De l'hospice au reseau sante: Sante publique et systemes hospitaliers valaisans, XIXe-XXe siecles (review)

Two Swiss medical historians present here a study of the development from the hospice to hospitals and hospital systems, and on to a public health network, in the Swiss canton of Valais during the nineteenth and twentieth centuries.

The first part of the book portrays the health system around 1800 and describes the gradual shift of emphasis from individual to public health. As the influence of the church diminishes, the state becomes an actor, increasingly controlling the health workers (physicians, surgeons, obstetricians, veterinarians, pharmacists, nurses, midwives) and their education. The state also propagates hygienic rules and vaccination, and it fights against epidemics, quacks, and noxious traditions. The second part of the book shows the development from the medieval-style hospice for the poor, pilgrims, and foreigners to the hospital as a product of medicalization in the nineteenth century. The economic bases of the hospitals are discussed and the role of women is emphasized. The third and final part of the book deals with the network of modern hospitals in the twentieth century as a result of factors like diversification, technical development, labor medicine, and health insurance. However, at the end of the twentieth century the goal of medical care for all the people is endangered by conflicts and crises as well as by economic pressure.

Rather than being a local history, this book mirrors the history of the hospital and of public health on an international level. The authors analyze the historical background on the social, political, and cultural levels, emphasizing the aspects of modernization—changes in political life and institutions as well as mentalities. They describe the increasingly complex legislation and administration; the turmoil of proposals, laws, experiments, contradictions, and compromises; the resulting helplessness; and the struggle to build a public health system that is scientifically justified, economically viable, and socially acceptable. They also shed light on the actors (politicians, administrators, clerics, physicians) and their debates. The book provides a key to an understanding of today's complex situation by bringing the narrative up to the present—that is, up to a public health that goes beyond a hospital-centered system.

This study is the result of extensive research in local archives. It is based on an impressive amount and diversity of sources. In addition to an appendix and bibliography there is a wealth of illustrations, documents, and biographies throughout the text. They are of particular value to readers interested in the local aspect—who, however, will miss a name index in a book so abundant in names.