Healing Body and Soul. Medicine and Hygiene in the 18th Century
Annual exhibition of the Francke Foundations 2021 online
Issues of physical and mental health determine our lives. Like us today, people in earlier centuries were concerned about their health. The well-being of body and soul was a pressing concern for Halle Pietism. Three hundred years ago, in 1721, August Hermann Francke (1663–1727) laid the foundation stone for his »Krancken-Haus«. It served mainly to care for orphans. Up to 20 boys were treated there, and in individual cases girls as well. Today, it is considered one of the first children’s hospitals in Europe. The 300th anniversary of the laying of the foundation stone is the occasion for the annual exhibition of the Francke Foundations in 2021, which focuses on medicine for body and soul, hygiene and dietetics, as well as pharmacy and alchemy, and encourages visitors to build bridges from the past to the present. Then, as now, the challenge is: Stay healthy!
The new construction of the hospital from 1721 broke new ground in the care of sick children. The building was designed according to the most modern requirements of the time.
It was situated somewhat apart to the south and surrounded by gardens, which guaranteed the necessary peace and quiet. Moreover, this particular location ensured that the house and its interiors were supplied with fresh air. This was considered a mandatory requirement for the prevention of infection. The interior of the hospital was filled with light through windows and it was connected to the foundation’s own fresh water system.
In the everyday life of the foundations, which were called »Anstalten« (asylums) in the 18th century, high value was placed on maintaining hygienic standards.
But the basis was a completely different knowledge than today: viruses and bacteria had not yet been discovered. Above all, fresh, odorless air was essential for disease prevention. The use of clean spring water instead of contaminated river water became increasingly important.
According to the medical understanding of antiquity, body and soul were closely interrelated. Therefore, in order to cure diseases, physicians considered both the patient’s lifestyle and his temperament (e.g., choleric or phlegmatic). Their interaction determined the balance of the four humors in a person: black and yellow bile, phlegm and blood. An imbalance of these humors led to diseases and had to be regulated, in case of too much blood, for example, by means of cupping.
This view was only fundamentally challenged by the work of the French philosopher René Descartes (1596–1650). Our current view of a separation, a dualism of body and mind in man goes back to him. Descartes’ thoughts led to a focus in medicine on the pure functionality of the human body. The soul no longer played a role in this mechanistic understanding of medicine.
The pietist physicians around Christian Friedrich Richter (1676–1711) opposed this view, building on the teachings of the Halle physician Georg Ernst Stahl (1659–1734).
The Dutch physician Boerhaave was one of the most famous doctors of his time. He was the first to describe Boerhaave’s syndrome, named after him, the rupture of the esophagus caused by too violent vomiting or coughing. In 1727, he discovered urea in urine.
As professor of botany, Boerhaave decisively developed the botanical garden of Leiden University and, as director of the university hospital, introduced practical teaching of students at the bedside. During his teaching period, Leiden was the center of mechanistic medicine, which considered the body equivalent to the mechanics of a clockwork, with no importance given to the soul. This medical approach was fundamentally different from that of the Pietists, yet Francke and his fellows also held the Dutch scholar in high regard.
Christian Friedrich Richter’s (1676–1711) major work, Die höchst-nöthige Erkenntniß des Menschen (The Most Necessary Knowledge of Man), which runs to over 1,000 pages, explains the Pietist understanding of medicine in all clarity. Here he explains the correlation between the undisturbed connection of the human soul with God and the health of the body.
For Richter there was a direct, indissoluble connection between body and soul. If this connection was disturbed by affects or sinful behavior, man became ill. The assumption that only reconciliation with God would lead to true healing and recovery is the basis of the medical knowledge collected by Richter on a wide variety of diseases, symptoms and treatments.
The publication in German increased the benefit for the population immensely and led to a popularization of medical knowledge.
This was definitely in the interest of Richter, who wanted, by his work, to give people the possibility to treat themselves in emergency situations. However, it also enabled people to judge the treatment they received from a doctor. The work, which had been reprinted at least 18 times by the end of the 18th century, thus not only ensured a general dissemination of medical knowledge, but at the same time promoted the maturity of patients.
In the mechanistic understanding of medicine, the internal organs of the human being were viewed like the gears of a machine, meshing together.
The establishment of this idea correlated in time with the increasing production of mechanical models for construction, representation and teaching purposes. In the thinking of the physicians influenced by Boerhaave, diseases represented disorders that prevented the physical mechanism from meshing. The goal of healing was therefore to correct this disturbance, which was seen as physical-mechanical. The soul played no role in these considerations and the associated treatment methods. In contrast, pietistic physicians understood the soul as the key to understanding life and to healing and recovery. In their view, the human »machine« required the soul as the purpose and reason for life. The pietistic higher valuation of the soul led to the search for the causes of diseases in this very soul.
The unity of body and soul and a Christian way of life were the central coordinates in the medicine of the Pietists. Keeping oneself healthy was a fundamental duty. The soul, wrote the Pietist physician Christian Friedrich Richter, was »a stream of living water«. Full of divine wisdom, it flows through the human body, which is its home and useful tool. Without soul there would be no life in the body and no connection of man to God.
Body and soul are connected through the mind, which is an interface between the outside world and the inner man. It is a gateway of the senses and influenced by the affects. These are inner reactions to stimuli from the outside, which become visible through gestures and bodily movements such as increased pulse. For the Pietists, in addition to spontaneous affects such as terror, negative emotions such as anger or greed could be causes of illness. However, this also applied to exaggerated positive emotional states such as love and joy. Maintaining calmness of mind was therefore central to health in pietistic medicine.
Dietary recommendations for a good, balanced lifestyle applied to balanced nutrition and general moderation in addition to a balanced state of mind. The dietary teachings were practically illustrated in everyday life and in the lessons of the Francke Foundations; botany and anatomy were taught and moderate and healthy exercise was encouraged in the »hours of recreation«.
Once a week, woodturning was part of the lessons at the Francke Foundations. The schedule also included a number of practical exercises, which were designed to be meaningful and to provide a good opportunity for practical learning.
The necessity of physical exercise for health was also emphasized at the Francke Foundations. August Hermann Francke wrote that »the children who study have well to do to enliven the mind to exercise with herbal collection, the rest, so not study, can have in the court their motion«. The »motion« therefore belonged in the 18th century as a subject to the everyday school life in the Foundations. On the motion court, certain games were allowed, such as the volant (an early form of badminton). In the so-called recreation hours, students were supposed to learn something while engaging in meaningful movement and relaxation. Basically, however, it was believed that idleness was the beginning of all vices; useful work in motion was therefore recommended, such as woodturning at the lathe, which was also part of the timetable at the Paedagogium Regium.
A man suffering from gout sits at a richly laid table and enjoys himself. There is a juicy roast on the table and a rather alcohol-heavy shopping list on the floor. What would the pietists say to this?
The supply of fresh water was at all times a necessary condition for life and survival of people. In addition to direct consumption, it was needed both for food production and for cleaning the body and clothing. Around 1700, a regulated water supply was the exception. This applied both to the city of Halle and to August Hermann Francke’s educational institutions, which initially drew the water they needed from the Saale River, which was already polluted with contaminants at the time. Starting in 1717, a supply system was built up over a period of years that piped fresh spring water into the asylums.
Tree trunks over three meters long, hollowed out on the inside, served as pipes for the water supply of the institutions. The construction and maintenance of the fresh water supply was technically demanding and at the same time meant hard physical work.
Tubes made of clay or lead had also been known since ancient times, but wooden tubes provided a cheaper alternative that was easier to maintain and replace. The tubes were connected either by sleeves or by means of brass connecting elements. A dendrochronological examination of the water pipe on display in the exhibition revealed the year the tree was cut down to be 1782. The tree itself, a pine, was found to be growing on the edge of the forest. Records in the archives of the Francke Foundations indicate that the logs intended for use as pipes were transported by river. Our specimen was cut in Saxony.
Hand drills were used to make the wooden water pipes. The spring water that passed through often carried small amounts of sediment, and the wood of the logs rotted and detached over time. This necessitated constant maintenance of the tubes, with particular emphasis on cleaning them. For this purpose, tools were used to pierce and loosen the sediments.
Cleanliness was an essential theme in the school institutions founded by August Hermann Francke, and it was not limited to the cleanliness of people and their clothing.
The device for cleaning the central traffic route of the orphanage complex makes this very clear.
As this plan shows, water from a nearby pond (C) was used for this purpose, which was led by means of an underground tube into the upper so-called Schwarzer Weg (Black Way –today approximately where the Mehrgenerationenhaus is located). The tube was closed with a bung, which could be accessed through a wooden box (F). When the bung was removed, the water poured out of the outlet (G) into the Schwarzer Weg. Here, the natural east-west slope of the foundations was used. However, the necessary condition for the success of this clever street cleaning was the paving of the path. Such paved paths were not the standard in the early modern period, but in addition to easier cleaning, they offered the advantage that mud and feces did not accumulate so easily and were then carried into the buildings via the shoes. The paving and cleaning of the paths in the Glauchasche Anstalten thus served to improve hygiene and prevent disease.
The medical understanding of the Halle Pietists was not to remain theory: they set out with the claim to reform society. This could only succeed if people were healthy, i.e. pious and capable of acting. The appropriate care of the many boys and girls in the schools and the orphanage therefore had to be guaranteed.
The Francke Foundations were a remarkable holistic health care topography in the 18th century: there were supply facilities such as the dairy, the bakery and brewery, kitchens and dining halls; there were infirmaries in the schools and boarding schools of the Latina and the Paedagogium Regium for bourgeois and noble children as well as at the girls’ school; there was an engineeringly sophisticated water supply system, facilities for hygiene such as a washhouse and latrines; there were laboratories for the production of the necessary medicines and, finally, since 1708, their own hospital, to which a small »madhouse« for mentally suffering people was attached.
The location and furnishings of the first children’s hospital anticipated basic requirements for modern hospitals as they had been formulated since the end of the 18th century.
On the first floor, the hospital’s supervisor occupied a room. Here was also the dining room for the young patients who were not bedridden. The building was close enough to the ensemble of buildings of the foundations to form an architectural and functional unit with it. The sick children thus remained part of the community despite temporary segregation for their care and protection of the healthy. The house was surrounded by fresh, clean air, its interior was filled with light through windows and it was connected to the fresh water system.
The hospital was completed in 1723 at a construction cost of 2,447 Taler. The young patients were accommodated in the four rooms of the upper floor (IIte Etage) and the two of the attic (IIIte Etage). All of the rooms were heated by back-loading stoves that were fired from the hallway, which kept soot out of the patients’ rooms.
The basis of the medical organization of the Francke Foundations was a variety of advanced hygienic measures designed to prevent disease. At the head of the organization was the Medicus Ordinarius, the »ordinary« (= employed) physician. This was maintained by regular contributions paid by the out-of-town students: an early form of health insurance! He also performed surgical procedures that were otherwise performed by hand-trained surgeons.
The famous practical classes for medical students, introduced by orphanage physician Johann Juncker (1679–1759), took place in the consultation-hour for the poor in the orphanage. Here, about 1,000 sick people were treated free of charge each month and provided with medicines from the orphanage.
Pietist medicine had a worldwide resonance in terms of its concepts and pharmaceuticals. Doctors sent out by the foundations worked at the places of activity of the Halle missionaries in India.
At the medical faculty of the Friedrichs University in Halle, students of Georg Ernst Stahl and Friedrich Hoffmann continued to advance research, e.g. in forensic medicine and obstetrics.
This statuette comes from the Cabinet of Artefacts and Curiosities of the Leipzig pharmacist Johann Heinrich Linck the Elder (1674–1734). It is the only known wooden anatomy of its kind so far.
Until the 18th century, only midwives provided obstetric care. They had no formal training and passed on their knowledge only orally.
In Germany, gynecology and obstetrics were integrated as a teaching subject within medical studies, as in 1741 at the University of Halle, where Philipp Adolph Böhmer (1711–1789) offered courses in obstetrics. In 1746, he published a manual of obstetrics by the English physician Richard Manningham in Latin, which for the first time advocated the use of forceps in the event of complications. Subsequently, however, obstetrics at the University of Halle remained only a sub-specialty of surgery.
This changed in 1808, when a gynecological clinic, combined with a birthing center, was opened. The experienced Halle physician and obstetrician Carl Friedrich Senff (1776–1816), who had attended the Paedagogium of the Francke Foundations as a student, was appointed its director. Senff was also involved in the training of midwives and taught in the maternity school attached to the birth center, where midwives were also trained. For this purpose he wrote a special textbook, from which the copperplate engraving on the right is taken. There is evidence that Senff was involved in the second Caesarean section in Halle.
Johann Juncker was the most important physician who worked at the Francke Foundations in the 18th century. He also has an extraordinary biography.
Juncker was born into a poor family in a Hessian village, the fifth of 12 children. Probably because of his talent he was allowed to attend a high school in Giessen and from 1697 he studied theology with August Hermann Francke in Halle, among others, who also hired him as a teacher at his Paedagogium. However, after a short time he returned to Hesse to work as a teacher. Along the way, he acquired medical knowledge through self-study and practiced medicine. In 1707, he married Countess Charlotte Sophie von Waldeck und Pyrmont, who was 12 years his senior – an astonishing marriage given the social gulf between the two spouses.
In 1716 Francke brought him back to Halle and he became – without having studied medicine! – Medicus Ordinarius of the Francke Foundations. He not only organized the medical system in the foundations and saw to the construction of the hospital, but also introduced regular consultation hours for the poor. In doing so, he involved medical students, who were thus able to gain experience in medical practice.
The University of Halle awarded him a doctorate in medicine in 1717 and a professorship in 1729. He wrote textbooks on various fields of medicine and chemistry, which were widely distributed and reprinted several times. His social rise from poor village boy to professor of medicine and Prussian court councillor testifies to the fact that in the 18th century social advancement through education was possible, at least for talented boys in isolated cases.
One of the most important pioneers of forensic medicine as a legally relevant sub-discipline was the pietist physician Michael Alberti (1682–1757), who taught at the University of Halle.
His Commentatio in constitutionem criminalem Carolinam medica of 1739 uses various examples to illustrate the many uses of medicine in legal proceedings.
The illustration shown here is the title copperplate of Alberti’s work. It was engraved by the artist Gottfried August Gründler (1710–1775), who was also responsible for the design and furnishing of the Kunst- und Naturalienkammer of the Halle Orphanage. It is an allegory of the interaction of the disciplines of jurisprudence and medicine.
Medicines based on alchemical formulas constituted an essential part of the medicine cabinet in the 18th century. There were two pharmaceutical facilities at the Halle orphanage at this time: the orphanage pharmacy and the medicine expedition. In the laboratories of the latter, in-house preparations were produced on a large scale, which were not only sold in the orphanage pharmacy, but also shipped worldwide as far as India and North America. In addition to the alchemical manufacturing instructions for many of these remedies, the orphanage even kept manuscripts that would lead to the »philosopher’s stone.«
A wide variety of furnaces and equipment were needed for the elaborate alchemical laboratory processes. By means of distillation, extraction and other processes, preparations were obtained that were supposed to have a ›spiritual‹ effect in the body of the patient – in contrast to the purely material effect assumed today.
Our image of alchemists today is often limited to the figure of the elderly book scholar in the midst of a mystically transfigured, dark laboratory setting. But the history of alchemy has been shaped just as much by younger people and women.
The laboratory model from the model collection of the Cabinet of Artefacts and Curiosities still demonstrates important prerequisites of alchemical work, which were also fundamental for the production of medicines according to chemical processes.
The model shows a laboratory building with a barrel roof, in the center of which there is a large fume hood. Through it could escape the smoke produced by the furnaces inside. Heating played an important role in laboratory processes. Therefore, the miniature furnaces of the model represent different types made of bricks, clay and iron. Among them are distillation ovens with inserts for sand and water baths, as well as a so-called wind oven with a chimney. With different furnaces it was possible to achieve different degrees of heat. The furnaces consisted of a working chamber, a fire chamber and an ash chamber, some of which merged into each other. Fuel was wood or charcoal.
In the 18th century, the pharmacists at the Halle orphanage developed in-house medicines in laboratories based on alchemical formulas. One example is the famous gold tincture Essentia Dulcis.
The copper engraving shows a young alchemist in her laboratory. The frontispiece from Die Mitleidende und Leichte Chemie (1673) makes it clear that women were also active in the alchemical field in the early modern period.
Its existence has been debated for millennia, numerous artists have tried to depict it, but no one has ever seen it – the soul. Often it is death that provides the occasion for artistic engagement with it. So it is hardly surprising that corresponding examples can be found in the context of memorials to the dead.
Epitaphs are a special type of memorial to the dead, which, in addition to allegorical and pictorial representation of the dead person or persons, have an inscription to the deceased person. They can also function as a memorial independently of the tombstone.
The medallion from 1743 was formerly part of the epitaph at the grave of Johanna Henriette Francke, née Rachals (1697–1743), Gotthilf August Francke’s first wife, on the city graveyard. Designed by an unknown hand, the work draws on established allegorical motifs with its depiction of a skeleton releasing a bird from a cage. The pictorial repertoire still invites us today to reflect on the question of the soul.