Wide neighborhoods. A story of the Frontier Nursing Service

medieval Italian town physicians, who, initially at least, had no duties of supervising and licensing subordinate practitioners, such as pharmacists, and no remit for inspecting public hygiene (unlike the office of the hisba within Islam, as shown by Ghada Karmi). Indeed, the drift of the articles by Vivian Nutton and Richard Palmer is that there is almost an inverse relationship between medical presence and town appointments. In centres where physicians were lacking, a post, a salary, a tax immunity, would lure a recruit (and aim, rather futilely, to tie him to his post during epidemics and plague). Once, in the late Middle Ages, physicians swelled in numbers, market forces could be left to do their own work. Indeed, one of the most interesting findings of these essays on Italy, and Toby Gelfand's piece on Paris-trained surgeons in Southern France in the reign of Louis XV, is the relative abundance of well-trained medical personnel ( 180 in Milan by the early fourteenth century). These papers (which unfortunately abound with printers' errors) tell us much about how medical men became woven into the fabric of official life from the Middle Ages, perhaps particularly because of the urban imperative to handle epidemics as part of public policy rather than leaving them, like other sickness, to private prudence and philanthropy. They suggest three further areas for research and analysis here little dwelt upon. First, comparison with other parallel areas of doctor-state involvement, e.g. military medicine. Second, analysis of tensions within the emergent medical practitioners between their profile as public servants and their selfimage as an independent, corporate, collegiate liberal profession. And third, the chronological outcome: how did the ad hoc traditions of town appointments discussed here relate to cameralist philosophies of medical police developed under Enlightened Absolutism? Manfred Stulrzbecher in his essay on German-speaking countries concludes that the progression of town doctors to becoming "government officials" was "still incomplete" at the end of the eighteenth century (p. 127). It is a transition which would make an important further study. Roy Porter Wellcome Institute