An der Wende zur Moderne: Die hessischen Hohen Hospitäler im 18. und 19. Jahrhundert (review)

In 1533, Phillip the Magnanimous of Hesse laid the groundwork for a set of social welfare institutions collectively known as the Hohen Hospitäler. Of the four original foundations, three continue to serve the state of Hesse today. Thus, the Hohen Hospitäler can look back over an unbroken history of 475 years. An earlier anniversary (the 450th in 1983) occasioned the publication of a volume treating the territory-wide institution over its first two hundred years. An der Wende zur Moderne picks up the story and carries it forward through the end of the nineteenth century. Although An der Wende zur Moderne is a commemorative volume and possesses many of its associated qualities (excellent reproductions, glossy paper, and solid bindings), there is nothing lightweight about its content. The several authors explore a series of questions about how hospitals became "modern," inquiries that continue to animate medical historical research in the twenty-first century.

Four parts—on medical care and "discipline," on patients, on administration and personnel, and on physical plants—trace the changes the hospitals underwent between 1700 and 1900. From their inception, the four Hohen Hospitäler—in Haina, Merxhausen, Hofheim bei Darmstadt, and in the old Benedictine cloister Gronau near St. Goar—both resembled and differed from other institutions of care and cure. Unusual were the common, territory-wide administration supervised by a general director (Obervorsteher) and the charge to accept indigent subjects from throughout Hesse. Early modern hospitals were, of course, usually (if not invariably) set in cities. The modernization process these hospitals underwent in the eighteenth and nineteenth centuries involved an evolution from their original status as multifunctional hospitals to specialized institutions, such as the designation of the two hospitals in Haina and Merxhausen exclusively for patients suffering mental disturbances.

The great strength of these articles derives equally from an extensive exploitation of a rich archival base and the authors' engagement with up-to-date medical historiography. Although, of course, the records of the Hohen Hospitäler are not without gaps—sometimes significant ones—the generally excellent documentary situation allows the contributors to craft lively portraits of individuals, detail daily routines, and follow trends meticulously over decades, as well as test a series of historical interpretations about the development of hospitals more generally. There are many examples of this, but a few will suffice to demonstrate how even a Festschrift (a generally celebratory publication and one not often marked by analytical rigor) can successfully address major historical topics in a convincing and accessible manner. Christina Vanja, for example, considers whether a "trade in lunacy" such as that often described for eighteenth-century England also existed in Hesse. Her study of the documentation leads her to conclude that "one cannot speak of a 'trade in lunacy' in the Hohen Hospitäler" (p. 238). Instead of profiting from wealthier, private patients, these organizations actually lost money on them. Christoph Friedrich takes on—and refutes—the old chestnut that the poor, and especially those living in rural areas, lacked all recourse to prescribed medicines and could draw on only a "very restricted range" (p. 154) of medications. His analysis of the Merxhausen hospital around 1760 reveals a large pharmacopeia. He also uncovers in rural apothecaries an independent production of medicines of almost startling dimensions. Other authors take on other significant medical historical topics: investigating the role of surgeons, the character of care for the mentally ill, the delivery of corpses to university anatomy theaters, provisions for Jewish patients, the tasks and origins of personnel, the development (retarded) of a true psychiatric practice, and so on. These contributors comment intelligently on the quality and characteristics of medical care during a transformative period. Although the authors frequently confirm the findings of others, they remain especially attuned...