The Arrival and Diffusion of Academic Medicine in Rural Sweden: The Case of the Sundsvall Region in the late Nineteenth Century

his study examines the numerous logistical, cultural and psychological obstacles that midwives had to overcome before women in the Sundsvall region of Sweden would entrust them to deliver their infants. By extension, this analysis reveals the tenuous position academic medicine had in many remote villages. These well-trained women benefitted from numerous pieces of legislation designed to enable them to replace the help-women who remained their greatest rivals. None the less, trained doctors and midwives often encountered resistance among local populations. Historians have tended to focus attention on the work of individual physicians and the consequences of government intervention without paying much attention to the patients themselves and the reasons they either accepted or rejected the people sent to provide medical care. This paper represents an attempt to address this imbalance by suggesting how theories of diffusion, concepts of trust, and perceptions of risk can help us understand the decisions made by people confronted with new medical practitioners. Diffusion theory provides an opportunity to illuminate the process by which the acceptance of academic medicine, here represented by an increased willingness to have midwives attend births, diffused through the Sundsvall region of Sweden during the second half of the nineteenth century. Certainly the role of formal legislation, medical associations, and the practices of individual medical practitioners were critical to the introduction of new innovations. No one should dismiss the integral role these agents played in making academic medicine available to the public. Unfortunately, historians have tended to place less atten-