Kranke und Krankheiten im Juliusspital zu Wurzburg, 1819-1829: Zur fruhen Geschichte des Allgemeinen Krankenhauses in Deutschland (review)

This book presents the results of a research project on patients and their diseases in the Würzburg general and university hospital (Juliusspital) in the early nineteenth century. It is based on the casebook in which Johann Lukas Schönlein, physician and founder of the naturhistorische Schule in German medicine, documented all the 10,609 cases admitted to his department between 1819 and 1829. This material is supplemented by registers from the hospital and a journal by one of Schönlein’s colleagues. Schönlein’s casebook is unique because it was kept, not as a public account of the hospital’s efficiency, but for Schönlein’s private research purposes. It contains more medical details than other casebooks from the period, and, thanks to Schönlein’s empirical approach, uses a systematic and reliable classification of diseases.

In the first chapter Johanna Bleker outlines the objectives, methods, and sources of the study of hospital patients in earlier times. Next, Eva Brinkschulte surveys the history of the hospital and its related institutions, including the university and the sick-funds. Because general patient care and university education were combined, the Juliusspital was an exception among German hospitals of that time. In chapter 3, Eva Brinkschulte and Pascal Grosse examine the hospital’s admissions policy and its implications for the types of patients and diseases described in Schönlein’s journal. Among other things they point out that although the hospital admitted only “curable” patients, many of them actually had little chance of full recovery. The decision to admit a patient was the complex result of medical, social, and economic considerations. In chapter 4, Bleker discusses the possibilities of using modern diagnoses to interpret the cases in Schönlein’s journal and carefully explains her procedure for grouping Schönlein’s designations into eleven disease categories. But, as the author herself admits (p. 90), the classification involves a serious and questionable manipulation of the data; everything said about the patients’ diseases therefore rests on very shaky ground, and Bleker’s quantitative analysis (chapter 5) is neccessarily of limited validity. Despite this shortcoming, it is obvious that a surprisingly large number of patients were admitted for rather trivial medical problems such as hangovers, and that many suffered from skin afflictions. The disease spectrum included acute infections as well as chronic and wasting diseases. In chapters 6 and 7 Grosse demonstrates other ways in which historians can use the medical information in the casebook. For example, the journal can help to illuminate Schönlein’s understanding of febris intermittens, which Grosse identifies as malaria; and the analysis of the venereal disease cases can yield clues about the sexual behavior in population groups for which other sources are not available. In the end, however, this chapter reveals more about the journal’s limitations than about its potentials as a historical source. In the final chapter Bleker gives a succinct survey of the results. As might be expected, the hospital’s main function was not so much to offer medical treatment in a narrow sense as to provide a form of temporary social welfare. From the case histories Bleker concludes that the vast majority of patients drew considerable benefit from this kind of welfare provision.

The book is of special interest because the authors are courageous enough to explore the difficult matter of the hospital’s medical functions and effects. As a case study, it is a valuable contribution to a field that has recently attracted enormous interest among German medical and social historians.