Environmental historians are not sufficiently aware of the extent to which mid twentieth-century thinkers turned to medical geography—originally a nineteenth-century area of study—in order to think through ideas of ecology, environment, and historical reasoning. This article outlines how the French–Croatian Mirko D. Grmek, a major thinker of his generation in the history of medicine, used those ideas in his studies of historical epidemiology. During the 1960s, Grmek attempted to provide, in the context of the Annales School’s research program under the (...) leadership of Fernand Braudel, a new theoretical framework for a world history of disease. Its development was inspired by several sources, most notably the French–American Jacques M. May, who was then pioneering an opening up of medical geography and movement towards the concept of disease ecology. The cornerstone of Grmek’s “synthetic approach” to the field was the notion of “pathocenosis”. The diverse uses of this notion in the course of time—from his early agenda focused on a longue durée history of diseases in Western Antiquity to his last, relating to the new epidemiological threat of emerging infectious diseases, specifically HIV/aids—enables us firstly, to note how concepts of ecology sat uneasily alongside those of medical geography; secondly, to assess the reach and limits of his theoretical contribution to historical epidemiology; and thirdly, to understand better the uneven fortunes of his concept of pathocenosis at the end of the twentieth and beginning of the twenty-first centuries. (shrink)

This paper summarizes Grmek's theoretical contribution to history of disease and explores to what extent the longue durée could still be a useful concept in order to better understand past perceptions of, and reactions to, diseases. The case of the medical responses to epidemic disease in pre-industrial Europe is synthetically expounded in order to illustrate this issue.

Have invisible barriers for women been broken in 2007, or do we still have to break through medicine's glass ceiling? Data from two of the most prestigious university hospitals in Barcelona with 700-800 beds, Hospital Clínic (HC) and Hospital de la Santa Creu i Sant Pau (HSCSP) address this issue. In the HSCSP, 87% of the department chairs are men and 85% of the department unit chiefs are also men. With respect to women, only 5 (13%) are in the top (...) position (department chair) and 4 (15%) are department unit chiefs. Similar statistics are also found at the HC: 87% of the department chairs and 89% of the department unit chiefs are men. Currently, only 6 women (13%) are in the top position and 6 (11%) are department unit chiefs. Analysis of the 2002 data of internal promotions in HC showed that for the first level (senior specialist) sex distribution was similar. Nevertheless, for the second level (consultant) only 25% were women, and for the top level (senior consultant) only 8% were women. These proportions have not changed in 2007 in spite of a 10% increase in leadership positions during this period. Similar proportions were found in HSCSP where 68% of the top promotions were held by men. The data obtained from these two different medical institutions in Barcelona are probably representative of other hospitals in Spain. It would be ethically desirable to have males and females in leadership positions in the medical profession. (shrink)

Survivors of the Black Death confronted a world changed very much for the worse, or so we often say when ignoring nuance. There is no denying that many chroniclers wrote from a situation of real anxiety about an uncertain future. Many locales felt the effects of severe wage inflation and dramatic price fluctuations, some work regimes intensified, social mobility increased, and the utility of traditional safety nets failed to provide against localized food scarcity. Nevertheless, we should view with caution descriptions (...) of plague-induced economic and social dislocation leading to anarchy and decadence, which can become colorful exaggerations, especially when buboes and piled bodies get added to the narrative mix. In recent years many researchers have begun to confront the overload of stereotypes about postplague living to which a human inclination to prurience and some vast historical lacunae have led us. Edwin Hunt, James Murray, and others have found men and women in late-medieval Europe seizing latent economic opportunities in the midst of their difficult circumstances, stimulating producer innovations and encouraging a consumption boom. The medical practitioners studied by Jon Arrizabalaga and John Henderson did not surrender to the defeatism often ascribed to them. And despite the evidence that social stress made room for extremism—flagellant self-abuse, attacks upon Jewish communities, urban riots and rebellions—in government and the world of custom pragmatic flexibility insulated foundational institutions against radical upheaval. Important continuities bridged the pre- and postplague eras. Plague epidemiology has also grown more complex in response to a keener understanding of the morphology of disease agents and the historical shaping of disease categories. (shrink)