Die Heil- und Pflegeanstalt Herborn Anfang des 20. Jahrhunderts: Ein Beitrag zur Geschichte der Anstaltspsychiatrie aufgearbeitet anhand von Sektionsprotokollen

In 1911 a new sanatorium and nursing home (Heil- und Pflegeanstalt, HPA) was founded in Herborn (Hesse, Germany) due to a steady increase in the number of patients. From the very beginning all deaths in the clinic were documented in detail and as soon as structural conditions permitted the deceased were usually dissected. Thus, between 1911 and 1930 (with a gap from 1917 to 1926), autopsy protocols were created which documented autopsies that had been performed, but also those who had not. In this thesis the primary question is what knowledge was gained from these autopsies in the psychiatric institution. In addition to the autopsies and the circumstances under which they were carried out, the content of the protocols is of interest. Based on this source a part of the history of HPA Herborn from 1911 to 1930, but also a part of the history of psychiatry will be explored. For this purpose the diagnoses and causes of death were evaluated, also concerning historical circumstances such as World War I, which had a great influence on the institutions' activities and the work on autopsies. Numerous medical records, inventory lists and contemporary medical journals supplemented the evaluation. The autopsies in HPA Herborn were carried out regularly with a fixed structure starting from the analyzed period in 1911. With the beginning of the war especially due to the shortage of nursing staff this practice was interrupted. During the second period under investigation beginning in 1927 autopsies were carried out more regularly, however with an increasing number of non-performed autopsies without any further explanation. In other cases relatives of the deceased refused the autopsy. The autopsies served in particular to determine the cause of death. Psychiatrists implemented dissections just as doctors of mere somatic fields. Their aim was to underline the scientific claim of psychiatry and to gradually establish this medical subject. In this thesis the scientific claim of the Herborn psychiatrists is demonstrated by the numerous publications of the local doctor Werner H. Becker. In addition, a professional cooperation of HPA Herborn with the pathological institutes in Marburg and the university in Frankfurt am Main was revealed. The evaluation of the data identified syphilis as a predominant medical condition in psychiatric hospitals as well as the nosological process of the term schizophrenia and, not at least, different terms of causes of death summarized as "states of exhaustion" (“Erschöpfungszustände”): Patients suffering from advanced stages of syphilis were admitted to psychiatric institutions such as HPA Herborn because of their mental symptoms. However this disease was associated with such severe somatic consequences that those affected eventually died. Evaluating the protocols showed that the proportion of those who died with or from syphilis in the period under investigation was significantly higher than previously known: by up to 48% in 1913 these are almost half of those who died. This clinical relevance of syphilis is also reflected in the contemporary medical discourse in numerous articles and research projects. As a further result the nosological process of the concept of schizophrenia was traced and elaborated based on the protocols: While the term “dementia praecox” was still used in the beginning, the term schizophrenia is increasingly found later on. During the years of war, the cruel death by starvation of numerous patients at HPA Herborn was documented and finally hidden by naming "states of exhaustion" as actual causes of death. This is particularly evident during the year of war 1917, when about 40% of all patients died in HPA Herborn. In addition to the autopsies, which were important for the scientific process of psychiatry, not at least by processing an exemplary medical record it was possible to work out a vague picture of patients' lives in HPA Herborn and to explore how these eventually had come to an end. In this thesis an access to the history of German institutional psychiatry in the early 20th century is provided based on the institutions' autopsy protocols and medical records. The numerous results should remain of interest for future research.