This special issue on patient history in hospitals and asylums has been published as part of the biennial yearbook of the German Society for the History of Hospitals. Of its 606 pages, about 160 deal with patient history; another part contains conference reports and papers, for instance on ‘Disability in Early Modern Society’; a third part is dedicated to issues more closely associated with the Society itself, such as the papers given at the society’s annual meeting. The special issue on patient history in hospitals contains five papers. After a short introduction, Irmtraut Sahmland describes the petitions of inmates at the Haina hospital, an infirmary near Marburg (Hesse) that served as a nursing home and a facility for treating chronic cases of mental illness. Since the 1780s, some corpses of the deceased inmates of the Haina hospital had been transferred to the medical school of Marburg university and used for medical training and dissections. With the reform of the medical curriculum and the introduction of practical anatomical courses, the demand increased and patients at Haina started to resist. They wrote to governmental agencies, demanding their rights to physical integrity after death and a proper burial. Sahmland describes everyday hospital life, the key historical actors, their social background, and how the group of petitioners formed. Sahmland also analyses the petitioners’ changing arguments between 1839 and 1853. Although the petitioners were physically disabled, they were not helpless and powerless: they knew whom to address and how to argue. At first, they rejected dissections for religious reasons; later on, they took into account the needs of the medical school and argued that only the bodies of lunatics should be used for anatomic dissection because they did not feel the heartache and, according to the petitioners, they were unaware of the mental cruelty that such post-mortem practices entailed. The second contribution by Jürgen Schlumbohm compares British and German maternity hospitals in the eighteenth century. First, Schlumbohm analyses the different forms of funding. Whereas in Britain the hospitals depended on donations, in German territories most of the hospitals were funded by state or municipal authorities, to whom they were responsible. British hospitals had to convince potential donors in a competitive marketplace of charities and had to report to those donors that their donations were being used efficiently. Funding also affected the hospital’s organisation. Donors had the right to recommend people for hospital treatment, and large donors could also become involved in the hospital’s management as governors. Physicians, who drew their income from their private practices, played a minor role in hospital management—unlike in Germany, where the hospital physician was much more important. Furthermore, the social composition of patients in maternity hospitals was different. In Britain, patients were selected and as a result, mainly for moral reasons, married women were more likely to be treated. These women and their families were seen as prospective donors. In contrast, the patients treated in Germany’s maternity hospitals were largely poor and were often used for medical training. Marina Hilber picks up similar themes by analysing patient complaints at the Innsbruck Maternity Clinic in 1879, particularly the complaints of female patients about the examination methods of the obstetrician Ludwig Kleinwächter. Based on letters and interview protocols, Hilber reconstructs everyday practices at the clinic, patient treatment and the gynaecological examinations conducted as part of daily rounds in the medical training of students and midwives. After Kleinwächter arrived at the clinic, the methods of gynaecological examination changed: contrary to prior convention, pregnant women were examined nearly naked, lying down and in a very rude manner. Some women left the hospital before giving birth, while others wrote letters complaining about the brutal and undignified examination that was followed by bleeding and heavy abdominal pain. An investigation found that the number of premature deliveries and miscarriages had increased since Kleinwächter had become the chief obstetrician. In the end, Kleinwächter was dismissed because the maternity clinic feared for its reputation. Hilber’s article illustrates that women were not powerless, but rather actors who knew how to express their displeasure. Jens Gründler investigates power relations in a lunatic asylum in Glasgow between 1875 and 1920, reconstructing the everyday life, the routines and interactions between physicians, attendants, poor law administrators, patients and their relatives. Drawing on patient case files, Gründler describes how and to what degree hospital physicians and attendants were able to implement and enforce rules, and in what ways patients were able to subvert those rules. Gründler states that his analysis of power imbalances and hospital hierarchies shows ‘that even in settings like “total institutions” power remains volatile’ (p. 98). The last contribution portrays three patient stories from asylums in Baden and Wurttemberg. Uta Kanis-Seyfried discusses deviant behaviour in society and asylums, how and for what reasons three asylum inmates were diagnosed and treated. Kanis-Seyfried illustrates how the inmates negotiated power relations in the asylum, and how they influenced their surroundings. The first case involved an inmate who, in the decades around 1900, had been admitted to at least 16 different asylums. He committed himself voluntarily and stayed until he was dismissed, only to enter another asylum after a short while. The second patient became institutionalised after he lost a lawsuit (and following appeals). In the asylum, where he stayed for nearly ten years, he was diagnosed as a ‘troublemaker’. Compared to the first case, the disruptive patient had very little scope to negotiate amenities, although he behaved well. He was dismissed only after his story was published. The third patient, a prominent parish priest, politician and author, entered the asylum voluntarily to cure his depression and stayed for a couple of months. As a prominent ‘guest’, he was treated very differently than ‘normal’ patients: He had a single room, dined with the physicians and received privileged treatment. After his stay, he published his experiences, recommending a stay in a mental hospital in order to overcome a life crisis. Maternity hospitals and mental asylums comprise the focal point of the contributions: according to the introduction, the aim of the special issue was to revise Roy Porter’s article on ‘The Patient’s View’ and Stollberg and Lachmund’s publication on ‘Patients’ worlds’.1 Gründler and Kanis-Seyfried argue that power relations were not always as clear-cut as suggested by Goffman, who misinterprets Foucault’s arguments that power relations are negotiated in many different ways.2 Even in asylums—as ‘total institutions’—power relations were volatile and patients found ways to resist or to negotiate their own position within the institutional hierarchy. This becomes clear in the contribution of Sahmland and Hilber, where patients successfully reacted against the methods of examination (Hilber) and fought to protect their physical integrity (Sahmland). In Britain, female patients in maternity hospitals were in a stronger position vis-à-vis physicians (Schlumbohm). While Sahmland adopts a microhistorical approach, Hilber refers implicitly to Foucault by citing literature on medicalisation. On the one hand, the contributions are able to demonstrate that power was not hierarchical, static and merely detrimental to patients. Instead, power relations were negotiated between different actors. On the other hand, the special issue focuses on hospitals that have traditionally been considered to exhibit a strong imbalance of power between the patient and the institution: mental asylums and maternity hospitals. In addition, it would have been interesting to compare the role of patients in other hospital regimes or in the second half of the twentieth century. Nevertheless, the special issue gives a good overview of hospital history from a ‘Patient’s viewpoint’ in different countries and from the eighteenth to the early twentieth centuries. Footnotes 1 Roy Porter, ‘The Patient’s View. Doing Medical History from Below’, Theory and Society, 1985, 14, 175–98; Gunnar Stollberg and Jens Lachmund, Patientenwelten. Krankheit und Medizin vom späten 18. bis zum frühen 20. Jahrhundert im Spiegel von Autobiographien (Opladen: Leske+Budrich, 1995). 2 Michel Foucault, Wahnsinn und Gesellschaft. Eine Geschichte des Wahns im Zeitalter der Vernunft, 11th edn (Frankfurt: Suhrkamp, 1973); Erving Goffman, Asyle. Über die soziale Situation psychiatrischer Patienten und anderer Insassen, 10th edn (Frankfurt: Suhrkamp, 1995). © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
Social History of Medicine – Oxford University Press
Published: Feb 1, 2018
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