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  • Bâtir, gérer, soigner: Histoire des établissements hospitaliers de Suisse romande
  • Marcel H. Bickel
Pierre-Yves Donzé . Bâtir, gérer, soigner: Histoire des établissements hospitaliers de Suisse romande. Bibliothèque d'histoire de la médecine et de la santé. Geneva: Georg, 2003. xviii + 367 pp. Ill. Sw. Fr. 48.00 (paperbound, 2-8257-0829-1).

"To Build, Manage, and Care: History of the Hospitals of French-Speaking Switzerland." The plural histories might be even more accurate, owing to the diversity of these hospitals. Suisse romande, the western part of Switzerland, comprises six cantons, some Protestant and others Catholic, displaying a rich social, economic, and cultural diversity.

Some of these hospitals have a history of almost a thousand years. Those founded in the Middle Ages were ecclesiastical institutions for the poor—beggars, the aged, the alienated, alcoholics, and abandoned children. They were paupers rather than patients, but many of them had been led into pauperization by disease. A process of secularization began at the end of the Middle Ages and led into the reforms of the sixteenth century, which brought the hospitals under [End Page 123] the social and political control of the municipalities, of local citizens, but mostly of the local aristocracy. This remained the case until the end of the ancien régime. The hospitals were wealthy, and they increased in number during the eighteenth century, but the charitable model persisted well into the nineteenth century, as did a process of diversification. It was only during the second half of the nineteenth century that the hospitals became institutions for patients only; however, medicalization was slow and was often hindered by the paternalistic administration. To the heterogeneous rural and town hospitals, some of them very small, were added the two university hospitals of Geneva and Lausanne. Under the influence of industrialization and urbanization, the decades between World Wars I and II showed a total transformation—in particular, a modernization, homogenization, and professionalization of both the medical and administrative sectors. Costs rose and led to an increasing role for public funding. Hospitals underwent enlargements, new private hospitals were founded by physicians, and the total number of hospitals rose to more than sixty. Finally, the first three decades after World War II saw what the author calls the "explosion" of the system. However, the 1970s produced another transformation, this time a restructuring due to the new economic, financial, and political obstacles. Mergers and cooperations were among the results. The two university hospitals became large, fund-devouring research institutions. The 1990s brought a crisis of public finances resulting in the intervention of political authorities. The whole hospital system was increasingly squeezed between state authority, health insurers, physicians, and other powers.

Pierre-Yves Donzé's book, however, is far more than a linear history of these hospitals. Rather, it is a striking analysis of the various factors involved in their development: social, economic, cultural, medical, technical, professional, institutional, biographic. It tells of the difficulties along the way, the conflicts and controversies. To be sure, the fact that the book deals with each individual hospital makes it heavy in details; however, they are all based on a careful analysis of a rich body of documents, mainly from the archives of the hospitals and other sources. Most important, the author's synthetic view makes the book more than a local history, in fact a real contribution to the history of the hospital. And finally, the end of Donzé's history leads right into the contemporary debate by reflecting on the hospital systems and their problems in view of the exploding cost of hospitals and of the health-care system at large. Wisely, he refrains from final answers, but addresses pertinent questions such as the overriding one, whether in the light of the present situation all patients will have access to our high-tech medicine.

Marcel H. Bickel
University of Bern
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