State medicine and medical bureaucracy in the Habsburg monarchy: Public health, medical police, and the governance of medical space with a focus on the bohemian lands (1740-1820)

Abstract

This article examines the emergence and development of Staatsarzneikunde (state medicine) in the Habsburg monarchy between 1740 and 1820, with a specific focus on the Bohemian lands. It analyzes how public health reforms, rooted in Enlightenment rationality, were mobilized not only as tools of hygiene and disease prevention but also as part of a broader process of state-building, administrative centralization, and knowledge standardization. The creation of a hierarchical medical bureaucracy — supported by education reforms, legislation, and surveillance — reflected an evolving vision of governance that tied medical knowledge to the state’s administrative needs. Rather than adhering to traditional medical historiography that presents these developments as a linear story of institutional and scientific progress, this study draws on the insights of the sociocultural turn and the cultural history of administration. It emphasizes the negotiated and contested nature of medical reforms, shaped by local conditions, resistance, and the everyday practices of physicians, officials, and patients. Inspired by Foucauldian critiques of medicalization and biopolitics, the article further interrogates how medical knowledge became embedded in bureaucratic power structures and contributed to the formation of the modern state. By bridging the historiographical divide between older institutional narratives and newer sociohistorical approaches, the article contributes to our understanding of medicine as both a scientific and a political project. It argues that Staatsarzneikunde functioned not merely as a medical doctrine, but as an administrative vision — a “cosmology” of health governance that influenced the lived experience of public health far beyond the realm of policy ideals.