George Weisz

From the 1960s, the World Health Organization (WHO) sought to reconcile ambitious international goals with scarce resources and the socioeconomic realities of low-and middleincome countries by developing a field called Health Systems Research (HSR). This field remained small, marginal, and largely confined to WHO during the second half of the 20th century. The WHO worked to promote HSR, apply it to concrete problems, and define its scope and methodologies while linking it to policymaking. Results were seriously limited by lack of interest from policymakers, confusion about its scope and methods, and competition from numerous disciplines working on overlapping subjects, notably economic analysis. This latter rivalry originated with debates about Primary Health Care versus Selective Primary Healthcare in the late 1970s and was overcome, rhetorically, in the late 1980s. Tensions however remained and by the end of the 20th century, economic analysis had temporarily triumphed at the WHO.

Dans les premieres decennies de la Troisieme Republique, lorsque le ministere de l'Instruction publique effectua de profondes reformes dans l'enseignement superieur, le recrutement universitaire connut une croissance considerable. De 11 200 environ en 1876, le nombre des etudiants passa a 42 000 vers 1914, soutenant favorablement la comparaison avec le taux de croissance des universites allemandes. L'augmentation des effectifs fut le resultat de nombreux facteurs, notamment les changements socio-economiques grace auxquels les carrieres ouvertes par les diplomes universitaires exercerent une attirance accrue sur le public, et les mesures administratives qui faciliterent l'acces a l'enseignement superieur. Deux nouveaux groupes d'etudiants les femmes et les etrangers constituaient ensemble 21 % des effectifs vers 1914 (1). Pour les grands universitaires qui soutenaient le mouvement de reformes, l'augmentation des effectifs apparaissait comme eminemment souhaitable. Tout etudiant supplementaire accroissait le budget universitaire en versant des droits et legitimait la demande de credits supplementaires de la part des doyens et administrateurs. Dans une perspective politique, cette expansion etait le couronnement logique des efforts de la Troisieme Republique pour imposer l'integration sociale a travers l'education. Afin de surmonter le divorce issu de la division de l'enseignement secondaire entre un secteur prive catholique et un secteur public laique il fallait soumettre le plus d'etudiants possible aux effets salutaires d'une education universitaire susceptible d'effacer les divisions sociales et religieuses. Pour faire passer cet ideal dans la realite des faits, les etudes universitaires devaient etre fondamentalement transformees. On effectua des reformes de structure et l'on proposa de nouveaux cours. Mais au-dela des programmes officiels, on esperait que les modeles de la sociabilite etudiante seraient modifies. A la place de l'individualisme traditionnel des etudiants, les reformateurs universitaires cherchaient a imposer la > et la vie communautaire. On comptait que les associations etudiantes deviendraient les instruments de cette socialisation. Nous analyserons donc les efforts des etudiants et des

Introduction: The institutional basis of French science in the nineteenth century Robert Fox and George Weisz Part I. The University: 1. The emergence of the Ecole Normale Superieure as a centre of scientific education in the nineteenth century Craig Zwerling 2. Reform and conflict in French medical education, 1870-1914 George Weisz 3. Educational qualifications and university careers in science in nineteenth-century France Victor Karady Part II. Technical education: 4. Education for the industrial world: technical and modern instruction in France under the Third Republic 1870-1914 C. R. Day 5. Apollo courts the Vulcans: the applied science institutes in nineteenth-century French science faculties Harry W. Paul 6. From 'corps' to 'profession': the emergence and definition of industrial engineering in modern France Part III. The advancement and diffusion of science 7. The development of the Museum d'Histoire Naturelle of Paris c. 1800-1914 Camille Limoges 8. The savant confronts his peers: scientific societies in France 1815-1914 Robert Fox 9. The prize system of the Academy of Sciences 1850-1914 Elisabeth Crawford Part IV. A Foreign Perspective: 10. The organisation of science and technology in France: a German perspective Peter Lundgreen Bibliography Index.

Page 1. Body Counts Medical Quantification in Historical & Sociological Perspectives I jm La Quantification medicale, perspectives historiques €t sociologiques Edited by / Sous la direction de Gerard Jorland, Annick Opinel, George Weisz k • f • Page 2. Page 3. ...

Background: This article presents a history of efforts by the World Health Organization and its most important ally, the World Federation for Medical Education, to strengthen and standardize international medical education. This aspect of WHO activity has been largely ignored in recent historical and sociological work on that organization and on global health generally. Methods: Historical textual analysis is applied to the digitalized archives and publications of the World Health Organization and the World Federation for Medical Education, as well as to publications in the periodic literature commenting on the standardization of international medical training and the problems associated with it. Results: Efforts to reform medical training occurred during three distinct chronological periods: the 1950s and 1960s characterized by efforts to disseminate western scientific norms; the 1970s and 1980s dominated by efforts to align medical training with the WHO's Primary Healthcare Policy; and from the late 1980s to the present, the campaign to impose global standards and institutional accreditation on medical schools worldwide. A growing number of publications in the periodic literature comment on the standardization of international medical training and the problems associated with it, notably the difficulty of reconciling global standards with local needs and of demonstrating the effects of curricular change.

This paper seeks to provide a systemic perspective on the development of medical specialization in France. Making use of information in medical directories of the period, it offers a quantitative analysis of developing specialization in Paris and the major provincial cities from 1880 to 1935. The first section examines the size and scope of the different specialties in 1884, 1905, 1920, and 1935. The second section analyses evolving patterns of linkage among specialties through the cases of multiple identification which occurred. The final part looks at the relative élitist character of specialties as measured by official hospital and faculty posts and membership in the Academy of Medicine. The conclusion suggests how these quantitative results might orient future research on specialization.

... Includes bibliographical references and index. ISBN 0-19-509037-3 1. Academie de medecine (France)—History—19th century. 2. Academie de medecine (France)—History—20th century. ... [DNLM: 1. Academie de medecine (France) 2. Societies, Medical—history—France. ...

France lagged several decades behind Germany and the USA in dealing with specialist certification. The reason for this delay, it is argued, has to do with the centralized, state-controlled structure of French medical institutions and with the lack of a powerful national professional association capable of taking on the task. Once such an association did appear in the late 1920s, debate within the profession began in earnest. Nonetheless, it took several years to define an acceptable form of certification from among several possible alternatives and many years more to implement the ambitious national system of state regulation that French doctors wished to introduce. Once the system was established in 1947, the attempt to set rigorous, national rules in a multi-regional and multi-institutional context provoked considerable difficulties and complaints.

DISEASE AND DEMOCRACY is the first compar-ative analysis of how Western democratic nations have coped with AIDS. Peter Baldwin's exploration of divergent approaches to the epidemic in the United States and several European nations is a springboard for a wide-ranging ...

ABSTRACT Bulletin of the History of Medicine 78.1 (2004) 232-234 This is not a long book. Made up of only six essays held together by a brief but incisive introduction, it nevertheless makes a useful contribution to the burgeoning literature on medical quantification. After briefly discussing existing literature on the subject (from a British and American perspective), the editors introduce an important distinction between simple quantification (what I would call "counting") and statistics using more sophisticated mathematical techniques. The essays that follow can be seen as exemplifying the movement from the first to the second in the British medical context. Phillip Kreager gets things started with a long and erudite essay on John Graunt's late seventeenth-century work on the London Bills of Mortality, often seen by historians as one of the first works of vital statistics. Kreager, however, sees this work as belonging to rather different traditions: Baconian natural history on the one hand, and what he calls "mercantile bookkeeping" on the other. If this was most definitely not "statistics," it was recognized, in Kreager's account, to be a "new way of reasoning of a general and potentially scientific kind" (p. 4). Perhaps the most original part of this analysis is the author's effort to place this new method within the framework of rhetorical analysis. Numbers, in other words, were not just mathematical entities but part of the ordinary language that sought to understand and convince. Andrea Rusnock looks at the work of Thomas Nettleton to similarly argue that eighteenth-century discussions about the risks and benefits of smallpox inoculation introduced a new kind of quantified argumentation in medicine. Like Kreager, she emphasizes the nonmathematical quality of this reasoning by calling it "Merchant's Logick." This method of argumentation, she suggests, became increasingly common in discussions of inoculation during the eighteenth century. Edward Higgs presents a "textual history" of the Annual Report of the Registrar General from 1839 to 1920, and describes the changing form and content of this seminal publication of public health statistics. He is generally in accord with the account of the evolution of this publication offered elsewhere by Simon Szreter, but while the latter explains the highs and lows of publication on the basis of large-scale changes in the nature of public health institutions, Higgs focuses on the managerial qualities of leading individuals and institutional policies. There has always been a tension in medicine between skill (the "art") and impersonal quantification. John Senior shows nicely that this emerged even in so technical a field as electrotherapy. Debate within the field pitted advocates of "metrology"—the use of precision instrumentation and standardized dosage—against the defenders of clinical experience as a criterion for determining exact electrical dosage. The essay makes it clear that simple distinctions between technology and clinical experience are insufficient for understanding changing medical practices, for technology can be understood as a simple extension of clinical experience. Karl Pearson lies at the heart of this book. Eileen Magnello's impressive essay provides an important account of the shift from vital statistics to mathematical statistics. The "bridge" between the two was Francis Galton—but it was Pearson who was the founder of mathematical statistics, introducing such innovations as standard deviation and the chi-square test. His techniques were gradually assimilated into both public health and clinical medicine through figures like Major Greenwood and his student Austin Bradford Hill. J. Rosser Matthews contributes to this story by returning to a subject about which he has already written, the debate between Pearson and Almroth Wright on the opsonic index. The debate nicely illustrates the conflict between modes of reasoning based, in the latter case, on physiologically based clinical research, and, in the former, on new mathematical modes of reasoning about populations. Despite the current dominance of Randomized Clinical Trials for therapeutic evaluation, the current furor over "Evidence-Based Medicine" suggests that this tension...