Health & Healing in Eighteenth-Century Germany (review)

Mary Lindemann’s new work on German health care in the eighteenth century is an excellent piece of research, a pleasure to read, and a highly useful instructional text. It is one of the very few contemporary studies to describe early modern German health practices and structures both in English and in a conceptual context that consciously draws on recent English approaches to the social history of medicine and medical care. One has to look back very far to find a successful study of German medical care after Paracelsus and before the nineteenth century that is accessible to the English and American medical history community in both language and method. (However, the maps are not terribly helpful, and one wonders at the choice of a 1648 map to introduce a volume on the eighteenth century.)

Lindemann uses her skills as a self-described “archive rat” to mine the rich primary sources and the contemporary literature of a medium-sized German duchy, Braunschweig-Wolfenbüttel, during the period 1700–1800. Her major focus is the second half of the century, when efforts to modernize and systematize health care and the structure of the provider system were already well established throughout Northern Europe. The duchy during this period was not at the forefront of the dynastic expansion or internal consolidation that characterized the neighboring electorates and subsequent kingdoms of Prussia or Hanover. Its old university at Helmstedt was being eclipsed by Halle and Göttingen, and neither Braunschweig nor Wolfenbüttel was more than a sleepy residential town. But as the author justly concludes, it is difficult to argue that in terms of health and illness, of patterns of mortality, or of the struggle between the various layers of local and regional bureaucracies, the practice of medicine in the duchy was sufficiently different from the rest of Germany to make this a mere regional study. On the contrary, the duchy’s very Durchschnittlichkeit makes it a more suitable object for this type of social history than places like Prussia or Bavaria, where even minor events tend to be forced into large and contested political or confessional schemes. It is clear from the introductory chapter on the fit of medicine into state and society that Braunschweig-Wolfenbüttel shared in the slow restructuring of urban and rural society and its executive organs that had been the goal of most German governments since the end of the seventeenth century, but this process was neither swift nor successful.

Lindemann uses her source materials in multiple ways and from different perspectives, providing a fascinating kaleidoscope of case histories reminiscent of the historians of the French Annales, although she apparently finds it hard to share their ready awareness of the issues of class and their anticlericalism. This permits her to engage in a very level-headed and useful reexamination of such issues as folk versus elite medicine, and of the bugbear of the medicalization of health and healing. There are few physicians in this book—whether on the policy-making collegium medicum, or working as rural or town physici—who either wished to or could have medicalized society on the lines proposed by French historiography. There is a large and central chapter on this distinctly German group of early modern providers. They usually were only a few steps ahead of their brothers in the clergy in social standing and economic independence, and their efforts to make a living and hold on to their patients are an excellent reminder of the low rewards reaped by most eighteenth-century physicians and their need to ward off interlopers. A large, varied, and omnipresent group, these medical interlopers came from all social classes and levels of training, and from both genders. Lindemann deals with them in an account that is impressive in its richness and lack of bias, illuminating even the special anatomical knowledge that the Scharf-und Nachrichter derived from their relatively easy access to cadavers both animal and human.

The last two chapters deal...