Anna Lundberg, Care and coercion: medical knowledge, social policy and patients with venereal disease in Sweden 1785–1903, Report no. 14 from the Demographic Data Base, Umeå University, 1999, pp. 309 (91-7191-675-X).

Abstract

Anna Lundberg's book covers a number of topics related to venereal disease in nineteenth-century Sweden such as political ideas, legislation, medical knowledge and practice, social characteristics of patients treated at hospitals, and the social and health consequences of being hospitalized for a venereal disease. Lundberg has undertaken a huge task in analysing a wide variety of material in order to tell the story of venereal disease in Sweden. The sources studied include transcripts of parliamentary debates, laws, medical journals, patient records, records from parish meetings, etc. The reader is presented with many interesting stories about both doctors and patients. It sometimes seems as if the author wants to share with us most of what she has gathered together. The amount of information sometimes overshadows important findings, such as the change from the view of venereal disease as connected with poverty to that of its being connected with immoral behaviour. The most interesting findings result from Lundberg's analysis of the demographic life-course of patients from one hospital during 1814–44 and from another during the following forty-five years. She shows that the majority of patients with a venereal disease did not suffer serious social or health consequences from being hospitalized. That is to say, they got married like others. One important exception is that mortality among the patients discharged from the first hospital was higher than that among the control group. Children born to former female patients also had a high mortality rate at the first hospital. Patients discharged from the second hospital investigated had hardly any excess mortality as compared to the control group and the difference in infant mortality was smaller than among patients from the first hospital. There are some problems with the study. The patients are compared to a control group, described as “similar men and women”. This, however, is not a satisfactory description of the control group sampling. There was no infant mortality at all in the offspring of the control group of the first hospital. This gives the impression that the control group was neither representative in terms of the rest of the population nor comparable to the patient group, because the general level of infant mortality was so high (around 15 per cent) at the time that one would expect at least some mortality also in the control group. When the geographical distribution of patients is studied, it is not calculated in relation to the population, hence we do not know if the high numbers are due to a big population in the area or a high frequency of venereal disease and therefore if it is of special interest to study the areas with many patients. The author also gives some surprising interpretations of her results, as when she says that there was no significant gender difference between the patients at the department of venereal disease and the general hospital, in spite of the fact that the women constituted 61 per cent of the patients at venereal departments and only 43 per cent at the general wards. The book would have gained from a clearer focus from a more selective use of the extensive information, and especially from more careful work with the analyses of the demographic data. The book does, however, have the merit of presenting a lot of interesting information and references to sources on venereal disease in Sweden which will be of great help for scholars in the field.