Marie-France Vouilloz-Burnier and Vincent Barras, De l'hospice au réseau santé: santé publique et systèmes hospitaliers valaisans XIXe–XXe siècles, Sierre, Editions Monographic, 2004, pp. 441, illus., €32.00 (paperback 2-88341-109-3)

Autor: Lion Murard
Rok vydání: 2007
Předmět:
Zdroj: Medical History. 51:254-256
ISSN: 2048-8343
0025-7273
DOI: 10.1017/s0025727300001289
Popis: Published at the instigation of the Valais public health service, De l'hospice au reseau sante has all the merits and shortcomings of a local monograph. Its use of archival sources is ample: medical biographies, picturesque reports on “rhabilleurs” (bonesetters), “meges” (charlatans) and other healers using dormouse oil, fox fat or chamois suet, make this a truly valuable contribution to the study of health care in that small part of rural, mountainous Europe (63,000 inhabitants at the dawn of the nineteenth century, 250,000 today). On the other hand, written by and for the Valaisan people, this commissioned work disregards mainstream medico-social history (not a word about AIDS), opting rather for the disjointedness of an impressionistic narrative. Abandoned children, begging, midwives, friendly societies: the book is a mine of information, but the absence of a thoughtful introduction to more subtle concepts such as “bourgeoisie” applied to hospital management (certain hospitals took in only poor bourgeois, others only non-bourgeois) is all the more regrettable. The work is almost two books in one. Under the somewhat generous title of ‘A history of public health’, there is a short study (of about 100 pages) of health legislation and the attributions of the Conseil de sante (1807). This is followed by over 250 pages describing hospital provision and, more precisely, the painful transformation of the (non-medicalized) hospital-asylum into an institution administering care. The main value of the book is its evocation of a sort of ancien regime of care lasting until the 1960s. Although assistance for the sick was the responsiblity of the localities, the canton's hospital system was simply a loosely connected string of widely differing institutions—religious, communal, or initiated by a particular doctor—like island communities without a core. Until the period between the two world wars, Martigny took in the elderly in exchange for a fee and participation in the maintenance work. Another curiosity was the rotation of local practitioners, who took turns to be the hospital doctor for one-year periods. In short, vagaries and diversity are apparent everywhere: Saint-Maurice treated foreigners who were passing through; Brigue and Martigny accommodated and fed them only in cases of extreme necessity; Monthey, intended for curable patients, nevertheless refused admittance to anyone with venereal disease, or the mentally ill or contagious; Bains de Loeche demanded a certificate of indigence as well as one of good conduct signed by the local priest or clergyman. The anti-centralization tendencies were so strong that the 1858 project for a cantonal hospital open to any Valaisian citizen, regardless of their commune of origin, was permanently blocked. And the state? It was totally absent here. The booming postwar economy pushed the fragmentation even further. For example, Brigue and Viege, only six miles apart, engaged in a fierce race to build new wards rather than splitting up specialities between the two sites. Overtaken by delusions of grandeur, the thirteen districts of the Valais thus joyously conducted thirteen separate hospital policies until the creation of the Reseau sante Valais in 2002. Indifference and disorder reigned throughout public health as a whole. The only period looked on kindly by the authors in the history of what was to become a Swiss canton (1815), is that of the Napoleonic years, when the Valais was first an independent Republic (1802–7), then the French department of Simplon (1810–13). Propagation of the smallpox vaccine, reform of the hospital accounting system, inquiry on the populations' health: order and Napoleonic rule contrasted sharply with the subsequent laissez-faire attitude. In fact, the entire book could be read as a lament for impossible centralization. The authors' sympathy clearly lies with those liberal, progressive doctors in the early nineteenth century, Hyacinthe Grillet and Maurice Claivaz, who, by constantly publishing advice on the preservation of health and advocating the development of education (“that of girls in particular”), followed in the footsteps of the Enlightenment. None the less, disease prevention turned into a “lost cause”, starting with the illegal practice of medicine. The Valais, “pledged to its religious principles”, closed and backward, was in this respect the laughing stock of neighbouring cantons. Critics “singled out” its apathy in combating epidemics (no measure was taken in 1830 against cholera, from which the canton believed itself protected by its pure mountain air), the lack of rigour of its medical exams (considered until the late nineteenth century as a “real joke”), and its strange insouciance regarding tuberculosis even though it had the highest mortality rate in the Confederation (18.6 per thousand in 1928, against the Swiss average of 13.5 per thousand). The most critical flaws were ethno-cultural antagonisms between the Upper and the Lower Valais, quarrels between neighbouring villages, rivalries between religious congregations. A cantonal public health service was created in 1917, but we are told that the doctor's post was “highly exposed” to endless criticisms. Consequently, a Federation of Anti-Tuberculosis Leagues was established only in 1931, a canton sanatorium in 1941 and a nursing school in 1944. The gradual secularization of health care was not initiated until 1960. Intense provincialism, government inactivity, and balkanization: are these features peculiar to the Suisse romande? The authors refer mockingly to the 1961 law as “the first health law of the xxth century”. Why not look further afield than their homeland, at France for instance, where the flimsy public health structure was also falling apart. Apparently for a young Valaisanne to study midwifery in Lausanne, Berne or Saint-Gall in the 1920s was to “exile herself”. But narrowness of horizons is the most common thing in the world, not unlike feelings of hostility towards general practitioners, or the “head in the sand” approach to social scourges (tuberculosis or syphilis) that it was hoped could be cured without their being recognized. What appears to be peculiar to the Valais is the excessive importance given to private initiative, above all denominational. It seems unbelievable that it was necessary to wait until 1945 for the school medical service created in 1907 to be equipped with an X-ray machine, thanks to private funds. As for the rest—the deep and fatal apathy of public opinion, the protracted ineffectiveness of governments—evidence suggests that Alpine Europe as a whole was hardly the poster child for prevention. Accordingly, the absence of a comparative dimension is felt all the more strongly.
Databáze: OpenAIRE
Externí odkaz: