Facing Illness in Troubled Times: Health in Europe in the Interwar Years, 1918-1939 (review)

In this book, a consortium of distinguished scholars has chosen to focus on international public health in the interbellum years ("troubled times") from a comparative perspective, between West and East and also between North and South Europe. The chapters document the epidemiologic transition that occurred during this period: the decline of infectious diseases and the rise of chronic illnesses, such as cardiovascular, degenerative, and cancerous afflictions (interestingly, it was only in 1970 that the epidemiologist Abdal Omran called attention to this phenomenon).

If the indicators forged by the Health Organization of the League of Nations remained rather crude, amounting to a simple draft of the Weekly Epidemiological Records produced today by WHO, the archives and reports of the HO remain an invaluable source for historians. The International Health Yearbook, a yearly compilation of data (a highly symbolic enterprise of the HO) is also useful; significantly, it was discontinued in 1930: even before this date, some states had been reluctant to submit to what appeared to them as a kind of nascent supranational control, and the task was not resumed until many years after World War II. Facing Illness also exploits other original sources, such as the previously untapped archives of the national insurance companies that preceded the unified Social Security system in many places.

The East-West comparison is fraught with difficulties arising from the hetero geneity of the data. If the analysis of the British case shows clearly the overarching influence of aging on disease distribution in the population, in Balkan countries we learn more about the official changes in public health strategies than about their real impact. Moreover, the constant revisions of international disease classification do not make it easy to track changes in morbidity patterns.

Some chapters provide interesting considerations on the ambiguities of some once very popular trends in the history of public health. Eugenics, the medical movement attached to the improvement of the human species, is a well-known case: before becoming anathema in the wake of its adoption by Nazi doctors, eugenics, or the art of selecting the best-fit elements for reproduction, was a respectable and widespread academic topic among physicians. A little-known example of an eugenicist program is provided in this volume by the Zionists' efforts to sort out the healthiest elements among the immigrants heading to Palestine.

Eugenics was not the only trend laden with political and social ambiguities: the ideal of the "total" measurement and control of health, supported by state officers and doctors, also had perverse, far-reaching effects. Showing that the enterprise of reforming bodies and improving public health happens to resonate with both Nazi and socialist ideologies, Paul Weindling pleads convincingly for an in-depth reappraisal of hygienic agendas in the context of the international, rather than local, political and scientific scene, and warns against the totalitarian fascination of sanitary control.

As one of the coeditors remarks in her introduction, the diversity of situations targeted by these case studies hinders the emergence of a clear picture of the respective achievements of European countries. A stronger editing might have clarified the contrasts between them, and the disparities between national vital statistics, globally attributed to differences in lifestyle and behavior, deserved more extensive comments. Yet the chapter on the British case, the most extensively documented, illustrates how, despite the abundance and apparent reliability of the data, it remains difficult to track the invisible changes that operate in the environment and in people's bodies.

If this book, at first sight, is primarily a document on the sanitary history of interbellum Europe, it is also a useful introduction to the political nexuses of the present time. For example, Patrick Zylberman describes vividly how the building of hygiene in the Balkans coincided with the invention of nations, and how the determination of ethnic borders, allegedly related...