Health and Healing in Nineteenth-Century Germany.

By Mary Lindemann (Baltimore: Johns Hopkins University Press, 1996. xiii plus 506pp.).

Scholars of the social history of medicine have a wide spectrum of methodologies from which to choose; the legacy of the Annales school - the history of mentalities, the history of everyday life, the history of socioeconomic structures - beckons. Those who study eighteenth- and nineteenth-century medicine, at least for the West, can address the medicalization/professionalization question that colored much of the scholarship in the 1970s and 1980s. The thought of Michel Foucault and the notion of a normalizing, regularizing state or bourgeoisie provide another avenue. More recently, narratives, especially illness narratives, have received pride of place. And cultural studies can cast the history of health and disease in a new light (or, sometimes, in a new semi-darkness).

Mary Lindemann's magisterial study of health and healing in eighteenth-century Germany deftly weaves together the best of these approaches to provide a rich picture of the patient and the healer, struggling to stay alive physically, economically, and morally. The state's relation to medical life is also explored. Lindemann combines painstaking research in the government archives of Braunschweig-Wolfenbuttel, a formidable knowledge of the secondary literature for several European countries, and a refreshingly light hand with theory to produce a study that will remain a benchmark for social historians of medicine as well as for scholars interested in the emergence of the modern state.

Braunschweig-Wolfenbuttel, the geographical focus of the book, was a predominantly rural, predominantly Protestant area in what is today lower Saxony. Its duke, along with four privy councillors, ruled the area as the privy council, but their approach to governance was reactive, not proactive; "the word pastiche characterizes the reality of early modern governing better than the word design." (p. 26) Although the privy council established a Collegium medicum in 1747 to supervise medical affairs, it aimed less to police medical practice than to maintain a particular moral world where all members of the community, even irregular practitioners, could survive. Physici, or government-salaried physicians were sent out in the duchy, and their numbers rose during the eighteenth century.

Lindemann's picture of the physicus, drawing heavily on well-chosen examples, is brilliant, capturing the tone of rural life. Dr. Christian Loeber, the most peculiar physicus, irritated his neighbors by performing an autopsy on his own child, engaging in the folly of trying to teach young boys surgery, and romanticizing nature. But almost all of the 110-120 physici who served in Braunschweig-Wolfenbuttel between 1730-1808 were involved in protracted small clashes. Personal eccentricities blended with the strains of a world where the traditional guild system was changing to make the introduction of health measures problematic.

Not that the farmers of Braunschweig-Wolfenbuttel were hidebound traditionalists. Growing grain on small plots of land, they were open to innovation in agronomy and, according to Lindemann, willing to pay attention to new things about health if these things made sense. Thus, inoculation for smallpox was passed up because the cost-benefit ratio seemed poor, but vaccination safer - was more popular.

Lindemann casts the medicalization/professionalization question in a new light. Both academically trained physicians and other healers, she argues, did similar things. Both took careful histories from the patient; both believed in humoralism and in equilibrium as a criterion of good health. If physicians had given up their belief in transference by the eighteenth century, they still prescribed remedies based on it. What defined quackery in eighteenth century rural Germany, according to Lindemann, was its attempt to encroach upon the livelihood of another practitioner who deemed himself more qualified; quackery was not seen as a dangerous deficiency in medical knowledge.

Lindemann has some new things to say about folk medicine which she does not see as the "bastard child of a more cultured parent." (p. 304) Noting that there is strikingly little information about what folk healers actually did, she suggests that, to a certain extent, folk medicine may be an artificial construct in that doctors railed against it and scholars subsequently "successfully reified it" (p. 305). Certainly, what passed for folk medicine in Braunschweig-Wolfenbuttel was not redolent of magic. Overwhelmingly, peasants favored naturalistic remedies.

Nor were the people who sought them fatalistic. The inhabitants of Braunschweig-Wolfenbuttel seemed to use doctors and healers almost interchangeably, but they did have recourse to them. Drawing on a subset of documents that shows patterns of patient choice, Lindemann is able to show that doctors were four times as likely to be consulted for fevers as healers; they also were favored for chest diseases. But medical attention was sought only in about a quarter of smallpox cases, and during epidemics, neither doctors nor healers were consulted much. Decisions seemed to be made on the basis of what practical gain could be achieved by a medical consultation. Pediatric ailments were not accepted as routine; for a problem that would hinder their eventual ability to work or reproduce, children received a considerable amount of medical attention.

This short review can barely do justice to the richness of this book that describes a world whose residents may have believed in a moral economy more strongly than we do, but who, in their great desire for health, "approximated us more than their two centuries' removal in time might suggest." (p. 373)

Evelyn Bernette Ackerman Lehman College and Graduate Center, City University of New York