Grossstadt und Hygiene: Kommunale Gesundheitspolitik in der Epoche der Urbanisierung (review)

In late-nineteenth-century Germany the challenge of rapidly expanding urban populations was met by innovative municipal health policies. Witzler’s study of this crucial phase in German society compares developments in Hamburg, Munich, Dresden, Leipzig, Cologne, and Frankfurt am Main. This choice avoids tackling the important histories of Berlin—inherently complicated because of the lack of a unified municipal structure—and the very large and ethnically diverse cities of Breslau and Königsberg on Germany’s eastern margins. German cities had to overcome an entrenched ideal of autonomy and accept intervention in the sphere of health. Witzler suggests that state medical policing agencies were replaced by city sanitary commissions, and there are interesting episodes concerning relations between state and municipal medical authorities.

On the whole, cities are presented as centers of dynamic medical innovation. Witzler starts by comparing mortality trends, and then considers epidemic prevention by disinfection, water supply, and sanitary provision. She unravels administrative structures and the innovative municipal hospital provision. Finally, there are sections on the promotion of hygiene, and the combatting of tuberculosis and infant mortality.

The author’s ability to state issues in a highly concise way has the virtue of clarity but also the vice of being somewhat schematic. One could easily devote a massive monograph to a single city, so the ambitious scale of the work is something of an achievement. Yet the lucid exposition is achieved at the cost of analytical probing: the comparison raises rather than resolves fundamental questions as to why certain innovations took place in one location rather than another. Why, for example, should it have been Frankfurt that in 1883 appointed the first full-time salaried municipal medical officer in Germany? Why did Hamburg in 1899 appoint two medical officers and one harbor physician? Comparing innovations raises intriguing questions concerning functional, political, and professional explanations. Overall, this is a useful and stimulating contribution—but, as the author herself concludes, many issues remain open for further study.