Hygiene im Namen des Staates: Das Reichsgesundheitsamt 1876–1933 (review)

In Hygiene im Namen des Staates: Das Reichsgesundheitsamt 1876–1933, Axel Hüntelmann provides a lucid and meticulously researched account of the first half-century of the German Imperial Health Bureau (Reichsgesundheitsamt; RGA), the central but little-known health body of Imperial Germany and the Weimar Republic. In 416 densely written pages, and on the basis of a bibliography covering another forty pages, Hüntelmann describes how the institution developed from an insignificant miniature office without either a clear mandate or competence into the primary health body of the federal government.

Rooted in public concern about pauperization as a source of social unrest and of spreading disease, the project soon mixed with attempts by organized doctors to find professional representation. This contradictory beginning reflected an ongoing ambivalence in which efforts to improve public health obscured contradictory underlying motives ranging from medical and social reform to a consolidation of existing power structures. It also set the stage for the difficult position of the RGA as a federal institution in a highly fragmented Germany. Although it inexorably gained ground against communal and state interests, the RGA never had more than a consultative function.

Its early years were marked by vehement criticism, especially on the part of doctors’ associations that vented their disappointment at the feeble, understaffed, and powerless organization, which could hardly satisfy the varied original expectations. But, unperturbed, its first director, Heinrich Struck, sowed the seeds for an increasingly professional institution whose work systematically integrated laboratory science (recruiting the help of Robert Koch, among others). Its work centered on antiepidemic efforts, public hygiene, and food safety—in other words, on disease prevention. RGA activities had an effect on almost all spheres of people’s daily lives, including their nutrition, housing, work, and urban environment, though this influence remained largely invisible. The RGA also helped establish bacteriology and hygiene as science and as part of university-level medical training. In addition, the RGA engaged in pioneering work on medical statistics, which helped communicate key topics of public health to the public. Nevertheless, social hygienists criticized RGA’s work foci for not addressing the true health concerns in Germany at the time, which they saw in socially grounded illnesses—above all, tuberculosis.

In the 1920s, this firm bacteriological approach to health served to exclude the RGA from the social hygiene scene, which gradually gained dominance in Germany and became increasingly eugenic in character. For a while, the RGA compensated for this distance from the domestic biomedical discourse with growing international ties. However, this development was cut short by the National Socialist takeover of the RGA and of Germany at large in 1933. As Hüntelmann takes pains to point out, RGA work was hardly apolitical. Although the organization stayed aloof from eugenics, it accepted the nationalist paradigm of the period, which perceived public health as an essential component of military preparedness. In more indirect ways, its focus on bacteriology propagated a policy that appeased the impoverished masses without questioning political hierarchies.

Institutional histories are methodologically difficult. The varied facets of health institutions, including the scientific, political, practical, ideological, or economic connotations of their work, make it difficult to establish one core question without losing sight of other important aspects. And indeed, Hüntelmann fails to find a central theme that would steer his narrative. But to compensate, he structures his text in several chapters, the different perspectives of which add up to a nuanced, comprehensive picture. Collectively, they leave few questions unanswered and provide a careful analysis of an important player in biomedicine and health in the context of a country experiencing profound transformations. He thereby fills a distinct void in existing scholarship. Written in a smooth style, the book is a must read for anyone interested in health issues during the nineteenth and early twentieth century in Germany and beyond.