Leiden, the Netherlands (Spring 2017)
On November 14, 1709, King Frederik I of Prussia planted a small seed that over the following three centuries grew, branch by branch, into one of the foremost medical research and treatment centers in the world.
Plague House, 1709
|The Plague, later Almshouse, Matthäus Seutter (1678-1757), circa 1740|
In 1709 a malignant outbreak of bubonic plague that had almost depopulated Prussia was marching on to Brandenburg and Berlin. In response to the impending danger, the wary King Frederick I of Prussia, attended by his palace physicians Hoffmann and von Nidda, ordered that a tiny hospital be built outside the city walls. Its remote location at the Spandau Gate on the banks of the river Spree served to quarantine the sick. This half-timbered plague house met the highest hygienic standards of the day. Elsewhere in Europe, even large hospitals had three to eight patients sharing a single bed. Not so in Berlin. This modest almshouse, measuring merely 162 square feet on each of its two floors, gave each patient a bed. It even had space between those beds for easy removal of the dead plague victims. The top floor was dedicated to patients, segregated by gender. The ground floor housed personnel. The Black Death never reached Berlin, but the little almshouse was not forgotten. It branched out to serve the poor, beggars, unwed pregnant women, and prostitutes.
In 1714 Frederick William I, the Soldier King, succeeded his father. His main interest was to build a strong army with exceedingly tall soldiers. But he was fascinated by the work of anatomist Professor Spener, who had been trained by the renowned Dutch anatomists Rau and Ruysch in Amsterdam. Their mutual interest in anatomy and dissection soon led to the founding of the Theater Anatomicum. Beginning in 1713, this added an unusual coda to the open executions people were accustomed to witnessing. The King’s passion ensured that all the corpses went to Spener, who after only five months had already performed ten pedagogical dissections.
Despite teaching in the vernacular instead of the more erudite Latin favored elsewhere in Europe, and in an open theater instead of a university, Berlin now earned respect. The open mockery from its European colleagues at the older European universities of Paris (1150), Padua (1222), Montpellier (1289), Halle (1502), Leyden (1575), and Edinburgh (1583) went silent.
By 1724, in the face of much criticism and conflict between surgeons trained in the field vs. physicians, King Frederick William decided to bolster the expertise of both groups and promote their collaboration by founding the Collegium Medico-Chirurgicum. He even granted them access to the botanical garden and royal pharmacy. The king also had his royal surgeon Holtzendorff and royal physician Eller find new professors to lecture on necessary fields of expertise –anatomy, physiology, pathology, internal medicine, surgery, chemistry, and botany.
|Charité Hospital, 1899|
The only thing missing from the king’s growing garden of science was a clinic. Eller’s visit to Leyden planted another seed! There Professor Boerhaave (1668-1738) preached that observation and experience should precede theory, and that students could learn in a hospital ward instead of a lecture hall. So, in 1726 the King opened the almshouse as a home for the poor and for his regiment (Figure 1). He called it Charité to underscore the fact that both the state and generous citizens would support it. Indigent patients were to receive free treatment without delay, but would pay off half of their incurred indebtedness later in the attached workhouse (assuming they survived!). Those who could afford to pay, did so. Just as the population of Berlin had more than doubled in that time from 72,000 to 169,000, the number of patients followed suit, from 300 to 700. True to its original roots, every patient still had his own bed. The only concession was tighter spacing among them.
Military Medical Academy, 1798
As the hospital outgrew its original plot, new plans took shape. But in 1740 the new king, Friedrich II “the Great”, had to use all his resources to stave off an invasion from an alliance of Austria, Russia, France, and Sweden. His military distractions during the Seven Year War cost the hospital dearly. Admittedly, by 1760 he had steered Prussia into calmer waters, but the hospital still tossed on rougher seas. A new team managed the hospital and rewarded themselves with extraordinary salaries. The medical doctors had their own private practices beyond the hospital walls, donations dried up, and construction projects were put on hold. It was not until 1785-1798 that the hospital’s stunted growth found more fertile soil and rediscovered its original roots. Complaints were taken seriously, salaries reined in, and doctors now lived on the premises. In 1795 there were new buildings, later to be renamed in French as the Pépenière. Its crop of students still consisted of officers and enlisted men who received a general academic education in addition to medical training. Despite its initially limited student body, this hybrid Military/Medical School continued to grow in prominence and reputation under professor Eller’s guidance. In 1797, after a reign of ten years, Frederick William II died and was succeeded by Frederick William III, and briefly by namesake number IV in 1861. In homage to its royal legacy, the school became the “Friedrich Wilhelm Institute” from 1818 onwards, and “Emperor Wilhelm Military Medical Academy” in 1895. These would become part of an even larger and more prestigious endeavor.
Civilian University, 1810
In the early 1800’s students could stroll through Pépenière into the Ziegelstrasse to the hastily erected Humboldt University and its medical faculty. Ophthalmology and gynecology departments had now joined the ranks. The dean, former royal physician Hufeland, supported military physicians and surgeons by continuing the bedside teaching example of Charité Hospital. An institutional hybrid took root as well. In 1918, the Collegium Medico-Chirurgicum morphed into the civilian university. From 1828 to 1927 all university buildings coalesced on the Charité’s premises. In keeping with architectural trends at the time, the towering red-brick institution made good use of space, air, and light. From 1896 to 1917, in the backyard of the three-story main building on the river Spree (Figure 2), you could smell the flowers and feel the splash of fountains along the 547-yard long green chestnut-lined axis dividing surgical and internal medicine wards. Inside its fifty-seven individual buildings covering 300,000 square yards, one got into the buzz of its 700 medical personnel treating their 2000 patients. Meanwhile, the royal influence lessened with successive sovereigns: King William I (King of Prussia and also the first emperor of a unified Germany), Frederick III (1888) and William II (after 1888). After the November Revolution 1918, Prussia became a state of the Weimar Republic and William went into exile, and so did, in a manner of speaking, the hospital.
More decline beginning in 1933
When the Nazis came to power in1933 the hospital took another turn for the worse. Jewish hospital staff were transferred to research positions where they would not be treating patients, then dismissed. Most fled to the United States with the help of their gentile colleagues. President Hindenburg’s treatment was overseen by doctors from Charité’s Hospital, under the guidance of the famous surgeon Sauerbruch. The hospital itself was finally bombed to dust in World War Two, leaving only 10% of the pre-war structures standing.
State’s Showpiece, 1982
After 1945, the hospital regained its flair for charity: the population of East Berlin pitched in to literally (hands-on) help reconstruct the hospital, just as their predecessors to the first almshouse had done. As a magnet to medical care, Charité Hospital and Humboldt University even attracted patients from West Germany. In 1982 the twenty-one-story building in Luisen Street, a landmark housing 2000 beds, had earned its international reputation for excellence.
Cutting-edge Medical Research and Treatment Center, today
|Locations of the four campuses of today’s Charité University Medicine Berlin|
After the fall of the Berlin Wall and German reunification in 1989, Charité Hospital merged with the eastern Humboldt University, the western Rudolph Virchow and University Clinic Benjamin Franklin of the Free University; and the Robert Roessle and Franz Volhard Clinic in Buch.
Charité University Medicine Berlin, as it is officially called today, is now one of the largest in Europe. Its heart is preserved in Campus Charité Mitte (CCM), and has spawned other offspring across Berlin: Campus Benjamin Franklin (CBF), Campus Virchow Klinikum (CVK), and Campus Berlin Buch (CBB) (Figure 3): 3700 personnel, 7000 students, 100 clinics, at least 3200 beds, 125,000 patients, 900,000 outpatients, 17 Charité Centra (CC).
Today Charité ranks as the best hospital in Germany. Its famous doctors and facilities continue to attract important patients, in keeping with its roster of past patients, including Emperor William II, Lenin, Hitler, Friedrich Ebert, and Hugo Stinnes.
The hospital still enjoys an international reputation for the cutting-edge research conducted by its own staff as well as visiting Nobel Laureates, and seeds cast in distant lands. One landed in Chicago, at its partner, Northwestern University Feinberg School of Medicine. Its Collaborative Research Centers (CRCs) continue to put research and experience into practice just as its antecedents have done for centuries.
Today, the famous pathological and anatomical collection of the Medical History Museum (1899) and its permanent exhibition “On the Trace of Life,” documents how the king’s modest almshouse, planted in 1709, slowly blossomed into one of the most seminal medical research and treatment centers in the world.
- Abbott, A: Science in Germany: a beacon of reform. Nature, 2007, 447:630–633.
- Cooper-Mahlkorn D: Germany: doctors” training to change. BMJ, 1999, 27;318(7187):832. And its responses: BMJ, 1999, 318:832.
- Fischer, EP: Continuing on the road to health: a short history of the Charité–universitätsmedizin Berlin from a plague house in the past to a medical school with a future. J Mol Med, 2008, 86:971.
- Grau, G: Zwischen Wand- und Widerspruechen. Die Charité 1946-1990. 2003, 763-825.
- Hansen, R: Sauerbruch, Das war mein Leben, 1954 (movie).
- Jaeckel, G: Die Charité, die Geschichte eines Weltzentrums der Medizin von 1710 bis zur Gegenwart. Ullstein Verlag, 2003, 7-752.
- Jaeckel, G: Ein Pesthaus an der Spree (on Spinhaus inhabitants), Berliner geschriebenen Zeitungen, 9 September 1713, p19.
- Kettler, LH: On the 250th anniversary of the Charité in Berlin. Z Arztl Fortbild (Jena), 1;54:449-50.
- Murken, AH: From epidemic hospital to university clinic. The Berlin Charité 1710 to 1885. Hist hosp, 2008-9, 26:101-52.
- Rüster, D: From plague house to Charité—Berlin makes medical history (1724-1727). Z Arztl Fortbild (Jena), 1985;79(19):849-51.
- https://www.charite.de/die_charite/profil/historie (downloaded 25 December 2017).
- http://www.nobelprize.org/nobel_prizes/ (downloaded 24December 2017).
- https://www.charite.de/service/pressemitteilung/artikel/detail/charite_erneut_als_deutschlands_beste_klinik_ausgezeichnet/ (zum vierten Mal in Folge als Deutschlands beste Klinik) (downloaded 21 Decembre 2017).
- https://www.kma-online.de/aktuelles/klinik-news/detail/wieder-machen-die-grossen-das-rennen-a-32843 (downloaded 11 Decembre 2017).
- http://www.focus.de/gesundheit/gesundheits-news/die-focus-klinikliste-charite-ist-deutschlands-bestes-krankenhaus_id_4148513.html (downloaded 11 Decembre 2017).
- The Plague, later Almshouse, Matthäus Seutter (1678-1757), circa 1740. Berlinische Monatsschrift. Luisenstädtischer Bildungsverein e.V., Berlin 2000. https://commons.wikimedia.org/wiki/File:Berlin_Charite_1740.jpg
- Charité Hospital, 1899. Publisher: J.Goldiner Berlin. http://www.zeno.org/Ansichtskarten/M/Berlin,+Mitte,+Berlin/Charit%C3%A9,+Wasserseite
- Locations of the four campuses of today’s Charité University Medicine Berlin, made by Michael Bueker. https://en.wikipedia.org/wiki/Charit%C3%A9#/media/File:Charit%C3%A9_Standorte.svg
ANNABELLE S. SLINGERLAND, MD, DSc, MPH, MScHSR, was born in Sassenheim, the Netherlands. She earned her medical degree from the University of Amsterdam. She obtained masters degrees in public health and also health services research. Additionally, she earned a DSc in Genetics from the Erasmus University in Rotterdam. She (co-) authored research articles in several high-impact medical journals. She founded Kids Chain, an organization for Care, Cure, and Science in diabetes. In 2013, she came for a conference to San Francisco and swam from Alcatraz to shore, making her dive into the history of Alcatraz Hospital and its patients.
Highlighted in Frontispiece Summer 2017 – Volume 9, Issue 3