[Mental illnesses in medical certificates in 18 century Hessen].

This study deals with the medical certificates (Attestata medica) for mentally disturbed or insane and mad individuals which were issued by physicians (Stadt-/Landphysici) between 1750 and 1807 to gain admission to two of the Hessen High Hospitals (Hessische Hohe Hospitäler), Haina and Merxhausen. They provide an approach to mental illness in the 18th century from two perspectives: a study of coping with sickness, especially in the countryside, and mirrored by the doctor's view. In undoubted cases of madness the physician appears merely as a representative of public health care (Medizinische Policey), who must ensure that the patient is separated from the rest of society. In other cases caution and circumspection is absolutely required in the doctors' judgements. There is a catalogue of medical criteria on which the diagnosis is based. Nevertheless the physician must refer largely to the information he obtains from the social context of family, neighbourhood, pastor and officials whilst being well aware of the difficulties and danger of being instrumentalised by extraneous interests. From the physician's view, economic and social circumstances, to a great degree, are responsible for not being able to offer a cure to the individual. This fact gives great impetus to the demands for the hospital as an institution having the same recognised official standard of medicine but, at the same time, in combination with more favourable environmental conditions. These demands that can be seen from the second half of the 18th century were to be answered by special concepts of mental homes (Irrenheilanstalten) at the beginning of the 19th century.