Medical travellers. Narratives from the seventeenth, eighteenth and nineteenth centuries

investment is credited with promoting further improvement until the late 1930s. Thereafter, the economy lagged, but mortality continued to decline; a circumstance that argues for the success of modern medicine in fighting disease. The data on mortality since Castro's coming to power is also revealing. Between 1959 and 1980, average life expectancy increased eight to nine years, to the point that it is virtually on a par with that of the United States. Also the infant mortality rate declined from 46+ deaths per thousand live births (1969) to less than twenty per thousand (1979), and without significant distinction between rates in urban and rural areas. Because economic growth under Castro has been minimal, the author concludes that more equitable distribution of wealth, and equalized access to health care accounted for these gains. This collection of mortality data and disease information is immensely valuable-even fascinating-and the demographic analysis highly informed. And, indeed, one is left wanting more. It appears a reflection of the sources that the emphasis is weighted heavily toward the pre-1959 period, thus the data from Castro years seems rather lean. Similarly, the omission of economic data tempers the strength of the author's claims about the relative importance of economic growth as a determinant of mortality decline. Finally, except for the separate focus on the municipality of Havana, the author deals with the Cuban population as a whole. This misses the opportunity to distinguish mortality and morbidity trends, especially in the pre-Castro years, as related to wealth, occupation, and levels of nutrition. That is more the realm of epidemiology, I know, but grouping mortality data according to socioeconomic status is of critical importance in evaluating the scope of Cuba's health revolution. The fact that over the past two decades equalized access to health care has fostered mortality decline raises important questions about the organization and performance of Cuban medicine before and since Castro. Most provocative is the possibility that the Mexicos and Brazils that are chasing social progress through "modernization" might well study the example of Cuba for insight into improving life expectancy and bringing down infant mortality rates. It is certainly to its credit that this book provokes such issues, and invites further inquiry. This is a book that must have been fascinating to write, and every page affords points of interest to the casual reader which would make it welcome on the coffee, or, more appropriately, the …