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AbstractIn the year 1966, the first government hospital, Oshakati hospital, was inaugurated in northern South-West Africa. It was constructed by the apartheid regime of South Africa which was occupying the territory. Prior to this inauguration, Finnish missionaries had, for 65 years, provided healthcare to the indigenous people in a number of healthcare facilities of which Onandjokwe hospital was the most important. This article discusses these two agents’ ideological standpoints. The same year, the war between the South-West African guerrillas and the South African state started, and continued up to 1988. The two hospitals became involved in the war; Oshakati hospital as a part of the South African war machinery, and Onandjokwe hospital as a ‘terrorist hospital’ in the eyes of the South Africans. The missionary Onandjokwe hospital was linked to the Lutheran church in South-West Africa, which became one of the main critics of the apartheid system early in the liberation war. Warfare and healthcare became intertwined with apartheid policies and aggression, materialised by healthcare provision based on strategic rationales rather than the people’s healthcare needs. When the Namibian state took over a ruined healthcare system in 1990, the two hospitals were hubs in a healthcare landscape shaped by missionary ambitions, war and apartheid logic.

The great exhibitions of the nineteenth century were organised to show the industrial and cultural progress of civilisation. Many historians of recent decades have made creative use of these well-documented and spectacular material surveys of modernity to explore a whole range of themes, and this has especially been the case among those interested in the history of science and technology. However, so far, comparatively few studies have analysed how issues related to medicine and health were articulated when the world was put on display. Julie K. Brown’s overview of the four major American expositions between 1876 and 1904 from this perspective is thus a very welcome contribution to the literature. Brown’s study is organised as a rather straightforward description and characterisation of how health and medicine were part of the consecutive exhibitions, both as organisational problems and as subjects to be displayed. She documents how health and medicine were concerns in the planning and building of the fairs. At least some medical services had to be provided on site to the many thousands of construction workers as well as to the millions of visitors. A whole range of sanitary issues had to be addressed when planning and building such massive infrastructures from scratch. Epidemics, both as fears and realities, were real threats to the economic success of these private enterprises. Furthermore, she provides a broad picture of what was displayed at each exposition and traces in some detail how many significant exhibits came about. There is no shortage of examples: companies producing medical instruments; teaching material or hospital equipment; governmental agencies overseeing or providing healthcare; and scores of private organisations involved in civic or municipal improvement, brought together in sections on ‘social economy’, were all competing for the visitors’ attention. The descriptions are based on meticulous archival research, primarily on the work of committees and exhibition organisers, and Brown also provides a rich selection of visual material: a large number of photographs, cartoons and construction drawings are reproduced, and thirty additional images are available on the publisher’s website. However, her commitment to the administrative records also structures the narrative of the events. By choosing an insider’s perspective, a lot of information on how politics, organisational struggles, and economic considerations which shaped each exhibition is brought to light. The detailed study of local concerns and circumstances also provides good insights on, for example, the reactions to the high rates of accidents during the construction phase, the difficulties for various organisations to co-operate on group exhibits, or the budget concerns when constructing working exhibits or commissioning models. Nevertheless, as a consequence of this chosen point of view, each part of the exhibitions is primarily described as the result of various constraints and compromises. Brown’s book is intended as a survey of what was available to see and learn at these four events, and it is described as a resource for scholars to pursue more specific analyses. There are indeed many aspects that she did not have the opportunity to develop in this study, for example, how exhibits were part of ideological, professional and scientific debates, or how visitors and reviewers interpreted them. While displays rarely lived up to initial plans or educational ideals, they were heavily invested with meaning, not least because the expositions had a particular status and reached huge crowds. Furthermore, her descriptions and interpretations are very much centred on American exhibits and discussions. The fact that these expositions were highly international and that many didactic ideals, as well as exemplary displays, were from abroad, are important contexts to take into account. This monograph is an important contribution to the literature and an excellent resource for all interested in how health and medicine were put on display for the general public in the late nineteenth and early twentieth centuries. It should inspire more historians of medicine to explore the rich archives and the expository culture generated by the great exhibitions.

Marjaana Niemi examines the impact of political, social and economic interests on local public health policies in the early twentieth century by analysing and comparing infant welfare and tuberculosis prevention campaigns in the cities of Gothenburg, Sweden, and Birmingham, Britain. According to the author, these campaigns “served to depoliticize and ‘naturalize’ local economic arrangements, social structures and moral norms” (p. 22). Both cities were part of an international public health community and justified their public health policies by scientific knowledge, claiming to be value-free and politically neutral. Yet there were striking differences in their public health policies, partly due to national and local social, economic and cultural differences. In chapter four Niemi presents the infant welfare campaigns in each city and looks at how they served to regulate working-class family life and gender roles, and also how they were used to promote the aspirations of medical professionals. Political ideals and norms were embedded in the campaigns, like the norms of the responsibility of families to be self-supporting, and of the men as breadwinners. Although there were clear links between poverty and infant mortality, in the case of Birmingham, it was claimed that there was no direct connection to poverty. Infant mortality was considered to be primarily the result of ignorance and bad behaviour among the poor. The focus of the campaign was mainly on improving the home environment and the promotion of breastfeeding through education. The campaign upheld existing gender roles by arguing in favour of male breadwinners and criticizing female employment. In Gothenburg infant mortality was clearly lower than in Birmingham, and thus there was less pressure to make improvements. Never-theless, medical practitioners lobbied the government for measures to improve child welfare, partly so as to enhance their own professional status. By contrast to the situation in Birmingham, most practitioners in Gothenburg worked in the public health sector and thus had a vested interest in its expansion. The Swedish campaign was to a large extent directed at reducing the relatively high infant mortality among illegitimate children, blaming single mothers and absent fathers. Nurseries and milk depots were supported, making it possible for single mothers to have employment. In the 1920s the campaign shifted to wider sections of society by starting infant welfare centres for all children. Chapter five discusses how anti-tuberculosis campaigns regulated urban life and legitimized municipal intervention or non-intervention in the housing markets. Gothenburg had relatively high tuberculosis mortality compared with Birmingham. In Gothenburg the efforts were concentrated on isolating tubercular patients in hospitals and on housing inspections. In Birmingham, the poorer areas, characterized by overcrowding and defective housing conditions, experienced higher tuberculosis mortality than the more affluent ones. The dominant policy in combating tuberculosis was not to intervene in the housing market, but mainly to stress the unhealthy attitudes and lack of hygiene among the poor. As was the case in the infant welfare campaign, education was considered to be the most efficient way to combat the disease. The author sometimes implies that the public health actors had a hidden political agenda for promoting the existing social and economic order. The arguments presented often seem plausible, but it is not always clear whether different elements of the public health campaigns were primarily a product of more or less conscious intentions to reinforce or maintain the social and economic order, or whether they reflected the best efforts to promote health within the given political circumstances. Maybe Niemi could have developed this issue more extensively or discussed possibilities of alternative interpretations. I was somewhat surprised that eugenic ideas and theories that had a considerable impact on contemporary public health discourse, should have exercised relatively little influence on local public health policies in the early twentieth century. Niemi mentions that Swedish women who were believed to transmit serious hereditary defects were seen as grave threats to the health of the nation and the Nordic stock. Many were sterilized on these grounds, and pressure was put on mothers diagnosed with tuberculosis to place their children in foster care. This issue could also perhaps have been discussed at greater length. Nevertheless, this book provides valuable insights into the local public health policies in early-twentieth-century Sweden and Britain, and their interplay with political interests, gender structures, science and professional aspirations.

For more than two decades, the relation between health, social change and politics has been a primary target for Simon Szreter's historical studies. The present book is mainly a collection of previously published and slightly revised articles with an added introduction and final reflections. The empirical example is Great Britain during the nineteenth and, to a lesser extent, twentieth century, but his conclusions concerning the threats of social disruption caused by rapid change are general indeed. One article, ‘Economic growth, disruption, deprivation, disease and death’, published in 1997, has been widely read and quoted by historians, scholars and practitioners interested in the fate of contemporary developing societies. Later, Szreter has used “linking social capital” as a tool to understand why some societies are healthier than others. One of the articles is written together with Michael Woolcock, where this concept incorporates politics, the state and other formal and informal institutions as important and necessary means for the creation or preservation of trust, safety, a fair distribution of resources and a good life, especially during periods of rapid social change. The author is not afraid of drawing wide-ranging conclusions almost entirely from one historical case, the history of Great Britain. If we accept Szreter's interpretation of British experiences, it may of course still not be valid for what has happened in other parts of the world. Generally, however, there is by now a wide acceptance of his critique of Thomas McKeown's famous thesis that economic growth, increased standard of living and improvement of the nutrition of the population were the key factors behind rising life-expectancy in Europe during the last two centuries. A growing number of studies in other countries are, for instance, supporting Szreter's view that public health interventions were much more important than McKeown thought, particularly when implemented on a local level. Although details might still be diffuse, the first half of the nineteenth century and the most intensive first phases of industrialization and urbanization were obviously accompanied by hardship and severe health problems for large parts of the European population. According to Szreter, this coincides with a significant decline in life expectancy in Great Britain. In Sweden, as another example, this was also the case at about the same time among middle-aged men. Szreter claims that these historical lessons can be used to understand what happens or might happen in the future in developing countries of today. Most parts of his recipe for building wealthy and healthy societies are not controversial, for instance the need for functional democracy, protection of individual human rights and security, investment in human resources and literacy campaigns. It is the emphasis on the need for political interventions and investments in the human capital that makes him identify the chief opponents: believers in automatic links between economic growth, welfare and health, neo-liberals and advocates of an unrestricted free market. Criticizing those who welcome economic globalization without major objections, he even defends protectionism in situations when domestic economic systems are not yet fit to meet competition from the outside. Hence, Szreter does not avoid wide-ranging theoretical conclusions drawn from his case. Nor is he afraid of taking a clear standpoint on politically and ideologically controversial questions. The ever-changing historical and cultural contexts are of course always making such efforts open to attack. Yet, made by professional historians who have taken the time to reconstruct and reflect upon their cases, such ventures can, as in this case, be stimulating and enjoyable food for thought. Written with good humour, presenting interesting and provocative perspectives on his topics, Simon Szreter's book is recommended for all who are interested in the history of public health and its potential lessons for today's world. The articles do, however, overlap when it comes to evidence, argumentation and conclusions. Consumers who do not have the time or the need to go through all the chapters in detail should start with the summary introduction and continue with the final chapters before they decide where to go next.

Nils Rosen was one of the most prominent paediatricians in eighteenth-century Europe, and the author of an often cited textbook. Medical dissertations of the time were written in Latin, and are therefore not easily accessible for most modern researchers. In his linguistic PhD thesis Urban Orneholm has translated four dissertations completed under the direction of Nils Rosen that provide an improved opportunity to explore medical science and the understanding of diseases 250 years ago. Orneholm deals with linguistic characteristics such as orthography, morphology, choice of words, and especially the medical word-stock. Of greatest value for medical historians are, however, the translated texts. De variolis praecavendis (Roland Martin, 1751) and De variolis curandis (Petrus Jonas Bergius, 1754) both deal with the most feared disease of the century, smallpox. Between 1750 and 1800, 300,000 Swedish children died from smallpox, in a population of two million people. The first text discusses the prevention of smallpox in dialogue with the medical elite of eighteenth-century Europe. With references to, for example, Herman Boerhaave and Thomas Sydenham, the conclusion is drawn that there are good possibilities to prevent the disease. It is interesting to note that inoculation is not mentioned at all. The method was not introduced into Sweden until a few years later, and it seems that mercury and anti-inflammatory remedies were regarded as more important at the time. Nils Rosen later became a great promoter of inoculation, despite the fact that he lost two daughters due to that preventive method. The dissertations concerning smallpox are illustrative examples of the confusion concerning miasma and contagion. The conclusion is that they are both valid explanations of the disease; the former in the early stages of an epidemic, while the latter was preferred when understanding the infections that followed. Several cases are discussed where the different stages of the disease are described carefully. This provides a good insight into the working manners of an eighteenth-century physician, and his attitude towards the speckled monster. In De epilepsia infantili (Petrus Sundius, 1754) seven different forms of infant epilepsy are defined. They are related to constipated bowels, colic, teething, scabies, exanthemtic fevers, and worms. Warm linen and bloodletting are suggested as the best cures for the disease. The fourth text, De morbis infantum (Johannes Schroder, 1752) is concerned with a very relevant topic, infant mortality. The infant mortality rate in Sweden during the 1750s was more than 200 per 1,000 live births, and in Stockholm it was almost twice as high. Contemporary physicians did not know much about the causes behind these deaths. Consequently the most common cause of death in the so-called Tabellverket (population statistics of Sweden beginning in 1749) was unknown childhood disease. In De morbis infantum it is stated that mothers, nurses and servants are those mostly to blame. The dissertation describes various methods of preventing or defeating such diseases. It should be seen as an interesting forerunner to the articles on the same topic that Nils Rosen published during the following years. They were later collected in his famous textbook, The diseases of children and their remedies, published in 1764 and translated into English in 1776. Urban Orneholm has compiled and translated four medical dissertations that shed new light on the history of medicine, not only in the Swedish context but also in an international perspective. There is, however, no discussion or conclusions in the context of historical science, although an extensive list of commentaries is attached to each text. Hopefully the book will be used by those scrutinizing the medical world of the eighteenth century, and they should be able to find valuable references within these texts.

Dans cette etude, l'auteur analyse la relation entre les taux de vaccinations et la puissance de la religion et d'autres facteurs sociaux dans un pays. L'exemple choisi est celui de la Suede de la periode d'inoculation contre la variole au 18e siecle