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Health care policy in the Netherlands has long been guided by the values of solidarity and equality. As a result of several forces, particularly the scarcity of resources, the retreat of the Welfare State and the introduction of market forces in health care, both values are increasingly under strain. Next to solidarity and equality, freedom of choice and financial responsibility are playing an important role in Dutch health care. Consequently, there is a growing division in Dutch health care between two tiers, one basic tier giving access to a basic package of services and a luxury tier giving access to a higher quality of care and to services not included in the basic package. The main thesis of the article is that a two-tier system is morally justified on the condition that the basic tier is universally accessible and is based on the value of humanitarian solidarity.

Despite the political and economic reforms that have swept Eastern Europe in the past 5 years, there has been little change in Poland's health care system. The Ministry of Health and Social Welfare has targeted preventive care as a priority, yet the enactment of legislation to meet this goal has been slow. The process of reform has been hindered by political stagnation, economic crisis, and a lack of delineation of responsibility for implementing the reforms. Despite the delays in reform, recent developments indicate that a realistic, sustainable restructuring of the health care system is possible, with a focus on preventive services. Recent proposals for change have centered on applying national goals to limited geographic areas, with both local and international support. Regional pilot projects to restructure health care delivery at a community level, local health education and disease prevention initiatives, and a national training program for primary care and family physicians and nurses are being planned. Through regionalization, an increase in responsibility for both the physician and the patient, and redefinition of primary health care and the role of family physicians, isolated local movements and pilot projects have shown promise in achieving these goals, even under the current budgetary constraints.

The author presents a history of services for the blind and those with low vision in the United States focusing on the areas of orientation and mobility, and rehabilitation teaching. The controversies involving the development of these specialties are discussed. Emphasis is placed on the role of Father Thomas Carroll in the establishment of low vision and blind services for the military and veterans administrations. Published data regarding the past role of ophthalmologists in obtaining low vision services for patients is reviewed. The opportunity for a more active role for ophthalmologic involvement in the rehabilitation of the low vision and blind patient is discussed.

The article is the fruit of cooperation of the medicine historians from Grodno and Lódz. It is discussing the organization of health care service of Grodno up to 1939, revising the shortage of information, as in this field was experienced mainly by the Soviet historiography. This article is also drawing the attention at the significant part of the army garrison's physicians. Evaluating this service the authors have stated that as for the possibilities of those days, the town had well organized health care service, which was sufficiently answering the needs of population.

The social and cultural history of medicine and health is a growing field of research in Sweden, stimulated by the present political, economic and social concern about health and health care. Since there have never been any chairs in the history of medicine within the medical faculty, the topic has mostly been approached by historians of science and ideas, social historians and anthropologists and sociologists interested in long-term developments. Psychiatry and psychiatric care is one of the most popular subjects. Other fields are professional history and social policy, cultural and local studies on different aspects, epidemics and public health and socio-demographic studies of mortality and morbidity. This report presents some major Swedish contributions and gives a short summary of some of the results. There has, during the recent years, been a trend towards interdisciplinary exchange, for instance through Swedish and Scandinavian networks, and towards an international orientation that has led to comparative studies and exchange of results, a trend that can also be observed in many other countries.

During the period of 1894-1945, hygienic administration institutions were established in the central and local levels, responsible for general hygienic affairs, including prevention of infectious diseases, public health, anti-opium smoking and drug inspection. Medical education and research unit were also set up, such as Taibei Hospital, Taiwan Viceroy Medical School and Taibei Imperial University. From these institutions, not a few medical professionals were cultivated.

The nature of the medical treatment of prisoners in the Gulag has emerged from accounts published by survivors. Over a period of 70 years some doctors entrusted with the medical care of prisoners failed to discharge their ethical duties, contributing to the prisoners' neglect and suffering. The medical profession must carefully examine what occurred and properly assign responsibility for ethical as well as unethical medical acts. Understanding the history of these ominous events will alert doctors worldwide to the importance of medical autonomy in the support of imprisoned patients.

In order to critically assess the health-care system in Indianapolis, it is important to analyze this African-American population from two major perspectives. First, the local African-American population must be viewed in the context of the local health-care system in its present and historical setting. Second, the local African-American population must be viewed in conjunction with other urban African-American populations. These two perspectives will show how the region's economic, social, cultural, and political climate have affected the health-care status of African Americans in Indianapolis.

This is the speech pronounced by Dr Abraham Horwitz, Emeritus Professor of the University of Chile and Honorary Director of PAHO, during the academic act that celebrated the fiftieth anniversary of the Chilean Public Health School endowment. The school had a doctrinal and technical impact on Chilean health and decisively influenced the National Health Service creation. The majority of its founders were trained at the John Hopkins Public Health School, therefore naming this school "little Hopkins". Its creation was stimulated by the Chilean health profile of the forties. Chile had 5,273,000 inhabitants and a 28.2% of illiteracy. General mortality was 19.5%, infant mortality 18.1 and newborn mortality 73.3%. At the present time, forty years later, the figures are 14,000,000 inhabitants (85% in urban areas), less than 10% of illiteracy, a general mortality of 5.6%, infant mortality of 14.6, newborn mortality of 7.9% and a life expectancy of 72 and 75 years for men and women. Almost all labors are attended by professionals in institutional settings and only 5.6% of newborns have a low birth weight, one of the lowest figures in the world. To say that health in the Americas is in crisis and that population health needs are not satisfied is a dangerous generalization and Chilean health evolution seems to disprove this assertion. This does not mean that some reforms are needed that can be accomplished with the help of School of Public Health.

The first written serbian medical records could be found in the Middle Ages (XIIIth century) when the serbian state was very well organized. St. Save was the son of Grand-Prince Stefan Nemanja (1171-1196), founder of the Serbian independent state and of a powerful dynasty that ruled Serbia for two centuries. At that time the first hospital service was established, and the social program which regulated the relationship between marriage and family, and the kind of therapy, was under the church and state control.

The anniversary important for the health protection, medical education and medical science takes place. The 100 years of the State Hospital in Sarajevo, 50 years of the Medical Faculty in Sarajevo and 40 years of Medical Section of the Academy are noted. At the same time the 1.000 wartime days in our suffering country are with us. From one side good from the other bad, which befall us, is the eternal struggle of Good and Evil. The health protection effects done in the course of the past hundred years cannot be measured. Something could be done in the medical education, the easiest is the evaluation of the medical science results. Something could be evaluated if it is imagined what would happen if it did not happen. What would happen to our population, their suffering and lives? It is known that a bad war result was a much bigger danger than the arms, what evaded us thanks to the health protection. Unfortunately, there were not many persons who made notes on events in the health service, education and medical science, except some fragments, naturally. We have to admit that some meetings on history of medicine in our country took place in the Academy. Again, there are some enthusiasts who researched the history of health service in BandH. We have missed to note the old colleagues' memories of the beginnings and the later development. Notwithstanding, it will be necessary to do a research work of the past of our health service, success and development.(ABSTRACT TRUNCATED AT 250 WORDS)

Keizou Tanba wrote an article on separation of dispensary in Chugai-iji-shinpo in June, the year 23 of Meji Era. It was said that separation of dispensary had to be carried out and it brought many advantages. First, a pharmacist can examine the prescription and correct it if there are any mistakes. He will be able to give an advice to a doctor that the side effects will perhaps occur due to preparation of medicine. Secondly, a pharmacist can superintend whether unnecessary medicine is prescribed or not. He will check surplus prescription in such a case that a patients will be cured by observing dietary or exercise. According to Tanba's opinion, if we will get people to know what separation of dispensary is, it is easy to be carried out. Ougai Mori wrote an essay separation of dispensary in the same period. His opinion was opposite, basically. It caused to impose a burden on a patient. As the number of pharmacist were not enough, it was impossible to carry it out. A conflict of opinion also remains among people related to medicine at present. The circumstances on separation of dispensary have not been changing during one hundred years.

On the basis of the up to now historic-medical researches we can state that sanitarian legislation of the repacious states (Austria, Prussia, Russia) had a decisive influence on public health services development on Polish lands in XIX century. In the elaboration of the polish services project, actively participated the medical Association of Cracow and Warsaw. The presented approaches realizes in the liberated polish State, considered the desire for health services administration union, as well as underlined the decisive role of the urban and district self-government in the organization of health care services. In the multisectorial structure of medical care, public health services-state and self-governed, were rendering services for the whole of population. Some of the important achievements were: accessibility to the public of numerous medical care units, declination of mortality coefficient because of acute and social infective diseases, wide range of preventive activities, etc.

This review gives information about the origin and development of the Public Health organisms in Chile, particularly the National Health Service, outstanding governmental health institution created in 1952, whose achievements were favored by the coordinated support of the University and the Chilean Medical Association. At the present time, their work is carried on by the National System of Health Services. The National Health systems have contributed to the improvement of population's health conditions, specially of the most vulnerable groups. Among other accomplishments, the life expectancy of the Chilean population has increased from 57 years in 1960 to 1972 years in 1990, and the general and infant mortality rates decreased from 12.6 to 6/1000 and from 120.5 to 16/1000 respectively. In the same period, the system has increased the coverage of its programs, specially those addressed to technical assistance of delivery, responsible parenthood, healthy child control, vaccinations, complementary feeding and sanitary education. The main limitation to the system's actions has been the restricted availability and the unequal distribution of resources assigned to health (about US$ 100 per capita). It is postulated that the implementation of a new Health and Social Welfare System (in study at the present time) should improve the efficiency and solidarity of health care.

Retrospective and prospective demographic and health data collected on the population of Mlomp (6352 people in 1985), a rural area of Senegal, show that the probability of dying before the age of 5 years declined from 350 to 81 deaths per hundred livebirths in the last 25 years. This decline is greater and faster than ever observed in Senegal. The drop in mortality mainly results from improved access to new and efficient health services--a dispensary and a maternity clinic--and from growth surveillance, health education, vaccination and malaria programmes initiated in the 1960s and 1970s. Although socioeconomic conditions have changed in the area, the influence of classical factors such as women's educational level and improvement in transportation has probably been limited. Deaths from diseases that can be prevented by immunization (such as neonatal tetanus, measles, whooping cough) are now very rare (3% of the deaths of children under 5 years during the period 1985-1989). Although the risks of dying from diarrhoea or acute respiratory infections are much lower than in other rural areas of Senegal, these are still the main causes of deaths (33% and 19% of deaths after 1 month of age). Malaria, despite its high morbidity during the rainy season, causes few deaths (4%). This reflects the success of the health education programme promoting chemoprophylaxis and early treatment of fever cases. Mlomp is one example of an African rural area where the provision of well-organized health services at a reasonable cost has produced a dramatic decline in child mortality.

This article reminds the contribution of Health and Medical Services in overseas territories and other developing countries. Seconded to Health Services, Pasteur Institutes, other scientific research Organisations, and International Organisations (FAO, WHO), medical doctors and pharmacists, properly trained in nutrition, have studied under-nutrition and malnutrition, and their effects on the health of the populations and the economy of their countries. Later, in cooperation with all departments concerned, they have realised a number of applied programmes, aiming at a real improvement in the situation or even the eradication of nutritional deficiencies. However the article deals mainly with actions related to food production and distribution, from the establishment of a national food policy to agriculture planning and evaluation, including specific, applied nutrition programmes in agriculture development and supplementary feeding programmes.

The inhabitants of Mala Kladusa are mostly refugees from Cetingrad and Dreznik, and between 1790 and 1878 they had chances to cure more than 1200 wounded and a few thousand ill people in barber's shops in Gornja and Donja Baraka. Gornja and Donja Baraka are good places for hospital (barber's shop) because they are near the river Kladusnica, and in the wood. In barber's shop worked a barber who cured people and also prepared cures from local herbs. Also barber's wore bags with cures and medical instruments, and had duty to help people even if it was against law or patient was poor.

Protestant and Roman Catholic missions pioneered Western medicine and public health in much of Africa decades in advance of health services provided by colonial governments. A century later church-based hospitals and health care programs continue to account for 25% to 50% of available services in most African countries. In view of the important historical and continuing role of medical missions it is remarkable that there have been no systematic scholarly studies of the impacts of these pioneer institutions on the geography of health and social change in colonial Africa. How, for example, was the health of African populations and the areas they inhabited changed by the activities of medical missions? And how did Africans respond to Western medicine and its alien institutional social and technological structures and relations? This paper develops the historical context and conceptual framework for investigating such topics. It presents a detailed research agenda organized around nine themes, each of which suggests a series of interrelated questions. The methodology employs the techniques of medical and historical geography, and is based on comparative, longitudinal case-studies of medical missions at the local level coupled with archival study.

Organized health service in Bosnia and Herzegovina practically started by the treatment of the sick in the Hadji Sinan's Tekke that was founded in 1768. Before that, the civilian population had been mainly treated in their homes, while the army were treated in barracks or hired hans (inns). As late as the nineteenth century, health care was provided by quack doctors, treating physicians or surgeons and barbers, who were trained, beside the circumcision of male children, for tooth extraction, broken bone setting, and sometimes even for performing minor surgical operations (a specially trained barber called djerah). The first trained medical personnel were the Franciscans and Jews, who studied at the Universities of Italy, Austria, Hungary etc. The first Muslim trained physicians studied at the Medical Faculty in Istanbul. The first ones were: Dr. Mehmed Serbić and Dr. Zarif Skender, while the first Bosnian graduate in pharmacy was Jakov Sumbul. In Sarajevo and Bosnia and Herzegovina worked many a doctor who came from abroad. The majority of them converted to Islam and worked in the barracks, and later on in the Turkish Military Hospital when it was founded in Sarajevo. All of them played an important role in the prevention and treatment of the most frequent mass infectious and non-infectious diseases that were raging among the population--plague, cholera, syphilis, leprosy, tuberculosis, fungoid diseases etc.