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La souveraineté de l’État a déserté de nos jours le périmètre strict de l’ordre westphalien. L’État doit désormais protéger non seulement les intérêts, mais encore l’existence de sa population. Or le droit suffit-il pour assurer cette sécurité et cette tranquillité des individus ? La puissance publique n’est-elle pas parfois à la source de la violence de masse ? Cet article se propose d’en examiner un exemple en se penchant sur la réintroduction de la poliomyélite en Syrie par nul autre que le pouvoir lui-même. Et, dès lors, faut-il élargir le périmètre de la violence de masse et du meurtre collectif aux maladies infectieuses, à la famine et aux mauvais traitements ? Le stress post-traumatique résultant de l’expérience d’une épidémie de grande ampleur ne doit pas être oublié. Or, si les maladies infectieuses collectivisent l’histoire, le traumatisme l’individualise. Car nous voulons connaître le nom et le prénom des victimes et des bourreaux. L’histoire est dès lors un jeu d’échelles. Nowadays, the sovereignty of states is no longer limited to the strict confines of the Westphalian order. States do not only protect their own interests now but also the very existence of their populations. However, is the law a sufficient protector of individual peace and security? Aren’t public authorities the occasional originators of mass violence? This article will explore an example by examining the reintroduction of poliomyelitis in Syria by none other than the actual public authorities. As a result, should we expand the scope of mass violence and collective atrocities to include infectious diseases, famine and mistreatments? Post-traumatic stress as a consequence of a large scale epidemic should not be overlooked. Infectious diseases lead us to view history on a global level, but trauma brings it down to the individual level as we look to know the first and last names of both victims and perpetrators. As a result, history operates on various scales.

Depuis August Hirsch (1881), on appelle pandemie grippale une epidemie de grande ampleur se propageant de maniere exponentielle, avec des taux d’attaque eleves et une marche epousant les voies de communication terrestres et maritimes (puis aeriennes). La pandemie de 1889-1890 – dite grippe « russe » – est la premiere dont on peut demontrer la dissemination sur l’ensemble du globe. L’un de ses caracteres les plus marques tient aux recurrences de l’infection, lesquelles, jusqu’en 1895, occasionnent une mortalite superieure a celle causee par la pandemie initiale. La grippe « espagnole » a ravage la planete entre avril 1918 et avril 1919. Un taux de mortalite dix fois superieur a celui de la grippe « russe », une proportion importante de complications, une incidence tres haute chez les 5-15 ans, les plus de 75 ans declarant au contraire un taux de letalite inferieur a celui de la periode pre-pandemique, pres de la moitie des deces chez les 15-40 ans, trois vagues successives a bref intervalle (huit a neuf mois), la deuxieme ayant cause des epidemies simultanement dans les deux hemispheres. Les moyens medicaux etant requisitionnes par l’armee, la population civile a bien souvent manque de tout : lits, medecins, infirmieres, ambulances. Alors que 1918 fait exception dans la serie, les deux episodes de 1957 et 1968 rendent une image assez fidele de la douzaine de pandemies repertoriees depuis le debut du xviiie siecle. Ils se rangent a l’appui de la theorie qui tient la gravite des pandemies dans l’histoire pour inchangee ou declinante (le cas de 1918-1919 reserve), stabilite ou declin lies en partie aux progres social et medical mais aussi au « choix » du virus qui semble privilegier sa transmission aux depens de sa pathogenicite. En face, des Etats mal prepares. Ainsi, en France comme aux Etats-Unis, on vaccine trop peu, trop tard.

According to David Fidler, the governance of infectious diseases evolved from the mid-nineteenth to the twenty-first century as a series of institutional arrangements: the International Sanitary Regulations (non-interference and disease control at borders), the World Health Organization vertical programs (malaria and smallpox eradication campaigns), and a post-Westphalian regime standing beyond state-centrism and national interest. But can international public health be reduced to such a Westphalian image? We scrutinize three strategies that brought health borders into prominence: pre-empting weak states (eastern Mediterranean in the nineteenth century); preventing the spread of disease through nation-building (Macedonian public health system in the 1920s); and debordering the fight against epidemics (1920-1921 Russian-Polish war and the Warsaw 1922 Sanitary Conference). Resumo Segundo David Fidler, a gestão de doenças infecciosas entre meados do século XIX e e o XXI guiou-se por uma série de acordos institucionais: Regulamento Sanitário Internacional (não interferência e controle de doenças em fronteiras), programas verticais da OMS (campanhas de erradicação da malária e varíola), e posicionamento pós-vestefaliano além do estado-centrismo e interesse nacional. Mas pode a saúde pública internacional ser reduzida à tal imagem vestefaliana? Examinamos três estratégias que destacaram as fronteiras sanitárias: prevenção em estados vulneráveis (Mediterrâneo oriental, século XIX); prevenção à disseminação de doenças via construção nacional (sistema público de saúde macedônico, anos 1920); remoção de fronteiras no combate às epidemias (guerra polaco-soviética, 1920-1921 e Conferência Sanitária de Varsóvia, 1922).

We present here the proceedings of the 5th seminar on emerging infectious diseases, held in Paris on March 22nd, 2016, with seven priority proposals that can be outlined as follows: encourage research on the prediction, screening and early detection of new risks of infection; develop research and surveillance concerning transmission of pathogens between animals and humans, with their reinforcement in particular in intertropical areas (“hot-spots”) via public support; pursue aid development and support in these areas of prevention and training for local health personnel, and foster risk awareness in the population; ensure adapted patient care in order to promote adherence to treatment and to epidemic propagation reduction measures; develop greater awareness and better education among politicians and healthcare providers, in order to ensure more adapted response to new types of crises; modify the logic of governance, drawing from all available modes of communication and incorporating new information-sharing tools; develop economic research on the fight against emerging infectious diseases, taking into account specific driving factors in order to create a balance between preventive and curative approaches.

International audience

Review of: Josep L. Barona. 2019. Health Policies in Interwar Europe. A Transnational Perspective

The concept of global health security underpins the current framework for global preparedness and response to emerging infectious diseases. (1-5) The Global Health Security Agenda--a collaboration between governments--was launched in 2014, aiming to make our interconnected world safe from infectious disease threats. The governments involved in the Global Health Security Agenda focus on strengthening their countries' capacities for detection, response and prevention. (6) In the context of public health emergencies, the Agenda has received financial and political support from international organizations and almost 50 countries. (6) However, there is tension between the aims of global health security and governments' mandate to ensure national security. The 1994 United Nations Development Programme's Human Development Report first introduced the concept of human security, referring to security of citizens as individuals rather than that of the states in which they live. We posit that the use of the term global health security can have a negative unintended effect on the ultimate goal of improving health for all. There are three reasons why this term potentially privileges the security of the state rather than the security of individuals. First, global health security, in its current use, is largely focused on protecting high-income countries against public health threats coming from low- and middle-income countries. (8) Ebola virus, Marburg, Zika virus, dengue, chikungunya, Riff Valley and Lassa fevers, originated in low--and middle-income countries. If the Agenda is used to prioritize global health risk depending on the origin of infections, resource allocation may become even more skewed towards high-income settings. To ensure that a health security agenda is an integral part of national and foreign policy of each country, political attention and coordination between national ministries is needed as well as support from the national security budget. Second, global health security tends to emphasize disease containment to protect national security rather than the prevention of future local outbreaks. Disease containment is common practice in the control of emerging infectious diseases. A national security perspective often results in unilateral, neo-colonial and/or short-term solutions designed to protect national borders. For example, many countries and airline companies imposed travel restrictions during the 2013-2016 Ebola virus disease outbreak in western Africa, contrary to World Health Organization recommendations. (9) Third, we argue that respect for human rights and values such as equity and solidarity should underlie each national security agenda. Such values are consistent with the motives of many people who provide health services in public health emergencies. Health security agendas should aim to build resilience to future outbreaks of infectious diseases, and require a long-term systems approach based on surveillance and national health system strengthening. Protecting the world from infectious disease threats requires that national governments share the responsibility of serving those most in need, wherever they live. We believe that the concept of global health security should be expanded to include solidarity and sustainability. …

International audience

Rehabiliter le faubourg ouvrier, ce “milieu anti-biologique”, tel fut l’un des problemes brulants qui ont occupe la carriere d’Edouard Fuster. Ni socialiste ni meme veritablement liberale, son approche a lui etait toute entiere determinee par la science pasteurienne mais aussi par un profond souci spirituel, un christianisme pratique, veritable fil conducteur de sa philosophie sociale, bien dans la ligne de l’Ecole leplaysienne. Nomme secretaire general de l’Alliance d’hygiene sociale en 1903, il donne ses impulsions decisives a la mutualite francaise. C’est la qu’il scrute l’habitat et l’alimentation populaires, la vie des femmes du peuple et singulierement des meres, les ravages de la tuberculose. Comparee a la protection sanitaire des quartiers ouvriers de New York, comparee surtout a l’hygiene sociale allemande, la France fait mauvaise figure. La famille populaire francaise est a reinventer, mais a reinventer par le medecin. Reeduquer, prevenir, c’est ce que Fuster s’efforcera de realiser a Plaisance, Paris, dans le cadre de l’Institut Lannelongue de Vanves.

En 1918-19, la grippe « espagnole » a tué entre 2,5 et 5 % de la population mondiale (entre 30 et 50 millions de morts). Image quintessenciée de l’épidémie moderne, presque tous les scénarios pandémiques s’accordent aujourd’hui pour y voir le modèle d’une pandémie « sévère ». Peut-on toutefois sérieusement comparer le risque pandémique actuel à ce qui reste comme l’un des pires cataclysmes sanitaires de l’histoire ?, The 1918 pandemic is still unique in the history of flu pandemics. The pathogenicity of the virus was extreme, and young adults more than infants and old people were its main victims. Many a death was caused by complications. The response of the French authorities didn’t live up to the emergency requirements. Hospitals being requisitioned by the military, the civilian population lacked everything: beds, doctors, nurses, ambulances, drugs. For want of preventive or curative medicine, authorities could have done very little at any rate: public health measures (quarantine and isolation of the sicks) were unable to stop contagion. More than the war itself, present day historians indict the war-boosted increase in railways and sea communications between the continents and between the rear and the front. This momentous growth in transportation activities brought about a « bacterial equalization » throughout social categories and regions of the world. A most singular episode, whose historical chances to replicate within the next ten years are rather slim.

Besides industrialization, with its rapid economic growth, and urbanization, with its disruption of environmental health, did the advances made in social medicine also depend on the relation between health and development in the more traditional economies of eastern and southern Europe? In the 1920s, countries in this region strongly advocated rural health, and this had a strong impact in international public health circles. The diverging uses of the concept of social medicine by the Belgian, Rene Sand, and the Yugoslav, Andrija Stampar, are examined. Despite their common attitude towards private medicine and their shared intellectual background, these two eminences in social medicine worked out their own orientations. For Sand, social medicine had more to do with the family and workplace, whereas, for Stampar, the village was the ultimate target of health programmes. Health education thus took on different meanings for the two men. For the first, it entailed advertisements, films, and the means of propaganda used by US government agencies and philanthropies, whereas, for the second, it took a populist turn that entailed 'folklonzing' public health through patriotic songs, customs, and folkways. Given this East-West divide, how did the strategies based on rural health affect the worldwide development of social medicine in the 1930s?

Food safety is an ever more conflictive issue receiving media attention. “The increased activity of interest groups, the impact of the Common Agricultural Policy and changes in the retail economy have combined to transform [a relatively closed] food policy community into an issue network”.1 This account of recent changes lacks the historical dimension that might endow it with meaning. It is hardly appropriate to describe the current situation as a reawakening after a long slumber. In France at least, complaints about food safety voiced in numerous newspaper articles echo enduring concerns and a permanent sense of alarm.2 In 1957, Demain ran a catalogue of food scares: industrial bread causing eczema; wine adulterated with sulphur anhydride (for safe transportation); eggs and milk feared by doctors to be toxic (because chickens were being fed with chemicals or fish, and cattle with ground up rubbish); and filthy conditions on cattle and poultry farms. Much the same sort of list could have been drawn up early in the century during meetings of the Societe Scientifique d'Hygiene Alimentaire (created in 1904), or run in the press following passage of the 1905 Food Adulteration Act, or printed in popular pamphlets such as Dr Raffray's Le peril alimentaire (1912). As the Common Market took shape in the 1960s, repeated articles in the daily newspapers relentlessly focused on the issue of food and public health. In France, arguments were continually framed in the language of the 1905 act.3 The present media focus on this issue is not, therefore, something new. But what about the politicization of food safety? When, given an outbreak of foot-and-mouth disease, the British government suddenly considered, in March 2001, vaccinating potentially exposed animals instead of slaughtering them, this unprecedented policy switch sparked debate. According to the New York Times, “the discussion [was] laden with scientific dispute, political maneuvring, national pride and the bottom-line question of the long-term economic impact of vaccination on powerful farm lobbies”.4 Since public authorities could not effectively handle the outbreak, a policy field became a politicized issue instead of remaining an ordinary, functional matter of regulation. But was this so very exceptional? Or, on the contrary, had it often happened before? The issue of food safety brings food production techniques and epidemiology face-to-face with culture and politics in a context where national administrations no longer exercise full control. Policy-making about food safety does not just fuel conflicts of interest; it also feeds on radically incommensurable ideas about food, since arguments about technical standards may be grounded in divergent values and opinions about the degree and type of interdependence between values and facts. Standards thus become agonistic in that experts can use them as strategic arguments. This might explain why central authorities have less impact on defining food safety policies than border clashes between national public opinions and conflicting influences and interests—why international public health may well be called “agonistic sanitarianism”.5 Although focusing on food policy through the lens of international relations risks blurring domestic factors in full or in part, it will help us to glimpse the critical role of values in this policy field. Explanations might be formulated in line with the frequently drawn distinction between “high” and “low foreign policy”—the former about national security matters, the latter about secondary issues. This distinction, however, separates all sorts of technical issues from foreign relations in general. True, public health per se did not encroach on the domain of high foreign policy, apart from the significant exception of the western powers' struggle against epidemics in central and eastern Europe in the aftermath of the First World War. At the end of the nineteenth century, the “pork war” (an episode discussed hereafter) between the United States and certain European countries provides us with another exception. “Not even the Spanish-American War”, commented James Cassedy, “nor the question of Samoa seemed to disturb United States–German relations as much as the problem of German restrictions on imports of American pork”.6 Public health is all the more likely to interfere with “high foreign policy” when countries are not committed to general rules for dealing with such issues in their own right. For this commitment to be made, an orderly procedure—including a set of sanctions—for discussing grievances and settling misunderstandings among nations must be worked out. Ultimately, such rules and procedures signal that nations recognize that their actions in public health are a matter of mutual concern and not merely of domestic policy.7 When did this recognition arise in Europe? How strongly have nations adhered to general rules for food safety? What factors have prevented them from adopting a single orderly procedure for dealing with food safety? Let us examine these three questions.8

Creee en 1913, la Fondation Rockefeller se voulait le garant du « bien-etre de l’humanite ». L’envoi d’une commission pour la prevention de la tuberculose en France en 1917 marque un tournant dans l’action humanitaire des Etats-Unis pendant la guerre. En cinq ans, plus de 400 dispensaires seront crees, 79 departements dotes d’un comite antituberculeux. La moitie des dispensaires en service en 1940 fonctionnait en 1922 au moment ou la commission cessait ses activites. Phare des nations latines, la France constituait une parfaite tete de pont pour diffuser les methodes americaines en Europe centrale et dans les Balkans. Vingt ans apres, la Fondation regardera la lutte antituberculeuse comme ayant joue pour la sante publique en France un role important. Important, mais non decisif. Au total, l’aventure francaise, jugee trop ambitieuse, restera une exception dans l’histoire de la Fondation.

By the middle of the nineteenth century, the link between swamps (miasmas) and fevers appeared to be well established. The study of malaria was thus based on typical malarial landscapes—the marshes—in North America and Western Europe and on the cycles and intensity of transmission characteristic of Plasmodium vivax (tertian fever). However, this model could not explain the history of infection in other regions of the world where mosquitoes reproduced, not in marshes, but in mountain streams, tidal floodplains or hoof-print size puddles. The subject of this book resembles first of all a geo-history devoted to retracing the shifting distribution of malaria, a geo-history which borrows from these earlier authors on malaria. Secondly, it resembles an epidemiological history, retracing, over a very long period, the transformations in the nature and meaning of the infection in the course of its intercontinental migrations from Africa to Europe, then to the Americas, until the disappearance of malaria from the temperate zone. It is an historical epidemiology which quite logically takes an ecological perspective. Here, the units of analysis are the three main zones of malarial infection. The first, dominated by P. falciparum, is geographically limited to Africa. Mortality there is essentially among children under five years old. In the zone where vivax predominated, attacks occurred primarily in the summer. Mortality was rarely above one per cent: “Vivax was the great debilitator, not the great killer.” The zone of mixed infections was located between the first two, from southern China to the Mediterranean basin, by way of the subcontinent. Although mortality and morbidity were lower than in the zone where falciparum predominated, they could none the less reach very high levels when populations had no acquired immunity. Ecological history and cultural history are closely intertwined. Humanity’s burden identifies three main types of correlation between cultures and landscapes. The first was a pattern of avoidance (East Africa, the Balkans, Central and South America) where populations of the high plains avoided all contact with lowlands during the transmission season. More generally, in agricultural societies, the elites often stayed away from zones of malaria where workers of low social status were concentrated (slaves, serfs, untouchables). The second type was the opposition—disputed by some—between nomads and agriculturalists, the former keeping well away from the latter during the season when the mosquito bit. A third kind opposed agriculturalists and the forest people who remained unscathed by any contamination. By extending slash and burn cultivation (yams in tropical Africa, maize and manioc in the Brazilian forest), agriculturalists spread the infestation. Far from being isolated through disposition, “primitive” people were obliged to withdraw to the deepest forest because of the disease introduced by the agriculturalists. In all these cases, epidemiology and ethnicity were interwoven. The book is divided into two main sections organized according to an eminently Braudelian plan. The first section covers a very long history of the infection on the three continents. The second, with much shorter undulations, retraces the successes, but more often the failures, of science and of malaria policy as played out in eradication campaigns—in reality the “control” of transmission—from the end of the nineteenth century. A final chapter concentrates on the efforts in Africa with which, for better or worse, the name of the WHO is associated. A long chapter on treatment (quinine, opium) and on the “accelerators” of the diffusion of infection in the nineteenth century (migrations, colonization, transportation, war, drought and famine) separates the two sections. Humanity’s burden is testimony of a twofold success. The work offers a historico-epidemiological synthesis devoid of unnecessary technical language on a serious pathology of utmost importance in the world today. Epidemiologists, economists, anthropologists and students can draw on it with considerable benefit. It is also a very convincing essay on global history, both from inside (explaining the persistence of the virulence of the infection by studying the connections between different local epidemiologies) and from outside (integrating the advances in the social and natural sciences). The book is enriched by an abundant bibliography.

International audience; Healthcare workers (HCWs) can be an important source of transmission of influenza to patients and family members, and their well-being is fundamental to the maintenance of healthcare services during influenza outbreaks and pandemics. Unfortunately, studies have shown consistently low levels of compliance with influenza vaccination among HCWs, a finding that became particularly pronounced during recent pandemic vaccination campaigns. Among the variables associated with vaccine acceptance in this group are demographic factors, fears and concerns over vaccine safety and efficacy, perceptions of risk and personal vulnerability, past vaccination behaviours and experience with influenza illness, as well as certain situational and organisational constructs. We report the findings of a review of the literature on these factors and highlight some important challenges in interpreting the data. In particular, we point out the need for longitudinal study designs, as well as focused research and interventions that are adapted to the most resistant HCW groups. Multi-pronged strategies are an important step forward in ensuring that future influenza vaccination campaigns, whether directed at seasonal or pandemic strains, will be successful in ensuring broad coverage among HCWs.

International audience; Influenza epidemics occur regularly and prediction of their conversion to pandemics and their impact is difficult. Coordination of efforts on a global scale to control or reduce the impact is fraught with potential for under and overreaction. In light of the 1956 pandemic and more recently the SARS and H1N1 pandemics, the public health community took steps toward strengthening global surveillance and a coordinated response in keeping with the continuing memory of the tragedy seen in 1918. The scientific, professional, and technical resources of the 21st century are now advanced far beyond those then available. The H1N1 pandemic which commenced in 2009 progressed differently than predicted; its course was difficult to predict with any degree of certainty. Public responses to national immunization programs against the H1N1 virus have been weak. International movement of diseases can lead to creation of new endemic areas and continuous spread such as that which happened with West Nile Fever and Chikungunya. The lessons learned and the public and political responses to each actual or threatened pandemic will serve public health well in dealing with future challenges

Late disclosure of the large scale of sterilization practices in the Nordic countries created an outburst of scandal: did these policies rely on coercion? To what extent? Who in the end was responsible? Sterilization practices targeted underprivileged people first. The mentally retarded and women were their first victims. Operations were very frequently determined by other people's manipulative or coercive influences. Should the blame be put on the Social-Democrats in power throughout the period (except in Finland and Estonia)? Apart from Denmark, perhaps, local physicians and local services, more than governments, seemed to have strongly supported sterilization practices. Teetotalers and feminists shared responsibilities. How can one explain that eugenics finally declined? Based on a sound application of the Hardy-Weinberg law, the science of the eugenicists was correct. Was it politics? But uncovering of the Nazi crimes had only a very small impact on eugenics. Some authors underline the fact that the Nordic scientific institutions were particularly suited to liberal values. Others point to the devastating effect on eugenics once hereditarist psychiatry fell from favor in the middle of the sixties.

This dossier springs from a meeting of the network «Health in the Interwar years» held in Granada in April 2007. This international network, which it is loosely organised around the electronic list of distribution maintained by the spiritful dedication of Iris Borowy, from Rostock University in Northern Germany, had a first presentation meeting in 2003, which produced a book on Facing Illness in Troubled Times. Health in Europe in the Interwar Years, 1918-1939 1. There we tried to grasp the actual health experiences beyond political shifts and organizational changes of the time, taking a view on the forming of health statistics that remained as main quantitative sources for the period. This allowed for a nuanced approach to the European past and contributed to the better understanding of the several case-studies (on Yugoslavia, Spain, Macedonia, Germany or Palestine, among others) presented. The book produced a nitid view of health as becoming a firstclass political problem in the interwar years, full of questionings, rich in promises and burgeoning professional administrations, a space worth of further analysis. At a next informal gathering in Paris, at the occasion of the 2005 Conference of the European Association for the History of Medicine and Health, we decided that time was ripe for a second scientific meeting dealing with «Crises as opportunities for health?». We aimed to discuss aspects and initiatives of future developments that revealed themselves through the diverse critical situations lived during the interwar years in Europe, and their interconnecting links, by means of a plurality of singular, nation —or institution— centred studies. A selection of papers presented at the Granada meeting have been collected here, including a further one prepared independently that has been added because of its closeness to our subject. Thus, we present papers on Britain, Norway, Greece and Spain (two), as well as one on a Jewish organization in Russia and/or Poland and a further one on the activities of the main institutional international actor in public health of the time, the League of Nations Health Organisation.

In the nineteenth century, major epidemics raised border-related issues among people and animals. Cholera? The border between East and West. Cattle plague? The border between Tsarist Russia and Europe. Malaria? The frontier of modernization in the Balkans. The modern state has defined itself by its borders, whose complexity is a function of the state having become more complicated and organized.1 Public health has actively participated in this increasing complexity. Quarantines, international health regulations and delousing stations altered certain state’s relations with other states, as well as with its own society. France in 1822, Texas in 1910, or even the Germany of victorious bacteriology, are examples of modern health institutions spreading inward from the borders rather than outward from the center.2

Quand et pourquoi la grippe « espagnole » se retrouve-t-elle a la une de la presse parisienne en 1918-20 ? Quelles sont les motivations qui president a ce deplacement dont le but est de renforcer le contact entre le sujet, le media et le lecteur ? L’incidence du sujet sur les journaux suit tres nettement l’incidence de l’epidemie. Sont analyses successivement les noms donnes a la grippe en 1918-20, l’impact strategique de l’epidemie selon la presse, les figures du discours mediatique de la grippe, l’impact mondain et culturel de la grippe sur le traitement mediatique de l’infection, la comprehension medicale de la grippe « espagnole » et sa comparaison avec la grippe « russe » de 1889-92, l’etat du savoir en 1918 tel qu’il apparait a travers la presse, enfin le traitement journalistique de la crise hospitaliere d’octobre 1918.

The 1918 pandemic is still unique in the history of flu pandemics. The pathogenicity of the virus was extreme, and young adults more than infants and old people were its main victims. Many a death was caused by complications. The response of the French authorities didn't live up to the emergency requirements. Hospitals being requisitioned by the military, the civilian population lacked everything: beds, doctors, nurses, ambulances, drugs. For want of preventive or curative medicine, authorities could have done very little at any rate: public health measures (quarantine and isolation of the sicks) were unable to stop contagion. More than the war itself, present day historians indict the war-boosted increase in railways and sea communications between the continents and between the rear and the front. This momentous growth in transportation activities brought about a "bacterial equalization" throughout social categories and regions of the world. A most singular episode, whose historical chances to replicate within the next ten years are rather slim.

Late disclosure of the large scale of sterilization practices in the Nordic countries created an outburst of scandal: did these policies rely on coercion? To what extent? Who in the end was responsible? Sterilization practices targeted underpriviledged people first. The mentally retarded and women were their first victims. Operations were very frequently determined by other people's manipulative or coercive influences. Should the blame be put on the Social-Democrats in power throughout the period (except in Finland and Estonia)? Apart from Denmark, perhaps, local physicians and local services, more than governments, seemed to have strongly supported sterilization practices. Teetotalers and feminists shared responsibilities. How can one explain that eugenics finally declined? Based on a sound application of the Hardy-Weinberg law, the science of the eugenicists was correct. Was it politics? But uncovering of the Nazi crimes had only a very small impact on eugenics. Some authors underline the fact that the Nordic scientific institutions were particularly suited to liberal values. Others point to the devastating effect on eugenics once hereditarist psychiatry fell from favour in the middle of the sixties.

Le proces de Colmar (2005) a-t-il marque un inflechissement de notre jurisprudence concernant la transmission volontaire d’une maladie infectieuse ? Des 1905 sont proposes des projets de lois creant un « delit de contamination ». Sans succes. « Privilege » du juge civil dans les affaires de transmission d’une infection, tentative abolitionniste du regime de la prostitution, difficultes de prouver le lien de causalite, absence d’une legislation eugenique expliquent les raisons de ces echecs. Face a ces obstacles insurmontables, le « delit d’imprudence sanitaire » apparait comme une position de repli. Pourtant, dans le sillage de Colmar, les juridictions ont montre un indiscutable durcissement du droit en la matiere. Et si le combat abolitionniste, associe au delit d’imprudence sanitaire, avait montre la voie ?

This book investigates anti-malarial policies pursued in mandatory Palestine. It analyses the scientific and practical undertakings of the various agencies, mainly Jewish and British, which worked with a view to reclaiming landscapes from marshes and abating endemic malaria. The author’s main thesis suggests that the anti-malaria campaign highlights the “relationship between health and nationalism or statehood” so dear to Zionists. The book offers a good empirical survey using materials and sources in Israeli archives, the Central Zionist Archives, the Joint Distribution Committee, and the Rockefeller Foundation Archive among others. Nationalist redesigning of the demographic and epidemiological landscape through malaria control has been widely researched lately by social historians of medicine. Linking science, health and nationalism was by no means unique to Zionism; rather it was common to various nationalist ideologies throughout the world. As emphasized in chapter 7, Palestinian doctors were also quick to claim such linkage for themselves, as an issue in cultural and political “self-realization”. But malaria campaigns were undoubtedly of paramount importance for the Jewish colonization of Palestine. According to the author, Zionists were anxious to demonstrate to the mandatory government that they had indeed made a garden from a wasteland. Assuredly, this was part of the Zionist world-view, extensively dealt with in chapter 1. Such a cultural approach, however, can be misleading in some ways. Extension of malarial marshes because of agricultural neglect and abandonment was merely time-honoured knowledge among many malariologists, especially in Europe. Accordingly, matching Zionist ideology against the existing state-of-the-art strategies of malaria control was what one would have expected. Arab peasants were thought of as obstacles to malaria control; was this representation a Zionist generated idea (the problem is the Arabs)? Or was it a time-honoured scientific notion (the problem is the peasants)? The book gives the impression that every Zionist protagonist, whether politician, public officer or scientist delivered the same ideological discourse. But Zionist discourse on malaria was motivated not only by politics, or by science as politics in disguise, but also by science qua science. It took some time for malariology to become less inimical to peasants than formerly. Present-day critics of ideologies are frequently at risk of being anachronistic. Science is not to be thought of as simply cloaking political interests. Science is the way political actors see things when those things are populations, diseases and landscapes. Landscape is the key word of the book. Landscape is considered as archetypal (the Zionist Weltanschaaung), pathological (geography of malaria in Palestine), potential (reclamation projects), technological (two case-studies), perceptual (the “medicalization” of Palestine), cultural (health education) and contested (malaria as a symbol of the Palestinian/Zionist conflict). This gives the book a robust conceptual framework. Sufian could have referred to Michel Foucault, since landscape is nothing more than Foucault’s “dispositive”, that is, a rather heterogeneous set of discourses, institutions, technical devices, administrative measures, and cultural practices from which come change and variation. Through “landscape” we can see in the end how opposite camps strove to capture health as a most valuable political asset. The richness and the quality of the photographs, maps drawn by contemporaneous health agencies and health education documents put a premium on a book that will be an important resource to those interested not only in the history of the Middle East but more generally to students of the relationship between health and development.

Too little attention has been paid to the fact that the birth of scientific racism is contemporaneous with two other theories to which it is closely related: totemism and hysteria. All three follow the same themes and the same evolution. Hysteria moves man (woman in this case) closer to animality, in exactly the same way as totemism does. Racism dwells on external or internal accidents of fate (mental retardation, heredity, alcoholism) supposedly responsible for significant differences between social groups. As with hysteria, racism makes use of sexual determinism and, as with totemism, it is interested in physiological paternity. It is this metaphor for nature, or this “parti de la nature”, as Claude Levi-Strauss calls it, a veritable “touchstone enabling the segregation of the savage from the civilized within culture itself”, which is addressed by some twenty contributions to this pioneering volume, half emanating from Central and Eastern European researchers. The little-understood contribution of local eugenicists, their concept of the nation and their role as experts, are explored by these writers through the history of the sciences, medicine, the social sciences and through cultural and political history. And more importantly, they examine the particular way in which German, British or French eugenics, not to mention Italian biotypology, were “redesigned” in order to adapt them to new contexts. The editors tell us that in Central and Eastern Europe, eugenics and national racism were the cornerstones used in building the nation and the state. Far from giving in to the siren call of the forces of reaction, this “parti de la nature” brought together two modern and highly toxic substances: eugenics and ultra nationalism. And doubtless the rise, in the wake of a Nazified Germany, of racist nationalisms during the 1930s in Hungary, Bulgaria and Romania, and the racist rantings of certain Croatian ideologues also broadcast the familiar and sinister message. But was this radicalism in speech really useful as ideological cement for the State? Herein lies one of the important issues addressed by this book. In Estonia for example, the ideological mountain inspired by Germany gave birth in fact to a mouse “in the Scandinavian model”. Everywhere, people were getting carried away: sterilization! legal castration! eugenic abortion! And what next? In Hungary before Horthy (1920), eugenics was merely a chapter in social medicine; in Bulgaria, where eugenicist extremism was inspired by the exterminating lunacy of a Binet-Sangle, the State adopted a marriage law of Nazi inspiration but with only the prenuptial certificate surviving; in Poland, where eugenicists took over the Ministry of Health created in 1918 (abolished six years later), the church and indifference on the part of politicians aborted the adoption of the medical examination prior to marriage; again in Poland, the same Jewish physicians who were infatuated with social Darwinism (under the pretext that eugenics would have secured an excellent defense against assimilation) nevertheless lined up behind a proposal for a very moderate programme of preventive and positive eugenics. The conclusion is unavoidable: radical views produce modest achievements. The stilted method of examining countries individually runs the risk of simply finding repetitions. Yet, in this case, some good comes out of this shortcoming. Indeed, it is clear that everywhere and in each case, “eugenics has been characterized by a discrepancy between the utopian character of its ambitions and the actual possibilities for the realization of its projects”. Everywhere, except in Vienna. Of course, Vienna is Catholic; the Vienna of the Standstaat could not have gone beyond the prenuptial certificate, “modest instrument for the relatively pain-free integration of eugenics in the ‘Catholic milieu’”. And neither could socialist Vienna, which would never have gone over to the other side of the mirror. Still, long ready for the worst, thanks in particular to its university chair in anthropology, Nazi Vienna would not have such scruples following the Anschluss. From 1938, the innovative creation of a Department for Policy on Heredity and Race marked the beginning of the large-scale implementation of Austrian racial policy. This included the register of heredity, bringing together 767,000 files in March 1944, 6000 sterilizations (an estimation) between 1940 and 1945, 3200 people transported and euthanized at the Steinhof (the largest psychiatric hospital in the city) in the summer of 1940, 1850 children incarcerated at the Spielgelgrund, 789 of whom were killed by poison, lack of care, hunger or infection. Nothing escaped the Viennese. Bertrand Russell believed that “what stands in the way (of introducing eugenic measures) is democracy”. The author of Marriage and morals (1920) certainly did not know that in 1919, opposed to German racial hygiene, a democratic and progressive eugenics became the “official doctrine” of the newly formed Czechoslovakian Republic. And it was in Prague, starting in 1933, that the opposition of German-speaking biologists to Hitlerian racism was organized.

The coming of age of international health history is attested by the increasing number of scholars studying the relationship in various countries between US philanthropies and science and medicine, investigating global organizations, or embarking on such topics as borders and health. Latin America, Russia, Europe and India have recently been the main areas under scrutiny. Anne-Emanuelle Birn's excellent and highly readable Marriage of convenience is one more example of the growing success of this research programme, initially developed in 1991 at a conference on ‘Science, Philanthropy and Latin America’ sponsored by the Rockefeller Foundation and Indiana University Center on Philanthropy (see Marcos Cueto, Missionaries of science, 1994). The book under review pays special attention to the local reception of and response to US philanthropy. It may be read as a history of Mexican public health in the post-revolutionary era as well as an investigation into one of the Rockefeller Foundation's most significant ventures. Neither of these issues, however, is central for Birn. Rather, it is the long-lasting, fruitful and conflictual encounter between Mexico and the Rockefeller Foundation which is crucial. From the 1920s to the 1940s, the Foundation conducted a high-budget yellow fever campaign along the Gulf of Mexico and a far-reaching (though much less expensive) hookworm disease eradication campaign in the centre and in the south of the country. It established local health units in three states, sent sixty-eight public health fellows to North American universities and trained about 600 health workers in two training stations founded in Mexico. The relationship proved to be an “elastic and mutually beneficial marriage”. Imperialism, charity (international assistance), catalysis (foreign intervention to boost development), coincidence (foreign aid as a concomitant factor in the process of endogenous modernization), these are all concepts that explain such a relationship only to a certain extent. Accordingly, the book offers a fresh interpretation, which highlights interaction and competition alike between both partners. Birn explores the inherently national and nationalistic nature of modernity. Just as the creation of the Rockefeller charities had aimed to placate populist critics of Standard Oil, the intervention in Mexico was motivated by the necessity to ease tensions aroused by US invasions in 1914 and 1916. Birn rightly describes Rockefeller intervention in Mexico as a sort of “ersatz diplomacy” aka “invisible diplomacy” elsewhere (France). Of course, public health campaigns were put on display in order to protect foreign assets. But the Foundation took the nationalization of oil in 1938 as an opportunity visibly to demonstrate that its activities and commitment to Mexico were by no means connected with business interests. In appearance, the “Good Neighbor” policy of the mid-1930s might be regarded as a logical outcome of the Rockefeller Foundation strategy towards Mexico. Unlike Porfirio Diaz's regime, the post-revolutionary republic blended a pre-existing sense of ethnic heritage with the revolutionary values of political participation and autonomy. A militant intelligentsia keen on social medicine favoured a “vernacular mobilization” of Indian culture, associated with the spread of medical services in agricultural cooperatives (ejidos). The Rockefeller Foundation officers never felt at ease with this bottom-up nationalism. Another nationalist vision, the top-down building of a nation-state, united the Mexican medical elite and the Rockefeller officers. Heirs of the Porfiriato cientificos, although with a profoundly new face, and forerunners of the tecnicos of the 1970s, though with a socialist-populist ideology, well-educated doctors (thanks to Rockefeller fellowships) peopled the higher ranks of central public health bureaucracy. This double-barrelled nationalism helped bring about a more moderate sense of national identity among doctors whose traditional anti-Americanism had been aroused by the demanding standards imposed by the Rockefeller officers in their newly established health units (training, full-time commitment). It also helped to defuse the resistance of the rural population. Although by no means hostile towards the health units, villagers sometimes reacted with violence at the implementation of sanitary measures (smallpox vaccination, quarantine, DDT spraying). Certainly, Mexican and American physicians clashed more than once: upon the interpretation of the determinants of hookworm disease, and about the operating principles of the sanitary campaigns and the rural health service. Nevertheless, bureaucratic interest and a thirst for international prestige tied the modern professionalized state to US philanthropy. A proper balance was successfully achieved between Rockefeller aid and the preservation of the country's sovereignty—what Birn aptly calls “Rockefeller with a Mexican face”. In the end, did “Mexico shape the Rockefeller Foundation”? The Foundation's original style of governance remained untouched in many ways. In its usual manner, it played an “influential role” in Mexico, though “not a dominant one”. New York chose to circumscribe its activities to a limited section of the country and to a limited range of health problems. This does not deviate in the least from the road taken by the Foundation in 1915: “to pick up small things and do small things”. Birn would have it that “in Mexico, health revolutionaries and the [Rockefeller Foundation] took public health to be a technical force residing at the intersection of state building, economic growth, and material betterment” (p. 237). The question is, how can we reconcile this functionalist description (from politics to expertise) with the elitist nationalism that transformed technical issues into contentious high politics? In Mexico by and large, the Rockefeller Foundation's methods were remarkably similar in their patterns to those set in motion in the New South, or even in France for that matter. As the book itself demonstrates, the Foundation would first display ambitious campaigns (yellow fever, hookworm, tuberculosis), only subsequently to establish modern health units with exclusive and full-time personnel. And the whole effort would be embedded in a grand strategy of rural betterment, which the Foundation wished to spread throughout the world. This book will set the pace on the subject for many years to come. It is arranged with extraordinary care (not a single error could be found in the French references) and written in an inviting style, making it a real pleasure to read. Last, but not least, are the richness and high quality of the illustrations (apart from the map on p. 35, difficult to interpret).

Although it was one of the most influential public health agencies of the twentieth century and the best-endowed branch of the Rockefeller Foundation, the history of the International Health Division (IHD) has never been told so far. From his forays into the records of the Division, John Farley gives a fairly detailed account of the transnational disease campaigns that it conceptualized for the first time under the rubric of eradication. A “tribute” to the malariologist Lewis Hackett (p. 300), To cast out disease is at its best in the central chapters on hookworm, yellow fever and malaria. Farley makes no mystery of it; he believed from the start that the IHD was “more or less the American equivalent of the British Colonial Medical Service” (p. vii). This is understandable, coming as it does from the author of Bilharzia: a history of imperial tropical medicine (1991), but this perspective is somewhat misleading.

Butler et al 1 report convincing results confirming that the availability of HIV prevention tools, such as condoms in prisons, does not increase sexual activity among inmates but rather increases safe sex. These results represent a major step towards negating the widespread belief that the general availability of prevention measures in prisons increases at-risk practices associated with HIV, hepatitis and other sexually transmitted infections (STIs). Indeed, similar ad hoc studies regarding the availability of needles and syringes …