Building Community and Transforming Knowledge: Histories of Women's Health Practitioners and Community-Based Health Services in 20th-Century Alberta, Canada

As new government health policy was created and implemented in the late 1910s and the late 1960s, women patients and health practitioners recognized gaps in the new health services and worked together to create better programs. This article brings the histories of the district nursing program (1919-43) and local birth control centres (1970-79) together to recognize women's health provision (as trained nurses or lay practitioners) as community-based and collaborative endeavours in the province of Alberta. The district nursing and birth control centre programs operated under different health policies, were influenced by different feminisms, and were situated in different Indigenous-settler relations. But the two programs, occurring half a century apart, provided space for health workers and their patients to implement change at a community level. Health practitioners in the early and late twentieth century took women's experiential knowledge seriously, and, therefore, these communities formed a new field of women's health expertise.

Behaviour change in diabetes: behavioural science advancements to support the use of theory

Behaviour is central to the management of diabetes, both for people living with diabetes and for healthcare professionals delivering evidence-based care. This review outlines the evolution of behavioural science and the application of theoretical models in diabetes care over the past 25 years. There has been a particular advancement in the development of tools and techniques to support researchers, healthcare professionals and policymakers in taking a theory-based approach, and to enhance the development, reporting and replication of successful interventions. Systematic guidance, theoretical frameworks and lists of behavioural techniques provide the tools to specify target behaviours, identify why ideal behaviours are not implemented, systematically develop theory-based interventions, describe intervention content using shared terminology, and evaluate their effects. Several examples from a range of diabetes-related behaviours (clinic attendance, self-monitoring of blood glucose, retinal screening, setting collaborative goals in diabetes) and populations (people with type 1 and type 2 diabetes, healthcare professionals) illustrate the potential for these approaches to be widely translated into diabetes care. The behavioural science approaches outlined in this review give healthcare professionals, researchers and policymakers the tools to deliver care and design interventions with an evidence-based understanding of behaviour. The challenge for the next 25 years is to refine the tools to increase their use and advocate for the role of theoretical models and behavioural science in the commissioning, funding and delivery of diabetes care.

Occupational health responses to COVID-19: What lessons can we learn from SARS?

On 31 December 2019, the World Health Organization (WHO) received reports of pneumonia cases of unknown etiology in the city of Wuhan in Hubei Province, China. The agent responsible was subsequently identified as a coronavirus-SARS-CoV-2. The WHO declared this disease as a Public Health Emergency of International Concern at the end of January 2020. This event evoked a sense of déjà vu, as it has many similarities to the outbreak of severe acute respiratory syndrome (SARS) of 2002-2003. Both illnesses were caused by a zoonotic novel coronavirus, both originated during winter in China and both spread rapidly all over the world. However, the case-fatality rate of SARS (9.6%) is higher than that of COVID-19 (<4%). Another zoonotic novel coronavirus, MERS-CoV, was responsible for the Middle East respiratory syndrome, which had a case-fatality rate of 34%. Our experiences in coping with the previous coronavirus outbreaks have better equipped us to face the challenges posed by COVID-19, especially in the health care setting. Among the insights gained from the past outbreaks were: outbreaks caused by viruses are hazardous to healthcare workers; the impact of the disease extends beyond the infection; general principles of prevention and control are effective in containing the disease; the disease poses both a public health as well as an occupational health threat; and emerging infectious diseases pose a continuing threat to the world. Given the perspectives gained and lessons learnt from these past events, we should be better prepared to face the current COVID-19 outbreak.

The Kirkbride buildings in contemporary culture (1850-2015): from 'moral management' to horror films

The so-called 'Kirkbride Plan' is a type of mental institution designed by the American psychiatrist Thomas Story Kirkbride. The Kirkbride-design asylums were built from 1848 to the end of the nineteenth century. Their structural characteristics were subordinated to a certain approach to moral management: exposure to natural light, beautiful views and good air circulation. These hospitals used several architectural styles, but they all had a similar general plan. The popularity of the model decreased for theoretical and economic reasons, so many were demolished or reused, but at least 25 of the original buildings became protected places. Over the years, surrounded by a legendary aura, these buildings have become a leitmotif of contemporary popular culture: 'the asylum of terror'.

The Change of the Status of Joseon Medical Bureaucrats in the 15th and 16th Centuries

In the 15th century, Joseon dynasty's goal for the stabilization of the ruling system, the ideological freedom of the era, and the necessity of medicine due to the introduction of Jin and Yuan dynasty's medicine led to the increased interest in medicine by the nobility along with tolerant practice. The practice of reading medical books is a good example of this institutional demonstration. However, by the end of the 15th century, a noticeable change had taken place. Within the nobility, there was an ideological rigidity regarding technology other than those of Confucianism, as the nobility became concentrated on the principles of Neo-Confucianism. In addition, as the publication of large-scale editions such as Ŭibangyuch'wi (the Classified Collection of Medical Prescriptions) came to an end, they have become less inclined to nurture talent at the level of the central government as in the previous period. In addition, as the discrimination against illegitimate children became stronger, technical bureaucrats such as medical officials, which were open to illegitimate children, came to be seen in increasingly disdainful and differentiated manners. From the late Sejong period to the early Seongjong period, the entrance of illegitimate sons into the medical bureaucracy solidified the negligence of medicine by the nobility. After then, the medical bureaucracy came to be monopolized by illegitimate sons. As for illegitimate sons, they were not allowed to enter society through Confucian practices, and as such, the only way for them to enter the government was by continuing to gain experience as technical bureaucrats. Technical posts that became dominated by illegitimate sons became an object of contempt by the nobility, and the cycle reproduced itself with the social perception that legitimate sons of the nobility could not become a medical official. Medical officials from the Yi clan of Yangseong had been legitimate sons and passers of the civil service examination in the 15th century. However, in the 16th century, only illegitimate sons became medical officials. The formation of Jungin (middleclass) in technical posts since the middle of the Joseon period is also related to this phenomenon. The Yi clan of Yangseong that produced medical officials for 130years over four generations since Yi Hyoji, a medical book reading official, is an exemplary case of the change in the social perception in the early Joseon period regarding medical bureaucrats.

The Rise of the Surgeon in the Seventeenth Century Virginia Colony

Life in the early American colonies presented unique challenges to the British colonists. There was an acute need for health-care providers in the early Virginia colony at Jamestown. Many of the medical men who first arrived at Jamestown were surgeons who adapted themselves to fit the medical needs of the community. These men trained in the British system where they sat beneath physicians in a hierarchy that did not consider surgeons to be doctors. Through their service to the colonists, early surgeons earned the reputation traditionally given to physicians in Great Britain. The colonists in Virginia respected the surgeons and viewed them as doctors, which allowed surgeons to stand on equal ground with physicians as the colonies grew to eventually become the United States of America.

"I Was Doctor": White Settler Women's Amateur Medical Practice in East and South-Central African Communities, 1890-1939

Professional medicine in colonial British Africa has been extensively examined by historians. Few scholars, however, have adequately considered the role that white settlers without medical training played in the provision of colonial health care in local African communities. This article addresses the gap by exploring amateur medical treatment by white settler women in East and South-Central African communities between 1890 and 1939, primarily in highland areas of Kenya and Southern Rhodesia. It examines the types of conditions treated, what techniques and equipment were used for treatment, and where treatment was carried out. It also explores medical identity in settler women's memoirs. Last, it considers the degree of choice exercised by patients in these amateur medical encounters. Overall, this article situates white settlers' amateur treatment in African communities as an important strand of colonial health care and as an intimate contact zone between white settlers, colonial medicine, and local people.

A barrier to medical treatment? British medical practitioners, medical appliances and the patent controversy, 1870-1920

From the late nineteenth century onwards there emerged an increasingly diverse response to escalating patenting activity. Inventors were generally supportive of legislation that made patenting more accessible, while others, especially manufacturers, saw patenting culture as an impediment. The medical profession claimed that patenting represented 'a barrier to medical treatment' and was thus detrimental to the nation's health, yet, as I argue, the profession's development of strict codes of conduct forbidding practitioners from patenting resulted in rebellion from some members, who increasingly sought protection for their inventions. Such polarized opinions within the medical trade continue to affect current medical practice today.

[Peculiarities of training of military medical staff during the Great Patriotic War]

Peculiarities of training of military medical staff during the Great Patriotic War. Extreme conditions of the World War II required as soon as possible rebuilding the work of institutions for higher medical education concerning training of military medical personnel. During the war significantly changed the organization of educational process in the S.M.Kirov Military Medical Academy, the military-medical faculties and civilian medical institutions. During the war from military medical academies and military medical faculties annually graduated up to 1450 military and naval doctors, civil universities of the country prepared and sent to the front more than 65 thousand doctors. It called up from reserve 80 thousand doctors. Basically staffing problems have been resolved.

[Personnel work at the S. M. Kirov Military Medical Academy: chapters of history]

Personnel work at the S.M.Kirov Military Medical Academy: chapters of history. Brief historical sketches of the personnel work at the S.M.Kirov Military Medical Academy. Various divisions were in charge of personnel work at the Academy in XIX-XX centuries: the Special Office of the Registrar, the economic committee, the administrative part, the department personnel and others. For the first time the personnel department was introduced 'into the Academy in 1946.

Negotiating "The Social" and Managing Tuberculosis in Georgia

In this paper I utilize anthropological insights to illuminate how health professionals and patients navigate and negotiate what for them is social about tuberculosis in order to improve treatment outcomes and support patients as human beings. I draw on ethnographic research about the implementation of the DOTS (Directly Observed Therapy, Short Course) approach in Georgia's National Tuberculosis Program in the wake of the Soviet healthcare system. Georgia is a particularly unique context for exploring these issues given the country's rich history of medical professionalism and the insistence that the practice of medicine is a moral commitment to society. I argue for critical attention to the ways in which treatment recipients and providers navigate what, for them, is "social" about therapeutic practices and their significance for avoiding biological and social reductionism.

"It may not cure you, it may not save your life, but it will help you"

In the modern world, we are experiencing an epidemiological shift represented by the increasing prevalence of chronic diseases relative to that of acute diseases: more people are living longer, with more diseases, than ever before in human history. How are we to understand and to respond to this change? A study of provision of cancer treatment in Western Australia, especially among Indigenous populations, can illuminate ways in which healthcare providers and societies might better understand the treatment of chronic disease: healthcare providers should take care to appreciate patient perspectives and beliefs about disease aetiology and treatment. Consideration of treatment of disease in the ancient Graeco-Roman world supports the view that effective healing and maintenance of patient wellbeing occurs when healers communicate clearly with their patients about disease and treatment progression, and when healers are open-minded about patients' utilisation of multiple treatment modalities.

Historical and Social Evolution of the Healers' Charisma

This study aims to explore the relation between charisma and healing and how the concept of charisma evolved within medical profession over time. The development of medical profession from shamans to modern medical doctors, the gradual transition from ritual to physical healing, the relation between the physician and common people, and the transition from personal to professional charisma are presented in a medico-historical context. The article concludes that there is an indisputable link between the phenomenon of charisma and healing. Healers have often been considered among the most significant charismatic figures in their societies. With time physicians have lost their personal charisma and replaced it by a stable professional charisma. Today, the growing involvement of patients in healing and demystification of the medical profession is diminishing the charisma of the physicians, although medical profession still retains qualities found in classic charismatics and with it also some authority over patients.

Medicine and abortion law: complicating the reforming profession

The complicated intra-professional rivalries that have contributed to the current contours of abortion law and service provision have been subject to limited academic engagement. In this article, we address this gap. We examine how the competing interests of different specialisms played out in abortion law reform from the early twentieth-century, through to the enactment of the Abortion Act 1967, and the formation of the structures of abortion provision in the early 1970s. We demonstrate how professional interests significantly shaped the landscape of abortion law in England, Scotland, and Wales. Our analysis addresses two distinct and yet related fields where professional interests were negotiated or asserted in the journey to law reform. Both debates align with earlier analysis that has linked abortion law reform with the market development of the medical profession. We argue that these two axes of debate, both dominated by professional interests, interacted to help shape law's treatment of abortion, and continue to influence the provision of abortion services today.

Student internships with unions and workers: building the occupational health and safety movement

One of the most successful programs to recruit young professionals to the occupational safety and health field was launched more than 35 years ago, in 1976. Created by the Montefiore Medical Center's Department of Social Medicine collaborating with Tony Mazzocchi of the Oil, Chemical and Atomic Workers International Union (OCAW), it placed medical, nursing, and public health students in summer internships with local unions to identify and solve health and safety problems in the workplace. The experience of working with and learning from workers about the complex interactions of political, economic, and scientific-technological issues surrounding workplace conditions inspired many students to enter and stay in our field. Many former interns went on to make important medical and scientific contributions directly linked to their union-based projects. Former interns are now among the leaders within the occupational health and safety community, holding key positions in leading academic institutions and governmental agencies.

Moving among friends: the establishment of professional social work education at the University of Melbourne, 1929-1941

Despite the reputation of Melbourne, Australia, as a socially advanced city in the early twentieth century, professional social work training did not commence at what was then the city's only university, until 1941. This article describes the strategies by a coalition of wealthy philanthropists, welfare organizations, medical practitioners, social workers, and The University of Melbourne itself to establish such professional training. It does so with exploration of the hitherto unrecognized influence of New York Social Work and the unique intellectual leadership of the director of training of the founding Social Work course in Melbourne, Miss Jocelyn S. Hylsop.

[Deficiency, disability, neurology and literature]

INTRODUCTION

Literature has always been attracted to neurological pathologies and the numerous works published on the subject are proof of this. Likewise, a number of physicians have been fiction writers and have drawn on their scientific knowledge to help develop their stories.

AIMS

The study addresses the appearance of neurological pathologies in a sample of literary works and examines the description of the disease, its treatment, the patient's view and the relationship between healthcare professionals and the socio-familial milieu.

DEVELOPMENT

We review some of the greatest literary works of all times that deal with neurological pathologies, such as Don Quixote, Julius Caesar, David Copperfield, The Idiot or Miau, and many of them are seen to offer a very faithful portrayal of the disease. Similarly, we have also reviewed works that provide a personal account of life with neurological diseases and the ensuing disability written either by the patients themselves or by their relatives, examples being The Diving Bell and the Butterfly, My Left Foot or One Chance in a Thousand.

CONCLUSIONS

Literature has helped to offer a realistic vision of neurologically-based pathologies and the healthcare professionals who work with them; there are many examples that portray the experiences of the patients themselves and the importance of support from the family is a feature that is constantly underlined.

[The medical care in Smolenskaya guberniya: the end of XIXth - the early XXth centuries]

In Smolenskaya guberniya of the early XXth century, the main issues of therapeutic care provision were medical personnel deficiency, beds shortage and lower conditions of single core hospital. The First World War and aftermath of the Revolution events only deteriorated the situation since the hospital therapeutic care to population factually missed. In 1920, this condition became a determinative factor to organize medical faculty of State University in Smolensk. The functioning of faculty permitted not only to set going the graduation of medical professionals so needed in gubernia, but to provide sufficient proportion of medical care in clinics of its therapeutic chairs.

What is a "health" professional? The changing relationship of occupational therapists and social workers to therapy and healthcare in Quebec, 1940-1985

Studies regarding the medicalization process generally focus on the way various physical and psychological conditions have been identified as "health" problems, within specific historical contexts. Less well known is how the therapeutic roles of certain "health" professionals were also a result of the confluence of particular historical events. By comparing the professional trajectories of Quebec's occupational therapists and hospital social workers from 1940 to 1985, this article demonstrates how professionals originally outside of the world of health care created new therapeutic roles for themselves within the constantly expanding institutional health care system.

Expert evidence and medical manslaughter: vagueness in action

This article examines the reliance placed on expert evidence in prosecutions of health professionals for gross negligence manslaughter, where juries must decide whether conduct goes beyond civil negligence and constitutes the crime of involuntary manslaughter. It argues that the test for liability is vague and examines some of the consequences of this. Given the vagueness of the offence, jurors are likely to place great reliance on expert medical evidence. Little is known about how experts negotiate the legal process, empirically speaking: how they approach their task, how they view their role as expert witnesses, and the attitudes, biases, and beliefs that may underpin their testimony. Drawing on the experiences and perceptions often medical experts, this article explores how experts manage the vagueness inherent in the task of interpreting and applying gross negligence. Experts appear to go beyond offering purely medical opinion and enjoy engaging with law and the legal process.

TRAP abortion laws and partisan political party control of state government

Targeted Regulation of Abortion Providers (or TRAP) laws impose medically unnecessary and burdensome regulations solely on abortion providers in order to make abortion services more expensive and difficult to obtain. Using event history analysis, this article examines the determinants of the enactment of a TRAP law by states over the period 1974–2008. The empirical results find that Republican institutional control of a state's legislative/executive branches is positively associated with a state enacting a TRAP law, while Democratic institutional control is negatively associated with a state enacting a TRAP law. The percentage of a state's population that is Catholic, public anti-abortion attitudes, state political ideology, and the abortion rate in a state are statistically insignificant predictors of a state enacting a TRAP law. The empirical results are consistent with the hypothesis that abortion is a redistributive issue and not a morality issue.

[The medical personnel of Byelorussia during the fascist aggression and occupation]

[The article deals with the characteristics of professional activities of medical personnel in Byelorussia during the fascist aggression and subsequent occupation]

[Dissemination of German medicine in Spain and Latin America: the "Revista Médica de Hamburgo" and the "Revista Médica Germano-Ibero-Americana" (1920-1933)]

This article presents the development of the journals "Revista Médica de Hamburgo" and "Revista Médica Germano-Ibero-Americana," which were created to promote and disseminate the German science among the medical community in Latin America and Spain between the two World Wars. Shaken by the loss of Germany's colonies in Africa, the difficulties faced due to post-war economy, and the restrictions imposed by the armistice, the Germans sought to restore their cultural and scientific prestige through such initiative.

[Health workforce in Serbia in two periods: before and after 1950]

INTRODUCTION

Health workers are the embodiment of the core values of the health system, and they guide towards the most effective and economic utilization of all other resources. Historical developmental evidences can be helpful to understand their actual position in Serbia. Description of the health workforce development and coverage in two periods: before and after 1950 in Serbia.

MATERIAL AND METHODS

This retrospective study is a descriptive analysis of the health workforce development, based on literature review and routinelly collected data.

RESULTS

Health care workforce in Serbia before 1950 was inadequate in number and skills required with regard to the society needs. At the same time health workers were highly motivated to learn and were ready to fit and stretch when needed. Since 1950 onwards there has been a continual intention to enlarge the number and skills of healthcare workforce, but other mechanisms for capacity building of health profession have been often overseen.

DISCUSSION

Though health needs were recognized as criteria for health manpower planning and development, they were not appropriately followed in the practice.

CONCLUSION

Planning and development of health workforce were influenced by specific political, social and economic conditions in Serbia.

[Professionalization of public health officers in Japan]

In this paper, I describe how public health officers in Japan in the period of the late Taisho and early Showa eras claimed their position as professionals in the sanitary administrations of central and local governments. In the background of this push for recognition, there were related international and national movements. Internationally, public health ministries were established in developed countries and the League of Nations Health Organization (LNHO) was created. LNHO wanted to improve the level of public health officials world-wide, so the organization sponsored international exchanges of officials. These activities made a strong impression on Japanese public health officials, who realized that they belonged to an internationally recognized profession and that they needed to work hard to improve the substandard Japanese public health situation. Meanwhile, at the level of domestic politics, there were several movements of technical experts in different fields of government administration that worked to fight the unfair treatment of administrative officials, a situation that had existed since Meiji Period. The public health officers collaborated with the other technical experts to improve their positions and to play key roles in society. But while the other technical experts actively pursued social leadership, public health officials wanted to remain scientists. This is because the sanitary departments in the local governments were organized within police departments. In this environment, the law was dominant and science was secondary. But public health officials insisted that the basis of public health should be science, so they emphasized their scientific expertise.

A view from the streets: women and medical work in Elizabethan London

In Elizabethan London, women occupied a significant position in the city's medical marketplace, both as consumers of medical services and as practitioners. Though male medical authors of the period objected to the presence and practices of these women, a very different view of their medical work emerges if we shift our historical vantage point to the streets, houses, churches, and hospitals of the city. Using relatively underutilized sources such as parish records, probate records, lists of immigrants to London, hospital records, and individual manuscripts it is possible to draw a richer, more detailed portrait of how female health-care workers engaged with the business of health and healing. Women emerge from these records as active, prominent, and acknowledged participants in the delivery of services that promoted and preserved the health of many Londoners from cradle to grave. Hired by public institutions such as parishes and hospitals, as well as by private individuals, women were central figures in the delivery of nursing, medical, pharmaceutical, and surgical services throughout the city as part of organized systems of health care. Exploring how Londoners saw female practitioners, and how women played a recognized role within the city's range of health-care options, demonstrates that women were crucial to community health, and were also valued as such by their neighbors and patients.

Stigmatized ethnicity, public health, and globalization

The prejudicial linking of infection with ethnic minority status has a long-established history, but in some ways this association may have intensified under the contemporary circumstances of the "new public health" and globalization. This study analyzes this conflation of ethnicity and disease victimization by considering the stigmatization process that occurred during the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) in Toronto. The attribution of stigma during the SARS outbreak occurred in multiple and overlapping ways informed by: (i) the depiction of images of individuals donning respiratory masks; (ii) employment status in the health sector; and (iii) Asian-Canadian and Chinese-Canadian ethnicity. In turn, stigmatization during the SARS crisis facilitated a moral panic of sorts in which racism at a cultural level was expressed and rationalized on the basis of a rhetoric of the new public health and anti-globalization sentiments. With the former, an emphasis on individualized self-protection, in the health sense, justified the generalized avoidance of those stigmatized. In relation to the latter, in the post-9/11 era, avoidance of the stigmatized other was legitimized on the basis of perceiving the SARS threat as a consequence of the mixing of different people predicated by economic and cultural globalization.

Who chooses service providers? The spread of consumer choice, 1992-2004

Self-determination has been a dominant theme in the movement for the enhancement of the lives of adults with developmental disabilities, but who actually chooses the careproviders funded by state and federal dollars? Officials from all 50 states were interviewed to ascertain who chose the careprovider for youth transitioning from educational to adult services for each year from 1992 to 2004. The choices fell into roughly three levels: state-dictated, restricted individual choice, and unlimited individual choice. The highest level of choice offered in that state for a given year was tracked. The change in level of choice has been dramatic. In 1992, government dictated all careproviders in 42 states; by 2004, this was reduced to 9 states.

[Legal regulation of participation of medical personnel in the international peacemaking action: genesis and trends of the development]

The article is devoted to the question on legal regulation of participation of medical personnel in an international peacemaking action.

[The influence of the devotion movement on the health care in North Korea]

Since the early 1960s, North Korea has conducted 'devotion movement' under the directorship of Kim Il Sung across the nation. As a matter of fact, the movement was not a novel invention at all. When North Korean Temporary People's Polity was established in 1946, North Korea emphasized the importance of the devoted care of health personnel. It meant to reform the people's thought and mind along with complementing the lack of human and material resources. Thought reform was not a peculiar phenomenon observed in North Korea only. It was particularly stressed out among communist countries, including the Soviet Union. However any other communist country stresses the importance of thought reform. Devotion movement should be viewed as part of this process. As shown in many cases, the extent and degree of devotion movement and care are beyond our imagination, which does not intend to mean that North Korean health personnel's attitude towards patients is superior to the counterparts in South Korea. Indeed human being's behavior cannot be understood without taking account of society in general. The question can be raised as to whether or not North Korean health personnel's devoted care is really voluntary. To put aside the testimony that the most powerless group in a society can fall prey to victims, if social environment, whether directly or indirectly, is action on the people's thought and mind even in a subtle way and thus influence one's decision power, it is hard to highly evaluate the devoted care in North Korea. Moreover it seems like that the internal conflict exists surrounding devotion. In conclusion, I think that North Korean devotion movement has enforced health personnel to reform their thought and mind to adapt to North Korean regime and has played an important role to accomplish the purpose of North Korean Labor Party to realize essential constituents of its health system, in such a situation in which essential medical supplies are severely lacking. But it seems like that it plays reverse action to develope sound North Korean health system.

HIV/AIDS and bioethics: historical perspective, personal retrospective

Problems posed by HIV/AIDS differ from those of past epidemics by virtue of unique properties of the causative agent, dramatic societal changes of the late 20th century, and the transition of medical practice from a professional ethic to a technology-dependent business ethic. HIV/AIDS struck during the coming-of-age of molecular biology and also of bioethics, and the epidemic stimulated the growth of both disciplines. The number of articles published about AIDS and ethics (as identified by a MEDLINE search) peaked in 1990, just before the peak incidence of AIDS in the United States. The character of ethical dialogue has now shifted from familiar moral quandaries such as civil liberty versus public welfare to concerns about vaccine trials and public policy toward the developing world. Physicians and other health care workers who were involved from the onset endured something of an emotional roller coaster. Their compassion-based work ethic was to a large extent replaced by a competence-based work ethic after the introduction in 1996 of highly active antiretroviral therapy. The abundant recent literature on "professionalism" in medicine makes scant mention of AIDS/HIV. The disruptive effect of AIDS/HIV on society would have been substantially greater had relevant technology such as the ability to isolate retroviruses and potent therapy against tuberculosis not been in place. This sobering consideration, along with such recent events as the use of bioterrorism against civilian populations, suggests new relevance for Potter's definition of "bioethics" as a science of survival in which the biology of ecosystems must be taken into account.

[Revocation of Edict of Nantes and the dispersion of health professionals out of France]

In 1685 Louis XIV revoked the Edict of Nantes. Thus, he caused the exodus of more than 100,000 Huguenots who did not want to become Roman Catholics. Many of them were from medical professions including medical practitioners, surgeons, and apothecaries. They looked for sanctuary in Great Britain, the United Provinces (Holland), Switzerland, Prussia, America as well as Germany, and abroad Dutch colonies like South Africa. The tradition of their settlements took part in the tradition of their welcoming countries all the more as their Huguenot descendants maintained their original tradition.