"The Noblest Roman of them all?" Professional versus Popular Views of America's Country Doctors.

This essay studies the images, perceptions, and values of the professional medical journals, as well as popular sources such as magazine and films, to show that the country doctor was a contested figure in the late nineteenth and early twentieth centuries. The country doctor's image embodied competing ideals of a racialized professional and masculine identity that included both place as well as visions of science. Medical professionals pressed an image in their journals and professional advice books that mapped a celebration of science and its predictive value onto urban places that were enshrined in hospitals and laboratory facilities. The public, while embracing this image, also embraced a second one shown in popular media that glorified the self-sacrificing rural solo practitioner. This practitioner's wisdom came from long contact with patients, he was dedicated to seeing patients in their homes, and his identity was based in the larger needs of the entire community.

A Century Later: Rural Public Health's Enduring Challenges and Opportunities.

The US public health community has demonstrated increasing awareness of rural health disparities in the past several years. Although current interest is high, the topic is not new, and some of the earliest public health literature includes reports on infectious disease and sanitation in rural places. Continuing through the first third of the 20th century, dozens of articles documented rural disparities in infant and maternal mortality, sanitation and water safety, health care access, and among Black, Indigenous, and People of Color communities. Current rural research reveals similar challenges, and strategies suggested for addressing rural-urban health disparities 100 years ago resonate today. This article examines rural public health literature from a century ago and its connections to contemporary rural health disparities. We describe parallels between current and historical rural public health challenges and discuss how strategies proposed in the early 20th century may inform current policy and practice. As we explore the new frontier of rural public health, it is critical to consider enduring rural challenges and how to ensure that proposed solutions translate into actual health improvements. (Am J Public Health. 2020;110:1678-1686. https://doi.org/10.2105/AJPH.2020.305868).

Safe Villages during the 1918-1919 influenza pandemic in Spain and Portugal.

The 1918-1919 influenza pandemic had a significantly different impact on mortality rates in Spanish and Portuguese provinces and cities. In this study, several small villages have been identified which were not affected at all by the Spanish influenza pandemic. These all shared a number of features in common: their villages were very small, comprising only a few hundred inhabitants; they were located in mountainous regions, with very poor transport infrastructure; and they were self-sufficient and capable of fulfilling their basic alimentary needs. Their inhabitants were conscious of the problem and acted together, effectively isolating themselves from surrounding villages. Since these villagers managed to avoid direct contact with ill people from other municipalities, the flu was not transmitted and the pandemic did not arise in their villages. In this paper, it is proposed that the human habitability spaces that meet these characteristics, I call them "Safe Villages" or "Shelter Village". Knowledge of the circumstances in which the 1918-1919 flu pandemic developed and of the means employed to resist it can help us to take relevant measures when faced with future pandemics.

Building Community and Transforming Knowledge: Histories of Women's Health Practitioners and Community-Based Health Services in 20th-Century Alberta, Canada.

As new government health policy was created and implemented in the late 1910s and the late 1960s, women patients and health practitioners recognized gaps in the new health services and worked together to create better programs. This article brings the histories of the district nursing program (1919-43) and local birth control centres (1970-79) together to recognize women's health provision (as trained nurses or lay practitioners) as community-based and collaborative endeavours in the province of Alberta. The district nursing and birth control centre programs operated under different health policies, were influenced by different feminisms, and were situated in different Indigenous-settler relations. But the two programs, occurring half a century apart, provided space for health workers and their patients to implement change at a community level. Health practitioners in the early and late twentieth century took women's experiential knowledge seriously, and, therefore, these communities formed a new field of women's health expertise.

How the Seven Countries Study contributed to the launch and development of cardiovascular epidemiology in Italy. A historical perspective.

The Italian research group of the Seven Countries Study of Cardiovascular Diseases (SCS), through the independent use of the national cohorts and data, had the lucky opportunity, starting in the early 1960, to launch the Italian research in epidemiology of cardiovascular diseases (CVD). In this way, the Italian Section of that international study became the first investigation with baseline measurements in various cohorts, subsequent re-examinations, systematic search for morbid events, and follow-up for mortality up to 50 years. A large number of scientific aspects has been tackled including estimates of morbidity and mortality rates, the association of risk factors with cardiovascular events and total mortality, the role of risk factor changes, the use of multivariable models, the role of lifestyle behavior, the determinants of all-cause mortality including risk factors rarely measured in other studies, the identification of characteristics of a condition called Heart Disease of Uncertain Etiology (HDUE), the production of predictive tools for practical use and several other issues. All this has been enhanced by the availability of extremely long follow-up data rarely found in other studies. Field work organization, measurement techniques, diagnostic criteria, data handling and computing had the limitations and difficulties typical of those times, the mid of last century, when CVD epidemiology was at its beginning. All this represented anyhow the start of CVD epidemiology research in the country and was the stimulus to the start of other studies and a valuable collaboration with some of them.

Childhood health as reflected in adult urban and rural samples from medieval Denmark.

This study examines the evidence of three skeletal markers relating to childhood health that leave permanent observable changes in the adult skeleton. Two are well known to paleopathology, namely Harris lines (HL) and linear enamel hypoplasia (LEH). The third skeletal marker is less commonly used; the permanent changes in the temporal bones, induced by chronic or recurrent infectious middle ear disease (IMED) in childhood. A total of 291 adult skeletons from an urban (n = 109) and a rural (n = 182) cemetery, from the Danish medieval period (1050-1536 CE) were included. The markers were examined for their co-occurrence, and differences between the two samples. No statistically significant difference for the three skeletal markers between the two samples was found. A trend was nevertheless apparent, with greater frequencies for all three skeletal markers for the urban population. A statistically significant relationship was found only between IMED and HL. This positive relation was very low (rɸ = 0.307, 0.275) and may be considered non-existent. The lack of co-occurrence is interpreted as if an individual was exposed to conditions that could cause the osteological expression of all three markers this could be a life-threatening health condition, during developing years.

Influence of physiological stress on the presence of hypoplasia and fluctuating asymmetry in a medieval population from the village of Sypniewo.

This study aims to estimate the levels of physiological stress in the medieval rural population of Sypniewo by evaluating patterns of fluctuating asymmetry (FA) and enamel hypoplasia (EH), and provide information on the influence of physiological stress during the prenatal and perinatal period on early childhood development. Stress is defined as any external or internal condition that challenges homeostasis of an organism. FA is associated with physiological stress occurring mainly during prenatal development and early childhood. The level of FA is thought to reflect the intensity of the stressor(s). EH is caused by physiological stress such as nutritional instability during the first years of life. The studied material consisted of 126 skulls from the village of Sypniewo (Poland). Cranial radiographs were taken in postero-anterior (P-A) and basal views. The images were scanned and calibrated. Measurements of the cranium were used to estimate FA. The presence of EH was assessed using standard anthropological methods The highest levels of FA were observed in the region of the cranial base. EH was observed in 29% of individuals from the rural skeletal series. There was no statistically significant correlation between FA and EH occurrence or between sex and the studied stress indicators.

Osteochondritis Dissecans of skeletal elements of the foot in a 19th century rural farming community from The Netherlands.

Osteochondritis Dissecans (OD) is a pathological condition of the subchondral bone and surrounding cartilage of synovial joints, associated with strenuous activity and/or trauma. Reports of OD in archaeological skeletal remains are few and the majority demonstrate low OD prevalence (<1%). A predominantly 19th century skeletal sample from Middenbeemster, the Netherlands, was assessed for OD. The sample included adult individuals of both sexes. There were no definitive OD lesions in non-pedal elements, yet 12.9% of individuals suffered from pedal OD. Few archaeological and clinical reports specify the prevalence of pedal OD. According to the few that do, the Middenbeemster pedal OD prevalence is distinctly high. Several factors could have contributed to this. First, the rural Beemster community was centered around cattle farming, requiring extensive outside work and animal maintenance; thus, increasing the chances of acute/repetitive trauma in the foot. Second, the footwear worn during that period in the Netherlands was the wooden clog. It is suggested that the hard and inflexible clog, which is poor at absorbing shock and limits the movement of the foot, could have resulted in repetitive microtrauma. These two factors combined may have caused a high frequency of OD.

Social responsibilities of a physician: reflections of Major General S L Bhatia (1891-1981).

This paper examines various documents written by Major General SL Bhatia CIE, MC, IMS from the 1920s to the1960s on the "Social Responsibilities of a Physician". His reflections are of historical significance, since they provide us with an insight into the challenges confronting the people who attempted to rebuild a nation plagued by poverty resulting from fractured agricultural growth, a feudalistic social structure and the regional inequalities that accompany it, and prolonged imperial rule, among other things. Bhatia's thoughts, especially on medical education and the condition of rural health and sanitation, enable us to understand India's present health concerns through the prism of the past. The writings of Bhatia, who lived during a period of transition in India, reflect an understanding of health issues from the perspectives both of an administrator and a physician struggling to meet the challenges of a nascent nation. He insisted on rooting his medical teachings in the principles of the humanities and ethics.

[The sertão remediated: the clash between the elite of Goiás and sanitation thinking, 1910-1920]. / O sertão remediado: o embate entre a elite goiana e o pensamento sanitarista, 1910-1920.

In the early decades of the twentieth century, when health started becoming an issue on the political agenda, Arthur Neiva and Belisário Penna travelled to the sertão semi-arid region of Goiás state, Brazil, to diagnose the population's state of health, particularly highlighting the spread of Chagas disease and the decadence of the sertão. The political elite in the state reacted to the sanitarians' findings. This article observes the controversy played out in the pages of A Informação Goiana magazine. The publication supported the region's interests, because its leaders were sure that it was down to the people of Goiás to reveal the truth about the sertão, its people, and its potentialities.

La medicina rural a principios de siglo XX. A propósito de Martínez Saldise (1855-1937), socio de honor de la Sociedad de Pediatría de Madrid en 1927 / Rural medical practice at the beginning of the 20 th century. Martínez Saldise (1855-1937), honorary member of Paediatric Society of Madrid in 1927

INTRODUCCIÓN: En el centenario de la Sociedad de Pediatría de Madrid se quiere realizar un homenaje a la medicina rural de aquella época. Hay escasez documental sobre la historia de la medicina rural. El objetivo es describir el marco del ejercicio médico rural a finales del XIX y principios del XX en tanto que se desarrolla una revisión histórica biográfica de Manuel Martínez Saldise, que fue médico titular de Cazalegas (Toledo). En 1927 fue nombrado socio de honor por la Sociedad de Pediatría de Madrid. MATERIAL Y MÉTODOS: Búsqueda en repositorios de prensa digitalizada, portales web de historia de la medicina, pubmed, IME, archivos locales de diputaciones y colegio de médicos. Se revisó el archivo familiar con la colaboración de uno de sus descendientes. RESULTADOS: La contratación de los médicos rurales se realizaba por los ayuntamientos, el sueldo en gran parte dependía además del ejercicio privado, de las «igualas». Los médicos titulares participaban en las epidemias, en medicina legal, en las medidas de higiene; también tenían conflictos con alcaldes, caciques, con colegas y con el intrusismo. Se hace un resumen de aspectos biográficos y laborales de Manuel Martínez Saldise.comentarios:Los médicos rurales se entregaban a la sociedad de su época, ante los problemas que surgían, denunciaban las carencias de la administración local, dedicaban esfuerzos a su familia y a los más desfavorecidos

INTRODUCTION: On the centenary of the foundation of the Paediatrics Society of Madrid, a tribute is presented to rural medical practice of that time, although there are few documents on the history of rural medicine. The main objective is to describe the context of the rural medical practice in the late 19th and beginning 20th century, while presenting a historical biographical review of Manuel Martínez Saldise, who was medical specialist from Cazalegas (Toledo). He was appointed an Honorary Member by the Paediatrics Society of Madrid in 1927. MATERIAL AND METHODS: A search was carried out in repositories of digitized media, web portals of history of medicine, PubMed, IME files of local councils and medical colleges. The family archives were reviewed with the collaboration of his descendants. RESULTS: The hiring of rural doctors was carried out by the municipalities, and the salary largely depended on private practice as well as "retainers". Specialist physicians took part in epidemics, legal medicine, and in hygiene measures. They also had disputes with mayors, chiefs, with colleagues and with protectionism. A summary of the biography and occupational activity of Manuel Martínez Saldise is presented.comments: Rural doctors were subjected to the society of their time, with the issues that arose, denouncing the shortcomings of the local administrations, dedicated efforts to their family and the most disadvantaged

The laboratory and the village. The Algiers Pasteur Institute and "colonization physicians" in the fight against malaria (1904-1939).

From the late 19th century, some of the physicians settled in Algeria and teachers at the School of Medicine of Algiers sought to map the extent of malaria in order to propose prophylactic measures against a disease that was widespread in the countryside of the colony. When the fight against malaria was organized in Algeria at the beginning of the 20th century, under the joint direction of the General Government and the Pasteur Institute, the Institute researchers needed to gather various types of data for determining epidemic indexes and preparing action programmes. The so-called «colonization physicians¼, responsible for delivering healthcare to colonials and natives in rural districts since the 1850s, appeared to be appropriate collaborators with the administration in the campaigns. The organizers of these campaigns also worked with agents quininisateurs (quinine distributors) and those involved in anti-larval measures, as well as with agencies responsible for roads and bridges and for water services, among others. However, there were soon repeated calls for them to be trained in the new bacteriology techniques. Advanced courses were also proposed to allow these practitioners to act as true and effective agents of the anti-malarial service, such as the 34-day course organized in 1932 by the Pasteur Institute of Algeria.

El paciente, nuestra guía de formación / The patient, our training guide

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Tuberculosis: A biosocial study of admissions to a children's sanatorium (1936-1954) in Stannington, Northumberland, England.

This study considers the biosocial profile of children admitted to the Philipson Children's Sanatorium at Stannington, Morpeth, Northumberland, England (1936-1954). The objective was to understand the differential impact of TB on male and female admissions at Stannington, according to a number of variables. A total of 1987 medical files were analysed. More females than males were admitted, peaks of admission at age six and 13 were documented, and the majority of children derived from poor urban areas. Over 60% (1199, 63.5%) of children had pulmonary TB, and 12% (230) had bone or joint involvement. The implementation of chemotherapy (streptomycin) at Stannington (1946), the end of the 2nd World War (1945), and the founding of the National Health Service (1948) did not have any great effect on the biosocial profile of children admitted to the sanatorium and treated (age, sex, origin, type of TB suffered, and socioeconomic status). Reasons for these finding are discussed.

Tuberculosis and survival in past populations: A paleo-epidemiological appraisal.

Historical assessments of the last two centuries consistently placed tuberculosis as the leading cause of mortality. However, for earlier periods, we can only calculate the frequencies of archaeological bone lesions, which tell us little about the real impact of the disease on mortality. These lesions are usually observed in individuals who have developed immune resistance, which is visible as healed osteo-articular lesions. This study aimed to test the differential impacts of tuberculosis, cribra orbitalia and cribra femoris on adult survival and sex-based survival. We analyzed 28 French adult samples from the Antiquity and the Early Middle Ages. The age-at-death of 1480 individuals was estimated using cementochronology. Survival curves and median age-at-death were calculated to test new hypotheses that challenge the parasitic and deficiency theories of bone stress markers. Comparisons between carriers and non-carriers provided new information concerning the plausible causes of bone stress markers related to infections and TB. The most likely hypothesis is skeletal demineralization and osteoclastic resorption, which are usually observed close to tubercular granuloma or distant from active lesions. The bone marrow niche of Mycobacterium tuberculosis within CD271(+) BM-MSCs stem cells is the proposed explanation for the localized cortical resorption that is observed in bone stress markers.