The Centre for the History of Medicine and Disease, University of Durham, held its 3rd Workshop in the Wolfson Research Institute, Queen's Campus in Stockton, on 10 December 2004, bringing together academics and students from philosophy, health, medicine, history, biology, anthropology, theology, and biotechnology. The event was sponsored through the Centre's recent Wellcome Trust Enhancement Award.

In his introduction the Director of the CHMD, Holger Maehle, referred to a topical discovery in British stem cell research, reported in the German weekly magazine Der Spiegel on 2nd December 2004. At first glance, the new technique described, which allows harvesting of embryonic stem cells from blastocysts developed from chemically treated rather than fertilised human egg cells, seems to circumvent ethical problems. However, Maehle noted that this technique is unable to solve the problems linked with the human embryo's moral status. Issues surrounding egg donation, for research rather than infertility treatment, and the question of whether it can be guaranteed that cells cloned from the egg donor are guaranteed to be incapable of development into a human still remain. Problems still abound with informed consent to embryo donation in the context of IVF, and there are uncertainties about whether the new technique can yield stem cells equally useful to those derived conventionally from 'real' embryos.

This example served to address two main issues that were to be discussed in the workshop. First, historical legacies wield powerful effects upon current issues in reproductive medicine. Differences in debates, legislation and policies vary between countries, attributable to their different histories. The strong German and British presence facilitated a comparative approach in our discussions. The problem of the human embryo's status underlies and connects debates in stem cell research, IVF and infertility treatment, and abortion reform. Our second aim was to appreciate this interconnection of issues, to do each more justice, and thus raise our awareness of how cultural traditions act upon ethical reasoning.

Christine Hauskeller (Exeter), in a paper on the scientific and public debates on stem cell medicine in Germany and the UK, addressed many of the two countries' differences in attitude and legislation on embryo research. She outlined major breakthroughs and legislative decisions from the field in both countries, before exploring the apparent effects of their different ethical histories upon research trajectories and the embryo's differing moral status. UK research focuses on embryonic stem cells, and funding for adult stem cell work (considered less innovative) is elusive. German funding concentrates on adult stem cell research; creation of embryonic cell lines is forbidden and their use limited to imports under stringent conditions. Hauskeller discussed how strategic use of particular scientific terms and language styles reflect underlying differences in attitude to stem cell medicine, like the different connotations associated with 'cloning' and 'nuclear transplantation'. Asserting 'battlefields' of strategic language to be unhelpful to finding agreement in ethics, she called for a rational conception of dignity, detached from material substance. In our discussion, we noted that language changes during a debate and shapes it as it proceeds. This affects public understanding of science; the language in which a debate is couched greatly influences its interpretation. We agreed that no scientific language can be 'neutral', as no term is ahistorical, and that strategic language is unavoidable for both sides of a debate.

Nick Hopwood's (Cambridge) presentation, '"Ourselves unborn"? Human embryology before IVF', was an illustrated historical account of the field's development from 'marginal' topic in biology and medicine to major field in the life sciences subject to intense debate. He described the shift away from a concept of the embryo as proof for the existence of 'ideal types', to its gradual claiming by Darwinists as a proof of common ancestry. Hopwood began with developmental series created at the turn of the nineteenth century, arguing that despite their familiarity as textbook images, we should question their 'obviousness'. Closely examining their production reveals developmental schemes as embryologists' creations; 'development' was produced as a subject for scientific study, reconstructed on a magnified scale with drawings and wax models. Hopwood displayed pictures of Ziegler's wax models, explaining their importance as visual aids to the institutionalisation of a vertebrate developmental scheme. We discussed the disenfranchisement of women from whom embryonic tissue, before the advent of modern imaging techniques, was taken, linking this to ethical issues associated with the abortion debate and definitions of 'normal' development. We also considered the extent of women's, apparently considerable, interest in representations of the developmental processes. This lead to interesting comparisons with certain practices today including blurring of cutting edge embryonic images, because they are considered too shocking or politically charged, with respect to the abortion debate, for public viewing. Thus, pictures in science, as well as words, are usually heavily politicised.

Christina Benninghaus (Bielefeld) showed in her paper 'Displaying expertise: advice literature for infertile couples from the 19th and 20th century', that infertility is not only a recent problem. Focusing specifically on five German advice books, she argued the literature took two broad approaches, the first being the believed consequences of childlessness. Benninghaus discussed gendered meanings of infertility, describing ninerteenth-century portrayals of fatherhood as an 'essential' achievement for men, though they were believed able to compensate in other areas of their life. Female experiences of infertility were presented more emotionally, in terms of 'hysteria', devastation and non-fulfilment. Infertility was so stigmatised that it rarely even appeared in personal diary entries. The second focus concerned definitions, possible treatments and remedies, which varied among the books. Nineteenth-century advice appears more practical; many solutions pertain to the quality of sexual experiences for both partners, making the books interesting also as rare historical repositories of sexual advice. Early twentieth-century literature centred more on preparing couples for medical consultations or surgical procedures, rather than practical suggestions not requiring a doctor, supporting the idea of a shift towards the belief that these were lay-people's practices, and a more clinical attitude. We linked this biologisation of kinship to an increasing preoccupation with science as a source of 'answers', and addressed the changing importance placed upon family. We also discussed differences between male and female discourses of infertility, and examined passivity and activity concepts relating to eggs and sperm.

The presentation of Gayle Davis (Glasgow), on abortion law reform and the Scottish medical community between 1960 and 1980, contrasted with the preceding paper's emphasis on the desire for children. After outlining the Scottish common law system, she described Sir Dougal Baird's influence upon David Steel, the MP responsible for the private member's bill leading to the 1967 Abortion Act. Baird, a prominent Aberdeen gynaecologist, was unusual for capitalising on ambiguities in Scottish abortion law, and for publicly supporting 'therapeutic' abortion according to social criteria relating to the wellbeing of the mother. His stance starkly contrasted with that of Donald (another prominent Scottish gynaecologist, who pioneered ultrasound) in Glasgow, where Scotland's abortion rate was lowest. Davis argued that vocal political support from Baird and associates, driven by increasing desires for professional autonomy and the eradication of 'back-street' abortions, influenced the state's move towards legalisation. We discussed the impact of publicity for Baird's vision, and his opposition's persuasive use of ultrasound images for discouraging abortion, and their wider political uses, alongside their primary function as an informative health tool.

In his concluding remarks, Lutz Sauerteig (CHMD, Durham) stressed that debates on reproduction and the human embryo are culturally as well as historically contingent. The language employed in debates on stem cells, for instance, illustrates the fact that scientific language uses metaphors intentionally as well as unintentionally, hence meanings are transported. Accusing science of a strategic language use - an accusation often made in debates on reproduction - is in itself a strategic argument since there is no way that language can be objective. Visual representations, images of embryos for example, also carry meanings and have a political function, which contributes to alterations in the experience of pregnancy.