[Pandemic and Epidemic History as Nursing History?] / Pandemie- und Seuchengeschichte als Pflegegeschichte?

This paper is part of Forum COVID-19: Perspectives in the Humanities and Social Sciences. In the current COVID 19 pandemic, the importance of professional nursing is widely recognized. In German-speaking and international research, the history of nursing during pandemics and epidemics is largely unwritten. This paper gives an overview of questions and results in this research area and discusses the potential of a pandemic nursing history.

[The medical care of the poor in the city of Göttingen provided by the Poliklinische Institut (outpatient department) of the University]. / Die medizinische Versorgung der Göttinger Stadtarmen durch das Poliklinische Institut der Universität.

Around 1800 there arose a need in German university towns for patients to serve as subjects during the practical instruction of academic physicians. Since the early university hospitals could not provide enough patients for the practical training, the Poliklinische Institut (outpatient departments) whose doctors and nurses visited the patients in their home offered an economical alternative to the in-patient therapies. Patients from the lower social classes who could not pay for medical care had to offer themselves as "teaching objects" in return for receiving free treatment. Simultaneously, since the end of the 18th century physicians had been emphasizing both the causal connection between disease and poverty and their own significant role in fighting and preventing poverty. In addition to learning about diagnosing methods and therapies, the practical training also provided a lesson in dealing with patients from a lower-bourgeois background. Utilizing the example of the university city of Göttingen, the current article will reconstruct the discussion about the opportunities academic training with poor patients provided. I will analyse the medical care the poor received and the negotiation processes involved between the university and the city council's department for the poor.

[Consumption--sickness, health and morals in the early nineteenth century]. / Schwindsucht--Krankheit, Gesundheit und Moral im frühen 19.Jahrhundert.

At the start of the nineteenth century consumption, also called "phthysis", was one of the most dreaded illnesses along with cancer. The term usually referred to the widespread "pulmonary consumption". Metaphorical descriptions of the disease demonstrate the strong cultural significance attached to this medical, and also lay-medical, concept. Based on handwritten case histories and letters from Kaiserswerth deaconesses in the first half of the nineteenth century the author establishes the cultural implications with which sufferers met in the social practice. Consumption was seen as the visible manifestation of deviance. It was assumed that sufferers were also to blame for contracting the disease due to a lifestyle that was "excessive" in dietetic as well as Christian terms. The paper aims to analyze how the attribution of an "immoral" and "sinful" lifestyle was presented to sufferers by physicians and nurses and how this affected them. The attribution of moral implications to dietetic concepts--as the first thesis of the paper will suggest--originated from demographically motivated health policies prevalent around 1800. The paper will further try to show how, in the early nineteenth century, the idea arose that consumption was the disease of the proletariat suffering from metropolitan life.

Dying at home: nursing of the critically and terminally ill in private care in Germany around 1900.

Over the last twenty years, 'palliative care' has evolved as a special nursing field in Germany. Its historic roots are seen in the hospices of the Middle Ages or in the hospice movement of the twentieth century. Actually, there are numerous everyday sources to be found about this subject from the nineteenth century. The article at hand deals with the history of nursing the terminally ill and dying in domestic care in the nineteenth century. Taking care of and nursing the dying was part of everyday routine in the nursing care as practiced by the deaconesses and sisters in those days. Mit der Seelenpflege bei den unheilbar Kranken und Sterbenden schufen die Kaiserswerther Diakonissen sich einen von Arzten unabhängigen Kompetenzbereich. Meine Analysen zur Privatpflege zeigen jedoch darüber hinaus, dass die in ihrer Aufmerksamkeit auf das Mutterhaus ausgerichteten Diakonissen auch in Leibespflege sehr viel unabhängiger von den Arzten zu agieren schienen als die freien Krankenschwestern. The article takes a look not only at the actual nursing activities but also at the relationship between the sisters and their patients and their relatives and the family doctor. On the basis of the recorded letters which the nurses wrote to the deaconess motherhouse in Kaiserswerth, it is also possible to analyze how the deaconesses communicated and reflected their actions at the deathbed.

[An age of medical paternalism?--Reflections on medical disclosure and patient consent in 19th century Germany]. / Zeitalter des arztlichen Paternalismus?--Oberlegungen zu Aufklärung und Einwilligung von Patienten im 19. Jahr- hundert.

Research on the history of medical ethics in Germany still regards the nineteenth century as the age of medical paternalism. The authoritarian manner of German physicians is particularly emphasised by assuming that patients were normally not involved in decisions about serious therapeutic measures. This paper will analyse if and how physicians dealt with the issues of medical disclosure and of patient consent concerning surgery and other painful interventions in the first half of the nineteenth century. Physicians rarely dealt with this problem in their articles on medical ethics but reflected, instead, on the issues of disclosure and consent in descriptions of risky therapeutic interventions. They devoted considerable attention to the description of the decision making process, particularly in medical case reports on life-threatening surgery. The benefits hoped for and the risks of the surgical intervention were frequently explained in detail. It was important for them not only to legitimise their adventurous course of action by obtaining patients' consent but also to demonstrate that the seriously ill patients in reality played the active, demanding part in the decision on life-threatening surgery. It is remarkable that, even where patients from lower social classes were concerned, physicians stressed the necessity of obtaining their consent for risky surgical interventions. However, it cannot be established with certainty if the patients were comprehensively informed by the physicians about the risks involved. Nevertheless, physicians' awareness of the necessity of such disclosure, as expressed by their rhetorical "self-fashioning" in the published case reports, is beyond doubt.

[Incurable and dying patients in ambulant treatment in the early nineteenth century]. / Vom Umgang mit unheilbar Kranken und Sterbenden in "Kranken-Besuchs-Anstalten" zu Beginn des 19. Jahrhunderts.

Since the end of the 18th-century policlinics were founded in many German universities. A great number of underclass patients could benefit from a free treatment offered by students and assistant doctors who were trained in these institutes. Visiting the poor patients at home the doctors and students took advantage of observing them in their social surroundings. The article analyses those medical reports on women with uncurable uterine cancer who were treated at home by the staff of the policlinics of the universities of Wuerzburg and Goettingen.

["Querulantenwahnsinn"--insanity or stubbornness?]. / Querulantenwahnsinn--"Eigensinn" oder "Irrsinn"?

The German psychiatric concept "Querulantenwahnsinn" expresses the link between the juridical discourse, the critiques and the legitimation of asylum psychiatry around 1900. The paper will at first analyse the discourse on "Querulantenwahnsinn". In a second step the "patient's view" (Porter) on that social and psychiatric phenomenon will be constructed on the basis of medical records of the Landesheilanstalt Marburg (asylum). The inquiry of patient's experience demands a reflection of the fact that the clinical picture of "Querulantenwahnsinn" was very plausible. It had been created by psychiatrists as a reaction to the critiques on asylum psychiatry. Every attempt to question the pathologisation of a critical position on asylum psychiatry, every resistance results in a consolidation of the psychiatric diagnosis. Consequently the pathologisation, the confinement into an asylum influenced the auto-perception of the patients--so they possibly enroled in the discourse on "Querulantenwahnsinn" against their explicit will. The paper points out that the discourse on "Querulantenwahnsinn" is an expression of social conflicts and the legal culture in the Wilhelmine society.

[Living hysteria--hysteria in every day life and asyum psychiatry around 1900]. / Gelebte Hysterie--alltagsgeschichtliche Erkundungen zu Hysterie und Anstaltspsychiatrie um 1900.

Hysteria has been mostly analysed with reference to the medical and intellectual discourse. The patient's view (Porter) has been solely included on the basis of published case histories. Historians have focussed particularly on the relation between famous psychiatrists or neurologists and "their" hysterics. The social circumstances of a maid's mental illness in 1913 are reconstructed. The servant Grete K. was admitted to the Landesheilanstalt Marburg (asylum of Marburg) with the diagnosis of "depressive hysteria". Her hysterical malady was traced back to her reading of the novel 'Ich lasse dich nicht' ('I won't let you go') written by the popular novelist Hedwig Courths-Mahler in 1912. Physicians and pedagogues at that time uniformly claimed the reading of pulp fiction to be dangerous for the nerves in general. Elaine Showalter has pointed out that in the 19th century hysteria was spread by "media infection". This historical analysis of Grete K.s medical record will seize and improve Showalters suggestion. The analysis of the maid's medical record is a part of a dissertation project on hysteria in every day life and psychiatric practice around 1900. The study has turned the attention on the process of negotiation between psychiatrists and hysterical women.