Bamberg General Hospital [*]
Caroline, Wilhelm Schlegel, and Schelling paid an official visit to the Bamberg General Hospital on 4 August 1800, signing the guest register and touring the facility presumably in the company of one or both head physicians, Adalbert Friedrich Marcus and Andreas Röschlaub. A month later, in September 1800, Röschlaub also gave a personal tour to Johann Diederich Gries, and possibly to Christoph Wilhelm Hufeland, Caroline’s personal physician from Jena, who seems to have been in Bamberg at this time as well. [1]
Schelling, moreover, having become enamored with the Brunonian method, was entering a period during which he would have increasingly more contact with physicians and become increasingly interested in the interface between medicine and the philosophy of nature. He would, moreover, be held at least indirectly responsible for some of the excessive theoretical developments in medicine at the university in Bamberg as reflected in several doctoral theses submitted there over the next few years, not to speak of the scandal, documented in volume 2, associated with Auguste’s death. [2]
Here the location of the General Hospital on the Regnitz River in Bamberg (no. 40 the left) in relationship to the Hotel Bamberger Hof (“a” at right), where Caroline and Schelling stayed after returning from Bocklet after Auguste’s death: [3]
The gallery on the hospital provides illustrations of the hospital itself [4] and reproductions of the original construction plans for each floor. [5] The latter are useful especially for keeping track of the specific facilities, rooms, wards, etc. in the accounts below. The gallery also includes vignettes of typical patient situations from the period. Click on the image below to open the gallery:
The publications below generally increase in complexity, thoroughness, and length as one progresses from one piece to the next; readers can choose to examine only certain pieces or, depending on interest, all. Not surprisingly, because the accounts were written at different times, some details differ.
I. Joseph Heller, Guidebook to Bamberg (1831), a popular guidebook for visitors and residents; — II. Joachim Heinrich Jäck, Bamberg and its Environs (1813) (a more detailed account in the form of a visitor’s tour); — III. Adalbert Friedrich Marcus, Brief Description of Bamberg General Hospital (1797) (detailed description of the facility, staff, principles, and operation by the head physician at the time of Caroline’s visit).
I. Joseph Heller, Taschenbuch von Bamberg. Eine topographische, statistische, ethnographische und historische Beschreibung der Stadt und ihrer Umgebungen. Als Führer für Fremde und Einheimische (Bamberg 1831), 203–6.
The General Hospital
No other institution has bestowed more honor on its founder and the residents of Bamberg than has this hospital, one distinguishing itself from many other such institutions throughout Germany through its splendid facilities and excellent care for the ill. The justifiably universally respected prince bishop Franz Ludwig von Erthal, having become aware of the deplorable conditions in the institutions for the incurable, made the commendable decision to have a general hospital constructed in Bamberg using his own private wealth. In 1786 he bought the garden of the von Stadion family for 8000 florins in the Im Sande area of Bamberg with its two wings, had it lengthened, and connected the two wings through a primary middle edifice.
The prince, however, was particularly focused on seeing that the institution had purposeful, efficient interior facilities and equipment; hence he had several plans submitted that he then examined with his physician, Dr. Marcus, ultimately choosing that of Geigel and Fink. Marcus in his own turn contributed not inconsiderably to this institution by persuading the prince to include things that without Marcus’s initiative would not otherwise have been included. After the prince’s death, this excellent institution fell on hard times and was almost closed, and it is to the active engagement of the incomparable Marcus that we owe its preservation.
The completion of the building with its interior installations and equipment cost 60,000 florins. Its solemn dedication took place on 11 November 1798. Two hundred patients can easily and comfortably be accommodated in its rooms, though the usual number is sixty. Male and female patients are separated; medicines, food, laundry, etc. are provided free of cost. The halls are high and spacious, and each holds eight to ten beds. The lower floor is for patients who suffer from external ailments, the first story for those who suffer from internal ailments. —
A directing physician is responsible for the hospital’s general supervision. The institution also has a senior surgeon and a medical and a surgical assistant. The hospital’s own accountant oversees bookkeeping and finances. The highest official is the local municipal magistrate. Those who wish to become better acquainted with the institution need but contact the current directing physician, Dr. [Christian] Pfeufer. [6]
This excellent institution is a sibling to two others as well, namely, the institutes for patients from the trade guilds and that for patients from among domestics, all of whom are treated gratis. That said, every journeyman and every apprentice sojourning in Bamberg must pay 2 Kreuzer per week if they are to be admitted to the hospital in case of illness. For domestics, their employers must pay 21 Kronen quarterly.
Because this general hospital has done so much good work since its establishment, hardly a year passes without it receiving support through bequests. From 1794 to 1824, such came to the amoung of 157,317 Florins. The annual expenditures are approximately 25,000 Florins.
II. Joachim Heinrich Jäck, Bamberg und dessen Umgebungen. Ein Taschenbuch, 2nd ed. (Bamberg 1813), 76–81 (passages omitted that provide the same information as above):
The entire building is built of high-quality, massive, dry stonework; [7] it is situated toward the east, out in the open, with no other higher building around it, hence enjoys both light and air without obstruction, the latter of which is kept fresh through suitable ducts, vapor shafts, and ventilators. Fresh drinking water, pumped up above the ground floor, facilitates the work of staff caretakers and promotes cleanliness. The wards have high ceilings, are spacious, and are occupied by at most 8–10 patients, who are separated by sex and illness; each hall has one or, if necessary, two staff female caretakers. The food and drink are hearty and tasty, medications generously administered, and the number of patients is usually about 60, each enjoying regular changes of laundry, bedding, and clothing courtesy by the institution itself. . . .
This institution also provides preliminary training for the practicing physician, a place where he can become acquainted with every type of illness and its appropriate method of treatment. For no illness is excluded from clinical examination. The institute’s director performs the initial examination and at most allows the practiced apprentice physician to continue only by way of observation. Every new and old theory is evaluated to determine its usefulness or lack thereof. Assistants, supervised by the instructor, keep a diary of the progress of each patient’s illness, thereby providing apprentices with models for their own attempts.
This hospital is complemented by several other nearby institutions, rounding off the notion of a complete clinical educational complex, namely, the General Hospital for the citizenry or the infirmary, the Mental Health Institute, the Maternity Hospital, the Infirmary for the Poor, the House for the Incurable, the Orphans’ Institute, the Eye and Inoculation Institute, etc., whose annual support requires more than 50,000 florins.
So above all we are visiting a place that has educated thousands of young physicians and restored the lives of a great many patients who had despaired that such was even possible; the modesty of the sublime founder dedicated it “to Suffering Humanity.” [8]
Immediately at the entrance to the ground floor, we are shown the apartment of the building manager and surgeon, the rooms of the bursar, Institute of Journeymen, and the rooms for the regular meetings of the hospital commission — three halls for patients with external illnesses, e.g., wounds, and two for more complicated operations and public lectures.
At the center, a door opening to the east leads out into a grand garden planted with grapevines and fruit trees, and in which the necessary vegetables are grown for the entire hospital and where patients can enjoy an uplifting view and those in rehabilitation a refreshing, lovely promenade. A bit further in the background we see, next to the residence of the laundress, cook, and housemaid, also a series of chambers for various housekeeping needs, which we quickly pass by that we may sooner view the artificial high-efficiency stoves used by the adjoining kitchen, in which 6–8 large iron pots set into iron plates are quickly brought to boiling using very little wood.
By way of a handsome staircase in this adjacent wing, corresponding to another in the opposite wing, we make our way into the second story.
The hospital apothecary, equipped with a small kitchen in the center, offers patients medications for their recovery at every hour of the day; next to it there is lovely small chapel where daily masses are held in which patients in every ward on this floor can participate by way of windows and glass doors. Four wards for male and female patients are situated to the right and left of this hospital chapel, with bathing rooms to each side.
Between the halls there is a narrow section for the patients’ toilets, whose impurities are here removed without causing any foul odor. Every ward has a large air shaft for drawing off impure vapors — and 4 smaller ones through which fresh air can constantly flow in. All the patients’ beds are enclosed by curtains to make them resemble small, separate rooms; each bed consists of a straw sack, straw pillows, feather pillows, bed linens, a red-haired mattress, and a woolen cover with an overspread, and next to it a toilet, chair, and table.
Clothes that patients remove at admittance are returned when they are discharged after recovery; during their stay in the hospital, however, each receives from the house inventory slippers, socks, shirts, bonnets, sackcloth, leggings, and a sleeping smock for men, and instead of the latter two items a dress and cap for women. Every staff caretaker keeps a certain number of clothing items in a wardrobe, delivers the soiled ones weekly to the head laundress, and receives back an equal number of freshly washed pieces, a process ensuring that the initial inventory is always complete.
Four additional rooms are available for persons who pay for their own care — sometimes staying even in their own clothes etc. A long, open walkway with a bubbling spring at its center is serves as a place of exercise for recovering patients during cool or inclement weather; the hospital chaplain, whose apartment is located at the far end, visits patients daily and in emergency situations also administers the sacraments.
The rooms in the upper story are arranged approximately the same as here; a medical assistant also resides there.
A weathercock or anemometer is located on the roof of the right wing, which, set in a recessed disk, shows the direction of the wind by means of a simple machine; a log of such wind changes is kept by the hospital surgeon, as also of the barometric and temperature readings.
We pass by the pastor’s quarters and descend the stairs back to the ground floor and courtyard, in whose center a beautiful spring bubbles up through two pipes; at the right corner, a small side-structure provides both cold and warm baths for a modest fee — and also for doing the hospital laundry. The apartment of the hospital janitors is located across from the fountain, as is also the woodpile and mortuary, and finally behind these facilities also a small yard for poultry and a livestock barn.
While we return to the courtyard, our guide informs us that the hospital’s patients are divided into four categories:
(1) Patients belonging to the Institute for the Poor were formerly cared for completely gratis; but after the well-being of the hospital was severely weakened by the admittance of an excessive number of ill soldiers, by a general increase in prices, and by delayed or diminished interest payments from foreign investments, hospital officials found it necessary to have at least the ongoing alms drawn by the poor during their illness to be paid directly to the hospital cashier.
(2) All the town’s apprentices and journeymen pay weekly contributions to their own trade-organization’s cashier’s office, which when a journeyman becomes ill then covers the daily needs for food, laundry, medications, etc. and other care for only 30 kr. daily, covering the hospital’s own expenditures.
(3) Domestics also pay only an annual contribution of 2 fl. rhn. to their own cashier’s office, which similarly then pays but 30 kr. daily to the hospital during that person’s illness.
(4) According to the determination of the commission consisting of a royal deputy, the administrator of the Welfare Institute, and the 4 town pastors, persons who pay for their own hospital stay pay 1 or 2 florins daily for their entire care.
III. Adalbert Friedrich Marcus, Kurze Beschreibung des allgemeinen Krankenhauses zu Bamberg (Weimar 1797), 8–33. [9]
|8| The ground floor (plates II, IIa) contains, along with the patients’ rooms, also the apartment and facilities for the hospital staff and housekeeping. The building has adequate attic and cellar space as well as a six-foot deep channel into which the waste for the entire hospital flows; the channel is cleansed by water flowing in from outside and carries the waste flow into the nearby Regnitz River.
The water flowing into the building to rinse the channel is carried in part through pipes from the water reservoirs of the adjoining hill and in part through the roof gutters surrounding the entire edifice and then directed through pipes into the channel. A sluice, located at the end of the channel where it flows into the Regnitz, is closed during strong flow and then swiftly opened when the channel is sufficiently full such that all the waste is carried away at once. —
The auxiliary buildings (plate IIb) consist in a laundry and bathing house, wood storage, sheds, then also an apartment |9| for the gatekeeper and a mortuary that can be heated and has vapor shafts.
External features include an extremely handsome garden of several acres and an equally beautiful and spacious courtyard.
The front of the building (plate I), with the larger patient wards, faces east, with a view of the garden that patients use for taking walks and of a considerable portion of the town itself with its ships and bridges. This eastern orientation of the wards offers considerable advantages, and when building hospitals one should especially consider the location of patients’ rooms. In my opinion, the general rule should be to have them situated according to the given conditions of region or climate.
In quite hot climes, rooms should be facing north, in quite cold climes, south.
In temperate climes, such as that in Germany, I know from experience that having rooms face east is to be preferred above all others. In this hospital’s rooms facing west and north, patients can hardly bear the cold during winter as little as they can the heat in the summer in rooms facing south.
|10| Facing south, in the building’s wings for isolated female patients, one can view almost the entire town, including the opulent meadows known as the gardening areas. Facing west, one views the powerfully flowing river with its many boats up to the point where it unites with the Main River. Facing north, in the wing for isolated male patients, one has a view of the beautiful and famous prelature Michelsberg.
There is no need to discuss at length the advantages hospitals enjoy from rivers flowing by, or the various prejudices against such.
The advantages consist primarily in being able to direct drainage from the channels quickly and easily away from the hospital, and also, as is the case here, in the fact that running-water baths can be installed for patients. The air itself is purified and improved more efficiently by rivers, and the objection that an abundance of water causes the air to have a higher humidity and contain noxious vapors can apply only to standing water, not to a river like the Regnitz, which even in the most arid |11| summer still has enough water to support heavy shipping and always enjoys a powerful flow.
The hospital’s excellent location also derives from the fact that it has access to a sweet-water spring, which emerges from a rock from the nearby Michelsberg, a spring rich enough to supply the entire building with sufficient water. Earlier, this spring was used for a fountain in the garden that rose not much less than fifty feet into the air.
The building itself has four entries and exits, among which the main entry and portal is located on the garden side. The interior has two main staircases, completely of stone and equipped with iron railings on each side.
As far as the interior facilities are concerned, the hospital can quite comfortably accommodate 120 patients, with male and female patients completely separated. The separation is effected in part by double doors located at the mid-point in halls more than two hundred feet long, and in part also by the hospital chapel, located between the male and female wards.
|12| Patients of both sexes can listen to masses held in this chapel without actually assembling. Patients in the two upper stories can even attend devotionals without having to leave their rooms.
The middle, upper, and also lower story all have facilities for accommodating patients. The lower story is for patients with external ailments, and each smaller room has four beds; the middle and upper stories are for patients with internal illnesses. Rooms in the wings contiguous with the middle and upper stories have large wards but no community arrangements and are intended in part for distinguished patients and in part patients with contagious diseases.
The larger wards, four on each story, each contain eight beds. Each ward is fourteen feet high, thirty-three long, and thirty-one wide, and has four high, broad windows. The beds, each of which has curtains, are arranged not in rows, but rather four by four on each side, separated from each other by a distance of four feet; between each bed stands a close stool, which, however, stands not out in the ward itself, but in an enclosure. Just as an inside door leads from the patient to the close stool, |13| so also from the outside, in the lavatory space, a sliding door allows the close stool to be removed and cleansed.
The result of this extremely efficient and useful invention is that not even the slightest noxious odors remain in the patient wards.
In the larger wards, all beds have curtains, are numbered, and consist of a straw sack, mattress, and two horsehair bolsters, two pillows, two bed linens, and a woolen bedspread. A chair and small table stand before each bed, a kind of commode in which knives, forks, drinking vessels, hand towels, and the patient’s other small personal items are kept.
On the upper chalk board over the door leading to the close stool, one finds the patient’s name, date of admittance, institutional affiliation, illness, medication, food portion, and type of drink.
Vapor shafts that can be opened and closed as necessary have been installed in every ward for cleansing the air. These vapor shafts are kept open for several hours even during the winter, the result being that patients are always breathing pure, healthy air.
|14| On the ground floor, where externally ill patients are kept, air shafts and ventilators have been installed instead of vapor shafts. There are also several openings through which cleaner outside air can blow into the wards; these are equipped with a kind of sieve and special door enabling them to be opened and closed as necessary.
Heating in the wards is provided by an iron oven arranged such that it is equidistant from each row of beds. Each ward is illuminated at night by a lamp hanging in the center of the room. — Smaller bathing cabinets are available directly in the patient wards quite apart from those in an adjoining building, in the latter of which pipes enable the baths to be made cold or warm, and apart from the river baths installed in the flow of the Regnitz River itself.
The bathing cabinets in the wards are extremely useful and truly constitute some of the hospital’s finest facilities, facilities that indeed can be commended as a model for all hospitals, since baths installed outside hospitals are rarely or even never used because of their distance from the wards. One noteworthy convenience offered by these bathing cabinets is that they are warmed during the winter through the open door of the adjoining ward, and patients |15| can be brought there directly from their beds without a change of atmosphere that might make them catch cold. The water for these baths is brought in not through the patient wards, but through the lavatory halls, and flows off through a valve installed in the bottom of the bathtub, the latter of which stands in a stone enclosure.
The interior beauty of the entire building and the unique conveniences afforded patients include the grand, broad foyers and cordial hallways, each of which is more than two hundred feet long. These hallways, already pleasant enough quite in and of themselves, are made even more attractive through splashing water brought in through pumps; the gurgling and splashing caused by water flowing into small basins animates and refreshes everything nearby; these basins, always filled, also contribute considerably to maintaining cleanliness in the building.
Indeed, cleanliness in general is one of the considerations drawing particular attention in this hospital.
Accordingly, before being admitted to a bed, all patients must first be disrobed and cleansed. To this purpose, clothing is |16| kept available for both sexes. This clothing consists in shirts, linen sleeping gowns, and leggings for men, and jackets and skirts, then also neckerchiefs, bonnets, stockings, slippers, and handkerchiefs.
Female staff caretakers are charged with disrobing and cleansing new arrivals. In the case of especially befouled patients, this cleansing takes place in the baths outside the building; in the case of less dirty patients, in the bathing cabinets adjacent to the patient wards. Clothing belonging to patients is first fumigated, cleansed, and then put in safekeeping by the house manager until patients are ready to be discharged. Distinguished patients sufficiently supplied with clothing generally wear and keep their own clothes.
Clothing for patients ill with venereal and scabious diseases are so marked and never mixed together with the others. Such also applies to mattresses and woolen covers used for contagiously ill patients.
At the end of each week, patients receive a fresh set of clothes. In some cases, however, as dictated by the type of illness, patients may and often must have their clothing changed even daily. —
|17| Sick persons wishing to be admitted to the hospital must arrive at a designated time early in the morning, when the physicians and surgeons are already assembled. The latter have a proscribed procedure for dealing with patient admission.
Those ill persons for whom this hospital was originally founded are the town’s poor.
When those persons apply for admittance, they must produce a printed certificate attesting their poverty from a member of the Royal Commission for the Poor.
Physicians must determine whether the illness is curable, since the express will of the founder was that those with incurable and protracted illnesses, such as madness, epilepsy, and cancer are not to be admitted.
Apart from the town’s poor, it is also ill trade journeyman and domestics who are admitted assuming they have provided a printed attestation from the head of their institutions. These patients are admitted at the expense of each of these two institutions, whereby 25 Kreuzer Rheinisch daily is charged for each patient.
|18| Other ill persons, however, those from classes not belonging to one of the three public institutions, may be admitted only if they prepay or provide a guarantor. They pay 30 Kreuzer daily as long as they do not ask for a private room, in which case they pay 1 Gulden.
Ill persons in immediate danger are admitted at any time of day by the authorized deputy surgeon and house manager.
Even though separate wards are designated for patients of each of the three institutions, physicians do not have to adhere too closely to a fixed assignment of patients; instead, they generally act solely according to which patients might most favorably be put together with which other patients according to their illnesses.
Earlier these guidelines were applied only with respect to externally protracted or quickly passing illnesses. Experience, however, has taught us that a much more expedient and effective distribution comes about in a manner such as was also practiced earlier in the hospital. Such is carried out according to the temperature that is most conducive to treating any given type of illness.
|19| As is well known, inflammatory illnesses require a cooler environment, debilitating illness a warmer environment.
In my opinion, the Brunonian division into sthenic and asthenic diseases provides the best standard in this regard.
Yet another advantage enjoyed by this hospital in this division of patients is the smaller rooms into which patients may be transferred from the wards if they are burdening other patients by noxious vapor emanations or other attacks such as coughing, vomiting, and so on.
Care for the ill in this hospital is left to the female sex, since they provide patients with greater personal interest and love. One female caretaker is assigned to each ward — or also to two smaller rooms — of eight beds. During the construction of this hospital, every effort was made to make the size of the patient wards and other rooms such that a female attendant might easily and conveniently oversee and care for the patients in that space.
One consideration is of particular important for the well-being of patients and the smooth running of a hospital, namely, that caretakers not have to care for too many patients at once. We know from |20| experience that a staff caretaker can oversee seven or eight patients, providing one does not burden any one caretaker with too many patients with dangerously feverish diseases, lest both the ill and the caretaker then become victims of such disease.
Two female staff members in a single ward, however, rarely get along, in which case the sort of emulation necessary for the maintenance of order and cleanliness in the wards is also too often compromised as soon as more than one caretaker is involved in a single ward. In this regard, rewards at the end of each year for the caretaker who has especially distinguished herself through cleanliness, diligence, and compatibility have demonstrated how important such emulation among female caretakers is for the well-being or patients and the smooth operation of the hospital.
Since in every instance two patient wards abut each other and are separated only by double glass doors, each of the two caretakers in these wards is obligated to assist the other when necessary. Caretakers sleep in the rooms with the patients; in male wards, the female caretaker’s bed is separated from those of patients by a closet structure. One caretaker is always designated for help and nightly watch duties, and also for caring for convalescents when the latter are isolated from others.
|21| Each caretaker has a certain number of clothing items in her care for patients in her ward, as well as various items for their personal needs; she is, however, also responsible for these items. To this end, several cupboards are provided, located in the bathing cabinets. Each caretaker has an inventory for whatever is in her care, on which the head laundress keeps a check.
Each week, caretakers deliver dirty laundry to the head laundress and receive in return the same number of clean pieces, whereby the inventory is constantly at full level. This practice prevents the hospital from losing items through theft. — Caretakers are under the direct supervision of the directing physician, who accepts them into employment and can dismiss them without explanation.
Other duties of the female caretakers can be found in the instructions posted in each ward.
Just as no effort is spared to ensure that each patient receives adequate care in this hospital, similarly no effort is spared to ensure that patients are provided with healthy, nourishing food. Too many |22| hospitals and infirmaries pay unpardonably little attention to this consideration, one of the most important in hospital care. The inconsistent principles to which physicians themselves adhere, even with respect to meals, doubtless plays no small role in this state of affairs. Nothing more self-contradictory can be imagined than to feed ill persons with absolutely no consideration given to the type and severity of their diseases.
Many hospitals shy away almost completely from wine and meat; others feed all their patients, without distinction, solely strong meat broth and meat, thereby — as I myself know from experience — rendering any recovery of the patient impossible, or at least delaying such recovery and in other instances even causing a relapse. In this point, too, the “Brunonian doctrine” of diseases of increased strength or increased debility can serve as a standard, since no physician today seriously doubts that meat is deleterious in the case of inflammatory illness, just as a watery diet is deleterious in the case of debilitating diseases.
Hence I consider a division into weakening and fortifying diets to be extremely useful and necessary for every hospital.
The food portions in this hospital are accordingly classified as weak, quarter, half, and whole portions. To provide a better overview, I am including the food table introduced in our hospital.
|23|
Food Table
Weak portion: Water soup or weak meat broth and fruit.
Quarter portion: Meat broth, in the form of barely, rice, or oat gruel.
Half portion: Soup. Midday, vegetables, sauce. Evening, soup and fruit. 15-ounce roll.
Three-quarter portion: Soup, vegetables. Midday 1/2 lb. beef. Evening, soup and vegetables. 20-ounce roll.
Whole portion: Soup, vegetables. Midday, 3/4 lb. beef or roasted veal. Evening, soup, vegetables, 1/2 lb. veal. 20-ounce roll.
Extra items: Wine — Beer — Milk
|24| Each day, at the bedside of each patient and on a chalkboard set up in each ward, the physician notes the portions determined for that particular patient, which a surgical assistant then gathers together and writes up on a general chalkboard in the kitchen; this threefold noting of food portions prevents various errors and abuses on the part of patients and caretakers. To wit, patients have often tried to alter the weak portions prescribed for them and notated in chalk on the boards of their beds into stronger portions; the fact that the sum of all portions is noted yet again on a larger chalkboard in each ward, however, thwarts this modest attempt at deception on the part of patients.
On the other hand, the hospital has tried to keep caretakers from pilfering food portions by setting up a universal food table in the kitchen.
All food is prepared in iron pots and prepared in the cleanest way to be as tasteful as possible; in certain, prescribed instances, it is also seasoned. Each patient receives his or her portion on their own table, one item at a time in order that the various foods remain sufficiently warm. Whatever a patient cannot eat immediately, rather than be saved in the ward, is instead sent back to the kitchen.
|25| The medical staff in this hospital consists in the directing physician, the second physician, the senior and deputy surgeon, and an assistant.
The deputy surgeon alone resides in the hospital, specifically in a lower hall prepared for patients with external ailments. The two physicians also have their offices in this hallway.
The admission and examination of patients takes place in the office of the directing physician; clinical lectures are also delivered there. The hospital apothecary is located in the adjoining room.
The office of the senior surgeon also serves as the operating room.
The two physicians and senior surgeon meet daily at the hospital at a fixed time during the morning in order to visit patients together. During such visits, the two physicians share tasks; the first physician examines the disease and notes any attacks and changes, the second then immediately enters the patient’s history into the designated book.
After the examination, the two physicians discuss the medication to be prescribed, which is then also immediately entered into both the prescription log and the patient log.
The second physician is also charged with visiting patients once more toward evening, that is, apart from the morning visit. He must then transfer from his journal into the hospital’s general log the histories of patients who are recovering as well as those who have died.
This protocol, as described in the instructions of the two physicians, has undergone changes since the death of Franz Ludwig. To wit, for the sake of saving time, the two physicians now arrange to alternate their visits to the hospital each week and month.
What prompted the founder to provide for two physicians at this hospital was the following consideration. The number of patients could become so considerable (and already has on several occasions climbed to 80, even without the presence of epidemics) that a single physician no longer sufficed for their care, especially since the clinical teaching facility is part of such care.
Had a single physician genuinely been sufficient for the entire hospital, he would have had to be paid such that he could devote himself to this job alone. Because the hospital’s endowment, however, was not yet fixed when it was constructed, the salaries also could not be very generous. The illustrious prince, Franz Ludwig, |27| gave both physicians an extremely modest salary, together approximately 500 Gulden, but divided their responsibilities such that the hospital was adequately covered while yet allowing the physicians to pursue private practice on the side.
The founder well considered that if only a single physician were employed and then himself became sick, the operation of the hospital itself as well as the well-being of its patients would necessarily suffer.
Because Franz Ludwig was also quite aware of the prejudice of the common man against public hospitals, he engaged two physicians, each of which might enjoy the public trust. To the one he entrusted the care of his own health, while the second was a public teacher, and for several years now also the physician to the poor, someone quite familiar with the diseases and spirit of the poor, for whom, after all, the hospital was actually intended.
The prince wanted, daily if possible, to be informed of the disposition of his new institution, its progress, shortcomings, and possible enhancement toward perfection, and so chose the man as this hospital’s physician who, by virtue of his broader vocation, was around him daily. Since, however, other vocational obligations often called him away from the hospital for lengthier periods of time, the founder provided for a second physician to be engaged. —
|28| One of these two physicians was appointed director and charged with the special responsibility of attending the meetings of the hospital commission, where he directly presents for discussion anything that might improve patient care and enhance the overall institution.
All written orders are addressed to the directing physician, and he must similarly issue and sign all written papers and certificates. He is in charge of the engagement and dismissal of the female caretakers as well as the supervision of all medication personnel in the hospital. He is especially responsible for clinical instruction for young physicians and everything pertaining thereto, such as the organization of charts, logs, the choice and separation of patients, introduction of new remedies and healing methods, public announcements, safekeeping of pathological rarities, securement of the necessary machines, instruments, and books for the hospital library, autopsies, and so on.
The senior surgeon is obligated to observe the same protocol with regards to patients with external diseases as do the physicians for patients with internal diseases. He enters into the prescription log designated specifically for externally ill patients all the externally prescribed medications. He does not undertake |29| any important operation without first having discussed it with the physicians.
The deputy surgeon, who resides on the premises, simultaneously is in charge of supervising the female caretakers. Each day he must visit and carefully examine each ward to determine whether patients are receiving and taking the proper medication, and he keeps logs on the entry and exit of patients and concerning his weather observations. During each of the three periods of the day, he must enter the readings of the weather monitors in a special book. To aid these observations, an artificial weather vane has been installed on the hospital roof. This vane indicates the thirty-two different winds.
Patient medications come from the town apothecaries; the apothecaries deliver the simple ones at the currently posted price; those requiring special preparation, however, they have prepared in their officinal laboratories. They are obligated to send an assistant to the hospital during the physicians’ office hours.
To provide for patients’ devotional needs, masses are read in the hospital chapel, and patients themselves |30| visited daily by a cleric. Although no cleric resides permanently in the hospital, a room with a bed and other necessary furnishings is kept available for both the Catholic and Protestant cleric so that they can also remain here through the night is necessary. Many trade journeymen of various religions live in this town, and when they come down ill and are brought to this hospital, and if the necessary circumstances arise and they request a pastor, such is brought without regard to religion
The overall finances are directed by an appointed commission consisting of respected members of local administrations.
The endowment out of which expenditures are covered consists in part of a considerable principle and estates obtained through bequests, and in part from allowances from several benevolent foundations that even earlier focused on ill persons and that were recently newly sanctioned by the current territorial prince for such work. These and contributions from the medical insurance institutions for trade journeymen and domestics cover all the annual costs for the hospital, which comes to approximately eight thousand Gulden.
|31| Hospital finances and management as well as invoices are the responsibility of a steward who resides on the premises; each month he also presents all the information about income and expenditures for the perusal of the commission. He supervises the hospital domestics as well as part of the female caretakers. He, like the other hospital personnel, eats the food prepared in the hospital itself. All admitted patients must be presented to him and are logged in by him and by the deputy surgeon; he settles account quarterly with hospital supervisors and all patients who are staying in the hospital at their own expense. He is responsible in general for the operation and policing of the entire building and all its residents. All patient clothing and personal items to be stored are handed over to him. He must be present in the kitchen during the distribution of food portions and then distribute those to patients; he is also in charge of burials in the case of deaths.
|32| Apart from this household financial manager, the hospital also has an accountant who takes care of all income, expenditures, salaries, etc. He does not reside on the premises.
Laundry and bedding is taken care of by a laundress specifically charged with this task. Caretakers are subordinated to this person with respect to laundry and the maintenance of cleanliness in their own spheres.
The commission annually notes how much laundry has been lost and what needs to be secured anew and maintained at the proper numbers.
The inventory of laundry and bedding is considerable; currently reckoned for 84 patients, it is to be enhanced to cover 120.
Other hospital employees include a cook, housemaid, and two servants.
Non-residents and residents alike are allowed to visit the hospital and visit patients at almost any hour of the day, providing with respect to this latter point they adhere to the hospital rules, to which end the following admonition is posted immediately at the hospital entrance:
|33|
To all Hospital Visitors
Visitors to this hospital are reminded here at its threshold that they are entering a house for those who are suffering, one to which not unfeeling curiosity, but genuine concern for the fate of their suffering fellow human beings ought to be the reason for their visit. —
Hence they are asked always to express these intentions of goodwill during their visit, always to maintain a respectful silence, never to open the doors to patient wards without first asking permission to enter from the hospital manager, never to run tempestuously through the halls in groups; — never to open bed curtains that are already closed; — to wholly spare dangerously ill patients any visit, similarly not to burden less ill patients with exhausting or, certainly, passionate conversation; — and finally never to give patients money or anything else that might be detrimental to their recovery simply out of a sense of exaggerated generosity. — Only thus will their visit, commensurate with their beneficent intention, be both salutary and welcome to our patients and hospital.
Notes
[*] Illustration from Adalbert Friedrich Marcus, Kurze Beschreibung des allgemeinen Krankenhauses zu Bamberg (Weimar 1797), plate 1. Back.
[1] Caroline seems to have been treated by Marcus and Röschlaub during her visit to Bamberg prior to going to Bocklet. Back.
[2] See his letter to Goethe on 8 August 1800 (letter 265k). More letters and documents concerning this scandal appear in volume 2. Back.
[3] (Bamberg: Plan der Stadt Bamberg (nach officiellem Plan bearbeitet) [Bamberg n.d.]; Bibliothèque nationale de France). — No documentation attests where the three stayed after Wilhelm arrived in Bamberg, though Schelling did indicate in a letter to Johann Joachim Eschenburg on 22 September 1800 that Andreas Röschlaub would know his address (Fuhrmans 2:258). Back.
[4] Adalbert Friedrich Marcus, Kurze Beschreibung des allgemeinen Krankenhauses zu Bamberg (Weimar 1797), esp. mentions the views from the various patient wards and rooms in the hospital in his account below. Back.
[5] Construction plans from Marcus, Kurze Beschreibung des allgemeinen Krankenhauses zu Bamberg, plates at end of Marcus’s text. Back.
[6] Heller is writing in 1831. Back.
[7] Today the edifice is the home of the Hotel Residenzhof Bamberg. Back.
[8] The motto over the front entrance. Back.
[9] Although some passages are similarly omitted that provide the same information as above, others are allowed to stand for the sake of context. — Pagination from original. Identifying letters and numbers refer to the plates in Marcus’s book, all of which can be seen in detail in the gallery. Back.
Translation © 2014 Doug Stott