[Poverty and Sickness. The precarious lives of lower-class families in Würzburg and Göttingen, 1800-1850]. / Armut und Krankheit. Das prekäre Leben von Unterschichtenfamilien in Würzburg und Göttingen, 1800-1850.

This contribution focuses on the medical practice of the policlinics in Würzburg and Göttingen in the first half of the nineteenth century. In these institutions patients were treated free of charge by medical students and assistant physicians who, in turn, were able to gain further experience and develop their skills. The policlinics were therefore an important part of poor-healthcare in both these cities. The essay tries in particular to illustrate healthcare for poor patients against the background of their everyday lives and working environment. Based on the situation of individual poor patients, the concepts of 'sickness' and 'poverty' are discussed as mutually dependent determinants of the 'reality of life' among the urban lower classes. This contribution combines the evaluation of medical practice journals and patient histories with the analysis of source materials on urban poor relief and healthcare. It looks particularly at the children and elderly people who attended the policlinics. The encounters between physicians and poor patients documented in the sources not only provide valuable insights into historical patient behaviours, they also open up new perspectives of the physician-patient relationship during the nineteenth century transition from the 'sickbed-society' to hospital medicine.

Freud's free clinics: a tale of two continents.

Two important schools of thought began in the nineteenth century in Central Europe: Marxism and psychoanalysis. They had much common but there were significant differences. The Marxist influence on early psychoanalysts played out in one way in Europe and another way in the United States. Freud and his Austro-Marxist colleagues were committed to human welfare and social justice. They established a network of clinics that offered psychoanalysis to patients of limited means. The free clinics movement did not cross the Atlantic. There was a cohort of Marxists in the United States who belonged to the United States Communist Party. They were not publicly socially committed, but this paper will try to show that their Marxism influenced their psychoanalytic theory, practice, and politics.

["My reward is being able to serve". Housemother's retrospective memories of the loss of power in their position in houses "for the sick and needy" between 1945 and 1995]. / «Mein Lohn ist, dass ich darf¼.Wie Hausmütter den Machtverlust ihrer Position in Häusern für «Kranke und Pflegebedürftige¼ zwischen 1945 und 1995 im Rückblick erinnerten.

Institutional families were widespread in the 20th century. As there is very little empirical material on the function of the housemother, a qualitative study was launched to explore members' memories of the function of the housemother between 1945 and 1995 and how communal life in the institutional families of the period was possible. The study was methodologically oriented towards oral history techniques and the principles of Grounded Theory as well as towards sequential line by line analysis. For the purposes of this article, the interviews with nine housemothers were selected from the interviews conducted for the wider study (n=42). The central question concerned how housemothers experienced professional developments in retrospect and the influence these had on the function of the housemother. The interviews resulted in the definition of three phases which the housemothers passed through during their role as housemother. This article describes the third phase: "Leaving the function of the housemother - lost and frustrated power and dominance". Housemothers were not only housekeepers but also carers. Together with the husbands, they represented the heads of their institutional families. Housemothers found living in one house with the other members of the "family" a burden, but at the same time they benefitted from the great freedom they had. This aspect is described using the core categories of power and dominance.

The first lady almoner: the appointment, position, and findings of Miss Mary Stewart at the Royal Free Hospital, 1895-99.

This article examines the professional roots of the hospital almoner, a position which has been widely neglected in medical history. The first almoner was Miss Mary Stewart, a former Charity Organization Society employee, appointed at the Royal Free Hospital of central London in 1895. The Royal Free was a charitable hospital which offered free medical treatment to patients considered morally deserving but unable to afford medical care elsewhere. The role expected of Stewart was to means test patients in order to ensure that only those deemed "appropriate" received free medical treatment, and to establish the extent to which the hospital was being abused by those who could afford to contribute toward their medical care. While in office, Stewart continually reshaped the role of almoner. She fashioned the position into that of a medical social worker and undertook such duties as referring patients to other means of medical and charitable assistance, visiting patients' homes, and training almoners for positions at other voluntary hospitals. Through the examination of Mary Stewart's Almoners Report Book, this article considers the circumstances of her appointment, the role she performed, and the findings of her investigations.

[Biographies following release from mental hospital, Glasgow 1875-1921]. / Auf und davon. Lebensläufe nach der Entlassung aus einer psychiatrischen Anstalt, Glasgow 1875-1921.

For a long time mental asylums were seen as hermetically sealed units for the long-term confinement of patients. The broad and excluding nature of these establishments was their most prominent feature. From the end of the last century socio-historical and patient-oriented research has questioned and revised these properties. The present essay is based on that research. Using the example of a pauper asylum in Glasgow between 1875 and 1921 the essay analyses the number of released patients, how they were released and how they lived after being released. The sources used were individual patient files of the asylum and the corresponding files of the pauper administration. Although the number of releases--especially of patients who had been cured--declined in the period of investigation, the rate of successful outcomes remained, at 20 to 30 per cent, clearly above that of comparable institutions of the 1910s. According to the files, the key factor in favour of a release was the ability for social re-inclusion. The files examined reveal three typical biographical patterns: reintegration, psychiatric care and social care. While the first group tended to disappear from the sight of physicians and carers, members of the other groups frequently reappeared in the records. Apparently, social services as well as the asylum were often used to help cope with temporary family crises. Once the situation improved, the patients in question left social care and were taken home by their families.

[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.

Care of the insane in Lübeck during the 17th and 18th centuries.

Only selected aspects of the history of the House of the Poor Insane in the Hanseatic Free City of Lübeck have been studied to date.This article presents the results of an entire source study of this small institution in the 17th and 18th centuries, and briefly also during the next 40 years after the opening of a new building. In addition to the minute-book of the Governors, now kept in the Lübeck Municipal Archives, the results are based primarily on the account-books,which illustrate the institution's social history and activities. Examples are given. During most of the 17th century, the House was generally rather like a prison for the insane, but at the end of this century and in the early 18th there was a reform phase.This was followed by phases of repression and 'containment' at the end of the 18th century and in the early 19th century, before a renewed reform by the medical profession.The findings for Lübeck are compared with the development of inpatient care in institutions elsewhere, and the decisive factors in Lübeck are discussed.