Preliminary Programme

In the 16th century in Hessen four hospitals had been founded by the Hessian landgrave Philipp. Although situated in different parts of the country, there was a joint administration until the early 19th century. In addition to the existing hospitals in the cities these new institutions had to fill up the poor relief in the countryside. Countrymen und -women were admitted to these hospitals, when being unable to supply themselves - in most cases because of chronicle diseases and disabilities of various kinds.

The rich sources of the archive allow manifold studies in the history of hospitals as well as in patients’ history. Within a research-project promoted by the Deutsche Forschungsgemeinschaft we are especially interested in questions concerning coping with sickness and disability within the rural society in the 18th and early 19th centuries. This paper also refers to this context.

I will focus on the hospital Haina near Marburg and on the hospital Merxhausen near by Kassel. The first one was for men, the latter for women only. Both together had a capacity of about 500 places at the end of the 18th century.
Very important for our questions is the analysis of the documents that had to be generated in order to request for reception. Besides the supplication itself a medical certificate was indispensable. Furthermore the mayor of the village had to testify the economical and social situation of a person. The country parson copied the parish register, and often he rendered his opinion as well. To sum up: These sources contain descriptions and informations about one ill or in some way handicapped person from different points of view.
The reception to the hospital principally meant a lifelong supply and stay. Nevertheless those inmates estimated to be able to leave the hospital were to be named once a year. The following discussion between the medical staff and the administration of the hospitals in these cases supplies us with further information about the actual situation of the inmates as well as concerning the likely perspective of life after leaving. Actually many inmates registered in these specification lists stayed. For others the hospitals were just an intermediate station.

In my study I will try to reconstruct managing one’s life under conditions of chronicle disease and disability in the villages. Maybe, typical items and settings to request for reception to the hospital can be outlined. In particular concerning those inmates who left the institution afterwards, it will be interesting to know the reasons why care and welfare work ended, and furthermore, how these ex-inmates succeeded to manage their life beyond the hospitals. (Show less)

Premodern hospitals were places of privileged care for a very limited amount of individuals. People, who wanted to get admission to a hospital, had to write applications to the respective town council and the “Spitalmeister”, the manager of the hospital. These two authorities decided, whether an applicant was granted access to the hospital or not. In many cases the hospital was not only the most important enterprise of the city, but also the civic bank and the largest urban haulage company. Due to its important status within a community, the hospital was observed and controlled by various urban authorities. Apart from the “Spitalmeister”, who was elected by the town council, there were other authorities within the hospital e. g. the so called “Spitalmeier” (and his wife), who was responsible for the financial management of the hospital, or a priest, who was responsible for the religious care of the inmates. In larger hospitals staff was hired, like e. g. male and female “nurses”, who cared for the sick. Furthermore, “Siechenväter” and “Siechenmütter” were elected by the inmates of the hospital, in order to operate as spokespersons for specific groups of inmates. One can see quite clearly by the described situation that autonomy and heteronomy coexisted and mingled within the hospital.
The inmates of hospitals in the early modern times can be considered as a kind of “black box”, because one can find only little information about them in the historical sources. For the historian, it is possible to get at least some insight into the life of the inmates with the help of account books of hospitals, applications for the acceptance into a hospital or eventual court records. However, on the normative level of instructions or house rules, information about the organizational system of the hospital can be found. On the one hand the inmates were directly or indirectly controlled by the town council, the (catholic) church and the employees, but on the other hand they were also cared for by the previously mentioned authorities. The internal organization of the hospital had to be continuously negotiated, as everyday life was influenced by this “Kräftefeld” (field of power). Due to the different instances of control, the inmates had the possibility to depose someone from his/her office. The “Spitalmeier” could be overruled by the “Spitalmeister”, the “Spitalmeister” could be overruled by the town council and priest of the hospital (as a factor of power from outside) had indeed many different possibilities for intervention. It was quite difficult to keep the balance in this instable “Kräftefeld”, which was influenced and controlled by the obligatory financial accounting and the duty to report. However, all the involved authorities had a high interest in keeping up an equalized situation, in order to avoid endless complaints to the town council. The plea for peace and tidiness, which can be read quite often in house rules, was meant as an appeal for the inmates as well as the authorities of the hospital. The shared (corporate) house enclosed in its organization not only the inmates but also the employees. (Diesen Satz würde ich eher weglassen, oder ihn durch folgende etwas feiere Übersetzung ersetzten, wobei ich mir bei der inhaltlichen Korrektheit nicht sicher bin). (The specific house rules had to be obeyed not only by the inmates, but also by the staff.) The inmates controlled the “loyalty” of the “Spitalmeister” and vice versa the “Spitalmeister” controlled the behavior and the “thankfulness” of the inmates, which was “visualized” via prayers. As a consequence, a flexible system developed, which should react – according to the perception of the city councilmen – sensitively in detecting infidelity, misconduct and maladministration. For the contemporary people the hospital represented itself as an ecclesiastical as well as secular institution. This aspect opens up an additional facet to the interpretation of the behavior of the employees and inmates. (Show less)

In modern society, medical sovereignty of interpretation (Michel Foucault) seems to be predominant. Consequently doctors have the final word on whether an individual is to be considered “healthy” or “sick”, respectively “normal” or “disabled”. On the other hand, Barbara Duden highlighted the perspective of the female patient during the early 18th century, even if her patient’s story had been recorded by a male physician. There seems to have been a change in the perspective from the patient’s to the doctor’s view at the end of the early modern period. It is therefore quite astonishing that in 1803, at the men’s hospital in Haina, Hesse, it was not a medical doctor, but the manager of the kitchen who kept the patients’ list. In agreement with the standard practice of his time, he did not adhere to a generally accepted pattern of diagnosis. The medical conditions responsible for the lifelong confinement of these poor were all recorded under the heading of “infirmity” (Gebrechen); the question remains as to whether the “disabilities” or “afflictions” listed were actually diagnoses in today’s sense of the term. In any case, the “ailments” , “faults”, “damages” or “afflictions” were considered incurable. The housekeeper’s list includes nearly 400 inmates, using about 60 different categories for their sufferings. Who provided the civil servant with this information? The “list of the poor “, which in Haina had been updated annually since 1730, and which served as the basis for housekeeping and kitchen purposes refer to the admission documents archived in Haina. These consist of rescripts issued by the Hessian Landgraves, mostly accompanied by petitions written by the future patients themselves or by their relatives, advisory opinions authored by clergymen, local representatives and civil servants, as well as by medical attestations.
To the master of the kitchen, these files were sources of information, not only on the patients’ generally long history of suffering, but also on their origins, their family status and wealth, and also provided terms for their “afflictions”. Remarkably, a great variety of German-language and Latin terms were used, not only by laypeople, but even physicians rarely adopted a standard diagnosis. In nearly all of the cases, the terms used in the different documents are consistent; with some additional specifications added by the physicians, if at all. Comparison of the admission records with the housekeeper’s balance ledger clearly shows that the Haina civil servant took the names of the “afflictions” from the files that were obviously accessible to him, and did not create his own system of diagnoses. The kitchen administrator had a wide range of responsibilities, and was obviously well familiar with the hospital archive. This in-depth knowledge was obviously well-respected: In 1800, when an external enquiry demanded a detailed description of the Haina asylum (“Beschreibung des Fürstlich Hessischen Hohen Samt Hospitals Haina”), the head supervisor requested the chef of the kitchen to write this report, instead of passing the request on to the resident surgeon, or clergyman. This in-depth description provides a host of details on everyday-life at the asylum, on housing conditions, food, work, medical care and spiritual guidance, as well as discipline. The text exudes a certain pride in the 300-year-old tradition of hospital care, but also heralds the changes brought on by the transition to modernity, which then, too, were treated ambivalently. Central moments of this transition were the increasing importance and interpretive authority of medicine, and the specialisation of the hospital as a “mental asylum”. The kitchen manager’s balance for the year of 1803, as well as a number of other documents and the surviving admission records made it possible to exemplarily include 21 biographies, allowing us to take a look at the great diversity of definitions for “disability” and “disease” in pre-modern time, an era in which the patients’ representations of their ailments, respectively their “handicaps”, were for the first time officially allowed entrance into administrative procedures. (Show less)

From the beginning on the term “hospital” (“beadhouse”) has described a double function of long-term nursing of the sick and responsibility for all different kinds of needy people. In these institutions everyday life was regulated by rules and norms. The house rules, which have been preserved from the Early Modern Times to this day, are the most important sources for exploring the daily routine in the hospitals besides the occasionally passed down foundation charters and archeological relicts. Obviously the historian has to read and analyse these normative texts with the appropriate scepticism.

Rules and norms represent the idea of regulated daily routines, which the inmates had to obey until the time of their voluntary or forced release or their death (in the institution). Therefore, the analysis of house rules, weekly menu-plans as well as punishment regulations is important for the research about “places of custody”. According to the results of an Austrian history project (University of Vienna, University of Salzburg), hospitals are considered as “barracked places” (“kasernierte Räume”), which manifest themselves in written form in house rules for the inmates and working rules for the employees of the respective institution. Heteronomy as the central characteristic of poverty, illness and exclusion makes oneself think of the famous book “Asylums” of the American sociologist Erving Goffman (1922–1982). Hospitals were indeed secure places, in which power was administrated; however hospitals were not necessarily “Total institutions” according to Goffmans theory.

After the theoretical discussion (approach) of this theme, I will concentrate on the dimensions of the rules (spiritual, profane, official) as well as their value of information. (Show less)