Images of Disease: Science, Public Policy, and Health in Post-War Europe (review)

By the mid-twentieth century, public health concerns in Europe had shifted away from infectious diseases toward nonepidemic afflictions and problems. At the same time, European polities began investing in health care and biomedical research like never before. In the environment of the Cold War, improvement in the health of the population became one of several standards by which the successes and failures of liberal, fascist, and communist welfare states were measured. This volume, arising out of a conference held in Barcelona in 1998, explores European images of and policies toward health and illness after 1945. The essays focus on four major areas in postwar health policy: tuberculosis, cancer, addiction, and natalist health care.

One of the strengths of this volume is the willingness of its authors to discuss cultural representations of health and illness alongside developments in policy. Ilana Löwy, for instance, explores the ways in which new cancer therapies were portrayed as cellular soldiers and researchers as innovative and heroic saviors. Essays by Dagmar Ellerbrock and Barbara Markiewicz show how German, American, and Polish initiatives to combat tuberculosis were transformed into metaphors for contemporary political struggles. The contributions of Nikolai Krementsov and Lyubov Gurjeva provide us with suggestive insights into the possibilities for writing cultural histories of Soviet medicine.

Of interest, too, is the volume's attention to the postwar project of "producing better babies." Maternalist policies and health care have come to assume a central place in the historiography of twentieth-century welfare states, so attention to this dimension is particularly welcome. Jean-Paul Gaudillière discusses how specialists in hereditary disorders in Britain and France, following two very different paths, advanced medical genetics as a clinical enterprise that, in part, salvaged the ambitions of earlier eugenicists. Essays by Danuta Duch-Krzystoszek and Anna Firkowska-Mankiewicz and by Josep Bernabeu-Mestre and Enrique Perdiguero-Gil show how the campaigns to promote "happy and healthy children" in Poland and Franco's Spain, respectively, were explicitly politicized, particularly in the press.

As Ilana Löwy notes in the introduction to the volume, the comparison of health care policies and images across postwar Europe provides a unique opportunity to explore the ways in which political ideology has framed ideals of health in the twentieth century. And while the essays here do not always engage the topic in great detail, they do offer some promising directions for future research. Particularly noteworthy in this regard is the postwar treatment of alcohol abuse. During the second half of the twentieth century, a secularizing shift took place in the understanding and treatment of alcoholism, as psychotherapy and self-help replaced moral and religious reproach (see Virginia Berridge's piece). Alcoholism, however, appears to have posed particularly thorny problems for socialism, which, as Paolo Palladino shows for Britain, stressed responsibility to the community. In the Soviet Union and eastern Europe, growing concern about alcohol consumption, especially since the 1970s, led to campaigns against alcohol abuse, as Olga Amsterdamska and Justyna Laskowska-Otwinowska and Sergei Orlov document. Reformers tended to see alcohol dependence as the expression of morally corrupt tendencies in the population, and therefore to adopt more punitive measures toward its sufferers.

In sum, historians of medicine—particularly English-speaking scholars unfamiliar with developments on the continent of Europe—should find this to be a useful volume, one that points to some interesting lines of comparative historical inquiry.