Book Review

Science, Medicine, and the State in Germany: The Case of Baden, 1815-1871

N Engl J Med 1994; 330:722-723March 10, 1994

Article

Science, Medicine, and the State in Germany: The Case of Baden, 1815-1871
By Arleen Marcia Tuchman. 200 pp. New York, Oxford University Press, 1993. $39.95. ISBN: 0-19-508047-5

It is well known that German academic medicine was an important model for those who wished to improve American medical education in the years just before and after the turn of this century. What is less often appreciated is that it was the German tradition in research and laboratory training that reformers such as Abraham Flexner, William Henry Welch, and Franklin P. Mall wished to transplant to our universities. German clinical training at the time was still largely conducted in the amphitheater, at a distance from the patient, and was really inferior to the clinical training that was being developed in Boston, New York, Baltimore, and points west and south. We tend to disparage American medical schools of the 19th century, so it is important to realize that at the University of Heidelberg, the focus of Arleen Tuchman's useful case study, reforms came only in 1858, a mere decade before Charles William Eliot became president of Harvard University (1869), where he would soon begin to reform both the university and the medical school.

Tuchman has skillfully used the German state of Baden and its great university at Heidelberg as a detailed case study of the growth of a research university and, even more specifically, the political process of garnering support for research in a medical school. She follows a relatively new line of German historical scholarship in arguing that there was a close and intentional link between the growth of the German university system and the expansion of an industrial economy. She further argues that not all of Germany should be seen through Prussian eyes. The other states, or “lands,” such as Bavaria, Saxony, and Baden, were often actually ahead of Berlin.

The trend that Tuchman describes in her study of Baden is the slow but steady shift in the 1850s and 1860s toward support for teaching as well as for research in the sciences, modern languages, and the social sciences, and a shift away from the allegiance to the classics as the best means to educate students preparing for professional careers in government, medicine, or law. The medical sciences began to receive stronger support from the state as the link between scientific knowledge and economic growth became increasingly obvious. Tuchman clearly describes the atmosphere in Heidelberg, where such outstanding medical scientists as Jacob Henle and Hermann Helmholz worked at various times and where the emphasis was on looking toward the future, not the past. There was an implicit faith that laboratory exercises helped educate young physicians and that some of them would subsequently engage in research that would lead to practical benefits.

Tuchman makes an important point when she claims that even in the absence of truly effective therapy, the accumulating knowledge about physiologic and pathologic processes that came from the new German centers of academic medicine in the middle decades of the 19th century went far toward explaining disease. Explanation has always been a key feature of the physician's task, even if a cure has not yet been at hand.

Because so much of our own history of medicine and medical teaching is tied to the German model and because academic medical centers are under stress today, Tuchman's well-crafted and concise case study deserves wide reading and is a good candidate for a paperback edition.

Gert H. Brieger, M.D.
Johns Hopkins University School of Medicine, Baltimore, MD 21205