Industrialización and the construction of health risks in german workers' autobiographies from the late 19th and early 20th centuries

Industrialization and the Construction of Health Risks in German Workers' Autobiographies from the Late 19th and Early 20th Centuries GUNNAR STOLLBERG (*) (1) RESUMEN El proceso de industrialización produjo rápidos cambios en los modos de trabajo y de vida de los trabajadores, pese a lo cual en sus formas de vida conservaron creencias y actitudes tradicionales. Por lo que respecta a la salud y la enfermedad, estas creencias tradicionales se evidencian mediante este trabajo a través de las autobiografías de trabajadores. Estos, con el trascurso del tiempo llegaron a aceptar a los médicos del seguro. Por su parte, las medidas de seguridad social permitieron a los médicos el acceso al mundo obrero. Los trabajadores ni aceptaron simple o tácitamente la medicalización, ni se opusieron a la expansión del poder social de los médicos, únicamente interpretaron los riesgos sanitarios como parte de su forma de vida y no como resultado de los cambios sociales que estaban teniendo lugar en todas las esferas. 1. Industrialization brought about new health dangers and risks. These resulted from increasing population, from urbanization, and from the use of new materials and techniques, al1 of which were poignant features of the industrialization. These changes resulted from societal decisions, which were implemented by entrepreneurs: to promote the wealth of nations (Adam Smith), to make its material sources flow abundantly (Marx), to Fecha de aceptación: 21 de septiembre de 1992. (*) Fakultat fur Soziologie. Universitat Bielefeld. Postfach 10 01 31. DW4800 Bielefeld 1. Alemania. (1) Jeff Olick helped with the translation. Gerd Gockenjan commented upon an earlier version of this paper. DYNAMIS Acta Hzspanzca ad Medzcinae Scientzarumque Histonam Zllustrandam. Vol. 13, 1993, pp. 235-246. ISSN: 021 1-9536 236 GUNNAR STOLLBERG make society an expanding system of expanding needs (Hegel) etc. Modern sociologists distinguish between dangers - which result from nature - and risks - which result from societal decisions (2). Being the results of ' societal decisions, these features of industrialization are thus risks. As such, they were differentially experienced and opened different points of view to both the decision-makers and the people affected. Industrialization brought about changes in the world of work, in the worlds of workers: there was a shift from artisan to industrial modes of production; an increasing irnportance of machines in the process of work; changes of skills etc. The lifeworlds changed, too; these changes included urbanization, move to smaller households, new forms of families etc. Peter Berger and others have demonstrated that quick changes in work and life-world produce a «homeless mind» (3). Workers' control over the worlds of their work rapidly diminished in the course of industrialization. Thus they were urged to preserve traditional beliefs and attitudes in their life-worlds, which shaped a «heme» of their minds. 2. A connection between artisans' work and health risks has been hypothesized since early modern times. This connection was renewed by industrial medicine in the second half of the 19th century (4). Socialist physicians imparted these debates to socialist workers' organizations (5). But this discourse can scarcely be found in workers' autobiographies. Jens Lachmund and 1 read some 700 German autobiographies stemming from al1 social strata and covering the time from ca. 1780 to ca. 1930. We scanned them for descriptions of aspects and episodes of health and illness. There are only a few autobiographies written by artisans and workers before 1880, but some 250 have been published from ca. 1880 to ca. 1930. (2) LUHMANN, Ni$las (1991). Soziologie des Risikos, Berlin/New York, de Gruyter. (3) BERGER, Peter L.; BERGER, Brigitte; KELLNER, Hansfried (1973). The Homeless Mind. Modernization and Consciousness, New York, Vintage. (4) Cfr. MILLES, Dietrich; MULLER, Rainer (eds.) (1985). Berufsarbeit und Krankheit, Frankfurt, New York, Campus. (5) LABISCH, Aifons (1981). Das Krankenhaus in der Gesundheitspolitik der deutschen Sozialdemokratie vor dem Ersten Weltkrieg. Medizinische Soziologie, 1, 126-151; TENNSTEDT, Horian (1983). Vom Proleten zum Zndustriearbeitm. Arbeitmbewegung und Sozialpolitik in Deutschland 1800 bis 1914, Koln, Bund (pp. 455 ff.). Industrialization and the Construction of Health Risks 237 1 This literary genre generally constructs individuality and individual success. It was renewed by Rousseau's «Cbnfessions», which not only formed a new eepisoden in the history of the genre (6), but became a model for the genetic autobiography produced by the middle classes (7). Workers' autobiographies are determined by the characteristics of the genre, as well. New discourses were introduced - e.g. of poverty, of artisans' honour, and of socialism and socialist utopias. But collective experiences and constructions of collective identities can scarcely be found. dt cannot be denied that collective connections of sense and selfdefinitions play an important role in some autobiographies ... But always an individual self-perception precedes the collective one: the idea that the person and the career of one's own form a relevant unit. (8). 3. The workers adopted central elements from the middle-class discourse of health and illness from the late 18th century in constructing images of health and its risks (or dangers - the decisions, which risked industrial damage, had been made by others). These elernents included the individualist perspective on health: the latter thus resulted from personal success in preseMng controllable («willkürliche») health, which could be contrasted to the sickly noblesse of the nobility on the one hand, and to the «natural» health of the peasants, on the other hand (9). Kant had even discussed the right and the corresponding duty to gain or preserve health (10). Workers preserved many traditional features in their attitudes and (6) SPENGEMANN, William C. (1980). The Forms of Autobiography. Episodes in the Histoly ofa Literaly Genre, New Haven, London, Yale. (7) GUMBRECHT, HansUlrich (1981). Lebenslaufe, Literatur, Alltagswelten. Zn: MAlTHES, Joachim; PFEIFENBERGER, Arno; STOSBERG, Manfred (eds.), Biogrghie in handlungswissenschaftlicher Perspektive, Nürnberg, Nürnberger Forschungsvereinigung (pp. 231-250); SLOTERDIJK, Peter (1978). Literatur und Olganisation von &ebme$ahmng. Autobiographien der Zwanziger Jahre, München, Hanser (p. 17). (8) BERGMANN, Klaus (1991). Lebensgeschichte ak Appell: autobiopaphische Schriften der «kbinen Leutea und Aubenseiter, Opladen, Westdeutscher Verlag (p. 81). (9) GOCKENJAN, Gerd (1985). Kurieren und Staat machen, Frankfurt, Suhrkamp (pp. 64 ffl . (10) KANT, Immanuel (1964). Der Streit der Fakultaten. Zn: Werke, edited by Wilhelm WEISCHEDEL, Darmstadt, Wissenschaftliche Buchgesellschaft, vol. 9 ( p. 371). 238 GUNNAIZ STOLLBERG behaviour towards health and illness. This corresponded firstly to the attribution and assignment of health and illness to their life-worlds; secondly to the individualizing perspective of the autobiographical genre; thirdly to the individualizing perspective of curative medicine in general (1 1); fourthly to the wariety of workers' existence~ during the 19th century: this last refers to the fact that there was no homogeneity of life and work conditions i for the greater part of the working classes (12). 1 shall now demonstrate some patterns of workers' medical culture (13), drawing upon the autobiography of Moritz Bromme. It was «edited» by the protestant parson Paul Ghre in 1905, who may have influenced its constniction in general, and that of health and illness, in particular: for instance, Gohre aremoved al1 that turned out to be nothing but a critique of the establishment» in the chapter about a sanatorium (14). Bromme's father stemmed from a rural background and worked during the last decades of the 19th century as a railway-worker in Sachsen-Altenburg (Mid Germany). He was an active member of the Social Democratic Party even during its repression from 1878 to 1890, and a local cashier of the joiners' centralised sick and burial fund. Though thus participating in the formal health system, he bought a balm from an itinerant dealer to treat his son's dropsy, and tolerated his wife and his mother conjuring an exanthema and lice. When he fe11 ill with jaundice, and the doctor could not help him, his family read an advertisement in the newspaper and (11) Cfr. GOCKENJAN, Gerd (1985). Gesundheit und Arheit - Untersuchungen zur Frage, wie Konflikte verschwinden'. In: NASCHOLD, Frieder (ed.), Arbeit und Politik, Frankfurt, New York, Campus (pp. 305-337). (12) KOCKA, Jürgen (1983). Lohnarbeit und Klassenbildung, Berlin, Bonn, Dietz. (13) For the term see LACHMUND, Jens; STOLLBERG, Gunnar (1989). Zur medikalen Kultur des Bildungsbürgertums um 1800: Eine soziologische Analyse anhand von Autobiographien. Jahrbuch des Instituts für Geschichte der Medizin der Robert-BoschStijtung, 6, 163-185. .Cfr. ALBER, Wolfgang; DORNHEIM, Jutta (1983). ~Die Fackel der Natur vorgetragen mit Hintansetzung alles Aberglaubensa: Zum Entstehungsprozeb neuzeitlicher ~orhs~steme im Bereich medikaler Kultur. Zn: HELD, Jutta (ed.), Kultur zwischen Bürgertum und Volk, Berlin, Argument (pp. 163-181). «Somatic culture.: see BOLTANSKI, Luc (1976). Die soziale Verwendung des Korpers. In: KAMPER, Dietmar; RITTNER, Volker (eds.), Zur Geschichte des Korpers, Wien, Hanser (pp. 138183). (14) BROMME, Moritz Theodor William (1905). Lebensgeschichte eines modenzen Fabrikarbeiters, edited by Paul GOHRE (1971), Frankfurt, Athenaum (Introd. p. XI). Industrialization and the Construction of Health Risks 239 ordered a specific from a quack, which was very expensive and did not help at a11 (15). Moritz Bromme himself did not contact a doktor after being injured in an accident at work because he was afraid of the surgical sewing. When his step-son fe11 ill, biomedical and «natural» therapeutics were used, and Bromme tells us the story of a colleague in a factory at Gera who drank no alcohol, ate no meat and was a member of a nature cure society (16). Bromme himself was treated for his tuberculosis in hospitals and died at 33 years of age. Bromme's patterns may be interpreted as forming transitions from traditional to modern forms of behaviour, which use al1 the three sectors of the health system: 1 follow Arthur Kleinman in dividing that system into - the folk sector (religious and secular non-professional healers), - the popular sector (family members, medical laypersons), - the professional sector (17). The women conjuring an exanthema is an example of activity in the popular sector; buying balm from an itinerant dealer, or ordering a specific from a quack are in the folk sector. These patterns may be called traditional ones, but there are modern elements within them: for instance, the quack was contacted via an advertisement in a newspaper. The professional sector was used when a doctor was called to treat jaundice, and it was a rnixture of the professional and of the popular sector when Bromme's step-son was treated with biomedical and «natural» therapeutics. In general, using the non-professional sectors had two different roots: traditional medicine as performed in rural societies, and especially by its lower classes; and traditional dietary practices as performed by the middle (15) Ibidem, pp. 53, 43 f., 120 f. (16) Ibidem, pp. 108, 221, 233. For the nature cure societies see STOLLBERG, Gunnar (1988), Die Naturheilvereine im Deutschen Kaiserreich. Archiv für Sozialgeschichte, 28, 287-306; HERRMANN, Bernd (1990). Arbeiterschaft, Naturheilkunde und der Verband Volksgesundheit (1880-1918), Frankfurt a.M., Lang [Marburger Schriften zur Medizingeschichte 271. (17) KLEINMAN, Arthur (1980). Patients and Healers in the Context of Culture, Berkeley, University of California Press. 240 GUNNAR STOLLBERG and upper classes. Both traditions may be attributed to the popular sector of the health system, bilt aspects of the folk sector may be found here, too. The choices of the sector took both offensive and defensive forms: for example,, offensive when the professional sector was criticized, and defensive when it was simply too expensive. We find an offensive form in Ferdinand Hanusch's autobiography. The author was a textile worker and a socialist who propagated trade unionism; he stemmed from a rural community in Austrian Silesia. The author's brother suffered from a haemorrhage in the 1860's and was brought home, where neighbouring women crowded the house. One of them suggested sending for a doctor, but a rag-picker proposed sending for the priest, and made the mother buy a fat black dog. The son was to eat its fat and to be covered with its skin. Some days later he could Ieave his bed again (18). Another example of the offensive form of using the popular sector is one of traditional medicine. Wenzel Holek, a Bohemian socialist and worker in severa1 factories, had an accident as a young boy about 1870 when helping his parents, who worked at a brickworks, to build their house. When Wenzel's state worsened, his mother called for a woman who collected herbs and functioned as a physician in the village. She did not charge her patients, but lived as a beggar. She examined Wenzel and said: ~Hum, too much heat, nervous fever, due to overexertionn. Then she returned bringing herbs, bread, and milk from the peasants, and instructed his mother how to use these things. For a long time she visited her patient once or twice a day, and Wenzel believed that he owed his life to her (19). A third example shows, again, that traditional medicine and the offensive forrn of using the popular sector of the health system here connected. The Swiss mechanic Nicolaus Riggenbach worked in a factory in Paris about 1837 and was well known to his colleagues for being able to remove grains of coa1 dust etc. from their eyes. In his later years he became an engineer constructing mountain railways. He proudly told the story that when his cousin, who was a professor of surgery in Basel, was visiting a medical congress in Olten/ Switzerland in the 1890's, he «disdained the help of al1 (18) HANUSCH, Ferdinand (1912). Lazams . . . eine Jugendgeschichte, Wien, Vorwarts (pp. 50 ff.). (19) HOLEK, Wenzel (1909). 1,ebensgang eines deutsch-tschechischen Handarbeiters, edited by Paul GOHRE, Jena, Diederichs (p. 56). Industrialization and the Construction of Health Risks 24 1 his colleagues, and let the old mechanic perform surgery upon him» for a grain in his eye (20). The defensive form of using the non-professional sectors of the health system consisted of the comment that using professional aid was too expensive for the person suffering. Sometimes the argument was combined with elements of the offensive type: physicians were said to be expensive and incompetent, as an old Baltic maid and rural worker lamented at the turn of the century: NI don't want a doctor at al]; he can't help anyway. He quizzes me, and then he prescribes the medicine. He can soothe the pain, but he can't 'help'. God is the best physician ... Besides the doctor costs much money .... (21). The defensive argument is given by Franz Louis Fischer, a Saxonian miner, in a pure form: the popular sector functions as a compensation for the expensive professional one. This form of argument vanishes with the spreading of health insurance among the workers. Fischer's fifth brother worked in a lime quarry and often went fishing in his free hours. In 1876 he caught a serious cold when fishing. «For financia] reasons it was absolutely impossible to cal1 for a doctor at that time. My mother was called for, wbo knew the art of healing not by theory, but al1 the more by practica] studies. She opened her case at once, which contained a great number of different bags filled with teas; she read the inscriptions, put some bags into her .basket, and hurried to (20) RIGGENBACH, Nicolaus (1900). Erinnemngen eines alten Mechanikers, Basel, Reich (p. 10). Similar abilities of belt makers and of metal workers, especially of lathe operators, were praised by contemporary Physicians: cfr. COHN, H. (1868). Ueber das Vorkommen von Augeriverletzungen bei Metallarbeitern und über eine neue Art von Schutzbrillen. Nach Untersuchungen an 1283 Breslaiiei- ~ahrikarbbit~rcl. Berliner klinische Wochenschrift, Feb. 24th, 87-91; KOBLANK ( 1 X.5li). Vorlaufige Bemerkungen zur Physiognomik der verschiedenen Handwerker uiid zu deren Pathologie und Theraphie. AdolfHenkes Zeitschnfl]ür die Staatsarzneikunde, Erlangen, 11-21. (21) MOSZEIK, C. (1909). Aus der Gedankenwelt einer Arbeitmfrau. Von ihr selbst enahlt, Berlin, Runge (pp. 11 1 f). 242 GUNNAR STOLLBERG help her son. She lowered his fever within a short time, but he never recovered againn (22). A different form of the defensive argument appears in the employment of both physicians as well as of healers in the course of loriger lasting and chronic diseases. This was the case with Bromme's jaundice; and the Swiss textile worker Verena Conzett (who married the editor of a socialist journal and became a socialist publisher herself) told that her father, who worked as an attendant in a paper-factory, got an eyedisease in 1874: *He was treated by a competent eye specialist, but his sight became worse. We moved to a house outside the town (Zurich; G.St.) in order to \> pay less for living, for we had to expect our father would go absolutely blind. The disease became worse, and in his desperation my father did not contact the physician any more, but used drugs prescribed by different quacks. They were ineffective, too, and my father lost his sight, as we had feared before. (23). . Conzett's autobiography also shows that contacts to physicians became frequent and regular in later decades. When her childreri suffered from typhoid fever, their mother treated them strictly according to the instructions given by the physician: they got no solid food, and a setback was attributed to an offence committed by their father (24). Franz Louis Fischer used a part of the defensive argumentation in another context similar to that of Conzett: he accepted his medicalization, though it was expensive. His son suffered from a disease in 1882, which was diagnosed as «flux» by the doctor, and his therapeutic instructions were strictly followed, though he emight have had little experience with the financia1 situation of a worker)) (25). 4. Since 1845/ 1854 social policy obliged many workers in Prussia to join sick funds. In 1884 al1 artisans and industrial workers in the German (22) FISCHER, Franz L. (1906). Arbeiterschicksak, edited by Friedrich NAUMANN, Berlin, Hilfe (p. 95). (23) CONZETT, Verena (1929). Erstrebtes und Erlebtes. Ein Stück Leitgeschichte, Leipzig, Zürich, Grethlein (p. 51). (24) Ibidem, p. 206. (25) FISCHER (1906), 09. cit. (n. 22), p. 132. l Industrialization and the Construction of Health Risks 243 Ernpire were obliged to do so. They had to see a doctor, when they wanted to receive any help from the funds. The panel doctor «has a double role, he is a therapist and an expert witness for the goals of the fund at the same time, he is a therapist and an authorit. of control» (26). This moment of workers' medicalization affected their life-worlds. Thus it is not to our surprise that workers accepted the doctors only slowly and partially. Even modern physicians and medical sociologists critize workers' compliance as deficient (27). The acceptance was slow because of traditional reservations, which are reported in the autobiographies. Nikolaus Osterroth's mother distrusted the panel doctor because he was a protestant. She provided her son with a pitcher filled with water from Lourdes and asked her husband to send the heretical doctor away, and to cal1 for a catholic one at the family's expense. But the father refused to do so (28). The panel doctors' road to acceptance becomes evident in the autobiography of a young woman who worked in industry and as a waitress: in the 1880's, her mother sent for a doctor at the family's cost when the father was brought home suffering from an accident. The author's brother was hurt and her little sister broke her arm a few days later, so the poor-doctor was called for. The mother had tried for a long time to persuade her husband (26) GOCKENJAN (1985), op. cit. (n. 9), p. 354. (27) SCHMADEL, D. (1979). Nichtbefolgung irztlicher Verordnungen. Zn: SIEGRIST, Johannes; HENDEL-KRAMER, Anneliese (eds.), Wege zum Ant, München, Urban und Schwarzenberg, pp. 139-171. Working-class women are sceptical about drugs prescribed by doctors: CALNAN, Michael (1988). Lay Evaluation of Medicine and Medical Practice: Report of a Pilot Study. Intmational Journal of Health Seruices, 18, 311-322. The workers' confidence in the medical system is adiffuse.: GRUNOW, Dieter (1979). Einstellungen und Erwartungen der Bürger irn Hinblick auf Fragen und Instanzen der Gesundheitssicherung. Zn: HEGNER, Friedhart (ed.), Bürgernahe, Sozialbürgerrolle und sozzale Aktion, MS Bielefeld [Schriftenreihe d. Forschungsgruppe Sozialplanung u. Sozialverwaltung, 51; cfr. GROSS, Peter; HITZLER, Ronald; HONER, Anne (1985). Zwei Kulturen? Diagnostische und therapeutische Kompetenz im Wandel. ~sterreichische Zeitschrift J: Soziologie, 10, 146-162. (28) OSTERROTH, Nikolaus (1980). Vom Beterzum Kampfer, Berlin, Bonn, Dietz (orig. 1920), (p. 47). The author stemmed from a village situated close to Trier and worked at brickworks etc. He becarne a sociaiist. The denominational reservations may be interpreted as being part of traditional rese~ations: the physician was not primarily seen as a professional, but non-professional elements were judged to be more important than professional ones. The protestant physician was seen as a stranger who did not belong to the denominational ingroup, despite his professional qualities.