Krankenhaus und lokale Politik, 1770-1850: Das Beispiel Dusseldorf (review)

In the past quarter century, historians have reached a broad consensus concerning the changing relationship between medical care and poor relief in Central Europe. In this picture, four characteristics stand out. First, there was a redefinition of the meaning of poverty beginning in the sixteenth century, in which a distinction was made for the first time between the "virtuous" poor, deserving of communal support, and the "shiftless," or undeserving poor. Second, and connected with the first change, there was an increasing emphasis (especially in the 1700s) on the pursuit of wealth as the route to happiness. Third, governments began crafting policies aimed at promoting the domestic economy through manufactures, which had a medical correlate in "medical police"—a grab bag of proposals for increasing the size and health of the economically productive segment of the population. Finally, new institutions were established for delivering medical care to the working poor: ambulatory clinics—or "policlinics," as they came to be known in German—and new hospitals that ceased being the all-purpose welfare institutions they had been in the Middle Ages and focused instead on caring for patients with acute illnesses and discharging them back into the workplace.

Fritz Dross casts his book on hospitals and local politics in Düsseldorf against the background of these long-term developments. His aim is to show that the city was not merely a stage on which these forces played themselves out, but instead an active player in the establishment of new forms of medical care and poor relief. This is especially laudable in the context of German history, in which, as the author points out, the story has too often assumed the transformative role of statutes and ordinances instituted by princely governments, without inquiring into the resources available to the residents of those territories with which to resist (or simply to ignore) those laws. By making his book about the changes in medical care and poor relief in a single city, Dross demonstrates how the regulations laid on the city by the changing cast of sovereigns (first the Palatinate, then Bavaria, followed by French occupation, and finally Prussia) affected the city's institutions.

Dross begins with an account of Düsseldorf's social and economic situation in the 1770s. A rising need to control begging and improve the care of the working poor led to a number of disjointed initiatives, including a plan devised in 1800 to create a city-wide organization for poor relief. However, funds for the new institute were drawn, not from tax revenues, but instead from voluntary contributions and church collections, and supervisory positions in the organization were filled by volunteers from the city's social elites. Despite the organization's semiprofessional status, Dross claims (not without reason) that it represented a significant step away from the motley assortment of charitable foundations that had previously provided poor relief, and toward a more centralized system. This trend would receive further support during the period of French occupation, and especially after the Rhine provinces were made part of Prussia in 1815.

Hospitals come in for considerable attention from Dross. Interesting here is his description of attempts made by the provincial government to incorporate Düsseldorf's medieval foundation, the Hubertus Hospital, into its new poor-relief institute. By 1800, this hospital had been joined by a second two-room hospital founded by the Marian Congregation, a lay Catholic community. The Bavarian ruler, Maximilian IV Joseph, attempted to unify the two hospitals into a "Max-Joseph-Krankenhaus" in 1802, but real reform and the enlargement of hospital facilities in the city again had to await the new political and economic situation after 1815.

Dross offers a painstakingly researched and detailed account of how one city developed new systems of poor relief and medical care, and he succeeds particularly well in describing the tensions between the needs of Düsseldorf...