Articoli di riviste sul tema "History and Philosophy of Science and Medicine not elsewhere classified"

AbstractThe author examines Williams’ appraisal of Collingwood both in his eponymous essay on Collingwood, in the posthumously published Sense of the Past (2006), and elsewhere in his work. The similarities and differences between their philosophies are explored: in particular, with regard to the relationship between philosophy and history and the relationship between the study of history and our present-day moral attitudes. It is argued that, despite Williams usually being classified as an analytic philosopher and Collingwood being classified as an idealist, there is substantial common ground between them. Williams was aware of this and made clear his sympathy for Collingwood; but, nonetheless, the relationship between Williams and Collingwood has not previously been explored in any detail. After establishing the common ground between these philosophers, and the areas of disagreement, the author suggests that both may have something to gain from the other.

The history of the book is everywhere, so widely diffused that it merits comparison with the famously elusive Scarlet Pimpernel, whose pursuers sought him without success. Like that figure, book history passes among us in disguise, reluctant to reveal its presence even as it gains ever-greater recognition. In some quarters, it lurks within the domain of bibliography, a field of scholarship dedicated to describing the histories of printed texts and, in the service of this enterprise, concerned with the details of book-making. Elsewhere, book history installs itself within descriptions of libraries and education, sharing, with the first of these, a concern for how old books were accumulated and classified and, with the second, for the many ramifications of literacy and the fashioning of schoolbooks. Together with the history of journalism it studies how news was disseminated and ponders the significance of periodicals, be these newspapers or magazines. Political history has been another convenient site of disguise in the wake of efforts to connect the public sphere and concepts of nation with the emergence of print culture. And, of course, book history has enjoyed a long and fruitful kinship with literary history, a relationship freshly energized in recent decades as literary historians turned to describing the rise and remaking of a canon and to emphasizing the mediations that all texts undergo—the “sociology of texts,” to borrow a phrase made famous by D. F. McKenzie. To this list we can add the version of intellectual history that reconstructs the reading of a person or group and employs this data to generalize about the coming of the Enlightenment and similar formations.

The ArgumentI argue here that in its historical development, sexology developed differently in France than elsewhere in Europe. Though I concur that the modern notion of “sexuality” arose some time in the last half of the nineteenth century, the older notion of ”sex” persisted in French science and medicine for a far longer time than elsewhere because of a fear that nonreproductive sexual behavior would deepen the country's population crisis. I argue that the scientific and medical concepts of the sexual perversions, particularly homosexuality, were considered by French sexologists to be abnormal deviations from heterosexuality, whereas some English, German, and Austrian sexologists — including Freud — viewed the perversions more tolerantly as natural variations of the norm. I also address here the inadequacies of historical accounts of these developments that favor discursive ruptures in the Foucauldian manner, and stress the advantages of social history and causal historical explanation.

Bearing in mind the distinction between the universally-curious explorer and the scientist with a theory to test, we shall ask three questions as we look at scientific travellers coming to Brazil in the eighteenth and nineteenth centuries. These questions are: Why did they come? What did they notice? and What were the consequences of their work? In the early days, visitors were chiefly impelled by curiosity about the world and especially by the tropical abundance of Brazil. In the nineteenth century, naturalists arrived with theories to test and noticed unexpected phenomena, such as the mimicry among butterflies on the Amazon. Colonial authorities were suspicious of visitors, who might find out too much and try to seize the products of Brazil for themselves. Besides, economically-oriented botanists were also becoming interested in Brazilian rubber and the possibility of cultivating it elsewhere. Perhaps colonial officials were wise to be suspicious.

As the field of performing arts medicine continues to advance, it is essential that we maintain the trust that has been built over the last quarter century with the dancers, musicians, and other performing artists we serve. Trust is a precious commodity that is built over time, largely between individual health care professionals and the patients for whom they care. However, other things we do (or don't do) can have a major influence on the trust and confidence that others place in us. One of these is research and the way we conduct research, especially when it involves human subjects. The public's confidence in medical researchers has been shaken in the last few years as the result of a few well-publicized “bad outcomes” in clinical studies being done at leading academic medical centers in the U.S. and elsewhere. While we are unlikely to do gene-transfer or new drug development studies in an effort to address the health problems of musicians and dancers, we should still hold ourselves to the same ethical standards that apply to the rest of the healthcare world.

A research project entitled “A History of Science and Civilisation in Korea” is planning to publish an English-language monograph series that endeavours to learn from established scholarship on the history of science by benefiting from its accomplishments and overcoming some of its shortcomings. This paper argues that the following four points are important for Korean historians of science to consider: (1) overcoming ‘presentism’— to avoid writing history from a contemporary standpoint and to justify present-day Korea, (2) adopting a cross-cultural approach—to avoid unjustified nationalistic and ethno-centric interpretations of historical data, (3) considering both elite traditions and folk traditions in Korea—to present a more balanced view on different traditions in Korea, and (4) adopting traditional Korean concepts and categories of knowledge, if necessary; that is, that when no Western concepts are suitable for reference but indigenous Korean concepts are, adopting traditional Korean concepts is preferable. For example, the adoption of p’ungsu (geomancy) as a category of the Korean body of scientific knowledge. In this paper these four points will be discussed with supporting evidence, and I believe that using these four points as guidelines will enhance the quality of new writings on the history of Korean science by overcoming some of the shortcomings of existing scholarship on the history of science, technology and medicine in Korea or elsewhere.

Young trumpet players are predisposed to certain performance-related health risks. Nevertheless, the published experience with specific disorders is considered confusing and anecdotal. In the context of a review of the literature, we analyze a case report of a young patient who presented with two different disorders typically related to trumpet playing. After considering the diagnoses that had been made elsewhere, we were able to make the correct diagnoses and choose the correct treatment. We conclude that physicians need to be aware of these disorders, because they could be mistakenly attributed to instrumental performance itself or misinterpreted as serious conditions that require medical intervention.

AbstractOpenness of knowledge was in the Dutch Republic no more a natural state of affairs than in other parts of Europe at the time, but it became dominant there at an earlier date than elsewhere. This puzzling phenomenon is the subject of this essay. The article shows that tendencies to secrecy in crafts and trades in the Netherlands were by no means absent and that public authorities were not principled supporters of openness. Openness of knowledge did not prevail because arguments in favour of a free exchange of knowledge won the day against a rhetoric in defense of secrecy or because a rapid change in methods of production and marketing rendered the maintenance of craft secrecy practically impossible. The weakness of secrecy in the early-modern Netherlands, this essay argues, can be explained by the relative tardiness of the growth of the corporate system and the typical features of the institutional structure of the Dutch Republic. Craft secrecy in the Dutch Republic, as far as it existed before the middle of the eighteenth century, was normally based on a contractual relationship between individual actors rather than on any form of enforcement by public agencies.

Prolonged and incorrect postures are one of the main risk factors for the development of musculoskeletal pathologies. The aims of this study were to study the prevalence of incorrect postures among conservatory students; to identify if the use of an asymmetric instrument represents a risk factor for developing postural disorders; and to investigate whether a correlation exists between years of study, physical activity, and prevalence of postural disorders. METHODS: The subjects were recruited among students of the Giuseppe Verdi Conservatory of Milano. All musical instruments were investigated and classified as asymmetric and symmetrical. The observed student posture was classified without instrument as “correct posture” or “postural disorder” and with an with instrument as “optimal posture” or “non-optimal posture.” While playing, the postural disorder was classified as “unchanged” or “increased.” The data were analyzed with chi-square and linear regression methods. RESULTS: Of the 148 conservatory students entered into the study, 66.2% had a postural disorder; 73.4% had a non-optimal posture, and playing an asymmetric instrument was the only variable associated (p=0.01). While playing, the postural disorder was increased in 59.2%; playing an asymmetric instrument (p=0.01) and years of practice (p=0.007) were the significantly associated variables. CONCLUSIONS: To play an asymmetric instrument exposes musicians to an increased risk of non-optimal postures and to a worsened postural disorder when present. Considering that the years of practice have an additional negative impact on postural disorders, further studies are needed to clarify the role of non-optimal postures in the development of musculoskeletal complaints among students and professional musicians.

The 20th Annual Symposium on the Medical Problems of Musicians and Dancers took place in Aspen, Colorado, from June 20 to 23, 2002. When the first meeting was proposed back in 1982, it was without realizing that interest in musicians’ injuries was a rising national and international phenomenon. No one would have predicted that these meetings would continue at all, let alone for 20 years. This was clearly an example of an idea for which the time was ripe, and had the meeting not occurred in Aspen, it would likely have happened elsewhere. But it did happen in Aspen and it has been exciting to witness the growth and maturation of this meeting so far exceeding the original modest intent. However, from the onset these meetings have had special qualities that set them apart from other medical meetings and justify this attempt to describe them for MPPA’s readers, many but not all of whom have themselves attended.

Professor Juan Negrín López was Prime Minister of the democratically elected left-wing government of Spain for the latter two-and-a-half years of the three-year Civil War which ravaged the country between 1936 and 1939. The side loyal to the government lost, partly because of the generous aid received by their opponents from Germany and Italy, partly because of the Anglo-French agreement, observed by most countries but ignored by Germany and Italy, to outlaw arms supplies to either side, partly because of internal dissent, and partly because of the greater military capability of the enemy. Negrín led the country with tenacity and wisdom, but is remembered with ambivalence in Spain, and hardly at all elsewhere, although he spent the years of his post-war exile in the UK and France. This paper draws attention to a member of the medical profession who achieved both academic and political distinction, but whose career ended in a disaster which he was powerless to prevent. Among his admirable qualities, he should be remembered for his courage. Like most wars, the Spanish Civil War had its share of psychopaths and villains – but also its share of heroes, and Juan Negrín belongs among their number.

Shakespeare’s view of the world as a stage was the metaphor from which he drew drama from life, but presumably he was not concerned about real-life dangers lurking behind the arras, or elsewhere, on the actual stage. However, for many involved in our theaters, performance and danger are all too often inseparable. In fact, the physical characteristics of the stage itself are associated with significant factors that threaten the well-being of all performing artists. A recent event in Chicago illustrated this fact, all the more dramatically because of its none-too-subtle symbolism. During the finale of the second performance of Elton John’s new version of “Aida,” a casket containing the show’s stars, playing Aida and Ramses, was being carried aloft over the stage when it fell some 20 feet, along with its very much alive occupants. Fortunately for everyone concerned, the injuries were relatively minimal, necessitating only a two-day hiatus in the show, to allow the actors to heal and the stage crew to identify and correct their logistical errors. Undoubtedly, this cooling off time also provided for a collective sigh of relief for everyone in any way connected to this production. I should add that there is no evidence that this accident was in any way related to this being the first production in a totally renovated, very old theater.

Starting with a survey of the terminology that was used to describe the epistemological status of the mantic arts during the Middle Ages, this article focuses on the connections between the theoretical assumptions of these arts and of other prognostic disciplines of the time. While during the thirteenth century, mantic disciplines, medicine and meteorology were classified altogether as conjectural sciences that were all based on the interpretation of signs, during the fourteenth century, a more differentiated model of scientific prediction developed in medical theory as well as in meteorology. This model took into account the conditional probability of the expected events, which allowed the option to falsify or at least to revise and adapt a prognosis. Against the backdrop of the epistemological models of prognosis, it becomes obvious that when the mantic disciplines were ultimately excluded from the Western canon of the sciences, it was due not alone to moral and theological concerns.

BACKGROUND: Foot and ankle pain/injury (FAPI) is the most common musculoskeletal problem suffered in Irish dancing. A prospective examination of risk factors for FAPI in this cohort has never been performed. STUDY DESIGN: Prospective study over 1-year. METHODS: 85 elite adult Irish dancers were screened at baseline for biopsychosocial factors and followed up prospectively each month for 1 year to evaluate FAPI rates and potential risk factors. Subjects who suffered from multiple incidences of FAPI (with no pain/injury reported elsewhere in the body) or at least one moderate episode of FAPI were allocated to the foot/ankle-injured (FAI) group (n=28, 25 F/3 M). Subjects reporting no pain/injury or only one minor FAPI were allocated to the non-injured group (n=21, 14 F/7 M). Baseline differences in variables between groups were tested with the independent samples t-test, Mann-Whitney U-test for skewed data, and Fisher’s exact test for categorical variables. RESULTS: Baseline factors significantly associated with the FAI group included failing to always perform a warm-up (p=0.042), lower levels of energy (p=0.013), and more bothersome pain (p=0.021). Subjects also scored worse on two dimensions of the Athletic Coping Skills Inventory: i.e., coping with adversity (p=0.035) and goal setting and mental preparation (p=0.009). CONCLUSION: Several biopsychosocial factors appear to be associated with FAPI in Irish dancers. Biopsychosocial screening protocols and prevention strategies may best identify and support at-risk dancers.

AbstractIn Christian Europe of the High Middle Ages, saints played a central role in the everyday life of the ailing. Alongside healing attempts which involved magic and/or scientifically-based medicine, the invocation of specific patron saints for protection against evils or for the curing of ailments was a widespread practise. A large choice of patron saints was "available" for a wide range of diseases, especially those nowadays classified as neurologic or psychiatric. For the falling sickness alone, e.g., there is evidence of some twenty patron saints reputed to have a particular involvement. Surprisingly, there is no evidence of a comparable devotion to patrons for apoplectics. This "negative result" is confirmed by a thorough examination of medieval sources. St. Wolfgang and St. Andreas Avellino are the only two proven stroke patrons. Both, however, were only known within their respective locations. The absence of a specific supportive Christian figure for stroke victims deserves particular analysis: The high fatality rate of apoplexy and the lack of commercial interest on the part of the Christian places of pilgrimage may serve as possible explanations.

The European Jesuits’ mission to China during the seventeenth and eighteenth centuries is considered a world-historical event that played an important role in the transmission of knowledge between the West and the East. In spite of its historical significance, it was long assumed that the Jesuit mission to China and its scientific scholarship had never reached the mountainous regions of Tibet. As I have described elsewhere, this was not the case. Between the eighteenth and nineteenth centuries, Tibetans not only translated a large number of the Jesuits’ works into Tibetan, they also reformed the Tibetan calendar in accordance with the Jesuit-influenced calendar of the Qing. How did it happen and in which way? It was a twofold process achieved partially with Qing imperial sponsorship and partially on the Tibetans’ own initiative, sometimes even in a low-key, indirect and secretive way. In this article, I shall look at how a Tibetan Buddhist astronomer at the imperial court in Beijing wrote a manual for predicting solar and lunar eclipses. I will also look at how some Tibetan astronomers brought this imperial knowledge, apparently without explicit imperial approval, to the monasteries in Amdo, the North-East of Tibet, which mostly lies today in the Chinese provinces of Qinghai and Gansu, as well as how Tibetan astronomers in this region reformed their calendars according to the Jesuits’ astronomical system. Finally, I will describe how this tradition, in spite of recent political upheaval and tragedies, is still alive and practiced in Tibet.

Gender identity forms an important aspect of still developing youths. Gender is traditionally classified into two distinct categories, female and male. Transgender is a general term that describes individuals who self-identity as male, female, both, or neither (i.e., gender fluid) and do not match the assigned at-birth gender. Adolescent transgender individuals are currently a marginal population. There are limited demographics on youths, but as of 2014 an estimate of 1.4 million adults in the USA identified as transgender. It does seem, however, as more adults embrace their gender diversity and come out as transgender, in some cases opting for surgical reassignment, more adolescents and families are accepting their diversity. A growing body of research highlights transgender adolescents and their specific medical and mental health needs. This review seeks to underscore physiological phenomena relevant to trans-individuals, particularly in adolescents maturing into young adults, and disseminate this knowledge to dance, health, and education professionals.

This article examines how discursive frames modify forms of knowledge and practice. More precisely, it considers the problem of categories in early and medieval Chinese sources through the lens of recipes designed to facilitate intercourse. In pre-Buddhist Chinese sources, such prescriptions traditionally fell either under the rubric of ‘nourishing life’ (yangsheng 養生) longevity practices or spellbinding (zhuzu 祝詛). While recipes that appear in the former bracket—referred to in this study as ‘aphrodisiacs’—were couched in a discourse of healing and classified as a medical undertaking, those associated with spellbinding—referred to as ‘love philters’—were filed under the heading of mantic arts and divination in bibliographic treatises. With the arrival of Āyurvedic medicine in China via Buddhist sources, this partition grew increasingly blurred. Āyurvedic medical taxonomy in general, and its discipline of potency therapy (vājīkarana) in particular, did not distinguish between aphrodisiacs and love philters since both ultimately facilitate intercourse, albeit through different means. The imprint of Āyurvedic categories in China can be ascertained in Buddhist manuscript sources from Dunhuang, but also, more surprisingly, in widely circulated medieval non-Buddhist medical treatises. However, in contrast to the emblematic medical treatises of the middle period and surveyed manuscript Buddhist materials, canonical Buddhist texts appear to have shied away from the topic of aphrodisiacs and upheld the indigenous Chinese understanding of love philters as spellbinding and mantic art.

OBJECTIVES: To evaluate voice improvement after phonosurgery by subjective and objective voice analysis. DESIGN: Prospective observational analytic group study. METHODS: This study was conducted from January 2012 to December 2013. Two hundred forty professional voice users (patients), classified as Koufman level I or II with benign vocal fold lesions, were divided in two groups. Patients in group 1 had a diagnosis of superficial vocal fold lesions, and patients in group 2 had deep lesions on the vocal folds. All patients completed the Vocal Performance Questionnaire (VPQ) and underwent acoustic voice tests using the Praat program. Subjective and objective voice analyses were performed before phonosurgery and at 1, 2, and 3 months after phonosurgery. A control group of 100 volunteers was created and underwent the same voice metrics that were applied to the patients. RESULTS: Jitter, shimmer, harmonic-to-noise ratio, and VPQ scores significantly differentiated patients with vocal fold lesions from individuals in the control group. All of the analyzed parameters improved significantly after phonosurgery. Additionally, patients with superficial vocal fold lesions achieved normal voice parameters 1 month after surgery, and patients with deep lesions achieved normal voice parameters 3 months after surgery. CONCLUSIONS: Analysis of vocal parameters using the VPQ and acoustic tests revealed voice improvement after phonosurgery for both patient groups.

This study examined relationships between competitive trait anxiety and coping strategies among ballet dancers. Participants were 104 classical dancers (81 females and 23 males) ranging in age from 15 to 35 years (mean 19.4 years; SD 3.8 years) from three professional ballet companies, two private dance schools, and two university dance courses in Australia. Participants completed the Modified COPE scale and the Sport Anxiety Scale. Trait anxiety scores, in particular for somatic anxiety and worry, were significant predictors of 7 of the 12 coping strategies (wishful thinking, R2 = 42.3%; self-blame, R2 = 35.7%; suppression of competing activities, R2 = 27.1%; venting of emotions, R2 = 23.2%; denial, R2 = 17.7%; effort, R2 = 16.6%; active coping, R2 = 14.3%). Approximately 96% of dancers could be classified correctly as high or low trait-anxious from their reported coping style. No significant effects of gender or status (professional versus students) were found. Findings showed that high trait-anxious athletes tend to use more maladaptive, emotion-focused coping strategies compared with low trait-anxious athletes, a tendency that has been proposed to lead to negative performance effects. Dancers who are by nature anxious about performance may need special attention to help them to learn to cope with performance-related stress.

The number of students studying popular music, music technology, and sound engineering courses at both school and university to has increased rapidly in the last few years. These students are generally involved in music-making/recording and listening to a high level, usually in environments with amplified music. Recent studies have shown that these students are potentially exposed to a high risk of noise-induced hearing loss (NIHL) and are not covered by the same regulatory framework as employees. This study examined the pure tone air conduction hearing thresholds of 50 undergraduate students, including recent school leavers, on a range of popular music courses, to assess if there was evidence of hearing loss. Forty-four percent of students showed evidence of audiometric notch at 4–6 kHz, and 16% were classified under the UK Occupational Health and Safety guidelines as exhibiting mild hearing loss. Instance of audiometric notch was considerably higher than reported from studies of the general population but was around the same level or lower than that reported from studies of “traditional” music courses and conservatoires, suggesting no higher risk for popular music students than for “classical” music students. No relationship with age was present, suggesting that younger students were as likely to exhibit audiometric notch as mature students. This indicates that these students may be damaging their hearing through leisure activities while still at school, suggesting a need for robust education measures to focus on noise exposure of young people.

BACKGROUND: Anecdotal and media reports suggest that actors and performing artists are vulnerable to high levels of alcohol use. However, little empirical research is available to document the extent and correlates of alcohol use amongst these artists, particularly in an Australian context. OBJECTIVE: This study investigated alcohol use in a sample of Australian actors and other performing artists and its associations with sociodemographic background, psychological wellbeing, and work stress. METHODS: An online survey was distributed to the Equity Foundation membership representing Australian actors and performing artists. The survey included questions on sociodemographic and occupational background and psychological wellbeing (DASS-21), as well as the AUDIT questionnaire to assess self-reported alcohol consumption. A sample of 620 performing artists responded to the survey, a large majority of whom were actors. RESULTS: Australian actors and performing artists appear to consume alcohol at levels that are higher than those found in the general Australian population. About 40% of men and 31% of women were classified as drinking alcohol at potentially harmful or hazardous levels. Alcohol use was not strongly associated with age, education, or income, but it had a relationship with poorer psychological wellbeing. About 50% of respondents reported that their alcohol drinking was related to work stress as a performer. This perception was more pronounced amongst those performers who reported drinking at harmful levels. CONCLUSIONS: Australian actors and performing artists appear to be an at-risk population for harmful or hazardous alcohol use.

To date, the effects of body composition on injury occurrence and healing times in dancers have received limited scientific attention. The aim of the current study was to determine possible associations between somatotype, percent body fat, and self-reported injury characteristics in dance students. Forty-two full-time ballet students (11 male, 31 female) from two vocational dance schools volunteered for the study. The Heath-Carter protocol and Siri equation were adopted to calculate somatotype and percent body fat (%BF), respectively. Injury types, together with the time taken to recover from injury, were assessed using a recall injury questionnaire. Results revealed that the sample was classified as balanced-mesomorph somatotype (endomorphy – mesomorphy – ectomorphy = 3.4±0.9 – 3.9±1.4 – 3.2±1.2). Ectomorphy was a strong predictor of the number of acute injuries sustained (F1,36 = 5.4, p = 0.026); these parameters also revealed a significant negative correlation (r = –0.37, p = 0.016). Significant negative correlations were observed between the dancers’ total time off due to injury and %BF (r = –0.31, p = 0.048) and between the total time off resulting from acute injury and both %BF (r = –0.32, p = 0.04) and ectomorphy (r = –0.42, p = 0.005). The number of overuse injuries sustained and time off due to overuse injury also were correlated with mesomorphy (r = –0.38, p = 0.015 and r = –0.33, p = 0.032, respectively). It was concluded that high ectomorphy ratings, low %BF values, and low mesomorphy ratings are linked to injury. More relevant research is required on dancers from different genres.

BACKGROUND: Musicians are at risk of hearing loss from sound exposure, and earplugs form part of many musicians’ hearing conservation practices. Although musicians typically report a range of difficulties when wearing earplugs, there are many who have managed to successfully incorporate earplugs into their practice of music. OBJECTIVE: The study aim was to provide a detailed account of earplug usage from the perspective of the musician, including motivating factors, practical strategies, and attitudes. METHODS: In-depth interviews with 23 musicians were transcribed and content analysis was performed. Responses were coded and classified into three main themes: advantages, disadvantages, and usage patterns and strategies, together with an overlapping fourth theme, youth perspectives. RESULTS: Several positive aspects of wearing earplugs were identified, including long-term hearing protection and reduced levels of fatigue and pain. Musicians reported that earplugs present few problems for communication, improve sound clarity in ensembles, are discreet, and are easy to handle. However, earplugs also present challenges, including an overall dullness of sound, reduced immediacy, and an impaired ability to judge balance and intonation due to the occlusion effect, all of which influence usage habits and patterns. CONCLUSION: The experiences of the younger musicians and long-term users of earplugs indicate that practice, persistence, and a flexible approach are required for successful earplug usage. In time, there may be greater acceptance of earplugs, particularly amongst a new generation of musicians, some of whom regard the earplugs as a performance enhancement tool as well as a protective device.

In the present study, the degree and frequency of symptoms of depression and anxiety as well as signs of somatoform disorders were ascertained in former musician patients of a department of hand surgery by means of standardized psychometric instruments. It was also the goal of the study to find out to what extent musicians seeking somatically oriented therapy ascribe significance to psychosocial factors regarding the etiology and the course of their ailments, and to what extent they feel psychologically stressed by their somatic symptoms. Sixty-nine musicians were evaluated. The results of the study showed a low frequency of significant ratings for depression and anxiety compared with clinical and nonclinical populations of nonmusicians, whereas there was a clear tendency toward somatization in the sample investigated. A fourth of the musicians had ratings compatible with those of psychosomatic patients, and can be classified as an at-risk group for a somatoform disorder. Three fourths of the musicians evinced a somatically oriented subjective ailment model. This means that, from their point of view, psychosocial factors play but a minor role in the etiology and the course of somatic symptoms. Three fourths of the musicians, however, stated in retrospective evaluation that they had felt psychologically stressed by their physical symptoms. All in all, the results suggest that psychosomatic aspects play a decisive role in somatic problems of musicians, and that it would seem particularly important for hand surgeons to take note of psychosocial aspects in the etiology and the course of their symptoms.

This article investigates the early history of a Chinese mantic practice unattested before the late first century CE known as zhanhou 占候 (lit., omen watching; divination through observation; divination of atmospheric or meteorological conditions). While early occurrences of the term primarily present it as a learned form of divination used to forecast human fortune through the interpretation of anomalous emanations of qi 氣 in heaven-and-earth (e.g., wind; clouds; rain; rainbows), zhanhou is also variously classified as an astrological, Five Agents, or military technique; and variously identified as a hemerological, medical, and contemplative-visualization practice by the end of the Tang. I not only contend that zhanhou’s inherent polysemy and its multiple identities helped broaden and perpetuate its transmission during the first millennium of the Common Era, but also that the same messy multiplicity makes its early history and development difficult—but not impossible—to trace and understand. Zhanhou closely resembles many earlier named forms of astrology and divination focused on the observation and interpretation of macrocosmic qi conditions or phenomena, but late Han and early medieval writers carved out a space for zhanhou. This was done through increasingly frequent use of the term, by explicitly distinguishing it from similar families of techniques (e.g., astrology; turtle and yarrow divination; yinyang; algorithmic mantic techniques), and by identifying and constructing networks and lineages of practitioners, both of which helped form and perpetuate zhanhou’s identity as a discrete technique (shu 術). The present study compares different definitions and translations of zhanhou, analyzes a handful of late Han occurrences, and illustrates the term’s increasingly widespread medieval circulation, chiefly through biographic narratives and technical texts.

OBJECTIVE: Musicians are often compared to athletes because of the physical exertion required to play music. The aim of this study was to explore the physical activity level of music students and to study its relationship with musculoskeletal complaints. A second goal was to assess associations between physical activity and pain, quality of life, and disability. METHODS: This cross-sectional study among third- and fourth-year music students used an electronic survey including measures for physical activity (SQUASH—Short Questionnaire to Assess Health-enhancing physical activity), musculoskeletal complaints (DMQ—Dutch Musculoskeletal Questionnaire), disability (DASH—Disability Arm, Shoulder, Hand questionnaire) and quality of life (Short Form-12). Students were classified as compliers or non-compliers with moderate- and vigorous-intensity physical activity recommendations. Statistical analysis was done using (non)parametric tests (t-test, Pearson chi-square test, Mann-Whitney U-test) and correlational testing. RESULTS: Participants were 132 students, 63.6% female, with a median age of 23 yrs (range 21.3–25.0). 67% reported musculoskeletal complaints in the past 7 days. Their median physical activity level was 6,390 MET-min/wk, and 62% and 10% of the students accomplished recommendations for moderate-intensity and vigorous-intensity physical activity levels, respectively. No significant differences were found in prevalence of musculoskeletal complaints between students who met moderate- or vigorous-intensity physical activity recommendations and students who did not. Physical activity level was not associated with musculoskeletal complaints (r=0.12, p=0.26). Higher pain intensity was associated with a lower quality of life (r=–0.53 p<0.01) and higher disability (r=0.43, p<0.01). CONCLUSIONS: Music students are mainly involved in light- to moderate-intensity physical activities and rarely in vigorous-intensity activities. No correlation was found between physical activity level in the past months and musculoskeletal complaints in music students.

In this article, I will discuss one important aspect of historical encounters between Western colonial scientists and Japanese nature. In order to do so, I will shed new light on how geo-sciences became an object of scientific research of Japan, in the framework of Dutch colonial sciences. I will also show that Western interests in Japanese geo-sciences were primarily stimulated by economic motivations, and that, at the same time, it accompanied the process of the introduction of modern Western sciences into Japan. It is well-known that Philipp Franz von Siebold (1796-1866) studied Japanese natural history widely, and wrote two standard works, Flora Japonica and Fauna Japonica. This paper examines a newly found unpublished manuscript Geologica Japonica by von Siebold, which discusses Japanese geology and mineralogy, and reports on copper mining and smelting. Mineralogical and geological collections have also been discovered in museums at Leiden, the Netherlands. These collections are now identified as the research materials used in the preparation of this manuscript, and found to be the first systematic European geo-scientific collections from Japan. The collection of rocks and minerals from Japan has been proved as mostly collected and identified by Heinrich Burger (1806-1858), a pharmacist and assistant to von Siebold. Burger classified the collection using two nomenclature systems, those of A. G. Werner and R. Hauy. We further point out that the Dutch were interested in the useful natural resources of their trading partner, carrying out a survey of coal mines in Japan, and the trial of tea transplantation from Japan to Java. In my research on the newly found manuscripts and collections of geology and mineralogy, I clarify that von Siebold and Burger intensively investigated Japanese copper mining and smelting. They reported their visit to the Sumitomo copper refinery at Osaka, and Burger wrote an article on Japanese copper in the journal of the Batavian Society for Arts and Sciences. In conclusion, based on close study of newly examined manuscripts and detailed identification of geological collections, a network of interest in Japan’s geology and mineralogy by Dutch colonial scientist is illustrated, and its hybrid character is demonstrated against the background of Dutch- Japan cultural exchange.

Abstract This paper offers a new perspective on historical understandings of the relationship between alcohol, climate and the body, by studying the way that British explorers of tropical Africa drank alcohol and wrote about drink between c.1850 and c.1910. We demonstrate that alcohol was simultaneously classified as a medicinal, a preventative and a pleasurable drink, shaped by competing medical theories, but that distinctions between these different roles were highly blurred. We also show how many explorers thought certain drinks helped to protect white bodies from the effects of tropical diseases. While popular amongst travellers, these views came under growing scrutiny in the latter part of the nineteenth century, reflecting both changing scientific views about the relationship between alcohol, climate and the body and the development of a much larger European presence in tropical Africa. However, even those who opposed tropical drinking often supported the use of other stimulants and viewed the tropics as uniquely dangerous. As such, the paper challenges the idea that the late nineteenth century marked a paradigm shift in scientific attitudes towards tropical environments, as much previous scholarship has suggested. At the same time, our examinations of explorers’ descriptions of drinking by African people demonstrates how ideas about racial difference played an important role within medical understandings of alcohol. Overall, this paper examines the heterogeny of attitudes to alcohol to be found within tropical medicine and documents the continuities in approach shown between the nineteenth and twentieth centuries.

Historians of diabetes have long claimed that physicians were aware of two distinct types of diabetes mellitus by the 1880s, and that these were the direct forerunners of type 1, juvenile-onset and type 2, adult-onset diabetes. French physician Étienne Lancereaux (1829–1910), based on autopsy and clinical studies, classified diabetes either as diabète maigre (thin, or more accurately emaciated, diabetes), which he believed to be pancreatic in origin with a poor prognosis, or diabète gras (fat diabetes), which he believed had a much better prognosis and was not pancreatic in origin. Historians citing Lancereaux have claimed that he observed the former to occur in young and the latter in middle-aged and elderly people. We review the papers of Lancereaux to clarify his clinical observations and understanding of diabetes. Lancereaux’s description of diabète maigre bores little resemblance to juvenile diabetes and all of his thin patients were middle-aged or older. On the other hand, his diabète gras is akin to type 2 diabetes and he might well deserve credit for its characterization.

Ibn Sina is one of the greatest human history scholars as he left an indelible and appreciated mark in human evolution journey towards civilization. Ibn Sina has deepened in many science fields such as Medicine, Astronomy, Mathematics, Philosophy and psychology and classified hundreds of books in different sciences as well. It’s also worth mentioning that many Western European scientists have admitted Ibn Sina’s great efforts and major influence in finding many modern scientific theories.Â

This paper argues that artist Dope Saint Jude is transforming South African hip-hop by queering a genre that has predominantly been male and heteronormative. Specifically, I analyse the opening skit of her music video “Keep in Touch” in order to unpack the ways which she revives Gayle, a gay language that adopted double-coded forms of speech during the apartheid era—a context in which homosexuals were criminalised. The use of Gayle and spaces close to the city centre of Cape Town (such as Salt River and Woodstock) speaks to the city as it was before it was transformed by the decline of industries due to the country’s adoption of neoliberal economics and, more recently, by the gentrification of these spaces. Dope Saint Jude therefore reclaims these city spaces through her use of gay modes of speech that have a long history in Cape Town and by positioning her work as hip-hop, which has been popular in the city for well over two decades. Her inclusion of transgender MC and DJ Angel Ho pushes the boundaries of hegemonic and binary conceptions of gender identity even further. In essence, Dope Saint Jude is transforming local hip-hop in a context that is shaped significantly by US cultural imperialism. The artist is also transforming our perspective of spaces that have been altered by neoliberal economics.Setting the SceneDope Saint Jude (DSJ) is a queer MC from Elsies River, a working class township located on Cape Town's Cape Flats in South Africa. Elsies River was defined as a “coloured” neighbourhood under the apartheid state's Group Areas Act, which segregated South Africans racially. With the aid of the Population Registration Act, citizens were classified, not merely along the lines of white, Asian, or black—black subjects were also divided into further categories. The apartheid state also distinguished between black and “coloured” subjects. Michael MacDonald contends that segregation “ordained blacks to be inferior to whites; apartheid cast them to be indelibly different” (11). Apartheid declared “African claims in South Africa to be inferior to white claims” and effectively claimed that black subjects “belonged elsewhere, in societies of their own, because their race was different” (ibid). The term “coloured” defined people as “mixed race” to separate communities that might otherwise have identified as black in the broad and inclusive sense (Erasmus 16). Racial categorisation was used to create a racial hierarchy with white subjects at the top of that hierarchy and those classified as black receiving the least resources and benefits. This frustrated attempts to establish broad alliances of black struggles against apartheid. It is in this sense that race is socially and politically constructed and continues to have currency, despite the fact that biologically essentialist understandings of race have been discredited (Yudell 13–14). Thanks to apartheid town planning and resource allocation, many townships on the Cape Flats were poverty-stricken and plagued by gang violence (Salo 363). This continues to be the case because post-apartheid South Africa's embrace of neoliberal economics failed to address racialised class inequalities significantly (Haupt, Static 6–8). This is the '90s context in which socially conscious hip-hop crews, such as Prophets of da City or Black Noise, came together. They drew inspiration from Black Consciousness philosophy via their exposure to US hip-hop crews such as Public Enemy in order to challenge apartheid policies, including their racial interpellation as “coloured” as distinct from the more inclusive category, black (Haupt, “Black Thing” 178). Prophets of da City—whose co-founding member, Shaheen Ariefdien, also lived in Elsies River—was the first South African hip-hop outfit to record an album. Whilst much of their work was performed in English, they quickly transformed the genre by rapping in non-standard varieties of Afrikaans and by including MCs who rap in African languages (ibid). They therefore succeeded in addressing key issues related to race, language, and class disparities in relation to South Africa's transition to democracy (Haupt, “Black Thing”; Haupt, Stealing Empire). However, as is the case with mainstream US hip-hop, specifically gangsta rap (Clay 149), South African hip-hop has been largely dominated by heterosexual men. This includes the more commercial hip-hop scene, which is largely perceived to be located in Johannesburg, where male MCs like AKA and Cassper Nyovest became celebrities. However, certain female MCs have claimed the genre, notably EJ von Lyrik and Burni Aman who are formerly of Godessa, the first female hip-hop crew to record and perform locally and internationally (Haupt, Stealing Empire 166; Haupt, “Can a Woman in Hip-Hop”). DSJ therefore presents the exception to a largely heteronormative and male-dominated South African music industry and hip-hop scene as she transforms it with her queer politics. While queer hip-hop is not new in the US (Pabón and Smalls), this is new territory for South Africa. Writing about the US MC Jean Grae in the context of a “male-dominated music industry and genre,” Shanté Paradigm Smalls contends,Heteronormativity blocks the materiality of the experiences of Black people. Yet, many Black people strive for a heteronormative effect if not “reality”. In hip hop, there is a particular emphasis on maintaining the rigidity of categories, even if those categories fail [sic]. (87) DSJ challenges these rigid categories. Keep in TouchDSJ's most visible entry onto the media landscape to date has been her appearance in an H&M recycling campaign with British Sri Lankan artist MIA (H&M), some fashion shoots, her new EP—Reimagine (Dope Saint Jude)—and recent Finnish, US and French tours as well as her YouTube channel, which features her music videos. As the characters’ theatrical costumes suggest, “Keep in Touch” is possibly the most camp and playful music video she has produced. It commences somewhat comically with Dope Saint Jude walking down Salt River main road to a public telephone, where she and a young woman in pig tails exchange dirty looks. Salt River is located at the foot of Devil's Peak not far from Cape Town's CBD. Many factories were located there, but the area is also surrounded by low-income housing, which was designated a “coloured” area under apartheid. After apartheid, neighbourhoods such as Salt River, Woodstock, and the Bo-Kaap became increasingly gentrified and, instead of becoming more inclusive, many parts of Cape Town continued to be influenced by policies that enable racialised inequalities. Dope Saint Jude calls Angel Ho: DSJ: Awêh, Angie! Yoh, you must check this kak sturvy girl here by the pay phone. [Turns to the girl, who walks away as she bursts a chewing gum bubble.] Ja, you better keep in touch. Anyway, listen here, what are you wys?Angel Ho: Ah, just at the salon getting my hair did. What's good? DSJ: Wanna catch on kak today?Angel Ho: Yes, honey. But, first, let me Gayle you this. By the jol by the art gallery, this Wendy, nuh. This Wendy tapped me on the shoulder and wys me, “This is a place of decorum.”DSJ: What did she wys?Angel Ho: De-corum. She basically told me this is not your house. DSJ: I know you told that girl to keep in touch!Angel Ho: Yes, Mama! I'm Paula, I told that bitch, “Keep in touch!” [Points index finger in the air.](Saint Jude, Dope, “Keep in Touch”)Angel Ho's name is a play on the male name Angelo and refers to the trope of the ho (whore) in gangsta rap lyrics and in music videos that present objectified women as secondary to male, heterosexual narratives (Sharpley-Whiting 23; Collins 27). The queering of Angelo, along with Angel Ho’s non-binary styling in terms of hair, make-up, and attire, appropriates a heterosexist, sexualised stereotype of women in order to create room for a gender identity that operates beyond heteronormative male-female binaries. Angel Ho’s location in a hair salon also speaks to stereotypical associations of salons with women and gay subjects. In a discussion of gender stereotypes about hair salons, Kristen Barber argues that beauty work has traditionally been “associated with women and with gay men” and that “the body beautiful has been tightly linked to the concept of femininity” (455–56). During the telephonic exchange, Angel Ho and Dope Saint Jude code-switch between standard and non-standard varieties of English and Afrikaans, as the opening appellation, “Awêh,” suggests. In this context, the term is a friendly greeting, which intimates solidarity. “Sturvy” means pretentious, whilst “kak” means shit, but here it is used to qualify “sturvy” and means that the girl at the pay phone is very pretentious or “full of airs.” To be “wys” means to be wise, but it can also mean that you are showing someone something or educating them. The meanings of these terms shift, depending on the context. The language practices in this skit are in line with the work of earlier hip-hop crews, such as Prophets of da City and Brasse vannie Kaap, to validate black, multilingual forms of speech and expression that challenge the linguistic imperialism of standard English and Afrikaans in South Africa, which has eleven official languages (Haupt, “Black Thing”; Haupt, Stealing Empire; Williams). Henry Louis Gates’s research on African American speech varieties and literary practices emerging from the repressive context of slavery is essential to understanding hip-hop’s language politics. Hip-hop artists' multilingual wordplay creates parallel discursive universes that operate both on the syntagmatic axis of meaning-making and the paradigmatic axis (Gates 49; Haupt, “Stealing Empire” 76–77). Historically, these discursive universes were those of the slave masters and the slaves, respectively. While white hegemonic meanings are produced on the syntagmatic axis (which is ordered and linear), black modes of speech as seen in hip-hop word play operate on the paradigmatic axis, which is connotative and non-linear (ibid). Distinguishing between Signifyin(g) / Signification (upper case, meaning black expression) and signification (lower case, meaning white dominant expression), he argues that “the signifier ‘Signification’ has remained identical in spelling to its white counterpart to demonstrate [. . .] that a simultaneous, but negated, parallel discursive (ontological, political) universe exists within the larger white discursive universe” (Gates 49). The meanings of terms and expressions can change, depending on the context and manner in which they are used. It is therefore the shared experiences of speech communities (such as slavery or racist/sexist oppression) that determine the negotiated meanings of certain forms of expression. Gayle as a Parallel Discursive UniverseDSJ and Angel Ho's performance of Gayle takes these linguistic practices further. Viewers are offered points of entry into Gayle via the music video’s subtitles. We learn that Wendy is code for a white person and that to keep in touch means exactly the opposite. Saint Jude explains that Gayle is a very fun queer language that was used to kind of mask what people were saying [. . .] It hides meanings and it makes use of women's names [. . . .] But the thing about Gayle is it's constantly changing [. . .] So everywhere you go, you kind of have to pick it up according to the context that you're in. (Ovens, Saint Jude and Haupt)According to Kathryn Luyt, “Gayle originated as Moffietaal [gay language] in the coloured gay drag culture of the Western Cape as a form of slang amongst Afrikaans-speakers which over time, grew into a stylect used by gay English and Afrikaans-speakers across South Africa” (Luyt 8; Cage 4). Given that the apartheid state criminalised homosexuals, Gayle was coded to evade detection and to seek out other members of this speech community (Luyt 8). Luyt qualifies the term “language” by arguing, “The term ‘language’ here, is used not as a constructed language with its own grammar, syntax, morphology and phonology, but in the same way as linguists would discuss women’s language, as a way of speaking, a kind of sociolect” (Luyt 8; Cage 1). However, the double-coded nature of Gayle allows one to think of it as creating a parallel discursive universe as Gates describes it (49). Whereas African American and Cape Flats discursive practices function parallel to white, hegemonic discourses, gay modes of speech run parallel to heteronormative communication. Exclusion and MicroaggressionsThe skit brings both discursive practices into play by creating room for one to consider that DSJ queers a male-dominated genre that is shaped by US cultural imperialism (Haupt, Stealing Empire 166) as a way of speaking back to intersectional forms of marginalisation (Crenshaw 1244), which are created by “white supremacist capitalist patriarchy” (hooks 116). This is significant in South Africa where “curative rape” of lesbians and other forms of homophobic violence are prominent (cf. Gqola; Hames; Msibi). Angel Ho's anecdote conveys a sense of the extent to which black individuals are subject to scrutiny. Ho's interpretation of the claim that the gallery “is a place of decorum” is correct: it is not Ho's house. Black queer subjects are not meant to feel at home or feel a sense of ownership. This functions as a racial microaggression: “subtle insults (verbal, nonverbal, and/or visual) directed toward people of color, often automatically or unconsciously” (Solorzano, Ceja, and Yosso 60). This speaks to DSJ's use of Salt River, Woodstock, and Bo-Kaap for the music video, which features black queer bodies in performance—all of these spaces are being gentrified, effectively pushing working class people of colour out of the city (cf. Didier, Morange, and Peyroux; Lemanski). Gustav Visser explains that gentrification has come to mean a unit-by-unit acquisition of housing which replaces low-income residents with high-income residents, and which occurs independent of the structural condition, architecture, tenure or original cost level of the housing (although it is usually renovated for or by the new occupiers). (81–82) In South Africa this inequity plays out along racial lines because its neoliberal economic policies created a small black elite without improving the lives of the black working class. Instead, the “new African bourgeoisie, because it shares racial identities with the bulk of the poor and class interests with white economic elites, is in position to mediate the reinforcing cleavages between rich whites and poor blacks without having to make more radical changes” (MacDonald 158). In a news article about a working class Salt River family of colour’s battle against an eviction, Christine Hogg explains, “Gentrification often means the poor are displaced as the rich move in or buildings are upgraded by new businesses. In Woodstock and Salt River both are happening at a pace.” Angel Ho’s anecdote, as told from a Woodstock hair salon, conveys a sense of what Woodstock’s transformation from a coloured, working class Group Area to an upmarket, trendy, and arty space would mean for people of colour, including black, queer subjects. One could argue that this reading of the video is undermined by DSJ’s work with global brand H&M. Was she was snared by neoliberal economics? Perhaps, but one response is that the seeds of any subculture’s commercial co-option lie in the fact it speaks through commodities (for example clothing, make-up, CDs, vinyl, or iTunes / mp3 downloads (Hebdige 95; Haupt, Stealing Empire 144–45). Subcultures have a window period in which to challenge hegemonic ideologies before they are delegitimated or commercially co-opted. Hardt and Negri contend that the means that extend the reach of corporate globalisation could be used to challenge it from within it (44–46; Haupt, Stealing Empire 26). DSJ utilises her H&M work, social media, the hip-hop genre, and international networks to exploit that window period to help mainstream black queer identity politics.ConclusionDSJ speaks back to processes of exclusion from the city, which was transformed by apartheid and, more recently, gentrification, by claiming it as a creative and playful space for queer subjects of colour. She uses Gayle to lay claim to the city as it has a long history in Cape Town. In fact, she says that she is not reviving Gayle, but is simply “putting it on a bigger platform” (Ovens, Saint Jude, and Haupt). The use of subtitles in the video suggests that she wants to mainstream queer identity politics. Saint Jude also transforms hip-hop heteronormativity by queering the genre and by locating her work within the history of Cape hip-hop’s multilingual wordplay. ReferencesBarber, Kristin. “The Well-Coiffed Man: Class, Race, and Heterosexual Masculinity in the Hair Salon.” Gender and Society 22.4 (2008): 455–76.Cage, Ken. “An Investigation into the Form and Function of Language Used by Gay Men in South Africa.” Rand Afrikaans University: MA thesis, 1999.Clay, Andreana. “‘I Used to Be Scared of the Dick’: Queer Women of Color and Hip-Hop Masculinity.” Home Girls Make Some Noise: Hip Hop Feminism Anthology. Ed. Gwendolyn D. Pough, Elain Richardson, Aisha Durham, and Rachel Raimist. California: Sojourns, 2007.Collins, Patricia Hill. Black Sexual Politics: African Americans, Gender, and the New Racism. New York: Routledge, 2005. Crenshaw, Kimberle. “Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color”. Stanford Law Review 43.6 (1991): 1241–299.Didier, Sophie, Marianne Morange, and Elisabeth Peyroux. “The Adaptative Nature of Neoliberalism at the Local Scale: Fifteen Years of City Improvement Districts in Cape Town and Johannesburg.” Antipode 45.1 (2012): 121–39.Erasmus, Zimitri. “Introduction.” Coloured by History, Shaped by Place. Ed. Zimitri Erasmus. Cape Town: Kwela Books & SA History Online, 2001. Gates, Henry Louis. The Signifying Monkey: A Theory of Afro-American Literary Criticism. Oxford: Oxford UP, 1988.Gqola, Pumla Dineo. Rape: A South African Nightmare. Johannesburg: Jacana, 2015.Hames, Mary. “Violence against Black Lesbians: Minding Our Language.” Agenda 25.4 (2011): 87–91.Hardt, Michael, and Antonio Negri. Empire. London: Harvard UP, 2000.Haupt, Adam. “Can a Woman in Hip Hop Speak on Her Own Terms?” Africa Is a Country. 23 Mar. 2015. <http://africasacountry.com/2015/03/the-double-consciousness-of-burni-aman-can-a-woman-in-hip-hop-speak-on-her-own-terms/>.Haupt, Adam. Static: Race & Representation in Post-Apartheid Music, Media & Film. Cape Town: HSRC Press, 2012. Haupt, Adam. Stealing Empire: P2P, Intellectual Property and Hip-Hop Subversion. Cape Town: HSRC Press, 2008. Haupt, Adam. “Black Thing: Hip-Hop Nationalism, ‘Race’ and Gender in Prophets of da City and Brasse vannie Kaap.” Coloured by History, Shaped by Place. Ed. Zimitri Erasmus. Cape Town: Kwela Books & SA History Online, 2001. Hebdige, Dick. Subculture: The Meaning of Style. London: Routledge, 1979.Hogg, Christine. “In Salt River Gentrification Often Means Eviction: Family Set to Lose Their Home of 11 Years.” Ground Up. 15 June 2016. <http://www.groundup.org.za/article/salt-river-gentrification-often-means-eviction/>.hooks, bell. Outlaw: Culture: Resisting Representations. New York: Routledge, 1994.Lemanski, Charlotte. “Hybrid Gentrification in South Africa: Theorising across Southern and Northern Cities.” Urban Studies 51.14 (2014): 2943–60.Luyt, Kathryn. “Gay Language in Cape Town: A Study of Gayle – Attitudes, History and Usage.” University of Cape Town: MA thesis, 2014.MacDonald, Michael. Why Race Matters in South Africa. University of Kwazulu-Natal Press: Scottsville, 2006.Msibi, Thabo. “Not Crossing the Line: Masculinities and Homophobic Violence in South Africa”. Agenda. 23.80 (2009): 50–54.Pabón, Jessica N., and Shanté Paradigm Smalls. “Critical Intimacies: Hip Hop as Queer Feminist Pedagogy.” Women & Performance: A Journal of Feminist Theory (2014): 1–7.Salo, Elaine. “Negotiating Gender and Personhood in the New South Africa: Adolescent Women and Gangsters in Manenberg Township on the Cape Flats.” Journal of European Cultural Studies 6.3 (2003): 345–65.Solórzano, Daniel, Miguel Ceja, and Tara Yosso. “Critical Race Theory, Racial Microaggressions, and Campus Racial Climate: The Experiences of African American College Students.” Journal of Negro Education 69.1/2 (2000): 60–73.Sharpley-Whiting, T. Denean. Pimps Up, Ho’s Down: Hip Hop’s Hold on Young Black Women. New York: New York UP, 2007.Smalls, Shanté Paradigm. “‘The Rain Comes Down’: Jean Grae and Hip Hop Heteronormativity.” American Behavioral Scientist 55.1 (2011): 86–95.Visser, Gustav. “Gentrification: Prospects for Urban South African Society?” Acta Academica Supplementum 1 (2003): 79–104.Williams, Quentin E. “Youth Multilingualism in South Africa’s Hip-Hop Culture: a Metapragmatic Analysis.” Sociolinguistic Studies 10.1 (2016): 109–33.Yudell, Michael. “A Short History of the Race Concept.” Race and the Genetic Revolution: Science, Myth, and Culture. Ed. Sheldon Krimsky and Kathleen Sloan. New York: Columbia UP, 2011.InterviewsOvens, Neil, Dope Saint Jude, and Adam Haupt. One FM Radio interview. Cape Town. 21 Apr. 2016.VideosSaint Jude, Dope. “Keep in Touch.” YouTube. 23 Feb. 2015. <https://www.youtube.com/watch?v=w2ux9R839lE>. H&M. “H&M World Recycle Week Featuring M.I.A.” YouTube. 11 Apr. 2016. <https://www.youtube.com/watch?v=f7MskKkn2Jg>. MusicSaint Jude, Dope. Reimagine. 15 June 2016. <https://dopesaintjude.bandcamp.com/album/reimagine>.

Story spreads out through time the behaviors or bodies – the shapes – a self has been or will be, each replacing the one before. Hence a story has before and after, gain and loss. It goes somewhere…Moreover, shape or body is crucial, not incidental, to story. It carries story; it makes story visible; in a sense it is story. Shape (or visible body) is in space what story is in time. (Bynum, quoted in Garland Thomson, 113-114) Drawing on Goffman’s classic work on stigma, research documenting the existence of discrimination and bias against individuals classified as obese goes back five decades. Since Cahnman published “The Stigma of Obesity” in 1968, other researchers have well documented systematic and growing discrimination against fat people (cf. Puhl and Brownell; Puhl and Heuer; Puhl and Heuer; Fikkan and Rothblum). While weight-based stereotyping has a long history (Chang and Christakis; McPhail; Schwartz), contemporary forms of anti-fat stigma and discrimination must be understood within a social and economic context of neoliberal healthism. By neoliberal healthism (see Crawford; Crawford; Metzel and Kirkland), I refer to the set of discourses that suggest that humans are rational, self-determining actors who independently make their own best choices and are thus responsible for their life chances and health outcomes. In such a context, good health becomes associated with proper selfhood, and there are material and social consequences for those who either unwell or perceived to be unwell. While the greatest impacts of size-based discrimination are structural in nature, the interpersonal impacts are also significant. Because obesity is commonly represented (at least partially) as a matter of behavioral choices in public health, medicine, and media, to “remain fat” is to invite commentary from others that one is lacking in personal responsibility. Guthman suggests that this lack of empathy “also stems from the growing perception that obesity presents a social cost, made all the more tenable when the perception of health responsibility has been reversed from a welfare model” (1126). Because weight loss is commonly held to be a reasonable and feasible goal and yet is nearly impossible to maintain in practice (Kassierer and Angell; Mann et al.; Puhl and Heuer), fat people are “in effect, asked to do the impossible and then socially punished for failing” (Greenhalgh, 474). In this article, I explore how weight-based stigma shaped the decisions of bariatric patients to undergo weight loss surgery. In doing so, I underline the work that emotion does in circulating anti-fat stigma and in creating categories of subjects along lines of health and responsibility. As well, I highlight how fat bodies are lived and negotiated in space and place. I then explore ways in which participants take up notions of time, specifically in regard to risk, in discussing what brought them to the decision to have bariatric surgery. I conclude by arguing that it is a dynamic interaction between the material, social, emotional, discursive, and the temporal that produces not only fat embodiment, but fat subjectivity “failed”, and serves as an impetus for seeking bariatric surgery. Methods This article is based on 30 semi-structured interviews with American bariatric patients. At the time of the interview, individuals were between six months and 12 years out from surgery. After obtaining Intuitional Review Board approval, recruitment occurred through a snowball sample. All interviews were audio-taped with permission and verbatim interview transcripts were analyzed by means of a thematic analysis using Dedoose (www.dedoose.com). All names given in this article are pseudonyms. This work is part of a larger project that includes two additional interviews with bariatric surgeons as well as participant-observation research. Findings Navigating Anti-Fat Stigma In discussing what it was like to be fat, all but one of the individuals I interviewed discussed experiencing substantive size-based stigma and discrimination. Whether through overt comments, indirect remarks, dirty looks, open gawking, or being ignored and unrecognized, participants felt hurt, angry, and shamed by friends, family, coworkers, medical providers, and strangers on the street because of the size of their bodies. Several recalled being bullied and even physically assaulted by peers as children. Many described the experience of being fat or very fat as one of simultaneous hypervisibility and invisibility. One young woman, Kaia, said: “I absolutely was not treated like a person … . I was just like this object to people. Just this big, you know, thing. That’s how people treated me.” Nearly all of my participants described being told repeatedly by others, including medical professionals, that their inability to lose weight was effectively a failure of the will. They found these comments to be particularly hurtful because, in fact, they had spent years, even decades, trying to lose weight only to gain the weight back plus more. Some providers and family members seemed to take up the idea that shame could be a motivating force in weight loss. However, as research by Lewis et al.; Puhl and Huerer; and Schafer and Ferraro has demonstrated, the effect this had was the opposite of what was intended. Specifically, a number of the individuals I spoke with delayed care and avoided health-facilitating behaviors, like exercising, because of the discrimination they had experienced. Instead, they turned to health-harming practices, like crash dieting. Moreover, the internalization of shame and blame served to lower a sense of self-worth for many participants. And despite having a strong sense that something outside of personal behavior explained their escalating body weights, they deeply internalized messages about responsibility and self-control. Danielle, for instance, remarked: “Why could the one thing I want the most be so impossible for me to maintain?” It is important to highlight the work that emotion does in circulating such experiences of anti-fat stigma and discrimination. As Fraser et al have argued in their discussion on fat and emotion, the social, the emotional, and the corporeal cannot be separated. Drawing on Ahmed, they argue that strong emotions are neither interior psychological states that work between individuals nor societal states that impact individuals. Rather, emotions are constitutive of subjects and collectivities, (Ahmed; Fraser et al.). Negative emotions in particular, such as hate and fear, produce categories of people, by defining them as a common threat and, in the process, they also create categories of people who are deemed legitimate and those who are not. Thus following Fraser et al, it is possible to see that anti-fat hatred did more than just negatively impact the individuals I spoke with. Rather, it worked to produce, differentiate, and drive home categories of people along lines of health, weight, risk, responsibility, and worth. In this next section, I examine the ways in which anti-fat discrimination works at the interface of not only the discursive and the emotive, but the material as well. Big Bodies, Small Spaces When they discussed their previous lives as very fat people, all of the participants made reference to a social and built environment mismatch, or in Garland Thomson’s terms, a “misfit”. A misfit occurs “when the environment does not sustain the shape and function of the body that enters it” (594). Whereas the built environment offers a fit for the majority of bodies, Garland Thomson continues, it also creates misfits for minority forms of embodiment. While Garland Thomson’s analysis is particular to disability, I argue that it extends to fat embodiment as well. In discussing what it was like to navigate the world as fat, participants described both the physical and emotional pain entailed in living in bodies that did not fit and frequently discussed the ways in which leaving the house was always a potential, anxiety-filled problem. Whereas all of the participants I interviewed discussed such misfitting, it was notable that participants in the Greater New York City area (70% of the sample) spoke about this topic at length. Specifically, they made frequent and explicit mentions of the particular interface between their fat bodies and the Metropolitan Transit Authority (MTA), and the tightly packed spaces of the city itself. Greater New York City area participants frequently spoke of the shame and physical discomfort in having to stand on public transportation for fear that they would be openly disparaged for “taking up too much room.” Some mentioned that transit seats were made of molded plastic, indicating by design the amount of space a body should occupy. Because they knew they would require more space than what was allotted, these participants only took seats after calculating how crowded the subway or train car was and how crowded it would likely become. Notably, the decision to not take a seat was one that was made at a cost for some of the larger individuals who experienced joint pain. Many participants stated that the densely populated nature of New York City made navigating daily life very challenging. In Talia’s words, “More people, more obstacles, less space.” Participants described always having to be on guard, looking for the next obstacle. As Candice put it: “I would walk in some place and say, ‘Will I be able to fit? Will I be able to manoeuvre around these people and not bump into them?’ I was always self-conscious.” Although participants often found creative solutions to navigating the hostile environment of both the MTA and the city at large, they also identified an increasing sense of isolation that resulted from the physical discomfort and embarrassment of not fitting in. For instance, Talia rarely joined her partner and their friends on outings to movies or the theater because the seats were too tight. Similarly, Decenia would make excuses to her husband in order to avoid social situations outside of the home: “I’d say to my husband, ‘I don’t feel well, you go.’ But you know what? It was because I was afraid not to fit, you know?” The anticipatory scrutinizing described by these participants, and the anxieties it produced, echoes Kirkland’s contention that fat individuals use the technique of ‘scanning’ in order to navigate and manage hostile social and built environments. Scanning, she states, involves both literally rapidly looking over situations and places to determine accessibility, as well as a learned assessment and observation technique that allows fat people to anticipate how they will be received in new situations and new places. For my participants, worries about not fitting were more than just internal calculation. Rather, others made all too clear that fat bodies are not welcome. Nina recalled nasty looks she received from other subway riders when she attempted to sit down. Decenia described an experience on a crowded commuter train in which the woman next to her openly expressed annoyance and disgust that their thighs were touching. Talia recalled being aggressively handed a weight loss brochure by a fellow passenger. When asked to contrast their experiences living in New York City with having travelled or lived elsewhere, participants almost universally described the New York as a more difficult place to live for fat people. However, the experiences of three of the Latinas that I interviewed troubled this narrative. Katrina felt that the harassment she received in her country of origin, the Dominican Republic, was far worse than what she now experienced in the New York Metropolitan Area. Although Decenia detailed painful experiences of anti-fat stigma in New York City, she nevertheless described her life as relatively “easy” compared to what it was like in her home country of Brazil. And Denisa contrasted her neighbourhood of East Harlem with other parts of Manhattan: “In Harlem it's different. Everybody is really fat or plump – so you feel a bit more comfortable. Not everybody, but there's a mix. Downtown – there's no mix.” Collectively, their stories serve as a reminder (see Franko et al.; Grabe and Hyde) to be suspicious of over determined accounts that “Latino culture” is (or people of colour communities in general are), more accepting of larger bodies and more resistant to weight-based stigma and discrimination. Their comments also reflect arguments made by Colls, Grosz, and Garland Thomson, who have all pointed to the contingent nature between space and bodies. Colls argue that sizing is both a material and an emotional process – what size we take ourselves to be shifts in different physical and emotional contexts. Grosz suggests that there is a “mutually constitutive relationship between bodies and cities” – one that, I would add, is raced, classed, and gendered. Garland Thomson has described the relationship between bodies and space/place as “a dynamic encounter between world and flesh.” These encounters, she states, are always contingent and situated: “When the spatial and temporal context shifts, so does the fit, and with it meanings and consequences” (592). In this sense, fat is materialized differently in different contexts and in different scales – nation, state, city, neighbourhood – and the materialization of fatness is always entangled with raced, classed, and gendered social and political-economic relations. Nevertheless, it is possible to draw some structural commonalities between divergent parts of the Greater New York City Metropolitan Area. Specifically, a dense population, cramped physical spaces, inaccessible transportation and transportation funding cuts, social norms of fast paced life, and elite, raced, classed, and gendered norms of status and beauty work to materialize fatness in such a way that a ‘misfit’ is often the result for fat people who live and/or work in this area. And importantly, misfitting, as Garland Thomson argues, has consequences: it literally “casts out” when the “shape and function of … bodies comes into conflict with the shape and stuff of the built world” (594). This casting out produces some bodies as irrelevant to social and economic life, resulting in segregation and isolation. To misfit, she argues, is to be denied full citizenship. Responsibilising the Present Garland Thomson, discussing Bynum’s statement that “shape carries story”, argues the following: “the idea that shape carries story suggests … that material bodies are not only in the spaces of the world but that they are entwined with temporality as well” (596). In this section, I discuss how participants described their decisions to get weight loss surgery by making references to the need take responsibility for health now, in the present, in order to avoid further and future morbidity and mortality. Following Adams et al., I look at how the fat body is lived in a state of constant anticipation – “thinking and living toward the future” (246). All of the participants I spoke with described long histories of weight cycling. While many managed to lose weight, none were able to maintain this weight loss in the long term – a reality consistent with the medical fact that dieting does not produce durable results (Kassirer and Angell; Mann et al.; Puhl and Heuer). They experienced this inability as not only distressing, but terrifying, as they repeatedly regained the lost weight plus more. When participants discussed their decisions to have surgery, they highlighted concerns about weight related comorbidities and mobility limitations in their explanations. Consistent then with Boero, Lopez, and Wadden et al., the participants I spoke with did not seek out surgery in hopes of finding a permanent way to become thin, but rather a permanent way to become healthy and normal. Concerns about what is considered to be normative health, more than simply concerns about what is held to be an appropriate appearance, motivated their decisions. Significantly, for these participants the decision to have bariatric surgery was based on concerns about future morbidity (and mortality) at least as much, if not more so, than on concerns about a current state of ill health and impairment. Some individuals I spoke with were unquestionably suffering from multiple chronic and even life threatening illnesses and feared they would prematurely die from these conditions. Other participants, however, made the decision to have bariatric surgery despite the fact that they had no comorbidities whatsoever. Motivating their decisions was the fear that they would eventually develop them. Importantly, medial providers explicitly and repeatedly told all of these participants that lest they take drastic and immediate action, they would die. For example: Faith’s reproductive endocrinologist said: “you’re going to have diabetes by the time you’re 30; you’re going to have a stroke by the time you’re 40. And I can only hope that you can recover enough from your stroke that you’ll be able to take care of your family.” Several female participants were warned that without losing weight, they would either never become pregnant or they would die in childbirth. By contrast, participants stated that their bariatric surgeons were the first providers they had encountered to both assert that obesity was a medical condition outside of their control and to offer them a solution. Within an atmosphere in which obesity is held to be largely or entirely the result of behavioural choices, the bariatric profession thus positions itself as unique by offering both understanding and what it claims to be a durable treatment. Importantly, it would be a mistake to conclude that some bariatric patients needed surgery while others choose it for the wrong reasons. Regardless of their states of health at the time they made the decision to have surgery, the concerns that drove these patients to seek out these procedures were experienced as very real. Whether or not these concerns would have materialized as actual health conditions is unknown. Furthermore, bariatric patients should not be seen as having been duped or suffering from ‘false consciousness.’ Rather, they operate within a particular set of social, cultural, and political-economic conditions that suggest that good citizenship requires risk avoidance and personal health management. As these individuals experienced, there are material and social consequences for ‘failing’ to obtain normative conceptualizations of health. This set of conditions helps to produce a bariatric patient population that includes both those who were contending with serious health concerns and those who feared they would develop them. All bariatric patients operate within this set of conditions (as do medical providers) and make decisions regarding health (current, future, or both) by using the resources available to them. In her work on the temporalities of dieting, Coleman argues that rather than seeing dieting as a linear and progressive event, we might think of it instead a process that brings the future into the present as potential. Adams et al suggest concerns about potential futures, particularly in regard to health, are a defining characteristic of our time. They state: “The present is governed, at almost every scale, as if the future is what matters most. Anticipatory modes enable the production of possible futures that are lived and felt as inevitable in the present, rendering hope and fear as important political vectors” (249). The ability to act in the present based on potential future risks, they argue, has become a moral imperative and a marker of proper of citizenship. Importantly, however, our work to secure the ‘best possible future’ is never fully assured, as risks are constantly changing. The future is thus always uncertain. Acting responsibly in the present therefore requires “alertness and vigilance as normative affective states” (254). Importantly, these anticipations are not diagnostic, but productive. As Adams et al state, “the future arrives already formed in the present, as if the emergency has already happened…a ‘sense’ of the simultaneous uncertainty and inevitability of the future, usually manifest in entanglements of fear and hope” (250). It is in this light, then, that we might see the decision to have bariatric surgery. For these participants, their future weight-related morbidity and mortality had already arrived in the present and thus they felt they needed to act responsibly now, by undergoing what they had been told was the only durable medical intervention for obesity. The emotions of hope, fear, anxiety and I would suggest, hatred, were key in making these decisions. Conclusion Medical, public health, and media discourses frame obesity as an epidemic that threatens to bring untold financial disaster and escalating rates of morbidity and mortality upon the nation state and the world at large. As Fraser et al argue, strong emotions (such hatred, fear, anxiety, and hope), are at the centre of these discourses; they construct, circulate, and proliferate them. Moreover, they create categories of people who are deemed legitimate and categories of others who are not. In this context, the participants I spoke with were caught between a desire to have fatness understood as a medical condition needing intervention; the anti-fat attitudes of others, including providers, which held that obesity was a failure of the will and nothing more; their own internalization of these messages of personal responsibility for proper behavioural choices, and, the biologically intractable nature of fatness wherein dieting not only fails to reduce weight in the vast majority of cases but results, in the long term, in increased weight gain (Kassirer and Angell; Mann et al.; Puhl and Heuer). Widespread anxiety and embarrassment over and fear and hatred of fatness was something that the individuals I interviewed experienced directly and which signalled to them that they were less than human. Their desire for weight loss, therefore was partially a desire to become ‘normal.’ In Butler’s term, it was the desire for a ‘liveable life. ’A liveable life, for these participants, included a desire for a seamless fit with the built environment. The individuals I spoke with were never more ashamed of their fatness than when they experienced a ‘misfit’, in Garland Thomson’s terms, between their bodies and the material world. Moreover, feelings of shame over this disjuncture worked in tandem with a deeply felt, pressing sense that something must be done in the present to secure a better health future. The belief that bariatric surgery might finally provide a durable answer to obesity served as a strong motivating factor in their decisions to undergo bariatric surgery. By taking drastic action to lose weight, participants hoped to contest stigmatizing beliefs that their fat bodies reflected pathological interiors. Moreover, they sought to demonstrate responsibility and thus secure proper subjectivities and citizenship. In this sense, concerns, anxieties, and fears about health cannot be disentangled from the experience of anti-fat stigma and discrimination. Again, anti-fat bias, for these participants, was more than discursive: it operated through the circulation of emotion and was experienced in a very material sense. The decision to have weight loss surgery can thus be seen as occurring at the interface of emotion, flesh, space, place, and time, and in ways that are fundamentally shaped by the broader social context of neoliberal healthism. AcknowledgmentI am grateful to the anonymous reviewers of this article for their helpful feedback on earlier version. References Adams, Vincanne, Michelle Murphy, and Adele E. Clarke. “Anticipation: Technoscience, Life, Affect, Temporality.” Subjectivity 28.1 (2009): 246-265. 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