Homöopathie: Patienten, Heilkundige, Institutionen: von den Anfängen bis heute

particularly valuable chapter on some modem African medical men and their work, 1940-1960, and has more tables. It is especially aimed at those studying selected aspects of the medical history of Ghana in depth, who may wish to use it as initial source material. It is this book, particularly, that is covered by this review although much also applies to The history of western medicine. Stephen Addae is professor of physiology and lecturer in the history of medicine in the University of Ghana medical school. He is able, therefore, to bring to bear on his research and writing the perspectives of both a medical doctor and a historian, and he does so in a rewarding fashion. The broad historical framework is covered by two, inevitably brief, introductory chapters. The first is a survey of the status of health and disease on the west African coast between 1482, when the Portuguese built the Elmina castle, and 1878, when the first civil colonial hospital was built in Accra-shortly to be followed by others in the coastal towns. The second is a study of the way in which medical policy evolved between 1880 and the 1950s when the country became self-governing and then independent. To these chapters is added, at the end of the book, a valuable survey of medical institutions and public health services, bringing the story up to the mid-1990s. In this final chapter the author also highlights the damage caused by the initial failure in the 1960s to maintain the publication of medical data and the annual reports. Other chapters cover various aspects of the development of the public health service and include health, sanitation and laboratory services; medical education, training and research; and the formation of professional associations. There are also important chapters on the staffing of these services: the professional medical staff (including a section on women medical officers) and their supporting staff of dispensers, dressers, dispenser-nurses, nurses and midwives. Although internationally well known for his work on sickle cell diseases, Stephen Addae, interestingly, does not deal with these here. He does, however, devote individual chapters to some dozen other diseases, including malaria, smallpox, plague, trypanosomiasis, venereal diseases, yaws, yellow fever, tuberculosis and leprosy. Some of these chapters are tantalizingly brief, for example that on malaria and helminthic infections, the text of which covers less than two pages. He pays especial attention to the failure over the years to shift the policy emphasis from curative to preventative services, and the burden which this failure-common in virtually all developing countries, as elsewhere-has placed on successive administrations. The books are enriched by over two dozen tables and nearly a score of clear and well drawn charts and graphs in the text. Furthermore, there is a valuable seven page appendix giving year-by-year details from 1898 to 1955 of the number of reported cases of the various ailments to which individual chapters are devoted; and details of public health expenditure from 1883 to 1955, in absolute terms, as a proportion of total government recurrent expenditure and on a per capita basis. Professor Addae's study of the evolution (or history) of modem (or western) medicine in Ghana is a well written, attractively produced and valuable addition to the existing literature on the development of medical services in former British African territories. His notes and references-nearly 1,500 in totaltogether with his bibliography of official papers and reports, books, articles and unpublished papers, guide the reader to the sources which he has used in researching and writing these books. These sources, with his narrative and analyses, should be of great value to those who wish to take further the study of the development of medical services in Africa.