Sullivan, David Schoenbrun, Richard Rottenburg, and Nancy Hunt. For their astute comments on earlier drafts, our special thanks to Claire Wendland, Paul Ramírez, Steven Palmer, Peter Locke, and two incredibly helpful anonymous reviewers.

Without the Osiris editorial board’s willingness to take a risk on us, this volume never would have been possible. And without the sustained engagement from W. Patrick McCray and Suman Seth, it would have been much the poorer. To all the contributors who were willing to take up new projects, rewrite and reframe chapters, and explore genres of history writing (and storytelling) that were unfamiliar, my enduring gratitude. It has been an honor and a joy to think with–and learn alongside–one and all.

© 2021 History of Science Society. All rights reserved.

Osiris vol. 36 (2021): 1–24.

Medical Cultures, Therapeutic Properties, and Laws in Global History

Helen Tilley*

*History Department, Northwestern University, 1881 Sheridan Road, Evanston, IL 60208, USA; [e-mail].

For their astute feedback and comments on earlier drafts, my heartfelt thanks to Projit Mukharji, Suman Seth, Ronald Numbers, Paul Ramírez, David Schoenbrun, W. Patrick McCray, Justin Stearns, Sheila Ann Dean, and two anonymous reviewers.

This volume of Osiris takes as its central goal the need to bridge studies of medical cultures, past and present, with studies of the law and legal cultures, encouraging a sustained and historically informed dialogue across all these fields.¹ It deliberately concentrates most attention on the nineteenth and twentieth centuries when medical and legal connections intensified, institutional structures proliferated, and a diverse set of laws and regulations arguably achieved global impact. The field of medical history, for all its accomplishments, still lacks clear and persuasive grand narratives that take all these dynamics into account or that explain their consequences. At the same time, disciplines focused on (bio)medical phenomena today—such as critical global health studies, medical humanities, and science and technology studies—are still insufficiently engaged with the voluminous literature produced by historians, including those focused on science, medicine, and technology. The blind spots this produces matter. Indeed, anyone who ignores the multifaceted and entangled roots of medical and legal phenomena, or believes that the past is irrelevant because recent bioscientific and institutional changes have been so radical and rapid, tends to analyze current trends in ways that are themselves misleading.² Put simply, disciplinary and professional silos continue to prevent scholars from developing empirically robust and historically nuanced studies of medicine and law on a global scale. This volume offers one path forward.

Therapeutic Properties is premised on the idea that boundary work in medical activities has always been mediated and constituted by laws and legal thinking. It recognizes that when people have acted to sort and classify what would and would not count as medical or therapeutic, they did so across many geographical scales and within myriad legal jurisdictions, making these processes inextricably linked. Just as important, the articles in this volume parse legal issues in terms of both hard and soft laws. Where the concept of hard law captures such things as legislation, treaties, court rulings, judicial orders, legal customs, constitutions, and the like—all backed up in principle by tools to entice and force compliance—soft law gestures to rules, regulations, plans, norms, resolutions, guidelines, and protocols that come with no such tools of enforcement because they are by definition nonbinding (i.e., voluntary and aspirational); yet they still leave their mark on the world.³ Only by considering legal and medical histories in tandem is it possible to tease out the interrelations and effects of these different kinds of law.

The articles in Therapeutic Properties build upon four historical insights relating to (1) the global ascendency of biomedical cultures and their counterparts, (2) the persistence of unofficial and unorthodox forms of care, (3) the production of quotidian and clandestine therapeutics, and (4) the synergistic role of laws and legal processes in setting boundaries across all medical domains. This introduction walks readers through these four insights—with a section for each one—in order to explain the wider historical context that frames the volume. They should also help anyone taking up these issues for the first time to see more clearly how and why they are important. The concluding section discusses each article’s themes and arguments, tying several of the threads together.

Biomedical Cultures and Counterparts Across the Planet

Over the last two centuries, biomedicine—defined broadly to include public health and primary care—has achieved unparalleled authority at the global level.⁴ No one should be that surprised by this statement because it is now part of a shared and dominant reality. Medical historian Roy Porter came to a similar conclusion more than two decades ago, giving it a provocative twist: What began as the medicine of Europe is becoming the medicine of humanity.⁵ In spite of his confident claim, historians who trace these patterns continue to debate just how European all of Europe’s medicine really has been, while anthropologists and sociologists, and anyone focused on people’s health, rightly question whether it has indeed become humanity’s medicine.⁶ A more precise, though less pithy, statement of fact would be this: biomedical approaches are now the norm for governments the world over. This means that there is no single or archetypal biomedicine, but rather a mosaic of biomedical cultures, each with different kinds of official backing. For Porter, and so many others, biomedicine is one of history’s winners. Just why and how it won, he left to others to explain, surmising only that it resulted from some combination of western political and economic domination and the fact that it is perceived, by societies and the sick, to ‘work’ uniquely well, at least for many major classes of disorders.⁷ The forces that helped biomedical methods and ideas predominate picked up in pace and intensity in the middle of the nineteenth century when states, empires, and international organizations began to systematize and standardize their work on an ever-growing scale. Legal instruments and institutions were integral throughout, yet their exact roles in so many different places still remain opaque.

As biomedical approaches coalesced and began to achieve different degrees of official power, this process produced side effects of its own, generating an array of therapeutic cultures that were themselves novel and often without precedent.⁸ These patterns tend to be less well understood, certainly at a popular level, but even among historians of science and medicine (and specialists in area studies) because they require comparative and transnational methods to bring them fully to light. To put this in Porter’s terms, it forces scholars to pay attention to the other medalists, the runners-up, the also-rans, the dropouts, and even those who are still trying to come from behind. More to the point, it means looking at the referees, the umpires, the coaches, the rule books, the funders, the fans, the playing fields, and the pickup games. Porter thought about this himself and even had a cast of characters in mind: "It is conceivable that in a hundred years’ time traditional Chinese medicine, shamanistic medicine, or Ayurvedic medicine will have swept the globe … but there is no real indication of that happening, while there is every reason to expect the medicine of the future to be an outgrowth of present western medicine—or at least a reaction against it."⁹ True, and yet … in certain respects Chinese medicine has swept the globe, while Islamic-, Asian-, and African-influenced forms of therapeutics have held onto and even expanded their continental coverage, and shamans (or unorthodox practitioners of all kinds, including those metaphysically inspired) have not gone away.¹⁰ What should we make of these patterns, and how do we explain them in historical terms at the same time that we explain biomedicine’s ascendency?

Scholars, of course, have long recognized the frictions and fusions of cross-cultural exchanges, including their inequalities, and have noted the many epistemic and real-world phenomena they generated in their wake. Medical anthropologist Margaret Lock tried to put her finger on this dynamism in the following way: In no case, not even in Europe and North America, has biomedicine entirely usurped other forms of healing practices already present. Pluralism [has been] the norm and, paradoxically, with globalization, diverse forms of medical practice have actually proliferated both in countries that modernized early and in those where the process commenced much later.¹¹ Given that Lock is right—medical practices have multiplied—why has it also been so easy for powerful figures to render invisible different cultures of care and approaches to health in so many places over time? The answer lies, in part, in the way political entities have given certain professionals (and their institutions and practices) an official stamp of approval, otherwise known as legal recognition, while pushing to the margins so many other players. But it also rests in increasingly popular ideas of progress and the loaded term modern itself, both of which led people to cast whatever they viewed as the concepts’ opposites to be no longer important, useful, or relevant.

Even the history of medicine has fallen prey to this tendency, framing its origin stories and grand narratives in ways that deliberately winnow down definitions of who and what are most significant, because the field understandably wishes to contextualize prevailing and powerful patterns.¹² Whatever gets left to one side, scholars suggest, was insufficiently important anyway, because it failed to have enough of a lasting impact or secure the support of influential arbiters, or perhaps both. While most medical historians avoid telling Whiggish stories about an inevitable path toward more effective remedies, it is harder to sidestep methods and lexicons that inadvertently naturalize this kind of narrative arc. Certain concepts, in other words, are embedded in epistemic cultures of their own, and using them can lock scholars into genres of medical storytelling that create blinkered views.

Histories of infectious diseases—both specific and composite—offer a perfect illustration of this challenge because they tend to be premised on understandings of reality that make it tough to do justice to the sheer array of time-specific, place-specific, and language-specific ideas about illnesses, therapies, and cosmologies that have been coterminous.¹³ So, scholars must pick and choose, featuring some places and languages over others, all while moving in their stories toward the arrival of microscopes, the proliferation of laboratories, the creation of vaccines and new drug therapies, the hygienic triumph (or failure) over parasites, and, perhaps most important, a kind of secular disenchantment of the world.¹⁴ Such stories and their demographic lessons—about lives lost and saved, experts investigating and intervening, and people contesting and benefiting—make it hard to remember that germ theories and their accompanying tools arose within specific political and racial economies that shut down other conceptual and therapeutic possibilities.¹⁵ The people who wielded these new tools often insisted that they made medicine modern, which created an explicit trade-off; any diagnostic categories, definitions of health, or healing practices that did not fit within their epistemic cultures had to be rejected in order for these new epidemiological and bodily facts to take their place.

This dialectic—and circular—logic has created its own kinds of real-world effects and helps to explain why in some regions of the world, new or recently assembled medical cultures were labeled traditions and often placed in an explicit ethnonational lineage, eventually becoming something pervasively called traditional or indigenous medicine (e.g., traditional Chinese medicine or Maori medicine).¹⁶ Some scholars have taken to referring to these things as neotraditional to signal just such novelty.¹⁷ These synergies also explain why certain specialists were rejected outright, precisely because they failed to conform to the needs and moral requirements of states and empires that were aspiring to be modern (consider voodoo, obeah, or any number of other stereotypical terms).¹⁸ Such practitioners can be considered the losers in the global game; they were thrown out because they were considered unfit for the task. Those in positions of authority often chose labels for these players (and their expertise) that reflected a sense of danger, calling their work witchcraft, superstition, magic, or sorcery, and alleging their unreasonable and unreal natures, even as they responded to them in real and visceral ways.¹⁹

Over the last two centuries, different parts of the world experienced similar conditions as empires expanded (and contracted), as nation-states multiplied in successive waves, and as medical missionaries worked to spread their gospel. Leaders and laypeople alike struggled to distinguish between old and new forms of medicine—and between orthodox and unorthodox health practices—in the process.²⁰ To put these dynamics in stark relief, the globalization of biomedicine and the codification of traditional medicine were two sides of the same historical coin. Both also generated their own illicit shadows, including such phenomena as medical negligence and malpractice, activities around which robust legal cultures have arisen. Over time, modern medicine—and its cognates, Western medicine, biomedicine, and scientific medicine—became catchall categories for ideas about effective medicine (whether true or not). In turn, whatever was thought to have come before or to exist outside its remit was, by definition, less effective (risky even) and largely benched or suspended from official play.

As anyone familiar with biomedical cultures and their counterparts knows, the story does not end here. These dualisms—modern/traditional, effective/ineffective, Western/non-Western, reasonable/unreasonable, official/unofficial, real/unreal—rest upon myths and illusions of their own. It is just these partial perspectives that history’s winners have tried to insist upon, and that policy makers (and their enforcers) often echo, even when they criticize the status quo. To switch from a sports analogy to a judicial analogy, by paying too little attention to the long history of dissenting opinions (in medical practice), dominant approaches in global health studies manage to double down on just those blind spots, suggesting far more historical consensus about definitions—including what works, what does not, and why—than has ever existed in practice.²¹ If only the world were so simple.

Unofficial and Unorthodox Therapeutics: Competing Jurisdictions and Sovereign Publics

Until fairly recently, these legal distinctions and official policies have not really mattered for most people, which leads to a second historical insight on which this volume rests. Myriad forms of healing and state-sanctioned medicine, public and private, have coexisted and intermingled for centuries, and these patterns persist into the present.²² States and municipalities have never had a monopoly over cultures of care. This has been true both in places where there have been few (or poorly enforced) laws and in places where many laws exist, because people find ways to maneuver in pursuit of health on their own terms. Just as important, as laws proliferated, they created intersecting and competing jurisdictions, meaning that rules could operate at different scales and contradict, cancel out, or dampen each other’s authority. Antivaccination and faith-healing movements are just two of the more recent examples of this phenomenon.²³ Scholars may find it easy to acknowledge these juridical complexities, but it is also easy, especially for those focused on more recent biomedical or state-centric histories, to misconstrue or simply ignore them.

There are several reasons for such confusion and neglect. To start with, the very idea that each state would have its own sovereign health system is actually relatively new at the global level, and rests on shaky ground.²⁴ Even so, boosters have been especially effective in creating the impression that state-sanctioned systems are the best, if not the only, game in town. Metrics and rankings only reinforce this message. With these, many health care models count only those people the state designates as official, ensuring that anyone who does not fit the bill is either ignored or is sorted into religious, mutual aid, or informal economic categories.²⁵ The blind spots here have to do with cultures of care that are illegible to state techniques of counting. Going further, certain boosters of official models of health care have also been good at distorting the historical record by failing to acknowledge different polities’ past medical norms and practices, while they also exalt—even as they may misunderstand—the genealogies of others.²⁶ The blind spots here have to do with influential arbiters’ refusal to accept—or their need to deny outright—other models of care. This insight applies just as much to places where text-based understandings of health prevailed—within Eurasian and Islamic spheres where you might find influential classical texts—as to places where oral, but no less literary or learned, approaches were the norm, such as parts of Africa, the Americas, and various islands and archipelagos. And in truth, textual and oral approaches have coexisted almost everywhere.

Finally, unofficial and unsanctioned therapeutic practices have been easy to misunderstand, because they have involved types of agency that operated outside or alongside political hierarchies and elite activities. To follow their impact means studying forms of bottom-up and horizontal social power. Here we might think of the many ways people enslaved or subjected to colonial rule ended up playing crucial roles and leaving lasting traces within different domains of health care (and much else besides). These latter patterns are admittedly harder to pin down, especially as geopolitical units have changed (altering what counts as official) and as certain nation-states have come to exercise an outsized influence over the way the public in public health gets defined and imagined globally.²⁷ The Ottoman empire offers a good example of this. As British and French officials encroached on its sovereign controls in North Africa in the second half of the nineteenth century, the empire’s longstanding techniques of care and social welfare went from being authorized to unauthorized. Nonetheless, residents continued to look to Ottoman precedents, Islamic law, and enduring precepts about public health to guide them, even as French and British representatives built upon some of these practices, discarded others, and insisted that their civilizing mission would lead to improved health conditions for all.²⁸

Given that histories of public health tend to take the modern (European) state as the defining model, it has been easy to overlook that other ideas about sovereignty and health persisted.²⁹ This matters for many reasons, not least because it affects the kinds of stories scholars tell about the origins and lived realities of rights to health thinking. Without comparative and genuinely global perspectives, these histories usually write much of the world out of the picture, giving more credit, once again, to elite actors, powerful institutions, and imperial states. Such players have indeed been influential, but they are hardly responsible for every innovation. The fact that so many histories suggest otherwise does not just distort the historical record, it also impoverishes our imaginations.

Quotidian and Clandestine Therapeutics: Body Politics, Public Healing, and Medical Markets

Unofficial approaches to health have actually run the gamut from domestic forms of care, including palliative work surrounding debility and death, to institutions of public healing.³⁰ This introduces a third historical insight central to this volume. Studies of certain kinds of quotidian and collective healing have shifted the analytical frame away from doctor-patient dyads to explore intergenerational quests for therapy.³¹ Such a wide-angle lens has allowed scholars focused on African medical history, for instance, to reveal how different groups have linked forms of political and social power to therapeutic power. Their analyses have shown that different healing acts were not so much about individual bodies as they were about the body politic (and nonhuman nature too). These scholars have made it clear that people at the mercy of certain social structures—including (transatlantic) slavery, capitalist modes of production, and colonial rule—have viewed them as forms of misfortune and affliction in their own right, requiring an organized response to restore public health precisely because the effects were felt on a collective level.³²

Trying to draw neat and tidy lines around what has and has not constituted illness (or health) and who was and was not a healer—also expecting that people have held such rigid distinctions in their own minds—is often belied by historical evidence. David Schoenbrun explains: Healing in African history implicates other histories too…. The powers of kings, court ritualists, chiefs, certain mediums, and rainmakers—common actors in the domain of public health—are often understood to work in this expansive scope. Spirit possession activities cross these boundaries.³³ This point helps to clarify why many historians who have explored the social basis of health in Africa have also foregrounded relationships between healing and harming; not unlike biomedical approaches, efforts to secure collective or public health have made use of tools and practices that can also inflict harm.³⁴ Unless this point is made explicit, it becomes too easy to sanitize health histories and erase different kinds of conflict, and even violence.

Because the rules of the game have always been contentious, unofficial or unsanctioned healing has tended to develop simultaneously in quotidian and clandestine forms, allowing its adherents and practitioners to avoid detection or even appear to be ineffectual or inconsequential. This has also meant that (colonial and national) state actors—some of the more powerful umpires—have mistaken or simply missed these unauthorized forms because they were not themselves well versed in such specialties. Official verdicts on this front have nonetheless had enduring ripple effects for both those caught in the crosshairs and those watching on the sidelines. Whatever umpires deemed irrelevant or silly or dangerous or simply having no existence tended to be taken as true (or at least potentially true). Their judgments raised the stakes for anyone wishing to defend things labeled unorthodox or (dangerously) different. Efforts to regulate these individual and social dangers have been pertinent for both collective healing and for certain types of intimate care, such as menses and puberty, sexual relations and fertility, childbirth and infant survival, which have constituted so many people’s early encounters with medicine for much of human history.

Early modern and imperial historians have addressed at least some of these different modes of social power by describing them in terms of a medical marketplace, arguing that people of all backgrounds have played a driving role in shaping which therapeutic cultures flourished and which languished the world over. Even as biomedical practitioners (and their allied disciplines) consolidated their own authority over the last two centuries, their rules were still unevenly applied, their geographical reach could be limited, and their social status was not always superior to that of other professed experts.³⁵ As Porter himself understood only too well, it turned out that paying attention to the game’s audience—patients and their social networks—revealed a lot about therapeutics that a narrow focus on players—medical experts—did not. Interestingly, ethnographers and area studies scholars had taken this insight to heart decades earlier, often in the midst of empire building.³⁶

A focus on medical markets and people’s choices has helped generate a much better understanding of medical cultures from below. It has also produced clearer pictures of the importance of different kinds of (medical) supply and (popular) demand, the role of profits and fees, forms of professional competition, and even underlying assumptions about health, charity, suffering, and welfare. Patients, as Mark Jenner and Patrick Wallis have pointed out for England and its early modern empire, ‘had the relative freedom to choose the practitioners they liked’; they were ‘medically promiscuous,’ selecting therapies and therapists according to their estimation of the practitioner’s effectiveness or manners, not to mention cost.³⁷ Before the rules of the game became more stable at state and global levels, experts and laypeople alike not only improvised (and borrowed), but also assumed that their own rules—including how they viewed the world and cycles of life and death within it—gave them the right tools for the job.³⁸

Markets, of course, operated on a variety of scales simultaneously and ensured polycentric and multidirectional influences. They also generated their own legal and governing cultures that deserve more careful scrutiny.³⁹ As Mark Harrison points out, it was not just the existence of varied medical markets, but also the emergence of global commerce that accelerated interactions among different forms of healing and ensured that biomedical approaches reached wider audiences. As cities and industries grew in different parts of the world during the nineteenth and twentieth centuries, and as centers of agricultural production expanded, transnational trade brought more people in contact with Western medicine and its products. Harrison elaborates: Medicines and medical services were widely advertised and available in shops and in the workplace through numerous vendors and practitioners. This encouraged many people to experiment with a range of therapeutic alternatives to traditional remedies.⁴⁰ Markets and trade networks served as powerful vectors for transmission; as they did, they also codified rules and laws about legitimate and illegitimate practices, safe and unsafe goods, productive and unproductive bodies, fake and real therapies, profitable and unprofitable exchanges, and so on.⁴¹ As novel ideas, tools, texts, and techniques circulated, they were often given some kind of vernacular spin. In this way, they came to do different kinds of work and generated different kinds of meaning (and therapeutic effects), depending on who deployed them.

Yet, even when biomedical institutions and professions began to achieve more state power than others (that is to say, when the umpires started to call the shots more consistently in their favor), this did not always translate into similar levels of trust or popularity. The question is, why not? One set of answers has focused on unpacking biomedical cultures’ many imbrications with political power—as handmaidens of empire, as means of reifying inequalities and colonizing bodies, as dubious (even dangerous) inspectors and experimenters, and as gatekeepers for professions and forms of care—which made sufficient numbers of people everywhere both ambivalent and critical. There is certainly much validity to these arguments, but they overlook another set of patterns: as commercial forces increasingly shaped the world, certain classes of specialists simultaneously took advantage of other laws to become more market oriented and developed their own strategies to maintain and even expand their geographical horizons.⁴² Their clientele actively supported them in their efforts, not least because what they did seemed to work. In other words, just because the umpires and rule books declared certain players out of the game (or benched them for breaking the rules), this did not mean they or their patients complied, nor did it mean that others’ assessments of efficacy were accurate. Cosmopolitan trading zones on a variety of scales (including continental and oceanic) allowed many specialists and constituents room to shape the kinds of therapeutic cultures that made most sense for their needs, even if they lived in contexts such as colonial and racial states, or slave and settler societies that constrained liberties and possibilities. This insight, it is worth stressing, applies no less to nation-states and (neo)liberal regimes in the Global North than in the Global South.⁴³

Constitutive Powers of Laws and Legal Thinking

A fourth and final insight on which this volume rests, and that by now should be self-evident, is that none of these dynamics can be explained fully without exploring their imbrications with laws and legal thinking. Taking such steps with care allows scholars to historicize more fully a variety of ongoing debates—within states and intergovernmental institutions, and also among people themselves—over who has the right to heal, what constitutes a right to health, and why and how therapeutic properties so often become entangled with intellectual properties. Such analyses also get at the juridical dimensions of people’s search for security, including the restorative powers of justice and the pathological effects of injustice and social conflict.⁴⁴ Given the recent focus in global health on biosecurity, which often sees the world from the vantage point of (powerful) states and officialdom, it seems important to also gesture to unofficial understandings of security.⁴⁵ Adopting a vantage point of less powerful groups can remind us that collective harms to members of a body politic have had to be addressed and mended, no less than individual harms.

A phrase like racism kills has proven to be true in more ways than one and has been historicized along several fronts, including, most recently, in terms of the racial dimensions (and potential harms) of genomics, epigenetics, and neurophysiology.⁴⁶ Gendered analyses complement these insights. The fact that formal economies and so many workplaces have been calibrated to the bodies and life cycles (and partnering patterns) of adult men in most countries—as if the human species does not need to nurture, nourish, educate, or care for offspring, the ill, or the elderly—takes its own toll on workers who ultimately assume the (usually unpaid or undervalued) roles relating to care and education. That so many laws and regulations shore up androcentric (patriarchal) and ethnocentric (racist) perspectives the world over, and that rights-based concerns about health must contend with these dynamics everywhere, only underscores the need to keep them all in our scholarly scopes. In a poignant piece on the ways Black AfterLives Matter, Ruha Benjamin does just that as she interrogates US legal systems that sustain and reproduce lethal conditions in reproductive politics: white vitality feeds on black demise … white life and black death are inextricable.⁴⁷

Probing the foundations of these systems more carefully illuminates so much about the history of laws and legal cultures themselves, including their changing assumptions about minds, their jurisdiction over bodies, their definitions of personhood, and their drive to commodify. This last point on commodification warrants closer scrutiny given the myriad ways medical properties have generated profitable monopolies and, of course, given how copyright and patent laws (and ideas about invention and ingenuity) have increasingly intersected with and transformed medical pursuits.⁴⁸ The lines between legal and illegal, licit and illicit, patentable and unpatentable have had substantial consequences for therapeutic landscapes across the planet.

It was not just disciplines, institutions, professions, markets, and people that created and reinforced biomedical cultures, but also thickets of law and their accompanying regulations, judgments, and precedents. Different legal regimes and their intersecting jurisdictions served as malleable scaffolding for states and institutions (and empires), helping them naturalize specific ways of knowing the world that sometimes rendered so many other approaches irrelevant and invisible, and sometimes pathological and criminal.⁴⁹ This matrix of legislation and jurisprudence, rules and regulations, did its own boundary work by setting standards and guidelines—those elusive soft laws—for how to classify disease (nosology and etiology), think about human bodies (physiology, neurology, psychiatry, immunology, biochemistry, endocrinology, racial and reproductive sciences), interpret environments (epidemiology, ecology, climatology, toxicology), and marshal evidence (forensics, genetics, biometrics) that effectively occluded other ways of representing the world.⁵⁰ At the level of municipalities and states—as well as transnational organizations—this involved laws and rules relating to contagious diseases and their control, birth and death registrations, foods and drugs, contraception and abortion, insanity and other mental pathologies, eugenics and miscegenation, occupational health and pollutants, census categories and forms of identity, experimental protocols and investigative procedures, and any number of additions to criminal codes.⁵¹ Note that all these categories have been—and often still are—part and parcel of state-sanctioned realities.

Unsurprisingly, then, the transnational codification of hard and soft laws that regulated life and death, and health and illness, also produced a series of casualties, or losers, with respect to practice at the global level. This has been especially marked in terms of state bureaucracies’ and medical professionals’ persistent efforts to rid official medical spheres of three types of phenomena: categories of health and disease that invoke nonmaterial causes; definitions of bodies (and landscapes) that rest upon vital energies and animating spirits; and polyglot approaches to therapeutics, or the ability of experts to operate within more than one conceptual schema simultaneously. Over the last two centuries, officials have increasingly tried to place these first two dynamics beyond the pale of medicine proper and even beyond the realm of reality. Invisible germs and viruses influence the world, but spirits and ancestors and words themselves are alleged to have but imagined results. As scholars know, this kind of boundary work has always been more easily asserted than achieved. One need only think of waves of popular, scientific, and legal interest in psychic phenomena, extrasensory perception, trances, faith, and placebo effects, not to mention the endurance of ideas about and investigations into qi, chakras, àṣẹ, and any number of other concepts encompassing energy flows and real-world effects, to recognize their persistence.⁵²

Officials have likewise tended to eschew the very idea that medical experts could code-switch, or move linguistically, between therapeutic cultures, often leaving those labors to scholars in the humanities and social sciences (and to the small number of medical doctors who have also done PhDs in medical anthropology or history). Why? In part, because anyone able to move between different worlds of meaning might also question whether dominant approaches to health were legitimate, and they might even point to some of their fictional foundations. Polyglot therapeutics have been so threatening to states and institutions (and, on a more mundane level, so challenging logistically), because anyone with these diverse abilities has tended to find it difficult to trade in absolutes about reality or health. Official efforts to stamp out multivalent perspectives in the past—and into the present—have been underpinned by wishful thinking. Different types of illicit, unregulated, and unorthodox professionals and, more to the point, different notions of embodiment and illness have rarely disappeared entirely, but have instead adapted to new circumstances.

Connected Histories, Therapeutic Landscapes, and Juridical Dynamics

The foregoing remarks should help explain the reasons behind certain editorial choices for this volume. There are not many global histories of science or medicine, for instance, that begin with African actors, spaces of knowledge production, and medical influences. These therapeutic—and spiritual, political, and epistemic—cultures have been around for centuries, even as they transformed, and yet such historical patterns are still too little known beyond specialists focused on Africa and its global diasporas. To call this a view from the margins would be to misconstrue history, because these were not marginal practices or ideas: they were widespread, and widely influential. They were, and are, also deeply imbricated in the intellectual histories of states, empires, and transnational networks, yet somehow they are still not part of medical history’s dominant or mainstream narratives.

The volume begins, then, from the vantage point of the Atlantic world, with a section on Rebellious Spirits and Medical Imaginations. Paul Johnson starts the conversation with an article that traces the way ritual specialists of African descent in Brazil grappled with their changing social conditions (including the shift from slavery to freedom) and with new kinds of legal regulations and disciplinary objectifications.⁵³ As these practitioners were first classed as outlaws, then as public health dangers, and finally as a protected group vis-à-vis religious freedom, they still skirted worlds of national and professional belonging in terms of citizenship and institutional inclusion. Their work with spirits, in the meantime, challenged the very essence of liberal ideas of legal personhood (and medical ideas about the materiality of bodies). Spirits and the unborn have had this in common; as both realms have been increasingly medicalized, they also served as a litmus test for the boundaries of personhood and the rights and risks of those so embodied (i.e., spirit mediums and pregnant women).⁵⁴ Paying closer attention to the legal debates in different parts of the world surrounding ritual specialists also draws the curtain back on juridical approaches to self and consciousness. It hardly seems an accident that artificial intelligence gets caught up in some of these same issues, raising questions about whether the ghost in the machine deserves legal standing.⁵⁵

Kate Ramsey takes up cognate phenomena in the British Caribbean, as she considers how and why colonies passed laws against obeah in the decades after witchcraft was decriminalized in England and Scotland. Her argument turns on a set of Anglo-French medicolegal debates about human physiology and the powers of imagination to heal and harm. These were used, she notes, to play down the threat of witchcraft among Europeans (because what was only imagined was no real threat) and play up their dangers among enslaved Africans, because what was persistently imagined by those kept unfree challenged not just the social order, but also property relations and the reproduction of racial economies. Some of the theories in existence today about the powers of suggestion within mind-body medicine, Ramsey argues, can trace their roots to debates about anti-obeah laws in the British Caribbean. More to the point, her study also reminds us vividly of the power struggles over this kind of expertise. Consider why professional scientists and doctors, often of European descent, have insisted that other people’s cognitive and perceptual expertise is unreal—pseudoscience, superstitious, and dangerous—while their own analyses of faith and health, mind and matter, language and effect, and even energy flows, produce judicious and dispassionate understandings of reality. Why are some actors so easily dismissed as charlatans while others, performing and staging their own rituals with high-tech machines to boot, are said to be so trustworthy? As so many scholars have shown, and some scientists have even admitted, so-called sorcerers can know things, produce real effects, even win in a contest set by more powerful players (because their expertise is better), and still these same people can be written out of mainstream histories of science and medicine.⁵⁶

Turning to North Africa, Hannah-Louise Clark’s article raises a different set of questions about medical imaginations and the place of immaterial forces—in her case, these are focused on the role of jinn (spirits) and germs (microbes) as she probes the complexities of colonial Algeria where multiple legal orders intersected, including Islamic, Ottoman, French, and Berber customary law, as well as exceptional penal law (the indigénat).⁵⁷ France’s conquest of the region had been brutal. Its administrators used their legal powers to assimilate territory and rewrite the rules relating to property and belonging, ensuring that Muslims had an enduring subordinate status. These upheavals caused people across Algeria to reimagine etiologies and reassess different health threats, often in terms of jinn. Of particular interest to Clark are the debates such changes prompted among Muslims over whether French medical techniques and ideas, including quarantine and germ theories, were legal under Islamic jurisprudence. Because jinn appear in the Qurʾan, all Muslims were technically bound to accept their existence and address their malevolent influences, with women taking the lead in the realms of child and household well-being. Yet, as (male) French doctors and (male) Islamic reformers gradually made the case that Muslims could accept germ theories, they did so in ways that both used and supplanted jinn theories, in the process undermining both the moral work that jinn theories prompted and the therapeutic authority that women possessed.

Projit Bihari Mukharji kicks off the conversation in the second section of this volume on Unprecedented Traditions and Constitutive Laws, with a microhistory of subaltern surgeon Sukaroo Kobiraj, whose 1887 case in colonial Bengal had decidedly macro effects.⁵⁸ Kobiraj was charged and found guilty of criminal negligence in the death of his patient, with the Calcutta High Court rejecting his appeal. As Mukharji argues, the case established a new precedent in imperial common law traditions by consolidating existing views within colonial India about what it meant to have a regular medical education. The High Court’s judgment privileged scholastic practitioners who allegedly worked within a single system—whether Ayurvedic, Unani, or Western medicine—while they marginalized and criminalized, by definition rather than legislative fiat, those whose skills derived not from texts, but rather from braided forms of embodied and tacit practice. That this precedent was picked up in law textbooks, making it useful for legal pedagogy, explains its expanding geographical reach and its afterlives within colonial and postcolonial India, Pakistan, Bangladesh, and even Nigeria. It also explains how the colonial judiciary laid the legal grooves for more tightly bounded medical systems to be legible and have more legitimacy than open and porous practice.

Along these lines, Laurence Monnais turns our sights more squarely to the role of colonial states, examining the checkered history of French official efforts to intervene in therapeutic cultures across Indochina. The French gradually (and instrumentally) brought together a set of medical practices and ideas that they and others increasingly labeled Vietnamese.⁵⁹ Over the course of thirty-five years, from 1908 to 1942, native medicine transitioned from being considered dangerous to being characterized as useful and relatively benign. Through a legal division of labor, French officials shepherded this novel entity into existence by fixing, domesticating, and making less toxic its constituent components. In the process, its practitioners and clients asserted their own priorities, deploying these allegedly harmless medical traditions for burgeoning nationalist ambitions to emancipate themselves from French rule. While the French believed they had neutralized the sting of Vietnamese medicine, in truth they had inadvertently concentrated its power, allowing Vietnamese nationalists to wield it with scorpion-like precision.

My own article moves into the Cold War era and examines how African decolonization and pan-African political organizing affected both the timing and content of the World Health Organization’s (WHO’s) decision to take up a new program on traditional medicine in the 1970s.⁶⁰ As dozens of newly independent African member states joined different United Nations agencies between 1956 and 1970, they also pushed global organizations to take their collective needs and priorities more seriously. This included demanding—successfully—that the WHO expand its rights to health remit to include freedom from racial discrimination and colonial domination. It also involved pushing resolutions and writing reports on traditional medicine that insisted on adding ancestral, immaterial, oral, and intergenerational forms of expertise to the mix, all in an effort to decolonize medicine. These were nontrivial shifts in global governance and part of broader Cold War trends among Second and Third World countries (and a variety of social movements) that championed the needs—and knowledge—of the masses. Pan-African diplomatic efforts took these goals one step further by pushing precedent-setting model laws that could potentially protect newly liberated people’s intellectual property, including their medical heritage. While few African member states were able to implement or enforce their plans on the scale they envisaged in the 1960s and 1970s, their work did have lasting effects within global organizations and beyond. Without their organizing and collective diplomacy, it is tough to imagine that lexicons of traditional medicine would have become as salient or pervasive to so many governments during the Cold War decades.

The third section of the volume, Bodies of Law and Laws of Bodies, foregrounds some of the ways women’s bodies have served as global boundary objects, especially as reproduction and sexual violence came under increasing medical and legal scrutiny over the course of the long twentieth century.⁶¹ This choice too may seem odd, even unsettling, yet it is both timely and poignant given ongoing debates about these subjects and the need to situate sexual assault alongside robust literatures in the history of science and medicine on fertility, sexuality, and reproductive governance. As María Carranza Maxera’s research has revealed, sterilization actually became a sought-after form of birth control in Costa Rica over the last fifty years; indeed, more women around the world today avail themselves of surgical sterilization than any other form of contraception.⁶² This history seems to warrant far more attention than it has received. Such analysis would complement ongoing work on abortion—considering the number of countries that ban it outright or allow it only when a woman’s life or health is in danger—as well as the more widely known histories of forced and coerced sterilization associated with eugenics and family planning movements.⁶³ As Carranza Maxera explains, even in countries like Costa Rica, sterilization existed in a kind of legal limbo. While the penal code made it a crime for anyone to take away someone’s ability to reproduce, contingent state and professional dynamics ultimately made physicians judicial surrogates with the authority to create their own rules and protocols around the law. Doctors thus began to craft arguments about obstetric and social risks to determine which women had rights to access the procedure in the first place and to justify—and tacitly enable—sterilization surgeries as both therapeutic and licit.

The article by Susan Burns, on Japan and medical forensics relating to rape, and Jaimie Morse’s article on the globalization of rape kit protocols from their US origins in emergency medicine, illustrate some of the epistemological challenges that people have encountered when trying to document and prosecute sexual assault.⁶⁴ It turns out that violence and force—or, to put it differently, sexual acts without consent—do not always leave detectable traces or determinate facts on bodies, however traumatic they may be to people’s well-being. As Burns makes clear, Japan’s shift to forensic medicine and evidence collection in the late nineteenth century depended on importing and translating German, British, and French texts on medical jurisprudence. This process was accompanied by a crucial shift in Japan’s modernizing courts; women’s first-hand testimony, their embodied knowledge, so to speak, was rapidly demoted in favor of testimony by male physicians who could serve as expert witnesses. Advocates saw this new role as necessary because it would protect men as much as women, given their fears that women would make false accusations. Ironically, as (accused) perpetrators gained more procedural buffers to protect their rights, (alleged) victims lost ground because their claims were taken as untrue unless substantiated in specific and circumscribed ways by forensic evidence.

Morse, in turn, highlights the recursive nature of debates over sexual violence as she examines how an amorphous assemblage of forensic and therapeutic tools and practices came together in the United States in the 1970s. Eventually given the shorthand label of rape kit, this assemblage not only codified new ways of thinking about assault itself, but also pushed new standards of care for survivors of sexual violence. Unlike in late nineteenth-century Japan, in the mid-twentieth-century United States it was largely female nurses, women’s advocacy groups, and a handful of allied doctors who argued that systematic evidence collection with rape victims in hospital emergency departments could help effectively prosecute more rapists. Yet their efforts inadvertently created dual obligations for specialists. On the one hand, health practitioners owed their patients the kind of care that would help them heal from the aftereffects of assault (physical, emotional, and psychological). On the other hand, they owed plaintiffs and prosecutors robust kinds of evidence that would help secure a conviction. By the early 2000s, these tensions were introduced into global governance as advocates in United Nations agencies recommended that similar rape kit protocols be adopted as best practice for use in conflict zones, such as the Democratic Republic of Congo, where mass rape was wielded as a weapon of war. These protocols, circulating as a kind of technology of care and governance, have often forced survivors into a trade-off between their health rights and their civil (litigant) rights, with both in the end often being tragically out of reach.

The fourth section of this volume, Redefining Properties and Patenting Powers, delves more deeply into the interplay between medical and intellectual properties, with a pair of articles on the intricacies of biomedicine and another pair on the complexities of traditions. Too often, these dynamics are discussed separately, making it challenging to see how historically entwined they have been. It begins with a coauthored piece by Mario Biagioli and Alain Pottage that takes up a deceptively simple question: How does the emergence of personalized medicine unsettle the relationship between medical objects and patent concepts?⁶⁵ Making sense of this requires unpacking the history of patent epistemes themselves, tracing a central shift away from machine models (that accompanied industrial inventions) toward informational models (that accompanied diagnostic and procedural inventions). While it took Anglo-American medical professionals and research universities time to warm to patents, for most of the nineteenth and twentieth centuries there was still a stable match between the objects of medicine and concepts of patent law. This was true even with genetically modified organisms. Only when precision medicine became a goal, from the 1990s onward, did this begin to change. New diagnostic tools, such as the BRCA1 and BRCA2 gene tests for breast and ovarian cancers, emerged that were meant to work within unique human bodies. Court challenges to these kinds of patent claims have drawn attention to the epistemic disconnect, finding that medical diagnostics produced no new inventions, only new information. In practice, however, that information does real work in real bodies because the tools engage with each body using a logic based not on machines, but on cybernetics. Much like Carranza Maxera’s case (of sterilization), these diagnostic tools exist in a legal limbo, because rulings have so far deemed many of them patent ineligible. As judiciaries refine their stance on informational epistemes, that dam is likely to break, with huge implications for monopoly controls and inventors’ (not to mention, public) rights.

Laura Pedraza-Fariña’s article turns to examine behind-the-scenes power struggles between the World Health Organization and the World Trade Organization over how to define intellectual property in global health activities.⁶⁶ In an era of neoliberal policy making, one might have expected IP regimes in global governance to become even more geared to the trade priorities of wealthy countries and to double down on private protections for inventors. As Pedraza-Fariña shows, however, over the last two decades the trends have in fact gone in the opposite direction, with WHO staff successfully insisting that IP regimes move away from a property-centric paradigm toward one focused on human rights.⁶⁷ Through creative and even radical uses of the WHO’s own procedures and investigatory powers, its staff were able to expand its jurisdiction among global institutions, while also backing frameworks that gave less powerful states more sovereign controls to regulate IP regimes in terms of public needs. Yet the devil in Pedraza-Fariña’s story is in the details. The process of forging a shared vision among the WHO and the WTO on IP prompted them to settle tacitly on a more technocratic definition of health, elevating patentable goods—whether medical technologies, pharmaceuticals, or even the kinds of medical diagnostics that Biagioli and Pottage describe—over health infrastructures. In other words, the recent human rights turn in international IP law simultaneously decentered primary care, but bolstered states’ ability to act if their citizens’ health rights are jeopardized.

Different kinds of patent and property stakes are at play in Anna Winterbottom’s reconstruction of the neem tree’s material and intellectual histories.⁶⁸ This was a plant (Azadirachta indica) that was at the heart of patent controversies and accusations of US corporate biopiracy in India in the mid-1990s. As Winterbottom points out, while neem is indeed endemic to South Asia, it came to be considered Indian only after it had circulated and taken root in many other parts of the world. Likewise, its medicinal products were first glossed as traditional only in the early decades of the twentieth century, when the anticolonial Swadeshi (self-reliance) movement began to explore ways to commodify—and patent—the plant’s uses and link them more explicitly to Ayurvedic practice. Some of the problems inherent in biopiracy critiques—including the tidy binaries of modern and traditional and their focus on colonial appropriations—come across vividly as Winterbottom compares neem’s trajectory to that of cinchona. In certain respects, cinchona’s singular and commercial successes by the 1850s as an antifebrile and antimalarial (with its alkaloid derivative quinine) ensured that neem, which had many different applications and more than one active agent, would follow a different path. Neem became traditional, Winterbottom emphasizes, "because cinchona became modern." In fact, neem’s trajectory involved more than a few ironic twists. Perhaps most telling, biopiracy campaigns around neem in the 1990s ultimately led to a new kind of intellectual property (IP) enclosure, with Indian scientists filing more patent claims for neem products, and the Indian government seeking to police IP claims around neem’s uses elsewhere, including in East Africa.

Fittingly, Stacey Langwick’s article takes us to Tanzania, a country bypassed by the kind of biopiracy flashpoints affecting other parts of the world at the end of the twentieth century, and yet still haunted by the specter of intellectual property debates.⁶⁹ Langwick chooses to zero in on unruly aspects of healing practices—those that swirl around therapeutic acts designed to affect growth, vitality, fertility, and maturation—in order to explain the legacies of empire and the contradictions embedded in different modes of state building (colonial, socialist, and neoliberal). German and British conquests across eastern Africa at the end of the nineteenth century were, above all, acts of dispossession. These efforts displaced Kiswahili ideas about justice and malevolence (uchawi) that were at the heart of healers’ (waganga) activities, and began to dismantle therapeutic cultures that were designed to remedy different kinds of disturbance (individual and social). While political independence in late 1961 involved a state shift to socialism and a focus on self-reliance, it did not radically alter many of the governing grooves around health. These state-sanctioned ways of knowing, in both legal and scientific realms, continued to produce their own techniques of unknowing, actively concealing other therapeutic realities that endured. As Langwick helps us appreciate, the Tanzanian state continued to use categories that proved too inflexible and insufficient to capture what its people were actually doing for their well-being. The conceptual limits of state approaches are evident in Tanzania’s recent moves to craft what its officials consider to be more just intellectual property relations, even as certain healers refuse to play along because, to them, they seem patently unreasonable.

The final articles in the volume, in the section Judiciary Magic and Legal Therapies, come full circle, returning us to the double-edged sword of magical powers. In João Biehl’s article, magic is an emergent property that stems from people’s bottom-up efforts to insist that the Brazilian state, even as it has embraced neoliberal and autocratic policies, lives up to its 1988 constitutional promise that every citizen has a right to health.⁷⁰ Biehl has studied for several decades just how the pharmaceutical and judicial turns in health services have affected social worlds across Brazil, leading him to analyze thousands of health-related lawsuits in the southern part of the country. From this, we learn that those most forsaken by existing power structures have also been at the forefront of efforts to demand therapeutic justice. Citizen litigants and their legal allies, including public defender’s offices—or juridical hospitals—have worked with uncanny effect in the country’s courts to make the state procure medications and provide therapies that would otherwise be withheld. Their collective victories have added up to more than the sum of their parts (and appear to have parallels elsewhere in Latin America); people have not only been able to secure life-saving support for themselves, often for chronic ailments, but have also developed creative ways to hold their government accountable. The juridical process has altered the therapeutic landscape and generated communities with the skills to seize upon new openings—when and if they arise—that might turn zones of abandonment into potential zones of vitality.

In the coauthored article by Emilie Cloatre, Nayeli Urquiza-Haas, and Michael Ashworth, magic—and more specifically magical beliefs and their alleged corollary irrationality—are things to be feared and policed, especially when it comes to medical practices in secular states such as France.⁷¹ Licensing laws there have functioned for nearly two centuries through a tautology: to practice medicine (or pharmacy) legally, people must have state-approved credentials, and only those with such credentials are considered to practice legal medicine. As with most lines drawn in the sand, the borders between legal and illegal, or conventional and unconventional, were open to active negotiation, especially as older forms of pharmaceutical expertise, such as herbalism, moved from the mainstream to the margins, and newer, even foreign skillsets, such as acupuncture, became ones that (at least some) licensed doctors embraced. This perpetual need for French courts and professional associations to adjudicate the boundaries of legal medicine produced dual effects over time. On the one hand, it established zones of juridical tolerance, in which technically illegal practices could be introduced or allowed to persist without much fanfare or controversy, occasionally even achieving some