History of Medicine

MEDICAL HISTORY ON NETFLIX:

Life at the Charité

     I stumbled recently onto a Netflix TV series entitled “Charité”, dealing with one of the most interesting periods in the history of medicine. The scene opens at the famous Charité Hospital in Berlin in 1888, the “year of the three Kaisers” (see the blog of Feb 11, 2017). As far as I can tell it is fairly accurate historically, though a fictional romantic plot is woven into it.

     The story opens in 1888, the year that Kaiser Wilhelm I died and was succeeded by his son Frederick William, already suffering from a laryngeal cancer. Rudolf Virchow, the pathologist who was unable to find malignant cells in the Prince’s laryngeal biopsies, is

Ernst von Bergmann (Wikipedia)

shown discussing the case with Ernst von Bergman, the famous surgeon who had wanted to operate on Frederick. Von Bergman was a pioneer, who had introduced aseptic surgery into Germany early on, developed steam sterilization of instruments, and developed expertise in neurosurgery before it was a recognized specialty. His textbook, Surgical Therapy of Diseases of the Brain, went through three editions and broke new ground.

     It was an exciting time in medicine. Bacteria were accepted as causes of several diseases. In Berlin Robert Koch had seen the

Robert Koch (Wikipedia)

tuberculosis bacillus in 1882, the diphtheria organism was isolated in 1884 by Friedrich Löffler, and the Japanese bacteriologist, Kitasato, isolated the toxin causing tetanus. Paul Ehrlich was improving histological stains and embarking on antiserum studies. In Paris, Elie Metchnikoff had shown the effects of phagocytosis (1884), and Roux and Yersin had demonstrated the diphtheria toxin (1888).

     The principal character in the drama is Emil Behring (later von Behring), an excitable, often

Emil von Behring (Wikipedia)

pugnacious, but intelligent and hardworking scientist. He was an army doctor, assigned as a research assistant to Robert Koch. There, building on Roux and Yersin’s work, he developed a diphtheria antiserum with the help of Ehrlich and others. Diphtheria was a serious problem. Epidemics involving thousands of children swept through Berlin and

Paul Ehrlich (Wikipedia)

other cities, and with a mortality of a little over 50%, numerous families were devastated.

     Not shown in the film is that Behring tried, unsuccessfully, to provide a vaccine against tuberculosis in cattle, a project that squandered time and energy. The rest of the story I won’t divulge here.

     The Charité Hospital, serving as background in this series, has a long history. In the early 1700s a pesthouse for plague victims was erected at the southeast gate of Berlin that, when no plague appeared, became an almshouse for the poor. In 1726 a 200-bed “lazarette” was added to the almshouse, and when it opened as a combination hospital and medical school for military doctors it was baptized the “Charité”. Admissions went from about 600 per year to about 6000 by the end of the century, almost all poor workers. In the 1780s, related to shameful conditions, new buildings replaced the old ones. The miserable conditions for the patients continued, however. One observer noted that the Charité did more for the decimation of its population than the guillotine did in other cities. Patient mortality was about 30% and attendants were so poorly paid that they stole food from patients. Conditions improved somewhat by separating the almshouse function from the hospital, housing the poor nearby.

     In 1795 educational facilities for military doctors were enlarged to accommodate a steadily growing army, the new facility being named the “Pépinière”. In 1810 the University of Berlin and its medical school were founded with the help of Wilhelm von Humboldt, brother of the explorer and polymath Alexander (the university was renamed Humboldt University in 1949). Both medical teaching and research were instituted, a combination that fueled the great discoveries to come. The Charité, considered too shabby for training civilian doctors, was transformed into a more modern facility and its administration transferred from a bureau of poverty to the first Minister of Education in Prussia, Karl von Altenstein. The military built a new Medical-surgical Academy and shared use of the Charité with the University. Medical education in the military was free but required 8 years of service after graduation.      

Die Charité Hospital, 19th Century (Wellcome Library)

     Specialization began in the early 1800s, with the establishment of neuro-psychiatric, pediatric, ophthalmology, and physiology departments, followed by many others. Additional building progressed to accommodate the new activities.

German cartoon of Behring drawing serum from a horse (Wellcome Library)

    In spite of medical and scientific progress the lot of the patients improved only modestly. Rooms were overcrowded and unclean, bathroom facilities rudimentary, and patients often roughly treated by orderlies. Some of this appears in the TV series. Also on the screen are efforts by representatives of the SPD (Socialist Party of Germany, whose activities were suppressed by the government until 1890) to organize a strike in the hospital. Outside the hospital the “Krankenkasse”, the health insurance for lowly paid workers created by Bismark, was threatening a boycott of the hospital and actually carried it out in 1893. The government finally took notice and over the next two decades a major rebuilding took place, finishing in 1917 – during WWI. The prominent military presence in the hospital disappeared after the war, while civilian clinical and research facilities expanded. In the late 1930s Naziism decimated the faculty but after WWII and the reunification of Germany the hospital was rebuilt and modernized significantly.

     Presently the hospital has four modern campuses around Berlin. According to Wikipedia eleven Nobel Prize recipients have been connected with the Charité one way or another. Three are in the TV program: Behring, Koch, and Ehrlich.

SOURCES:

Fischer, Ernst. Die Charité. 2009, Siegler Verlag, München.

Linton, Derek. Emil von Behring: Infectious Disease, Immunology,    

    Serum Therapy. 2005, American Philosophical Society.

Marquardt, Martha. Paul Ehrlich. 1951, Henry Schuman, N.Y.

Brock, Thomas. Robert Koch: A Life in Medicine and 

   Bacteriology. 1999, ASM Press.

Salcman, Michael. “Von Bergmann, Kocher, and Krönlein – A 

   Triumphirate of Pioneers with a Common Neurosurgical   

   Concept”. 2013. Acta Neurochirurgica, 155: 1787.