Die Aufhebung des Wundarztberufs: Ursachen, Begleitumstände und Auswirkungen am Beispiel des Königreichs Württemberg (1806-1918) (review)

Dominik Groß. Die Aufhebung des Wundarztberufs: Ursachen, Begleitumstände und Auswirkungen am Beispiel des Königreichs Württemberg (1806-1918). Supplement 41 to Sudhoffs Archiv. Stuttgart: Franz Steiner, 1999. 320 pp. Ill. DM 124.00; öS 905.00; Sw. Fr. 124.00 (paperbound).

Dominik Groß has written an impressive book about the abolition of barber surgeons. Die Aufhebung des Wundarztberufs highlights the decline of a group of healers who played a leading role as health-care providers from the Middle Ages through to the early modern period. Groß exploits the rich store of documents in the archives of the kingdom of Württemberg, where the barber surgeons still existed when they had already been abolished in other parts of Germany. The ground for his work was prepared by a number of publications on the social history of medicine in Württemberg, of which two from the late eighties were especially important: my study of the artisan surgeons under the ancien régime, ¹ and Annette Drees's monograph on nineteenth-century physicians. ² These studies provided Groß with a number of stimulating hypotheses to be examined, supplied his research with questions and methodology, and made comparisons possible. Thus, he should be praised for his attentive elaboration of existing approaches rather than for the originality of his work. He diligently collected sources from no fewer than eighty-three archives and evaluated them carefully. Combining such a wealth of archival material with a bibliography of about 550 titles, Groß provides more than ample documentation for an analysis that is generally quite readable, although sometimes a little too exhaustive. For example, instead of following a chronological order in the discussions between barber surgeons, university-educated physicians, and government on the professional status of barber surgeons, he might have systematized his information and put the emphasis on aspects of particular importance. An eight-page summary, some illustrations, and many tables supplement the text, which is made accessible by cross-referenced indexes.

External developments constitute the historical framework of Groß's discussion: administrative and legislative changes, and the organization of other medical-care providers. During the nineteenth century, the way the surgeons and their subdivisions fit into this framework was redefined several times, while their licenses were more and more restricted. The end of this process came in 1871/72, when barber surgeons were abolished as a professional group, with their rivals, the physicians, as enforcers of the law.

Bureaucratic controls and the criminal justice system prevented the barber surgeons of the nineteenth century from practicing internal medicine and dispensing medicines, reducing their area of competence to surgery. They were in addition allowed to function as obstetricians, to inoculate against smallpox, and to sign death certificates. In the first half of the century their number was four times higher than that of physicians: there were 1,000 barber surgeons for the 1.25 million inhabitants of the kingdom. When this proportion decreased in the second half of the century, there was no corresponding increase in the number of physicians, and hence health care became less freely available. This was especially true for the rural regions, where 75 percent of the barber surgeons practiced (in contrast with physicians, who practiced in towns).

Contrary to the frequent assumption that barber surgeons and their patients came mainly from lower socioeconomic groups, both came mainly from the upper middle class; and barber surgeons were held in high esteem by their patients, although their reputation was attacked by physicians. While the physicians formed an organization to defend their professional rights in 1831, the surgeons did not do so before 1847--and their organization failed in its policies. In exchange for a temporary suspension of restrictions on their practice the organization agreed to the abolition of barber surgeons (which would surely have happened anyhow in Württemberg...