written by Henry S. Schutta, M.D. Professor of Neurology at the University of Wisconsin, Madison, while on sabbatical leave in the Neurology Department of the Charité in the month of May, 1995, solely for the amusement and edification of the writer and his friends and dedicated to his host, Prof. dr.med. Karl M. Einhäupl.
In 1709 a plague epidemic broke out in Gdansk (Danzig), quickly spreading to East Prussia and the rest of Poland. To prevent its spread into Brandenburg the border was closed. Those who were caught trying to cross into Brandenburg were hanged. In 1710 King Friedrich I of Prussia was advised that the contagion may spread to Berlin. As one measure of containing the pestilence, he ordered the construction of a building outside the Spandauer Gate, near the river Spree, to house those afflicted with the "pest". It was commonly known as the "Pesthaus". His motive is said to have been "true love of humanity and praiseworthy Christian eagerness" but fear of contagion might have been a significant motivating factor. The structure was a two story rectangle which surrounded a central court yard, with a one story tower at each corner. The building had a capacity for 400 beds. It was stipulated that no more than one patient was to be allowed per bed, and a space between beds was to be maintained at all times. This was remarkable for a public institution of this kind at that time, when a bed was usually occupied by multiple people, often in shifts.
The plague did not reach Berlin on that occasion, and the house was used as shelter for the poor, and unsuccessful thieves and prostitutes. It is not quite clear how their confinement was enforced. A woman, known only as the "fat seamstress" (die fette Schneiderin) was very good at collecting candidates for the Pesthaus, since as an ex-criminal she knew where to find them. She is said to have delivered 100 prostitutes to the "spinning house" in an 8 day period, a record that has not been surpassed. Her reward was sudden death, probably by poisoning. The employment that was provided for the incumbents consisted mainly of "spinning and all kinds of wool work", therefore the institution was also known, for a time, as " The Spinning House at the Spandau Gate".
King Friedrich I of Prussia was convinced that to improve the state of medical knowledge refinements in the methods of anatomy instruction were required. To that end he appointed the executioner Herr Coblentz to the post of a "court and personal medicus", because of his superior knowledge of anatomy, derived from torturing procedures and executions, quarterings, drawing of innards etc. The medical profession in Prussia was stung into action by this insult. Professor Friedrich Hoffman of Halle, the leading medical authority of the day who was highly respected for his theories concerning the influence of the nervous system in health and disease and who is immortalized by Hoffmann's drops (ether spirit) and Hoffman's anodyne (compound ether spirit), demanded in a speech delivered at the Prussian Academy of Sciences that an anatomic theater be created, where anatomy could be taught by the demonstration of dissections. King Frederick I was supportive, but nothing much happened in his life time. In 1713, shortly after he succeeded his father, king Friedrich Wilhelm I founded the "Theatrum Anatomicum". It was to be housed in the tower of the Marstalls (stables), Unter den Linden. The role played by the great mathematician and philosopher Leibnitz in the foundation of the anatomic theater is not clear. Leibnitz was president of the Prussian Academy of Sciences at that time, but there is no evidence that he took an active part in the planning of the anatomic theater. Not much progress was being made by the Prussian Academy, so to move things along, his majesty appointed Dr. Christian Maximilian Spener professor of anatomy and ordered him to go ahead with the dissections and the teaching of anatomy. Spener soon gave demonstrations, sometimes as often as 3 times a week, to which were invited not only physicians and surgeons, but also feldschers, apothecaries, medical students and barbers.
Executions were common in those times, and a number of people profited by them The 'poor priest' sold tracts describing the condemned last agonizing hours in gruesome detail, the executioner sold the blood, "an infallible method for the cure of epilepsy". Most expensive was the blood of a virgin, least desirable was that of a Jew. Activities of this kind were regarded as natural and found acceptable by the populace of twin cities of Berlin/Colln, but dissection was violently opposed, because of the conviction that in after-life even the most vile criminal was entitled to face his creator more or less in one piece. The king took no notice of the superstitious rabble and personally saw to it that "an excess of cadavers, for the glory of the Army and the People, and for the profit of citizens and foreigners" was supplied to the Theatrum Anatomicum. The State library now stands where the anatomical theater was located.
When as a result of the war with Sweden King Frederick William I realized that his army had poorly trained surgeons despite all that anatomy teaching, he became very unhappy. Ernst Conrad Holtzendorff, the king's personal surgeon who started his medical career as a company feldscher, suggested that the feldschers and surgeons should do their own dissections and that they should be taught how to operate on cadavers. Holtzendorff also suggested that a few feldschers be sent to Paris for surgical training. Holtzendorff was soon after appointed Surgeon General of the Army, director of surgery in Prussia, and assumed supervision of all surgeons, feldschers, barbers and midwives. He became quite powerful and was instrumental in combining the professions of medicine and surgery. Friedrich Wilhelm I was frugal to a fault, and the expense of this enterprise was robbing him of his piece of mind. After he became persuaded that it would be cheaper to have his own medical school, he issued and edict (on March 18. 1724) that commanded the establishment of a Royal Medico-Chirurgical Institute, appointing professors of Anatomy, Pathology, Medicine, Surgery, Chemistry and Therapeutics and Botany. Holtzendorff realized that in addition to instruction in the theoretical foundations of medicine, clinical instruction and experience was essential, for which purpose a "Klinik" was required. The old Pesthaus, which continued to function as a mixture of homeless shelter and geriatric nursing home was suggested for this purpose by Holtzendorff and Eller, the professor of medicine. But the King had other ideas. He ordered the Pesthaus cleared of its occupants and converted into a military hospital (Lazarett) for the use of the Potsdam and Berlin garrisons. This did not work out for many reasons, and Holtzendorff got his clinic. Although the King was afflicted by "Sparsucht" (savings mania), he relented after he was persuaded that the expense of a Prussian medical school would be no greater than keeping three feldschers in the chirurgical school of Paris. He provided the 14 000 talers needed to convert the Pesthaus into a Hospital, and in 1726 he permitted "that a civilian and military hospital be established in the Garrison hospital by the Spandau gate, for the treatment of citizens and soldiers". On the document establishing the hospital Friedrich Wilhelm I added in his own hand:
"Es soll das Haus die Charité heissen". (The house shall be callled "Charité").
The institution was officially known as "Koenigliche Maison de Charité", but was commonly referred to simply as "The Charite". Around the Maison de Charité was an extensive cabbage garden, no doubt to assure an ample supply of Sauerkraut (and excellent preventor of scurvy), a fruit garden in which additional vegetables could be grown, and a meadow. The new dining hall adjoined the main building, next to it was the new beer brewery, which was the most imposing of the new structures. The stables were set back from the rest. A little later a low two story building was constructed in the central yard, it provided sleeping quarters for the staff. The Royal Medico-Chirurgical Institute was now ready to supply all the doctors the Prussian army would need. Medical theory was to be taught at the Institute itself, which was based on the old theatrum anatomicum, and practical medicine at the Charite. Before graduating as an "Arzt" (physician and surgeon), each candidate had to work for one year as an "Unterarzt" at the Charité, under the supervision of qualified doctors.
Johann Theodor Eller, the first professor of medicine at the Institute,was trained by Boorhave and Stahl. He was a remarkably knowledgeable and innovative man who published his treatises in Latin. He worked well with his surgical colleague, the regimental feldscher Gabriel Senff, and wrote about surgery for him, since it is safe to assume that a regimental feldscher was illiterate in Latin and possibly also in German.. He established admitting procedures, segregating patients according to the types of disease they had. This could have been the beginning of specialization. Nr. 30 of the "Physikalisch-Chymisch-Medicinische Abhandlungen aus den Gedenkschriften der Koeniglichen Akademie der Wissenschaften, herausgegeben und übersetzt von Carl Abraham Gerhard, Berlin, Stettin U. Leipzig, 1764" is by Eller, and it gives an account of his experience early in the life of the Charite: "Nützliche und auserlesene Medicinische und Chirurgische Anmerckunger so wohl von innerlichen als auch ausserlichen Kranckheiten, und by selbigem zum Theil verichteten operationen, welche bishero in dem....Lazareth der Charite zu Berlin vorgefallen; nebst einer vorangegebenen kurtzen Beschreibung der Stiftung, Anwachs und jetzigen Beschaffenheit dieses Hauses" or "Useful and selected medical and surgical observations of internal as well as external diseases and also about operations performed hitherto in the Lazaret of the Charité of Berlin, with a short description of its foundation, growth and the present characteristics of this house." The account is just as long winded, but it gave an excellent picture of what was going on at that time. The illustrations are especially helpful. The one showing an overview of the place has a somewhat inebriated and cranky looking black eagle, sitting on a list of objects shown in the picture. Eller was a prolific writer of medical texts: Physiologia et pathologia medica (1748), Observationis de cognoscendis et curandiis morbis praesentim acutis (1762), Vollstandige Chirurgie (1763), Ausuebende Arzneywissenschaft (1767).
Professor Eller was clearly a remarkable man, an excellent doctor, a great teacher, an able administrator and one of the earliest neurologists (see below).
From the beginning treatment at the Charité´ was free, up to a point. Those who could pay were charged 8 - 12 pennies (groschen) a week, those who were impecunious but had caused the Charité significant expense, had to work the bill off in one of the work houses, mostly spinning wool.
King Friedrich Wilhelm ordered his son Friedrich (later II, the Great, and finally "der alte Fritz"), to visit the Charitée regularly, to become acquainted with human misery and acquire compassion. Opinions on the effectiveness of such treatment are divided, and the truth will never be known since a double blind study to decide whether the acquisition of compassion in rulers correlates with exposure to misery is not feasible. Housed on the third floor were patients with venereal disease, and those too the young prince had to visit. The intent was to warn him of the dangers of love. The ineffectiveness of this method of preventing sexually transmittable disease is a historic fact, young Fritz managed to catch it despite these visits and his peculiar sexual orientation.
A new, large hospital was added to the Pest house towards the end of Frederick the Great's reign, in 1785. The new king, Friedrich Wilhelm II was under the influence of occultists and peddlers of corruption, and medicine did not do too well in his reign. Upon his death however, the Charité benefited in part from properties of the King's chief mistress, all of which were confiscated by the new king, who hated her. The Charité's share of the proceeds was modest, 5 000 talers annually, which paid a little more that one third of the laundry bill.
In the late 1780s oxygen was introduced to the wards of the Charité by chemists and the internist Prof. Selle under the name of "Lebensluft".
By the end of the XVIII century the Charité was a well established institution, and the subject of criticism for certain deficiencies. The Lutheran Pastor Wilhelm Prahmer wrote a booklet on conditions at the Charité in 1798. It appears that patient care left much to be desired. There was a great shortage of clean linen and the administration routinely ignored the requests and advice of doctors. The food at the Charité was considered important, since good nutrition was regarded as part of treatment, possibly more important than medicaments. By all accounts food should have been excellent in the early days. Prof. Mutzell provided a detailed menu for Charité patients which included such dishes as mutton in wine and lemon juice, beef, veal and fowl (according to one J.G. Betheman, a tourist, meat was served twice a day, calf or beef at noon and fowl in the evening). Whether this was a mere suggestion or the actual food eaten by the patients is difficult to discover, but by the time Pastor Prahmer reported on the food it tasted foul, was of poor quality and the portions were small. It was prepared by women from the venereal disease ward with the aid of kitchen maids who were said to have been "sluts full of scabies and venereal disease", semiretired prostitutes, forced to work there for 4 pence a month. It was suspected that the kitchen workers pilfered much of the food designated for the patients. The bath tubs could not and were not drained, and were said to have been inhabited by frogs. The king (Friedrich Wilhelm III), at first did not give a damn, but his softhearted queen (Luise) nudged him into action (a street that goes thorough the Charite complex is Luisen-Strasse, could be in honor of this kind lady). At her insistence a royal commission was appointed to investigate conditions at the Charité. Members of the commission were the Director of the poor (Armen Director) and the man responsible for the Charité, it was as if President Nixon were put in charge of the Watergate investigation. Naturally they found no serious deficiencies, but some things nevertheless changed as a result of Pastor Prahmers efforts: a separate old folks home was established, the doctors, not bureaucrats were made responsible for running the hospital, and a physician would henceforth live on the premises, refraining from all private practice . The King promised the proceeds of the lottery to the Charité and iron bedsteads to replace wooden bed frames. Promised also were a table and stool for each patient The most farsighted and useful innovation was the rule that surgeons should always work under the supervision of a physician. Alas, like the edict that physicians should administer the hospital, this rule was soon abandoned.
1810 was the year in which the Alexander von Humboldt Universität of Berlin was founded.
Christoph Wilhelm Hufeland was the first dean of its medical school.
Cholera broke out in 1817 in India, by 1818 it reached Warsaw. At that time the director of the Charité was Geheimrat Prof. Johann Nepomuk Rust. He was a physician and a surgeon, who was very powerful because he was made a sort of medical dictator of Prussia by the King, with whom he got drunk periodically. Among Rust's recommendations were the closure of borders and cessation of trade between Kingdoms of Poland and Prussia. Penalty for contravention , as in 1709, was death by hanging. Cholera entered the kingdom anyway, the first case was discovered in Berlin by a Dr. Calow early in 1831. Calow immediately notified Geheimrat Rust who firmly believed that cholera was spread from patient to patient by direct contact. Dr. Calow, believed otherwise, and thought that he could prove it by drinking some blood of his cholera patient, whose autopsy he attended along with Geheimrat Rust and other dignitaries. Rust overcame the impulse to order Calow's arrest, since he did not want to stand in the way of a scientific experiment, even though he was convinced that along with Dr. Calow would perish those who came in contact with him. Calow attended many cholera patients and died himself of the disease within a week. Rust appeared to be vindicated, but a Dr. Moritz Romberg, a friend of Dr. Calow's soon proved that cholera was transmitted through excrements, which was confirmed much later by another Berliner, Robert Koch. (Moritz Romberg is better remembered for having written what is probably the first useful textbook of Neurology, his name is immortalized in the Romberg sign). The infectious disease (small pox ) ward and then other rooms of the Charite were soon overflowing with cholera patients, who invariably died. New cholera hospitals were created to accommodate the overflow.
The nursing care was a bit haphazard at first, but in 1832 a school for nurses was established at the Charite. The students were men at first. In 1843 Deaconesses, Lutheran nuns, were forced onto the Charité, because it was felt that the patients and the doctors needed to be to "moralized". Even though the General-stabsarzt (General Staff Physician) Dr. Weibel, assured the physicians most earnestly that he would protect them from the nuns, the doctors, including the young surgeon Virchow, were concerned, because they believed that the Deaconesses were sent by the Queen to spy on them, The Charité patients and the doctors protested vigorously. A chorus of "Nonnen raus" greeted the holy ladies (this only from the inmates).The Deaconesses were put in charge of the syphilitic harlots, one was assigned to company surgeon's Virchow's female scabies ward.
The Charité doctors, like members of the orthodox medical profession everywhere have fought charlatans from the beginning. Unfortunately the outcome of orthodox treatment in the 19th century was no better than that of witch doctors or faith healers, and accepted therapeutic measures were often more unpleasant and frequently more dangerous than those practiced by the quacks.
Mesmerism was experimented with at the Charité around 1790. A commission appointed by Louis XVI, which included Lavoisier and Benjamin Franklin pronounced that it is based on suggestion. Professor Dr. Selle, the director of medicine at the Charité, came to a similar conclusion. One Dr. Wolfart a practitioner in Berlin proclaimed loudly that he could cure all illnesses (except crabs and syphilis) with hypnosis. Noble ladies flocked to him, and eventually also noblemen in high government positions. The Mesmerists received a boost when the Prussian Chancellor, the Duke Hardenberg appointed a successful Mesmerist from Paris, David Ferdinand Koreff, as his personal physician. Koreff and Wolfart formed a team. The chancellor became infatuated with one of Wolfarts mediums, the consumptive ex Charité patient and baker's daughter, Friedericke Haehnel. She was installed as the Duchess of Hardenberg's companion. Friedericke appears to have recovered from her consumption (with the help of hypnosis), but developed falling cramps, which were promptly recognized as attention seeking fictitious seizures. In due course the chancellor persuaded the King to give Wolfart a professorial appointment - the chair of animal magnetism. The physicians of the Charite resisted and a chair of animal magnetism was not created, Wolfart had to be satisfied with a title of "Ausserordentlicher Professor". However the chancellor was not chancellor for nothing, and got back at the faculty by appointing Koreff professor of Physiology when that post became vacant and the faculty could not agree on an appropriate candidate. The inconvenient fact that Koreff was not baptized (holy baptism was a condition of employment for all Prussian officials) was dealt with by a bright young official, who procured a backdated baptismal certificate for Koreff, with the eminently Christian first name of Johann. The influence of the Mesmerists Koreff and Wolfart expired with the death of the Chancellor, which was delayed long enough for these swindlers to become very rich.
Ether anesthesia was introduced in the summer of 1846 by Morton, a Boston dentist. It was promptly accepted in England, but on the continent it was regarded as Yankee bluff. The French Academy opposed it; Morton did not help by botching up a demonstration and by his greed in trying to get ether patented. Eminent French surgeons opposed its use as a piece of flim-flam. The Prussians, being by nature conservative, were virtually the last to use ether in Germany. Eminent surgeons Jungken, chief surgeon at the Charité and Dieffenbach who had since moved to the new University Hospital, opposed ether anesthesia in flowery language, despite the urging of their younger colleagues. Rudolf Virchow, resorted to animal experiments, to prove that ether anesthesia was a great thing and recommended its use on patients. When finally the first ether anesthesia was used at the Charite on a patient of Geheimrat Jungken in February 1847, Virchow personally administered the anesthesia, assisted by the diener from the "Sterbezimmer" (dying room), Herr Camille. The first patient was an alcoholic and used to knockout drops. He was still conscious after inhaling ether vapors for 30 mins. The Geheimrat cut his leg off just the same, but the operation was painless, much to the surprise of the surgeon and the audience, and no doubt to the delight of the patient. Nevertheless, to demonstrate how ether anesthesia usually works another surgical candidate was procured forthwith, a teenager who needed a leg cut off. He went under quickly. All this was done in front of a large audience, the doctors dressed in black tail coats and in the presence of an open fire that was needed to produce cautery. Dieffenbach apparently was concerned about an explosion, but mercifully none happened on that or on many other occasions until 90 years later, when Prof. Sauerbruch blew up an etherised patient and several innocent bystanders. Chloroform had a similarly cautious reception. It was first tried out on a bear in the Berlin Zoo who need a cataract extraction. The surgeon requested that chloroform be administered. When the zoo director objected, the King personally ordered that the animal be anesthetized with chloroform. The bear never woke from the anesthesia, but this somehow did not delay the introduction of chloroform by much. The king found the episode hilarious and ordered a sculpture to commemorate the event. Geheimrat. Prof. Dr. Schoenlein (a drinking companion of the kings) who gave the anesthesia is represented as a ram, Geheimrat Prof. Dr. Jungken, the operator as a fox and the two nameless assistants as owls.
In the early years of the 19th century, physicians and surgeons gradually abandoned the practice of doing their own autopsies, and left such things to prosectors. The early prosectors were not medically qualified. A memorable one was Madame Vogelsang, a former midwife. She presided over the death house at the Charité and carried out dissections around 1838. She was capable of predicting what she was going to find, much to the annoyance of the internists, whom she referred to as the "Latins", because they used the dead language for lectures, even case histories.
Rudolf Virchow's grandfather was a butcher in Schivelbein (now Swidwin). His father, a municipal official and farmer, was not rich enough to afford the fees needed for a medical education at the Humboldt University. Rudolf, born in Schivelbein in 1821, was a brilliant student in high school. He took his "Abitur" (high school certificate) early, he was in a hurry to become a doctor. Because of his excellent high school record, Rudolf Virchow was admitted to the Medical-Chirurgical Friedrich-Wilhelm Institute, the "Pepiniere", situated at Friedrich Strasse 10. The help of two uncles, one a royal Prussian staff physician, the other a builder involved in the construction of the new Charité, was almost certainly superfluous. The Pepiniere provided tuition free education at the University and Charite, as well as free board and lodgings for future Prussian military doctors. After 4 years of study, the successful student became a company surgeon and Unterarzt and was put in charge of one of the wards at the Charite. After a year of this the physicians were assigned to a military company, at that time with a rank inferior to that of a sergeant. This bleak prospect was facing young Virchow in 1843 at the age of 21. In the spring of 1844 the Generalarzt Grimm, who must have taken a liking to young Virchow, told him to develop an interest and become knowledgeable in microscopic and chemical examinations by October 1844. The fact that he was quite ready by that time speaks highly of the 21 year old surgeon, whose regular duties kept him busy from 05 30 h to 21 00 h.
This laboratory was to be established in 1844. Until then such studies were performed under the direction of the chief of medicine, the famous and powerful Geheimrat Prof. Dr. Schoenlein, who had two civilian physicians (Drs. Remak and Heintz) do such studies for him for the love of science, i.e without pay. Schoenlein, naturally wanted this paid job to go to one of his men, but General-Arzt Grimm decided otherwise - he thought that a military doctor should be in charge of such a lab. A tug of war developed in the responsible ministry, of which Geheimrat Prof. Dr. Schoenlein was the chief advisor, but he could not prevail over the military, even though he was the King's drinking companion. Remak and Heintz continued to do work for Schoenlein's clinic, and Virchow became responsible for the chemistry and microscopy for the rest of the Charité. (Remak eventually became a Privat Dozent, the first to reach that rank without the benefit of holy baptism). As his clinical duties Virchow was assigned the administration of the death house. The prosector, Medizinalrat Froriep, who was Virchow's boss, let him do the autopsies. When Froriep resigned a year later, Virchow succeeded him as prosector at the Charité.
The widow Eulalia Zach, aged 54 years, died on November 11 1844 a day after the removal of a pelvic tumor. The cause of death was thought to be "inflammation of the veins". Virchow found a clot in the pulmonary artery, but no evidence of inflammation. He was also impressed by the fact that the clot was situated at the branching of the artery, which suggested that it came from somewhere upstream. Virchow eventually found a clotted vein in the leg. He carefully , removed the clot and found that its ends fit that of the lung clot, "eine Embolie!" concluded Virchow, of a "thrombus", in other words a clot, the result of coagulation of blood, not inflammation. Microscopic examination of the clot revealed that the little yellowish-white dots that are scattered in the red clot are white blood cells, and not pus as was then believed.
Experiments convinced Virchow that stasis is an important factor in the clotting of blood. He recognized that stasis, diseased blood vessels and abnormalities of the blood itself all contribute to clot formation in varying degrees. The study of the components of the Virchow triad that was initiated by Virchow continues to this day. Since nobody wanted to publish these findings, he founded in 1846 with his friend Benno H.E. Reinhardt the "Archiv fur pathologische Anatomie und Physiologie und fur klinische Medicin".
On May 3rd, 1845 Virchow was the main speaker at festivities of the Friedrich-Wilhelm-Medico-Chirurgical Institute, during which he stated that he did not believe that God created animals and man, asserted that all life begins with the smallest unit, the cell, attacked the miserable living conditions of the populace, the poor condition for the doctors and made a number of other inflammatory statements. To his surprise the speech was well received, especially by his military superiors, and it made him well known. It is difficult to understand why a 24 year old PG3 would be asked to give an important oration in front of a bunch of VIPs unless one assumes that someone at that time recognized that this man was a genius.
At the age of 24 years Virchow had an apartment at the Hospital, a large room at the old Charité, with a sleeping alcove and 300 talers a year, things were looking up. When Virchow became prosector at the Charité he began his lectures on pathological anatomy, for which he soon became famous. Through many years, although busy in pathology Virchow took care of a ward - he picked the one with women suffering from scabies. He became politically active during the revolutionary years of 1848, was elected to the national assembly, but was not seated because he was under the required age of 30 years. When the revolution failed, life was made difficult for Virchow. For a time it looked as though he might loose his job, but in the end he was merely deprived of his official apartment at the Charité. He eventually left to become Professor of pathology in Wüzburg, but there he was hounded by right wing politicians, and when he was asked to return to Berlin he did so gladly. With time he became recognized as the "Pope of Medicine" in Berlin, Germany and beyond. A brilliant debater, he could devastate the opposition with a few well chosen acerbic phrases. He remained active in politics all his life, was a powerful councilor of the city of Berlin, whom it was unwise to cross. He irritated the devil out of the government, and when he went too far the exasperated Iron Chancellor, Prince Otto von Bismark, actually challenged him to a duel. Virchow disdained to engage in such foolishness.
His scientific achievements cannot all be listed here, they are numerous and many of epochal significance. He established modern histopathology, and his treatises on Zellularpathologie, Boeshafte Geschwülste (Cancer), Coagulation of blood - are landmarks, that can today be read with pleasure and profit. He contributed early to neuropathology. He provided ana early discussion on cerebral milliary aneurysms , he described chordomas with their physalipherous cells, Perlgeschwülste (pearly tumors or dermoids), and every other brain tumor imaginable, but his most fundamental contribution was the recognition of the importance of "Nervenkitt" i.e. glia. He the eye findings in papilledema, and coined the term "leukemia" and described the condition in detail. Virchow was also instrumental in the introduction of ether anesthesia at the Charité and in fact gave the first anesthetic there. That he was occasionally (very rarely) wrong or not quite right, merely proves that he was also human. He maintained to the end that meningiomas (psammomas) are mesodermal tumors (which is only partly, not completely wrong as his opponents thought). In 1888 he misdiagnosed Kaiser Wilhelm III's throat cancer for a benign lesion. He did not like Koch or the microbe hunters that surrounded him. He tried hard to diminish Robert Koch's enterprise, arguing in the City Council, of which he was a member, that the salaries Koch was offering were too high. On the other hand he strongly advocated the use of diphtheria antiserum, to which there was much opposition initially. As city councilor he contributed significantly to the design and building of the Berlin's sewer system, several new hospitals and the Völkerkunde Museum (Ethnographic museum), which now has a wonderful collection of African, Oceanic, Pre-Columbian and Egyptian artifacts. He had his finger in everything. He was recognized as the father of modern pathology and was greatly honored far and wide. His hero was Morgagni.
Among his many awards and medals was a gold medal from the City of Forli, Morgagni's birthplace, and the honorary citizenship of Bologna, which he regarded as the cradle of scientific medicine. When he died at the age of 81 some time after he fractured a hip on the way to a scientific meeting, , he was in full possession of all his mental faculties and still the Director of the pathologic institute in name and in fact.
The town of his birth, Swidwin was silent about its great son, until 1991, two years after freedom broke out in Poland, when he was honored by a monument. It is a simple stone adorned with a plaque, which says that Rudolf Virchow, the son of Swidwin's soil was a world famous physician. The local Health Care Center is named after him. The house where he was born has disappeared, but the church on the square, which he may have attended, still stands, and so does an old castle that was build in 1810, the year the Humboldt University was founded. Swidwin is preparing to celebrate the 700the anniversary of its founding. The public library has next to nothing about Virchow, but they are interested in getting as much material as possible. There are stacks of archives in the cellars, untouched by human hand for decades, which might provide information on Virchow's family and his youth.
The Virchow Haus on the grounds of the Charité still functions as the department of pathology, although it is partly ruined. The ruined part is used for exhibitions and entertainments, for which it provides a dramatic backdrop. The restored part houses what remains of his collection and the pathology department. Virchow would be sad to see that a physician in training is in charge of neuropathology, but would be delighted to know that the study of glial function is currently a major research interest of the Neurology Department. A large part of Virchow's collection has been destroyed during WW II. During communist rule the wall was right behind it, patrolled by soldiers with submachine guns, Virchow would not have liked that.
Persons with mental diseases were housed in the Charité from the beginning, and attempts to improve their treatment were constantly made. Around 1765 Prof. Muzell, who was interested in mental illness, inoculated lunatics with scabies (Kraetze) in an attempt to procure a cure. Details of the outcome are not recorded, but the Professor must have been satisfied with it, as he practiced the method for some time.
Nothing much changed on the lunatic wards of the Charité until September 2nd 1798, when fire destroyed the Mental Asylum in the Krausestrasse. The beginning of the psychiatric department in the Charite dates from that day, since the survivors from Krausestrasse were transferred to the Charite. This created severe strains in the already inadequate facilities, but this disaster initiated an epoch in which the mentally ill were increasingly regarded as patients in need of treatment rather than human garbage, although effective treatment was a long way off.
Geheimrat Dr. Ernst Horn was an early director of psychiatry at the Charité.
The conventional therapies offered psychiatric patients at that time were heat, cold (100 buckets of ice water were poured over the victim), emetics (antimony vinegar), "Ekel Therapie"' (the placement of stinking rags and other disgusting things round the patients face), and the "Haarseil", (a seton placed into the neck skin to produce a festering sore). The placement of patients in the English rotating chair (up to 100 rpm) until their eyes threatened to spring out of their heads and they pleaded for mercy, was also an accepted method of treatment. Dr. Horn found all these treatments ineffective in highly agitated, maniacal patients who screamed, threw themselves about and generally made a nuisance of themselves (i.e. they had the "Tobsucht"). Dr. Horn observed on one occasion that a highly agitated patient became quiet when the lights went out. He repeated the experiment and found that "darkness was never without effect on the mentally disturbed". Dr. Horn concluded that darkness was one of the strongest agents for bringing maniacal patients to their senses, and from then on attempted to cure mental illness by placing patients into sugar or potato sacks for as long as it took to calm them down. This treatment was regarded as a sadistic torture by his colleagues, but by 1806 Professor. Horn, who by then was also director of all of internal medicine, claimed a 25% cure of violent mental illness by the sack method. Occasionally a patient would suffocate in the bag, the diagnosis of " apoplexia post maniam" was applied to such outcome. The sack became "der Sterbesack", the death sack. Particularly upset was the surgeon, the Confidential Medical Councillor Dr. Heinrich Kohlrausch, who fired off a letter to the authorities deploring the treatment of the mentally ill, and in addition accusing Dr. Horn of all kinds of fiscal irregularities. The trial created a sensation in Berlin, but by the time the verdict came in, the story was overshadowed by the proximity of Napoleonic wars. Horn was exonerated on the evidence of expert witnesses who convinced themselves and persuaded the judges that one could not suffocate in a potato or sugar bag. Horn is sometimes portrayed as a cruel ignoramus, but it was concern for his patients that drove him to try measures that were no more outrageous than many other things then perpetrated on the unsuspecting public by the medical profession. The treatment of psychiatric patients continued largely unchanged, until restraints were gradually abandoned for most patients, but significant advances did not occur at the Charité or elsewhere for some time.
From the founding of the Charité till 1737, the surgeon in chief was the regimental feldscher Gabriel Senff, who was said to have been be a skilled surgeon and he worked well with Dr. Horn, the chief of medicine.
At the time of the 1813 cholera epidemic Geheimrat Johann Nepomuk Rust was the medical czar in Prussia and also the professor of surgery. By 1835 the Geheimrat Rust became decrepit, but there was no mandatory retirement age and Rust had no intention to retire. His fingers were distorted by gout, his eyes dimmed by cataracts, yet he insisted on operating, and at times was possessed by a "furor chirurgicus". His assistants were in fear of their fingers and despaired for the patients' lives. His chief assistant got the great idea to hire a brilliant young practicing surgeon to be guided by the great man, but in fact to do the surgery for him, to which Rust agreed. Johann Friedrich Dieffenbach had a somewhat stormy beginning, but in the end developed into a great surgeon. He soon became famous and people flocked to the Charité because of him. Dieffenbach experimented with transplantation (mainly hair to cure baldness), and plastic surgery. He did nose jobs and fixed cleft lips. He successfully tackled club feet and also had a go at torticollis using a sickle shaped knife that he saw used in France. With this sickle shaped knife he could cut a lot of muscle or tendon, without letting too much air into the tissues which was then thought to be the source of suppuration.
Around that time Dieffenbach had the idea that squints could be cured with the aid of his sickle shaped knife. He asked Madame Vogelsang who took care of the dissecting room to look out for squinting corpses. Within a year he is said to have dissected the eyes of hundreds of squinting corpses (possibly an exaggeration), coming to the conclusion that cutting the overacting eye muscle as suggested by Strohmeyer (who invented an operation for club foot) is feasible and should be used to cure squints. His first patient was the 7year old son of Madame Vogelsang, who in addition to getting cured of his squint earned himself a gold coin by not crying during the operation. Not that Dieffenbach was soft hearted, but he was afraid that the salty tears would muck up the wound. Squinters flocked to the Charite, but soon complications became apparent, and his main competitor, the surgeon Carl Ferdinand von Graefe began to gloat. Dieffenbach eventually reported on 1200 operations for squint, in a non-peer reviewed publication. Among his failures he described the case of the Countess Ida Hahn-Hahn, a notoriously promiscuous divorcee. Her eye became infected because she did not follow post operative instructions. The outcry nearly ruined him.
Heinrich Adolf Bardeleben became surgeon in chief at the Charité at the age of 49 with Jungken's retirement at the age of 75. He had been professor of surgery at Greifswald, a small Pommeranian town. The appointment had been suggested by Junkgen, and vehemently opposed by Langenbeck, Traube and Virchow, who wanted Billroth.. The bust of Bardeleben in front of the surgical clinic suggests that he was formidable man. Bardeleben spent a month in Glasgow and became an enthusiastic advocate of carbolic acid. When he wanted to introduce Lister's antiseptic methods at the Charite he was opposed by the Hospital administrator Herr Esse, a former Prussian army sergeant, on the grounds that gauze was too expensive. Bardeleben engaged Herr Esse in a shouting match, making liberal use of profanity at which he was an expert. Highest authorities were appealed to. The judgment eventually was to produce gauze in Prussia since it was concluded that it will prove of military importance. In the meantime Bardeleben imported gauze from Scotland at his own expense. Clearly the reforms that placed administration of the Hospital into the hands of physicians have not lasted long.
August Bier, Sauerbruch's immediate predecessor was the most accomplished surgeon of his time. He is remembered for his bad luck of having Hugo Stinnes, the richest man in Germany, and Friedrich Ebert, the German President die after he performed abdominal surgery on them. He sent a bill for 150 000 marks plus 30 000 for an assistant, (in 1927 that was a lot of marks), to Stinnes' widow, which he managed to collect despite objections from the Stinnes' children. The fee for the fatal operation on President Ebert is not recorded.
Geheimrat Professor Dr. Ferdinand Sauerbruch
This surgical genius took over from the unhappy Geheimrat Bier in 1927. He treated Lenin when both lived in Zurich, President von Hindenburg when he was dying. He was a master surgeon, who did lungs, brains, bones - anything that could be cut he had
a go at, very successfully. At the end of the war he was at the Charité operating round the clock, as around him building by building was damaged or destroyed. When the Russians finally came to the Charité, former pupils of Sauerbruch were among
them, and since they were in high positions, they could give their old teacher a helping hand.
Albrech von Graefe was the son of the famous Berlin surgeon Carl Ferdinand von Graefe, founder of the University surgical clinic, a competitor of surgeons of the Charité. He completed his medical studies at the age of 19, following which he studied with the best surgeons in Prague, Vienna, Paris and London. Upon his return to Berlin he hung out his shingle and placed an advertisement in 'National Zeitung' announcing that he is ready to treat patients with eye diseases and that those who cannot pay will be treated free of charge.
He was interested in ways to inspect the optic fundus in the living patient, and encouraged the Vienna physicist and physiologist Brücke to produce a suitable instrument, but Brücke could not solve the problem of illumination. In 1851 Herman Helmholtz, a Pepiniere alumnus, published a monograph entitled "Beschreibung eines Augen-Spiegels zur Untersuchung der Netzhaut im Lebenden Auge". (Description of an eye-mirror for the examination of the retina in the living eye.) Von Graefe immediately realized that "Helmholtz opened a new world for us", and had an instrument constructed to Helmholtz's specification. He also wrote to Helmholtz requesting one or two examples of his instrument, so that he can compare it with his production. Von Graefe introduced Helmholtz's mirror into clinical use, not only in Germany, but also in England and France. His descriptions of papilledema (Stauungspapille) in patients with brain tumors were instrumental in thrusting the opthalmosocope into the hands of neurologists. He also devised an operation for glaucoma and made other invaluable contributions to opthalmology. When the ancient Jungken finally retired in 1868, Albrecht von Graefe was made professor of ophthalmology and director of the eye clinic of the Charité. By then he had advanced lung tuberculosis and was addicted to morphine. He died in 1870. On receiving the Von Graefe gold medal of the Ophthalmologic society for inventing the ophthalmoscope in 1886, von Helmholtz compared himself to a clever blacksmith who invented the tempering of steel with which great sculptors created immortal works of art. Von Graefe would have liked to hear that.
The Charité had an obstetrics department from the beginning. King Friedrich Wilhelm showed his disapproval of pregnant single women by having them flogged. After a thorough beating they were then admitted to the Charité for delivery, because the king was interested in the offsprings as potential soldiers. In 1770 obstetrics was taught at the Collegium Medico-Chirurgicum on models by Johann Friedrich Meckel, the professor of anatomy and obstetrics. Meckel who was famous for discovering the submandibular ganglion and an intestinal diverticulum was also a fashionable doctor, "the most prolific prescription writer of all times". He never set foot at the Charité and never delivered a baby. The Charité obstetrician was a Dr. Joachim Friedrich Henckel, a highly skilled surgeon, who was regarded as a pushy, knife happy feldscher, and who did not have a doctorate for a long time, but knew exactly what to do when a baby got stuck. Meckel and Henckel despised each other. The chief surgeon, Pallas, supported Meckel, the chief internist supported Henckel, and a situation developed, which has been repeated in diverse countries over the succeeding centuries. The enemies of Henckel managed to influence the King against him; he was, for a time, forbidden private practice. He consequently resigned from the Charité and the army (all Charite medical personnel were employed by the army). He eventually established a thriving practice, and taught a lot, his lectures were thronged, being superior to the collegium professors. In time Henckel was called to the bedside of a noble, unmarried lady, who was in labor for 48 hours. He decided that a Cesarean section was required, and the patient badly wanted it done. Henckel knew that if things should go wrong, he would be crucified, but decided to go ahead. The baby lived, mother died from peritonitis. Frederick the Great heard about this event, and when years later he needed an obstetrician to deliver a potential successor, he remembered the courage of Henckel and employed him to deliver the baby. All went well with the delivery and when his enemy Pallas died, Henckel became professor and chief of surgery at the Charite. He soon got into fights with bureaucrats and others. He continued to operate even when he became old and shaky and sadly became the object of scorn and ridicule.
Professor Eduard Martin was the first professor of obstetrics and gynecology. As his recruitment package, the University had to establish a gynecologic clinic for him. The surgeon Jungken objected to Martin "cutting himself a few juicy pieces from the medical and surgical cake of private practice". He did not prevail in view of the support of Schoenlein and Virchow, who wanted the best in obstetrics at the Charité, and that evidently was Martin, then professor of obstetrics in Jena. Martin was a real wizard at delivering babies, and it was he who delivered Friedrich Wilhelm Victor Albert, later Kaiser Wilhelm II in 1859. It was a breech presentation, and the child's left brachial plexus was damaged during delivery. Those who believe that this injury made the Kaiser an ill tempered blood thirsty assassin blame professor Martin for WW I.
In the early 18th century treatment for venereal disease consisted of inunctions with mercury and exposure to heat. The rooms were heated and hermetically sealed, and since they could be opened only from the outside the patients had no way to get relief. Mercury induces salivation, which was thought to be the decisive factor in curing syphilis, and the sweating which added to the flow of juices was regarded as helpful. A special room, the "Salivations Stube" (# 69 on the third floor) was provided for this purpose.
Felix von Baerensprung was given the title professor in 1853 at the age of 31 and placed in charge of the syphilitic wards. Von Baerensprung devised a new cure for syphilis, since he believed that mercury was harmful. The cure consisted of a balanced diet, alternating with periods of starvation, daily ablutions in clear water and ample sarsaparilla tea. He claimed that recurrences were reduced with this treatment. Virchow endeavored to disabuse the man of this delusion:" it is true" he said "that recurrences are less common in the clinic, because instead going to the clinic, patients are turning up at the autopsy table". Baerensprung felt wounded by Virchow's remarks and decided to initiate a series of experiments to show Virchow and the world that he was a great scientist. He injected, without consent, material from a chancre into a 23 year old woman, who had repeated attacks of gonorrhea, but who had no signs of syphilis. She developed a hard chancre, confirming the notion that the first stage of Syphilis is infectious. The prevailing view was that the second and third stages of syphilis were non-infectious. Von Baerensprung thought that he proved that this was incorrect, by showing that injecting second stage material produced a hard chancre. It is unlikely that he obtained consent (informed or other) from the 18 year old woman who was the subject of this experiment. The women were given von Baerensprung's treatment and discharged as cured. A protracted feud developed between the aristocratic von Baerensprung and the plebeian revolutionary Virchow. It can be assumed that von Baerensprung, who was no ogre, justified his action by the conviction that the lifestyle of these ladies assured the acquisition of syphilis sooner or later anyway. Von Baerensprung eventually became psychotic and finally drowned. Autopsy confirmed the suspicion that he had syphilis, the brain showed evidence of G.P.I.
a graduate of the Pepiniere, was a county doctor near Posen (Poznan), when he studied wound infection. He managed to show that wound infections were caused by bacteria This work attracted a modicum of attention, but it was the pathologist Prof. Cohnheim and the botanist Prof. Cohn, both at Breslau (Wroclaw) University who were enthusiastic and encouraged Koch to visit Berlin. Koch's visit to Virchow did not go well, the great man gave him no encouragement, and his assistants insulted Koch. However, Dr. Struck, director of the new Imperial Health Office (Kaiserliches Gesundheitsamt) had read Koch's papers and offered him the job of Division Chief in his enterprise with the title of "Regierungsrat". The institute was at 57 Luisenstrasse, next to, but not in or of the Charité. When Koch wanted to apply his sterilization methods, which were replacing carbolic acid, he had to go to the Universitats Klinik in the Ziegelstrasse to introduce, with the surgeon Ernst von Bergman, the aseptic method of surgery.
In1880 tuberculosis was a devastating problem, every 7th person in Germany and every 4th in Berlin died of lung tuberculosis, and Koch wanted to do something about this dismal state of affairs. Tuberculin seems to have worked on guinea pigs, it was tried on humans with initial success, but in time its true value became painfully obvious. The clinical trials were done on the Charite tuberculosis wards. When von Bergman asked to be shown the guinea pig pathology, Koch had to admit that there was none. This gave Koch a bit of a bad name for a while, but he should not have worried, the very discovery of the tubercle bacillus saved millions of lives in a very short time.
Emil Behring was also a graduate of the Pepiniere. As a military doctor he came across extensive wounds, which were then routinely treated with iodoform. This disinfectant had its side effects, which Behring investigated. While studying at the pharmacologic institute in Bonn, he discovered that rats were not affected by anthrax (Milzbrand) because its serum killed the bacteria. His boss was not overwhelmed, but Behring persisted. Following his stay in Bonn he was ordered to the Pepiniere as a chemistry teacher, but on arrival was commanded to Koch's laboratory. Koch appreciated his work on anthrax, but told him to get busy on finding a cure for tetanus and diphtheria, which he did with the help of Paul Ehrlich. Behring did not give Ehrlich the credit he deserved in the discovery of diphtheria antiserum, which, it is said, he later regretted, making a tearful apology at Ehrlich's funeral. Behring became ennobled and rich, Ehrlich got nothing out of the immunization business. Both won the Nobel prize, Ehrlich for discovering Salvarsan (preparation 606).
Richard Schaudinn, a zoologist working in the dermatology laboratory of the Charité discovered the 'spirocheta pallida'.
Adolph Paul Wassermann, working in the institute for infectious disease of Robert Koch introduced his reaction for syphilis in 1906.
Paul Ehrlich was an Oberarzt at the Charité when he made his great discoveries. He hardly saw patients, which was a cause of complaints, but his boss, Prof. Frerich, who was an odd bird himself, protected him. Ehrlich liked colors, and it puzzled him why different tissues took up different dyes preferentially. He studied the oxygen requirements of tissues, invented the diazo reaction. When Frerich died of an opium overdose, and his successor began to press Ehrlich to do what an Oberarzt is paid for, Ehrlich quit the Charité and joined Koch's outfit. He eventually became director of the Royal Institute for Therapy and of the" Georg Speyer Haus fur Chemotherapie". Salvarsan was introduced in 1910 and continued to be used as the most effective drug for the treatment of syphilis until replaced by penicillin.
In 1730, on one of his visits to the Charite, Prince Friedrich of Prussia (Later King Frederick the Great) was shown a patient who recovered from a stroke. He was treated by Professor Eller's new method: fever. Eller read in Hippocratic manuscripts that fever is beneficial in strokes, but hitherto patients who developed fever following stroke were treated with measures that reduced fever. Eller changed all that, and on his wards fever in stroke patients was not only left alone, but encouraged.
Appointed in 1864 as professor of pychiatry, Professor Wilhelm Griesinger was the first director of the combined psychiatric and neurologic clinic at the Charité. Griesinger considered himself both a psychiatrist and neurologist. In his younger years he was director of the medical school in Cairo, Egypt. In this position he was also responsible for all health care in Egypt and the personal health of the Vice-Roy. He did not like administration much, so he returned to Germany, first working at Tübingen, then becoming director of an institute for the mentally retarded. In 1860, he accepted a position in Zurich, and from there, in 1864 he moved to Berlin. He exerted himself to combine the specialties of neurology and psychiatry, and designed the Neuropsychiatric Institute with this in mind. To this day the building designed by Griesinger houses the administrative offices and research laboratories of both the psychiatry and neurology departments. His bust stands at the entrance, on the left side of the main entrance to the neurology/psychiatry building. He seems to be casting a beneficent and watchful eye over the vehicles parked in the vicinity, and it is said that cars parked within his field of vision are immune from damage, theft and towing (Abschleppen). Griesinger was interested mainly in mental illness, he maintained that mental illnesses arise from derangement of brain function. He wrote a textbook of psychiatry as a very young man, and later a monograph on "Pathology and Therapy of Psychological Illnesses". Griesinger loved to travel, when in Egypt he traveled extensively in the Middle East. During his early Berlin years he visited London, Paris, Switzerland and many other European cities. He was passionate about reforming the treatment of patients with mental illnesses, and especially insistent on the treatment of psychiatric patients without restraints (free treatment). These views attracted considerable opposition, and an acrimonious, sometimes personal polemic developed. He also made careful observations on several neurologic conditions. The one that stands out is a case report of a patient with otitis media with a number of complications, including lateral sinus thrombosis. Griesinger was aware of the symptomatology associated with lateral sinus thrombosis, and contributed a new sign: "In one of these cases I observed a condition, hitherto unknown, that can serve as an indirect indication of thrombosis of the transverse sinus, namely: a circumscribed area of painful edema, a phlegmasia dolens en miniature, behind the ear". Griesinger explains this phenomenon by thrombosis of the mastoid emissary veins. This phenomenon is now known as Griesinger's sign. He was also interested in cholera. He was a member of a cholera commission, and organized a symposium on this disease. He died in 1868 without seeing his neuro-psychiatric clinic completed.
He founded the "Archiv fur Psychiatrie und Nervenkrankheiten".
started his career at the Charité in 1858 as an Assistentsarzt in charge of the smallpox ward. By then he had done research in physiology under Ludwig, and had traveled widely. After a year on the smallpox ward, he published his observations on the "Disorders of the nervous system after small pox and typhus". Later Westphal joined the psychiatric clinic and in 1869 succeed Griesinger as professor of Neurology and Psychiatry. In 1871 he opened the first "Polikinik fur Nervenkrankheiten", i.e. a neurology out patient clinic, at the Charité. In 1878 he published a paper on diseases of the nervous system resulting from railroad accidents (railroad spine), which, he argued, was not a psychogenic, but an organic condition. During 1888 he devoted himself to the study of disorders of eye muscles. In London he studied the effects of myxedema on the nervous system. He recognized the significance of an absent knee jerk simultaneously with Erb, the loss of knee jerks was for a time referred to as "the Westphal phenomenon" He wrote extensively on spinal cord disease, myotonia, myopathies, paralysis agitans, and "pseudosclerose". He was an intellectual, active in the "Mittwochgesellschaft", where distinguished professors of the university got together and instructed one another in their specialties. He loved good literature, his favorite authors were Euripides, Sophokles, Shakespeare and Goethe. The Edinger-Westphal nucleus perpetuates his name.
was a brilliant clinician, one of the founders of modern clinical neurology. He was an Oberarzt at the Charité, and a very busy practitioner. His text book "Lehrbuch der Nervenkrankheiten" first published towards the end of the 19th century had many editions, the last one in the 20s, was posthumous, prepared by his pupils. Along with Gowers' book and Charcot's collection of lectures, it was the standard neurology text for half a century. It is a magnificent two volume book, which can be read with profit to day, and should be made required reading for neurology housestaff who generally have the impression that Neurology started with their own puberty. In the course of his introductory oration during the opening ceremonies of the International congress of neurology in Hamburg in 1985 Prof. Zülch mentioned Oppenheim. Apparently the great Munich psychiatrist Kraepelin was offered the psychiatry chair at the Charité and the Humboldt University. He agreed to come, provided he could have Oppenheim as his chief neurologist. The faculty council declined to award Oppenheim a professorship and Kraepelin stayed in Munich. There is hardly a neurological condition that escaped Oppenheim's observation, he reported hundreds of interesting diseases, some for the first time. His description of an acute intervertebral disc herniation causing a cauda equina lesion and its successful treatment by Fedor Krause, was a first. He had opinions on every neurologic condition, some turned out to be correct, others not. He thought that sciatica was genetically determined because in his experience it particularly afflicted the Jewish race.
The Charite was at its peak early in the 20th century. The 200th anniversary of the Charite was celebrated in 1910. In that year Professor von Leyden, head of the 1st Medical Clinic, allegedly told a medical student who came to be examined by him, that he had the honor to be in the first medical clinic of the world. The professor may have been right.
The famous pathologist Geheimrat Otto Lubarsch, a pupil and successor of Virchow's, along with many German citizens, was violently opposed to the Weimar Republic. He is said to have looked forward to some order being created out of the Weimar chaos by Hitler. He believed that when referring to Jews Hitler meant the "east Jews" (Ostjuden), whom Lubarsch himself despised. He was after all a German Geheimrat, properly baptized and married to a blond Prussian lady. Mercifully he died in 1933.
In 1933 Dr. Nissen, Sauerbruch's favorite Oberarzt, Drs. Asheim and Zondek the founders of gynecologic endocrinology along with 47 of 100 internists, 14 of 57 surgeons, 8 of 40 gynecologists, 7 of 17 neurologists/psychiatrists, 5 of 17 dermatologists, 8 of 26 pediatricians, 7 of 20 pathologists were forced to resign from the staff of the Charité because they were Jews or had Jewish ancestors. Their Aryan colleagues offered advice and letters of introductions to professors abroad. It is not known whether anyone protested.
The fifth director of the neuropsychiatric clinic, Professor Karl Bonhoefer was a highly respected psychiatrist. Although he admitted candidly that " Unfortunately, neither I nor any of the other professors had the courage to get up and walk out in protest" at the Nazification process of German Universities, he endeavored against great odds to generate an atmosphere of decency and fairness in his department after the Nazis came to power. He was not in sympathy with the Nazis, and eventually became an active opponent of the regime. He was therefore dismissed from the chairmanship of his department and was replaced by Professor Max de Crinis. De Crinis, an Austrian by birth, was a member of the NSDAP and a high official in the SS. He must have been a bit of a thug - in 1939 he was decorated with the Iron Cross by Hitler himself for helping to kidnap two British intelligence officers in Holland, then a neutral and yet unconquered country. The rumor that he conducted rounds at the Charite in his black SS uniform, is unfounded. On the contrary, for some reason De Crisis , like others involved in the "Euthanasia" projects kept his SS affiliation quiet, and apparently did not allow patients of the Charite under his care to be killed. De Crinis was "the most outspoken and influential Nazi within the German psychiatric establishment" and became a regular advisor of the Ministries of Culture and of Health and to the Rassenamt. (There was a department of race hygiene - Rassenhygiene at the Humboldt University during the Nazi era). Naturally, he was one of the of 5 psychiatry professors summoned to the Reich chancellery in July 1939 to help in "Aktion Gnadentod" - mercy death. "Aktion Gnadentod" was a program, initiated by the Führer personally to kill severely mentally disabled and incurable patients. Only one of those present, Prof. Ewald of Göttingen, refused to cooperate and was asked to leave the meeting. (Hitler was advised not to bother inviting old Prof. Bumke, because he would refuse to come). De Crinis, a strong supporter of the program from beginning to end, is said that he drafted the language contained in Hitler's orders concerning "Gnadentod".:
"Reich Leader Bouhler and Dr. Brandt are charged with the responsibility for expanding the authority of physicians, to be designated by name , to the end that patients considered incurable according to best available human judgment of their state of health, can be granted a mercy death (Gnadentod).".
De Crinis was an active evaluator of candidates for gassing. By the spring of 1941 one of the murder centers "celebrated" the 10,000th death. Eventually some 100,000 people were killed in the "Aktion".
A few protested. Professor Karl Bonhoeffer, was distraught and actively opposed the program. His entire family was opposed to Nazism - his son Dietrich Bonhoeffer, a noted Protestant theologian, and his son in law Hans von Dohnanyi were executed by the Gestapo. Ferdinand Sauerbruch was furious when told about Gnadentod by pastor Braune: "these criminals are ruining the medical profession from the roots up". Pastor Braune was arrested by the Gestapo, but survived. The most vocal critic was the catholic archbishop of Munster, Count von Galen: "Who, in the future, will trust a doctor? Perhaps a doctor will declare him "unproductive", possibly a doctor has an order to kill him. Unhappy people, unhappy Germany, when the commandment "Thou shalt not kill" is transgressed unpunished." (Archbishop Count von Galen, 8.3.1941, Munster)
De Crinis took cyanide in the last days of the war.
The laryngologist Professor Carl von Eicken took a polyp off Hitler's vocal cord and tried to instruct him how to speak without rupturing his throat. Hitler was worried that he might have cancer, reminding von Eicken that even the great Virchow could be mistaken in such things. The operation was successful, no cancer was found and a few days after the operation a check for 10 000 marks arrived from Hitler. Von Eicken, did not want to accept it, but Hitler insisted, explaining that the proceeds from his publications were so high he did not know what to do with all that money. Von Eicken asked permission to give the money to a foundation for the support of Assistentsaerzte (housestaff). Permission was accompanied by an additional check for 60 000 Reichsmark. The money was invested and the income was used for one resident's salary. Von Eicken's private consulting rooms were in the Unger Klinik. He was ordered by Nazi party authorities to get out of there because Unger was a Jew. Unger had treated von Eicken and they were old friends. Someone who cured the Führer's hoarseness could afford to ignore the party, and von Eicken continued to use the Unger clinic and managed to shield Unger. When asked after the war by a Soviet officer why he didn't kill the Hitler when he had a chance, he said that he was a doctor, and Hitler was his patient.
After the second world war the Charité was located in East Berlin, just by the wall. As things settled down, it became obvious to many that the type of medicine that would be practiced in the "socialist" East Germany, will be a disaster like everything else. More than half the faculty left Berlin as the Wall went up. To become a professor it was then necessary to join the communist party or its surrogates, and to get ahead one had to collaborate with the Stasi (Staats Sicherheit), the successor of the Gestapo; one dictatorship was succeeded by another.
In 1972 plans were drawn up for a modern high rise building. It was completed in 1980, and it appears to be the most distinguished building accomplishment of the DDR. It does not have the usual Stalinist appearance, and it is partly build with materials imported from the west. The whole building is wired with fiber optic lines. It became the hospital for the communist elite from the DDR and other "socialist" countries. Not infrequently nameless and heavily guarded Russians were admitted, nobody knew who they are until their photographs were spotted by chance in the papers at a later date. The 20th floor housed the Stasi surveillance apparatus that eavesdropped on the Reichstag proceedings.
After the unification of Germany a proposal was made to close the venerable Charité. The Dean, a survival of former times formed a human wall around the Charité with the help of Charité employees and the populace, and the Charité was saved. The Dean, although anointed as the savior of the Charité was nevertheless fired soon after this effort, naturally with expressions of profound gratitude for saving the Charité. It cost 14,000 talers to convert the Pesthaus into a Hospital, it will take millions to convert a fairly run down communist hospital and medical school into an institution capable of competing with the great medical institutions of this world. Gradually, energetic and farsighted clinical scientist are being appointed to leadership positions at the Charité. If the developments in the Neurology department can serve as a predictor of the future, then there is every reason to hope that the Charité will recapture its past glory in the 21st century.