2024-02-06 19:31:00
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 the control of public health and health practices through the hiring of doctors as state officials, i.e. as medical authority, and the development of a range of health policies. Everything happened in the context of the fascination for the science of public administration (“Police”) and for the control of population (including births and mortality) and the economic output of the kingdom. We are in the time of cameralismHim mercantilism and the birth of health education e medical policethat is, public health.
In Europe in the 17th and 18th centuries, important changes in healthcare organization occurred as absolutist monarchies decided to intervene more in the dynamics of economic, demographic and social development, including the control of medical practice and birth rates, with their potential implications on gender. differences in these health 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 in the cultivation of an administrative science (“police”), with the training of public officials, the registration and control of people, and the development of population statistics. 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 for “the maintenance and control of midwives, the care of orphans, the appointment of physicians and surgeons, the protection against the plague and other infectious diseases, against the ‘excessive use of alcoholic beverages and tobacco, inspection of food and water, measures for the cleaning and drainage of cities, the maintenance of hospitals and the provision of aid to the poor.[1].
This police science (Police science) would form the basis for the concept of medical policing. This would consist of a medical authority (call Faculty of Medicine and Surgery by the Frankfurt cameralist of the Oder Justis Christopher Dithmar (1677-1737)), who in addition to supervising public health, monitored health 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 the improvement and stimulation of medicine, surgery, obstetrics and pharmacy, regulating these arts to prevent quackery and abuse[2]. Other influential cameralists who proposed similar measures on the 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 Comprehensive medical police force system since 1799 [2b]. Without forgetting his important previous text from 1790, which we have already talked about in a previous entry: The misery of the people, mother of diseases [2c].
Image by Johan Peter Frank and the content of its “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 he had experienced as a doctor, in the huts of German and Lombard peasants, is “the mother” of their illnesses, and that it has its origins in the system of serfdom for the great. So, he asked himself as a protophysicist of Lombardy, what was the point of reorganizing healthcare companies, 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 a concern for self-sufficiency and productivity, which included addressing the poor and unemployed, creating under Mazarin’s rule 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 municipalities felt overwhelmed. Throughout the century there was a shortage of doctors, surgeons and midwives, and municipalities attempted to bind them to one-year contracts to care for the needy. In addition, the authorities offered 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 more scarce and poorly informed, so healers turned to[3]
General hospitals 18th century for helping the poor: visit to the Charité pavilion, Berlin, copper engraving by Daniel Chodowiecki (1726 – 1801), circa 1783.In this period, following the didactic impulse of the Enlightenment as the path to public or common happiness, books were published to educate the people on medical and health matters, as we would say today. health educationthe most famous being Augusto Tissot (1728-1797), Advice to people about healthpublished in 1761[4]. Despite the misleading title (“advice to the people”), the advice was obviously aimed at the bourgeois and noble classes, and not at the peasants.
Samuel Auguste André David Tissot (1728-1797) and the cover of his 1761 book «Advice to people about health» (Advice to people for their health), the new furore over health education works
Municipal and state doctors (Physics and Protomedicine)
The hiring of municipal doctors (Physicist, civilian doctor, Stadtärzte-led doctor) to take care of the local poor, dates back to the Middle Ages. During this period, these professionals tended to disappear as there were more academically trained doctors in the locality. Until the 18th century, a corps of officials was not created to cover a province or district, such as Prussia, Hungary or France, but they were very scarce. Him physicist (the administrative district of a a scientist) spread to some German territories, in the fervor of cameralism. On the other hand, in local health authorities with public health powers, doctors did not have a dominant position 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 of the poor. Indeed, mercantilist projects aimed to ensure that there were enough medical personnel to care for the entire population and to vet and license doctors. In the 18th century the number of available doctors increased dramatically.
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 officers of the monarchs, through the chamber doctor or protomedico. The Catholic Monarchs issued a pragmatic in 1477 that created the Protomedical Tribunal, as an institution to license 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, for which he commands all the Doctors, who exercise their profession in the Villa de Madridobserve, safeguard and promptly comply with the provisions of His Majesty referred to in the first article of the Royal Ordinances and Integrations, issued on the subject of contagion, which are included therein, with everything else expressed therein. Madrid, 1784. Source: [1] ROSEN, G. (1985). From Medical Police to Social Medicine. Mexico: Siglo XXI publishers, pp. 144-145.
[2] IbidP. 152.
[2b] FRANK, J.P., Comprehensive medical police force system6 vols, Mannheim-Stuttgart-Vienna, 1779-1819. It deals with different (and I would add current) topics such as: marriage, reproduction, pregnancy and childbirth (volume 1); sexual relations, prostitution, venereal diseases, abortion and orphanages (volume 2); nutrition, food control, clothing and shelter (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 institutions of medical education (volume 6)
[2c] FRANK, JP, Popular poverty: mother of diseases. [Traducción del latín al inglés e introducción de Henry Sigerist]. Bulletin of History and Medicine. 1941;9:81-100. Accessible to:
[3] ROSEN, G. (1985), ON. cit.page 148.
[4] Ibidpp. 223-248.
[5] López Piñero places the origin of the professionalization of medicine in Western Europe in Frederick II’s 13th-century kingdom of Sicily, delegating the accreditation of medical practice in his territory to the municipalities. LÓPEZ PIÑERO, J. M. (2002). Medicine in history. Madrid: The sphere of books, pp. 167-168.
[6] IbidP. 169.
[7] GOODMAN, D. (1990). Power and misery. Government, technology and science in the Spain of Philip II. Madrid, Editorial Alliance.
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Medical police (volume 6). This extensive work highlights the evolution of health regulation and social medicine in the 18th and 19th centuries.
Public Health in the 18th Century
The 18th century marked a significant transition in the understanding and management of public health. This period saw the emergence of formal structures and protocols aimed at controlling diseases and improving health outcomes among the population. The establishment of public health offices and the role of government in health matters became more prominent, reflecting a growing recognition of the importance of organized health care systems.
Throughout this century, various European countries began to adopt and adapt models for public health based on local needs and conditions. The integration of scientific knowledge into medical practices played a crucial role during this transformative era. Governments increasingly valued medical expertise, leading to a systematic approach to health governance.
Integration of Medical Professionals
As the demand for qualified medical practitioners grew, the qualifications and regulation of medical professionals became paramount. Employing physicians who were not only well-trained but also ethically accountable became a priority, contributing to the establishment of a more standardized medical practice. The concept of public health evolved from being solely focused on individual treatment to encompassing wider health determinants and preventive measures.
the 18th century was a vital period for the development of public health as governments began to take more responsibility for the health of their populations, resulting in an intertwining of medicine, ethics, and public policy that would influence health systems for centuries to come.