Arztliche Standesorganisation und Standespolitik in Deutschland, 1945-1955 (review)

The history of the modern German medical profession has gone from a virtual wasteland to a respectable edifice in the last fifteen years or so. The field has moved from dominance by self-interested members of the profession to analysis by scholarly, critical, social, and medical historians, producing a string of works in German as well as English, from specialized monographs to comparative studies of learned professions.¹ Inevitably, the role of doctors in the Third Reich has drawn considerable attention, and some is finally being paid to what is now a very long "postwar" period, particularly since about 1955. Largely neglected by historians, the immediate postwar period of occupation, dismantling of the Nazi establishment, (re)construction of a medical profession on decentralized Federal lines (West Germany) or Stalinist principles (East Germany), and initial recovery has lacked sufficient well-researched study up to now.

This gap is meant to be filled by Gerst's book, originally a Ph.D. dissertation at the University of Stuttgart. As this reviewer can attest, research on this period in the history of the German medical profession was long rendered problematical to impossible by the condition and limited accessibility of relevant primary source material, which Dr. Gerst has finally been able to use—particularly the files of the directors of the federal and state medical chambers (Ärztekammer) after 1945, as well as of the Working Group (Arbeitsgemeinschaft) of the West German state Panel Doctors' Associations (Kassenärztliche Vereinigungen) after 1949.

The profession had been largely cut loose from state supervision around the time of the founding of the German Empire by Bismarck, but the efforts of the German Medical Association to shape the conditions of physicians' work had not always met with complete success. The introduction and constant expansion of mandatory, employment-related health insurance by and after Bismarck altered the balance of power (and money) in favor of the insurance companies, resulting in the founding of an economic combat organization, the Hartmann League, and successful doctors' strikes before World War I. The economic upsets of the interwar years led to ever-louder cries for a national physicians' law that would enhance the bargaining position and autonomy of doctors. Ironically, promises by the Nazis to hand the profession a long-demanded National Physicians' Chamber no doubt lured German doctors in disproportionate numbers to support the Hitler regime, at least initially, as physicians' incomes began to rise; but the promise of autonomy and the monopolization of health-provision proved illusory as the Nazi regime became increasingly totalitarian.

Against this background, the occupying Allies were loath to continue the previous setup of the medical profession, and the first postwar decade witnessed many improvisations and unexpected twists, including the sundering off of East Germany and the creation of a Soviet-style national health system there. In West Germany, the remnants of the Weimar-era medical organizations, from the Hartmann League to state medical chambers and panel-doctors' associations, gradually resumed their activity as pressure groups, particularly in the face of American occupation authorities' attempts to undermine the self-regulating autonomy of the profession. In the same early years, threats to reorganize the large part of the profession consisting of panel physicians along labor-union lines were headed off.

Simmering discontent with the fees paid to doctors led to efforts by the Hartmann League to increase physicians' honoraria—but these efforts failed to unite the medical profession, instead producing divisions within it and irritations on the side of the legislative branch (read: the Christian Democratic Union) that delayed the passage of an updated legal framework for panel physicians. Nevertheless, doctors elected to the Bundestag and receptivity by the Bonn government to the physicians' point of view often, if not always, assured satisfaction for the medical pressure groups. A good example of success on the federal level was the passage of the...