Neuropathological research at the "Deutsche Forschungsanstalt fuer Psychiatrie" (German Institute for Psychiatric Research) in Munich (Kaiser-Wilhelm-Institute). Scientific utilization of children's organs from the "Kinderfachabteilungen" (Children's Special Departments) at Bavarian State Hospitals

During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

Idiocy in Virginia, 1616-1860

Like the English, Virginians tended to think that idiocy, a condition analogous to intellectual disability in the twenty-first century, was congenital, untreatable, and incurable, and they adopted legal remedies that corresponded closely to the laws of England. In addition, concepts of idiocy reflected some of the unique aspects of Virginia's social system, which was dominated by a coterie of powerful men. With a need to preserve social order and maintain decorum, the Virginia legislature established in 1769 the Eastern State Hospital to house unruly and objectionable people who were mentally disabled. Although idiots were among the hospital's first patients, they were eventually banished due to their presumed failure to respond to treatment. The social stigma attached to idiocy extended from Virginia's city streets and jails to the private homes of prominent families. Personal reticence regarding shameful family matters hid the identity of people thought to be intellectually disabled. Even Thomas Jefferson, a prolific author, entered only cryptic notes about the limitations of his sister, Elizabeth. In summary, Virginians' response to idiocy suggests a two-tiered approach: public disclosure and disdain of poor and dependent people with intellectual disabilities, and silent avoidance of the problem in prominent families. In both situations, idiocy represented images of shame and humiliation that threatened the social order.

Psychosurgery in Sweden 1944-1964

This study presents results on hitherto unknown data on lobotomies performed at the former State Mental Hospital of Umedalen (from here on called simply "Umedalen") in the north of Sweden. More than 700 operations were carried out from 1947 through 1960, and we calculated the average rate of postoperative mortality to 7.4 percent, and that 63 percent of those who were operated were women. By considering annual hospital reports to the National Board of Health (Medicinalstyrelsen), we also made the first mapping of early psychosurgery in Sweden; approximately 4,500 lobotomies were performed between 1944 and 1966. Statistical analysis, qualitative content analysis, and discourse analysis were used. The study supports earlier findings of female preponderance in the number of lobotomy operations.

Nursing care in a state hospital before and during the introduction of antipsychotics, 1950--1965

Oral history methods were used to describe the experiences of American nurses who practiced in a state mental hospital before and during the introduction of antipsychotic medications. The nurses described their responsibilities for supervising staff, administering patient care, and assisting with special psychiatric treatments. They expressed resignation and frustration with trying to provide care despite obstacles such as unqualified physicians, crowded wards, and inadequate personnel and supplies. The nurses adopted a Cartesian approach in which they focused on the patient's body, instead of the patient's mind, and developed camaraderie among nurses through which they found acceptance and were able to continue to do a thankless job.

Long-stay patients in state psychiatric hospitals at the end of the 20th century

OBJECTIVES

The purpose of this study was to assess the characteristics of long-stay patients in contemporary state psychiatric hospitals and to identify factors representing possible barriers to alternative placements for these patients.

METHODS

All patients in inpatient units of the Massachusetts Department of Mental Health who had been hospitalized for at least three years as of April 1, 1999, were assessed by their treatment teams with a standardized data collection instrument. Domains assessed included medical problems, need for nursing care, psychiatric diagnosis, and history of problematic behaviors.

RESULTS

The 330 individuals identified as long-stay patients had an array of medical problems and nursing care needs that likely would have been manageable in other long-term-care settings. A total of 276 patients had at least one significant medical problem. However, some patients exhibited behavioral problems that might have complicated such placements, especially when behavioral problems co-occurred with the need for medical supervision. A total of 228 patients had exhibited a significant problematic behavior in the previous 30 days.

CONCLUSIONS

Although the number of long-stay patients in state psychiatric hospitals declined dramatically during the second half of the 20th century, a small group of patients still requires care in this setting. State psychiatric hospitals continue to occupy a significant niche in the mental health system.

[National socialist "children's euthanasia" program in the province of Westphalia (1940-1945)]

As part of the organization structure of the "Reich committee for scientifically registering genetic and inherent serious illnesses" "childrens' special wards" were established in the province Westphalia in the child-psychiatry St. Johannesstift in Niedermarsberg (end of 1940), and then in the Provinzialheilanstalt Aplerbeck (end of 1941). The establishment thereof and personnel recruiting were done in close operation with provincial authorities. In Niedermarsberg external nurses were also employed. When the activities in the Marsberger ward became public despite efforts to keep them secret, the provincial association felt forced to establish a replacement ward in Dortmund-Aplerbeck. This ward was integrated stronger into the hospital-internal and regional care structures regarding personnel and institutional aspects than the previous ward. The actions of "child euthanasia" were based on a combination of hierarchical decision-making structures, limited responsibility, and scientific justification. The people performing these activities were provided action options withdrawal possibilities. For the affected parents the events were shifted into a psychological grey area which did not force decisions in principle. The internal conditions of the "childrens' special wards", the procedures and the "treatments" of the children were clearly regulated; the "euthanasia" activities themselves can be comprehended only in fragments from testimonies. By analyzing the reception books in connection with the medical files it is possible to make statements regarding the number of deaths, the death rate and cause, and also several social characteristics of the children. The fate of the children in the Westphalian "childrens' special wards" shows that the work in these regional "Reich committee wards" was limited to caring, observing, selecting and killing. The attempts of scientific justification are exposed as cover-ups.

["Euthanasia of children" during dictatorship of national socialism: "special children's department" Ansbach in Germany]

Focus of this paper is a description of "child euthanasia" during National Socialism 1939-1945 in the "specialized children's department" of the Ansbach state hospital. The historical and ideological bases for euthanasia and the development of child and adolescent psychiatry are explained. Material was found in public archives and trial records of German courts. 156 case histories of children who were killed in the Ansbach state hospital were evaluated. Child euthanasia in Ansbach was done in the same stereotyped way as in other specialized children's departments. The 156 children were aged between one week and 16 years. 39 children died within the first three months, 31 children died within three to six months in hospital. Most children were autopsied, at least 86 brains were examined neuropathologically. The trials against the involved physicians were quashed finally in 1968.

[Early days of the Ocean Road Hospital in Dar es Salaam: from mission hospital to government hospital]

On 1 October 1997 Ocean Road Hospital in Daressalam commemorated one hundred years of its existence. As early as 1888 a provisional hospital had been set up in Zanzibar by the German Lutheran Church to serve the needs of the Germans living and working on the East African coast. But when the British established their protectorate over Zanzibar in 1890, the hospital was moved to Dar es Salaam. As cooperation between Mission hospital and Government authorities proved difficult, the German colonial administration was determined to build an hospital of its own. Lack of funds delayed the construction of the building which had to be built on a more modest scale than originally planned. But when the hospital was inaugurated in October 1897, people were impressed both by its functional usefulness and aesthetic attraction. The history of the German Government Hospital reflects the political context of the time as well as the progress of medicine in combatting endemic diseases. While patients were often segregated by race--the Government Hospital in Daressalam almost exclusively reserved for Europeans--all were benefitting from the results of medical science. For Robert Koch the hospital (and its laboratory) served as basis for his research in the field of malaria, black water fever, sleeping sickness, and relapsing fever. It was from Africa that the embarked on his journey to Stockholm to receive the Nobel Prize in December 1905. During the First World War Ocean Road Hospital, as it was called from now on, was taken over by the British. Since independence, the Tanzanians are in charge. It is presently the only tumor hospital of the country, closely cooperating with the German Cancer Research Center (DKFZ) in Heidelberg. Restoration of Ocean Road Hospital, completed at the beginning of this year, was made possible by a grant of the Federal Republic of Germany.

History of clinical chemistry in a children's hospital (1914-1964)

The historical development of a charitable children's hospital and the evolution of its clinical laboratory are presented. With the appearance of practical quantitative blood chemistry tests in the period between the two World Wars, applications to pediatrics were hampered by the need for ultramicro procedures then unavailable and for improved skin-puncture blood sampling. World War II brought economic demands that forced the hospital to privatize its beds and to charge fee-for-services. In turn, this brought added income, allowing the hiring or subsidizing of a professional staff, including the clinical chemist. The development of ultramicro blood chemistry followed, along with improved skin-puncture technology.

LINDA RICHARDS AT THE KALAMAZOO STATE HOSPITAL

Linda Richards was the first nursing graduate in America and a major pioneer in nursing education. Moral therapy was the major treatment at the Kalamazoo Asylum and its use persisted into the early 20th century under the supervision of Richards, one of its adherents. Richards added district nursing experience in the City of Kalamazoo to the curriculum and the school was described by the Trustees as being in vigorous condition during her leadership.

Therapeutic effectiveness and social context: the case of lobotomy in a California state hospital, 1947-1954

Images

Voices of the mad: patients' letters from the Royal Edinburgh Asylum, 1873-1908

BACKGROUND

This paper is based on a rich archive of 1151 letters by patients, who were admitted to the Royal Edinburgh Asylum during the reign of Thomas Clouston (1873-1908).

METHODS

All letters were examined for evidence of psychopathology, and the material obtained was organized under the various psychopathological categories, such as delusions or hallucinations, as defined by Sims (1988).

RESULTS

A descriptive account of patient symptomatology is given. It is found that nineteenth century psychopathology is very similar to that of the modern day, and that most forms of morbid mental phenomena can be found in the patients' letters. More specifically, most of the cardinal symptoms of schizophrenia were described in the patients' correspondence. The letters also illustrate how mental symptoms reflect the cultural and scientific concerns of their time.

CONCLUSIONS

The evidence in the patients' letters argues for the unchanging nature of mental illness across time, at least for the last 120 years. It also demonstrates that patients admitted to the Royal Edinburgh Asylum suffered from serious mental illness, and it undermines the view that the Asylum was simply a dumping ground for society's disaffected.

The architecture of psychological management: the Irish asylums (1801-1922)

This analysis examines some of the psychological, philosophical and sociological motives behind the development of pauper lunatic asylum architecture in Ireland during the time of the Anglo-Irish union (1801-1922). Ground plans and structural features are used to define five psycho-architectonic generations. While isolation and classification were the prime objectives in the first public asylum in Ireland (1810-1814), a combination of the ideas of a psychological, 'moral', management and 'panoptic' architecture led to a radial institutional design during the next phase of construction (1817-1835). The asylums of the third generation (1845-1855) lacked 'panoptic' features but they were still intended to allow a proper 'moral' management of the inmates, and to create a therapeutic family environment. By the time the institutions of the fourth epoch were erected (1862-1869) the 'moral' treatment approach had been given up, and asylums were built to allow a psychological management by 'association'. The last institutions (1894-1922) built before Ireland's acquisition of Dominion status (1922) were intended to foster the development of a curative society.