Male Students and Female Apprentices in the Lying-in Hospital of Göttingen University, 179

34 Pages·2006·0.28 MB·English

MedicalHistory,2007,51:3–36
The Practice of Practical Education: Male Students
and Female Apprentices in the Lying-in Hospital
of Go¨ttingen University, 1792–1815
JU¨RGEN SCHLUMBOHM*
It is generally agreed that, in most European countries, practical education became
increasinglyimportantforfuturephysiciansandsurgeonsduringthecourseoftheeight-
eenthcentury.Recentstudieshaveshownthat,around1800,clinicalteachingtookplacein
a variety of contexts: hospitals with inpatients, polyclinics or outpatient dispensaries,
consultation hours for poor people, private tutoring by, or a kind of apprenticeship
with, an experienced practitioner.1 While these organizational forms have become fairly
clear in several countries, much less is known about what ‘‘practical’’ training actually
meant.Diditmainlyconsistof‘‘studyingwrittencasehistories’’,2orfollowing‘‘clinical
lectures’’ in the classroom where the teacher brought in patients and explained their
diseases? Did students attend the hospital rounds of professors and hospital physicians,
ordidthey‘‘walkthewards’’ontheirown?Towhatextentweremedicalstudentsallowed
to question patients, and physically examine them? Were they given responsibility for
patientsunderthesupervisionofaprofessororanexperiencedphysician?Ifso,howmany
patients did they examine or treat during their education? It is true that we know the
regulations of some medical schools at specific points in time, but we have much less
knowledgeabouthowtheseruleswereimplemented.Thefewsurvivingmemoirs,diaries
andtravelaccountsmakeclearthattheremayhavebeenaconsiderablegapbetweennorms
andpractice.Amajorconstrainingfactorwasofcoursethenumberofstudentsperpatient,
and per teacher.
Detailedarchivalandprintedsourcesfromthelying-inhospitalofGo¨ttingenUniversity
allowadeeperinsightintothepracticeofclinicalteachingduringthelateeighteenthand
early nineteenth centuries. In this period, when midwifery was being transformed into
#J€uurgenSchlumbohm2007 teaching:pastandpresent,Amsterdam,Rodopi,1989;
VivianNuttonandRoyPorter(eds),Thehistoryof
*J€uurgenSchlumbohm,Max-Planck-Institutf€uur medicaleducationinBritain,Amsterdam,Rodopi
Geschichte,Postfach2833,D-37018Go¨ttingen, 1995;LWBBrockliss,‘Beforetheclinic:French
Germany;[email protected] medicalteachingintheeighteenthcentury’,inCaroline
HannawayandAnnLaBerge(eds),ConstructingParis
medicine,Amsterdam,Rodopi,1998,pp.71–115;
TheauthorthanksBirgittSippelandNadineSchilligfor
MaryLindemann,Medicineandsocietyinearly
theirhelpinbuildingandanalysingthedatabaseusedin
modernEurope,CambridgeUniversityPress,1999,
thisarticle.HeisgratefultoCarolineTonson-Ryefor
pp.92–119.
revisinghisEnglishandtoVivianNuttonforchecking
2LisaRosner,‘Eighteenth-centurymedical
histranslationsofGermanquotations.
educationandthedidacticmodeloftheexperiment’,in
1ThomasNevilleBonner,Becomingaphysician: PeterRDear(ed.),Theliterarystructureofscientific
medicaleducationinBritain,France,Germany,and argument:historicalstudies,Philadelphia,University
theUnitedStates,1750–1945,NewYork,Oxford ofPennsylvaniaPress,1991,pp.182–94,onp.191.
UniversityPress,1995;OthmarKeel,L’avee(cid:1)nementde Forotherformsofpracticalteaching,seeLisaRosner,
lame´decinecliniquemoderneenEurope:1750–1815, Medicaleducationintheageofimprovement:
Montreal,Pressesdel’Universite´deMontre´al,2001; Edinburghstudentsandapprentices1760–1826,
seealsoHarmBeukersandJMoll(eds),Clinical EdinburghUniversityPress,1991.
3
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press
Juu€rgen Schlumbohm
abranchofmedicalscience,accesstopracticalexperiencewasofparticularimportance.
Males,physiciansorsurgeons,couldcompetesuccessfullywithfemalemidwivesonlyif
theyacquiredpracticalskillsinadditiontothesuperiortheoreticalknowledgewhichthey
claimed.Midwives,ontheotherhand,hadfreeaccesstopracticeandwereusuallytrained
byaninformalapprenticeshipwithanoldermidwife.But,accordingtomanymedicalmen,
they were ignorant because they lacked any theoretical knowledge.3 In Germany, where
medicaleducationcontinuedtobecentredmainlyonuniversities,4thelying-inhospitals
attachedtothemwereofcrucialimportancefortheriseofman-midwifery.Thematernity
hospitalofGo¨ttingenUniversity,foundedin1751,playedapioneerrole.5TheUniversity,
a foundation of the Enlightenment, had tried to include bedside teaching from its begin-
nings in the 1730s because its medical faculty was aware that this was a prime factor in
attractingstudents.Thematernityschoolof1751,however,wasitsfirstclinicalinstitution;
ageneralinfirmarywasopenedonlyin1781.6Intheearlydays,underthedirectorshipof
Professor Johann Georg Roederer (1726–63), the lying-in service consisted of just two
roomsinahospitalwhichmainlyhousedelderlypersons,andthenumberofdeliverieswas
usually less than 30 per year. In the 1780s, the University persuaded the government to
have the old building pulled down and replaced by a spacious new structure, earmarked
exclusivelyforthematernityhospital.Onthefirstfloor,thereweresevenchambersfora
totaloffourteenpatients,thedeliveryroom,theteachinghall,andthehospitalmidwife’s
accommodation.Thesecondfloorhousedthedirectorandhisfamily;whilethemanager
andhisfamily,theservantandthemidwifeapprenticeslivedonthegroundfloor.Thenew
houseopenedin1791,andin1792,anewprofessorofobstetricsandhospitaldirectorwas
called to Go¨ttingen. Friedrich Benjamin Osiander (1759–1822), trained in T€uubingen,
StrasbourgandKassel,heldofficeuntilhisdeath.Inthenewbuilding,theannualnumber
of deliveries rose to between 70 and 100.
Osianderwasoutspokenaboutthehospital’sorderofpriorities:‘‘Thelying-inhospitalat
Go¨ttingenaims,aboveall,totrainskilfulobstetricians...secondly,totrainmidwives...
andfinally,toprovideasafeshelterforpoorpregnantwomen,marriedornot,duringthe
period of childbirth ...’’.7
To what extent were students and midwives attracted by this offer?
3Onthemeaningofthisreproach,seeWaltraud universitairesetlame´dicalisationdelasocie´te´
Pulz,‘‘NichtallesnachderGelahrtenSinngeschri- allemande,1730–1850,Lyon,Pressesuniversitaires
eben’’.DasHebammenanleitungsbuchvonJustina deLyon,1997,pp.101–19;AxelKarenberg,Lernen
Siegemund,Munich,M€uunchenerVereinigungf€uur amBettderKranken:diefruu€henUniversitaa€tskliniken
Volkskunde,1994,pp.117–136;eadem,‘Aux inDeutschland(1760–1840),H€uurtgenwald,Pressler,
originesdel’obste´triquemoderneenAllemagne 1997,pp.42–45,95–105.
(XVIe–XVIIIesi(cid:1)eecle):accoucheurscontrematrones?’, 7FriedrichBenjaminOsiander,Annalender
Revued’histoiremoderneetcontemporaine,1996, Entbindungs-LehranstaltaufderUniversitaa€tzu
43(4):593–617. Go¨ttingenvomJahr1800,2volsin4parts,Go¨ttingen,
4ThomasHBroman,Thetransformationof Dieterich,1800–1804,vol1,part1,p.IX:‘‘Das
Germanacademicmedicine,1750–1820,Cambridge Entbindungs-HospitalinGo¨ttingenhatganzbesonders
UniversityPress,1996,pp.26–66. denZweck,dassdaran...geschickte...Geburtshelfer
5J€uurgenSchlumbohm,‘‘‘Thepregnantwomenare gebildetwerden.EinzweiterZweckist,dassauch
hereforthesakeoftheteachinginstitution’’:thelying- Hebammen...daringebildetwerden...Eindritter
inhospitalofGo¨ttingenUniversity,1751toc.1830’, Zweckendlichist,dassarme,ehelicheunduneheliche
Soc.Hist.Med.,2001,14:59–78. SchwangereeinesichereUnterkunft€uuberdieZeitihrer
6IsabellevonBueltzingsloewen,Machinesa` Geburt...finden...’’.Inquotations,Ihave
instruire,machinesa`gue´rir:leshoo^pitaux modernizedthepunctuationandspelling.Where,
4
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press
The Practice of Practical Education
The Lying-inHospital: AnAttraction for Medical Students
TheUniversityofGo¨ttingenoftheElectorateofHanoverwasnotonlythemostrecent
foundation(1734/37)amongGermanuniversities—rivallingHalle(inPrussia,foundedin
1694) as the most modern8—but it was also among the largest. During the eighteenth
century,itwasoneofthetopfourintermsofstudentnumbers,togetherwithHalle,Jena
andLeipzig,andforsomeyearsintheearlynineteenthcenturyitevenbecamethelargest
ofthemall.9Inthe1790s,thetotalnumberofstudentsatGo¨ttingenaveragedover700,and
in1815itwasmorethan800.10Themedicalfaculty,too,wasamongthemostimportantin
Germanyintermsofnumbersofstudents(morethan100inthe1790s:seeTable1,col.1),
MD degrees awarded (a total of almost 200 in the decade 1790–99), and full professors
(eight in 1796).11 Like the other faculties, it was able to attract many young men from
‘‘abroad’’, i.e. from other German states, as well as from foreign countries including
Russia, Switzerland and England.12
Outofthislargenumberofmedicalstudents,howmanywereinterestedintherelatively
newspecialityofobstetrics?AsTable1(cols.1and3)shows,duringeachsemesterinthe
1790sanaverageofone-third(32.5percent)ofallthemedicalstudents‘‘used’’thelying-
inhospital,andin1815closetohalf(43.6percent).Thisfigureissurprisinglyhigh,butcan
inpartbeexplainedbythefact thataround1800inGermany studentstendedtostayfor
onlyabouttwoyearsataspecificuniversity.13Somemovedfromoneuniversitytoanother,
but many appear to have studied for only a relatively short time, since there were no
establishedcurricula,andfewfinalexamsorformalrequirementsforgraduationinterms
of expert knowledge. This was true of the medical faculty of Go¨ttingen, as well,14 and
there,too,studentsspentanaverageoffoursemestersinthe1790s(Table1:ratiobetween
col.1andcol.2).ThosewhoreceivedanMDfromGo¨ttingenUniversityinthelastdecade
of the eighteenth century had spent there on average less than a year and a half.15
Forsomesemesters,Osiander’slistofstudentsspecifiedhowmanyattendedhiscourse
forthefirsttimeandhowmanywererepeaters(Table1,col.4).Theproportionofthelatter
however,wordswerepronounceddifferentlythanin HartmutTitze,etal.,WachstumundDifferenzierung
modernstandardGerman,Ihavekepttheoriginal derdeutschenUniversitaa€ten1830–1945,Go¨ttingen,
spelling.ThetranslationsfromGermanandLatin Vandenhoeck&Ruprecht,1995,p.232.
sourcesaremine. 11Eulenburg,op.cit.,note9above,pp.153,313,
8WilliamClark,Academiccharismaandthe 319;EThNauck,‘DieZahlderMedizinstudenten
originsoftheresearchuniversity,Universityof deutscherHochschulenim14.–18.Jahrhundert’,
ChicagoPress,2006,pp.377–97;Johanna SudhoffsArchiv,1954,38:175–86,pp.182,184;Ulrich
Geyer-Kordesch,‘Germanmedicaleducationinthe Tro¨hlerandSabineMildner-Mazzei,Vom
eighteenthcentury:thePrussiancontextandits MedizinstudentenzumDoktor:dieGo¨ttingerMedizin-
influence’,inWFBynumandRoyPorter(eds), ischenPromotionenim18.Jahrhundert,Go¨ttingen,
WilliamHunterandtheeighteenth-centurymedical Vandenhoeck&Ruprecht,1993,pp.10–15.
world,CambridgeUniversityPress,1985,pp.177–205. 12Tro¨hlerandMildner-Mazzei,op.cit.,note11
Inthenineteenthcentury,BerlinUniversity,founded above,pp.16–21,41.
in1810,becamepredominant. 13Eulenburg,op.cit.,note9above,pp.181–2.
9FranzEulenburg,DieFrequenzderdeutschen 14Tro¨hlerandMildner-Mazzei,op.cit.,note11
Universitaa€tenvonihrerGruu€ndungbiszurGegenwart, above,pp.21–31.
Leipzig,Teubner,1904,pp.145–51,182–5.Austrian 15Ibid.,p.41.Inearlierdecades,theperiodwas
universitiesarenotincluded. twiceaslong.ItwasclearlylongerinEdinburgh,
10NorbertKamp(ed.),250JahreGeorg-August- Rosner,Medicaleducation,op.cit.,note2above,
Universitaa€tGo¨ttingen:Studentenzahlen pp.68–9.
1734/37–1987,Go¨ttingen,Goltze[c.1987],pp.2–3;
5
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press
Juu€rgen Schlumbohm
Table1
NumberofstudentsatthemedicalfacultyofGo¨ttingenUniversity,numberofstudentsand
ofmidwivesusingthelying-inhospital,1792–1801and1815
Semester Numberofstudents Numberofusersofthelying-inhospital
atthemedicalfaculty
Totalnumber outofwhomnewly Medicalstudents Midwives
matriculated
Totalnumber1 Repeaters First/second
quarters2
(1) (2) (3) (4) (5)
WS1792/93 110 35 21 –* –/4
SS1793 114 23 36 8 2/–
WS1793/94 116 29 24 6 1/–
SS1794 108 25 18 – –/–
WS1794/95 103 22 27 7 –/–
SS1795 102 26 30 10 –/–
WS1795/96 114 25 40 17 –/2
SS1796 118 28 49 13 2/–
WS1796/97 105 26 47 – 5/6
SS1797 114 26 39 – 2/0
WS1797/98 110 32 41 – 2/2
SS1798 110 28 31 – –/–
WS1798/99 113 28 41 – 4/4
SS1799 103 30 47 – 4/4
WS1799/1800 104 20 28 17 3/3
SS1800 106 26 48 15 8/1
WS1800/01 100 25 35 20 1/–
Subtotal 1,850 454 602
WS1814/15 145 – 65 –
SS1815 136 – 60 – 163
W1815/16 146 – 61 –
Subtotal 427 186
*Dashes indicate thatthese numbers are not available.
1The source gives the number of students per quarter (three-month period). In most cases, the
number was the same for both quarters, or given for only one of the two quarters. For the three
semesterswherethenumbersforthetwoquartersdifferedbyone,thetablegivesthehigherfigure.
Forthetwosemesterswherethenumbersofthetwoquartersdifferedbytwo,andforonesemester,
where thenumbers ofthetwo quartersdiffered byfour, thetable givestheaverage.
2Thecoursesformidwivesusuallylastedthreemonths.Sincewedonotknowtheexactdatesin
mostyears,itisdifficulttotelltowhatextentthesamemidwivesarecountedasusingthelying-in
hospital, intwo subsequent quarters. Cf.note103ofthe text.
3The sourcegivesa totalof16midwives forthewhole of1815.
6
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press
The Practice of Practical Education
Table1(continued)
Sources:
Col. 1: Norbert Kamp (ed.), 250 Jahre Georg-August-Universitaa€t Go¨ttingen: Studentenzahlen
1734/37–1987, Go¨ttingen, Goltze [c.1987], p. 29; Hartmut Titze et al., Wachstum und
Differenzierung der deutschen Universitaa€ten 1830–1945, Go¨ttingen, Vandenhoeck &
Ruprecht, 1995,p. 232.
Col. 2: My own calculation, based on: Go¨tz von Selle (ed.), Die Matrikel der Georg-August-
Universitaa€tzuGo¨ttingen1734–1837,Hildesheim,Lax,1937,pp.338–412.Ihavecounted
thoseenrolled1Marchto31Augustasnewlymatriculatedforthesummersemester(SS,1
April–30 September), and those enrolled 1 September–28 (29) February for the winter
semester (WS,1 October–31March).
Cols. 3 and 5: AUFK Go¨, O 3: Friedrich Benjamin Osiander, ‘Sammlung der viertelj€aahrigen
U¨bersichten der Ko¨niglichen Entbindungsanstalt zu Go¨ttingen’, 1785–1800; for 1815:
FriedrichBenjaminOsiander,U¨bersichtuu€berdieEreignisseinderEntbindungslehranstalt
im Jahr1815,Go¨ttingen, Huth, 1816,pp. 14–15.
Col. 4: AUFK Go¨, W 29: Ank€uundigung von Lehrveranstaltungen, 1790–1797, fols. 8–9, 16–17,
23–24,27–28;FriedrichBenjaminOsiander,KurzeU¨bersichtderVorfaa€lleindemKo¨nigl.
EntbindungshospitalaufderGeorg-Augustus-Universitaa€tzuGo¨ttingenvom1.Octob.1794
bis 23. Maa€rz 1795 [...], Go¨ttingen, (no date, no publisher given), p. [1]; idem, Kurze
U¨bersicht der Vorfaa€lle in dem Ko¨nigl. Entbindungshospital auf der Georg-Augustus-
Universitaa€t zu Go¨ttingen vom 1. April bis 31.[sic] September 1795 [...], Go¨ttingen, (no
date, no publisher given), p. [1]; AUFK Go¨, A 1: Tagebuch, vol. 4, 1795–1797, fols.
[364]–[365];FriedrichBenjaminOsiander,AnnalenderEntbindungs-Lehranstaltaufder
Universitaa€t zu Go¨ttingen vom Jahr 1800, 2 vols. in 4 parts, Go¨ttingen, Dieterich, 1800–
1804,vol.1, part1, pp.164–6, vol.1, part 2,pp.91–5, vol.2,part 2,pp.320–1.
amounted to more than a third of the total number of participants in those semesters
(113 out of 317, i.e. 35.6 per cent). Therefore, the total of 602 students (col. 3), when
corrected for repeaters, probably implies about 387 individuals. Thus the overwhelming
majorityofthestudentsenrolledatthemedicalfacultydidinfactusethelying-inhospital:
387 out of 454 (col. 2), that is 85 per cent.16
Asthisfigureshows,Osianderhadgoodreasontoarguethathislying-inhospitalwasa
major asset of the University’s medical faculty and helped considerably to attract both
German and foreign students.17 The fact that attendance at his course was so high is
particularlyremarkable,sinceinmanyGermanstatestherewerenoformalrequirementsof
thiskind,neitherforgraduation,norforadmissionbypublicauthoritiesasapractitioner.18
16Ontheotherhand,Ihavefound23malebirth 17Tro¨hlerandMildner-Mazzei,op.cit.,note11
attendantsinthehospitalcasebooksandcalendarswho above,p.40.
seemnottohavematriculated,sincetheydonotappear 18Hans-ChristophSeidel,Eineneue‘Kulturdes
inGo¨tzvonSelle(ed.),DieMatrikelderGeorg-August- Gebaa€rens’:dieMedikalisierungvonGeburtim18.und
Universitaa€tzuGo¨ttingen,1734–1837,Hildesheim, 19.JahrhundertinDeutschland,Stuttgart,Steiner,
Lax,1937.Iftheyaresubtractedfrom387,still80per 1998,pp.280–2;seealsoI[sidor]Fischer,Geschichte
centoutofthe454studentsmatriculatedusedthelying- derGeburtshilfeinWien,Leipzig,Deuticke,1909,pp.
inhospital.InEdinburgh,only27percentofthe 149–57;Tro¨hlerandMildner-Mazzei,op.cit.,note11
studentsattendedthecourseinmidwiferyduringthe above,pp.22–49.
lateeighteenthandearlynineteenthcenturies:Rosner,
Medicaleducation,op.cit.,note2above,p.55.
7
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press
Juu€rgen Schlumbohm
Itappearsthatthefacultyreliedonthestudents’owninterestinagoodeducationasthebest
way to achieve success in practice.
For how long did the students participate in the courses at the maternity hospital?
Osiander reported that, during nine semesters between summer 1793 and winter
1800/01,outofatotalof313students,200attendedforthefirsttime,90forthesecond,
15forthethird,5forthefourth,and3foreventhefifthtime.Onthisbasis,theestimateis
thatthemajority(55percent)ofthestudentsattendedhiscourseforonlyonesemester,but
morethanathird(37.5percent)fortwosemesters,5percentforthreesemesters,and2.5
per cent for four or even five semesters.19
These figures show that the medical faculty of Go¨ttingen attracted high numbers of
studentspartlybecauseoftheimportanceofthelying-inhospital.Almostallthemedical
studentsenrolledinGo¨ttingenmadeuseofit,althoughamajorityforonlyonesemester.
Therewasaminorityofmedicalstudents,however,whowereeagertogetamoreextensive
training in midwifery.
Asforthetrainingoffemalemidwives,thefiguresclearly seemtoshowthatthiswas
muchlessimportantthantheeducationofmalestudents(Table1,col.5).Usuallybetween
two and six women participated in the course, that is about one-tenth of the number of
medical students. The course for midwives lasted three months, generally from May to
July,andfromDecembertoFebruary.20Asearlyas1752,justsixmonthsafterthelying-in
hospitalopened,thegovernmentofHanoverhadorderedthattownsshouldnotacceptany
newmidwivesunlesstheyhadbeentaughtatthematernityhospitalandexaminedbythe
professorofobstetrics.21Thiswouldhavecreatedastrongincentiveforwomentoattend
thecourse,inparticulariftownsfollowedtheadviceofthegovernmentandpaidthecostof
theirmidwives’stayatGo¨ttingen.Itappears,however,thatittookalongwhilebeforethis
ordinancewasfullyimplementedinalltowns,andevenlongerbeforeruralcommunities
followed suit.22
‘‘A Complete Courseon the Theoreticaland Practical Parts ofMidwifery’’
‘‘Every semester a complete course on the theoretical and practical parts of
midwifery is held’’, Professor Osiander told the medical reading public.23 What
19Thisestimateisbasedonthefictiveassumption FriedrichBenjaminOsiander,Denkwuu€rdigkeitenfuu€r
thatinthesefigureswearealwaysdealingwiththe dieHeilkundeundGeburtshuu€lfeausdenTagebuu€chern
samegroupofstudents.Underthisassumption, derKo¨niglichenpractischenAnstaltenzuErlernung
thosestudentswhoattendedthecourseforthesecond dieserWissenschafteninGo¨ttingenausgehoben,
time,areincludedamongthosewhoattendedforthe Go¨ttingen,Vandenhoeck&Ruprecht,1794,vol.1,
firsttimeintheprevioussemester,andthosewho part1,pp.CXVIII–CXX.
attendedforthethirdtimeareincludedamongthose 22HenrikeHampe,ZwischenTraditionund
whoattendedforthesecondtimeintheprevious Instruktion:Hebammenim18.und19.Jahrhundertin
semester,andamongthosewhoattendedforthefirst derUniversitaa€tsstadtGo¨ttingen,Go¨ttingen,Schmerse,
timeinthesecondtothelastsemester,etc.Accordingly, 1998,pp.85–89,seealso47–59.
theestimateisthatwearedealingwith200different 23Osiander,Denkwuu€rdigkeiten,op.cit.,note21
students,outofwhom110attendedthecoursefor above,vol.1,part1,p.CVI:‘‘JedeshalbeJahrwirdein
onlyonesemester,75fortwosemesters,10forthree vollst€aandigerCursus€uuberdentheoretischenund
semesters,2forfoursemesters,and3forfivesemesters. praktischenTeilderGeburtsh€uulfegehalten’’.
20Osiander,Annalen,op.cit.,note7above,vol.1,
part1,1800,p.XI.
21Universit€aatsarchivGo¨ttingen(hereafterUnivA
Go¨),Kur.5406,fols1–4,dated17June1752.Seealso
8
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press
The Practice of Practical Education
this meant becomes clearer by his remark that he based his course on Stein’s
textbook.24 Georg Wilhelm Stein (senior), whom Osiander revered as his teacher,25
divided his manual into two parts Theoretische Anleitung zur Geburtshuu€lfe (Theoretical
Guide to Midwifery), and Practische Anleitung zur Geburtshuu€lfe (Practical Guide to
Midwifery),bothexplicitlydesignedaslecturetextbooks.26Thefirst‘‘theoretical’’volume
hadchaptersonthefemalegenitals,pregnancy,the‘‘fruit’’or‘‘embryo’’,andchildbirth,in
particular ‘‘natural childbirth’’.27 The second ‘‘practical’’ volume dealt with ‘‘contra-
natural and difficult cases’’, and had chapters on ‘‘manual’’ and ‘‘instrumental opera-
tions’’.28 Later, Osiander used his own Grundriss der Entbindungskunst zum Leitfaden
beiseinenVorlesungen(OutlineoftheArtofAccouchement),publishedin1802,29forhe
believedthatthedevelopmentofthedisciplineduringthepreviousdecademadeamoreup-
to-datemanualnecessary.30Thistextwasalsointwovolumes,thefirsttreatingpregnancy
and childbirth, and the second, delivery and instruments.31 The second ‘‘practical’’ part
explained‘‘whatanaccoucheurshouldandshouldnotdoincontranaturalcasesandinsuch
casesofchildbirthwhichrequireartificialassistance’’.32ItisnocoincidencethatOsiander,
like most of his colleagues, in Germany at least, thought that artificial assistance in
childbirth was reserved for the male sex, while female midwives should, in principle,
24Ibid.Osianderstressedthat,althoughhefollowed newed.,Marburg,NeueAkademischeBuchhandlung,
theorderofStein’stextbook,headdedandchanged 1793(lsted.,1770);idem,PractischeAnleitungzur
whereverhefoundfit. Geburtshuu€lfe:zumGebrauchederVorlesungen,
25Inthewinterof1781/82,whenOsianderwas newed.,Marburg,NeueAkademische
alreadyapractitioneratKirchheimunterTeckinhis Buchhandlung,1793(lsted.,1772).
nativestateofW€uurttemberg,hetookaprivatecourse 27Idem,TheoretischeAnleitung,op.cit.,note26
withSteininthetownofKassel,and,underStein’s above,p.88:‘‘Frucht(Embryo)’’;pp.165–220
direction,practisedforfivemonthsinthelying-in ‘‘nat€uurlicheGeburt’’.
hospital.WilhelmEgenolf,‘FriedrichBenjamin 28Idem,PractischeAnleitung,op.cit.,note26
Osiander,OrdentlicherProfessorderArzneiwissen- above.Ontheunnumberedpagefollowingthe
schaftundDirektorderKgl.Hannoverschen tableofcontents,thebooktitleisgivenas
EntbindungsanstaltunddesInstitutiClinicider PractischeAnleitungzurGeburtshuu€lfein
Universit€aatGo¨ttingenvon1792–1822’,Vorarbeiten widernatuu€rlichenundschwerenFaa€llen;pp.96–143:
zurGeschichtederGo¨ttingerUniversitaa€tundBiblio- ‘‘VonManualoperationen...’’;pp.190–264:‘‘Von
thek,1937,22:31–58,onpp.39–41.GeorgWilhelm Instrumentaloperationen...’’.
Stein(1737–1803)hadstudiedwithRoedererin 29Thisismentionedinthelistofcoursesat
Go¨ttingenandAndre´LevretinParis.In1763he Go¨ttingenUniversity,e.g.,inthewintersemester
becameaprofessorinKassel,andfrom1766,in 1803/04andinthesummersemester1805:
addition,thedirectorofthematernityandfoundling Go¨ttingischeGelehrteAnzeigen(hereafterGGA),
hospital.In1789,hewasappointedprofessoratthe 1803,no.146,10Sept.1803,p.1456;ibid.,1805,
UniversityofMarburg,andin1792directorofthe no.51,30March1805,p.504.FriedrichBenjamin
maternityhospitalthere.ChristinaVanja,‘Das Osiander,GrundrissderEntbindungskunstzum
KasselerAccouchier-undFindelhaus1763–1787: LeitfadenbeiseinenVorlesungen,2vols,Go¨ttingen,
ZieleundGrenzen‘‘vern€uunftigenMitleidens’’mit Dieterich,1802.
Geb€aarendenundKindern’,inJ€uurgenSchlumbohm 30Osiander,Grundriss,op.cit.,note29above,vol.
andClaudiaWiesemann(eds),DieEntstehungder 1,p.XI.
GeburtsklinikinDeutschland1751–1850:Go¨ttingen, 31Vol.1hadthesub-title:Schwangerschafts-und
Kassel,Braunschweig,Go¨ttingen,Wallstein,2004, Geburts-Lehre,vol.2:Entbindungs-undWerkzeuge-
pp.96–126,onpp.103–110;MaritaMetz-Becker,Der Lehre.
verwalteteKo¨rper:dieMedikalisierungschwangerer 32Osiander,Grundriss,op.cit.,note39above,vol.
FrauenindenGebaa€rhaa€userndesfruu€hen19. 2,p.III:‘‘...waseinGeburtshelferbei
Jahrhunderts,Frankfurt/Main,Campus,1997, widernat€uurlichenunddieH€uulfederKunsterfordernden
pp.107–8. Geburtsf€aallenzutunundzulassenhat’’;p.V:‘‘...in
26GeorgWilhelmStein,TheoretischeAnleitung demgegenw€aartigenpraktischenTeil...’’.
zurGeburtshuu€lfe:zumGebrauchederVorlesungen,
9
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press
Juu€rgen Schlumbohm
belimitedtoassistingin‘‘natural’’deliveries.Thiswasinlinewithadichotomousnotion
ofgenderinwhichmaleandfemalewereboundupwiththepolaritiesofcultureandnature,
activityandpassivity,reasonandemotion.33Allthisimpliesthatthe‘‘theoretical’’partof
midwiferydealingwith‘‘natural’’childbirthbasicallyconcernedthetypeofcaseswhich
medical doctors were willing to leave to female midwives, while the ‘‘practical’’ part
treatedthosecomplicatedcaseswheremalephysiciansorsurgeonsthoughtthattheirown
intervention was required.34
Therewere,however,furtherreasonswhyOsiandercalledhiscoursepracticalaswellas
theoretical.Heheld‘‘practicalexercises’’,inadditiontothelecturecourse.Studentsappear
tohavebeenevenmorekeenlyinterestedintheformerthaninthelatter.Inthesummerof
1796, the only semester for which a list for both the ‘‘collegium theoreticum’’ and the
‘‘practical exercises’’ is preserved, 36 students participated in the lectures, but 49 in the
practicalpart.AllthosewhotookOsiander’scourseforthefirsttime,attendedboth;those
whowererepeatersparticipatedinthepracticalexercisesonly.35Notsurprisingly,Osian-
deradvertisedthisaspectofhiscoursebyemphasizingthedemonstrationsandexercises
with a manikin or ‘‘phantom’’, a female pelvis covered by leather. Compared to mere
lecturesandeventopictures,thisformofpractisewasconsideredtobeamajorimprove-
ment, and it was an important element in the courses taught by ‘‘the King’s midwife’’,
MadameduCoudray,tomidwives,surgeonsandphysiciansinmanypartsofFrancefrom
1759to1783,aswell asinthelessonsgivenbyWilliamSmellieandotherBritishmen-
midwivestomalestudentssincemid-century.36LikehisteacherStein,37Osianderwaswell
awareofthispracticalturninobstetricteaching,andduringhisfirstterminGo¨ttingenhe
bought,atthehospital’sexpense,aphantomdesignedbyacolleagueinJena.38Thenext
semester,helecturedonMondays,Tuesdays,ThursdaysandFridaysfrom9a.m.to10a.m.,
andsetasideWednesdaysandSaturdaysforpractisingwiththedummy.Laterheusedthe
33Schlumbohm,‘Pregnantwomen’,op.cit.,note5 Main,Campus,1999,pp.234–46;LaurenceBrockliss
above,pp.69–70. andColinJones,Themedicalworldofearlymodern
34SeeBroman,op.cit.,note4above,p.29,on France,Oxford,ClarendonPress,1997,pp.740–3;
medicaleducationateighteenth-centuryuniversities: MatthewRamsey,Professionalandpopularmedicine
‘‘Thedivisionbetween‘theoretical’and‘practical’ inFrance,1770–1830:thesocialworldofmedical
coursesreferstothetypeofknowledgepresented,notto practice,CambridgeUniversityPress,1988,pp.24,53;
themethodofinstruction.’’ AdrianWilson,Themakingofman-midwifery:
35ArchivmaterialienausdemBestandder childbirthinEngland1660–1770,London,UCLPress,
Universit€aats-FrauenklinikGo¨ttingen,inderBibliothek 1995,pp.124–26;JohannaGeyer-KordeschandFiona
derAbteilungEthikundGeschichtederMedizinder Macdonald,PhysiciansandsurgeonsinGlasgow:the
Universit€aatGo¨ttingen(hereafterAUFKGo¨),W29,fols historyoftheRoyalCollegeofPhysiciansandSurgeons
27–28.ThiswasinlinewithOsiander’sviewthat ofGlasgow1599–1858,London,Hambledon,1999,pp.
instructionbytheoralandwrittenwordhastoprecede 261–4;LisaFormanCody,Birthingthenation:sex,
thepracticaltrainingofaccoucheurs;Osiander, science,andtheconceptionofeighteenth-century
Grundriss,op.cit.,note29above,vol.1,p.11. Britons,OxfordUniversityPress,2005,pp.171–2.
Repeaterspaidonlyhalfthetuitionfeeofbeginners,see MadameduCoudray,however,useda‘‘machine’’
note99belowandrelatedtext. madeoutoftextiles.
36JacquesGe´lis,Lasage-femmeouleme´decin:une 37Stein,TheoretischeAnleitung,op.cit.,note26
nouvelleconceptiondelavie,Paris,Fayard,1988,pp. above,‘Vorbericht’,unpaginated.
111–72,esp.160–1,andphotobetweenpp.248–9; 38Osiander,draftofreporttothegovernmentonthe
NinaRGelbart,Theking’smidwife:ahistoryand lastquarterof1792,8–12Jan.1793,inAUFKGo¨,O4,
mysteryofMadameduCoudray,Berkeley,University pp.28–9.In1799,Osianderboughtasecondphantom,
ofCaliforniaPress,1998,pp.60–4,207,213–14;Eva athisownexpense,inordertogivethestudentsmore
Labouvie,BeistandinKindsno¨ten:Hebammenund opportunitiesforpractising,UnivAGo¨,Kur.4731,
weiblicheKulturaufdemLand,1550–1910,Frankfurt/ fol.37.
10
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press
The Practice of Practical Education
entirefinalmonthofeachsemesterforexerciseswiththephantom.39Heinsistedthatno
morethanfourstudentsperhourcouldpracticeonit.Therefore,inadditiontothelessons
whichOsiandertaughthimself,heletgroupsofstudentsexerciseontheirown,supervised
byonewhowasmoreexperiencedthantherest.Evenso,thetimeavailableforeachstudent
wasquitelimited.Thisismadeplaininanannouncement,handwrittenbyOsianderinlate
August 1793, and posted in the hospital at the end of his lecture course. He notified his
students that the exercises with the phantom would continue during the first half of
September, four days a week from 9.00 to 10.00 in the morning. He distributed the 31
studentswhoremainedoutofthe36whohadattendedhisclassesduringthesummerterm
intogroupsoffourandassignedadaytoeachgroup.40Thismeantthateachstudenthad
just fifteen minutes’ practice during the two-week period.
Withthephantom,Osiandertaughttwothings:first,thesemioticsoffoetalpositions,i.e.
howtodiscoverthepositionoftheunbornintheuterusbytouchingitwithoneorseveral
fingersthroughthevagina,and,second,howtointerveneindifficultcases.Inparticular,he
demonstrated, and let his students practise, how to deliver a child presenting the feet, to
turnachildintheuterus,andtousetheforcepsandthevectis.41Accordingtohispeculiar
approach,herefusedtoteachembryotomy,andinsistedthat,inalmostallcases,aliving
child could be delivered with the forceps.42 Following Stein, Osiander endeavoured to
make the exercise on the phantom as realistic as possible. They both preferred to use
corpses of stillborn babies, preserved in alcohol, rather than artificial dolls. Osiander
consideredthistobetheonlyeffectivewayoftrainingpalpation,43andtherewasalways
a supply of dead babies in the hospital.
Above all, the hospital made living patients available for teaching purposes. The stu-
dents were thus trained in palpation not only on the phantom, but also on the pregnant
women in the clinic. They learnt how to perform both external and internal manual
examinations, and in this way determine the state of the pregnancy and the position of
the foetus. A man touching a woman’s genitals and womb clearly transgressed a strong
shame taboo, and that was not easily allowed in private practise.44 The women in the
hospital, however, who were mostly unmarried servants,45 had free board, lodging and
treatment during their stay, and had to accept being used for this purpose. To be sure,
midwiveshadpractisedmanualexaminationsofpregnantwomenforalongtime.Formale
obstetricians, however, it was a recent development, crucial for their efforts to build a
knowledgeoftheirown,independentofthatofthewomenconcerned.46Forthisreason,
39GGA,1793,no.43,16March1793,p.431; 44Seidel,op.cit.,note18above,pp.286–91.
Osiander,Denkwuu€rdigkeiten,op.cit.,note21above, 45J€uurgenSchlumbohm,‘‘‘VerheirateteundUnver-
vol.1,part1,pp.CVI–CVIII. heiratete,Inl€aanderinundAusl€aanderin,Christinund
40AUFKGo¨,W29,fol.14,cf.fols8–9. J€uudin,WeißeundNegerin’’:diePatientinnendes
41Avectisisaleverusedtofreethechild’shead. EntbindungshospitalsderUniversit€aatGo¨ttingenum
42J€uurgenSchlumbohm,‘‘‘Dieedelsteund 1800’,inH–JGerhard(ed.),StrukturundDimension:
n€uutzlichsteunterdenWissenschaften’’:Praxisder Festschriftfuu€rKarlHeinrichKaufhold,2vols,
GeburtshilfealsGrundlegungderWissenschaft,ca. Stuttgart,Steiner,1997,vol.1,pp.324–43,on
1750–1820’,inHansErichBo¨deker,PeterHReilland pp.330–1.
J€uurgenSchlumbohm(eds.),Wissenschaftalskulturelle 46Idem, ‘GrenzendesWissens:Verhandlungen
Praxis,1750–1900,Go¨ttingen,Vandenhoeck& zwischenArztundSchwangerenimEntbindungs-
Ruprecht,1999,pp.275–97,esp.289–95. hospitalderUniversit€aatGo¨ttingenum1800’,inBarbara
43Osiander,Denkwuu€rdigkeiten,op.cit.,note21 Duden,J€uurgenSchlumbohmandPatriceVeit(eds),
above,vol.1,part1,pp.CVII–CIX. GeschichtedesUngeborenen:zurErfahrungs-und
11
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press
Juu€rgen Schlumbohm
teachingmedicalstudentshowtoexaminepregnantwomen‘‘accordingtotherulesofthe
art’’ was an important part of the practical course.47
Likethatofthemedicalstudents,thetrainingoffemalemidwiveswastheoreticalaswell
aspractical,althoughwithsignificantdifferencesinthecontentofthetheoreticalknowl-
edgetaughtandinwhatwasexercisedonthephantom.Thus,inanannouncementofthe
coursesforthesummersemesterof1796,postedinthematernityhospital,Osianderspoke
of the ‘‘Collegiumtheoreticum’’on the ‘‘science of obstetrics’’for the male students,as
opposedtothe‘‘lessonsintheartofmidwifery’’forthefemaleapprentices.48Themedical
students were supposed to know Latin. As for the midwife apprentices, Osiander would
have liked them alltobeabletoread andeven write, buthewasunabletoinsistonthis
because he had no control over which women came to his course.49 They were either
electedby the married women in their community, or picked by local officers.50 Infact,
manyofthemdidnotevenspeakhighGerman,butonlylowGerman,thelanguageofthe
North, including the Electorate of Hanover. During his first years in Go¨ttingen, this
appears to have been a problem for Osiander, since he was from W€uurttemberg, in the
southwest.
Likethelecturesformedicalstudents,thelessonsformidwifeapprenticeswerebasedon
a textbook by Georg Wilhelm Stein, the Hebammen-Catechismus (Catechism for Mid-
wives).Consistingofonlyabout100pages,thiswasmoreelementaryandshorterthanthe
students’textbook,andwaswrittenintheformofquestionsandanswers,whichEnlight-
enment authors thought especially appropriate for teaching ordinary people.51 Osiander
wouldaskthemostliterateapprenticetoreadoutaparagraphfromthetextbook.Hewould
thenquestionthewomentoascertainwhetherallhadproperlyunderstoodthemeaning,and
he endeavoured to imprint the matter firmly in their memory by using terms from their
WissenschaftsgeschichtederSchwangerschaft,17.–20. 50Hampe,op.cit.,note22above,pp.45–59;see
Jahrhundert,Go¨ttingen,Vandenhoeck&Ruprecht, alsoLabouvie,op.cit.,note36above,pp.99–125;
2002,pp.129–65,onpp.132–3;seealsoAnneCarol, Seidel,op.cit.,note18above,pp.243–5.
‘L’examengyne´cologiqueenFrance,XVIIIe–XIXe 51Osiander,Denkwuu€rdigkeiten,op.cit.,note21
si(cid:1)eecles:techniquesetusages’,inPatriceBourdelaisand above,vol.1,part1,pp.CXV–CXVI.GeorgWilhelm
OlivierFaure(eds),Lesnouvellespratiquesdesante´: Stein,Hebammen-Catechismus:zumGebrauchder
acteurs,objets,logiquessociales(XVIIIe–XXesiee(cid:1)cles), HebammeninderGrafschaftLippe,Lemgo,Meyer,
Paris,Belin,2005,pp.51–66. 1776.Inaddition,heusedHeinrichGeorgMarschall,
47Osiander,Annalen,op.cit.,note7above,vol.1, UnterrichtzurPflegederMaa€dchenundSchwangern
part1,1800,p.X:‘‘[Eswirdregelm€aaßig]indem besondersderMuu€tter,fuu€rsichundihreSaa€uglinge,in
kunstm€aaßigenUntersuchenanSchwangerendes ihrenbesondernKrankheitenundZufaa€llen:ein
HausesUnterrichterteilt’’. VolksbuchallenHebammenundgutenMuu€tternsehr
48AUFKGo¨,W29,fols27–28:‘‘IndemCollegio nuu€tzlich,undnothwendig,Frankfurt/MainandLeipzig,
theoreticoderEntbind[ungs]wissensch[aft]...’’; 1791.In1796,Osianderhimselfpublishedatextbook
‘‘UnterrichtinderHebammenkunst’’. formidwives,anduseditinhiscourses:Osiander,
49FriedrichBenjaminOsiander,Lehrbuchder LehrbuchderHebammenkunst,op.cit.,note49above,
Hebammenkunst:sowohlzumUnterrichtangehender p.XV.Itcontainedmorethan770pages,however,not
HebammenalszumLesebuchfuu€rjedeMutter, muchfewerthanhislatertextformedicalstudents
Go¨ttingen,Rosenbusch,1796,p.22,seealsop.VI; (Osiander,Grundriss,op.cit.,note29above),andhe
idem,Denkwuu€rdigkeiten,op.cit.,note21above,vol.1, admittedthatitwasnotwrittenfornormalcoursesand
part1,pp.CXVI–CXVII.Inalistoffivemidwife ordinarymidwives,butratherfortheeducatedfew
apprenticeswhotookhiscourseinwinter1796/97, amongthem,andforteachersofmidwives.Itwastobe
Osianderwashappytonotethatfourofthem,aged ‘‘abibleoftheirart’’(‘‘eineBibelihrerKunst’’),allthe
betweenthirty-oneandforty-three,knewhowtoread knowledgeinasinglevolume.Moreover,thebookwas
andwrite;thefifth,agedthirty,couldread,butnot destinedforabroaderpublicofenlightenedlaypersons,
write;AUFKGo¨,A1(Tagebuch,vol.4),fols362–3. namely‘‘nobleandmiddleclassladies’’,civilservants
12
https://doi.org/10.1017/S0025727300000879 Published online by Cambridge University Press