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The SCIMITAR+ trial was commissioned to evaluate the effectiveness of a bespoke smoking cessation intervention for people with severe mental ill health compared with usual services. It is difficult to define what constitutes usual care in smoking cessation services. We aimed to define what this was during the trial. Twenty-two National Health Service healthcare providers participated in a bespoke survey asking about usual care in their area.
All sites offered smoking cessation support; however, service provider and service type varied substantially. In some cases services were not streamlined, meaning that people received smoking cessation counselling from one organisation and smoking cessation medication from another.
To better implement the National Institute for Health and Care Excellence guideline PH48, clearer referral pathways need to be implemented and communicated to patients, staff and carers. People with severe mental ill health need to be able to access services that combine nicotine replacement therapy and behavioural support in a streamlined manner.
Tonio Andrade's The Gunpowder Age is a big book. It spans roughly 800 years, in both China and Europe. Its boldest claims concern China, but Andrade delves into European history as well, making it a challenge for any one scholar to assess his evidence and arguments. Because China specialists would want to know how historians specializing in European warfare and in Western science and technology evaluate Andrade's challenges to received wisdom, the Journal of Chinese History’s editor and editorial board invited historians outside the China field to contribute to a joint review. We succeeded in recruiting a distinguished panel, all of whom have written extensively on these issues: David Parrott, author of such books as The Business of War: Military Enterprise and Military Revolution in Early Modern Europe; Philip Hoffman, author most recently of Why Did Europe Conquer the World?; Stephen Morillo, author of War in World History, among other books; and Ian Inkster, author of Science and Technology in History: An Approach to Industrial Development, among other books. This introduction provides an overview of the discussion so far, and a few additional observations from a historian who has also tried his hand at Sino-European comparisons.
There is a known high prevalence of genetic and clinical syndrome diagnoses in the paediatric cardiac population. These disorders often have multisystem effects, which may have an important impact on neurodevelopmental outcomes. Taken together, these facts suggest that patients and families may benefit from consultation by genetic specialists in a cardiac neurodevelopmental clinic.
This study assessed the burden of genetic disorders and utility of genetics evaluation in a cardiac neurodevelopmental clinic.
A retrospective chart review was conducted of patients evaluated in a cardiac neurodevelopmental clinic from 6 December, 2011 to 16 April, 2013. All patients were seen by a cardiovascular geneticist with genetic counselling support.
A total of 214 patients were included in this study; 64 of these patients had a pre-existing genetic or syndromic diagnosis. Following genetics evaluation, an additional 19 were given a new clinical or laboratory-confirmed genetic diagnosis including environmental such as teratogenic exposures, malformation associations, chromosomal disorders, and single-gene disorders. Genetic testing was recommended for 112 patients; radiological imaging to screen for congenital anomalies for 17 patients; subspecialist medical referrals for 73 patients; and non-genetic clinical laboratory testing for 14 patients. Syndrome-specific guidelines were available and followed for 25 patients with known diagnosis. American Academy of Pediatrics Red Book asplenia guideline recommendations were given for five heterotaxy patients, and family-based cardiac screening was recommended for 23 families affected by left ventricular outflow tract obstruction.
Genetics involvement in a cardiac neurodevelopmental clinic is helpful in identifying new unifying diagnoses and providing syndrome-specific care, which may impact the patient’s overall health status and neurodevelopmental outcome.
Armand-Jean du Plessis, Cardinal Duc de Richelieu, and Giulio Mazzarino, Cardinal Mazarin, respectively first ministers of France from 1624 to 1642 and 1643 to 1661, might seem the personification of early modern statesmanship. Undoubtedly some of the political achievements with which they were traditionally credited now appear anachronistic and questionable, such as the creation of Bourbon ‘absolutism’, the empowering of the secular nation-state or the establishment of a European system of collective security. Yet if statesmanship is essentially about articulating and building support to achieve clear and consistent political goals, then the cardinal-ministers still figure strongly. Their political goals were chiefly dynastic: both Richelieu and Mazarin represented themselves as servants of their kings and of the family policy of the House of Bourbon. The aggressive pursuit of dynastic advantage was nonetheless accompanied by a broader appeal to the public interest, with a particular concern for French territorial security. Pointing to a Habsburg ‘encirclement’ of France by territories governed from Madrid and Vienna, the cardinals articulated and pursued policies which not only sought the glory of the Bourbon monarchy, but also aimed to roll back the supposed threat to France posed by Habsburg ambitions.
Central to building a reputation for statesmanship was their status as ‘first ministers’. Richelieu enjoyed the unmediated favour and support of Louis XIII; Mazarin that of his widow and Regent, Anne of Austria, and subsequently the young Louis XIV. Both ministers exercised a virtual monopoly of influence in determining policy. The other government ministers were their subordinates, and in many cases their appointees, and in no position to compete in offering an alternative perspective on policy. In this respect, Richelieu and Mazarin shared much in common with their Spanish counterparts and opponents, Gaspar de Gúzman, the Count-Duke of Olivares, and his successor from 1643, Don Luis de Haro. All four built their predominance on an ability to combine official positions with what was effectively the status of royal favourite, and by doing so gained a remarkable degree of political initiative.
The Ecclesiastical Law Society (ELS) is a charity whose object is ‘to promote education in ecclesiastical law for the benefit of the public, including in particular the clergy and laity of the Church of England’. The ELS Committee has recently begun a review of this part of the society's work and this piece is a part of that review. This article seeks to set out what is currently happening and to solicit views on how our education work could be developed. The current education function may be described under three headings.
It was an age of great generals, commanding small armies and achieving great things . . .
Jacques de Guibert, writing of the Thirty Years War after the death of Gustavus Adolphus in his Essai général de tactique of 1772.
Interpreting early modern warfare
In the aftermath of Gustavus Adolphus’ victory at Breitenfeld in September 1631, Imperial and Bavarian forces were fragmented across the Empire and faced a large, confident army divided into powerful field forces which were rapidly consolidating a Swedish grip across central and western Germany. Elector Maximilian of Bavaria, whose main priority was preparing for the imminent Swedish assault on Bavaria, appointed Gottfried Heinrich von Pappenheim to command the remnants of Bavarian and Imperial forces spread in garrisons across the Westphalian Circle, with instructions to attempt a diversion which might take military pressure off the south. Pappenheim had no financial resources, and calculated that raising an army adequate to conduct this operation would cost 300,000 talers. Neither Maximilian nor the Emperor would spare troops and money from what they anticipated would be the main struggle to decide the fate of southern Germany and the Habsburg lands. Nevertheless, by stripping troops from the Westphalian garrisons and drawing upon his reputation to encourage enterpriser-colonels to advance some capital to raise or reconstruct units, Pappenheim put together a modest force of some 4,000–5,000 troops, though these were, in his own words ‘experienced men, hardened and eager to fight’. Pappenheim’s operational instinct was to take the campaign deep into enemy-held territory, and in early January he broke out of Westphalia towards Magdeburg in the Lower Saxon Circle, where an Imperial garrison was blockaded by Swedish forces of 10,000 men commanded by the relatively inexperienced Johan Banér. Successfully misleading Banér about the strength of his own troops, Pappenheim drew him off and entered Magdeburg on 14 January 1632. Notoriously, of course, Magdeburg had been sacked and virtually destroyed by the Imperial army eight months previously; but it remained a prestigious and strategically important centre, and the military assumption was that such strongpoints should be held.
The aim of this book is to examine the rise, success and transformations of military enterprise – warfare organized and waged by private contractors – in early modern Europe (c.1500–1700). Military enterprise as it is discussed here amounts to a lot more than hiring mercenaries to serve in the ranks of a state-run army or using privateers to supplement or stand in for the state’s navy. Enterprise includes a more extensive delegation of responsibility and authority to include the supply of food, clothes and equipment to troops, and the manufacturing and distribution of munitions and weapons. Warship and fortress building were outsourced, as were entire naval operations. Garrisoning and siege-works were put out to contract. A large part of this process did involve the hiring and maintenance of soldiers or sailors, but the terms of many of the recruitment contracts drawn up with the field and unit commanders reveal significant differences from those before or after this period. Moreover the way in which these commanders interpreted their authority and autonomy in waging war on behalf of their employers was significantly changed. They acted through their own creditors to raise the funds required for recruitment and military operations, and they drew on networks of private manufacturers, merchants and transport operatives to ensure that their troops were fed and equipped. Some fundamental aspects of the financing of war were placed in the hands of private military contractors or their agents, who also ensured that their credit and costs were recovered, by force if necessary, even when the army was on the territory of its notional employer.
As troops across western Europe dispersed into winter quarters, ports and garrisons in late 1555, the fifth continuous campaign fought between the Emperor Charles V and his rival, Henri II of France, came to an inconclusive end. Both rulers and their governments were well aware of the fiscal stresses that this uninterrupted warfare was generating. In 1553 French military expenses, not including fortification works, were conservatively estimated at 13.2 million livres, and with similar expenditure in prospect for each successive year of war, it was impossible to meet military expenses without a dramatic increase in borrowing. In 1555 the French crown sought to reorganize its financial dealing through what became known as the Grand Parti, based on a consortium of Lyon-based bankers who raised the ever-larger sums required by the crown via the international financial community which transacted business at the three-monthly Lyon money fairs. Charles V and his son Philip were no less aware of the fiscal pressures of warfare. In February 1555 it was estimated that more than a million ducats would be required simply to maintain Spain’s defensive positions on the frontiers of the Milanese, while a serious offensive would cost vastly more. The situation in the Netherlands was even worse, with a state debt of 7 million florins by the end of 1555, and an annual deficit of 3 million ducats.
The traditional instinct of rulers in this situation was to look for a peace settlement that would preserve reputation but would allow for the drastic curtailment of borrowing and some consolidation of existing debts. This had been the case after the last round of the Habsburg–Valois struggle, fought from 1542 down to the 1544 Peace of Crépy. The negotiation of the truce of Vaucelles in February 1556 came as no great surprise therefore; but its collapse later in the year, as the new Carafa pope, Paul IV, provoked a conflict with the Spanish over control of Naples and drew the French back into Italy to provide military support, was an alarming new development. War broke out again in northern France and was to reach its climax in August 1557 with the crushing French defeat at St Quentin.
The previous chapter illustrated how the shift by European states towards reliance on mechanisms of military enterprise was an evolutionary process, shaped by a variety of pressures and problem-solving needs from the early sixteenth century onwards. Whether military enterprise would subsequently have expanded and flourished so extensively without the particular factor of the Thirty Years War is a matter for speculation; hard-pressed governments had certainly discovered before 1619 that the contracting-out of military functions and the mobilizing of subjects’ resources which it permitted offered a practical solution to some of the constraints on mobilizing military force. Yet the Thirty Years War, through its unprecedented length, geographical scale and number of belligerents, offered a vital forcing-house for the development of military enterprise. At one level this has been noted by historians: the war is strongly identified with the hiring and use of mercenaries, whose self-serving and strategically sterile military activities are considered in part responsible for the brutality, destructiveness and length of the struggle. The career of the Imperial Generalissimo Albrecht Wallenstein, the greatest of all condottiere, whose absolute authority over an army of more than 100,000 men raised and maintained through his own networks and resources, is offered as the epitome of an age of military enterprise. Whether seen as an extraordinary project launched by an organizer and administrator of precocious talent, or the last gasp of a system of warfare dominated by over-powerful and unreliable aristocratic power-broking, Wallenstein’s army is placed at the apex of a process by which a long-running form of military enterprise finally reaches its high-water mark in the context of Imperial politics in the 1620s. After Wallenstein the military world changes: fighting wars through private enterprise is everywhere acknowledged as dangerous and unviable, even if many states were unable to act upon that recognition until after the end of the Thirty Years War.
The previous chapter focused upon the military effectiveness of armies raised under private contract. Unit commanders, whether on land or in command of naval forces, were generally motivated by more than a short-sighted desire to raise troops as cheaply as possible and then to exploit them for immediate financial self-interest. Regimental proprietors and ships’ captains sought to recruit experienced soldiers and sailors, and acknowledged the need to offer these men incentives to stay in service and to reward their military skills. Concern with operational viability shifted military activity away from large-scale, attritional warfare where the risk of supply failure and disruption was high. Enterprise encouraged military thinking and practice more appropriate to the limitations and possibilities available to armies and navies in this period: a strong emphasis on the mobility of field armies and willingness to draw upon the military qualities and resilience of the experienced troops within them; a massive downsizing in the scale of operational forces during the 1630s and 1640s as quality was preferred over quantity. All of this was the response of experienced, ambitious and capable commanders, who were certainly not combat-averse but were realistic in setting the pitched battle into a wider context of operational warfare which put more emphasis on territorial control and denial, and on maintaining the initiative through speed, surprise and flexibility.
At the heart of this case for a more economical and flexible use of force lay the management of logistics and finance. Albrecht Wallenstein put his campaigning priorities with characteristic succinctness when he wrote that his army needed bread, then munitions, and after these, wages. Military commanders who deployed their armies in increasingly mobile, flexible approaches to campaigning were well aware that this put even greater weight on well-coordinated supply systems, capable of meeting at least a part of their armies’ needs across a campaign which might extend over ten months and many hundreds of miles of marches, encampments, engagements and sieges. If they were sea captains the centrality of provisioning their vessels for an entire voyage would in most cases be a self-evident requirement before setting out from port.
This battle of Anghiari (1440) lasted two hours, during which first Niccolò [Piccinino] and then the Florentine troops were masters of the bridge . . . Niccolò’s troops won the bridge many times, and always they were repelled by the fresh troops of their adversaries. But when the bridge was won by the Florentines, so that their troops gained the road, Niccolò did not have time, because of the fury of those who came and the inconvenience of the site, to relieve his men . . . the whole army was compelled to turn round and everyone fled toward Borgo without any hesitation. The Florentine soldiers attended to the spoil, which was very great in prisoners, harnesses and horses . . .
Nor were there ever times when war waged in these countries or others was less dangerous for whoever waged it than these. In such a defeat . . . only one man died, and he not from wounds or any virtuous blow, but falling off his horse, he was trampled on and expired.
On 31 August 1515 the recently crowned king of France, François I, at the head of an army which had just crossed down into Italy, halted at Bufalora, 50 kilometres south of Milan. Standing between the king and his objective was the ruler of the Duchy, Massimiliano Sforza, and an army whose core was made up of 12,000–15,000 Swiss infantry. François had not neglected diplomatic efforts to gain Milan, and his agents had been in negotiations with the leaders of the Swiss since late August. Already 5,000 Swiss from Fribourg and Berne had accepted French terms and marched out of the Milanese. On 9 September a treaty was agreed by which the rest of the Swiss troops would accept 1 million écus to abandon the territories they occupied in the Milanese and their military contract with Sforza. Expecting merely to settle the details of the treaty, François and his army of around 30,000 men, together with the best artillery in Europe, moved to Marignano, where they established a well-fortified encampment. While this was going on, the Swiss debated what to do next. Half those present voted to accept the French offer and return home, but others from the eastern cantons argued that they were bound to honour their contract with Sforza.
This is a major new approach to the military revolution and the relationship between warfare and the power of the state in early modern Europe. Whereas previous accounts have emphasised the growth of state-run armies during this period, David Parrott argues instead that the delegation of military responsibility to sophisticated and extensive networks of private enterprise reached unprecedented levels. This included not only the hiring of troops but their equipping, the supply of food and munitions, and the financing of their operations. The book reveals the extraordinary prevalence and capability of private networks of commanders, suppliers, merchants and financiers who managed the conduct of war on land and at sea, challenging the traditional assumption that reliance on mercenaries and the private sector results in corrupt and inefficient military force. In so doing, the book provides essential historical context to contemporary debates about the role of the private sector in warfare.