Institutions of Confinement: Hospitals, Asylums, and Prisons in Western Europe and North America, 1500-1950.

Edited by Norbert Finzsch and Robert Jutte (Cambridge: Cambridge University Press, 1996. ix plus 369pp.).

Norbert Finzsch provides a most useful introductory essay to this collection, linking the theoretical contributions of Michel Foucault, Norbert Elias, and Gerhard Oestreich so as to range practices of confinement in a common domain, whether the ostensible purpose of confinement was to provide medical treatment, long-term care, rehabilitation, or incarceration. The division of the book into one group of essays dealing with hospitals and asylums and another dealing with prisons somewhat diminishes the power of the synthesis that might have been achieved, but much is accomplished by placing these two sets of essays side by side. They were originally conceived as part of a common program for a conference held in 1992 at the German Historical Institute in Washington, D.C.

One purpose - or result - of the conference was to draw connections between German historiography (including the works of American Germanists) and the debates sparked by Foucault among French and English-speaking scholars. Martin Dinges surveys the relatively limited impact of Michel Foucault on the German historiography of criminal justice, social discipline, and medicalization. Guenter Risse offers a corrective to Foucault's Birth of the Clinic in an elegant survey tracing the influence of Herman Boerhave's clinical methods in European cities outside France. He argues that the emergence of clinical methods, in France and elsewhere, may best be understood by "employing Ludwig Fleck's thesis that particular styles of thought and types of knowledge emerge from specific cultural and historical contexts that define and restrict the range of observation."

Robert Jutte's article on the rise of syphilis hospitals at the end of the fifteenth and through the sixteenth century throws up yet another dementi to Foucault. Unlike the general hospital, which continued to receive the chronically ill for long-term custodial care, the specialized Blatternhaus marshalled medical knowledge in the provision of treatment and cure. Jutte argues that institutions of this kind set a precedent for using hospitalization as a means of advancing public health.

Foucault's views on the modern construction of insanity serve as a reference point for Christina Vanja's study of three hospitals in Hesse. She begins with an account of the relatively gentle treatment these hospitals provided to the insane through the mid-nineteenth century, subjecting inmates to a monastic regime - sleeping, praying, reading the Bible, taking meals, and working. The evolution toward a modern psychiatric hospital was gradual and piecemeal, she argues. The new institutions of the nineteenth century served the professional agenda of validating medical expertise, but they continued to treat inmates in traditional ways. They were, then "neither modern medical clinics nor prisons." Foucault was only partly right.

German historians are, of course, not the only ones to put some distance between themselves and Foucault. Colin Jones' spirited reflection on "The Construction of the Hospital Patient in Early Modern France," includes a section on "The Clinic before the Clinic." Like Risse, he argues against a "big bang" theory that consigns early modern medical history to a Beckettian limbo, "waiting for Foucault." Doctors had to negotiate their way into an institutional context that was not simply a vacuum. Nursing orders, in particular, had served as major purveyors of medical practice and prescription before doctors displaced them. Military medicine also played a key role in "the construction of the patient," a gradual, evolutionary process in which the improvement of life chances had at least a modest part along with the expansion of medical power.

The influence of Norbert Elias seems to have found readier acceptance than Foucault among the scholars represented here. Pieter Spierenberg, in an article on "Four Centuries of Prison History" (sharing pride of place with Finzsch's introductory essay) proclaims Elias superior to Foucault in explaining the relationship between attitudes toward the body and the willingness to accept pain and suffering in punishments. Elias links these developments to personality structure, and takes into account social processes such as state formation.

Patricia O'Brien picks up on Elias's concern with the state in an article focused on nineteenth-century European prison reform. Although her reflections draw substantially on her research in French sources, her main argument is comparative in nature. Across regimes and space, she finds debates on prison reform to be linked to questions about the nature of political legitimacy. Weaving together a series of historiographical debates, O'Brien detects a shared moral consensus in the West on such matters as the treatment of juvenile offenders and the possibility of monitoring convicted offenders outside of prison. While her article does not fully develop the evidence for such a hypothesis, she believes that such common sensibilities arise from common developments in the European state. Elias is key for her, because he "allows for a triangulation of the problem of public and private and the role of the state through a history of customs and feelings."

Finzsch's evocation of Gerhard Oestreich along with Foucault and Elias will be particularly helpful to social historians of Europe and America in the United States, since Oestreich's concept of "social discipline" opens a path of interpretation that has heretofore been confined largely to Germanist scholarship. Characterizing it as an alternative both to Weber's "rationalization" and Elias's "process of civilization," Finzsch offers a further distinction between Oestreich's concept and the modern sociologist's concept of "social control." As Finzsch explains, "'Social control' denotes much more the dissonance of acts defined as 'deviant' from predefined behavior, whereas 'social discipline' refers to a historical development that tries to minimize exactly this dissonance."

Several of the articles in the collection reflect a concern with measures designed to lead inmates (particularly delinquent youths) to internalize a self-discipline that will prepare them for unfettered participation in the larger community. In fact, if one seeks a theme that unifies the essays on hospitals and those on prisons, the most salient of these is the relationship between pedagogy and therapy in the two distinct domains of the universe of confinement. Renate Wilson, in particular, emphasizes the pedagogical regeneration of society in her finely documented article, "Pietist Universal Reform and care of the Sick and Poor: the Medical Institutions of the Francke Foundation and their Social Context." Wilson explores a domain relatively little known to historians of France, England, and the United States - the world of evangelical activism supported by the first two "kings" of Prussia in the seventeenth and eighteenth century in alliance with an intellectual cadre at the University of Halle. Calling for re-examination of the duality of enlightenment and religion in the area of welfare reform, Wilson suggests that the Pietist tradition played a formative role in German approaches to welfare and medical care.

Of the ten essays under the heading, "Prisons," most touch on the question of education or the rehabilitation of delinquents. Gerlinda Smaus would seem to bear out Wilson's contention, since she demonstrates the powerful influence of a belief in the power of re-education to correct criminals and delinquents of all kinds in the early nineteenth century in Germany. Franz von Liszt's influence at the end of the century in shifting the role of prison toward simply punishing and removing unwanted members of society reflected disappointment with the experiments of reformers. Smaus attributes this failure to the context of economic deprivation in which prisons acquired an inflated function of general social control. This problem remains unresolved, in her view, although resocialisation is now recognized as the only alternative to Liszt's idea of incapacitation. Sebastien Scheerer provides a related discussion of the evolution of solitary confinement with a focus on Prussia and Germany in the past two centuries.

Karl Tilman Winkler's contribution on American and German Juvenile Courts at the turn of the century, one of the more fully developed comparative articles, takes as a point of departure the use of American practice as a model by German reformers at a moment when the juvenile crime rate was rising dramatically in Germany. Reformers' demands that a child had "a right to be educated," and not just incarcerated with older offenders, had the effect of legitimizing heavy sanctions on all forms of youthful behavior that failed to conform to adult norms. By a different path American Progressive reformers promoted a similar development, stressing preventive intervention and reformatories in which conformity to adult norms was the sole path to release.

All in all, the collection is useful in opening up some important lines for synthetic work: considering in one sweep the domains of penology and welfare, setting side by side monographic contributions from national studies that speak to each other, and essaying some substantively comparative studies. It is not surprising that truly comparative studies always prove to be the most difficult: those in this volume achieve only mixed results. Norbert Finzch in particular offers comparative case-studies of prison administration in Washington, D.C. and Cologne. His results are fragmentary - although as a heuristic essay the article is useful, highlighting the importance of American models in nineteenth-century German debates.

The well-documented monographic articles in the collection, on the other hand, speak comparatively only in their silences. Lynn Adrian and Joan E. Crowley provide empirical data and analysis to show that the police apparatus of Pittsburgh and its environs marshalled resources to control what the authors define as "the bachelor subculture" that provided the key to the labor supply of the city's growing heavy industry at the beginning of this century. In the context of this collection, the argument radiates a comparative penumbra (social control vs. social discipline?), but the reader infers what she or he will unaided - and unconstrained.

Other monographic articles offer more explicit comparative "hooks." The article by Luigi Cajani on the Casa di Correzione of San Michele a Ripa in Rome holds great significance for students of European confinement, particularly in the context of the Counter Reformation. The broader comparative import of the study is elegantly adumbrated with an opening citation from John Howard, and Cajani vindicates an older view that Thorsten Sellin scorned, according to which the architecture of the institution prefigured the central concepts of Bentham's Panopticon.

Two specifically German perspectives end up affirming Foucault's vision but transpose it to the era of Nazi dictatorship. Gellately shows what a departure Nazi "protective custody" was from previous German jurisprudence. He carefully traces the expanding use of the concept from the decrees following the Reichstag fire in 1933, through the regulations of 1938 in which the Ministry of the Interior recognized the ascendancy of the special police over the regular police and the justice system, and the effects of wartime measures. More speculatively, he sketches a progression of opinion in a population exposed to increasingly severe and unpredictable brutality and a widening circle of confinement.

Richard F. Wetzell, meanwhile, takes on the thesis advanced by Detlev Peukert that German currents of science, medicine, and welfare policy had something to do with the rise of Nazism. In an article on the medicalization of criminal law reform, Wetzell argues that there was a divide as well as a continuum between the German liberals who favored a therapeutic approach to individual criminals (but also supported measures to alleviate the social conditions that promoted crime) and the Nazis who made the theories of Franz von Liszt and others the justification for isolating and eradicating "deviants" of all kinds.

Returning last to the first of the articles in the section on hospitals, one finds in Morris J. Vogel's essay on the American hospital experience an intriguing foretaste of the strengths and limitations of the collection as a whole. He establishes an explicitly comparative framework at the outset, emphasizing the extent to which early American hospitals drew on European models. At the same time, by arguing for the importance of social factors in conditioning the development of institutions, he suggests that the urban living standards in which the French clinical model arose found their true analogue in the flood of immigration to the United States that furnished likely subjects for clinical inquiry at the end of the nineteenth century. The comparative dimension of the essay becomes less explicit in the eight pages in which he recasts his earlier work on "the invention of the modern hospital." He suggests that the relation of hospitals to communities since the turn of the century precluded rational planning and that hospitals colluded with physicians, and eventually with the federal government, in creating the conditions for a rate of hospitalization far above that of any European country. In a Veblenesque passage he describes American hospitals searching for new missions now that they all "studiously avoid caring for the poor." One would have liked a comparison at this point with the more recent evolution of European hospitals. As it is, the reader can be grateful for a provocative distillation of the work of a leading American historian of the hospital, recast to elicit comparative reflections. So it goes throughout this challenging and richly informed set of essays.

Thomas M. Adams Washington, D.C.