This chapter completes the description of the delivery system, focusing on three fundamental categories of providers: hospitals, doctors and nurses. For each of these three categories, recent data regarding the density of these providers with respect to the resident population are reported. These data are provided for the twenty-seven OECD countries analyzed in this book. A particular focus is reserved for the mechanism through which hospital facilities and physicians are remunerated.

Chapter Six, ‘On the Wards’, shifts to hospitals. Hospitals were sites of colonial entanglement in the ‘in-between’ zones bestriding active combat and civilian life. Despite the apparent limitations of the space, where men were rendered immobile by the injury or illness, hospitals facilitated encounters, particularly between patients and nurses. For nurses in these spaces, new responsibilities were expected, as chaperones of racial, national and sexual boundaries. Using not only the men’s letters and diaries but those of the women who nursed them – from Britain and the dominions – the politics of caring for colonial troops, white and of colour, are examined. Complex responses to nursing by both the men and the women surpassed existing maternal motifs of caregiving. The threat of racial mixing placed new limits on ‘care’ but there were complicated individual reactions to the new and intimate contact between white women and men of colour: neglect, anxiety, apathy, curiosity and even desire.

uses the biopolitical and socio-environmental perspectives on health constructed in the previous chapters to reinterpret municipal responses to plague. This chapter argues that when Netherlandish cities took action against epidemic spread, they applied pre-existing health policies. It challenges two scholarly biases, namely of crisis and of government. First, actions to prevent spread of the plague are often interpreted as radical innovations, yet many subjects targeted in plague ordinances were usual suspects and recurring problems; already regulated outside the context of plague because they were perceived as posing a (combined) threat to physical and moral communal well-being. Cities employed various strategies, from quarantine and street sanitation to spiritual measures and culling dogs. Secondly, there is a clear need to move beyond a top-down perspective and complicate the playing field of daily dealings with an epidemic through networks of plague care, which are discussed here by focusing on the role of hospitals, medical officials and confraternal caregivers, especially the Cellites.

Secondary and tertiary care (STC) evolved to progressively improve access and quality of care. For various phases of development, the chapter analyses the dynamic interactions of various components of the health system such as human resources, financing, information, medical products and technology and their influence on STC, and the influence of wider factors such as political, socio-economic, demographic and population behaviour. Challenges include the provision of affordable, integrated, seamless care from primary to tertiary levels. Outcomes are discussed in terms of access, utilisation, client satisfaction and quality of care. The analysis includes the dynamics inherent in the dichotomy between the public and private sectors in financing and provision of STC services. Systems thinking illustrates the challenges in the dichotomous public-private system that is subject on the one hand to increasing specialisation and compartmentalisation in medical care and on the other hand to the need for integrated care for the individual patient.

The Victorian period was the most formative era for professional nursing and for cultural concepts of the nurse. The most prominent representative figures of nursing from the period were the disreputable Sairey Gamp – the infamous character from Charles Dickens’s Martin Chuzzlewitt – and the very real and very proper Florence Nightingale. The Victorian cultural perception of nursing was more complex than these polar opposites might suggest, however. The influences that cumulatively fashioned the popular figure of the nurse were legion and contradictory, ranging from camp follower to proselytising nun to heroic martyr.

The evolution of nursing practice from menial to professional work was widely examined and debated in the media and through fictional representations of nurses. As these treatments reveal, there was marked cultural ambiguity about the entrance of refined women into nursing, which, even in its most professional form, entailed a level of intimacy with both male and female bodies and bodily fluids that was disturbing to Victorian sensibilities. What emerges in both the media and fiction is a curious and very Victorian fixation on sexuality that was explicitly or implicitly directed at the women who practised nursing.

This chapter documents and identifies the presence of several kinds of European medical practitioners in West-Central Africa. It shows that African healers were not the only ones whose practice could come under the scrutiny of ecclesiastical or secular authorities. The legitimacy of white healers was similarly discussed from time to time. In Luanda, ailing patients could theoretically go to a number of Portuguese practitioners, but in reality the number of physicians and surgeons was limited and concentrated on treating the colonial elites and soldiers serving in the military. A fair number of Africans were trained as and served as barbers in Angola and Kongo, pointing to the transfer of European medical technology to Africans. Medical pluralism reflected mostly local African practices and values, but global influences were also present in the form of the charitable brotherhoods, which ran hospitals in Luanda, Benguela and Massangano. It is also evident in the arrival of quina bark from Brazil as early as the 1720s.

Chapter six investigates the economic bases of Jeddah, trade and pilgrimage. A brief overview of major trends in trade and transport is followed by a more detailed discussion of the merchants of Jeddah and their internal organisation. The political role of the merchants and their relation to the respective ruling powers forms another topic. The chapter then turns to the pilgrimage, starting by investigating the pilgrims’ guides and the way in which they organised reception, accommodation and transport for pilgrims. Given the attempts of Western powers to limit what were perceived health and political threats emanating from the pilgrimage, the ways in which such organisation played out locally through the consulates is touched upon, notably in as far it affected local water and health provision. Finally, the chapter turns to the Bedouin, a population usually residing outside of the city walls but indispensable to trade and pilgrimage and constituting a vital link between the city, its suburbs and surroundings.

Discusses the use of the gramophone for both educational and recreational purposes, showing how this developing technology was used on the fighting fronts in the maintenance of servicemen’s morale, as well as for medicinal and therapeutic uses in hospitals and convalescent homes.

Provides an overview of the ways in which music was used in medical settings during the war. It will outline how the British Red Cross, which was tasked by the War Office to coordinate the organisation and supply of British hospitals, ensured that provision was made for live and recorded music in the majority of their facilities. This chapter will also consider how the medical profession came to recognise that music was an aid to servicemen’s recovery and convalescence. The experiences of civilian entertainers in military medical settings will also be examined.