2024-02-06 19:31:01
Javier Segura del Pozo, health doctor
Today we begin a series of posts dedicated to the organization of health and reproductive care in the 18th century, as well as the complex ways in which these forms of health care were consumed by the population (medical pluralism). We will begin by describing how between the 17th and 18th centuries, European absolutist monarchies became interested in controlling public health and health practices through the hiring of doctors as state officials, that is, as medical authority, and the development of a series of health policies. Everything occurred in the context of the fascination with the science of public administration (“police”) and for the control of the population (including birth and mortality) and the economic production of the kingdom. We are in the time of cameralismohe mercantilism and the birth of health education and medical policethat is, public health.
In Europe in the 17th and 18th centuries, important changes occurred in the health organization as the absolutist monarchies decided to intervene more in the economic, demographic and social development dynamics, including the control of medical practice and birth rates, with their potential implications on gender differences in these health care practices, as we will see. In German-speaking countries, this state intervention will be called cameralism and mercantilism in France.
Cameralism and the concept of medical police
Cameralism developed in the German states, between the end of the 17th and 18th centuries, and consisted of the cultivation of an administrative science (“police”), with the training of public officials, registration and control of people, and the preparation of statistics of the population. Ludwick von Seckehndorff (1626-1692), in his legislative compendium The German Princely State (The German Principality), published between 1655 and 1754, proposes a government program to “maintain and supervise midwives, the care of orphans, the appointment of doctors and surgeons, protection against plagues and other infectious diseases, against excessive use of alcoholic beverages and tobacco, the inspection of food and water, measures for the cleanliness and drainage of cities, the maintenance of hospitals and the provision of relief for the poor.[1].
This science of the police (Police science) would be the basis for the concept of medical police. This would consist of a medical authority (call Medical and surgical college by the Frankfurt cameralist of the Oder Justis Christopher Dithmar (1677-1737)), who in addition to supervising public health, controlled sanitary practices. The main representative of cameralism in the 18th century was Johannes Heinrich Gottlob von Justi (1717-1771), defender of the enlightened despotism of the courts of Austria and Prussia. In his work State economy (State Economy) of 1756 advocated improving and stimulating medicine, surgery, obstetrics and pharmacy, regulating these arts to prevent quackery and abuse[2]. Other influential cameralists who proposed similar measures on medical police were: Ludwicg von Hörnigk (1600-1667), Wolfgang Thomas Rau (1721-1772), Joseph von Sonnenfels (1732-1817), JF Zückert (1737-1778) and Ernst Gottfried Baldinder (1738-1804). This trend culminated in the work of the considered father of public health, Johann Peter Frank (1745-1821) and his work System of a complete medical police force from 1799 [2b]. Without forgetting his important previous text from 1790, which we already dealt with in a previous entry: The misery of the people, mother of diseases [2c].
Picture of Johan Peter Frank y de la portada de su “Oratio Académcia de Populorum Miseria: Morborum Genitrice” (The misery of the people, mother of diseases) 1790. In this academic speech Frank concludes that the misery that he had known as a doctor, in the cabins of the German and Lombard peasants, is “the mother” of their illnesses, and that it has its origin in the system of serfdom of the greats. feudal owners. So, as protophysicus of Lombardia, he asked himself, what was the point of reorganizing the health authorities, hospitals, pharmacies and medical schools, while the population did not have enough food? It was not necessary to carry out health reforms, but rather social and economic reforms. Image source unknown.
Mercantilism and health policy
On the other hand, French mercantilism arose from the concern for self-sufficiency and productivity, which included addressing the poor and unemployed, creating under the government of Mazarin the general hospitals. Until the revolution, assistance to the needy was provided at the local level, together with charitable organizations. The provincial or royal government only acted when the municipalities felt overwhelmed. Throughout the century there was a shortage of doctors, surgeons and midwives, and municipalities attempted to tie them down to year-long contracts to care for those in need. In addition, the authorities gave free training to surgeons and midwives. According to Baron de Montyon (1733-1820), in his Research and considerations on the population of Francepublished in 1778, in rural areas doctors were even scarcer and had little knowledge, so they turned to healers[3]
General hospitals 18th century for assistance to the poor: visit to the Charite pavilion, Berlin, copper engraving by Daniel Chodowiecki (1726 – 1801), circa 1783.
At this time, following the didactic impulse of the Enlightenment as a way to public or common happiness, books were published to educate the people on medical and health issues, what we would call today. health educationthe most famous being Auguste Tissot (1728-1797), Advice to the people on healthpublished in 1761[4]. Despite the misleading title (“counsels to the people”), the councils were obviously addressed to the bourgeois and noble classes, and not to the peasantry.
Samuel Auguste André David Tissot (1728-1797) and the cover of his 1761 book «Advice to the people on health» (Advice to the people about their health), the new fury for health education works
Municipal and state doctors (Physicate y Protomedicato)
The hiring of municipal doctors (Physicist, civil physician, physician conducted by Stadtärzte) to take care of the local poor, dates back to the Middle Ages. Throughout this period, these professionals tended to disappear as there were more doctors with academic training in the locality. Until the 18th century, a body of officials was not created to cover a province or district, such as Prussia, Hungary or France, but they were very scarce. He physicate (the administrative district of a a scientist) spread in some German territories, in the heat of cameralism. On the other hand, in local health boards with public health powers, doctors were not dominant until the end of the 18th century. In rural areas, their presence was scarce and in the cities the physicist was not the only one, nor the main doctor for the poor. In fact, mercantilist projects were aimed at ensuring that there were enough medical personnel to care for the entire population and at examining and licensing doctors. In the 18th century, the number of doctors available increased significantly.
Since the end of the Middle Ages, in some territories of the Hispanic monarchy, the accreditation of medical practice had passed from the municipalities[5] to the officials of the monarchs, through the chamber doctor or protomedic. The Catholic Monarchs issued a pragmatic in 1477 that created the Tribunal del Protomedicato, as an institution to authorize and monitor medical practice. The Austrian dynasty would spread this model throughout Europe and its territories in America.[6][7].
Office of the Royal Protomedical Court of these kingdoms, by which he commands all the Doctors, who practice their profession in the Villa de Madridobserve, keep and punctually comply with the provisions of His Majesty in the first article of the Royal Ordinances and Additions, issued in matters of contagion, which are inserted, with the rest that is expressed therein. Madrid, 1784. Source:
[1] ROSEN, G. (1985). From the Medical Police to Social Medicine. . . . Mexico: Twenty-first Century publishers, pp. 144-1
[2] Ibidemp. 152.
[2b] FRANK, J.P., System of a complete medical police force, 6 vol, Mannheim-Stuttgart-Wien, 1779-1819. It covers topics as varied (and I would add as current) as: marriage, reproduction, pregnancy and childbirth (volume 1); sexual relations, prostitution, venereal diseases, abortion and orphanages (volume 2); nutrition, food control, clothing and housing (volume 3); accidents, crimes and how to prevent them (volume 4); the end of life and death (volume 5) and the art of healing and medical education institutions (volume 6)
[2c] FRANK, J.P., The People’s Misery: Mother of Diseases. [Traducción del latín al inglés e introducción de Henry Sigerist]. Bulletin of the History and Medicine. 1941;9:81-100. Accessible at:
[3] ROSEN, G. (1985), On. cit.p.148.
[4] Ibidempp. 223-248.
[5] López Piñero places the origin of the professionalization of medicine in Western Europe in the kingdom of Sicily of Frederick II of the 13th century, delegating the accreditation of medical practice in its territory to the municipalities. LÓPEZ PIÑERO, JM (2002). Medicine in History. Madrid: The Sphere of Books, pp. 167-168.
[6] Ibidemp. 169.
[7] GOODMAN, D. (1990). Power and penury. Government, technology and science in the Spain of Philip II. Madrid, Editorial Alliance.
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