Images of disease: science, public policy and health in post-war Europe

Despite its spatial and temporal constraints, this is a book with a wide brief. It collects papers given at a 1998 conference in a series sponsored by the European Commission dealing with science and society, the aim of these being to compare and contrast European experiences and to reflect on international collaboration. The conference title, "images of disease", echoes Charles Rosenberg's formulation of the process by which the understanding of disease is "framed" within its historical context, and the concern of the contributors is the interplay between medical science, public health professionals and the state in this process. Beyond this there is considerable variation in approach: some essays take cultural representations of health as their starting point, situating these within the changing interests of political regimes; others begin with scientific advances and go on to draw out the factors which condition the experts' influence upon public policy; others deal not with particular diseases but with health systems themselves, relating matters such as the extent of institutional care to ideological and organizational climate. There are thematic variations too. Some contributors discuss epidemiological interventions (with four chapters focused on tuberculosis), some examine campaigns against smoking and alcoholism and some treat public health in the broadest sense through a study of state agencies (with two chapters on maternity and child welfare). It is probably a reflection of the state of scholarship that there is little genuinely comparative or pan-European material here, with most authors concerning themselves with individual states. Two exceptions are Barbara Gutmann Rosenkrantz's discussion of internationalism in the campaign against tuberculosis and Jean-Paul Gaudilliere's study of the contrasting interventions pursued by Britain and France to address Down's syndrome. Gaudilliere's chapter, in particular, illustrates the potential of comparative work to illuminate national differences in the reception and application of new diagnostic techniques. Otherwise the authors deal mainly with Britain, Germany, the Soviet Union, Spain and Poland, with the latter two claiming significant attention. This apparently idiosyncratic choice of national settings throws up some fascinating insights. On the one hand we see how health policies were overtly driven by ideological concerns in authoritarian regimes; for example the Francoist anti-tuberculosis campaign was initially depicted as part of a broader struggle against the "sick Spain" (p. 143) of the Republic, while in postwar Poland the prevalence of the disease was blamed on the iniquities of capitalism. In the West meanwhile, as Ilana L6wy notes in the introduction, the politicization of health policy was often veiled by the technical language in which debates were couched. L6wy's own chapter powerfully develops the point, arguing that visual and rhetorical representations of cancer treatment as a heroic struggle to destroy "killer cells", have sustained the dominance of cytokine therapy since the 1970s, perhaps to the detriment of other approaches. The theme of imagery is less well-developed elsewhere. A particularly frustrating section is Lyubov Gurjeva's short, but intriguing, analysis of Soviet propaganda images of child health; this is incongruously embedded in a chapter about archival resources in Russia, and has no accompanying illustrations from the poster collection it discusses. A more effective section is the coupling of two Polish chapters, one on anti-alcohol propaganda and the other on literary images of alcoholism. These contrast the policy failure of governmental appeals to collective responsibility with the multiplicity of ways in which novelists deployed drunkenness to represent the contradictions and hypocrisies of Polish society. Shortly after comes an all too brief concluding chapter by Klim McPherson, despairing of the contemporary failure in the West to address nicotine addiction and the reduction of cholesterol. Juxtapositions such as these, which drive to the heart of the dilemma of reconciling individual freedoms with long-term