Subjects on paper

Internal medicine in Germany, 1890-1960

The project of Alexa Geisthövel investigates relations between medical paper technology and modern subjectivity. On the level of ideas this refers to conceptualizing the sick individual as a “personal whole” and appreciating the patient’s subjective view of disease as a key to diagnosis and healing. On the level of practice the intersection of doctor-patient-interaction and performances of subjectivity (patients’ as well as physicians’) will be discussed.

Around 1900 scientifically trained clinicians started to criticize a medical practice that disregarded the sick individual because it focused on causal uniformity of organic functions. It was considered crucial to reinstall the patient as a “whole person” with at least some relevant knowledge about him/herself. Understanding differences between patients would enable physicians to understand the emergence and course of an affection in the first place. The investigation is bound to show how these objectives were translated into practice, as far as can be inferred from patient records, scientific publications, or privates notes.

The research outlook does not include the ethical question of “humaneness” of medicine. Moreover the project aims at placing the concept of “patient medicine” within 20th century cultures of knowledge. On the one hand, the urge to acknowledge the “wholeness” of a sick individual seems to reflect increased complexity awareness.
In the life sciences a major step to complexity was the notion of systemic self-regulation of organisms. In this line of argument patient treatment meant influencing the self-regulatory processes from different angles (bodily functional systems, the unconscious, the conscious) without effects being completely predictable. Educating the patient for self-guidance was declared a major goal of doctor-patient-interaction.
Secondly, especially after WW I sickness became a question of individual work ability. Physicians learned to treat medical cases as insurance cases, linking clinical paper technologies to welfare state governance. The project asks how this changed clinical processes, how it challenged physicians’ self-perception and helped to shape therapeutic innovation.

The project focusses on the neurological department of Heidelberg medical clinic, headed by Viktor von Weizsaecker, a well-known theorist of „anthropological“ or „biographical“ medicine. The department’s patient records have survived and include a large number of „Gutachten“ (expert assessments) for social insurers.