The Transformation of German Academic Medicine, 1750-1820 (review)

Thomas Broman has produced an important and subtle addition to the history of German, and indeed European, medicine. He begins by exploring a problem that increasingly generates debate among social, educational, and occupational historians—namely, the “inappropriateness of applying the criteria of modern professionalism to its early modern version” (p. 6). Broman argues that the premodern medical profession was defined not so much as a special set of skills but as a special kind of person: learned gentility was more important than scientific theory and even therapeutic success.

The central point of Broman’s title is that the shift from this premodern to a modern definition of the medical profession was not abrupt, but gradual, covering several generations. The book begins with a sketch of the “ideal physician” and his social and educational world at the beginning of the eighteenth century, with Boerhaave as the model for his many German admirers. It next disputes the image of the utter decrepitude of German higher education in the eighteenth century and shows how certain pressures associated with reforming bureaucracies nudged medical education along toward greater practical and public health concerns. Broman deftly interweaves such late-eighteenth-century developments as the rise in social esteem of surgeons, the introduction of clinical instruction in medical faculties, and a rising backlash against the “utilitarian” deprecation of traditional learnedness by the 1790s. The fashionability of Naturphilosophie among physicians is subtly explained as their joining the “first avant-garde in history” (p. 97), the German Romantics, as fellow men of letters renewing a commitment to the values of what had by now come to be called Bildung.

The book rounds out its chronological voyage with chapters on the Brunonian “revolution,” a rebellion of younger (and disadvantaged) physicians against the medical “establishment,” reminiscent of the thesis put forward by Henri Brunschvig a half-century ago. The resulting wall between “theory” and “practice,” Broman argues, actually shaped both into the modern forms we know, with “theory” being tempered by a consciousness of the socially progressive use of knowledge and “practice” becoming defined increasingly as the application of, not indifference toward, theory. That the profession survived such internal confrontations was remarkable and yet shows it as a constantly evolving elite.

Broman’s approach itself is one of social, intellectual, and institutional history, and is not intended to shed new light on changing medical practice. Indeed, since the first signs of an organized medical profession only began to emerge at the end of the period under investigation here, one might better style his book a contribution to the study of the mentality among physicians and medical schools that made such organization increasingly necessary in the nineteenth century. It is nevertheless a welcome addition to the growing body of studies on the problems of professions in the modern and premodern world, as well as an eminently readable and thought-provoking reconsideration of a learned estate, their fields of discourse, and their social ambience during an important period of transition.