- The Transformation of German Academic Medicine, 1750–1820
Thomas Broman’s book is about three “transformations” that shaped modern medicine around 1800: “the modern bureaucratic state,” with the authority to enforce sanctions against unlicensed practice; “the advance of industrialization,” with new urban centers that depersonalized medicine and legitimated boards of expertise; and “the rapid advance of scientific knowledge,” which lent physicians success at the bedside and prestige in public (2). The main objective of the author is to challenge the prevailing notion that changes in the German medical profession were tied to the French Revolution and the Napoleonic reconstruction of Europe. His [End Page 125] goal is to show continuity in the gradual emergence of modern medicine as a “transformation of a continuously existing elite” (9). Broman makes his point by arguing that the professional turn was not in the actual work of the physicians, in the “function” of their office, but in the cultural and social public life that followed from new patterns of education (9).
In the first of six chapters, Broman describes the typical doctor of the various German territorial states during the period of Enlightenment. With short biographical sketches, he argues the point that in the period before the turn of the century the training of doctors was largely pragmatic, more dependent on the printed word than on the experimental lab, which culminated in dissertations written in Latin. This utilitarian ideology, the author argues in the second chapter, began to break down in the second half of the eighteenth century with the establishment of new universities like Göttingen, with curriculum reform in older universities, and with the gradual introduction of training in clinics. In the conclusion to this chapter Broman introduces the concept of Bildung (71) as an emergent form of education, which he argues went beyond the pragmatic ideals of the learned doctor and replaced the old Gelehrsamkeit (18) with a divine mission inspired by “the traditional Lutheran virtues of ‘calling’” (72).
In the next three chapters, Broman shapes his two main “perspectives” on the transformation of medicine in Germany, the first his thesis that the motor driving the change was a debate “on theory and practice” (9), the second that “this story” was informed by Jürgen Habermas’s “public sphere” (11). The third chapter is primarily about the “public sphere,” about the new mission, or calling found in the term Bildung, which Broman links to the rise of a new philosophy of nature [Naturphilosophie] that freed the doctor from the shackles of a pragmatic, utilitarian view of the human being. The fourth chapter discusses the “art of healing” (101) that shaped the “professional identity” of the modern doctor (125), and chapter 5 breaks with tradition by replacing the radical influences of the French Revolution with reforms advanced by the Scottish physician, John Brown (1735?-88), a “Brunonian revolution in Germany” (128). The evidence for this “storm that overtook the medical community in 1791” (131) is limited to marginal figures from the University of Bamberg (149), and it is not clear why the author made “Brunonianism” central to his thesis and then in the conclusion to the same chapter judged it to have been “a failure” (157). In the sixth and last chapter of the book, the author returns to Germany and examines the work of von Stein, von Humboldt, and other reform artists from Prussia.
In the conclusion, Broman examines his “story of the ‘professionalization’ of German medicine,” asking “how novel in fact was it?” (194). He does not want “to claim too much,” but does want first to emphasize the value of Habermas’s “public sphere” as a research tool for examining the genre of the literary doctor, and second, wants to review the importance of the tension between theory and practice. Here he concludes that “the structure of knowledge has become largely a binary one, a duality implied in the famous ‘two cultures problem’ addressed by C. P. Snow” (195). In this dichotomy, the author has found the problem in his own book, which...