Vom Armenhospital zum Grossklinikum: Die Geschichte des Krankenhauses vom 18. Jahrhundert bis zur Gegenwart (review)

The fact that a third and revised edition of Axel Hinrich Murken’s well-known book From Hospital for the Poor to Clinical Centerhas now been published shows that the book has advanced to the status of standard reading on the history of German hospitals. Therefore this review has essentially to restrict itself to the revisions only. In addition, some references to the modern history of hospitals would seem appropriate.

The book contains the following chapters: (1) Hospitals and Isolation Hospitals; (2) The Transition of the Infirmary to the Hospital; (3) The Development of the Hospital at the End of the Eighteenth Century; (4) The Hospital during the Biedermeier Period; (5) Between the Restoration and the Gründerzeit Period; (6) The Era of the Pavilion Hospital; (7) The Pavilion Hospital in Germany from 1868 to 1918; (8) The Hospital from 1900 to 1985. Following these, a “Chronological Summary of Important Hospital Construction Projects in Germany,” a glossary, a bibliography, and an index of places and names conclude the richly illustrated book.

The author does not mention new approaches or aspects in his revised preface. The changes are scattered carefully throughout the text. Here and there names of architects, dates, and new hospital buildings have been added. Sometimes old paragraphs have been divided into new ones, without alteration to their contents. With only one exception (fig. 139a), the illustrations are fully identical. Thus the newer edition is by and large identical to the former one. One is tempted to ask why an author should make alterations at all in such a successful book.

Some remarks may be in order here, in view of the current international and national work on the history of hospitals. Although Murken mentions the role of the hospital in society and its social importance, the first edition of his work did not contain much information about issues, methods, and results in (general) history, especially not in the social history of the periods discussed. Murken’s repeated references to the influence of poverty on hospital organization during the early periods of industrialization displayed a touching helplessness. Although many aspects of the influence of hospital care on society and vice versa were mentioned, the substantial influence that poverty and the pauper classes had on the early modern hospital, and the mechanisms through which this influence occurred, were not explained at all. The present edition also leaves out newer developments in the (general) history of medicine, and especially in the history of hospitals.

Without explanation, the wider history of hospital care is reduced to one methodical approach, and thus to one single aspect: “particularly in Germany the most important stages of development of hospital building are shown by a large number of examples, thus giving a demonstrating manual to its history” (p. 8)—that is, the idea should speak for itself via such sources as the construction plans or pictures of the buildings. However, the author should at least be aware of the fact that the modern historiography of hospital care goes beyond the concept of constructional and architectural history and tries to elucidate the relationships between hospital, medicine, and society. Some relevant questions would be: Who built hospitals, and who ran them? What were the reasons for building a particular hospital, and what were the real interests behind it?

The modern history of hospital care is more profound because it also studies the internal organization of the hospital, including patient care, hospital management, and many other aspects. Who provided the financial means for the hospital? How did this aspect influence the type of patients? What patient group was the hospital originally built for, and which patients were treated in the end? What kind of disease and mortality patterns were seen in the hospital compared to the overall morbidity and mortality? What happened to the patients during their stay? How did nurses and...