The Development of German Social Medicine in the Nineteenth Century

Abstract

In his influential treatise System einer vollstandigen medizinischen Polizey, Johann Peter Frank(1745-1821) made significant contributions to the establishment of the concept of medical police, which has been understood as the forerunner of social medicine. Cameralism, the German version of mercantilism, became the very basis on which Frank and other German writers developed the framework of medical police. ’Medical reform’ was the catchword of German medical men in the 1840s. The medical reform movement of 1848 was partially caused by a deep political, economic, and social crisis. Although Industrial Revolution began in Germany later than in England and France during the first half of the nineteenth century, by 1848 the formation of German industrial working-class made medical reformers recognize the causal relationships between social and health problems. The outstanding figures in the German medical reform movement of this period were Rudolf Virchow(1821-1902), Solomon Neumann and Rudolf Leubuscher. In his famous Report on the Typhus Epidemic in Upper Silesia, Virchow proposed several radical measures that could be used against the epidemic: the absolute separation of the schools from the church, the establishment of self-government in the state and community, unlimited democracy, road building, and the improvement of agriculture and horticulture. The progressive German medical reformers of the 1840s held to several principles through their action for the enhancement of public hygiene: (1) the health of the people is a matter of direct social concern, (2) social and economic conditions have an important effect on health and disease, (3) steps taken to promote health and to combat disease must be social as well as medical. The 1848 Revolution was defeated. To most Germans after 1870s, the 1848 movement was something from a strange past. The German intellectuals and the middle class accepted social policy of Bismarck. As Bismarck launched national health insurance in 1883, more emphasis in social medicine was given on better health care rather than on social hygiene. The ideologically-oriented social medicine of 1848 was transformed into more administrative one and began to include the insurance concept in health care.