Medicine

KRÁSZ, Lilla

Medicine

The period of European science between 1770 and 1830, following Reinhart Koselleck’s terminology, is regarded by historians of science as a period of transition or a “saddle period” (Sattelzeit). The term has been used widely since the 1970s. In medicine, this transition can be understood as a process and it can be viewed not in terms of major theoretical discoveries and technical-material innovations that brought about rapid and spectacular breakthroughs, but rather in terms of the organisation of knowledge; changes in the functions of the spaces of knowledge; the dynamics of the closely interrelated triad of institutionalisation, administration, and management; in the transformation of the culture of observation; in the development of new standards; in the valorisation of “fieldwork” at the bedside; and last but not least in the transformation of old media and writing practices that has existed since Antiquity and the emergence of new practices for sharing knowledge. These complex processes, which essentially unfolded on the level of individual careers and performances, seem to be well described by the conceptual web of the following terms: republic of letters, natural and human resources, body concept, administration, and public policy (Polizey).

As for Hungarian medicine, the transition outlined above is well illustrated at the level of the individual by the (scholarly) physician profiles that unfold from various ego-documents (e.g., travelogues, wills, correspondence). At the collective level, the transformation that took place in the period under study can be reconstructed mainly based on the practices of writing, registration, and standardisation and the techniques of registration and selection associated with new epistemic genres (e.g., health reports, medical topographies, medical statistics) that emerged as part of the modern organisation of state and society based on public policy (Polizey) as a result of the conscious development of (public) health care.

Upon examining the individual physician profiles, it should be kept in mind that in terms of the acquisition of medical knowledge, the eighteenth-century Kingdom of Hungary occupies a special place on the contemporary knowledge map of Europe. Until 1770, there was no university, where medical knowledge could have been acquired, and all medical doctors working in the country were graduates of foreign universities: Protestants tended to go to German, Dutch, and in lesser numbers, Swiss universities, while Catholics opted for the University of Vienna after the Habsburg educational reforms were introduced (1748/1749); before that, they mostly attended the famous medical schools of Italy (especially Padua, and less frequently the universities of Bologna or Rome). On the one hand, this situation resulted in significant disadvantages for the organisation of knowledge in Hungary and the development of the organisational and medial background of the transfer of knowledge (e.g., the lack of learned societies or specialist journals). On the other hand, however, the multi-focal peregrinatio medica hungarica meant that doctors who had studied at foreign universities brought to Hungary a wide variety of theoretical and methodological concepts, practical medical knowledge, and scholarly literature from the most modern educational centres of contemporary Europe, thus facilitating the simultaneous adaptation of heterogenous forms of knowledge and experience, and thus the development of a specific medical tradition characteristic of the region. The predominance of foreign graduates, especially among the Protestants, remained characteristic even after the establishment of the medical faculty at the University of Nagyszombat (Trnava)/Buda/Pest, which – by European standards – was a late foundation. However, peregrinatio medica hungarica did not only mean the completion of studies required to obtain a university degree, but also, depending on the financial resources available to each student, one- or two-month or sometimes even several years long study tours (gelehrte Reise) were taken in Western Europe, either during their university training or, more commonly after graduation to build a network of professional contacts and acquire practical skills and abilities.

The training of Sámuel Cseh-Szombathy (1757–1838), who later practiced in Pest, is a good example of the typical settings, targets, and methodological characteristics of organising scientific travels, and last but not least, the character of the forms of knowledge and practical experiences acquired on the way. For practical reasons, after completing his studies at the University of Göttingen between 1786 and 1789, Cseh-Szombathy enrolled for two semesters at the University of Vienna to comply with the requirement of the nostrification of foreign degrees in the Habsburg Monarchy and obtained his doctorate in medicine there in July 1790. According to his travelogue, he set out from Vienna in December 1790, and his last entry shows that he was still in England in May 1792. What makes his travelogue so particular is that so far only a very few primary sources (e.g., travel diaries, albums amicorum) have been found that record the study and/or scientific tours of Hungarian physicians: most profiles from the period can be reconstructed from short biographical fragments that formed part of medical dissertations, obituaries, and correspondence.

During his nearly two-year journey in Germany, Cseh-Szombathy spent longer periods in Erlangen, Bamberg, Würzburg, and Mainz, and from there he went to the Netherlands, where his main destinations were Amsterdam and Utrecht besides short visits to Nijmegen, Haarlem, Franeker, Leiden, The Hague, Delft, and Rotterdam. His longest stay, around eight and a half months, was in England, but his account of his experiences there is very brief, only a few pages long. He describes everything that interested him as a doctor, everything he saw, experienced, and found useful for his later medical practice. In every city where he spent longer time, he visited the university’s medical faculty, the university clinic, the medical-surgical college, the maternity hospital, the botanical garden, the anatomical theatre, the collections of physical instruments and the natural history collections, the chemistry laboratories, the observatories, the municipal and military hospitals, the foundling hospitals, and the lunatic asylums. He also spent long periods in the private libraries of physicians and aristocrats, where, in keeping with contemporary customs, he made handwritten copies of old manuscripts and notes on medical textbooks. In his diary, he gives short, factual descriptions of the quality of medical education, the condition and equipment of the hospitals he visited, and the operations he was able to assist. His notes also include hospital case histories, which he, as a graduate physician, was able to follow actively from the diagnosis to the outcome.

In building his network of contacts and planning his destinations during his travels, the most important link seems to have been the years he spent in Göttingen as a student, and thus the ties to Göttingen: he had no difficulty in gaining access to the schools, hospitals, libraries, and collections, where those scholars were working, who had graduated from the Georgia Augusta and had thereafter acquired a great reputation. He met, for example, the renowned naturalist Samuel Soemmering (1755–1830), Georg Wedekind (1761–1831), professor of medical therapy at the University of Mainz, or the great traveller and naturalist-ethnologist Georg Forster (1754–1794), who worked as a librarian at the University of Mainz when he visited the institution.

Sámuel Cseh-Szombathy’s training profile, which can be considered paradigmatic, also shows that in the acquisition of knowledge the most important points of orientation for the Hungarian medical community, which was an integral part of the contemporary republic of letters, were hospitals that were organisationally linked to the universities, botanical gardens, anatomical theatres, natural history collections, collections of instruments and specimens, laboratories, and libraries and, on the other hand, it was also important to visit the institutions of social care going through a transformation in the period under study (foundling hospitals, orphanages, workhouses, lunatic asylums).

The medical habitus in the sense of Pierre Bourdieu can be interpreted as an important segment of the physician’s profiles who were at home in both the European and Hungarian networks of the republic of letters, representing the values, norms, and patterns of behaviour acquired during their individual socialisation and expressed in their everyday lives and professional activities, as well as their wealth, public roles, and even scientific patronage. All of this can be discovered in the wills (dated to 1815) of Sámuel Cseh-Szombathy and his brother, József Cseh-Szombathy (1748–1815), who followed a similar path in his medical training: he studied for nearly six years at the universities of Franeker and Göttingen and finally graduated in Vienna. They both conferred about their jointly collected library in the testaments, a unique collection in the period in terms of both quantity and quality, containing some 3700 medical works. In addition to the Calvinist congregation in Pest, the brothers also donated money to the Reformed Colleges of Debrecen, Sárospatak, and Pápa. As for their wealth, movable and immovable properties, and financial assets, which form part of the brother’s medical habitus, the sources show that they were rather affluent: their apartments were furnished with valuable objects, they owned good horses, a carriage, and a nice household with servants. The elder brother, József Cseh-Szombathy’s will and the addendum he made to it seven years later is particularly noteworthy: with this gesture – to promote scientific education – he set up a foundation worth 25,000 florins to establish a professorship for the teaching of chemistry, mineralogy, technology, and botany in Hungarian and left instructions to use the interests to maintain the position.

In the second half of the eighteenth century, a new epistemic genre emerged in the Kingdom of Hungary as part of the development of the bureaucratic organisation of the modern state and the (public) health administration, which at the same time served the purposes of quality assurance, an empirical cognitive practice, and a networking tool. The county physicians (physicus/Physiker) responsible for counties, free royal towns, and privileged districts were also entrusted with registration tasks. In their yearly health reports, which functioned as a new textual instrument for sharing information and knowledge between the imperial and local administrative offices, the physicians gave a retrospective account for each month of the climatic conditions, the various diseases, their course, and the forms of therapy used. The reports are a clear reflection of the government’s efforts of getting to know the human and natural resources, following the guidelines of public policy (Polizeywissenschaft), which can be understood both as the strategy and practice of state organisation and an administrative technique.

In terms of the systematisation of the content and the development of the standards of writing, the reporting system actually began to function professionally during the reign of Joseph II. However, there were significant local differences depending on the training and qualifications of a physician in a given jurisdiction, the categories of observation used, and the recording systems. From the vast corpus of medical reports available in the National Archives of Hungary from between 1770 and 1848, the two selected samples illustrate the different methods of contemporary registration techniques and the requirements for the standardization of diagnosing and naming diseases and the remedies used to cure them.

János Jakab Engel, the chief physician of Késmárk (Kežmarok, today in Slovakia) in his almost 14 folios long medical report for the year 1784, following the Hippocratic tradition and the typology of human constitutions, provides a monthly summary of the atmospheric conditions and the related illnesses, and in several cases detailed descriptions of the variations of a certain disease, their age- and gender-specific courses, the remedies used, and, in general, all phenomena associated with health and illness. Accordingly, Engel’s text includes in a condensed form the description of specific diseases, epidemic and endemic diseases, lifestyle, climatic conditions, and rinderpest, which we can link to the main concepts of human and natural resources. As for the main category of body concept, Engel’s text comprises the following sub-concepts: explanations of diseases, symptoms, the general course of the disease, the variations of a disease, turning points in the course of a disease, forms of therapy, and the deep-seated bad habits of self-medication. Engel himself explains in the introductory part of his text the writing style used to prepare his report, which we can understand to be part of the main concept of administration. He makes a clear reference to the fact that in March 1785 he compiled a report for the preceding year on the health conditions of the people living in the area entrusted to him, based on the daily entries summarizing his observations made at the bedside on a daily basis in his journal (“Tage-Buche”), which he kept as a kind of nosological repository for private use.

In the short, altogether 6 folios long report of the chief physicians of Sopron, József Conrád (1750–?) and János Czepecz (1756–1788) for the year 1785, which they noted down jointly, typically of early medical statistics, the main emphasis is on the provision of quantitative information on the whole spectrum of diseases registered during the year. Following the interpretive tradition of the constitutional doctrine, the description of the atmospheric conditions is followed by a thick synoptic description of the internal diseases, i.e., the ailments detected by the physician, and the external conditions, i.e., those that require surgical intervention. In the final part of the report, the individual and endemic diseases and the patients themselves are presented divided into different groups (the number of people suffering from specific diseases, the number of deaths by age group in a given year, the number of people who used the services of learned physicians, surgeons, and midwives, the number of stillbirths and deaths) in a visually transparent and quantified form, either in a tabular arrangement or in bullet points. This is why the conceptual web unfolding from the report of the two doctors from Sopron presents an even more focused image of the administrative practices than Engel’s text: it is clearly dominated by the approach of Polizey, and within it, the use of medical statistics.

In a system of observation defined by the structure of health reports, physicians essentially created parallel series by recording weather and atmospheric conditions and other topographical circumstances on a monthly (but sometimes daily) basis; by quantifying the observed ordinary or extraordinary individual, endemic, or epidemic diseases; by carrying out their systematic analysis and their nosological-taxonomic classification; and by describing their development, crisis, course, outcome, and therapeutics. In principle, these series enabled the reporting physician at the local level and the experts and officials of the various administrative bodies at the national and the imperial level (the Health Department of the Statthalterei, the office of the protomedicus, the medical faculties of the universities of Vienna and Pest) to monitor and archive the information thus gathered, and, most importantly for knowledge production, to compare it by analogy. The comparison of the numeric and thematic series of reports received from each jurisdiction from the various offices of the central specialised administration made it possible to reconstruct the causal relations between diseases, their affinities, and possible new links, and even to generate new knowledge.

At the same time, the corpus of texts published here shows that science in the period under study was still characterised by the spontaneous accumulation, collection, description, and systematisation of data obtained from bedside observations and the observation of the visible signs of illness, as well as the reading, reinterpretation, and annotation of canonized authorities. On the other hand, however, as is evident from the form and content of the medical reports and the standard categories of observation that were based on professional consensus, there was a need to put the collected information into the service of the common good, to make it applicable in practice, and to establish a causal relationship. However, taking into account the time factor, the investigation and analysis of the invisible functions linked to the inner processes of life in the framework of organised research had not yet become an integral part of medical practice in the period.