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  • Patientenwelten: Krankheit und Medizin vom späten 18. bis zum frühen 20. Jahrhundert im Spiegel von Autobiographien
  • Renate Wilson
Jens Lachmund and Gunnar Stollberg. Patientenwelten: Krankheit und Medizin vom späten 18. bis zum frühen 20. Jahrhundert im Spiegel von Autobiographien. Opladen, Germany: Leske & Budrich, 1996. 242 pp. $36.00.

Using autobiographical accounts of medical events, the authors provide an overview of lay and patient perceptions of illness and intervention. The period covered ranges over a century, with the main emphasis on the decades from 1790 to 1850. As is true for the prevalence of upper-middle-class accounts and the full array of female voices, this concentration is due not to deliberate choice but to the type of material available from German-language areas. Autobiographical writing, diaries, and correspondence flourished in terms of both style and narrative range in the upper-middle classes of this period. It appears from the introduction that both material and method were drawn from a larger project that collected and evaluated roughly seven hundred autobiographies for the period 1770 to the mid-twentieth century. The working classes begin to gain a voice only after the middle of the nineteenth century and, as noted by the authors, their writings had a far more didactic purpose than the discourse on medicine conducted within the tight social web of the educated middle and upper-middle classes.

The theoretical and methodological structure of the book ranges from “Cultural models of illness and health around 1800” (chap. 1) to “The ill in a medicalized society” (chap. 6). It is guided by the European literature on patient accounts and patient mentalité. The volume thus carries a heavy burden of theoretical models whose usefulness for a cultural history or anthropology of illness and intervention is discussed at length in the introduction. Fortunately, [End Page 150] the ability to write well and perceptively was the cultural endowment of most of the contributing writers of the time; this gift relieves the modern reader of the burden of deciding whether the accounts before them should be interpreted in terms of the more familiar historical and medical anthropology or whether medical sociology needs to be informed by the methods of ethnology. Rather, the fit between category—whether a priori or a posteriori—and narrative is surprisingly easy, and in most cases illustrates the targeted patient, familial, and provider behaviors quite well. Individual accounts also afford insight into traditional beliefs concerning illness, its manifestations and effects, and the ability to manage it that have persisted into modern times despite changes in interventions and medical techniques.

The authors have gone to great lengths to draw attention to the limitations of their method and their materials, particularly in terms of social selectivity. But again, this serves the reader well, because the various titled ladies and clerical philosophers who contributed much of the selected material are a pleasure to read, and they probably provide a better picture of medical mentalities than could have been garnered from categorical displays of the data. Unfortunately, the strong feeling of period is sometimes difficult to verify from the sparse apparatus provided for the primary sources, which are often cited by the year of publication—in many cases, several decades after the event. The volume also is a bit short on the more recent literature, and it lacks an index and other textual amenities.

The reader familiar with medicine during the eighteenth and even earlier centuries will not find much that is different, either in patient and family conduct or in provider conflicts. While the authors, in line with much (but by no means all) of the literature, postulate the early nineteenth century as a crucial period for redefining provider and patient relations, there is much in these accounts that has clearly recognizable antecedents in an earlier period—from the training of surgeons at chirurgical faculties (e.g., in Berlin in the 1740s) to a much earlier recognition of the advantages and disadvantages of variolization than postulated in chapter 4. Attempts to stem heroic cures and to reform the materia medica likewise go back to the late seventeenth century, if not further.

Nonetheless, both in the survey of the medical...

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