Beginnings count: the technological imperative in American health care

problem epidemiologically (through careful investigation of trends in mortality and morbidity) before formulating a practical solution or policy. It was a method which, Eyler plausibly argues, led to socially sensitive and constructive ideas and policies which, if pursued in the longer term at national level might have led to earlier remedial action on child health and maternal mortality during the interwar period. Newsholme was a man driven by a strong sense of moral purpose, intelligent, of great personal integrity, who came up against powerful operators in his own and related fields who were less scrupulous and more adept at political intrigue and character assassination than he was. His reputation as an epidemiologist was denigrated by Karl Pearson, Major Greenwood and Raymond Pearl; his reputation as an administrator by the ambitious, arch-intriguer George Newman. Newsholme's enforced retirement when Newman was appointed Medical Officer to the new Ministry of Health in his stead was greeted with genuine regret by local medical officers of health; Eyler's account restores Newsholme to what is surely his rightful place as a thoughtful, far-sighted and pragmatic administrator, the success of whose later career was compromised by the confusions and consequences of war. State medicine as an independent entity plays little direct part in this book, although hand in hand with Newsholme in the title. The detailed chapter analyses provide an admirable account of how this Victorian policy invention worked in practice, and Eyler provides an excellent and succinct last chapter placing his study in the context of current historiography of the field, but a larger framework of explanation, subsidiary and complementary to Newsholme himself, would have been welcome. Newsholme's career was, after all, in many senses the culminating chapter in the history of state medicine, and it seems a pity that this should not have been explicitly explored. It may, of course, be that this perspective was neglected by design, to accommodate some unjustifiable insistence of the publishers on the need to restrict word length. At 400 pages, Newsholme was probably pushing its luck in CUP's eyes. Tell-tale items may be discerned by the critical readerNewsholme's handling of the 1918 influenza epidemic crisis, for example, examined over just two pages in the concluding survey (pp. 388-89), seems a prime candidate for fuller examination. If wishes were publishers, authors would ride. John Eyler is one who could with justification be trusted to do so.