New narratives on health, care and citizenship in the nineteenth and twentieth centuries

This edited volume offers the first comprehensive historical overview of the Belgian medical field in the nineteenth and twentieth centuries. Its chapters develop narratives that go beyond traditional representations of medicine in national overviews, which have focused mostly on state–profession interactions. Instead, the chapters bring more complex histories of health, care and citizenship. These new histories explore the relation between medicine and a variety of sociopolitical and cultural views and realities, treating themes such as gender, religion, disability, media, colonialism, education and social activism. The novelty of the book lies in its thorough attention to the (too often little studied) second half of the twentieth century and to the multiplicity of actors, places and media involved in the medical field. In assembling a variety of new scholarship, the book also makes a contribution to ‘decentring’ the European historiography of medicine by adding the perspective of a particular country – Belgium – to the literature.

Open Access (free)
Sokhieng Au
and
Anne Cornet

This chapter reviews the history of medicine in what were the Belgian colony of Congo and the administered territories of Ruanda-Urundi (now Rwanda and Burundi). Highlighting both the commonalities and particularities of the Belgian case in the history of colonial medicine, the chapter examines the four main aspects of Western medical endeavours in the Belgian colonies – a state-organised medical service, missionary medicine, industrial medicine and research organisations and activities. While Belgian colonial medicine aligned closely with the activities of other colonial powers, it was exceptional in many ways. Political, economic and church interests vested in the Belgian colonies were in some instances freer to shape the colony as they saw fit, outside the interference of a general metropolitan public. The downside of such disinterest, however, included fewer resources from the metropole and a lack of checks on colonial abuses. Ultimately Belgium, starting a bit 'behind the curve' as a colonial power, had to innovate solutions for health problems in a colony that was poor in resources and political will. Belgian colonial medicine, in the end, left strong traces in the current field of international humanitarian aid.

in Medical histories of Belgium
Open Access (free)
Joris Vandendriessche
and
Tine Van Osselaer

This chapter offers a varied overview of the historical relation between medicine and religion in Belgium, which was until the 1960s a predominantly Catholic country. Moving beyond a too strong political reading of healthcare debates, in which both fields have been described as opposites (competing with one another or aiming for compromise), this chapter pays attention to intellectual encounters and to the role of religious practices and beliefs in medicine. First, the chapter sketches the evolution of Catholic organisations and institutions, most notably the changing role of religious orders, which in Belgium have held a firm grip on the medical field. It describes evolving Catholic views on ‘care’, along with political conflicts over an expanding welfare state and changing views on the growing role of lay medical personnel. Second, the chapter turns to religious practices, rituals and exceptional phenomena such as miracles, and the medical debates these inspired. From a medical perspective, religion could be a source of health (e.g. ‘moral therapy’ to treat mental illness) or disease (e.g. Christomanie). Third, the chapter goes on to discuss how Catholic doctors and caregivers gave their religious views a place in their professional work and identities. Here the chapter turns to medical ethics and professional codes of conduct, and the ways in which these have been inspired by Catholic thinking. The chapter pays particular attention to questions related to reproductive medicine and the end of life.

in Medical histories of Belgium
Jolien Gijbels
and
Kaat Wils

This chapter focuses on the ways in which, since the nineteenth century, medicine and medical discourse have legitimised, reinforced or altered gender relations in Belgium. It focuses on three themes: the social division of medical labour, the gendered character of medical knowledge and the role of feminists in claiming and redefining the female body. Addressing the theme of the social division of labour allows us to provide readers with general information about the presence and status of women and men within the main medical structures throughout the period. The chapter presents key social and political debates relevant to the history of medicine, such as discussions on the supposedly limited competences of midwives or women’s access to medical education and the medical profession.

The history of gynaecology enables us to look more closely at the impact of these structures on the treatment of women’s bodies and on discursive practices defining women’s health. Gynaecology emerged at the end of the nineteenth century as a new profession founded on the successes of modern surgery and dedicated to the protection of maternity, femininity and sexual modesty. During the first and in particular the second wave of organised feminism in Belgium, activists involved in political debates about women’s rights had to struggle with stereotypical, often medically legitimised views about women’s moral and physical weaknesses and incapacity to assume various social roles. In women’s political fights centred on themes such as contraception and abortion, feminists developed alternative understandings of women’s bodies, also using medically informed representations.

in Medical histories of Belgium
Tinne Claes
and
Katrin Pilz

Medicine has become increasingly professionalised and institutionalised in the modern era. Within this narrative of medicalisation, popularisation has been interpreted as a process directed by the traditional protagonists of medical history: physicians and institutions. Although historians have argued that medical knowledge was ultimately democratised throughout the nineteenth and twentieth centuries, they have mostly portrayed the increasingly large numbers of users of medicine as passive consumers of knowledge that was nominally created by professionals. Over the past two decades, however, historians have paid more attention to the circulation of knowledge, arguing that knowledge is constructed by mutual interactions between the scientific and the public domain. In a similar vein, historians have shown that the sharp antagonism between ‘official’ and ‘alternative’ medical beliefs was not a historical reality, but a cultural construct.

This chapter shows the implications of these new theoretical approaches for the Belgian context – in which ‘popular’ and ‘alternative’ views of medicine have not yet been subject to much historical scrutiny. By focusing on visual media through which medical knowledge was communicated and circulated, concrete models displayed in health exhibitions and public health films, this chapter takes a first step to decentralise the history of ‘popularisation’. By drawing attention to the ways in which medicine circulated, we give lay audiences agency in the historical narrative: they transform from passive recipients into active actors and consumers, who have the agency to interpret, choose from and respond to different views of the body, sickness and health.

in Medical histories of Belgium
Dirk Luyten
and
David Guilardian

This chapter outlines how the organisation of financing of the cost of medicine has evolved since the late eighteenth century. The economic burden of caring and healing has been largely ‘mutualised’ over the past two hundred years. It is no longer individual patients who pay the largest part of medical fees, but society, with – as a consequence of the introduction of a compulsory social security system in 1944 – a key role for the state. However, the state delegated this redistribution to non-profit private health insurance funds – mutual societies – which, since the late nineteenth century, developed into central players in financing of healthcare. However, this narrative does not take into account public welfare at local level in financing the cost of care, nor the middle-class philanthropy and Catholic charity that characterised the field in Belgium as well.

The collectivisation of costs makes the discussion on how to fund the system an ongoing topic in the public space, while also tending to conceal the continued existence of major social differences. At the same time, the medical industry (private hospitals, pharmaceutical companies, etc.) became an important economic factor, both as an employer and as a central player in a knowledge-based economy. These changes had effects on the administration of care, requiring new forms of financial efficiency. As medicine became a business, different norms of management were introduced, which, in turn, were heavily criticised.

in Medical histories of Belgium
Thomas D’haeninck
,
Jan Vandersmissen
,
Gita Deneckere
, and
Christophe Verbruggen

"The medicalisation of society was strongly intertwined with both the overall scientification of society and the rationalisation of dealing with the social question on a pan-European scale. This chapter reassesses the history of Belgian public health by looking at the social activism of physicians and ‘hygienists’ as part of a global field of discourse and practice. In doing so, it nuances the image of the nineteenth-century state as a ‘nightwatchman’, and in particular for the twentieth century, considers the Belgian Congo as an integral component of Belgian health policies.

The chapter consists of four parts that are structured chronologically. The first part starts in the late eighteenth century and focuses on the emergence of scientific medicine and the growing awareness that the study of many diseases could not be separated from the socio-economic context in which they originated. The second part discusses the bacteriological revolution in the 1870s and its impact on public health questions, linking social medicine more closely to applied sciences and preventive healthcare. Social medicine became increasingly entangled with other reformist movements. The third part deals with the further development of social hygiene and the rise of eugenics, national health protection and improvement policies in the interwar period. Finally, the fourth part re-evaluates the period after 1960 when national public health systems were strongly questioned, local community health centres emerged and medical activism went increasingly beyond borders. For each time period, representative players are highlighted, including Adolphe Burggraeve, Victor Desguin, Gustave Dryepondt, Peter Piot and Marleen Temmerman.

in Medical histories of Belgium
Open Access (free)
Renaud Bardez
and
Pieter Dhondt

Although medical knowledge has been produced in different forms and locations over the past two centuries, the modern university was certainly its primary locus. The medical faculties of leading educational institutions evolved into the central spaces of scientific research ‒ an evolution that in turn had an impact on the medical curriculum. In Belgium, this ‘scientification’ occurred along the ideological dividing lines between Catholics and liberals, between the Flemish- and French-speaking communities, and was influenced by the competition between state and private universities. Its principal driving force was the development of laboratory science. However, this dominant form of scientific medical knowledge was often contested. Engaging in the age-old debate between medicine as a science and an art, nineteenth-century practitioners claimed to have practical knowledge, rooted in everyday observations, that was just as ‘scientific’. Their knowledge originated primarily around the bedside, what contributed to the changing position of the hospital as an additional professional training site.

This chapter presents the development of medical education at the medical schools and later the faculties of medicine in the southern Netherlands/Belgium from the end of the eighteenth century up until today. It focuses on the shifts in the balance between general education, vocational training and scientific schooling, and on the continuous tension between medical specialisation and (the perceived need of offering) a more holistic approach. The process of professionalisation in general followed a similar line of development in Belgium as in most other European countries, yet many specific circumstances also created a unique situation.

in Medical histories of Belgium
David Larsson Heidenblad

The chapter provides an in-depth account of the moment when the environmental debate in Sweden took off: the autumn of 1967. Special emphasis is put on the choir of natural scientists who at this point in time started to warn the public and politicians of an impending environmental crisis. Most influential was the chemist Hans Palmstierna, who in October 1967 published the short paperback book Plundring, svält, förgiftning [Plundering, famine, poisoning] which became the first major environmental bestseller in Sweden. Another influential group was the scientists behind the book Människans villkor [The predicament of man]. The chapter studies how these two books, and the expertise of their authors, circulated in the mass media (press, broadcast). In addition, it examines how environmental issues were discussed at this time at the highest state level and at the Swedish National Defence Research Institute. In closing, an exchange of letters between Hans Palmstierna and a layperson in Gothenburg sheds light on how environmental issues were understood outside of the media and the corridors of power.

in The environmental turn in postwar Sweden
David Larsson Heidenblad

This chapter highlights how the dynamics of the environmental debate in Sweden changed during the early 1970s. Partly, it was the new environmental movements that raised the level of conflict. However, representatives of the establishment were also profoundly involved. The first part of the chapter examines the media storm that erupted after Hans Palmstierna gave a speech on work-environment issues at the Factory Workers’ Union’s congress in Stockholm in August 1971. There he accused researchers of pursuing the interests of business, rather than workers and society. Axel Iveroth, managing director of the Federation of Swedish Industries, struck back and a heated debate ensued. One of those who sought to moderate the tone – to no avail – was Birgitta Odén. The second half of the chapter is devoted to the large future debate that followed upon the publication of biochemist Gösta Ehrensvärd’s paperback book Före – Efter: En diagnos [Before – after: a diagnosis] in 1971. The book became a major bestseller and sparked open controversy when in February 1972 the nuclear physicist Tor Ragnar Gerholm published a counterpart named Futurum exaktum. Taken together, the chapter demonstrates that the environmental debate of the early 1970s was increasingly polarized and politicized.

in The environmental turn in postwar Sweden