District doctor

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The district doctor (formerly also district physician ) was the state health officer of the district in Prussia . District doctors performed public tasks such as disease control, the control of medical personnel and forensic medical matters. The Prussian District Doctor Act of September 16, 1899 also assigned them social hygiene tasks. With the "Law on the Unification of Health Care" (GVG) of July 3, 1934, the district doctors were replaced by state health authorities on April 1, 1935 .

From physicist to district doctor

From the beginning of the 16th century, cities, estates and sovereigns began to employ salaried doctors, who were called urban physicists , district, official, rural physicists, etc. The appointment of city doctors can even be traced back to the 13th century. Its tasks, which were laid down in medical regulations since the end of the 16th century, were primarily in the field of public health care. They were responsible for disease control and supervised the medical system, but also had to treat the poor. At the state level, a central “Collegium medicum” was created based on this communal model in Prussia, for example, through the medical edict of November 12, 1685, which had to supervise the medical professions. Probably on the occasion of the plague of 1709 , but secured in 1719, the “Collegium sanitatis” was also founded for sanitary tasks such as disease control. Both institutions were combined in 1799 in the "Ober-Collegium Medicum et Sanitatis". For a long time, the duties of the district physicists lay exclusively in the special supervision of the medical system in their district and in forensic medicine, but less so in the field of medical police.

A doctor who wanted to become a district physicist had to take a special examination since 1764. With the reorganization of the physics test in 1825, apart from a written thesis on a problem of the state medical customer, either a corpse autopsy or a practical pharmacy visit were included. The content of the circular physicists only part-time working was rather low and their position to district administrators subordinate. The physicist usually earned his living with a private medical practice. Nonetheless, jobs in larger cities, for example, were popular because they made it easier to set up a practice. The relationship between physicists and resident doctors, on the other hand, was often difficult because they viewed the physicist as a kind of “robber of the practice”, and the physicist, as a medical examiner, also checked certificates from the resident doctors.

The Prussian District Doctor Act of September 16, 1899

As hygiene developed into an experimental science, the sanitary tasks of the district physicists increased in importance and effort. For this reason, the demands made since the 1840s for a medical reform increasingly concentrated on the position of the district physician. The cholera epidemic of 1892 finally gave the impetus for a comprehensive reform . In Prussia, the District Doctor Act was passed on September 16, 1899, which replaced the “District Physicist” with the “District Doctor” as a modern health officer. The employment now required the passing of a special examination after five years of medical practice and the completion of compulsory courses and internships in hygiene, pathological anatomy , forensic medicine and psychiatry .

The district doctor acted as an advisor to the district administrator or, in urban districts, to the police authority . His main task was to monitor the health of his circle. This included both the medical supervision of institutional welfare as well as the supervision of the vaccination business and industrial hygiene. Further service instructions specified that the district doctor had to find out about sewage disposal and drinking water supply, for example, and to operate the construction of a sewerage system, but should also check dormitories, hostels, mass quarters and workers' apartments. In addition, the district doctor had to perform social hygiene tasks such as school hygiene. Furthermore, he remained the forensic doctor in his district, although special forensic doctor positions could be set up under special circumstances. Full-time, fully paid district doctor positions, on the other hand, were also only permitted under special circumstances. Accordingly, fully paid district doctors did not appear on a larger scale until after the First World War .

The public health system in the Weimar Republic

At the lowest administrative level, the District Doctor Act also regulated the state health system after 1918. However, in Prussia in particular, state access to the municipal health system was reduced, where the tasks of public health care were gradually taken over by newly established municipal health departments. The Prussian development was marked accordingly by the competition between the district doctors as state administrative doctors and the municipal doctors as welfare and preventive doctors. Complaints about the disorganization of the public health system and demands for standardization gained momentum, especially in the wake of the global economic crisis. As part of the emergency and savings ordinances , it was decided to unify the medical administration by the end of 1932, although the legal form (district doctor or local doctor) remained controversial. The "Ordinance on the Simplification and Cheap Administration" of September 3, 1932 already provided that district doctors in districts in which district offices were formed should no longer have any responsibility.

The "Law for the Unification of Health Care" of July 3, 1934

According to the last count before the implementation of the GVG, there were 397 district doctors in 471 Prussian districts and urban districts, who usually worked as one-man businesses without their own office or auxiliary staff and in some cases were also responsible for two or more districts. In addition, according to a census from 1931, there were around 50 municipal health offices in Prussia, equipped with premises and materials, in which several hundred doctors worked full-time and part-time. With the GVG of July 3, 1934, municipal and state health systems were combined in the local health department. As an independent institution of the lower administration, the health department had its own equipment and rooms as well as its own staff. It should be managed by a state medical officer who previously worked as a district doctor, or by a sufficiently qualified local doctor. The tasks were laid down in implementing ordinances that were based on the Prussian instructions for district doctors of March 5, 1934, and thus ultimately on the instructions for district doctors of September 1, 1909. In addition to the tasks that have been carried out by the district doctors to date, these were, not least, tasks of heritage and race care including marriage counseling as well as public health education in the sense of "spreading hereditary and racial knowledge". The new health authorities were directly subordinate to the Reich Ministry of the Interior. This reform, which was largely carried out by the former district doctor Arthur Gütt , thus pursued the goal of, on the one hand, “heritage and race maintenance” and, on the other hand, centralizing the public health system in order to guarantee uniform state administrative action. In the summer of 1935, health authorities were set up in 424 of 474 districts in Prussia.

literature

  • Isak Schlockow: The Prussian Physicist. Instructions for the physics examination, the management of the medical officers and the expert work of the doctors. Berlin 1886.
  • Isaak Schlockow: The district doctor. Instructions z. District doctor examination, z. Management d. Medical officers uz expert activity d. Doctors. Under consideration. d. Reichs- u. Edit state legislation by Dr. Emanuel Roth et al. Arthur Leppmann. 2 vols. 5th probably edition Berlin 1900–1901.
  • Alfons Labisch, Florian Tennstedt: The way to the "law on the standardization of the health system" of July 3, 1934. Lines of development and development moments of the state and municipal health system in Germany (=  series of publications of the Academy for Public Health , 13, 1.2). Düsseldorf 1985, ISSN  0172-2131 (xxxi, 601 pages in 2 volumes).
  • Alfons Labisch, Florian Tennstedt : Public Health Office or Public Health Office? On the development of the public health service since 1933. In: Norbert Frei (Hrsg.): Medicine and health policy in the Nazi era. Munich 1991, pp. 35-66.
  • Ragnhild Münch: Healthcare in the 18th and 19th centuries. The Berlin example. Berlin 1995.

Individual evidence

  1. ^ Ulrich Knefelkamp: City and hospital in Upper Germany in the late Middle Ages. Using the example of southern German imperial cities . In: Peter Johanek (Hrsg.): Urban health system and welfare system before 1800. Cologne, 2000, pp. 19–40.
  2. ↑ Ragnhild Münch: Healthcare in the 18th and 19th centuries. The Berlin example. Berlin 1995, pp. 28-52; Sandra Krämer: The plague, the white woman and a far-reaching cabinet order. In: Deutsches Ärzteblatt , Volume 107 (2010), A331.
  3. ↑ There is only one general instruction: Instruction for the Land, Creyß and City Phisicos in which Königl. Prussia. Countries. De Dato Berlin, October 17, 1776 . In: Novum Corpus Constitutionum Prussico-Brandenburgensium Praecipue Marchicarum . Part 6, 1780, addendum to the regulations for the year. v. 1780, no. 12, col. 3315-3322.
  4. ^ Claudia Huerkamp : The rise of doctors in the 19th century. From the learned level to the professional expert: The example of Prussia. Göttingen 1985, pp. 167-171 .; Alfons Labisch u. Florian Tennstedt : The way to the "Law on the Unification of the Health Care System of July 3, 1934". Lines and moments of development in the state and municipal health care system in Germany. Düsseldorf 1985, pp. 7-17, cit. P. 17.
  5. ↑ Huerkamp: Ascent. Pp. 171-177; Labisch u. Tennstedt: Away . Part 1, pp. 42-57.
  6. ↑ Labisch u. Tennstedt: Away . Part 1, 63-116; Alfons Labisch u. Florian Tennstedt: Health Department or Public Health Department? On the development of the public health service since 1933. In: Norbert Frei (Hrsg.): Medicine and health policy in the Nazi era . Munich 1991, pp. 38-42.
  7. ↑ Labisch u. Tennstedt: Health Department. Pp. 38-39
  8. ↑ Labisch u. Tennstedt: Away. Pp. 313-332.
  9. ↑ Labisch u. Tennstedt: Health Department . P. 49.

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