Laura Frances Goffman’s Disorder and Diagnosis is an important new contribution to the field of the history of medicine and disease in the Middle East. Its strength lies not only in the gaps it fills in our understanding of the medical history of the Arabian Peninsula, but also in its methodological sophistication. The book draws upon a wide variety of sources, including community folklore, British records, American missionary writings, oral testimonies, and interviews. Positioned as a “regional” rather than a national history, it traces the evolution of healthcare in the Arabian Peninsula from the nineteenth-century imperial era to the period of corporate capitalism ushered in by the 1973 oil boom occurring post–World War II (8).

The originality of Goffman’s work lies in foregrounding of the lived experiences of ordinary people, who have often remained outside the purview of the existing scholarship. It analyzes their access to healthcare, responses to medical interventions, and negotiations with evolving systems of care in a quickly shifting sociopolitical landscape. More importantly, it does so in a textured manner, in which the varied experiences of different gender and class groups really shine through, rather than assuming a generalized picture that overlooks these nuances.

The book reminds us that the silences of the archive or the elitism of the available sources on medical history should not deter us from exploring the “lived experiences of the subalterns” and offers a useful approach to navigating these challenges (194). Particularly impressive is Goffman’s compelling defense of her methodology of using sources produced by members of the “dominant class” for understanding the lived experiences of “non-elite subjects” in the nineteenth century, which otherwise would have invited scholarly criticism (194). The book argues that medical institutions, imaginaries, and practices existed long before the emergence of modern biomedicine. Together, the chapters challenge the prevailing narratives that overstate the significance of the oil economy. Furthermore, they question the traditional division of Persian Gulf history into before and after the oil discovery by emphasizing the continuities in public health trajectories in the area.

Goffman addresses a wide range of themes, including contagion, hospitals, childbirth, experiments, nursing, and folk medicine, structured into six separate chapters. The first chapter, titled “Contagion,” focuses on the system of quarantines, demonstrating how they functioned as arenas of imperial rivalries and mechanisms of control, surveillance, and social categorization along lines of class, race, gender, and nationality, thereby reiterating a well-established argument in existing historiography. This field is already enriched by insights from scholars like Michael Christopher Low, Isacar A. Bolaños, Valeska Huber, Birsen Bulmuş and Sabri Ateş, among others, which makes saying something new particularly challenging.Footnote ¹ Yet, the novelty of Goffman’s analysis lies in bringing together the distinct motivations of varied imperial powers in implementing such measures and highlighting regional specificities of quarantine practices in ports such as Muscat, Bushire, Basra, and Kuwait. This comparative analysis is a productive outcome of the author’s methodology of framing the work as a regional history rather than one limited to a specific nation–state. The chapter also describes how ordinary people understood contagion, their ways of coping with it before the advent of modern biomedicine, and their navigation of the coercive system of quarantines that followed.

The second chapter explores the emergence of hospitals in places like Muscat, Bahrain, and Kuwait, as centers of care and sites of social categorization based on class, race, and gender. It puts the spotlight on ordinary people, demonstrating that, rather than being passive recipients of healthcare, they were active participants in hospital projects across the Gulf who served not only as donors but also as decisive actors. Goffman shows how the fierce competition between different powers, like the British and the American missionaries, encouraged their growing attention to healthcare, as they viewed it as a means of consolidating their authority. The author skillfully captures how this tussle created opportunities for ordinary people to negotiate their space within this evolving healthcare landscape, because such projects could only succeed if people were open to seeking their care. Rather than being “top-down” institutions like quarantines, hospitals emerged as spaces where the ruling elites had to constantly accommodate the sociocultural sensibilities of the local people, which in turn granted them agency (54).

The third chapter, titled “Childbirth,” further elaborates on the agency of ordinary people by focusing specifically on women of the Arabian Peninsula and the sociocultural factors that shaped their understanding and experiences of childbirth. The author demonstrates how the reliance of local women on traditional midwives, as opposed to professional care, presented a major hindrance to the British and American missionaries’ healthcare services, who were compelled to accommodate local cultural preferences to attract them into hospitals. It traces the gradual acceptance of modern medicine by local women and their simultaneous reliance on various forms of care, including folk medicine. The chapter also details the condition of vaginal atresia, which was common among women of the Arabian Peninsula, and its associated local custom of vaginal salt packing, explaining how it was understood by foreign doctors through an “Orientalist” lens (81).

In Chapter 4, “Experiments,” Goffman shifts focus to the rise of the oil industry in the aftermath of World War II and the role of the Arabian American Oil Company (Aramco) in the transformation of healthcare in Saudi Arabia. She demonstrates how, on one hand, Aramco’s health initiatives linked public health to oil production and labor efficiency and exacerbated social inequalities of various kinds, and on the other its Harvard project transformed local inhabitants into guinea pigs for conducting medical experiments in the name of global scientific advancements, particularly focusing on illnesses like trachoma and malaria. However, the chapter convincingly shows that this did not silence ordinary people as they found new ways to negotiate their place within this highly globalized context, demanding universal access to healthcare. Chapter 5 builds on this theme of globalization in the oil era by showing how intense migrations and exchanges across the Persian Gulf shaped healthcare in the twentieth century. The author argues that noncitizen Arab nurses came to form the backbone of healthcare in the Gulf, exploring not only the gendered aspects of nursing but also how these women carved out space and agency within a male-dominated system. Chapter 6, titled “Folk Medicine,” explores how alternative forms of medicine continued to persist despite the popularization of modern biomedicine; they evolved in tandem, enriching one another rather than existing in opposition.

Despite the many strengths of this book, there are, of course, certain limitations. Despite being framed as a regional history, the book sometimes falls short of fully realizing this regional perspective as it gets trapped in its focus on the dynamics between the different political powers operating in the area. Although Goffman acknowledges mobility and migration as defining forces and rethinks the Persian Gulf as a “nexus of global circulations of people and pathogens”, there is barely any engagement with how these exchanges shaped healthcare (7). For instance, there is mention of the British Indian doctor A.S.G. Jayakar (1844–1911) and how he understood cholera epidemics in Muscat, but there is no acknowledgment of how his ideas were tied to the larger developments in other parts of the empire, particularly India. Notably, many of Jayakar’s ideas, whether it was his racial categorization of the subject population, his approach to understanding diseases, or even the structure of his text, were deeply informed by the medical topographies developed in India, which also were adopted in other parts of the empire. His perception of certain communities also was closely tied to the biases entertained about them in other parts of the empire. Similarly, in the chapters that deal with the twentieth century, the book misses a chance to explore how the ideas and training that foreign or noncitizen doctors and nurses brought from their origin country shaped healthcare in the Gulf. Perhaps situating the book more firmly within the Indian Ocean framework and a stronger, more direct engagement with that body of literature would have helped the author explain the transregional influences better.

Nevertheless, Goffman’s book is a valuable resource for anyone interested in the history of science and medicine, the Middle East, gender studies, global history, and Indian Ocean studies (even if the book is not explicitly positioned that way). Although the discipline of the history of medicine has witnessed a gradual shift from expansive macrolevel histories to more focused, microlevel approaches, Goffman’s work brings the former back in vogue. It presents a sophisticated balance between these two opposing historiographical approaches, in which the broad generalizations that plague expansive histories are offset by attention to local specificities, achieved by a careful selection of themes spanning a broad temporal scope.