Lernen am Bett der Kranken: Die frühen Universitätskliniken in Deutschland (1760-1840) (review)

Axel Karenberg. Lernen am Bett der Kranken: Die frühen Universitätskliniken in Deutschland (1760-1840). Schriften zur Wissenschaftsgeschichte, no. 15. Hürtgenwald, Germany: Guido Pressler, 1997. 286 pp. Ill. DM 160.00.

A portrayal of clinical teaching and the academic institutions associated with it has long been overdue. Axel Karenberg's scholarly and readable volume on early university clinics presents a well-founded survey of the first crucial epoch of clinical educational institutions in the German-speaking region. Gradually, in addition to the general hospital, a new type of edifice devoted to medical care came into existence that took upon itself not only the care of the sick, but also the task of training physicians through teaching and research. These clinics then became entities in their own right.

Following a short review of the history of clinical training from classical antiquity to the baroque era, Karenberg devotes his first chapter to the beginnings of the method of bedside teaching in the first half of the eighteenth century. The first new structures connected with this particular method were established as independent university clinics in Vienna (1754), Prague (1767), Freiburg (1768), and Wurzburg (1769). Karenberg gives a very detailed description of this flourishing of clinical teaching under the aegis of Empress Maria Theresia and her son, Joseph II, who joined his mother in handling state affairs in 1765. The social reforms that they instigated came to be regarded as models for Europe, and new academic clinics were soon established in the university towns of every German principality, from Jena (1779) to Erlangen (1815).

Prussia initially lagged behind, but after the reintegration of the Left-Rhine area following the Vienna Congress, the newly established University of Bonn was immediately expanded with generously designed clinics housed in the Electoral Palace. In Greifswald and Breslau, clinical training took place in separate medical and surgical colleges established by the Prussian administration under Carl Wilhelm Wutzer, following the example of the Pépinière (1795) in Berlin. A surgery school was also established in Munster, Westphalia, in 1821, to replace the Westphalian Medical Faculty (which had been abolished in favor of the new University of Bonn in 1818); this school is not mentioned by Karenberg. These new medical and surgical colleges did not last long, however: in 1849 all were abolished.

In the last section of his study, Karenberg examines the clinical institutions that were established in Munich (1825), and the new Swiss clinics in Zurich (1833) and Bern (1834). The method of clinical instruction that had been introduced to the University of Landshut in 1802 made its appearance in the General Hospital of Munich (at the Sendlinger Torplatz) following the transfer of the university to Munich. However, the lack of space and the hygienic problems of the two clinics (for surgery and for internal medicine) soon gave rise to vehement complaints. The Canton Hospital of Zurich (1837-42), on the other hand, comprised a group of buildings for the two big clinical fields that was a model for its time; the General Hospital of Bremen (1849-51), finished ten years later, faithfully copied the arrangement of the Zurich operating theaters and other buildings, and this arrangement has been maintained to the present time. Karenberg vividly details the manifold preconditions for the establishment of particular clinics, the first announcements of clinical training, and the spatial arrangements, making use of primary texts as well as supplying illustrations and floor plans. The book's extensive appendix contains maps, surveys, and a list of clinics with their year of foundation, and there is an exhaustive bibliography. Karenberg has pioneered in making accessible a complex field of research in its complete historical depth, skillfully combining general historiography with both the history of medicine and the history of hospitals. Furthermore, he shows the essential outlines of regional peculiarities in the development of clinics...