Indus ializa ion and he Cons uc ion o
Heal h Risks in Ge man Wo ke s'
Au obiog aphies om he La e 19 h and
Ea ly 20 h Cen u ies
GUNNAR
STOLLBERG
(*)
(1)
RESUMEN
El p oceso de indus ialización p odujo ápidos cambios en los modos de abajo
y
de
ida de los abajado es, pese a lo cual en sus o mas de ida conse a on c eencias
y
ac i udes adicionales. Po lo que espec a a la salud
y
la en e medad, es as c eencias
adicionales se e idencian median e es e abajo a a és de las au obiog a ías de abaja-
do es. Es os, con el ascu so del iempo llega on a acep a a los médicos del segu o. Po
su pa e, las medidas de segu idad social pe mi ie on a los médicos el acceso al mundo
ob e o. Los abajado es ni acep a on simple o áci amen e la medicalización, ni se opu-
sie on a la expansión del pode social de los médicos, únicamen e in e p e a on los iesgos
sani a ios como pa e de su o ma de ida
y
no como esul ado de los cambios sociales que
es aban eniendo luga en odas las es e as.
1.
Indus ializa ion b ough abou new heal h dange s and isks. These
esul ed om inc easing popula ion, om u baniza ion, and om he use
o new ma e ials and echniques, al1 o which we e poignan ea u es o he
indus ializa ion. These changes esul ed om socie al decisions, which
we e implemen ed
by
en ep eneu s: o p omo e he weal h o na ions
(Adam Smi h), o make i s ma e ial sou ces low abundan ly (Ma x), o
Fecha de acep ación: 21 de sep iemb e de 1992.
(*)
Fakul a u Soziologie. Uni e si a Biele eld. Pos ach 10 01 31. DW4800 Biele eld 1.
Alemania.
(1) Je Olick helped wi h he ansla ion. Ge d Gockenjan commen ed upon an ea lie
e sion o his pape .
DYNAMIS
Ac a Hzspanzca ad Medzcinae Scien za umque His onam Zllus andam.
Vol. 13, 1993, pp. 235-246.
ISSN: 021 1-9536
236
GUNNAR STOLLBERG
make socie y an expanding sys em o expanding needs (Hegel) e c. Mode n
sociologis s dis inguish be ween dange s
-
which esul om na u e
-
and isks
-
which esul om socie al decisions (2). Being he esul s o
'
socie al decisions, hese ea u es o indus ializa ion a e hus isks.
As
such,
hey we e di e en ially expe ienced and opened di e en poin s o iew o
bo h he decision-make s and he people a ec ed.
Indus ializa ion b ough abou changes in he wo ld o wo k, in he
wo lds o wo ke s: he e was a shi om a isan o indus ial modes o
p oduc ion; an inc easing i npo ance o machines in he p ocess o wo k;
changes o skills e c.
The li ewo lds changed, oo; hese changes included u baniza ion, mo e
o smalle households, new o ms o amilies e c. Pe e Be ge and o he s
ha e demons a ed ha quick changes in wo k
and
li e-wo ld p oduce a
«homeless mind» (3). Wo ke s' con ol o e he wo lds o hei wo k apidly
diminished in he cou se o indus ializa ion. Thus hey we e u ged o
p ese e adi ional belie s and a i udes in hei li e-wo lds, which shaped
a
«heme»
o hei minds.
2.
A
connec ion be ween a isans' wo k and heal h isks has been
hypo hesized since ea ly mode n imes. This connec ion was enewed by
indus ial medicine in he second hal o he 19 h cen u y
(4).
Socialis
physicians impa ed hese deba es o socialis wo ke s' o ganiza ions (5).
Bu his discou se can sca cely be ound in wo ke s' au obiog aphies. Jens
Lachmund and 1 ead some 700 Ge man au obiog aphies s emming om
al1 social s a a and co e ing he ime om
ca.
1780 o
ca.
1930. We
scanned hem o desc ip ions o aspec s and episodes o heal h and illness.
The e a e only a ew au obiog aphies w i en by a isans and wo ke s
be o e 1880, bu some 250 ha e been published om
ca.
1880 o
ca.
1930.
(2)
LUHMANN, Ni$las (1991).
Soziologie des Risikos,
Be lin/New Yo k, de G uy e .
(3) BERGER, Pe e L.; BERGER, B igi e; KELLNER, Hans ied (1973).
The Homeless
Mind. Mode niza ion and Consciousness,
New Yo k, Vin age.
(4)
C .
MILLES, Die ich;
MULLER,
Raine (eds.) (1985).
Be u sa bei und K ankhei ,
F ank u , New Yo k, Campus.
(5) LABISCH, Ai ons (1981). Das K ankenhaus in de Gesundhei spoli ik de deu schen
Sozialdemok a ie o dem E s en Wel k ieg.
Medizinische Soziologie, 1,
126-151;
TENNSTEDT, Ho ian (1983).
Vom P ole en zum Zndus iea bei m. A bei mbewegung und
Sozialpoli ik in Deu schland 1800 bis
1914,
Koln, Bund (pp. 455 .).
Indus ializa ion and
he
Cons uc ion o
Heal h Risks
237
1
This li e a y gen e gene ally cons uc s indi iduali y and indi idual
success. I was enewed by Rousseau's «Cbn essions», which no only o med
a new eepisoden in he his o y o he gen e
(6),
bu became a model o
he gene ic au obiog aphy p oduced by he middle classes
(7).
Wo ke s'
au obiog aphies a e de e mined by he cha ac e is ics o he gen e, as well.
New discou ses we e in oduced
-
e.g. o po e y, o a isans' honou , and
o socialism and socialis u opias. Bu collec i e expe iences and cons uc ions
o collec i e iden i ies can sca cely be ound.
d canno be denied ha collec i e connec ions o sense and sel de ini ions
play an impo an ole in some au obiog aphies
...
Bu always an indi i-
dual sel -pe cep ion p ecedes he collec i e one: he idea ha he pe son
and he ca ee o one's own o m a ele an uni .
(8).
3.
The wo ke s adop ed cen al elemen s om he middle-class discou se
o heal h and illness om he la e 18 h cen u y in cons uc ing images o
heal h and i s isks (o dange s
-
he decisions, which isked indus ial
damage, had been made by o he s). These ele nen s included he indi idualis
pe spec i e on heal h: he la e hus esul ed om pe sonal success in
p eseMng con ollable
(«willkü liche»)
heal h, which could be con as ed o
he sickly noblesse o he nobili y on he one hand, and o he «na u al»
heal h o he peasan s, on he o he hand
(9).
Kan had e en discussed he
igh and he co esponding du y o gain o p ese e heal h (10).
Wo ke s p ese ed many adi ional ea u es in hei a i udes and
(6)
SPENGEMANN, William C. (1980).
The Fo ms o Au obiog aphy. Episodes in he His oly
o a Li e aly Gen e,
New Ha en, London, Yale.
(7) GUMBRECHT, HansUl ich (1981). Lebenslau e, Li e a u , All agswel en.
Zn:
MAlTHES,
Joachim; PFEIFENBERGER, A no; STOSBERG, Man ed (eds.),
Biog ghie in
handlungswissenscha liche
Pe spek i e,
Nü nbe g, Nü nbe ge Fo schungs e einigung
(pp. 231-250); SLOTERDIJK, Pe e (1978).
Li e a u und Olganisa ion on &ebme$ahmng.
Au obiog aphien de Zwanzige Jah e,
München, Hanse (p. 17).
(8)
BERGMANN, Klaus (1991).
Lebensgeschich e ak Appell: au obiopaphische Sch i en de
«kbinen Leu ea und Aubensei e ,
Opladen, Wes deu sche Ve lag (p. 81).
(9) GOCKENJAN, Ge d (1985).
Ku ie en und S aa machen,
F ank u , Suh kamp (pp. 64
l
.
(10) KANT, Immanuel (1964). De S ei de Fakul a en.
Zn: We ke,
edi ed by Wilhelm
WEISCHEDEL, Da ms ad , Wissenscha liche Buchgesellscha , ol. 9 ( p.
371).
238
GUNNAIZ STOLLBERG
beha iou owa ds heal h and illness. This co esponded i s ly o he
a ibu ion and assignmen o heal h and illness o hei li e-wo lds; secondly
o he indi idualizing pe spec i e o he au obiog aphical gen e; hi dly o
he indi idualizing pe spec i e o cu a i e medicine in gene al (1 1); ou hly
o he wa ie y o wo ke s' exis ence~ du ing he 19 h cen u y: his las
e e s o he ac ha he e was no homogenei y o li e and wo k condi ions
i
o he g ea e pa o he wo king classes (12).
1 shall now demons a e some pa e ns o wo ke s' medical cul u e (13),
d awing upon he au obiog aphy o Mo i z B omme. I was «edi ed» by he
p o es an pa son Paul Gh e in 1905, who may ha e in luenced i s cons nic ion
in gene al, and ha o heal h and illness, in pa icula : o ins ance, Goh e
a emo ed al1 ha u ned ou o be no hing bu a c i ique o he es ablish-
men » in he chap e abou a sana o ium (14).
B omme's a he s emmed om a u al backg ound and wo ked du ing
he las decades o he 19 h cen u y as a ailway-wo ke in Sachsen-Al enbu g
(Mid Ge many). He was an ac i e membe o he Social Democ a ic Pa y
e en du ing i s ep ession om 1878 o 1890, and a local cashie o he
joine s' cen alised sick and bu ial und. Though hus pa icipa ing in he
o mal heal h sys em, he bough a balm om an i ine an deale o ea
his son's d opsy, and ole a ed his wi e and his mo he conju ing an
exan hema and lice. When he e11 ill wi h jaundice, and he doc o could
no help him, his amily ead an ad e isemen in he newspape and
(11)
C .
GOCKENJAN, Ge d (1985). Gesundhei und A hei
-
Un e suchungen zu
F age, wie Kon lik e e schwinden'.
In:
NASCHOLD, F iede (ed.),
A bei und Poli ik,
F ank u , New Yo k, Campus (pp. 305-337).
(12) KOCKA, Jü gen (1983).
Lohna bei und Klassenbildung,
Be lin, Bonn, Die z.
(13) Fo he e m see LACHMUND, Jens; STOLLBERG, Gunna (1989). Zu medikalen
Kul u des Bildungsbü ge ums um 1800: Eine soziologische Analyse anhand on
Au obiog aphien.
Jah buch des Ins i u s ü Geschich e de Medizin de Robe -Bosch-
S ij ung,
6,
163-185.
.C .
ALBER, Wol gang; DORNHEIM, Ju a (1983). ~Die Fackel
de Na u o ge agen mi Hin anse zung alles Abe glaubensa: Zum En s ehungsp ozeb
neuzei liche ~o hs~s eme im Be eich medikale Kul u .
Zn:
HELD, Ju a (ed.),
Kul u zwischen Bü ge um und Volk,
Be lin, A gumen (pp. 163-181). «Soma ic cul u e.:
see BOLTANSKI, Luc (1976). Die soziale Ve wendung des Ko pe s.
In:
KAMPER,
Die ma ; RITTNER, Volke (eds.),
Zu Geschich e des Ko pe s,
Wien, Hanse (pp. 138-
183).
(14) BROMME, Mo i z Theodo William (1905).
Lebensgeschich e eines modenzen Fab ika bei e s,
edi ed by Paul GOHRE (1971), F ank u , A henaum (In od.
p.
XI).
Indus ializa ion and he Cons uc ion
o
Heal h Risks
239
o de ed a speci ic om a quack, which was e y expensi e and did no help
a a11 (15).
Mo i z B omme himsel did no con ac a dok o a e being inju ed in
an acciden a wo k because he was a aid o he su gical sewing. When his
s ep-son e11 ill, biomedical and «na u al» he apeu ics we e used, and
B omme ells us he s o y o a colleague in a ac o y a Ge a who d ank no
alcohol, a e no mea and was a membe o a na u e cu e socie y
(16).
B omme himsel was ea ed o his ube culosis in hospi als and died a
33
yea s o age.
B omme's pa e ns may be in e p e ed as o ming ansi ions om
adi ional o mode n o ms o beha iou , which use al1 he h ee sec o s
o he heal h sys em:
1
ollow A hu Kleinman in di iding ha sys em in o
-
he olk sec o ( eligious and secula non-p o essional heale s),
-
he popula sec o ( amily membe s, medical laype sons),
-
he p o essional sec o (17).
The women conju ing an exan hema is an example o ac i i y in he
popula sec o ; buying balm om an i ine an deale , o o de ing a speci ic
om a quack a e in he olk sec o . These pa e ns may be called adi ional
ones, bu he e a e mode n elemen s wi hin hem: o ins ance, he quack
was con ac ed ia an ad e isemen in a newspape . The p o essional sec o
was used when a doc o was called o ea jaundice, and i was a nix u e
o he p o essional and o he popula sec o when B omme's s ep-son was
ea ed wi h biomedical and «na u al» he apeu ics.
In gene al, using he non-p o essional sec o s had wo di e en oo s:
adi ional medicine as pe o med in u al socie ies, and especially by i s
lowe classes; and adi ional die a y p ac ices as pe o med by he middle
(15)
Ibidem,
pp.
53, 43 ., 120 .
(16)
Ibidem,
pp.
108, 221, 233. Fo he na u e cu e socie ies see STOLLBERG, Gunna
(1988), Die Na u heil e eine im Deu schen Kaise eich.
A chi ü Sozialgeschich e,
28,
287-306; HERRMANN, Be nd (1990).
A bei e scha , Na u heilkunde und de Ve band
Volksgesundhei
(1880-1918),
F ank u a.M., Lang [Ma bu ge Sch i en zu
Medizingeschich e 271.
(17) KLEINMAN, A hu (1980).
Pa ien s and Heale s in he Con ex o Cul u e,
Be keley,
Uni e si y o Cali o nia P ess.

240
GUNNAR STOLLBERG
and uppe classes. Bo h adi ions may be a ibu ed o he popula sec o
o he heal h sys em, bil aspec s o he olk sec o may be ound he e, oo.
The choices o he sec o ook bo h o ensi e and de ensi e o ms: o
example,, o ensi e when he p o essional sec o was c i icized, and de ensi e
when i was simply oo expensi e.
We ind an o ensi e o m in Fe dinand Hanusch's au obiog aphy. The
au ho was a ex ile wo ke and a socialis who p opaga ed ade unionism;
he s emmed om a u al communi y in Aus ian Silesia. The au ho 's
b o he su e ed om a haemo hage in he 1860's and was b ough home,
whe e neighbou ing women c owded he house. One o hem sugges ed
sending o a doc o , bu a ag-picke p oposed sending o he p ies , and
made he mo he buy a a black dog. The son was o ea i s a and o be
co e ed wi h i s skin. Some days la e he could Iea e his bed again (18).
Ano he example o he o ensi e o m o using he popula sec o is
one o adi ional medicine. Wenzel Holek, a Bohemian socialis and
wo ke in se e a1 ac o ies, had an acciden as a young boy abou 1870
when helping his pa en s, who wo ked a a b ickwo ks, o build hei
house. When Wenzel's s a e wo sened, his mo he called o a woman who
collec ed he bs and unc ioned as a physician in he illage. She did no
cha ge he pa ien s, bu li ed as a begga . She examined Wenzel and said:
~Hum, oo much hea , ne ous e e , due o o e exe ionn. Then she
e u ned b inging he bs, b ead, and milk om he peasan s, and ins uc ed
his mo he how o use hese hings. Fo a long ime she isi ed he pa ien
once o wice a day, and Wenzel belie ed ha he owed his li e o he (19).
A
hi d example shows, again, ha adi ional medicine and he o ensi e
o n o using he popula sec o o he heal h sys em he e connec ed. The
Swiss mechanic Nicolaus Riggenbach wo ked in
a
ac o y in Pa is abou
1837 and was well known o his colleagues o being able o emo e g ains
o coa1 dus e c. om hei eyes. In his la e yea s he became an enginee
cons uc ing moun ain ailways. He p oudly old he s o y ha when his
cousin, who was a p o esso o su ge y in Basel, was isi ing a medical
cong ess in Ol en/ Swi ze land in he 1890's, he «disdained he help o al1
(18)
HANUSCH, Fe dinand
(1912).
Lazams
.
.
.
eine Jugendgeschich e,
Wien, Vo wa s
(pp.
50
.).
(19)
HOLEK, Wenzel
(1909).
1,ebensgang eines deu sch- schechischen Handa bei e s,
edi ed
by
Paul
GOHRE, Jena, Diede ichs
(p.
56).
Indus ializa ion
and
he Cons uc ion o
Heal h
Risks
24
1
his colleagues, and le he old mechanic pe o m su ge y upon him» o a
g ain in his eye
(20).
The de ensi e o m o using he non-p o essional sec o s o he heal h
sys em consis ed o he commen ha using p o essional aid was oo expensi e
o he pe son su e ing. Some imes he a gumen was combined wi h
elemen s o he o ensi e ype: physicians we e said o be expensi e and
incompe en , as an old Bal ic maid and u al wo ke lamen ed a he u n
o he cen u y:
NI
don' wan a doc o a al]; he can' help anyway. He quizzes me, and
hen he p esc ibes he medicine. He can soo he he pain, bu he can'
'help'. God is he bes physician
...
Besides he doc o cos s much
money
....
(21).
The de ensi e a gumen is gi en by F anz Louis Fische , a Saxonian
mine , in a pu e o m: he popula sec o unc ions as a compensa ion o
he expensi e p o essional one. This o m o a gumen anishes wi h he
sp eading o heal h insu ance among he wo ke s. Fische 's i h b o he
wo ked in a lime qua y and o en wen ishing in his ee hou s.
In
1876
he caugh a se ious cold when ishing.
«Fo inancia] easons i was absolu ely impossible o cal1 o a doc o a
ha ime. My mo he was called o , wbo knew he a o healing no by
heo y, bu al1 he mo e by p ac ica] s udies. She opened he case a
once, which con ained a g ea numbe o di e en bags illed wi h eas;
she ead he insc ip ions, pu some bags in o he .baske , and hu ied o
(20) RIGGENBACH, Nicolaus (1900).
E innemngen eines al en Mechanike s,
Basel, Reich
(p. 10). Simila abili ies o bel make s and o me al wo ke s, especially o la he
ope a o s, we e p aised by con empo a y Physicians:
c .
COHN,
H.
(1868). Uebe
das Vo kommen on Auge i e le zungen bei Me alla bei e n und übe eine neue
A on Schu zb illen. Nach Un e suchungen an 1283 B eslaiiei- ~ah ika bbi ~ cl.
Be line klinische Wochensch i ,
Feb. 24 h, 87-91; KOBLANK
(
1
X.5li).
Vo lau ige
Beme kungen zu Physiognomik de e schiedenen Handwe ke uiid
zu
de en
Pa hologie und The aphie.
Adol Henkes Zei schn l]ü die S aa sa zneikunde,
E langen,
11-21.
(21) MOSZEIK, C. (1909).
Aus de Gedankenwel eine A bei m au. Von ih selbs enahl ,
Be lin, Runge (pp. 11 1
).
242
GUNNAR STOLLBERG
help he son. She lowe ed his e e wi hin a sho ime, bu he ne e
eco e ed againn
(22).
A
di e en o m o he de ensi e a gumen appea s in he employmen
o bo h physicians as well as o heale s in he cou se o lo ige las ing and
ch onic diseases. This was he case wi h B omme's jaundice; and he Swiss
ex ile wo ke Ve ena Conze (who ma ied he edi o o a socialis jou nal
and became a socialis publishe he sel ) old ha he a he , who wo ked
as an a endan in a pape - ac o y, go an eyedisease in 1874:
*He was ea ed by a compe en eye specialis , bu his sigh became
wo se. We mo ed o a house ou side he own (Zu ich; G.S .) in o de o
>
pay less o li ing, o we had o expec ou a he would go absolu ely
blind. The disease became wo se, and in his despe a ion my a he did
no con ac he physician any mo e, bu used d ugs p esc ibed by di e en
quacks. They we e ine ec i e, oo, and my a he los his sigh , as we had
ea ed be o e.
(23).
.
Conze 's au obiog aphy also shows ha con ac s o physicians became
equen and egula in la e decades. When he child e i su e ed om
yphoid e e , hei mo he ea ed hem s ic ly acco ding o he ins uc ions
gi en by he physician: hey go no solid ood, and a se back was a ibu ed
o an o ence commi ed by hei a he (24).
F anz Louis Fische used a pa o he de ensi e a gumen a ion in
ano he con ex simila o ha o Conze : he accep ed his medicaliza ion,
hough i was expensi e. His son su e ed om a disease in 1882, which was
diagnosed as « lux» by he doc o , and his he apeu ic ins uc ions we e
s ic ly ollowed, hough he emigh ha e had li le expe ience wi h he
inancia1 si ua ion o a wo ke )) (25).
4. Since 1845/ 1854 social policy obliged many wo ke s in P ussia o
join sick unds. In 1884 al1 a isans and indus ial wo ke s in he Ge man
(22) FISCHER, F anz
L.
(1906).
A bei e schicksak,
edi ed
by
F ied ich NAUMANN, Be lin,
Hil e (p. 95).
(23) CONZETT, Ve ena (1929).
E s eb es
und
E leb es. Ein S ück Lei geschich e,
Leipzig,
Zü ich, G e hlein
(p.
51).
(24)
Ibidem,
p. 206.
(25) FISCHER (1906),
09.
ci .
(n.
22),
p.
132.
l
Indus ializa ion and he Cons uc ion
o
Heal h Risks
243
E npi e we e obliged o do so. They had o see a doc o , when hey wan ed
o ecei e any help om he unds. The panel doc o «has a double ole,
he is a he apis and an expe wi ness o he goals o he und a he same
ime, he is a he apis and an au ho i . o con ol»
(26).
This momen o wo ke s' medicaliza ion a ec ed hei li e-wo lds. Thus
i is no o ou su p ise ha wo ke s accep ed he doc o s only slowly and
pa ially. E en mode n physicians and medical sociologis s c i ize wo ke s'
compliance as de icien
(27).
The accep ance was slow because o adi ional
ese a ions, which a e epo ed in he au obiog aphies. Nikolaus Os e o h's
mo he dis us ed he panel doc o because he was a p o es an . She
p o ided he son wi h a pi che illed wi h wa e om Lou des and asked
he husband o send he he e ical doc o away, and o cal1 o a ca holic
one a he amily's expense. Bu he a he e used o do so
(28).
The panel doc o s' oad o accep ance becomes e iden in he au obiog aphy
o a young woman who wo ked in indus y and as a wai ess: in he 1880's,
he mo he sen o
a
doc o a he amily's cos when he a he was
b ough home su e ing om an acciden . The au ho 's b o he was hu
and he li le sis e b oke he a m a ew days la e , so he poo -doc o was
called o . The mo he had ied o a long ime o pe suade he husband
(26)
GOCKENJAN
(1985),
op. ci .
(n. 9), p. 354.
(27) SCHMADEL,
D.
(1979). Nich be olgung i z liche Ve o dnungen.
Zn:
SIEGRIST,
Johannes; HENDEL-KRAMER, Anneliese (eds.),
Wege zum An ,
München, U ban
und Schwa zenbe g, pp. 139-171. Wo king-class women a e scep ical abou d ugs
p esc ibed by doc o s: CALNAN, Michael (1988). Lay E alua ion o Medicine and
Medical P ac ice: Repo o a Pilo S udy.
In ma ional Jou nal o Heal h Se uices,
18,
311-322. The wo ke s' con idence in he medical sys em is adi use.: GRUNOW,
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(28) OSTERROTH, Nikolaus (1980).
Vom Be e zum Kamp e ,
Be lin, Bonn, Die z (o ig. 1920),
(p. 47). The au ho s emmed om a illage si ua ed close o T ie and wo ked a
b ickwo ks e c. He beca ne a sociaiis . The denomina ional ese a ions may be in e p e ed
as being pa o adi ional ese~a ions: he physician was no p ima ily seen as a
p o essional, bu non-p o essional elemen s we e judged o be mo e impo an han
p o essional ones. The p o es an physician was seen as a s ange who did no belong o
he denomina ional ing oup, despi e his p o essional quali ies.