The impact of the professionalization of physicians on social change in Germany during the late 19th and early 20th centuries

Abstract

Der Autor untersucht die Auswirkungen der Professionalisierung der deutschen Ärzteschaft Ende des 19. und Anfang des 20. Jahrhundert auf den langfristigen sozialen Wandel. Ausgehend von einer starken Zersplitterung der Ärzteschaft in einzelne konkurrierende Untergruppen bis Beginn der achtziger Jahre entwickelte sich nach Maßgabe des Verfassers eine durch Professionalisierung geprägte, akademisch ausgebildete homogene Ärzteschaft durch den gemeinsamen Widerstand gegen das Anwachsen des Einflusses staatlicher Gesundheitspolitik. Diesem Prozeß steht eine wachsende Akzeptanz und Hochschätzung der Ärzteschaft durch die Bevölkerung, vor allem durch die vom sozialen Wandel stark betroffene Arbeiterschaft gegenüber. Die ansteigende Professionalisierung bewirkte hiermit, so der Autor, eine stärkere Akzeptanz rationaler Wertemuster durch die wachsende Bedeutung der 'medizinischen Kultur' und war deshalb ein Beitrag zur Abschwächung sozialer Gegensätze. (RS)

'The professionalization of German medicine during the late 19th and early 20th centuries apparently develops its specific dynamics precisely in a phase of social development characterized by a threat to the privileges of the bourgeoisie and to the health sector as a whole, which exposed especially the medical profession to the pressure of increasing tendencies towards socialization. The imagination with regard to organization and planning of a great number of doctors was not however limited during this period to the consolidation of medical organizations as combat units to establish professional autonomy, for clearly defined and in the long run increasing social status, or for an income appropriate to that status. Rather, by participating in the development of the system of social welfare and health-related infrastructure, doctors contributed - as a number of authors have emphasized - to a remarkable extent to the medicalization process of the German population. This process can be seen in the rapid growth of receptivity of the population, especially the lower strata, for the so-called 'medical culture' and thus for rationalistic patterns of values and behavior. This function of the 'Hidden Curriculum' of the social insurance and infrastructure system, which physicians helped to shape, went far beyond profession-specific goals, although such goals - especially the expansion and stabilization of the market for medical services - were also attained. In this light, the doctors can be seen as unconscious propagandists and promoters of a type of society which has often - misleadingly - been called 'nivellierte Mittelstandsgesellschaft' (leveled/uniform middle class society). Since the late 19th century, the medical profession has again and again attempted to exclude itself as an elite cultural and income group from these 'leveling tendencies'. In this manner it has functioned as an exceptional agent for the patterns of values and behavioral orientations which support socio-structural homogenization.' (author's abstract)