Bioscapes: Gendering the Global History of Medicine

It is no coincidence that when Pamela Crossley sat down to write What Is Global History? one of her four structuring concepts was “contagion,” a popular title for medical historians.¹ Joining “convergence,” “divergence,” and “systems,” “contagion” was more than metaphor or conceptual device; it was a substantive object of inquiry, and one that has been developed by several generations of medical historians. Mark Harrison is key among them, and indeed few could execute the cosmopolitan sweep across continents, cultures, periods, and scholarship displayed in his essay. And yet, if anything, Harrison’s call underplays the contribution of the history of medicine to the emergence of global history in the first place, precisely the scholarship to which those outside our field, like Crossley, have strongly responded. My own inclination would be to assert the history of medicine as rather more formative of the field of global history itself.

Harrison’s aim is to examine “the impact on health and medicine of the global market” (p. 663), and his strong lead in foregrounding the 1970s, and in drawing medical historians’ attention to commercial drives, is appreciated. However, the confluence of global history, the economics of globalization, and the substantive topic of health and medicine invites a more robust conversation with all kinds of scholarship on sex, reproduction, and gender.² This is not just because of the depth of scholarship on gender and medicine that hardly needs reiterating for readers of this journal, but also because the dynamics of gendered consumption, production, and reproduction are more or less canonical in economic history. Unsurprisingly, then, there is a very substantial literature on gender and globalization too, including the study of masculinity.³ Might bringing these fields together shed different light on the global history of medicine, health, and disease? Put another way, if this scholarship is put aside, what is left insufficiently accounted for, or even unexplained?

These days, I’m less interested in posing this as a political intervention, or even an epistemological question, and far more interested in sex and gender as a straightforward empirical matter. That is, our historical actors, across time and place, were often explicitly engaged in managing, researching, comprehending, and treating the fact of differently reproductive kinds of humans, however problematically defined, presumed, naturalized, acculturated and so forth. Thus, while Immanuel Wallerstein might set aside his critics who asked for a gendered analysis of world systems, can historians of medicine afford to be quite so evasive?⁴ I would say not, precisely because bodies are our core business.

Consider the vast global traffic in bodies, bits of bodies, and different kinds of reproductive bodies that has not just accompanied globalization, but has formed part of it. Harrison notes health tourism, but it is insufficient to analyze this economy of consumers, suppliers, regulators, and traffickers without considering gendered power and authority (and violence) on the one hand, and reproductively sexed bodies on the other. The globalized bioeconomics of late modernity is about sex and gender through and through, international markets and medical interventions that have together produced a step change in health and medicine, and in reproductive labor especially, both locally and globally.⁵ Again, this is partly, even mainly, because sex and gender were often explicit objects of inquiry for the historical actors that we study, from medical researchers on oocytes and their transfer, to the governance or subversion of transnational surrogacy, to differently sexed human research subjects, to sperm donors buying into some element of gift-exchange economies. We can be sure that health tourism providers and their advertising agents have not forgotten about gender, whether they seek to maximize fertility tourism, variants of cosmetic surgery, or cardiovascular procedures.

This raises the work of economic historians who have put production and reproduction together since Engels, and that of anthropologists, who have been central to the analysis of globalization. Medical anthropologist and Middle Eastern specialist Marcia C. Inhorn has usefully added the concept of “bioscapes” to Arjun Appadurai’s sequence of “scapes” through which to consider globalization—ethnoscapes, technoscapes, financescapes, mediascapes, and ideoscapes. Might the global history of medicine be...