Die Eroberung der Gesundheit, 1750-1900: Aus dem Französischen von Andrea van Dülmen (review)

Calixte Hudemann-Simon. Die Eroberung der Gesundheit, 1750-1900: Aus dem Französischen von Andrea van Dülmen. Europäische Geschichte. Frankfurt am Main: Fischer Taschenbuch, 2000. 256 pp. s12.90 (paperbound, 3-596-60136-3).

For general readers interested in health issues, this historical overview may be of interest. It was originally written in French, and the current German translation in a series on European history reflects the growing importance of the subject in social historiography. The dense prose covers a span of 150 years, from mid-eighteenth-century Enlightenment to 1900, describing the "conquest" of health within the contexts of a dramatic demographic expansion, accelerated urbanization, and the effects of the industrial revolution. The study is comparative, although primarily centered on developments in England, France, and Germany. The author contends that by the end of the nineteenth century, Europe had indeed completed its medical revolution.

The book is organized into four chapters. The first two cover the evolution of medical professionalization, with a focus on education and practice, prestige and status. They are followed by a sketch dealing with the transformation of the hospital from shelter to house of sickness, and a final section on relationships between physicians and the state on issues of public health. The content will be quite familiar to historians. Unfortunately, the presentations rely excessively on older secondary, non-English-language sources. The author points out the chief characteristics shaping medicine in the various countries, including the British laissez-faire attitude and corporate structures dominated by Royal Colleges, the German reliance on state intervention, and the French traditional ambivalence between liberalism and statism.

Among the most informative parts of the book is a section on nineteenth-century medical practice. The growing popularity of medicine led to substantial increases in the numbers of students and a veritable glut of newly minted graduates. Here we read about the costs involved in setting up shop in Germany, about British physicians seeking military careers or joining the colonial service, and about the fierce competition for hospital posts in France. Handicapped by stark differences in health-related knowledge and understanding among their patients—who spoke in numerous dialects—physicians opted for the colloque singulier (a one-sided dialogue) with their patients, ignoring their complaints and shutting them out of most therapeutic decisions. Others simply came to practice through the mails. Such approaches constructed a particular patient-physician relationship that survives into our own day.

Hudemann-Simon concludes her work by stressing the success of an elite nineteenth-century medical group—mostly associated with leading universities and academies—in communicating and helping to diffuse the new scientific knowledge across Europe and beyond its borders. Given the multiple challenges to individual and collective health created by the Industrial Revolution, physicians encountered excellent opportunities to improve their social prestige and status. High infant mortality led to the medicalization of birth and the displacement of midwives and wet nurses, while epidemic crises opened new possibilities for vaccination and sanitary campaigns. As the state became increasingly involved in health matters, Germany with its social policies took the lead while Britain fell behind. This trend tragically culminated in the twentieth century during the Nazi regime with its multiple atrocities designed to "conquer" the public health of the German Volk.