Vom Hospital zum Krankenhaus: Zum Umgang mit psychisch und somatisch Kranken imfrühneuzeitlichen Europa by Carlos WatzkaReview by: Ulrike WiethausThe Sixteenth Century Journal, Vol. 39, No. 4 (Winter, 2008), pp. 1128-1130Published by: The Sixteenth Century JournalStable URL: http://www.jstor.org/stable/20479153 .

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1128 Sixteenth Century Journal XXXIX/4 (2008)

Vom Hospital zum Krankenhaus: Zum Umgang mit psychisch und somatisch Kranken im friihneuzeitlichen Europa. Carlos Watzka. Cologne: B6hlau, 2005. 385 pp. E42.90. ISBN 978-3-412-25205-2.

REVIEWED BY: Ulrike Wiethaus, Wake Forest University

The basis for Watzka's analysis of early modern care for mentally and physically ill patients is the author's dissertation, a detailed study of the treatment of mental illness in the Steiermark, "Soziologie und Sozialgeschichte der psychisch Kranken in der neuzeitlichen Steiermark. Eine Studie zu bislang unzureichend beachteten Formen des institutionellen Umgangs mit dem 'Irrsinn"'; later published as Arme, Kranke, Verruckte. Hospitdler und Krankenhduser in der Steiermark vom 16. bis zum 18. Jahrhundert und ihre Bedeutungfur den Umgang mit psychisch Kranken (Graz: Landesarchiv, 2004). The core of Watzka's work relies on archival documents from the convent of the Barmherzige Bruider in Graz; its local specificity is harnessed to challenge Michel Foucault's thesis of the criminalization, institu tionalization, and marginalization of mentally ill persons in the early modern period (cf. Histoire de la folie, [1961]). Foucault's thesis is part of a wider mythos of the brutality and incompetence with which premodern "folk medicine" treated mentally ill persons, incar cerating them and endangering their lives through a variety of treatments. In terms of crim inal punishments per se in early modern Austria, Watzka finds a predominance of "soft disciplinary measures" (324) that rarely impacted personal autonomy. Institutionalized sur veillance and cruelty were reserved for only the most severe criminal cases.

Watzka situates the traumatic cultural change in the treatment of mental illness in late eighteenth- and early nineteenth-century social settings where a secular medical class, aligned with and dependent upon a centralized, authoritarian government, increasingly delimited its sphere of influence from religious institutions of healing. He asserts that insti tutionalized violence against the mentally ill to the point of their social and physical anni hilation has been more common in the modern era than in the preceding centuries (327). Not to paint an overly rosy picture of premodern compassion, medical competence, and respect for the ill, however, Watzka can trace an increasing willingness to use violent means for healing mental illness, so for example the near drowning of manic patients beginning in the seventeenth century (52).

For most of Europe during the early modern period, however, mentally ill persons enjoyed remarkable autonomy, multiple choices of diagnosis and treatment, and stability in their social role and status. The author suggests that such widespread early modern practice is confirmed by a linguistic comparison of learned and vernacular definitions of mental ill ness: although Latinate and Greek medical terminologies, following Galen, are remarkably nuanced to identify varied manifestations of the three main categories, melancholia, mania, and phrenitis, German vernacular vocabulary offers comparatively few designations, with the more euphemistic terms reserved for wealthier subjects. German vernacular terminol ogy roughly corresponds to four symptom categories of mental illness: timid-depressive, bizarre-expansive, vehemently aggressive, and reduced mental ability (25). Demonic pos session constituted its own symptomatic class, a diagnosis with fluid demarcations as well.

Watzka offers a brief excursus on the question whether persons accused of witchcraft were mentally ill. He concludes that although it seems likely that mentally ill men and women were overrepresented in the number of those accused of witchcraft, the majority of the accused were neither identified nor self-identified as mentally ill-at least before the appli cation of torture and prolonged incarceration. Early modern medical etiologies of mental illness, according to the author, were "surprisingly modern" (49), with somatic causes more

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Book Reviews 1129

frequently diagnosed than psychodynamic causes. Originating as houses for pilgrims in early Christianity, hospitals were from their

inception linked to monastic institutions, with several orders specializing in the care of the sick. Medieval and early modern hospitals were multifunctional, housing and caring for the poor and indigent, the physically ill, mentally ill clients, and the old; as such, they lacked the differentiated and perhaps more discriminatory functions of institutionalized care in the modern era. Divisions occurred only in terms of gender by assigning separate rooms or wings of a hospital building to women and men, and by the choice of location at the margins of a settlement to minimize the danger of infectious diseases.

Watzka's study is organized into the following sections: an introduction circumscribes the scope of the study's focus and position vis-a-vis Foucault's thesis. Parts 2 and 3 offer an overview of mental illness and the care of mentally ill patients in early modern Europe; sec tions 4, 5, and 6 analyze and evaluate in great detail health care delivery by the Order of the Barmherzige Briider in the Steiermark and in Graz in particular. Sections 7 through 9 con tain extensive bibliographical references, maps and illustrations, and the index.

In the year 1700, the order of the Barmherzige Brider managed 180 hospitals dedi cated to the cure of mental and physical illness and the care of the old and poor, with a capacity of approximately 1,200 beds. Health care delivery was remarkably well organized and competent, and communal support for financing the hospitals was steady and gener ous. The majority of patients diagnosed as mentally ill were released after an average hospi tal stay of several weeks. They lived together with other hospital inhabitants (the poor, physically sick, and old), enjoyed half the mortality rate of somatically ill clients, and even tually were diagnosed as cured.

Watzka's work is fascinating and thoroughly researched. Its strength lies in the detailed analysis of archival records and the effort to articulate a well-argued response to Foucault's theses. I especially appreciate the author's insistence on an ethically reflective approach to past generations who are voiceless and whose remembrance is utterly dependent upon the contemporary researcher's interpretation. What will have to wait for further analysis, how ever, is a complementary analysis of qualitative rather than quantitative primary sources, which may adjust the conclusions derived from Watzka's focus on administrative docu ments such as housekeeping records. I am also missing an emphasis on issues of gender and age both in terms of religious caregivers and those cared for. The author discusses the issue of female religious health care very briefly (114-16), noting that female religious orders devoted to the care of the sick were predominantly to be found in France, but neglects to explore the vital role of tertiary orders, the history of leprosaria managed by female monas tics, and the attachments of hospitals to enclosed monasteries, tended to by conversc and

managed by a bailiff. It is essential for an analysis of this important topic to address whether and how women's and girl children's experience of mental illness differed from that of their male counterparts, and to note that nuns and religious laywomen delivered health and indi gent care in a pattern that differed from male models.

St. Elisabeth of Thuringia, for example, is the saintly symbol par excellence for women's social role as competent health and indigent care administrators, yet she is also remembered as a victim of clerical abuse. Many noblewomen served as patronesses of hos pitals. How did female sponsorship and endowments affect regional, communal health care delivery? As to clients, the interpretation of existing data will likely yield a more complex and accurate interpretation if one were to document and analyze the percentage of women and girl children in hospitals, even if only as absent referents. Was their well-being, ranging from available room size to meals to access to medication as well attended to as that of men?

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1130 Sixteenth Century Journal XXXIX/4 (2008)

Were women and girl children sufficiently protected from the threat of rape and sexual abuse in hospitals? I hope that the author will use his admirable scholarly skills to answer these questions in due time.

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Chivalry and Knighthood in Scotland, 1424-1513. Katie Stevenson. Woodbridge: Boy dell and Brewer, 2006. xi + 228 pp. ?50.00. ISBN 978-1-84383-192-1.

REVIEWED BY: Brian G. H. Ditcham, Independent Scholar

Late medieval Scotland was a small, relatively impoverished, and often politically unstable realm on the western fringes of Europe. Did it nevertheless participate in the chi valric culture of Western Christendom? Katie Stevenson looks at a range of key indica tors-the practical and ceremonial aspects of knighthood, tournaments, devotional practices, literature, and the exploitation of chivalry by the Stewart dynasty-and concludes that Scotland's elites conformed to the chivalric model developed by Maurice Keen in his seminal 1984 work (Chivalry [New Haven: Yale University Press, 1984]).

Her demonstration is broadly convincing, though some might see the glass as a little emptier than Stevenson suggests. Scottish participation in jousting and tournament culture was at best marginal until the splashy and high profile events of James IV's reign (r. 1488-1513). Medieval Scotland (unlike, say, Denmark) never generated an order of chiv alry; indeed Stevenson herself has debunked claims that James III (r. 1460-88) established one. Royal sponsorship of chivalric culture was very patchy until the reign of James IV. Scot tish participation in battle against the Infidel was almost nonexistent after the Baltic cru sades wound down with the conversion of Lithuania. Only perhaps for a few years around 1500 could Scotland have been credibly presented as a significant presence in the chivalric world.

Stevenson has had to work with scrappy and intractable sources, a task she has under taken with commendable thoroughness (though Gaelic-speaking Scotland barely figures in her account). As a result, every piece of evidence needs to be squeezed for the last drop of significance, which can lead to a degree of repetitiousness in presentation. It also sometimes tempts the author to push her material a little beyond its limits (for instance, likely Scottish participation in a joust at Chalon-sur-Saone on page 79 has become certain by page 115). On other occasions one wishes she had been a little more prepared to engage with and debate established scholarship. She notes Michael Brown's argument that it was the Douglas family rather than the Stewart monarchy which was the predominant player in Scottish chi valric culture during the 1440s and early 1450s and suggests she disagrees but does not develop her argument further-a pity, since James II (r. 1449-60) appears to have differed from his father and son in displaying a degree of engagement with chivalric culture, even if Stevenson is perhaps inclined to overstate developments which we know about primarily because of one event which figures in a Burgundian source.

Indeed the whole issue of royal sponsorship of chivalry merits more discussion than it receives. Stevenson convincingly shows that neither James I (r. 1424-37) nor James III dis played any sustained interest in chivalric activity beyond a certain instrumentalization of the bestowal of knighthood. The former is however usually seen as a highly successful mon arch while the latter is portrayed as a failure. This perhaps suggests that too much emphasis can be placed on the political importance of a late medieval ruler's ability to conform to ste reotypes drawn from chivalric romances. As Stevenson's examination of Scottish chivalric literature shows, there were also awkward crosscurrents which a ruler had to negotiate in a

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