Professional Medicine and the Working Classes in Imperial Germany

One of the outstanding features of modem industrial societies is the gradual but steady extension of social security systems. Following the rapid industrialization of the nineteenth century, programmes of social reform and welfare designed to mitigate its sometimes disastrous effects were set up in most European countries. As traditional networks of social assistance and support had been seriously weakened or even swept away by the tide of industrial progress and urbanization, new schemes and institutions were needed to fill the gap. The political-administrative system thus tried to establish and extend forms of social security which met the demands of an expanding labour force and, at the same time, stabilized the system of industrial production and social organization. In Germany, the pace of industrialization accelerated in the second half of the nineteenth century, but the state reacted comparatively quickly to the social problems caused or aggravated by economic and social change. Beginning in the 1840s, in Prussia, a programme of social legislation was begun, aimed at encompassing more and more sections of the working classes. Insurance schemes covering sickness, accidents at work, invalidity and old age, were introduced on a compulsory basis in the 1880s. Supplemented in the 1920s by unemployment insurance, this system was gradually improved and extended, until today about 90 per cent of the West German population is entitled to the benefits of the various insurance schemes. Although social inequality has never ceased to exist, its worst features have been softened by social legislation and the effects of redistribution. This can best be seen in the case of sickness insurance, which brought about a rapid medicalization of society allied to a gradual equalization of life expectancy in all social strata. In this respect, 'medicalization' a term coined by Michel Foucault2 means a complex process involving not only the extension and improvement of medical services and health institutions, but also the spread of a 'somatic culture', shaped and controlled by an increasingly

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