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From the Middle Ages to the first lunatic asylum in Hamburg
The first evidence of public "care for lunatics" in Hamburg dates from the year 1376. The sick were "detained" in a tower of the city wall ("cista stolidorum" or "custodia fatuorum"), and a caretaker supplied them with the "vital necessities". The tower had four floors; the topmost floor was reserved for the mentally ill. This area, referred to as "mad box", was equipped with chains and ankle blocks. "Minor delinquents of the lower class" were detained on the other floors. There were probably several of these establishments, financed by the city; however, the social organisation of that time was such that only few people were kept in these asylums; most mentally ill persons were cared for within their guild or confraternity and remained in the family circle.
Around 1500, care for the mentally ill was transferred to the Holy Ghost city hospital ("Heilig-Geist-Hospital"); here, too, medical care was not provided and utilisation was very low (not a single "madman" was fed there between 1526 and 1535). The petition by the brothers Kahlenberg to the city council in 1566 speaks for itself: They request the release of their brother, "whom the almighty god made ill and weakened in his senses", in order to "bring him, according to what is appropriate for him and what pleases us, to a different and more quiet place, were he can be better cared for. Because we do not intend to accept or to suffer nor can we take the responsibility before god to leave him sitting in this stench any longer".
In 1607, a new hospital, the "pest court", was inaugurated outside the Millerntor. This hospital was designed for 700 - 900 residents and financed by the church. Since 1679, the "really mad" were also kept there in a sort of locked bunks, which stood in rows in the halls and communicated with the outside only by holes the size of a hand. "Fools and idiots" enjoyed greater freedom.
The reputation of the "pest court" was such that it attracted (well paying) patients even from out of town. On account of these, the "evil mad" - from today's perspective mentally ill delinquents - were no longer admitted after 1764. They remained in the Spinnhaus - a jail.
At that time, obsessions with witches and superstition were flourishing also in Hamburg. The mentally ill were often regarded as witches, sorcerers or possessed by the devil. Those who were "possessed" normally went to the priest and not to the doctor. In the hospitals, the "pest and food master" ("who bought his office with big money") and some surgeons attended to the patients already since the 16th century.
In November 1700, Dr. Johann Gertmann abandoned his doctorate to become the first physician in the office of "pest and food master". Under pressure from the guild of surgeons and from the parsons, he resigned from this office after three years. But now the management insisted on a "scientifically trained physician for internal diseases" so that the first hospital doctor was elected in 1704. It was his duty to visit the sick three times a week. In the 18th century, the hospital expanded and the doctors' importance increased. Since 1797, the hospital received state subsidies and in 1800, it was renamed in "sick court". Since 1804, there were daily medical visits. From 1806 to 1814 the hospital was used as a French military hospital (set on fire by the French in the liberation war), but the mentally ill continued to be cared for - 104 in 1810, 40 of them "maniacs" and 36 "epileptics". Prior to moving to the "general hospital" (now AK St. Georg) in 1823, the mentally ill were accommodated in the "Lombard", the former pawnshop. As the estimated costs did not allow building a separate "madhouse", a total of 264 beds on the first floor and in various basement rooms of the general hospital were used as "mental ward".
Now there were ward rounds twice a day for the isolated mentally ill, and chains were no longer in use. The rule was now that "... coercives, often required with these patients, of which we have the coercive chair, the bag, straight jackets, waist belts, feet belts, are in the custody of the senior wardens, so that they can never be used at the whim of the wardens". This was indeed very progressive for those times.
In 1858, Ludwig Meyer, a former student of Virchow and Ideler and an active participant of the 1848 revolution, was appointed senior physician of the mental ward at the general hospital, and Hamburg became the precursor of a progressive psychiatry in Germany. Shortly after taking up his post, Meyer was the first in Germany to sell all coercive means by auction because they were not necessary.
Friedrichsberg
Already in 1840, the senate had bought farmland from the peasant Friedrich (28,351 ha situated on a hill) with the intention to build the first "lunatic asylum" in Hamburg. The concepts and strength of a physician like Ludwig Meyer were needed to push this plan towards achievement. On July 5, 1861 the foundation stone was laid; on October 20, 1864, the asylum was given over to the council, who named the hospital "Irrenanstalt Friedrichsberg" (mental asylum Friedrichsberg, now AK Eilbek). Meyer had conceived a main building with 200 beds without bars and coercive means and a "boarder house" with 40 beds. An English style park was laid out on the grounds with ponds, game reserve, palm garden and concert hall.
Only patients assessed as curable were transferred from the "general hospital". Medical care was provided only by Ludwig Meyer as senior physician and one assistant doctor. In 1866, Meyer accepted a chair in Göttingen, and Wilhelm Reye, previously Meyer's assistant at the general hospital, became his successor.
Under Reye, the hospital considerably expanded. In 1870, the uncurable men, who had remained at the general hospital, were admitted, and in 1881, there were already more than 1000 beds. In 1893, the "Anstalt Langenhorn" (asylum Langenhorn; now Klinikum Nord - Ochsenzoll) was set up as agriculturally oriented dependance with initially 200 beds for quiet mental patients who were fit for work (already 1,800 patients in 1914). In 1897, Reye's position was renamed from assistant medical director to medical director, two senior physicians and four assistant doctors were additionally employed.
In 1908, Dr.phil. et med. Wilhelm Weygandt became director of Friedrichsberg. Weygandt first of all abolished a number of intolerable practices: "It was still common use to dispense alcoholic beverages to many patients, the entire nursing staff and even to the orphans who sang at religious celebration services. In the men's admission ward, open gas flames burned on the walls to light cigars and pipes". Isolation treatment was no longer applied. Instead, he introduced long-term bathing, then modern, to the treatment catalogue and initiated basic re- and new building. In 1918, the hospital was renamed in "Staatskrankenanstalt Friedrichsberg" (state hospital Friedrichsberg). In 1919, open wards for men and women respectively were established.
During the first world war, the number of patients dropped from 1242 (1914) to 750 (1919) "due to the circumstances of war and increased subsistence costs" - meaning concretely that about 40% of the patients starved to death, although the entire grounds were used agriculturally (In Langenhorn, "only" about 25% died - presumably because a larger area was used agriculturally). What really happened to the patients in these winters of hunger is now being investigated scientifically based on the available documentation. It is suspected that already in those years, a mentality developed within society and among psychiatrists that readily accepted the death of patients without interfering. When the weakest starved to death, a process started which, under the national socialist dictatorship, made it possible for physicians to become murderers. Investigations of these events have not yet been concluded.
But there were always doctors who fought for a better treatment of their patients. Weygandt was the first medical director who set a high value on scientific activity in Friedrichsberg. The anatomical laboratory, set up under Reye (1899, director Theodor Kaes, now neuropathology), was enlarged, a serological and bacteriological laboratory (now also part of the neuropathology) and an experimental-psychological laboratory (the first of its kind in Germany) were set up in 1909. In 1929, the "Institut für Kulturpsychopathologie" (institute for cultural psychopathology; headed by Lange-Eichbaum) and, in 1930, the department for "Psychiatrische Erblichkeitsforschung" (psychiatric heredity research) were affiliated to the hospital. Beside two lecture halls, there were 32 rooms covering a total of 1,500 square metres for research. Between 1914 and 1930, a total of 65 doctors from Germany and abroad worked in the anatomical laboratory and published about 150 papers.
In 1919, Weygandt was offered the chair for psychiatry at the newly founded university of Hamburg. Hamburg was leading in Germany regarding the differentiation of neuropsychiatry into the subjects psychiatry and neurology. Nonne, a founder of this subject, obtained the first chair for neurology in Germany at the university of Hamburg.
Until 1927, Friedrichsberg was alone responsible for admissions in the entire urban area of Hamburg; for some time, Langenhorn became also responsible for a small admission sector.
From 1930 on, in the wake of the general economic crisis, the authorities tried to save money in the field of psychiatry - at first by transferring "appropriate cases" to less cost intensive institutions (95% of the treatments were financed by the welfare work, which corresponds to today's social services department). One example was the "Versorgungsheim der Hamburger Wohlfahrtsbehörde Farmsen" (maintenance asylum of the Hamburg welfare authority in Farmsen), where 1,400 homeless persons, alcoholics, prostitutes with venereal diseases and other "unsocial persons" were kept by 20 employees (one of them a doctor). There were plans to convert Langenhorn completey into a maintenance asylum (30% saving in hospital charges); the health department and social services department convened in 1931 that 800 beds in Friedrichsberg and Langenhorn were converted into separate departments ("B departments") with a daily charge of 3.50 RM instead of former 5.80 RM.
1933-1945 The national socialistic regime
The era of national socialism brought radical changes. In 1934, the senate of the city of Hamburg decided:
"In the treatment of mental patients, following aspects will be decisive in the future:
1.) The curable patients shall be treated with the utmost input of medical care;
2.) the uncurable patients shall primarily be kept. Medical care should be reduced to a justifiable minimum." (StA HH, HW II, G b 13 Bd.1, Bl. 6f).
Reverting to the plans of Dr. med. Friedrich Ofterdinger, then president of the department of health and social services, the senate decided to build a psychiatric hospital with 200-300 beds in the grounds of the Eppendorf hospital. As Wygandt had presented similar plans already in 1928, this plan was welcomed both by the hospital and by the faculty. In a first step, Friedrichsberg was reduced in 1934/35 by transferring 1,800 patients to other hospitals (Langenhorn, Ricklingen, Alsterdorf, Strecknitz) and to maintenance asylums.
Weygandt had to evacuate his position by decision of the senate despite his national attitude and radical genetic thinking, presumably instigated by the Hamburger "Ärzteführer" (leading physician) Willy Holzmann, who wanted to eliminate a competitor in matters of race hygiene. For anti-Semitic reasons in the framework of the "Gesetz zur Wiederherstellung des Berufsbeamtentumes" (law to restore the civil service system), following persons were also dismissed: Professor Hermann Josephy (prosector pathology), Professor Victor Kafka (head of the bacteriological-serological institute) and Dr. Richard Löwenberg (assistant doctor). Nothing is known about other staff members of the hospital in this respect.
The department of psychiatry and neurology
Between 1934 and 1936, Professor Ernst Rittershaus (like Weygandt a vehement advocator of race hygiene) was temporary head of the hospital. In 1936, the hospital was renamed in "Psychiatrische und Nervenklinik der Universität" (department of psychiatry and neurology of the university).
The associate professor Hans Bürger-Prinz was appointed new temporary head - against all the rules and disregarding the faculty, who was in negotiations with other candidates - presumably instigated by the Reich's ministry of the interior. He was appointed head of the department in 1937. In 1936, responsibility for the hospital was transferred from the public health department to the education department of the state. The hospital disposed now of 300 beds with 13 places for physicians and 137 places for certified nursing staff.
The hospital moved to Eppendorf only in 1942. For a short while, Hamburg was divided into two equal-sized admission sectors; on May 18, 1936, the senator for public health Ofterdinger decreed that the PNK was the only institution responsible for admissions (Sta HH, HW II, A e 7, Bl. 6). All patients were first of all examined and diagnosed at the PNK. Depending on the assessed prognosis, patients were then treated at the PNK or kept at the treatment and nursing institution of Langenhorn (Heil- und Pflegeanstalt Langenhorn). This concept was born mainly of the initiative of Ofterdinger and Bürger-Prinz. Only mentally ill delinquents were directly admitted to Langenhorn (safety apect). In 1938, after the city expanded by 40% due to the Großhamburg-Gesetz (Greater-Hamburg law), Hamburg was divided into three sectors. Patients were allocated to the PNK (central city area), to Langenhorn or to the psychiatric department of the AK Altona. In 1942, the PNK became again alone responsible for the admissions; thus, this regulation was frequently re-negotiated and, moreover, not all registered doctors followed it.
Between 1936 and 1941, about 20% of the patients of the PNK were transferred to other establishments (StA HH, HW II, G b 24, Bürger-Prinz to state administration), 65% were discharged to their homes.
In 1937, the so-called shock treatments were introduced (insulin, cardiazol) - 80 beds were exclusively reserved for this type of treatment. Beside electric convulsive therapy (from 1938 on), treatment with pyramidone was introduced in 1941, which induced cerebral convulsions. Whether this treatment is responsible for the procentual increase of mortality compared to admissions as postulated by Ebbinghaus is not proved. But it is a fact that the mortality rate reached a peak in 1941 with 14% of all admissions and was twice as high as in the years prior to the war. Many patients went to extermination camps via Langenhorn, some also directly from the PNK. The role of the hospital and its medical director Bürger-Prinz in relation to euthanasia and coercive sterilisation is not yet completely cleared. His own statements after the war are open to doubt. The mortality rate among patients was extremely high during the war. There is strong suspicion that killings occurred at the hospital. The available documents and death certificates are currently being analysed to find out what happened during those years.
Before the war, patients stayed at the hospital for an average of 129 days; the average duration declined to 64 days in 1940 and to 31 days in 1945. In 1942, the hospital moved from Friedrichsberg to Eppendorf to four pavilions and rooms within the surgical and the I. medical department. Although the UKE was hit by numerous bombs, the PNK was spared.
The university hospital in the Federal Republic since 1945
Bürger-Prinz, who had been replaced by Hans Büssow during the first two years of the war, was suspended by the British after the war and again replaced by Büssow, for a short period also by Hans Jacob. In 1947, Bürger-Prinz was restored to his office. The hospital now disposed of only 230 beds, "to be able to do more research". Based on designs by Bürger-Prinz from 1958/59, the lecture hall, the library and the closed ward were ready to move in in 1963; the other wards followed in 1968. The hospital benefited from the reconstruction boom of the universities at that time.
Under Bürger-Prinz, there were further alterations of the hospital structure. In 1959, the institute for sexual research (founded by Prof. Giese) and, in 1965, a department for experimental brain research were affiliated to the PNK. In 1966, the institute for children's psychiatry, the first of its kind in Germany, was established under the direction of Prof. H. Albrecht (now department of psychiatry and psychotherapy for children and adolescents). Since 1967, the hospital had a department for neurobiochemical research - now the neurobiological laboratory.
After the retirement of Prof. Bürger-Prinz, Prof. Jan Gross became head of the department. His personal integrity was beyond doubt and he was "distinguished" by persecutions of two different dictatorial regimes (Nazi Germany and the communist CSSR). He led the hospital through the tumultuous seventies. However, a severe Parkinson's disease prevented him from putting his stamp on the development of the department and from leading it to scientific distinction.
In 1995, Prof. Dieter Naber was appointed head of the department. It became his task to lead the department through a basic reorganisation. Both in treatment and research, the goal was to reach and exceed new university standards. The department is currently in a transitional phase determined by new appointments, the creation of new research groups and cooperations with neuroscientific subjects, but also by strengthening tried and tested structures. The new requirements imposed on the university hospitals by health policy, the accelerated promotion of community based care of patients and the more limited financial resources required permanent reorganisation since 1995. In 1997, the department was renamed in "Klinik für Psychiatrie und Psychotherapie" (department of psychiatry and psychotherapy) of the university of Hamburg.
Seven psychiatrists of the department were directly appointed to chairs: L. Meyer to Göttingen in 1866, F. Meggendorfer to Erlangen in 1935, H. Jacob to Marburg in 1959, H. Albrecht to the chair of children's psychiatry in Hamburg in 1966, H.J. Bochnik to Frankfurt/Main in 1967 and H.J. Colmant to the chair of neuropathology in Hamburg in 1967, Otto Schrappe to Würzburg.
