Medizin im Brief. Der städtische Arzt des 18. Jahrhunderts im Spiegel seiner Korrespondenz


he traces back to the interwar years. And he looks at the controversies swirling around the proposed use of sterilization as a "solution" to the problem of mental deficiency, essaying some comparative references to the development of social policy in this area in France, Germany, and the United States. Inevitably, Thomson's approach, which involves repeated traverses of the same territory from a range of starting points, creates a certain degree of repetition and redundancy in the discussion. My own copy of the text was also marred by the shoddy technical quality of the book: ink bleeding through from one page to another made portions hard to read, and copy-editing lapses gave further evidence of a carelessness I find reprehensible in a publisher as distinguished as the Clarendon Press. These are genuine annoyances and deficiencies, but they are offset by a number of virtues. In the first place, Thomson's attempt to place policy towards mental deficiency within a broader context of the development of the Welfare State is largely successful. In an area ripe for sensationalism, his discussions of such issues as the social roots of support for sterilization or the relations between gender, sexual activity, and certification as feeble minded are reassuringly balanced, detailed, and sensible. The monolithic models others have sought to deploy in polemics on these subjects fare poorly when confronted with detailed data-which is not to imply that Thomson shies away, for example, from discussing the reasons for the over-representation of females in the ranks of the mentally defective or is sparing of those who could refer unblushingly to his subjects as "human vermin" who "crawl about, doing absolutely nothing, except polluting and corrupting everything they touch" (quoted p. 43). Valuable, too, is Thomson's demonstration of the tendency of professionalization to lead to neglect of the most gravely disabled, and a migration to the margins, where more treatable cases might be found-a point that echoes one of Gerald Grob's claims about the proclivities of twentieth-century American psychiatry. Professionals operating in this arena had a particularly difficult time of it, for as Thomson points out, psychiatrists had problems legitimizing their role in the care of the mentally defective-who were by definition incurable-and those who elected (or where sentenced) to practise in this area found themselves in "a residual and stagnating area of the welfare system" that threatened to leave them "trapped in the incarceral mode of the past" (pp. 97, 98). Their dilemmas and difficulties are usefully illuminated, as are the tensions that arose between volunteers in this sector and the emerging generation of professionally trained social workers. Noteworthy, too, is a trenchant chapter on the fate of the mentally defective under the Welfare State, with the growing tendencies to differentiate "between high-priority and wellresourced services for the curable, and a continuing decay and neglect of services for the incurable and chronic" (p. 293) having obviously deleterious consequences for this vulnerable population. In sum, this generally well written monograph is a welcome addition to a somewhat sparse literature.

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@article{Maehle1999MedizinIB, title={Medizin im Brief. Der st{\"a}dtische Arzt des 18. Jahrhunderts im Spiegel seiner Korrespondenz}, author={Andreas-Holger Maehle}, journal={Medical History}, year={1999}, volume={43}, pages={528 - 529} }