SUPERVISIÓN Y MONITOREO

UniversitMten Deutschlands, der deutschen Schweiz und Osterreichs', Gesnerus. 1990, Vol.47, pp.303-28

clinical director.

It had been noted that the philosophical faculty generally responded generously to the demands of newly emerging disciplines. Here the elders tried to get their younger colleagues rather sooner than later at least budgeted status and thereby enhanced their chances of establishing an independent chair.

Things appear to be different at the medical faculty during the same period, which was dominated by rivalry and competition. The medical faculty tended not to support demands for chairs or clinical

representation in the new disciplines. The government acted on the whole more open-minded, but was often limited in setting up new institutions by financial constraints

Towards the end of the nineteenth century the existence of independent disciplines became more accepted. A flood of requests to establish "extra­ ordinary" and "ordinary" chairs at Heidelberg

University set in. Their representatives received in most cases only the status of "etatmassiger

Extraordinarius" (budgeted Extraordinarius) without their own institutional base. Parallel with these events Heidelberg established its own natural scientific/mathematical faculty separated from the

E.Wolgast, op. cit., see note 4, p.19 and R.Riese, op.cit., note 8, p.112

philosophical facuity.“

After 1890 specialised departments in dermatology and venerology, neurology, dental surgery and

orthopaedics evolved in either the Surgical or the Medical University Hospital. Their existence and survival depended on the good will of the clinical director of the respective hospital where they had found shelter. In 1914 neurology received a "Lehrstuhl”

(chair) at Heidelberg University.

One of the oldest hospitals in Heidelberg was a Leprosarium founded by Ludwig (1410-1436) which was

located in Schlierbach and dissolved in March 1741. All its assets were distributed among the hospitals of the three ecclesiastical communities (Catholic, Reformed, Lutheran) which had been established in the meantime and continued to exist alongside each other well into the 20th century.

Around 1600 the Medical Faculty made the first attempts to convert the university's Nosocomium into an institution for practical bedside teaching. Until then it had been customary to take medical students into the homes of the sick and to instruct them there.

In 1766 a school for midwives had been founded in nearby Mannheim, initiated by Princess Elizabeth Auguste. In 1805 the school of midwifery was

R.Riese, ibid., p. 112

Anon., Illustrierte Festchronik der V.SSkularfeier der Universitat Heidelberg. 1886

transferred from Mannheim to Heidelberg into the Dominican cloister and thus the first "stationary" inpatient hospital of Heidelberg's University was founded. In the same year a medical Poliklinik was introduced, aimed at the instruction of medical

students in conjunction with home-visits conducted by the medical students throughout the town.2 5

The Poliklinik or so called town-clinic has the aim to introduce young doctors into the practice, not just in the artificial environment of a hospital where the recognition of each individual disease picture is distorted by the confluence of varied disease pictures of patients living together; but it is aimed at instructing the beginners at the various bedsides in a spacious, sprawling town to

demonstrate them the forms of diseases in their different exactly defined circumstances and to show them the patients themselves in their varied

conditions of civic life, surrounded by anxious

parents and children...in short to introduce them to the specific conditions of their career they are just about to enter.

The students would on return from their home visits report back to their teachers. This exercise was often accompanied by a case presentation, provided the

patient was fit enough to attend. It took another ten years (1815) until an actual inpatient facility

(Hospitalklinik) was opened in the same building. In 1818 Chelius inaugurated a surgical ward there, too.

Hufeland coined the term Poliklinik. His definition indicates that this medical facility was specifically set up to be a "city-clinic". (gr.polis= city, town) D.Jetter, 'Die ersten Universitâtskliniken westdeutscher Staaten', Dtsch.med.Wschr., Jahrg.87, Nr.40, 5.0kt. 1962, pp.2037-2043

Eberhard Stiibler, Geschichte der medizinischen Fakultat Heidelberg 1386-1925. Heidelberg, C.Winter, 1926, p.200

Soon the building was no longer spacious enough to accommodate three inpatient wards (hospitals, also referred to as Klinik) and the anatomical theatre. In the same year the three clinical institutions moved into an old army barrack Marstall,^’’ The anatomical theatre remained in the Dominican cloister. Space in the new Marstall building was divided between the surgical, obstetrical and medical wards. The medical ward was initially given the entire first and some parts of the second floor, a total of twenty eight

rooms with the same number of beds. A further two rooms were reserved for patients with eye diseases.

The Poliklinik was attached to the medical ward/hospital whereas the surgical ward had its own outpatient department. During 1819 a total of 352 patients had attended the Medical Klinik^® and 152

patients had been admitted to the Surgical Klinik which was under the direction of Professor Chelius. He

remained in charge till 1864, which meant that he singlehandedly conducted the administration of the surgical and ophthalmological hospital for forty six years. During his time in office he had witnessed the coming and going of six physicians directing the

Also referred to as Welnbrennerbau

"Klinik" the term was introduced into the German language in the 13th century from l.clinice = art of healing bedridden diseased people 2.kline (Greek) bed, stretcher and 3.klinein (Greek) to lean over, also used in German in the sense of "institution aimed at the instruction in the art of healing."

neighbouring medical hospital.^

The medical hospital (also referred to as Klinik) remained in the same building, but experienced a less continuous history than the adjacent surgical hospital. Space continued to be a problem and subsequently the obstetrical ward was moved to the West Wing of the Marstall building in 1830. Fourteen years later it

moved back again into the main Marstall building, after the latter had been vacated by the medical and surgical wards. They had been moved (1844) to the

Jesuitenkollegium. The West Wing of the Marstall was eventually sold off to accommodate offices for the department of customs and excise.

In 1844 Pfeuffer followed a call to Heidelberg and was given the Ordinariat in pathology and therapy

(= medicine). He demanded the direction of his own medical hospital and therefore a second one had to be established in addition to the existing one directed by Puchelt. Pfeuffer's medical hospital was now referred to as Medizinische Klinik II. It provided initially sixteen beds. Pfeuffer's new institution was intended to be an university facility and thus entirely funded and maintained by the state. Puchelt's Medizinische Klinik I maintained the character of a civilian-urban institution and the town remained responsible for its

2^ They were Conradi, Sebastian, Puchelt, Pfeuffer, Hasse and Duchek.

u p k e e p . T h e latter was also nicknamed the servants' hospital (Gesindespital).

For the purpose of conducting the Poliklinik the town was divided into two districts, one to be looked after by Puchelt, the other by the newcomer Pfeuffer. Since Puchelt was a blind old man, increasingly unable to fulfil his commitments, Pfeuffer was practically directing the Medizinische Klinik I and II plus the entire Poliklinik. His successor Ewald Hasse entered into the same working conditions. Following Puchelt's death in 1856 Ewald Hasse left utterly frustrated with the confused and unsatisfactory administration of the medical institutions.^^ Subsequently a thorough

revision of the situation was undertaken. Medizinische Klinik I and II were amalgamated with the surgical

hospital under one administrative management. All three hospitals combined were subsumed under the heading

"Akademisches Krankenhaus" in 1856. From then on the university was responsible for the financial management of the hospital and the upkeep of the building itself. This marked its gradual shift from an urban into a university institution. Thus the academic hospital gradually lost its function as a medical institution for the urban poor. The municipal council had to pay the fees for this category of patients once they had been admitted. A hospital commission was established

30

31

R.Riese, op.cit., note 8, p.226 E.Hasse, op.cit., note 14, p.250

directly responsible to the Ministry of Interior in Karlsruhe. This commission was supposed to supervise administrative and financial matters. It consisted of the clinical directors of the hospitals, a third

independent professor (from the faculty of law or national economics), the university magistrate, the university treasurer and two members, selected by the municipal council.

Following Puchelt's death the two medical

inpatient facilities (Med.Klinik I & II) were united under the clinical direction of Adalbert Duchek (1824-

1882). He taught general pathology, therapeutics and pathological anatomy in Heidelberg, whilst offering practical exercises in microscopy. His major interest was devoted to pathological a n a t o m y . D u c h e k spent

only a brief period in Heidelberg and chose to follow a call to Vienna where he succeeded Skoda in 1858.

By then Badenese government officials felt that the medical faculty needed an injection of younger blood and more administrative stability. Karlsruhe

decided to emancipate the Poliklinik "aimed at the care of the town's poor population" from the medical

hospital. In 1856 Privatdozent Theodor Dusch (1824- 1890) was promoted (a.o.) Professor and clinical director of the Poliklinik. However, government

ministers had not sought the medical faculty's approval or rather had acted against it. Inevitably relations