Compulsory health insurance. The continuing American debate

to become exclusively a medical institution focusing on curative procedures, and ultimately to expand its clientele to all levels of society. While large-scale involvement of medical men with hospitals doubtless preceded the administrative-institutional transformation of the latter (medical professionalization around the hospital clinic in France following the Revolution may have been one necessary condition for the late-nineteenth-century transformation of hospitals), Cugnetti's detailed study of the Grenoble instance confirms the lack of interaction between organized medicine (with the partial exception of surgeons) and hospitals during the Old Regime. The curious melange of welfare and penal functions served by the old hospital is evidenced by the Grenoble Hopital General's rules concerning discipline. In the scale of punishment inflicted on troublesome patients, the most severe penalty worse than solitary confinement or ceremonial humiliation was to be exiled from the institution. Toby Gelfand University of Ottawa