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The Politics of Public
Administration
Reform in Italy
Sabrina Cavatorto
Antonio La Spina
The Politics of Public Administration
Reform in Italy
Sabrina Cavatorto • Antonio La Spina
The Politics of Public

Administration
Reform in Italy
Sabrina Cavatorto Antonio La Spina
University of Siena Luiss Guido Carli, Free International
Siena, Italy University of Social Studies,
Rome, Italy
ISBN 978-3-030-32287-8 ISBN 978-3-030-32288-5 (eBook)

https://doi.org/10.1007/978-3-030-32288-5
© The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer
Nature Switzerland AG 2020
This work is subject to copyright. All rights are solely and exclusively licensed by the
Publisher, whether the whole or part of the material is concerned, specifically the rights of
translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on
microfilms or in any other physical way, and transmission or information storage and retrieval,
electronic adaptation, computer software, or by similar or dissimilar methodology now
known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information
in this book are believed to be true and accurate at the date of publication. Neither the
publisher nor the authors or the editors give a warranty, expressed or implied, with respect
to the material contained herein or for any errors or omissions that may have been made.
The publisher remains neutral with regard to jurisdictional claims in published maps and
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Cover illustration: Pattern © John Rawsterne/patternhead.com
This Palgrave Macmillan imprint is published by the registered company Springer Nature
Switzerland AG.
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Contents
1 Introduction: The Puzzle of Administrative Change 1

Sabrina Cavatorto and Antonio La Spina
2 Pressures to Reform and the Impact of the Fiscal Crisis 23

Sabrina Cavatorto
3 Restyling Public Management–Inspired Reforms 43

Sabrina Cavatorto
4 Fighting Corruption 75
Antonio La Spina
5 Obstacles to Performance Evaluation and Improvement 101

Antonio La Spina
6 Conclusions: Still Risking Implementation Gaps127

Index145
v
List of Figures
Fig. 2.1 Public employment in the Italian general government (N). For
obvious problems of definition and measurement, an ensured
level of comparison among OECD countries is that of
“general” government, which comprises state, central and local
authorities (OECD 1997). (Source: Own elaboration based on
https://www.contoannuale.mef.gov.it/)29
Fig. 2.2 Citizens attitudes towards the PA: Italians among Europeans
(%). (Source: Own elaboration based on Eurobarometer
Interactive “PA in [OUR Country]” (11/2018)) 35
Fig. 4.1 Control of Corruption (2017) (percentile rank 0–100).
Country’s rank among all countries in the world: 0 corresponds
to lowest rank and 100 corresponds to highest rank. (Source:
Own elaboration based on http://info.worldbank.org/
governance/wgi/index.aspx#home)78
Fig. 4.2 Favouritism in decisions of government officials (2017 (1–7
best)). In your country, to what extent do government officials
show favouritism to well-connected firms and individuals when
deciding upon policies and contracts? 1 shows favouritism to a
great extent; 7 does not show favouritism at all. Italy’s rank in
2017 was 118/137. (Source: Own elaboration based on
http://reports.weforum.org/global-competitiveness-
report-2018/)79
Fig. 5.1 Provision of public services (2017) (%). QA1a. “How would
you judge the current situation in each of the following? The
provision of public services in [OUR COUNTRY]”. Only in
Greece a higher percentage of respondents (85%) believe that
the provision of public services in their country is “total bad”.
vii
viii List of Figures
Seven countries follow Italy: Croatia (66%), Romania (63%),

Spain (58%), Bulgaria (54%), Portugal (53%), Slovakia and
Cyprus (50%). On the contrary, a majority of respondents think
their country’s public services are good in 19 EU member
states, with levels of satisfaction ranging from 46% in Poland
and 54% in France, to 90% in the Netherlands. Satisfaction
exceeds 80% in Luxembourg (87%), Finland (86%) and Austria
(81%). (Source: Eurobarometer Standard 88 (Autumn 2017)) 122
Fig. 5.2 Satisfaction and confidence on the national government (% of
citizens expressing confidence/satisfaction). Data for “national
government” refer to the percentage of “yes” answers to the
question: “In this country, do you have confidence in each of
the following, or not? How about national government?”
(Source Gallup World Poll). (Source: Own elaboration from
OECD Government at Glance (2013, 2017)) 122
Fig. 6.1 Compliance checks by the Inspectorate for the public function
and “severe” sanctions. (Source: Own elaboration from http://
www.funzionepubblica.gov.it/strumenti-e-controlli/controlli-
ispettorato/documentazione)133
Fig. 6.2 Total staff employed by public administrations per year
(thousands of units). The Annual Account shows the data on
the consistency and costs of PA personnel and constitutes the
official source of information for decisions regarding public
employment. (Source: General State Annual Account 2017) 135
List of Tables
Table 2.1 Implementation of CSRs to Italy in the PA field 34

Table 3.1 “Management-” and “governance-”oriented ideas from the
parliamentary narratives 60
Table 3.2 Delegations according to law 124/2015 reorganizing the PA 68
Table 6.1 Turn over quotas in central PA (% of expenditure equal to
that relating to personnel who left the previous year) 135
Table 6.2 Designing PA change through EU structural resources
(2014–2020)137
ix
CHAPTER 1
Introduction: The Puzzle of Administrative

Change
Abstract This introductory chapter develops the theoretical framework

of the book, placing the country case study of Italy on main trajectories of
administrative change in Europe. The variety of administrative traditions
and models of innovation are at the core of our reflection about possible
new policy trends: in the way reform options have been incrementally
shaped, we examine how New Public Management (NPM)-oriented
approaches have been taken into consideration, together with the devel-
opment of post-NPM narratives. The peculiarity of an empirical science of
public administration is put forward.
Keywords Policy change • New Public Management • Neo-Weberian

state • Public governance • Implementation • Italy
1.1 Administrative Reforms, Types of Public Policy

and the Empirical Science of Public Administration
The adoption and implementation of administrative reforms could be

thought of as being relatively smooth. Neither they imply the huge finan-
cial costs of social policies, nor do they focus on identitarian and ideologi-
cally divisive issues. Rather, they are based on the commonsensical idea
© The Author(s) 2020 1

S. Cavatorto, A. La Spina, The Politics of Public Administration
Reform in Italy, https://doi.org/10.1007/978-3-030-32288-5_1
2 S. CAVATORTO AND A. LA SPINA
that red tape is excessive and public bureaucracies are rigid, tardy and
inefficient. In principle, therefore, they could easily attract some consensus
among both citizens and members of the political elite. At the same time,
for the above reasons the decision making processes leading to their
approval could be expected not to be ridden with controversies and con-
flicts. According to the seminal taxonomy of public policies proposed by
Lowi (1970, 1972), administrative reforms seem to belong to “constitu-
ent policies”, which are in fact characterized by remoteness of coercion
and low levels of conflict.1
Gustavsson (1980) combined Wilson’s (1980) and Lowi’s taxono-
mies: administrative reforms can be seen as measures with diffused costs
and diffused benefits, being to some extent able to “determine” (in
Lowi’s vein), like any type of public policy, the way political interactions
(i.e. politics) develop. This would be consistent with their supposed rela-
tive “easiness”. One might guess that all that is actually needed is the
availability of certain technical policy instruments (which could be cre-
atively devised or, more frequently, imitated), whose application can be
credibly expected to reduce or solve certain problems plaguing existing
public bureaucracies. Imitation and learning would therefore be the main
factors in order to explain why certain historical phases apparently exhibit
“waves” of administrative reforms, which expand themselves across many
countries. This is what is supposed to have happened at first with the dif-
fusion of the neo-liberal version of new public management (NPM),
which stressed the need to cut costs and import efficient tools from the
private sector, and then with other more progressive approaches, which
rather emphasized service quality, involvement of citizens/users, open-
ness of governance and participation (the so-called “post-NPM” mod-
els). Such a picture, however, would be overly simplistic, and anyway is
contradicted by several hard facts. When they are really impactful,
1
When Lowi wrote about constituent policies, the examples he made were rather hetero-
geneous. He mentioned “reapportionment, setting up a new agency, propaganda”; then
“constituent or system maintenance policy” (Lowi 1972: 300, 310). Elsewhere, he was more
explicit in subsuming the organization of public bureaucracies under constituent policies
(Lowi 1985). When describing them, Spitzer (1987: 678, 680; see also Tolbert 2002) indi-
cated as an example of constituent policy “administrative/departmental reorganization”, or
a “agency reorganization”. Salisbury (1968) tried to fill the empty fourth cell of the taxon-
omy with self-regulation, which has to do with some of Lowi’s examples of constituent poli-
cies, but not with administrative reform.
1 INTRODUCTION: THE PUZZLE OF ADMINISTRATIVE CHANGE 3
administrative reforms often modify, reduce or eliminate existing advan-

tages and opportunities for rent-seeking. Therefore, in such cases they
would rather imply concentrated costs and diffused benefits, hence a
much more adversarial and difficult decision path. Apart from the more
or less overt opposition of bureaucrats or other actors whose material
interests would be directly damaged by a reform, also the general culture,
the institutions or the policy style of each country are relevant in favour-
ing or obstructing the adoption and implementation of administrative
reforms (Lenschow et al. 2005; Stillman 2016; Gustafsson and Richardson
1980; Richardson 1982). It must also be remarked that the diffusion of
the various waves of public management reforms was not in fact so wide-
spread, homogeneous and uncontroversial (Pollitt and Bouckaert 2017;
Goldfinch and Wallis 2010; Massey 2018). A public intervention in this
field could be merely or mostly symbolic, when it is devoid not only of
the necessary minimum of financial resources, but also of sanctions or
other tools that can alter bureaucratic structures and performances deeply
enough. It can also happen that, even if the innovation is explicitly
inspired by some foreign experience or managerial approach, it resorts to
choosing inappropriate instruments (e.g. performance evaluators that are
supposed to be independent, but actually are not).
Public administrations and the policies affecting them can be studied
from three different cognitive points of view: that of the jurists, who inter-
pret valid texts in order to derive from them legal obligations and conse-
quences; the managerial one, which is focused on the practical need of
performance improvement; that of empirical social scientists (who belong
to the science of administration, political science, sectoral sociology and
other relevant fields), who produce explanatory/predictive accounts based
on factual evidence, concerning the actual operation of real public bureau-
cracies, as well as the genesis, formulation, drafting, legitimacy and impact
(including unintended consequences) of reforms.2 The present study is to
2
A somewhat similar but actually different threefold distinction is proposed by Bauer
(2018), who sees public administration as surrounded by the three sides of a disciplinary
triangle: law, management and political science (the latter being focused on legitimacy and
unintended consequences). In this respect, Kingdom (1990) warns against the limitations of
managerialism and defines public administration a “peculiarly vulnerable discipline”.
According to Pollitt (2010), “what unifies public administration is his subject”. Kettl (2000)
shows how several social sciences and theoretical approaches address public administration
and can enhance its rigor. Wright (2011, 2015) speaks of “administrative management’s
nearly exclusive focus on efficiency and effectiveness”, too. In his opinion, an empirical and
be attributed to the third point of view. We examined Italian administra-

tive reforms against the background of the interface between external
pressures, isomorphic change, path dependency and domestic politics.
The framework is dynamic and reflects the balance of power relations
among the relevant actors and institutions involved in the administrative
policy as a subsystem. That is the way we see politics and the policy pro-
cesses interact, confirming that in order to understand administrative
reforms trajectories the “pure” dichotomy between politics (politicians)
and administration (bureaucrats) within the policy cycle (decision making
vs. implementation) is not enough.
1.2 Continuity and Changes Within

Public Administrations
There is wide convergence among scholars of public administration (PA)
that “administrative reform is a slow process of incremental small changes,
with radical changes occurring only occasionally” (Kickert 2011: 802),
often as a result of external shocks (the so-called critical junctures3).
Anyway, beyond the pessimistic view that administrative reforms “are
mostly piecemeal, gradual and incremental” and that “almost nothing
happened at all”, particularly in Southern European states, Kickert con-
cludes that “many small changes could add up to a substantial change”
(ibidem). In fact, modes of gradual, nevertheless transformative change,
were also taken into consideration by historical institutionalists,
traditionally more used to adopt an “all-or-nothing” dichotomous way of
thinking (the well-known “punctuated equilibrium” theory).
The heritage from the Napoleonic state model, dominated by formal-
ism and legalism, explains why in Southern European administrations new
public management reforms (such as privatization, contracting-out, pub-
lic–private partnerships, view of the citizen as a client, performance mea-
surement, results-based budgeting and decentralization) were mainly
rigorous “science of public administration” is not an easy accomplishment, but much prog-
ress was made in that direction since Dahl’s article (1947). On the one hand, Dahl already
spoke of generalizations, experiments and deduction. On the other, he argued that “the
study of public administration inevitably must become a much more broadly based discipline,
resting not on a narrowly defined knowledge of techniques and processes”. Therefore, it had
to include also societal contexts, cultural traits, historical roots and economic processes.
3
A useful literature review on the use of the “critical juncture” concept was provided by
Capoccia and Kelemen (2007). The potentialities and the limitations of the concept in com-
parative-historical analysis were further described by Capoccia (2015, 2016).
reframed in legal terms (Capano 2003)4 and often produced limited, or

even perverse, effects (Pollitt et al. 2007).
Studying the dynamics of public management reform in Italy, Ongaro
(2009) asked whether there was change of “a radical kind through disrup-
tion of the old equilibrium and transition to a new equilibrium” or whether
reforms of the public sector were “purely superficial”, that means that
“path dependency has prevailed and there has been no or limited change,
or else whether there has been change through accumulation of small
changes” (ivi: 10). He suggested a mixed interpretation, generally agreed
in the scholarly debate: by reason of an unfavourable environment for
paradigmatic reforms since the beginning of the 1990s—described by the
notion of “context in motion”, i.e. a scenario characterized by continuous
transformations of the political and institutional system (Ongaro 2011),
hence a context of political instability (Mele and Ongaro 2014)—there
was but only limited, “patchy” change. On the one hand, it was “partly in
the form of punctuated change occurring through disruption driven
mainly by political turmoil” in the 1990s (after the Tangentopoli corrup-
tion scandals); on the other hand, it was “partly through accumulation” in
the way of specific mechanisms, like layering and conversion (ivi: 30). A
process of “negotiated change” (Bull and Rhodes 1997; 2007) is strongly
characterized by path-dependent evolution.
This is also why, describing the types of national structures and pro-
cesses, and their link to patterns of management reforms, still in recent
times Pollitt and Bouckaert (2017) considered Italy as a “hard-to-classify”
case of modernizer: “Italy has been quite volatile on the surface—espe-
cially in the mid-1990s—but simultaneously exhibits some deeper cultural
and organizational continuities” (ivi: 118).
With the severe, systemic crisis at the beginning of the 1990s, the iner-
tia of previous decades was “replaced by a permanent cycle of reform”
(Capano 2003: 787) aimed at developing a management-oriented pro-
gramme of change within the public sector. In discontinuity with the past,
from the early 1990s up to the eruption of the global crisis in 2008, three
major waves of administrative reform worked in substantial continuity
with respect to one another.5 These were promoted, first, by the
4
Explaining the Italian trajectory of administrative reforms during the 1990s, Capano
stressed how ideational variables are essential and argued the “hegemony” of administrative
law as a cultural paradigm governing the institutionalization of public organizations in all
European countries with Rechtstaat traditions (Capano 2003: 785–787).
5
Previous cycles of administrative reform in the Italian republic, immediately after World war
II ended and the democratic constitution was approved in 1948, are discussed by Capano (1992).
“technical”6 governments led in the 11th Legislature by Giuliano Amato

(1992–1993) and by Carlo Azelio Ciampi (1993–1994); then, in the 13th
Legislature, by the centre-left coalitions (1996–2001); finally, by the
centre-right Berlusconi IV cabinet (2008–2011), which did not resist the
impact of the Eurozone sovereign debt crisis intensified in early 2010 and
thereafter and was then replaced by the president of the Republic Giorgio
Napolitano with a “fully technocratic” government headed by Mario
Monti (2011–2013).7
By reason of its economic and fiscal vulnerability, the impact of austerity
measures resulting from the great recession and its developments was in
fact for Italy particularly harsh and the implementation of further addi-
tional cuts in public spending was made possible by the technical executive
backed by a very large majority. Within this crisis-influenced context (Di
Mascio and Natalini 2014, 2015), still in an emergency climate despite the
worst peak of the crisis had passed, the new wide-ranging administrative
reform of the Renzi government (2014–2016) took place.
1.3 One Policy Design, More Trajectories

of Policy Reform
Following Capano (2003), we consider that a suitable way to understand

the logic and the content of policy reforms is through “the reformers’ own
words” (ivi: 789). Conveniently, in addition to literature review on Italian
administrative reforms during the 1990s and early 2000s, we directly took
6
In technical governments, parties are in principle largely excluded from the choice of
ministers. That is why, even if at a minimum degree, the Amato cabinet had not been con-
sidered a typical expression of the party government, being the party system substantially
collapsed at that time. More appropriately, the first “technocrat-led-government”, being
served by a non-parliamentarian as prime minister, was the Ciampi one (Ciampi was gover-
nor of the Italian central bank when he was asked by the president of the Republic to form a
government). Then, the Dini cabinet (1995–1996) followed, entirely composed of experts
and officials from outside Parliament. On the empirical variability of the concept applied to
the Italian case, see Verzichelli and Cotta (2018). The constitutional and parliamentary
effects of technical governments have been analysed by Lupo (2015).
7
According to Verzichelli and Cotta (2018: 78), the Monti government formed at the end
of 2011 was the “most extreme case of ‘party abdication’ has happened”. The authors com-
pare the Ciampi, Dini and Monti cabinets considering, on the one hand, the amount of
non-party personnel and, on the other hand, the scope of delegation conferred to the gov-
ernment. The potential of political autonomy granted to Monti and to his ministers resulted
to be much higher than in the two previous cases.
into account written evidences (interviews and articles) published over

time by key players of administrative reform processes: first of all ministers,
top bureaucrats and directly involved experts (mainly scholars of adminis-
trative law).
Strongly committed to overcome “maladministration” in a period of
severe crisis for the country, the minister of public function in the Ciampi
executive, the professor of administrative law Sabino Cassese,8 was able to
act as a policy entrepreneur and successfully “reframed the issue of public
sector reform in terms of efficiency and cost-effectiveness” (Ongaro 2009:
71). In a brief report of a year’s work (Cassese 1994), he reminded that
before 1993 the administrative reform was not on the political agenda;
administrative inefficiency was perceived in a “latent” way by citizens and,
to some extent, “administration was ‘left’ to exist” for itself; it was a very
“introflexed” system (ivi: 249). On the contrary, also taking into due con-
sideration the outcome of the 1993 referendums,9 the Ciampi govern-
ment stressed the administrative issue, “doing so much in such a short
time, like never before” (ivi: 250). Seven lines of action were promoted at
that time, choosing items from an NPM-inspired menu, as other European
countries already did and, in the South of Europe, were still doing: (1)
“put public offices at the service of citizens” (a consumer-oriented PA);
(2) “aim for a less centralized administration, conversely closer to the
communities to be served” (decentralization and simplification); (3)
“streamlined administrative structures” (downsizing and functional bun-
dling; modernization); (4) “a less expensive PA” (politics of cutbacks to
reduce the public debt, but also reduction of administrative burdens;
codes of conduct for civil servants; public procurement and anti-
corruption); (5) “a more efficient PA” (privatization of public employ-
ment; negotiation of labour contracts; recruitment and career paths;
8
He took part in the commission that drew up “the Giannini Report” about the reform of
public administration in Italy, prepared in 1979 (Capano 1992; Mele 2010). That report
“remained inoperative” (Cassese 2003: 134), also because it radically overturned the tradi-
tional approach to administrative reform of previous decades (Melis 2003). However, it
sowed those innovative ideas that would be then budded in the policy change of the early
1990s: private management models, concepts of planning and control, performance indica-
tors, unification of measurement methodologies and organization offices (http://www.tec-
nichenormative.it/RapportoGiannini.pdf).
9
In March 1993, seven abrogative referendums out of eight concerned the organization
of the state and a clear majority of voters called for the abolition of part of the administrative
apparatus.
measurement of workloads; training); (6) “more effective controls” (inter-

nal auditing added to the external system); (7) “a more European PA”
(EU citizens can access Italian public competitions). In just one year of
activity, the work of the Ciampi cabinet was of course “unfinished” but
transmitted as “a positive legacy” to successive governments (ivi: 255).
Further achievements were in fact strictly linked to the implementation of
already approved delegations by the parliament (as for the ministerial
reform contained in law 537/1993).
As predictable, nothing happened during the first right-wing Berlusconi
cabinet (May–December 1994), which was also very short, and not even
under the technical government led by Lamberto Dini (1995–1996),
which was in charge of leading the transition to a snap general election in
April 1996. In that occasion, the winner was “the Olive” centre-left coali-
tion: in the 17th Legislature, with the Prodi government (1996–1998),
the administrative reform season started again.
In full continuity with Cassese, the minister of public function in the
centre-left cabinets—after Prodi I, D’Alema I and D’Alema II (respec-
tively, 1998–1999 and, after a reshuffle, 1999–2000); Amato II
(2000–2001)—Franco Bassanini, professor of constitutional law, further
strengthened some pillars of previous policy reform cycle, namely admin-
istrative simplification and better regulation, a performance-oriented pub-
lic sector management, the development of horizontal and vertical
subsidiarity (administrative federalism), the e-government. The “first
government-wide reform since 1865”—as Bassanini himself defined it
(Bassanini 2002: 27)—was aimed at “rethinking and redrawing the perim-
eter of public intervention and public services, by focusing public admin-
istrations on its ‘core business’ and systematic outsourcing” (Bassanini
2010: 372). He acknowledged the reduction of the cost of the PA as “the
first objective from the early 1990s on” in order to consolidate the public
finances and enable Italy to join the European Monetary Union (EMU),
as indeed it happened. Thereafter, “since 2000 the problem of Italy’s PA
is not so much the cost of general government bodies, which naturally
must be contained and, if possible, reduced further, but the quality of the
goods and services that they supply to individuals and firms, together with
the quality of regulation and the regulatory and bureaucratic burden
imposed on individuals and firms” (ivi: 370). Of course, he found that a
“strong leadership” for the coordination of the change strategy was a fun-
damental determinant to make the reform successful: as minister of PA,
Bassanini was effectively delegated with ample powers of policy direction
and was responsible for all tools of reform. He admitted that “the whole
administrative culture” had to be changed (Bassanini 2000: 230), in the
sense of a new focus on results instead of procedures.
The third comprehensive reform is dated 2009 and was promoted by
the minister of PA and innovation (professor of labour economics) Renato
Brunetta, under the Berlusconi IV government. The Brunetta reform10
was particularly aimed at improving “the system of incentives and evalua-
tion of performance” by bringing “citizens themselves into the process of
evaluation and preference formation for the correct allocation of resources”
(Brunetta 2009: 351–352).11 Again, so that the competitive system of
incentives (both between individuals and between production units) could
properly realize its full innovative scope, it was evoked a “conceptual tran-
sition from the culture of mere formal compliance to that of substantial
results” (ivi: 361). Therefore the cultural dimension was explicitly con-
firmed as a crucial component of the extant reform strategy. Anti-
corruption through transparency was another dominant foundation. Such
a “revolution”, which was perceived, at least in the short-medium term,
with the appearance of a costly challenge for the recipients, was conversely
prospected by the reformers as a catalyst of more diffuse benefits in the
medium-long run, that is, “the” way for relaunching the economic growth
in Italy. Accordingly, updated e-government plans were mobilized too.
During the same Berlusconi IV cabinet, it is worth mentioning the
decision to delegate—for the first but, for now, even the last time—a spe-
cial minister for legislative simplification, additional to the minister for PA:
Roberto Calderoli,12 a leading member of the Northern league, was
10
The legislative decree 150/2009, implementing the enabling law 15/2009, was aimed
at improving labour productivity as well as efficiency and transparency of PA through the
recognition of the merits and shortcomings of executives and of all government employees
(OECD 2010).
11
Legislative decree 198/2009, also approved to further implement law 15/2009, estab-
lished that, in case of inefficient services, citizens and business may file a collective action
against public administrations and public services’ providers. Brunetta’s own words: “I want
from my side sixty million customers, who are also sixty million controllers, entitled to
express their own preferences, but also their anger” (speech to the students of the National
administration school, Rome, May 2010, http://sna.gov.it/www.sspa.it/wp-content/
uploads/2010/05/Brunetta-spiega-la-riforma-della-Pubblica-Amministrazione-
%E2%80%A6.pdf).
12
He also served as minister for reforms and devolution in the Berlusconi II cabinet
(2004–2006). At that time, administrative reform tasks and responsibilities were split in a
appointed to emphasize the legislative simplification process already

started by the Bassanini reform.
As a result, despite the alternation of governments, the substantial
homogeneity of the reforms’ policy design, that is, “the purposive attempt
by governments to link policy instruments or tools to the goals they would
like to realize” (Howlett and Mukherjee 2017: 1), was largely recognized
by the various reformers themselves. For instance, comparing the Brunetta
law with the previous 1996–2001 reform’s cycle, Bassanini found that
“the factors of continuity outweigh the few innovations” (…) and judged
continuity “not only positive as a method, but also commendable on its
merits” (Bassanini 2010: 369).
More in detail, when considering the specific “trajectories”13 of the
Italian public-sector reforms over time, in the period 1992–2012 they
were summarized as follows (Ongaro et al. 2016):
• As for the organization, a shift from homogeneity to differentiation:

regional and local decentralization (devolution14) became a major
political reform issue15; furthermore, independent administrative
number of actors, in fact a minister for information and technology was also appointed, and
some lack of coordination emerged.
13
According to Pollitt and Bouckaert (2017: 75), a trajectory “is more than a trend (…) is
an intentional pattern—a route that someone is trying to take”. They selected five main
“conventional” components: finance, personnel, organization and performance measure-
ment. Then they added transparency and open government. In Italy, public sector reform
concerned almost all components of public organizations.
14
After many years of debate, a significant wave of devolution started in 1997 with law
59/1997 (the law so called by Bassanini first), which profoundly altered the distribution of
administrative functions across levels of government, reallocating competences from the cen-
tral government to regional and local governments in different policy fields, although it did
not affect the Constitution. Then the notion of “concurrent legislation” between the central
and the regional governments was introduced by a constitutional reform in 2001 (Ongaro
2009, 2011). Bassanini himself described the way the reshaping of the government macro-
structure was pursued in Italy (Bassanini 2000: 232–235).
15
Albeit Capano (2003: 792) argued that “decentralization is one more thing that can
hardly be considered a novelty to Italian PA, and it is interpreted through the hegemonic
paradigm”, losing its meaning of “a strategy to adopt in drawing up public policy”, and just
conceived in terms of “mechanical division of duties” (ibidem). This interpretation confirms
the idea that many of the measures introduced were (reasonably) chosen because they were
compatible with the administrative tradition. The latter defined as “a historically based set of
values, structures and relationships with other institutions that defines the nature of appro-
priate public administration within society” (Peters 2008: 118) and, consequently, composes
elements of explanation for administrative behaviour. Administrative traditions may also be
authorities were established and public agencies increased in their

number; additionally, ministries adopted divisional, next to func-
tional, models.16
• As for the financial management, a move from an input-oriented,
highly fragmented, spending responsibility framework to an output-
oriented system of spending responsibility attributed to public man-
agers17; the new model was clearly inspired by the “management by
objectives” (MbO) perspective and aimed at integrating financial
and strategic planning.
• As for the personnel, the privatization18 of the working relationships
and labour conditions was introduced and a clear separation between
politics and administration19 was stated.
considered as just a restatement of the concept of “style” used to describe policymaking in

various states (Richardson 1982).
16
Law 50/1999 (another piece of the Bassanini reform), together with the legislative
decree 300/1999, also established the reduction of the total number of ministries to 12.
However, the reorganization design was soon reversed by the centre-right Berlusconi II
government through law 317/2001 and law 137/2002.
17
Closely linked to law 59/1997, law 94/1997 (the Ciampi law, from the name of the
minister of economy and finances in the centre-left Prodi government) reformed the state
budget and accounting system, reducing the number of line-items—which stood at about
7.000 at the time (Blöndal et al. 2016) and binding them, first, to the authorization by the
legislature, then to the responsibility of general directors in ministries: “the aims of that
measure were to reorganize government budgets according to mission and programme,
assign the resources required to implement each programme to the responsible administra-
tion as an aggregate, and give each organization and its administrators complete autonomy
in managing their financial and human resources, a precondition for making public bodies
and their administrators accountable for performance and results” (Bassanini 2010: 378).
The second wave of reform was launched in 2009 with a new budget structure based on
broader “missions” then articulated in “programmes” instead of aggregated “units” (law
196/2009).
18
The contractualization of public employment (i.e. the “de-legislation” of organizational
acts concerning human resources, instead regulated by private labour laws) was introduced
in 1993 by the legislative decree 29/1993 (Ciampi government), putting into effect the
enabling law 421/1992 (Amato government); the premises were further articulated in
1997–1998 by the Bassanini reform (the legislative decrees 396/1997, 80/1998 and
387/1998 modified the legislative decree 29/1993 in several points, for instance by estab-
lishing the possibility also for the PA to use flexible contractual arrangements to recruit per-
sonnel); all the subject was then codified in 2001, after the approval of the constitutional
reform (legislative decree 165/2001).
19
The legislative decree 80/1998 (Bassanini reform) allowed political bodies to make top
official appointments, introducing in that way a form of “spoil system”, which was further
strengthened in 2002 by the centre-right Berlusconi II government, with minister Franco
• As for audit and performance measurement, ex ante compliance con-

trols on administrative acts were shifted mainly to ex post controls
and performance indicators were developed.20
In conclusion, from the early 1990s Italy adopted managerial tools to a

significant extent, anyway not in such a radical way as to have changed the
overall administrative system. Moreover, if scholars agree that the 1992
crisis was perceived as a window of opportunity for administrative mod-
ernization which then continued during the rest of the decade (Capano
2003; Ongaro 2009, 2011; Ongaro et al. 2016), contrarily the response
to the 2008 crisis, and its politics of cutbacks, was considered a setback
which substantially hindered managerial modernization.
Accounting for the larger trajectory of administrative reform in Italy, Di
Mascio et al. (2013) interpreted the 2008 crisis as a part of the reform
sequence set in motion by the 1992 crisis. In particular, they interpreted
the politics of austerity strengthened after 2008 as partially influenced by
cutbacks already experienced by policymakers to deal with previous 1992
monetary crisis. In the framework of the global crisis, anyhow, “the mana-
gerial repertoire has been sidelined by cutbacks” (ivi: 29). Nevertheless,
“the principles and institutions disseminated by the previous waves of
reforms—i.e. managerial-oriented tools and structures—have not been
entirely reversed” (ibidem). As a consequence, Italy has been considered
in the midstream with respect to many components of the public manage-
ment reforms yet.
Actually, most European continental countries showed to be more
“interested in modernising their public administration in order to make it
more transparent, accountable and closer to citizens”, instead of “imple-
menting the ‘Anglo-American global reform package’ (Torres 2004: 109).
Besides, it has been well proved that “in terms of trajectories (…) not
every country has played the NPM game, and certainly not many are
doing so now” (Pollitt and Bouckaert 2017: 127). Last, but not least,
beyond trajectories, the “uncomfortably sharp question” has in fact to do
with the “slippery concept” of results (ibidem).
Frattini (law 145/2002). That system was strongly criticized by the former minister Cassese
(2002) and partially mitigated by a number of Constitutional Court’s rulings.
20
Evaluation mechanisms consistent with the new private-sector-type contracts for civil
servants were started by Bassanini through the legislative decree 286/1999. In 2009, the
Brunetta reform tightened the rules to enforce personnel performance rankings.
1.4 Results and Operational Challenges

On the basis of data collected by a top executive survey (realized in the
context of the Cocops21 project) aimed at analysing the impacts of recent
public sector managerial reforms, scholars described a picture of “a not
irrelevant penetration of managerial tools” in the Italian PA (…) at a level
higher than the Cocops average” (Ongaro et al. 2016: 188). However the
research demonstrated that the use of market-type mechanisms (NPM
inspired) were still combined, at least in the top managers’ perceptions,
with more traditional elements consistent with the so-defined Weberian
model of bureaucracy.
Indeed, scholars largely concurred to identify the mixed outcome of
administrative managerial reforms in most continental European states
with a neo-Weberian state (NWS) model,22 categorized as “an attempt to
modernize traditional bureaucracy by making it more professional, effi-
cient, and citizen-friendly” (Pollitt and Bouckaert 2017: 19). In the words
of minister Brunetta: “The notion of performance can, and must, embrace
more than just efficiency and effectiveness (…) and be broadened to
include the ability of the PA to embody such fundamental values as
transparency, integrity, equity, participation—in a word accountability”
(Brunetta 2009: 343).
Hence, interpretive schemes play a role when handling the puzzle of
policy change and its outcomes, particularly in the case of administrative
policy, for the sake of the legacy of traditional norms and values in the
organizational culture, as well as path-dependent dynamics. All in all, evo-
lutionary models of public policy presuppose more merging and sedimen-
tation than dismantling or demolition. Consequently, it makes a difference
when the concept of policy change is made operational (Capano 2009),
for instance distinguishing the phases of policy agenda and decision mak-
ing from the implementation.
Just so, questioning how policy frameworks are put into practice,
Cepiku and Meneguzzo (2011) underlined that in Italy “the contents and
tools of reform suggest the adoption of a pure NPM model to PA mod-
ernization (…) However, a closer look at the implementation approach
21
http://www.cocops.eu/.
22
Considering how Weber’s conception of the state is basic in the theory of the modern
state, it has been recently observed that “it makes more sense to talk about degrees of webe-
rianism rather than to distinguish between states that are (neo)-Weberian and those who are
not” (Byrkjeflot et al. 2018: 1006).
and the results of reforms invalidate this position pointing instead toward
a neo-Weberian model” (ivi: 23). Conclusively, Italy has been interpreted
as a neo-Weberian implementer of NPM-oriented reforms. Main failures
in the implementation of the managerial reforms had been therefore traced
back to this specific feature.
However, over time, implementation gaps were also addressed to limi-
tations of the NPM recipes themselves, especially for the excessive focus
on private sector and competition, ignoring organizational specificities
and the context-dependency of public administrations. Additionally, we
know that implementation always takes place in a dynamic environment
where different factors, even unintentionally, may influence outputs and
outcomes. Thus, between market and hierarchy, governance mechanisms
and the cooperation within complex public–private networks of actors
seemed to offer potential alternative solutions to administrative policy
problems. Indeed, a “more sophisticated understanding of public policy
implementation and public services delivery within a plural (with multiple
interdependent actors) and pluralist (with multiple processes informing
policy-making) state” was then suggested by the New public governance
(NPG) approach (Osborne 2010: 5 ff.).
From a normative stance, NPG-influenced administrative reforms are
inter-organizationally oriented, enhancing coordination between the gov-
ernment and multiple stakeholders. Civil servants are seen as network
managers and partnership leaders: they are crucial actors for change pro-
cesses. The plurality of inter-relations between state, non-state/private,
para-state agencies and civic society become a focal point for “co-
production” and “co-responsibility” of public service delivery and “pro-
duction of public value” (Liddle 2018). As Capano et al. (2015) properly
outlined: “Governments are still very much in charge, in every governance
mode (…) from hierarchical to market and network forms” (ivi: 319).
Hence, empirically, elements of each ideal type (PA, NPM, NPG) are
predicted to occur intertwined, resulting in increased complexity and
hybrid organizational forms, and conceivably producing recurring types of
dilemmas and contradictory effects (Christensen and Lægreid 2011).
These non-linearities would be able to direct the process of implementa-
tion towards failures. Nevertheless, scholars also observed that some con-
tradictions could only be apparent: for example, Pollitt and Bouckaert
(2017) wrote a shortlist which includes “some (seemingly) incompatible
paired statements and some complicated/less obvious combinations” (ivi:
191), such as “give priority to making savings/improving public service
quality”, or “promote flexibility and innovation/increase citizen trust and

therefore governmental legitimacy”, along with “develop more partner-
ships and contracting out/improve horizontal coordination” (ibidem).
As far as Italy is concerned, Bassanini already argued in 2010 that “since
2000 the problem of Italy’s PA is not so much the cost of general govern-
ment bodies, which naturally must be contained and, if possible, reduced
further, but the quality of the goods and services that they supply to indi-
viduals and firms, together with the quality of regulation and the regula-
tory and bureaucratic burden imposed on individuals and firms” (Bassanini
2010: 370). In that respect, new technologies had been universally
regarded as an indispensable ingredient to solve that contradiction which
seems to polarize “money-saving” vis-à-vis “services’ quality”. Besides,
under cutback management this challenge’s results are amplified, and it
should be considered, at the same time, that cutback management is any-
how about the long term. Yet it had been also considered that innova-
tions, unintentionally, do not produce egalitarian effects; then a narrower
scope of activities, in order to simplify and reduce public opinion’s mis-
trust, can emerge. Similarly, when relationships become multiple and hori-
zontal, as it happens through contracting-out and partnerships,
coordination is more difficult than in the case of hierarchy, which is verti-
cal and two-dimensional. Anyhow, it is not given that more hierarchical,
centralized systems do not endure fragmentation. Thus, once more, results
are sensitive to context specificity; and the same applies to the adaptation
of the “big reforms” to manifold theoretical/normative models.
We expect that the latest administrative reform cycle signed in Italy by
the Renzi government would fit more than its antecedents into this
extremely variegated repertoire, influenced by post-NPM models as well.
1.5 Structure of This Book

The book aims at providing a synthetic presentation of the Italian admin-
istrative system and an empirical as well as critical perspective on the pro-
cesses of administrative reform in Italy, focusing more in depth on some of
the most recent changes developed during the years of austerity and fiscal
crisis (a comprehensive overview which tends to cover all areas of admin-
istrative reform is given by Merloni 2018).
Literature review and secondary analysis were conducted to frame
research questions about models of administrative innovation, policy pref-
erences and options, implementation risks. These topics were developed
through new empirical data: process tracking and a qualitative methodol-

ogy had been at the basis of the comprehensive and up-to-date policy
analysis presented in the book. A number of primary sources were col-
lected from the parliamentary arena, from executive, administrative actors
and experts at the national level. We took into account written evidences
published over time by key players of the reform processes: the positions
adopted by the rulers were tracked, in such a way as to systematically
describe different components of the politics of administrative change in
Italy and explain its results.
Following this Introduction, Chap. 2 is devoted to clarifying to what
extent the austerity agenda adopted in the long run by most Southern
European states under the pressure of influential international actors, as
well as of authoritative EU institutions, resulted in Italy as an interplay
between external impositions and national constructions. In fact, we
assumed that to the transnationalization of policy frames through expert
knowledge and cross-national comparisons based on best practices, along
with the harmonization of regulations, howsoever domestication pro-
cesses correspond. Empirically, we took into consideration the interplay
between Italy and the EU in the frame of the European economic semes-
ter in the aftermath of the Great Recession.
Seeing therefore that the nature and contents of reforms are always
influenced by the structure of the arena of policy discourses, and the way
in which reformers frame innovation matters with regard to further devel-
opments in the policy cycle, Chap. 3 explores the agenda setting and pol-
icy formulation of the latest Italian administrative reform, that of the
Renzi government. In that regard, we found it useful to examine the nar-
ratives that emerged from crucial steps of the government policy cycle and
during the parliamentary debates. The executive–legislature relationship
and the role of party politics were examined.
Chapters 4 and 5 are dedicated to two specific topics, established as
decisive elements in the trajectory of public sector modernization particu-
larly in Italy, and both revised by the latest Renzi reform (through the
so-called Madia law): corruption and performance. In Chap. 4, we
reported, the pressures made by a multiplicity of actors, after decades of
political inattention, for an increasing expansion in the Italian regulation
of measures to fight corruption. Within this constellation, the National
Anti-Corruption Authority (ANAC) entrepreneurship is in the long run
especially discussed, as well as the use of evidence-based knowledge and
orientation towards outcomes, which acquired specific relevance in the
most recent policy developments. Chapter 5 investigates advantages and

disadvantages of independent bodies as a lever of change studying the case
of performance planning, implementation and evaluation. In their real life,
the OIVs (Organismi indipendenti di valutazione) are appraised as a pol-
icy failure.
It is precisely to the implementation failures that the conclusive Chap. 6
is concerned. The vicious cycle of administrative reforms in Italy is explained
with a focus on the most recent developments from the 18th legislature
(started on 23 March 2018) and especially on the Five-Star Movement
(M5S)/League coalition which, after months of political deadlock, agreed
on an independent prime minister—the private law professor Giuseppe
Conte, almost unknown to the public—thus giving birth to the “govern-
ment of change”23. As for the PA, the government committed itself to
achieve the “concreteness” of existing regulation instead of changing it in
a comprehensive way. After all, the request for avoiding other waves of
comprehensive reform is nowadays largely diffused in the policy commu-
nity. Moreover it has been confirmed by the coalition government which
took over after the crisis of the Conte I cabinet24 and was formed by the
traditional rivals M5S and the centre-left Democratic Party (PD): they let
Prime Minister Conte surviving the collapse of his own first government
and, in the PA sector, the line of “concreteness” was understood with even
greater continuity with the Madia (PD) reform.
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Title: The married woman's private medical companion

embracing the treatment of menstruation, or monthly
turns, during their stoppage, irregularity, or entire
suppression. Pregnancy, and how it may be
determined; with the treatment of its various diseases.
Discovery to prevent pregnancy; its great and
important necessity where malformation or inability
exists to give birth. To prevent miscarriage or abortion.
When proper and necessary to effect miscarriage.
When attended with entire safety. Causes and mode of
cure of barrenness, or sterility.
Author: A. M. Mauriceau
Release date: August 25, 2023 [eBook #71485]
Language: English
Original publication: US:
Credits: Richard Tonsing and the Online Distributed

Proofreading Team at https://www.pgdp.net (This file
was produced from images generously made available
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*** START OF THE PROJECT GUTENBERG EBOOK THE

MARRIED WOMAN'S PRIVATE MEDICAL COMPANION ***
Transcriber’s Note:
New original cover art included with this eBook is
granted to the public domain.
THE MARRIED WOMAN’S
PRIVATE MEDICAL COMPANION,
EMBRACING THE TREATMENT OF
MENSTRUATION, OR MONTHLY TURNS,
DURING THEIR
STOPPAGE, IRREGULARITY, OR ENTIRE SUPPRESSION.
PREGNANCY,
AND
HOW IT MAY BE DETERMINED;

WITH THE TREATMENT OF ITS VARIOUS DISEASES.
DISCOVERY TO
PREVENT PREGNANCY;
ITS GREAT AND IMPORTANT NECESSITY WHERE
MALFORMATION OR INABILITY EXISTS TO

GIVE BIRTH.
TO PREVENT MISCARRIAGE OR ABORTION.
WHEN PROPER AND NECESSARY
TO EFFECT MISCARRIAGE.
WHEN ATTENDED WITH ENTIRE SAFETY.
CAUSES AND MODE OF CURE OF

BARRENNESS, OR STERILITY.
BY DR. A. M. MAURICEAU,
Professor of Diseases of Women.
Office, 129 Liberty street.
NEW YORK.
1847.
Entered according to Act of Congress, in the year 1847, by
JOSEPH TROW,
In the Clerk’s Office of the District Court of the Southern District New York.
PREFACE.
The “Introduction” in the succeeding pages, being amply

explanatory, but few prefatory words will suffice. The object and
intention of the work is manifest and self-evident.
It is to extend to every female, whether wife, mother or daughter,
such information as will best qualify her to judge of her own
maladies, and, having ascertained their existence, apply the proper
remedies.
From these pages she will learn the causes, the symptoms and the
remedies, for such complaints to which she may be liable, the nature
of which she may not desire to impart to another.
Whether married or unmarried, she can, from these pages,
compare her own symptoms with those described, and act in
accordance with the mode of treatment prescribed. She will thereby
be exempt from those doubts, perplexities and anxieties, which arise
from ignorance of her situation, or the causes which produce it.
In short, the author sincerely believes that to the female budding
into womanhood,—to one about to become a wife, or to the wife
about becoming a mother, as well as to every one already a wife and a
mother, as also to the female in the decline of years, in whom nature
contemplates an important change, the “Married Woman’s Private
Medical Companion” contains instructions of such paramount
importance, as to embrace the present happiness and future welfare
of each.
One word in conclusion. It is not pretended that the concentration
of the results of medical research emanates from one author, for be
he ever so versed in medical science, he would come far, far short of
so herculean a task. It is, therefore, necessarily derived from authors
on medical and physiological sciences, of great acquirements and
distinguished celebrity.
It hardly need be added that great labour has been encountered in
the preparation of a work of this nature, as the most reliable and
correct sources have been availed of.
THE AUTHOR.
INDEX
Page.
ABORTION—
„ Symptoms of, 169
„ Causes of, 171
„ Treatment of, 171
„ Prevention of, 175
„ When dangerous, 168
„ When necessary to effect, 177
„ When attended with no danger, 169
AFTER-PAINS—
„ Causes of, 203
AFTER-BIRTH—
„ Caution respecting, 199
„ Mode of extracting, 199
ARTIFICIAL DELIVERY, 180
BARRENNESS, OR STERILITY—, 223
„ Causes of, 225
„ Remedy for, 232
CONCEPTION—(See Pregnancy), 36
„ Signs of, 37
„ Prevention of (See Pregnancy), 104
CHILDREN—Management of, 210
CONCLUDING REMARKS, 237
DELIVERY—Artificial, 180
DISEASES OF PREGNANCY, 61
Desomeaux’s Prevention to Pregnancy, 142
FALSE PAINS IN PREGNANCY, 187
FALSE Conception, 30
FAINTING, during Pregnancy, 87
FLOODING, 174
„ Causes of, 23
FRENCH SECRET, 144
„ For what purpose used, 144
„ Its use in France, 144
INTRODUCTORY REMARKS, ix
INFANTS, still-born, 202
INFLAMMATION OF THE BREASTS, 205
„ To prevent inflamed or broken Breasts, 208
Index, v
LABOUR—Signs of, 182
„ Management of, 185
„ Ordinary or natural, 186
„ Preternatural or Cross-Births, 201
„ Laborious, or difficult, 202
„ Directions during, 198
„ Directions after, 99, 203
MALFORMATION of the Pelvis, 180
MENSTRUATION, or Monthly Turns, 1
„ Retention of, 8
„ Description, 8
„ Causes, 8
„ Symptoms, 9
„ Treatment, 10
„ Suppression of, 11
„ Description of, 11
„ Causes, 12
„ Symptoms, 12
„ Specific certain to effect a cure, 16
„ Painful and Imperfect, 18
„ Symptoms, 19
„ Causes, 19
„ Treatment, 20
MENSES—
„ Immoderate Flow of, 22
„ Symptoms, 22
„ Causes, 23
„ Treatment, 23
„ Prevention, 27
„ Decline of the, 28
„ Symptoms, 30
„ Causes, 30
„ Treatment, 33
MISCARRIAGE—See Abortion.
MORAND’S “ELIXIR,” 232
„ Its success in effecting Cures, 233
NAVEL CORD—
„ Manner of tying, 198
NURSING, 204
PORTUGUESE FEMALE PILLS, 16
PREFACE, iii
PREGNANCY, Signs of, 36
„ How it may be determined, 37
„ Ceasing to be unwell, 38
„ Morning Sickness, 49, 62
„ Shooting Pains through, Enlargement of and other Changes of the Breasts,
50
„ Changes of the Nipple, 51
„ Presence of Milk, 54
„ Quickening, 57
PREGNANCY,—Diseases of, 61
„ Being unwell during, 96
„ Costiveness, 72
„ Diarrhœa, 76
„ Enlargement of the Veins of the Legs, 82
„ Fainting Fits, 87
„ Heart-Burn, 70
„ Headache, 98
„ Inconvenience from size, 95
„ Painful and distended condition of th Breasts, 90
„ Pains in the Legs, &c., 92
„ Palpitation of the Heart, 85
„ Piles, 78
„ Salivation, or Discharge of Saliva, 89
„ Swelling of the Feet and Legs, 84
„ Soreness and Cracking of the Skin of the Abdomen, 94
„ Toothache, 88
„ Violent movement of the Child, 93
PREGNANCY—Prevention of, 104
„ When unnecessary, 110
„ When indispensable, 107
„ Practicability of, 141
„ Morality of, 146
„ Social importance of, 114
„ Mode of prevention, 142, 143, 144
„ Healthiness of, 145
„ Reasons for prevention, 144
„ Objections answered, 146
„ Proofs of success, 150, 152, 154
„ Use of in France and other parts of Europe, 149
SEXUAL WEAKNESS,
„ Symptoms, 157
„ Causes, 158
„ Treatment, 158
„ Regimen, 163
WOMB, falling down of the, 163
INTRODUCTORY REMARKS.
In introducing a subject of the nature treated of in this volume we

are perhaps treading upon interdicted if not dangerous ground, for
the world is not free from those pseudo-moralists, who would check,
and, if possible, arrest the onward progress of medical and
physiological science, and compel all to trudge on in the old beaten
path, neither turning to the left nor the right, much less to look
forward, but cast their glance backward. And although they behold
every other science marching with rapid strides to comparative
perfection:—what through the agency of steam and iron rails, space
as it were, annihilated; what but yesterday, comparatively speaking,
required weeks to perform, a few hours now suffice; nay the
lightning fluid itself is made subservient to man’s powers of
discovery and ingenuity, transmitting intelligence from distant
points with the speed of thought:—yet, in physiological and medical
science, we are required to be as an immovable rock, upon which the
overwhelming billows of physiological science and discovery are to
wash fruitlessly and in vain, to recede back into the dark sea of
ignorance.
Truly, is it that in all that concerns man’s welfare and woman’s
happiness, we are to stand still, while improvements and discoveries,
in arts and sciences connected with agricultural and mechanical
pursuits, are rushing by with the impetus of a torrent? Is it that
physiological and medical science has long since reached that state of
perfection that improvement and discovery are impossible? Is it that
preceding generations had engrossed, in physiology, all the
knowledge that could be attained, and left nothing for succeeding
generations to attain? Is it that disease, decrepitude, bodily suffering
and stinted and imperfect physical development among mankind has
no longer an existence? Is it that every woman enjoys the full bloom,
virgin freshness and beauty belonging to the enjoyment of a perfect
condition of health? Is it that we no longer behold the deathly pale,
sallow, sickly female of sixteen or eighteen, in the last stage of some
chronic disease, prepared for the cold embrace of death? Is it that for
the married woman six of the nine months of pregnancy is often a
state of suffering and anguish destructive to her health and cutting
off her days? Is it too, that it never happens that she often has
children only at the hazard of her own life, and that of her offspring?
Is it that children are invariably born healthy and rugged, capable of
enduring the ordinary maladies to which infancy may be subject, to
be reared into robust and virtuous sons and daughters? Is it that by
far the greatest proportion of those born, survive, instead of, at the
least, two-thirds being cut off in infancy? No, indeed, it is not
because of all this. It is because prejudice or ignorance thinks that if
men and women acquired the knowledge whereby to improve their
condition as social moral beings, guard against disease, and preserve
their health, that perhaps, it might lead to immorality and vice. This
is ever the pretext to arrest the progress of physiological discovery.
Discoveries, then, so directly and intimately connected with the
personal individual happiness of every man, woman, and child, are
alone to see no progress; without being met at the threshold with the
senseless and idle cry of “vice and immorality.” Thus then, the
sufferings, the pains, the anguish, which have existed five hundred
years ago, are to be irremediable and endured in despite of any
discoveries by which they can be prevented. We must do nothing to
alleviate, or better still, to prevent, the sufferings of the wife,
daughter, or mother, because it was not done five hundred years ago!
Monstrously absurd as is this reasoning, yet it is of this kind which
the discoveries introduced before the public in this work will be met.
But the subject is one which embraces our social joys and
comforts, the endearments of home and the family fire-side, the
health and well-being of wives, mothers, and daughters, and cannot
be retarded by the cobwebs in its way, to stem its onward course. No
female, either married, or about to be married—no wife about
becoming a mother—no mother having a daughter—no father who
desires to prolong the health, beauty, and vigor of his offspring—no
husband who has his own happiness, or the happiness of the
companion of his bosom at heart—no young man, even, having a
regard to his future welfare, should be without this important little
work. Here the wife, mother or daughter, can detect her own
complaints, trace them to their causes, and apply the remedy. This is
all important. For, how often does the young female (because of a
supposed delicacy), suffer in health rather than impart her malady to
another, and especially to a medical man; and thus, many diseases,
which though trifling in their origin, and at first easily removed,
become seated and confirmed in her constitution. How deplorable
are the consequences arising either from neglect or ignorance in the
treatment of females who are afflicted with a stoppage, irregularity,
or entire suppression of the menses or monthly turns, from which
spring a train of diseases, which it would, in this place, be useless to
enumerate, but which make our wives and daughters sickly, and our
offspring short-lived.
It is also important that the female should understand the cause
which might occasion a stoppage of the menses to possess the
information contained in this work, by which it can be ascertained
whether it may not arise from pregnancy and thereby avoid that
anxiety of mind arising from an uncertainty as to her real situation,
alternately imagining the one or the other, as her inclinations or
fears may tend.
During pregnancy, many a wife lives in almost perpetual bodily
ailment and suffering, which ought and should be prevented, and
would not in most cases exist if this work is perused. Here important
truths and discoveries are revealed, which may be the means of
saving many an affectionate wife and fond mother from a premature
grave. How many females marry, who, in becoming pregnant,
jeopardize their life, would learn, if they perused these pages, of the
discovery by which pregnancy can be prevented, by means at once
safe, simple, certain, and healthy, and thus many a victim would not
fall a sacrifice to the Cæsarean operation.
In respect, too, when a woman is threatened with miscarriage or
abortion it is important that the treatment, either to prevent it, or,
when that is impracticable, to assist and expedite it, should be
thoroughly understood, and its treatment made clear and simple,
that no unnecessary alarm need be occasioned when it occurs.
So, too, in regard to the various diseases accompanying and
belonging to pregnancy, every woman should know how to prevent
the one and ameliorate the other.
And finally, the subject of unfruitfulness, sterility, or barrenness, is
here presented in a manner, which, to some extent, demonstrates
that in most cases it can be cured, yet how many are pining in
childless loneliness, in utter despair of cure.
Such are some of the important topics treated of in these pages, so
intimately connected with every woman’s peace and happiness, with
which every woman should be conversant, and yet how little
informed are most females with what concerns themselves, their
children, and their husbands so much.
MANAGEMENT
OF
FEMALE COMPLAINTS.
MENSTRUATION.
One of the principal constitutional characteristics of the female, is

menstruation, or the monthly evacuations peculiar to the sex.
This important operation generally takes place about the age of
twelve or thirteen; but varies through the world, either in degree or
frequency, both from constitution and climate.
Women in the higher ranks of life, and those of a delicate, nervous
constitution, are subject to sickness, headache, and pains in the back
and loins, during periodical evacuation. Those of the lower rank,
inured to exercise and labor, and strangers to those refinements
which debilitate the system, and interrupt the functions essential to
the preservation of health, are seldom observed to suffer at these
times, unless from general indisposition, or a diseased state of the
womb.
After the discharge has become established it recurs periodically
while in health; and its recurrence is so regular, that it can be
calculated with great exactness. The usual period of its visitations is
from twenty-seven to thirty days. As to the time of its continuance,
this is various in different women; but it seldom continues longer
than six days, or less than three, and does not cease suddenly, but in
a gradual manner.
Its approach is generally preceded by certain feelings of
oppression or deviation from the ordinary state of health, which
warn the individual of what is to happen. There is, in particular, a
sensation of fulness about the lower part of the belly, and a
relaxation about the uterine system which can scarcely be overlooked
by the most heedless. The appetite becomes delicate, the limbs
tremble and feel weak, the face becomes pale, and there is a peculiar
dark streak or shade under the eyes; sometimes great restlessness,
slight fever, headache, heavy and dull pain in the small of the back
and bottom of the belly, swelled and hardened breasts, &c. All of
which are sometimes instantly relieved by a trifling discharge from
the vagina, and this not necessarily colored. It must at the same time
be admitted, that in some few constitutions these feelings are so
inconsiderable as to be little attended to; so that the woman mixes in
society as usual without any apparent inconvenience.
The period at which the menses make their appearance, is various;
it is much influenced by constitution, climate and mode of life. As a
general rule, it takes place at puberty, or at that period at which the
female is capable of propagating her species; and this period varies
as climate may differ. They constantly, however, keep pace with the
development of the body; where this is rapid, they will appear
proportionably earlier; where this process is slower, they will appear
later: but whenever the menses appear as regular evacuations, they
mark the period of puberty: thus, in hot countries, women
commence to menstruate at eight or nine years of age, and are not
unfrequently mothers at ten.[1]
In the more northern regions, as in Lapland, &c., this evacuation is
generally delayed until the female has attained her eighteenth or
nineteenth year: in the temperate latitudes the average period will be
found from the fourteenth to the sixteenth year. A difference, will,
nevertheless, be found in the women who may reside in cities, and in
those who dwell in the country of each respective portion of the
globe. It may also be observed, that in cold countries, women
continue to menstruate for a longer period than in warm; and as a
general rule, it will be found they are obnoxious to this discharge
double the period that elapses before it commences. Thus, women
who have not this discharge until eighteen, will be found to have it
until beyond fifty; those who commence at fourteen or fifteen, will
leave off at forty-five; those who begin so early as eight or nine, will
have it cease at twenty-five or six.[2]
On the appearance of the menses, or monthly turns, nature seems
to perfect her work, both as regards development and proportion: it
is the period of the most perfect beauty of which the female is
susceptible; it is the one at which the moral changes are not less
remarkable than the physical; it is a moment, of all others, the most
replete with consequences to the inexperienced and confiding
female.
At this period a great variety of interesting and curious
phenomena present themselves: the voice is found to change; the
neck and throat to increase in size, and to become more symmetrical;
the mammæ to swell; the nipple to protrude; the chest to expand; the
eyes to acquire intelligence, and increase of brilliancy; in a word, a
new being, almost, is created.
The quantity of fluid expended at a menstruous period differs in
different individuals; with girls who precociously menstruate, the
quantity is in general smaller, and the returns less regular. Climate
exerts an influence upon the quantity discharged, as well as upon the
periods at which this evacuation shall commence. Thus, in the
equatorial and more northern regions, it is less than in the more
temperate climates.
It is of importance for women to know that occasional
irregularities are not always the consequences of disease.
Constitutions vary as much in respect to the regular returns of this
discharge, as they do with regard to their first appearance or final
cessation. Those in whom the change occurs very early from vigor of
constitution, require little to be done for them; but in weak and
delicate habits, the non-appearance of this evacuation is too often
considered as the cause, whereas it ought to be viewed as the effect,
of the state of the habit unpropitious to its taking place. And,
according to family practice, under this false impression, warm teas
and forcing medicines are employed at the approach of this disease,
which have often done much harm.
Nature is not so defective in her own judgment as to require
auxiliaries. Care should be taken to improve the general state of the
health, by attention to diet, moderate exercise, change of air, &c.
In some instances the menstrual discharge does not make its
appearance before the age of seventeen or eighteen, and,
nevertheless, health is not in the least affected. The mere want of
evacuation at the ordinary time, therefore, is not to be considered as
morbid, unless the system be evidently deranged thereby. In many
cases, however, symptoms of disease appear which are evidently
connected with the defect of the menses, and go off upon its
discharge. The treatment, in such cases, must be regulated by the
particular circumstances and constitution of the individual. There is
no remedy adapted to every case of this kind; but an open state of the
bowels, and a due regulation of the diet, together with moderate
exercise, are useful in every instance of this complaint. Warm
clothing, too, particularly about the lower extremities, is of most
essential benefit. The occasional use of the warm bath is pleasant and
beneficial, especially if the skin be dry and warm. As the health
improves, the cold bath will prove an auxiliary, if, after using it, the
patient feels a glow of heat and a greater degree of liveliness. When
the means ordinarily employed have failed, marriage, or a change of
climate, has produced the wished-for effect.
In some instances the evacuation is impeded by a mechanical
cause, that is an obstruction of the passage to the womb. This
occasionally is met with, and the chief obstacle to its speedy removal
is the difficulty of ascertaining its existence. The operation by which
it is completely remedied, is not more painful nor formidable than
blood-letting.
Fortunately, in most cases, the evacuation takes place in due time,
and the constitution sustains no material or permanent injury. It is,
however, in every instance, proper to pay particular attention to the
system during the continuance of the evacuation.
The stomach and bowels, at this period, are very easily disordered,
and therefore, everything which is heavy or indigestible, ought to be
avoided. Some are hurt by eating fruits or vegetables; others by
taking fermented liquor. In this respect experience must enable each
individual to judge for herself. Exposure to cold, particularly getting
the feet wet, is hurtful, as it tends suddenly to obstruct the discharge.
The same effect is likewise produced by violent passions of the mind,
which are also, at this time, peculiarly apt to excite spasmodic
affections, or hysterical fits.
It is, in general, a very proper rule not to administer any very
active medicines, at this time, unless some violent symptom
absolutely requires them. Opiates, for instance, are, in many cases,
necessary to allay spasmodic affections, or abate pain; and they are,
in such circumstances, uniformly safe. They give speedy relief to
hysterical feeling or suffocation, or to spasm of the stomach or
bowels.
Dancing, exposure to much heat, or making any great or fatiguing
exertion, are improper. These causes may increase, to an improper
degree, the quantity of the evacuation, and in certain circumstances
may give a disposition to a falling down of the womb.
RETENTION OF THE MENSES.
Description.
The menstrual discharge is liable, from many causes, to become
obstructed at the period when it ought to appear; when this takes
place it is attended with very painful or serious effects; and, if nature
is not assisted, the health is impaired or the constitution
undermined, inducing consumption or some other complaint.
Causes.
The remote cause of this complaint is most frequently suppressed
perspiration; and it may arise, in part, from an inactive sedentary
life, and such habits as are peculiar to the higher classes of society,
particularly in cities and towns. The proximate cause of it seems to
be a want of power in the system, arising from inability to propel the
blood into the uterine vessels with sufficient force to open their
extremities and to allow a discharge of blood from them.
Symptoms.
Heaviness, listlessness to motion, fatigue on the least exercise,
palpitation of the heart, pains in the back, loins, and hips, flatulence,
acidities in the stomach and bowels, costiveness, a preternatural
appetite for chalk, lime, and various other absorbents, together with
many other dyspeptic symptoms. As it advances in its progress the
face becomes pale, and afterward assumes a yellowish hue, even
verging upon green, whence it has been called green sickness; the
lips lose their rosy color; the eyes are encircled with a livid areola;
the whole body has an unhealthy appearance, with every indication
of a want of power and energy in the constitution; the feet are
affected with swellings; the breathing is much hurried by any great
exertion of the body; the pulse is quick, but small; and the person is
liable to a cough, and to many of the symptoms of hysteria.
Sometimes a great quantity of pale urine is discharged in the
morning, and not unfrequently hectic fever attends. In cases of a
more chronic character there is a continued, though variable, state of
sallowness, yellowness, darkness, or a wan, squalid, or sordid
paleness of complexion, or ring of darkness surrounding the eyes,
and extending perhaps a little toward the temples and cheeks.
Treatment.
As this disease proceeds from debility, it is evident that the great
object to be fulfilled will be to give tone and energy to the system;
and if this debility has arisen from a sedentary life, the patient must
begin immediately to exercise in the open air, and, if practicable, to
change her residence. The tepid or warm bath should be used in
preference to the cold. The first medicine given may be the
pulverized mandrake root, combined with a little cream of tartar.
This, as well as other medicines, should be taken upon an empty
stomach: after it has been given, motherwort, pennyroyal, and other
herb teas may be freely drunk. After the exhibition of the purgative,
which may be occasionally repeated, gum aloes may be taken,
combined in such a manner as to prevent the piles. This medicine,
from its action upon the uterus through the medium of the rectum, is
very useful in retention of the menses. Emmenagogues, or “forcing
medicines,” should not be used to bring on the menses, except there
be a struggle or effort of nature to effect it, which may be known by
the periodical pains and pressing down about the hips and loins.
When this occurs let the feet be bathed, and perspiration promoted,
by drinking freely of diluent teas, such as pennyroyal, motherwort,
and garden thyme. Should considerable pains attend the complaint,
eight or ten grains of the diaphoretic powders may be given, and
fomentations of bitter herbs applied over the region of the womb.
Desomeaux’s Portuguese Pills are now recommended as the best
specific, especially if the disease proves obstinate.
The female should be very careful not to expose herself to the
vicissitudes of the weather, and not suffer the feet or clothes to
become wet: warm clothing must be worn, and particularly flannel.
For pain apply a heated brick, covered, to the bowels.
The diet should be light, nutritious, and easy of digestion.
SUPPRESSION OF THE MENSES.
Description.
In this disease there is a partial or total obstruction of the menses
in women from other causes than pregnancy and old age. The
menses should be regular as to the quantity and quality; that this
discharge should observe the monthly period, is essential to health.
When it is obstructed, nature makes her efforts to obtain for it some
other outlet; if these efforts of nature fail, the consequence may be,
fever, pulmonic diseases, spasmodic affections, hysteria, epilepsy,
mania, apoplexy, green sickness, according to the general habit and
disposition of the patient. Any interruption occurring after the
menses have once been established in their regular course, except
when occasioned by conception, is always to be considered as a case
of suppression. A constriction of the extreme vessels, arising from
accidental events, such as cold, anxiety of mind, fear, inactivity of
body, irregularities of diet, putting on damp clothes, the frequent use
of acids and other sedatives, &c., is the cause which evidently
produces a suppression of the menses. This shows the necessity for
certain cautions and attentions during the discharge. In some few
cases it appears as a symptom of other diseases, and particularly of
general debility in the system, showing a want of due action of the
vessels. When the menses have been suppressed for any considerable
length of time, it not unfrequently happens that the blood which
should have passed off by the uterus, being determined more
copiously and forcibly to other parts, gives rise to hemorrhages;
hence it is frequently poured out from the nose, stomach, lungs, and
other parts, in such cases. At first, however, febrile or inflammatory
symptoms appear, the pulse is hard and frequent, the skin hot, and
there is a severe pain in the head, back, and loins. Besides, the
patient is likewise much troubled with costiveness, colic pains, and
dyspeptic and hysteric symptoms.

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The Politics of Public Administration

Reform in Italy Sabrina Cavatorto

Public Administration Understanding Management Politics

Routledge Handbook of Korean Politics and Public

Public Administration in Europe: The Contribution of

Public administration partnerships in public service

Organizational Development in Public Administration:

Swiss Public Administration Andreas Ladner

Colonial Administration and Land Reform in East Asia

The Palgrave Handbook of Public Administration and

The Politics of Public

ISBN 978-3-030-32287-8 ISBN 978-3-030-32288-5 (eBook)

Cover illustration: Pattern © John Rawsterne/patternhead.com

1 Introduction: The Puzzle of Administrative Change 1

2 Pressures to Reform and the Impact of the Fiscal Crisis 23

3 Restyling Public Management–Inspired Reforms 43

5 Obstacles to Performance Evaluation and Improvement 101

6 Conclusions: Still Risking Implementation Gaps127

Seven countries follow Italy: Croatia (66%), Romania (63%),

Table 2.1 Implementation of CSRs to Italy in the PA field 34

Introduction: The Puzzle of Administrative

Sabrina Cavatorto and Antonio La Spina

Abstract This introductory chapter develops the theoretical framework

Keywords Policy change • New Public Management • Neo-Weberian

1.1 Administrative Reforms, Types of Public Policy

The adoption and implementation of administrative reforms could be

© The Author(s) 2020 1

administrative reforms often modify, reduce or eliminate existing advan-

be attributed to the third point of view. We examined Italian administra-

1.2 Continuity and Changes Within

reframed in legal terms (Capano 2003)4 and often produced limited, or

“technical”6 governments led in the 11th Legislature by Giuliano Amato

1.3 One Policy Design, More Trajectories

Following Capano (2003), we consider that a suitable way to understand

into account written evidences (interviews and articles) published over

measurement of workloads; training); (6) “more effective controls” (inter-

appointed to emphasize the legislative simplification process already

• As for the organization, a shift from homogeneity to differentiation:

authorities were established and public agencies increased in their

considered as just a restatement of the concept of “style” used to describe policymaking in

• As for audit and performance measurement, ex ante compliance con-

In conclusion, from the early 1990s Italy adopted managerial tools to a

1.4 Results and Operational Challenges

quality”, or “promote flexibility and innovation/increase citizen trust and

1.5 Structure of This Book

through new empirical data: process tracking and a qualitative methodol-

most recent policy developments. Chapter 5 investigates advantages and

Bassanini, F. (2010). Vent’anni di riforme del sistema amministrativo italiano

Cassese, S. (2003). The Age of Administrative Reforms. In J. Hayward &

Pollitt, C. (2010). Envisioning Public Administration as a Scholarly Field in 2020.

Title: The married woman's private medical companion

Release date: August 25, 2023 [eBook #71485]

Original publication: US:

Credits: Richard Tonsing and the Online Distributed

*** START OF THE PROJECT GUTENBERG EBOOK THE

STOPPAGE, IRREGULARITY, OR ENTIRE SUPPRESSION.

HOW IT MAY BE DETERMINED;

MALFORMATION OR INABILITY EXISTS TO

1 Introduction: The Puzzle of Administrative Change 1

2 Pressures to Reform and the Impact of the Fiscal Crisis 23

3 Restyling Public Management–Inspired Reforms 43

5 Obstacles to Performance Evaluation and Improvement 101

6 Conclusions: Still Risking Implementation Gaps127

Table 2.1 Implementation of CSRs to Italy in the PA field 34