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Richard von Krafft-Ebing - UCL Discovery contrast the granting of the actual doctoral degree was in the hands of the medical faculty and.
Psychiatry and Forensic Psychology Krafft-Ebing in 1894 had the.
It seeks to paint a more accurate picture than is so far available by bringing together new biographical data including background information on the institutional settings in which he worked.
Above all, it explores the full range of Krafft-Ebing's written work and ideas over the whole period of his life.
This shows Krafft-Ebing as a man of many interests and is intended to counteract our present, limited understanding of his work.
Although Krafft-Ebing is, in fact, known to many, this knowledge is mainly based on the cursory reading of one book, the Psychopathia sexualis, 1886.
This has led to a seriously one-sided view of Krafft-Ebing, particularly in Englishspeaking countries.
Part one is about Krafft-Ebing's outer life: a brief summary of known biographical data, followed by several chapters on those places where he lived and worked.
Different points are highlighted according to their relevance for Krafft-Ebing's ideas: for example, chapter 2 emphasises the general atmosphere of the Illenau one of the leading asylums at the timewhich shaped his approach to psychiatry lastingly; the chapter on Graz centres around the very varied patients he treated during that period.
Part two represents an intellectual biography.
Exploiting the full range of published work see appendixchapter 5 gives an overview over the topics Krafft-Ebing wrote on, followed by more detailed analyses of specific areas: sexuality including its important forensic aspecthypnotism and neurology.
Part three - the appendix - consists of a new and complete list of Krafft-Ebing's published works containing about 550 items; the few letters by Krafft-Ebing found so far have also been transcribed and reprinted here.
Table of contents Introduction p10 The image of Krafft-Ebing today p10 The sources P 14 The aim of the thesis p16 Chapter summary P 18 Part 1: 1 The career p 27 Medical Studies: 1858 - 1863 P 28 At the Illenau from 1863 -1869 P 30 The first academic post: Strasbourg in 1872 p 34 The years at Graz: 1873 - 1889 P 36 Vienna: 1889 - 1902 P 39 2 The IIlenau: an ideal psychiatric asylum p 54 Introduction p 54 The History of the Illenau p 56 Roller's understanding of mental illness and its remedy: the Illenau p 60 Krafft-Ebing's daily life at the Illenau in the 1860s p 68 The legacy of the Illenau P 76 3 Graz 1873 - just click for source : 3 institutions and their patients Introduction p 85 History of medical teaching and medical care at Graz p 87 Feldhof p 90 The psychiatric clinic in Graz p 105 Administration and teaching p 113 MariagrOn p 116 The driving forces behind MariagrOn p 125 Krafft-Ebing's private practice 3 21 game plus blackjack 127 Summary p 132 4 Vienna and the Society for Psychiatry and Neurology The Verein filr Psychiatrie und Neur%gie p 140 The methodology at the time p 143 Krafft-Ebing and Freud p 147 Krafft-Ebing's personal acquaintance with Freud p 148 Freud at the Verein P pokersnowie preflop advisor The discussion about methodology P 153 Summary p 160 Part 2: 5 Mapping his work P 167 The format p 168 Krafft-Ebing as a prolific author p 168 How did he manage it?
First, my thanks to Bill Bynum who has been such a sympathetic and patient supervisor.
Vivian Nutton gave me invaluable advice and also helped with editing suggestions, and I have taken up far too much of his time.
Roy Porter has been generous and inspiring.
I am deeply grateful for the constructive criticism, time investment and friendship I experienced from the other students and postdoctoral students at the Wellcome Institute.
I am indebted to many but most directly to Mark Micale, Alexander Zahar, Andreas Hill, Akihito Suzuki and Sue Morgan.
In researching this study, I have relied upon the resources and services https://tayorindustry.com/blackjack/spanish-21-blackjack-strategy.html the following libraries most: the Wellcome Library, the British Museum library, the library at the Neurologisches Institut Wienthe University library in Basel and the excellent historical collection at the psychiatric University clinic, Basel.
Thanks to all their staff for their assistance and friendliness.
My research has been made possible thanks to grants from the Wellcome Trust and the Swiss National Fund, as well as the financial generosity of my parents.
Finally, my personal votes of thanks to some of those who supported me so generously: Michael Neve, Andy Foley, Amal, Sandra, Susan and Rus, Angela, David and Carola.
Introduction 10 Although Richard von Krafft-Ebingls name is well-known there is so far no full biographical account.
The following introduction gives a summary of what is known about him today before giving an outline and stating the goal of my own work.
The image of Krafft-Ebing today Not only historians of medicine, historians of sexuality and many Freud scholars, but also cultural and literary historians of fin-desiecle Vienna know of Krafft-Ebing.
His name appears in many historical texts, yet there are few attempts at elaboration and on the whole the secondary literature on him is sparse.
Given the repeated stress on Krafft-Ebingls professional importance, it is surprising that most general histories of medicine merely reiterate the same few facts: that he was born in 1840 and died in 1902, that he trained in Heidelberg, moved on to becom ing a professor of psychiatry in Strasbourg - later at the universities of Graz and Vienna - and that he was the author of the Psychopathia sexualis 1886the first classification of sexual disorders.
Some add that Krafft-Ebing also wrote the leading psychiatric textbook of his day and that he made his name as a forensic expert.
Despite the scarcity of information, Krafft-Ebingls name seems sufficiently important that even shorter overviews of the history of medicine give him a few sentences.
German examples range from Julius Pagells classic of 1915 up to more recent histories of medicine like Fischer-Hombergerls Geschichte der Medizin and Harig and Schneck's similar textbook of 1990.
There is no doubt that looking at Krafft-Ebing as a representative of degenerationist thought has proven very fruitful in many ways.
Such important historians as the husband and wife-team Leibbrand-Wettley5 or Lesky, amongst others, have stressed that Krafft-Ebing was the most influential German-speaking psychiatrist within the degenerationist tradition and that this theoretical model was the basis of his very categorisation of psychiatric disease.
Gefasspsychopath%gie - the attempt to explain psychological functioning by examining the physiology and pathology of vessels in the nervous tissue, especially in the brain.?
Those historians who singled out one of Krafft-Ebing's specific interests have, without exception, explored his work on sexuality.
This is very understandable and fully justifiable if we are mainly concerned with the history of influences as opposed to the history of the origin of ideas.
For many historians today Krafft-Ebing, after a", 11 made his name with the Psychopathia sexualis and it is doubtful whether he would be remembered, had he not written this particular book.
The body of literature which mentions that book is vast.
For the German historical literature it was again Leibbrand-Wettley who led the way in exploring Blackjack percentage table Ebing as the "father of sexology", both in an early work on the history of sexualit y8 and in their ambitious 2-volume project covering the complete cultural and intellectual history of the Erotic through several centuries.
They diverge more in their value judgements than in their information.
An untold proportion of the confusion which continues to surround the subject of sexual variation today stems directly from his writing.
On the contrary, he was interested in supplanting the waning power of the church with the waxing power?
The ability to enjoy and perform the sexual act, in the normal manner, appeared to be the most difficult of the arts.
It is obviously crucial that we remain aware of the fact that he has evoked such powerful feelings before attempting a more value-free account.
Most importantly he knew Sigmund Freud personally and apart from having a substantial influence on the latter's work on sexuality - he also interacted with him professionally.
Earlier Freud scholars have emphasised Krafft-Ebing's allegedly hostile refutation of Freud's views.
More recently and parallel to a more critical assessment of Freud's achievement, their relationship has also been seen differently and there is now more emphasis on the fact that the established Krafft-Ebing actively supported Freud's academic career and final professorship.
Some of the articles are difficult to obtain since they are buried in obscure Austrian journals.
The complete list of KrafftEbing's publications in the appendix to the thesis is designed to make them more accessible by newly providing full references.
In contrast to the vast amount of published material, I have found only a few manuscripts by Krafft-Ebing.
Some of these were 14 recorded in the libraries of Graz and Vienna, others in German libraries the University library of Berlin holds a central catalogue and a few postcards are still in the possession of Krafft-Ebing's family in Graz.
The letters and postcards found are reproduced in the appendix, although they do not appear to be of great historical value.
To my disappointment I have not come across any autobiography or autobiographical notes, diaries or candid correspondencewhich would undoubtedly be more interesting.
In addition to manuscripts by Krafft-Ebing there are other archival sources and although I know of their existence and have seen some of them, they have not been fully exploited here.
However, future research on Krafft-Ebing could well make use of two sources of unpublished material: 1 Graz University and apparently to a lesser extent Vienna University hold archival material which definitely sheds light on administrative aspects of his relationships to these universities and possibly on other aspects of his work, too.
The direct secondary literature has already been summarised above.
Whilst relatively little work relates directly to Krafft-Ebing, there exist, of course, many historical accounts which were relevant for this thesis.
Apart from books which provided a general-historical or cultural background,21 there are the histories of medical teaching, which are more fully quoted in the first part of the thesis.
It is not a study of sexology in the 1880s that is it does not trace the history of the emergence of Germanic Sexualwissenschaft.
As the above summary of our knowledge has already emphasised existing accounts tend either to single out one abstract principle or to emphasise Krafft-Ebing's interest in sexuality only.
Yet, compiling and reading his considerable output on an impressingly broad range of topics, I thought that this kind of focus did not do him justice and resulted in his false reputation of a one-book author.
I have tried to undermine this view and instead of focusing on Krafft-Ebing as an early "sexologist" I have emphasised that he was a man of many interests.
If Krafft-Ebing's work is evidence of his own reluctance to be a single-minded specialist, this same principle is also reflected in his 16 life.
Following Krafft-Ebing through the various stations of his professional life - from his training at the University of Heidelberg and the "model-asylum" Illenau to his multiple functions in Graz and his chair in Vienna - it becomes clear that his intellectual broadmindedness was born out of his many different experiences.
In addition to neglecting substantial parts of his work, the more usual approach seems flawed in treating and subsequently judging Krafft-Ebing for being someone he never intended to be: a pioneer in sexology.
His supposedly seminal text of 1886 is neither original nor was it meant to be a contribution to what only later became sexology or Sexualwissenschaft.
Historians of sexuality may well see the book as a catalyst to their field https://tayorindustry.com/blackjack/blackjack-shoes-777.html retrospect, but for understanding the original text it is more important to explore the context in which it was written.
My chapter on sexuality makes the point that this was at the time primarily a forensic context.
Contrary to Wettley, who argued that he took sexuality out of the context of general psychiatry I believe that he did no such thing but thought sexuality important because it was of forensic-psychiatric relevance.
On a more abstract level, the nature of the Psychopathia sexualis is explained precisely by Krafft-Ebing's other work.
Irrespective of how his classification of sexual disorders came to be interpreted later, the actual first edition of the text a small booklet of 110 pages is essentially a compilation of contemporary knowledge on sexuality.
To do Krafft-Ebing justice, although he says in the introduction that his book is novel - inasmuch as it is the first comprehensive medical book on sexuality,26 he nowhere claims that the factual content is original and new.
On the contrary, he 17 carefully refers to a vast number of sources many of them French and out of the 47 case-h istories on Iy 6 are h is own patients, the remainder being second-hand.
In essence the book is an over-view of the literature like the many others he had written such as his annual or bi-annual reviews of psychiatric-forensic literature or reviews on topics such as dementia paralytica.
There is an additional problem with singling out Krafft-Ebing's interest in sexuality and putting the Psychopathia sexualis centre stage: which of the 12 editions is actually meant?
Chapter summary The first part of my thesis chapters 1 to 4 deals with institutional and practical aspects of Krafft-Ebing's life.
The second part is an intellectual biography focusing on his main interests.
The appendix contains a full list of Krafft-Ebing's publications, the many different editions of the Psychopathia sexual is, and descriptions of several manuscripts.
Chapter 1 gives a survey of the important stations of Kraftt-Ebing's life.
After his final medical examinations in 1863, he trained for 5 18 years as a psychiatrist at the Illenau, a well-known mental asylum in Baden.
In the spring of 1872 he obtained his first lectureship at the University of Strasbourg, but left Germany after a year to accept a call to the University of Graz in Austria.
It is at Graz that Krafft-Ebing published his most important work and this is put into context, whilst the details of his clinical work are dealt with in chapter 3.
The remainder of this short summary of Krafft-Ebing's life go here his election to the chair of psychiatry at the University of Vienna and lastly gives a brief analysis of his personality.
Krafft-Ebing's training-period at the Illenau - from 1863 until 1869 -was profoundly formative for his later work and significantly he called himself its disciple throughout his life.
The daily life and atmosphere of this asylum has therefore been studied in detail in chapter 2.
This chapter also clarifies the extent to which he remained indebted to its teaching.
The legacy of the Illenau permeated Krafft-Ebing's what is 21 plus 3 blackjack approach to his patients - the individual case method - and most fundamentally his Weltanschauung, a view of medicine as a moral rather than a strictly natu ral-scientific enterprise.
The years at Graz chapter 3 were in many senses the high-point of Krafft-Ebing's career: it was the longest period he spent in anyone place; he was there during his middle age.
At Graz he wrote his major work and became interested in all the topics with which he 19 was later to be concerned.
He was simultaneously involved in three very different institutions: Feldhof a chronic asylumthe clinic in Graz hospital a ward with more acutely ill patients and, from 1886, Mariagrun, his own private sanatorium.
This chapter examines the types of patients he treated by making use of contemporary statistics for all three institutions.
These patients, of course, directly influenced his work since they represented the material on which he based his psychiatric theories.
This material changed over time and I argue that the changes are the most direct reflection of how Krafft-Ebing tried to shape psychiatry.
He did not simply passively accept patients, but actively selected them.
Leaving Feldhof after a few years resulted in fewer chronic patients and adapting the clinic o and later buying and running a private sanatorium see more chctSing more acute patients suffering from hysteria and neurasthenia.
These latter groups of patients were more valuable to Krafft-Ebing because he could use them better both for teaching and for publishing.
Chapter 4 is about Krafft-Ebing's time in Vienna which in many ways was less rewarding for him than the time spent in the smaller Graz.
He found less time to do creative work, administrative problems were more disagreeable and he never obtained a ward for in-patients suffering from nervous disorders like the one for which he had successfully fought at Graz.
On the other hand, Vienna was incomparably more prestigious than Graz and KrafftEbing had finally "arrived" professionally when he was elected to the chair of psychiatry there.
In addition to completing the story of his professional life, this chapter is mainly about one key aspect his involvement in the society of psychiatry and neurology of which 20 he became the president in 1892.
His relationship with Freud is discussed.
The second part of the thesis is about Krafft-Ebing's work.
Chapter 5 gives a chronological overview of it.
The working methods which allowed him to maintain such a prodigious output are discussed.
Whilst the bibliography of his publications part one of the appendix is comprehensive, this chapter selects what I see as his most important contributions to the major topics: forensic psychiatry, sexual psychopathology, hypnotism and neurology.
Lastly, I comment on the translations in various foreign languages and argue that Krafft-Ebing's reputation as the author of one book in the English-speaking world may be due to his works being translated into English only very selectively.
Krafft-Ebing's work on sexual pathology is both extensive and comparatively well-known.
Chapter 6 explores two of its most important aspects: the forensic connection and click here psychologisation of sexuality.
Krafft-Ebing was from the start - not least due to the influence of his grandfather Mittermaier - interested in forensic psychiatry.
His main motivation in taking up sexual psychopathology was clearly a forensic one.
In other words, his famous classification of sexual disorders as put down in the Psychopathia sexualis with its characteristic subtitle lOa clinicoforensic study" was above all designed as a framework for discussing sexual crimes in court.
This goes a long way towards explaining the nature of this classification.
By choosing the important example, homosexuality, I elaborate on the legal origin of Krafft-Ebing's model and also follow the development of his 21 engagement in sexual- forensic questions.
The second part of the chapter then goes on to discuss the clear signs of a "psychologisation" of sexuality in Krafft-Ebing's later work.
There is a shift from understanding sexuality as a physiological phenomenon to seeing it as a psychological event.
The new terminology which Krafft-Ebing introduced - with terms such as sadism and masochism - bear witness to this.
Chapter 7 is about Krafft-Ebing as one of the pioneers of hypnotism in German-speaking psychiatry.
This chapter shows him as a practising therapist.
The extent to which he spent time as a therapist - illustrated with a lengthy case study of his patient lima - may help to counterbalance our current view that psychiatry at the time was above all non-therapeutic.
The main significance of hypnosis for Krafft-Ebing's general work is that it opened up a new outlook for his work on sexuality.
Krafft-Ebing became interested in hypnosis in autumn 1887 and having treated the homosexual lima during winter 1887 and spring 1888 he quickly began to draw general conclusions and integrated his new therapeutic convictions into the later editions of the Psychopathia sexualis.
The last chapter shows that Krafft-Ebing, who is known to us as a psychiatrist, was more of a "neurologist" than is generally reported and that he wrote on a broad range of organic disorders.
In particular he contributed to the "general paralysis" question, important at the time, but receiving little attention from historians subsequently.
Apart from adding new factual information, the exploration of Krafft-Ebing's work on the causal link between syphilis general paralysis and tabes dorsalis, is also meaningful because it touches on the broader issue of his disease model.
The "general paralysis" problem was finally solved in the late 1890s and early years of the new century within the model of bacteriology.
Although it looks at first sight as if Krafft-Ebing subscribed to modern bacteriological thinking - he argued successfully using inoculation experiments conducted on syphilitic patients - a closer analysis reveals the extent to which he remained rooted in a more traditional disease model - and gives the likely reasons for this.
In addition to dealing with organic conditions affecting the nervous system including peripheral nerves, KrafftEbing was also interested in nerves in a more "abstract" sense: he treated neurasthenic or nervous patients and he also wrote on hysteria.
Chapter 3 has already described the outer setting in which he did so.
Chapter 8 raises the question of his relationship with other psychiatrists-cum-neurologists at the time as well as fundamental questions about the boundaries of psychiatry and neurology.
Pagel 1915 p 542.
Stuttgart Enke he did Illt:ntion him in his Kurze Geschichte der Psychiatrie 1967Β».
For the Anglo-Saxon literaturt:: CJarrison llJ29 pp 648; 701, mentioned Krafft-Ebing as the author of the best German work on forensic psychiatry as wt:ll as for bt:ing a scit:ntific student of sexology.
Ackerknecht 1967p 55.
Bynum 1983 P 35 and idem llJ84 pp 61-62.
Pick 1989who concentrates on the French scene.
The literature on degeneration generally is vast.
Sec for example on Morel as the "father of degeneration" : Durgener 1964Friedlander 1973 and the classic work by Genii-Perrin 1913.
More recently and more generally: Mann 1985 and Dowbiggin 1985.
Haeberle 1983Hofweber I 69.
Mosse 1985Neumann 1974.
Weeks 1977; 1989Brecher 1969.
Phayer 1977 curio~sly docs.
Lastly, Ranke- Hel nemann s cu It u ral-t heo log ic al and ant i-c lerical history of 19H8.
~~ehman or the last German cd.
Sec also chapter 4.
For the background story or asylums and individual institutions, see.
Krafn-Ehing may not have known of its existence - at Il: 25 As a SCCOlH.
Tannahill 1980 p 382 quotes the book's date i.
The career 1 27 Richard von Krafft-Ebing was born in Mannheim, in the Grand Duchy of Baden in South Germany on 14 August 1840.
He died in Graz, Austria, on 22 December 1902.
He was the oldest son of Friedrich Carl Conrad von Krafft-Ebing 28.
On the paternal side the Catholic family was of the Austrian aristocracy and Richard von Krafft-Ebing's title was Freiherr from birth.
Arch ives supply the names and birthdates of his three younger siblings3 - but little else about Krafft-Ebing's youth, and nothing about the family atmosphere.
The family moved away from Mannheim, probably around 1842, and later settled in Eberbach, a small town close to Heidelberg, where Krafft-Ebing's father was a higher district administrator of Baden h6herer Amtmann.
One reason for this move was that there was no Gymnasium education possible in Eberbach.
It is also known that in this period Richard's mother died when he was only 14 and his father married her older sister Luise Katharine Mittermaierbut again we do not know how this affected the boy.
By contrast the granting of the actual doctoral degree was in the hands of the medical faculty and required an extra oral and written examination, a written dissertation, as well as a substantial amount of money.
Many students did not bother with this degree since it carried little advantage unless a university career was aspired to.
He submitted his dissertation on the topic of sensory deliria in December 1863.
Between the final examinations in May 1863 and the Promotion in August, Krafft-Ebing spent some 28 time in Switzerland.
The main reason for his stay was a bout of fever possibly typhoidwhich he had acquired during his medical training on the internal-medical wards of Nikolaus Friedreich 1825- 1882.
He seems to have been quite ill - he later used his personal experience of hallucinations in his dissertation 10 - but he recovered fully and took the opportunity to listen to Wilhelm Griesinger's lectures in Zurich.
He was not officially registered as a student there 11 and this must have been an informal arrangement, quite common at a time when medical lectures, even those with demonstrations of patients, were less closed to the public than today.
During that term Griesinger was covering the nervous system in his lectures on special pathology and therapy, and he also gave clinical lectures on mental illness,' 2 the latter almost certainly with practical demonstrations of patients at the Burghblzli.
Later KrafftEbing mentioned in his medical dissertation that he got to know a patient of the local asylum during his stay at Zurich.
In July of 1863 he wrote to Schule, informing him of his decision to take up psychiatry as a speciality.
According to Schule he said that this was due to the impression Griesinger had made on him - a reason which may represent a later interpretation of Schule.
Mittermaier published extensively and one of his favourite topics was forensic 30 psychiatry.
It was this legal aspect of psychiatry which attracted Krafft-Ebing from the start.
At the Illenau from 1863-1869 Once Krafft-Ebing had made his decision to take up psychiatry, he applied for a post at the Illenau, the best-known psychiatric asylum of South Germany, where Schule was already working.
Krafft-Ebing obtained the post probably through family connections: his grandfather Mittermaier was a good friend of have blackjack virtual machine matchless medical director C.
Krafft-Ebing started first as a volunteer, staying for three months from 1 September to 1 December 1863; after an interval he was appointed for five years as a junior doctor 21 May 1864 - spring 1869.
Thanks to Schule we have a list of the books, which impressed and influenced them.
Spielmann's Diagnostik der Geisteskranken 1855Pinel and Esquirol, Wilhelm Wundfs Vorlesungen uber die Menschen und Thierseele and Gustav Theodor Fechner's Elemente der Psychophysik,1860, which inspired them to make experiments.
Above all Krafft-Ebing was apparently impressed by Morel both for his ideas on the importance of vessels and his concepts of disposition and degeneration and Darwin, who was then becoming very popular.
From the beginning of his career Krafft-Ebing was keen to publish, and he was to keep up a steady and impressive flow of publications all through his life.
During his Illenau period he wrote many book reviews, in 1867, for example, publishing 14, mainly in two journals.
The first was the Allgemeine Zeitschrift fUr Psychiatrie, the general psychiatric journal of the time, co-edited by C.
The second was a medico-legal journal called Friedreichs Blatter fOr gerichtliche Medizin.
Here it was probably Mittermaier who paved the way for his grandson: he had close connections with the editors and wrote personally in the journal until he died in 1867.
From 1866 Krafft-Ebing was in charge of a part of the annual book review of the whole of psychiatric literature published in this medico-legal journal: he reviewed the section on forensic psychiatry.
When Friedreichs Blatter discontinued its annual review in 1880 - a major enterprise then taken over by the Allgemeine Zeitschrift fUr Psychiatrie - it was again Krafft-Ebing who dealt with forensic psychiatry.
Krafft-Ebing, in other words, not only knew all the recent 31 work on forensic psychiatry, but also shaped his colleagues' opinions for several decades since there was only one systematised book review of psychiatry at this web page time.
During the years at the Illenau he also started to write monographs on various topics as well as legal reports.
Krafft-Ebing left his first job at the Illenau in spring 1869 and moved to Baden-Baden, where he set up his own office as a specialist for nervous disorders praktischer Nervenarzt.
Krafft-Ebing was called into the 32 army with the amusing flash blackjack agree of major on 20 June 1870 and put in charge of a medical service station to the Prussian troops situated in Rastatt, a military camp.
The patients suffered mostly from peripheral neurological lesions that is, organic conditions.
KrafftEbing published on his activity in that clinic and in a paper of 1871 described five soldiers suffering from paralysis of their arm-nerves after the prolonged use of crutches.
Germany, however, had only just created her first university chairs for psychiatry, asylums provided few posts and few of them offered any prospect - in fact, the Illenau was probably the best - so KrafftEbing's decision to settle in Baden may well have been born of necessity rather than choice.
By 1871 he had, however, published several forensic reports as well as a few monographs and he also seems to have established useful contacts such as with Franz von Holtzendorff, then a professor of law at Berlin, to whose Rechtslexikon legal dictionary he contributed 32 Helped by his 33 distinguished performance during the war, Krafft-Ebing started to look for an academic post which would give him some prospects.
The first academic post: Strasbourg in 1872 At first Krafft-Ebing approached the University of Leipzig, where Carl Wunderlich, dean of the medical faculty, was willing to appoint him.
This old university in Alsace had just fallen to Prussia as a result of the Franco Prussian war.
It appears that von Roggenbach, source fact, created this position, which had originally not been planned.
Krafft-Ebing was the first to leave, and although his chair was relatively insignificant, his decision would not have gone down well with his colleagues.
His deeper-rooted reason may have been that he as a South German Catholic did not agree with such an explicitly Prussian program.
His tasks in Strasbourg were twofold - lecturing and treating patients.
During the first term of 1872 the Sommersemester for example he delivered two courses of lectures 4 hours per week on general psychiatry with clinical demonstrations and one on criminal psychology 1 hour per week.
He did so despite difficult circumstances, above all the fact that with only 4 beds he had to rely on other wards in order to demonstrate any patients at all.
As psychiatry was an extracurricular subject, students were difficult to attract and more likely to attend when the teaching was of a "modern" format, that is when patients could be shown.
Krafft-Ebing used to take his students to both the Illenau and to Stephansfeld, a nearby provincial asylum, where Pelman would show him his patients.
The most important works are two monographs which he later put together and published, updated and enlarged, as his forensic textbook.
The first of these monographs of 1872 dealt with the criminal law, the second of 1873 with civil law.
Both put down some principles of the psychological approach towards offenders for medical experts and lawyers.
He seems to have been very happy in Graz and later in Vienna, in spite of his relatively higher status there, he always longed for the beautiful and healthy surroundings of Graz.
It was also during his time at Graz that Krafft-Ebing married and started a family.
His wife Luise 184619.
They were married in Karlsruhe Baden on 16 Dec 1874.
They had two sons, Friedrich Josef 31.
He appears to have been a good and dedicated family man and father, stern, rigid, "Victorian" but also warm and good-humoured, at least if his style of talking to children as described in his "hypnotic experiments" is anything to go by.
Marion Krafft-Ebing, the daughter of Krafft-Ebing's second son Johann called Hans remembered how warmly her father always spoke of his father.
Not only did he hold down an academic post involving regular lecturing and publishing steadily in large quantities, but he also had different clinical functions.
From 1873 to 1880 he was medical director at Feldhof, a newly built provincial asylum of about 300 beds.
This position was linked to the professorship of psychiatry at Graz University.
This ward of 24 beds was officially opened by him on 22 May 1874;46 he stayed in charge until he left Graz in 1889.
Lastly, Krafft-Ebing became involved in a third and very different institution, his private sanatorium MariagrOn, founded in 1886 and kept on when he moved to Vienna three years later.
It was then run by the two directors and former assistants of KrafftEbing: Hugo Gugl and Anton Stichl.
In addition to his hospitalised patients, Krafft-Ebing treated out-patients.
Publications It was at Graz that Krafft-Ebing produced his most original published work.
Later, at Vienna, he elaborated ideas formed in Graz, and a significant number of his publications from this later period would be re-editions of earlier work.
The forensic textbook - Lehrbuch der gerichtlichen Psychopathologie mit Berucksichtigung der Gesetzgebung von Oesterreich, Deutschland und Frankreich Textbook of forensic psychopathology with reference to the legal codes of Austria, Germany and France is important for two reasons.
First, it characterises Krafft-Ebing's specific interest best; secondly, it was the first textbook of the legal aspects of psychiatry.
It was the culmination of Krafft-Ebing's long standing interest in legal questions.
Motivated by his early contact with jurisprudence in Mittermaier's circles, Krafft-Ebing had for many years been specifically involved in these -questions and was by the 1870s on his way to becoming the leading forensicpsychiatric expert for the German-speaking community.
He regularly acted as an expert medical adviser by writing forensicpsychiatric reports.
Even before the publication of the forensic textbook, Krafft-Ebing had begun to systematise his views in various articles covering specific legal aspects.
He wrote on questions such as criminal actions under the influence of alcohol 1872the legal responsibility of hysterical patients 1872the self-accusations of the mentally ill 1873and on the validity of legal testimony in different psychopathological conditions 1874.
These are on the principles of crim inal psychology 1872 and an essay on dubious mental states in civil law 1873.
This book also had a significant impact on German-speaking psychiatry.
It went through seven editions during Krafft-Ebing's lifetime, was translated into several languages including French, English, Italian and Hungarian, and indeed became the leading standard textbook for many years until it was replaced by that of Emil Kraepelin.
One of its most remarkable features is the number of case-histories collected in volume 3 159 cases in the first edition, later less.
In addition he was also an active contributor to journals, writing not only several articles per year, but continuing to produce the annual reviews of the forensic-psychiatric literature.
Most important, and a sure sign of his high status in the field, was his position on the editorial boards of such journals as the Allgemeine Zeitschrift fOr Psychiatrie from 1879 and the Jahrbucher fUr Psychiatrie from 1887.
Vienna: 1889 - 1902 In 1889 Krafft-Ebing was invited to succeed Max Leidesdorf, who had died on 9 October 1889 in Vienna.
He had been replaced as a lecturer by Julius von Wagner-Jauregg in a so-called 'interregnum' position for four terms i.
Wagner-Jauregg was to follow in Krafft-Ebing's footsteps again in 1892, when Meynert died, and lastly in 1902, after Krafft-Ebing's retirement.
The organisation of Psychiatry in the University of Vienna was complex.
The relevant institutions were the Niederosterreichische Landesirrenanstalt provincial asylum of lower Austria an institution with mainly chronic patients and about 150 beds in 1889.
This was connected with the 'Leidesdorf' chair and has also been called Vienna I or first psychiatric clinic.
Vienna II was seen as the more desirable position.
Its higher academic status was intrinsically linked to the availability of more "interesting" patients for teaching purposes.
Due to different admission procedures - Vienna II was a medical hospital, whereas Vienna I was a psychiatric asylum.
KrafftΒ· Ebing was first elected to Vienna I in 1889 and three years later to Vienna II, which means that he was first running a provincial 40 asylum-type hospital with a lot of adm inistrative tasks and chronic patients, and only later 1892 a university type clinic.
Krafft-Ebing, delivered his inaugural lecture at Vienna I on 21 October 1889.
It was entitled: "Die Entwicklung und Bedeutung der Psychiatrie als klinischer Wissenschaft " The Development and Significance of Psychiatry as a Clinical Science.
This society played a key role in the psychiatric life of Austria as a whole.
Originally called the Verein fur Psychiatrie und forensische Psych%gie Society for Psychiatry and Forensic Psychology Krafft-Ebing in 1894 had the name changed to Verein fUr Psychiatrie und Neur%gie Society for Psychiatry and Neurology.
All three books proved to 4 1 be in high demand and were re-published regularly, usually in a revised, enlarged and updated form.
The latter is particularly true for the Psychopathia sexualis, which changed significantly both formally and in content over the years.
In addition to the books, he published a collection of earlier articles in four volumes 1897-99 : Arbeiten aus dem Gesammtgebiet der Psychiatrie und Neuropathologie Works in psychiatry and neuropathology.
In this he followed the example of Paul Mobius, who had published his former neurological papers in five volumes a few years earlier, and to whom Krafft-Ebing referred in his preface.
But such collections also seem to have served as ammunition in priority disputes.
In Krafft-Ebing's case, this was certainly true for his concept of Zwangsvorstellung obsessional thoughts.
He gave credit to Carl Westphal for putting the term into a clinical context in 1877 but stressed the fact that he himself had already coined the term "obsessional thoughts" in 1867.
The general impression of Vienna as a dynamic centre of psychiatry requires some modification here.
Krafft-Ebing, certainly, hated many aspects of the professional climate of Vienna and felt engaged in an uphill struggle for many years.
In a letter 42 dated 26 Feb 1894 to a friend unidentified he expressed his frustration with Vienna in the following words: I merely told him.
He had many administrative duties, in particular during the first few years when he was in charge of Vienna I with its 150 beds of chronic patients.
University teaching, Krafft-Ebing's ultimate goal, was difficult, not only because of lack blackjack counting chart finance, but even more because of a lack of enthusiasm for the subject.
Psychiatry, not yet a compulsory subject within the medical curriculum, was still some way from being a fully respected discipline.
Personal intrigues and border skirmishes with other disciplines such as neurology added to the difficulties.
Krafft-Ebing worked towards changing both administrative structures and psychiatric teaching practice and he.
He was widely known and praised as one of the leading names in psychiatry internationally.
One sign of his professional importance was the fact that he was allocated to speak in the plenary session of the international congress of medicine, held at Moscow in 1897.
On the whole he appears to have been widely respected.
Everybody agreed that he was a hard-working man, but he was also praised for such qualities as good breeding, good manners, respect for others, diplomacy and politeness.
His obituaries mostly stress his "truly aristocratic" character and strong sense of duty.
These obituaries - written by his close friends such as Schule or pupils such as Fuchs - are of course painting a one-sided picture, but there are also more objective indications: his style in talking to his patients was exceptionally tolerant and patient, if at times very patriarchal.
Those who did not like him accused him of being stiff and uncreatively formal; for example Kraepelin, who thought it typical of KrafftEbing's dullness that he always met his publisher's deadlines.
There was one outspoken "enemi' of Krafft-Ebing - Moriz Benedikt, who was professor of electrotherapy at Vienna and a notoriously difficult character.
He clashed professionally with Krafft-Ebing over forensic issues, hypnotism, and Lombrosian craniometry.
In his book on hypnotism and suggestion of 1894 he included a IIpsychological equation of Mr Krafft-Ebing", which reads like a tirade of hatred and professional envy.
Krafft-Ebing, we learn, is an "untiring collector who has acquired the false reputation of an expert".
He has a "fine instinct for worldly success" which allows him to "latch onto modern keywords such as neurasthenia, moral insanity, hypnotism, moral treatment, sexual perversity etc.
Although endowed with a certain "journalistic talent", he has remained a dilettante.
There is nothing to be hoped for in the clinics in Vienna for the next 10 years.
There is not only a lack of money, but a lack of other th ings, too.
For several years before his retirement, he had shown symptoms of arteriosclerosis, which apparently did not affect his mental capacity but he increasingly suffered from migraine, a very painful trigeminal neuralgia and fainting spells.
He managed to re-edit the twelfth edition of the Psychopathia sexualis and the seventh edition of his 46 general textbook, as well as writing a substantial monograph on menstrual psychosis, a topic again of forensic significance since the disorder is periodic.
He was buried in the St.
Leonard -cemetery of Graz, followed by his wife who died a year later.
~urCl's: I l'lltril's lin Krallt-Ebing in NOll by Kindt llJ~O ; the OI3L by Holl-Ulltcfrainl'r llJ6lJ and I3cttelheim 1905each with further litnaturl'.
Much or the following is taken from either Schule or Fuchs: Anon.
Jauregg 18981902.
Joseph Friedrich Richard von Krafft-Ebing.
Another official version of thl' name plus rull titles - Anon.
He gave the date as May I X63.
Iing to the official entry in the University archive of Heidelberg leiter of 2S.
Il X8 from the University archive : the Personulakte of Ira:!.
University in Krafft-Etling's hand renders the dute of promotion as 6th August.
~ ~ 12 See Zurich.
Tlwy art: ct:rtainly not listed in the letter collections of German libraries and archivt:s.
In Austria psychiatry - together with nt.
He was a co-editor of tht: jOllf'llal Frkdrt.
New psychiatric research and experiences in their forensic applkation towards best judging the question of legal responsibility.
Friedrl'ichs OIHtter 17 5-22; 16385; 243-76; 323-58 and IX 3-37; 161-X9.
The preface was dated 25 November I X63: the thesis was submitted to the faculty on 11 December I X63 Hnd Krafft-Ehing suhsequently asked for permission to publish.
Il XX from the University archive in Heidelberg.
Krafft-Ebing lkdkated his medical thesis to his grandfather Mitlermaier i.
IS probably due to Miuermaier's influence.
Krafn-Ebing's boss at the 11lenuu.
P 307 stressed above all 13crlin; Fuchs.
Prague alld I3crlin as the places Krarn-Ebing visited early on ill his carcer in Fuchs 1902 pp 34.
Krafft-Ebing himsclr latcr Illelltiolled in a paper of 1867 Ein Besuch in Ghecl.
IXl 2- IlIell 24 vol.
Fischer 1935 p 319; also information from the Gcnerallandesarchiv Karlsruhe letter of 18.
I X65 see appendix.
Krullt-Ehing's pcrsonal connection with vun Holtzendorfl' may w.
~11 h~lve bcen estahlished at an earlier date sincl von Holtzendorfr was a friend and pupil of Miltermaicr.
An HXlr {onlill {rius although carrying the same title of Professor has considerably less security, kss power and also less which money.
For an interesting cOlltelllp rary description f Stephansfeld see the memoirs of Pcllllan llJI2.
He mcnti ns Kral'f't-Ebillg only in passing and does not add anything new.
J lly IXX7 p 7.
Turisten and KraITt-Ebing IX73 Die zweifclhurten GcisteszusUinde vor tlell1 Civilricllter.
No exact date is known.
~g llJ50 p 43.
Wagner-buregg 1t X p 2311.
Ball 1I1111 von dic Bl:itril~l:.
For a rcccnt histmy or ohsL'ssiollal disorders including accreditation Krafrt-Ebin~ I'm c illing thc tl:rm sce 19R5.
I havc not comc :ILTOSS allY othcr uutspoken remarks against.
I Krafrt-Fhing certainly collahoratcd directly and voluntarily with.
Jcwish docturs; cxamples an: Magnus Hirschfeld in later years.
Schiller 19X2 p -1- alsll C llll11l'lIts on I3cnl'dikt's pcr'ionality.
Fuchs 1902 P II spokL!
Wil'Ill'f klinisclll' RlInlischall, SL!
SllidieSl:l: appendix.
Einl: klinisch- 53 Chapter 2.
The Illenau: an ideal psychiatric asylum 54 I ntrod u cti 0 n Krafft-Ebing worked at the IIlenau, the leading South-German asylum, click September and December 1863 as a volunteer, then from May 1864 until April 1869 as a full-time junior doctor.
Psychiatry as a university subject was still a very recent invention and the topic was not yet part of the final medical exam it became so in Germany only in 1901.
The institution he had chosen, - or rather that he was very lucky to get into, - was a particularly powerful place with a tradition shaped by such important figures as the medical director Friedrich Wilhelm Christian Roller 1802-1878 and his co-director later successor Karl Hergt 1807-1887.
At the time when Krafft-Ebing joined the staff in the 1860s, asylum tradition, for which the IIlenau was such an excellent example, was undergoing important changes.
On the one hand, new ideas such as non-restraint or Morel's and Darwin's teachings were taken on board; on the other hand, the heyday of the asylum was over and Roller was getting older.
Nevertheless, this was a time of forward-looking change and enthusiasm.
In a sense the Illenau represented the best of two worlds: Roller, the successful patriarchal figure of German asylums, was still fully active, but his junior staff were also in touch with the latest ideas taught at the universities.
The IIlenau thus combined humanitarian ideas and an idealist re-educational programme for the patients, with "natural-scientific" methods promising to get at the root of madness.
Krafft-Ebing was to call himself a disciple of the Illenau for all his life: he stayed in close contact with the institution and with the two friends he had made there, Heinrich SchOle 1840-1916the later director of the Illenau, and Wilhelm Erb 1840-1921who became a leading German neurologist.
Most importantly, however, his way of thinking remained permanently shaped by the "lllenau-school" as it was called at the time.
It shaped his basic belief as to what psychiatry should be, namely that it was a moral enterprise rather than one that was strictly "natural-scientific".
In a revealing sentence in the preface to the Psychopathia sexual is 1886 he claimed that it was up to medicine to "save the honour of humanity in the forum of moralitl.
The physician, in other words, also had a moral task.
Lastly, he subscribed to a view that was highly characteristic for asylum-psychiatry and could, in fact, have easily been the formulation of Roller himself: 55 For psychiatrists the mental asylum, a place of horror to the lay person, is the most important remedy against disease.
This asylum, Mariagrun, had many features in common with the Illenau.
KrafftEbing, who by then was well established in his university position at Graz - which meant practising a different type of psychiatry - may well have sought to recreate the old atmosphere he had trained in by building up his own small Illenau.
Given the importance of the Illenau for the later development of Krafft-Ebing, this chapter will look closer at the history of that institution and Roller's influential ideas, as well as explore the general atmosphere at the time when Krafft-Ebing was there.
Thanks to Schule we also have some more personal memories of Krafft-Ebing during those days.
These works provide the most direct insight into the asylum as seen through Krafft-Ebing's eyes.
The History of the II1enau 6o The history of the Illenau starts in the 1820s, when the Ministry of the Interior of Baden decided to improve the unsatisfactory state of care for the mentally ill in its Grand Duchy.
The care of the insane had become a focus of specific interest allover Europe.
The 56 conviction that "madness is curable", born out of the philosophy of the Enlightenment and put into action during the French revolution by the famous Pinel, had by the 1820s led to a considerable effort on the part of German States to keep up with modern healthcare.
The typical institutions catering for a mixture of social outcasts orphans, criminals, the sick, the mad, paupers - started to be replaced by more specialised institutions.
At first, the lunatics were segregated and, wherever possible, the old buildings, often old monasteries, were replaced or at least renovated so as to serve as specialised asylums.
The small, but prosperous, Grand Duchy of Baden, ruled by a liberal and progressive government and furthermore heavily influenced by its close neighbour France, was one of the first German States to take on this challenge.
Since 1718 there had been in Baden such an institution for various groups of society.
Situated in Pforzheim, it catered mainly for orphans and crim inals but also for lunatics.
Between 1804-1808 these groups were separated: the criminals were sent to Mannheim and Bruchsaal, and Pforzheim put to the exclusive use of lunatics and the sick lrren- und Siechenhaus.
The medical director of the institution in Pforzheim was Johann Christian Roller, the father of F.
Roller, who later founded the Illenau.
Roller senior died in 1814 and was replaced by one Math involved in blackjack Groos under whom the final separation took place: in 1826 those with physical disorders stayed in Pforzheim but the mentally ill patients were transferred to Heidelberg and put into a former Jesuit convent Heidelberger Anstalt.
This final segregation of the lunatics from other classes of patients was only part of a more far-reaching plan drawn up by a special commission advising the government.
During these years 57 the ministry of Baden tried to draw up a health care system for its lunatics in close connection with the University of Heidelberg - at that time a novelty.
The asylum director should Simultaneously be given a chair at Heidelberg University.
Other proposals included an attempt to improve the actual asylum, and for this the Ministry sent Roller junior on an international asylum tour; he visited Esquirol and Foville in France and also spent some time with Pienitz, Langermann, Horn, Heim and especially Jacobi Siegburg in Germany.
On his return from this explorative trip in 1826, Roller took up his first job in psychiatry working under Groos in the new Heidelberg clinic.
Within a few years Roller, a man as ambitious and ruthless as he was talented, had managed to convince the Ministry of the Interior of his own abilities and, in fact, his superiority to Groos, and in 1835 was made medical director himself, whilst Groos was sent off into early retirement.
Over the next few years Roller secretly opposed the scheme originally drawn up by the commission and sabotaged it from within.
His hostility was directed particularly at the close link with the University, a hostility which went both ways, since the University had refused to accept him as a lecturer on the grounds that he did not possess a proper degree.
The Illenau, in other words, was built in hostile reaction to the existing plans of the University of Heidelberg.
Whilst the 58 faculty's intention was to turn psychiatry into a truly medical speciality, Roller's view was that psychiatry was a very special medical discipline and therefore needed a very special institutional treatment.
This controversy and the way it was solved in Baden go a long way to explaining the later split between asylum- and university-psychiatry, which was to shape German psychiatry for the coming decades.
To a large extent Roller managed to make his dream come true.
The Illenau can be seen as a direct reflection of Roller's views about the nature of psychiatric diseases, or as he characteristically called them, "disorders of the sOUI".
The term "psychiatrt is also contemporary and was used by both asylumand university-psychiatrists.
Roller's asylum was built between 1837-42 close to Achern in idyllic countryside between the university towns of Heidelberg and Freiburg.
In the first place the sexes were strictly separated with the women to the left, the men to the right of the middle axis.
Another important principle was that of separating the noisy patients from the calm, and lastly there was a separation of social class.
Such 59 segregation were seen as therapeutical.
Illenau opened its doors in October 1842 with 291 patients, of whom the majority came from Heidelberg; a few were patients from the old Pforzheim clinic, which had served as an overflow for the inadequate clinic at Heidelberg.
Roller's understanding of mental illness and its remedy: the Illenau Roller's ideas on asylums and the essence of psychiatric care remained remarkably consistent over time although the outer situation and with it Roller's intentions in publishing changed.
We can thus here use both his major works published at an interval of some 40 years.
The first of these was his often quoted monograph of 1831: Die Irrenanstalt nach allen ihren Beziehungen The mental asylum in all its aspects.
Roller's early publication was the result of his international asylum-tour of 1826 and his few years of experience at Heidelberg.
The monograph had two outspoken goals: it argued against the idea of turning psychiatry into a university field and, second, Roller as many others attempted to convince the authorities that madness was indeed curable.
This latter conviction was, after all, a relatively new idea and the government was asked to invest a considerable amount of money into asylum construction.
The single most important point for Roller was the very indispensability of the institution "asylum" as he envisaged it.
With a first chapter on "necessity and value of mental asylums", the monograph covered a wealth of practical questions such as architectural details of rooms, heating systems, bathing facilities etc.
The 60 asylum was the only place, Roller argued, where the healing of the mentally ill patient could take place.
What he later called "the peculiar life of the asylum" constituted the remedy.
In the 1870s there was less of a need to justify psychiatric institutions and the existence of psychiatrists, but there was still an ardent debate on what psychiatry should be like.
Much of Roller's book was a contribution to this discussion, if not to say a direct attack on the university psychiatrists and their main exponent Griesinger.
In fact as far as docslot portal physio general political influence was concerned, Roller, who had successfully fought university psychiatry in the 1820s and 1830s was now, some decades later, on the losing side.
Roller's views were directed against Griesinger Griesinger's famous claim had it that mental illness was a disease of the brain.
He also accepted some of Griesinger's conclusions, for example, that doctors should be the ones to deal with mental illness.
Disagreement began when Griesinger implied that psychiatry was a medical speciality like others; for Roller it was something more than that.
Griesinger 61 arrived at a range of propositions concerning political, practical, architectural and legal aspects of psychiatry.
Roller disagreed vehemently with most of these and saw them as a consequence of that true, but unluckily narrow definition given by Griesinger.
Speaking of the fact that the majority of doctors understood IIdiseases of the soul as diseases of the brain", Roller made the following differentiating statement: It is not the mistake of the doctors that the term diseases of the soul is not explained fully by this: it is the nature of these phenomena that there are additional aspects which the usual nervous diseases lack, and that their knowledge and treatment is something peculiar.
Without taking into consideration these additional aspects there is no diagnosis and no therapy.
It is true that by calling the disorders of the soul diseases of the brain, we do indeed speak the undoubted truth, but if we do not know more, it is an unfruitful truth.
How poor would be our knowledge and treatment of certain forms of disorders of the soul, if we stopped at the phrase that they were merely diseases of the brain and the nerves!
Psychiatry should be a fully accepted medical speciality, but also only a medical speciality.
Therefore psychiatric patients should be treated in clinics that were within general hospitals, as other medical clinics, too.
The main goal of these clinics was to serve as a place of scientific research as well as providing teaching facilities for students.
They would subject patients to a medico-scientific treatment indistinguishable from that of other medical specialities and offer the same type of ward-round teaching.
Admission rules for psychiatric patients were to be the same as those for other medical patients.
These clinics would aspire to a high turn-over in patients in order to ensure varied teaching with patient demonstrations.
It is not difficult to see why Roller disliked Griesinger's vision of psychiatric university clinics - they were basically a serious threat to the asylums, effectively resulting in a degradation of the asylum.
The argument that psychiatric patients should be treated in the same way as medical patients was in Roller's eyes not practicable because he did not think they were the same.
Griesinger seemed to argue against the specialness of asylums and their peculiar characteristic of curing through isolation.
As far as Roller was concerned, Griesinger's suggestions carried the direct implication that the asylum was really a superfluous institution and he wrote sneeringly: In fact one hardly understands why asylums should be constructed in the first place and why the majority of patients should not be treated in their families like those patients suffering from nervous disorders.
His central claim was that the asylum was the remedy.
The asylum was a place of isolation.
It has been convincingly argued that there 63 were several factors behind the principle of isolation, for example: modern enlightened society distances itself from socially nonintegrated elements, and moral arguments such as those of Rousseau saw un spoilt nature as a major healing force.
Most arguments for isolation at the time originated in the views of Pinel and Esquiro!.
The latter in particular was extensively quoted by Jacobi, who was probably the most important German psychiatrist of the early 19th century.
Isolation, they pointed out, implied the removal of the patient from the damaging environment which made him go mad.
By putting him into a different surrounding, new ideas originated and order and new habits would be restored on a different leve!.
The asylum would become a place that offered such a special, healing atmosphere: It is not enough to take the patients out of their usual environment.
The new environment into which they are brought also has to be such that it fu rthers their treatment and cure.
The characteristic life in the asylum is an important help here.
All these were general characteristics of early 19th century German asylums.
The IIlenau was seen as a model, because it excelled in all these points.
It was during those years that first courses and detailed instructions for nursing personnel were drawn up.
They should be kind and tolerant, should not beat 6.
This discussion went on for decades before non-restraint was fully accepted in the German speaking world in the 1860s.
Its final acceptance was due to consistent efforts made by the psychiatrist Ludwig Meyer 18271900 and Griesinger, who was converted to it in the second edition 1861 of his famous textbookJ5 At the Illenau, too, the principle of non-restraint was put into full action during the 1860s, during the time of Krafft-Ebing's stay and partly due to his personal efforts.
Another important aspect of the humane treatment of patients that was much discussed at the time was the standard of the food.
The hazards of a one-sided diet were known and a need for fresh vegetables was emphasised.
Most physicians stressed the need for some meat, but too much animal food was seen as a stimulant, the latter principle particularly important for the various "nervous" diets in mental institutions.
Once more the Illenau did very well compared with other institutions: it was praised for its healthy food based on fresh home-grown vegetables.
It was the healing effect of an ordered, highly structured, large family that was seen as crucial.
This led to a strong feeling of community on the part of both the patients and the staff the latter were, of course, living on the premises.
The Illenau was 65 a home in the broadest sense of the word and this shows not least in the very emotional language used https://tayorindustry.com/blackjack/blackjack-es10.html the Festschriften or the descriptive brochures.
Hergt, the second medical director described his first impressions on arriving at the Illenau in 1842 as follows: This splendid man, who - together with his bosom friend Roller - saw the blossoming of our Illenau as the goal of his life, often described the unforgettable impression of the Illenau where the new arrivals at the portal were greeted by the new building, lit up by the evening sun against the background of proud silhouettes of the majestic Black Forest mountains in the warm colours of autumn.
Even the patients uttered many an involuntary exclamation of delight at the sight of this enchanting landscape and their new situation that appeared so homely compared to their former confinement in the town.
blackjack hand signals abundance of facilities provided for them: individually tailored work with set working hours, opportunities to go for "refreshing" walks after their "well-cooked" meals and participation in "healthy" communal leisure activities in the evenings.
The Illenau employed special workmen to teach the patients skills, there were lessons in subjects such as reading, writing, botany and geography the latter two taught by Hergt J9 Billiard and card game evenings were organised for the male patients, there was a proper swimming pool for men, whilst the women limited themselves to footbaths in the " riverbath".
There is a stylish engraving of both these bathing facilities in a Festschrift of 1865.
But the most important leisure activities were the many musical evenings organised and run by talented individuals including a proper music 66 teacher on the staff.
Beck has taken the trouble to count and list no less than 174 musical events of 1867.
Services were held regularly on Sundays in the house-chapel and Christian religion was integrated into daily life adding another spiritual element.
One of their tasks was to bury both patients and staff in the house cemetery - a final rem inder of how deeply the bond to the community went.
Amongst existing asylums, it was one of the best equipped.
It was, however, not only self-contained, but had strong links with the outside world, too.
The admiration with which the Illenau as an institution was regarded for many decades amounted almost to a cult.
Heinrich Laehr, the recognised expert on German asylums over many years described it in the preface to his Festschrift of 1892: The Illenau and its method of treating patients has attracted attention not only in Germany but also abroad.
The delightful features of its surrounding countryside, the location in the South of Germany close to the majestic Rhine further the inclination to direct one's steps there.
And then the spirit that pervades the place and is so visible in the personalities working there!
We can openly state that no establishment in Germany has welcomed more enthusiastic doctors than the IIlenau.
Younger doctors would pursue their studies, but senior colleagues, too, would leave increased in knowledge and enriched in their hearts, - to be warmly welcomed back 67 again whenever they felt the desire to renew old bonds of friendship.
The best known personalities from abroad were: Viszanik AustriaBrenner and Lehmann SwitzerlandVerhonteren HollandGoricke DenmarkMajor NorwayFalret, Foville and Morel France and Ray America.
Its intention was to make the life of the asylum in all its aspects public to anyone interested and to this purpose it published open reports on patients in letter form for the sake of their relatives, and as a means of inform ing other asylums.
It is likely that he had met Roller, the medical director, before, since Roller was a friend of his grandfather Mittermaier.
When a German in 1870 went to Italy it always seemed to recall the visits of Goethe, that most famous model of a German tourist to Italy.
Krafft-Ebing had planned to go for pleasure, but - unlike Goethe - he looked less at Italian art and women but instead visited psychiatric asylums.
The length of time a psychiatrist spent with his patients varied, depending on the type of ward he controlled.
Krafft-Ebing was at first given the ward for female care patients.
Krafft-Ebing's contacts with patients and the therapies he applied Since Krafft-Ebing was living in the Illenau he had ample opportunity for social contact with patients.
His way of relating was obviously very friendly: Schule later remembered as typical for Krafft-Ebing's personal warmth that for a while he used to bring a hand-picked flower every night to a hypochondriacal lady patient who said she could not sleep without it.
Krafft-Ebing seems to have been a competent player since he played with the surgeon Billroth in Zurich in the summer of 1863 Billroth was an excellent pianist.
According to Schule, Krafft-Ebing spent whole afternoons in the park in the company of very distressed patients showing the nurses that the new method was practicable.
The taking of histories was particularly important and very diligently performed.
It also led to Krafft-Ebing's main research interest: the hereditary components of mental illness, a research based on the compilation of family-histories.
Therapies were divided into the physical sort - diet, peripheral application of electricity and medication - and the psychological or 70 moral sort both words were used.
Physical therapies that KrafftEbing prescribed for his cases included diet,99 cold baths and iceapplications,100 luke-warm baths, 101 bloodletting,1 02 electricity,l 03 and a whole range of medication such as: quinine, morphium, chloroform, argentum nitricum and different syrups like 01 Jecoris or Syrup Chin.
More specific therapies were also applied and these partly reflected the moral tradition as laid down for Germany earlier in the century.
Reil made innumerable suggestions on how to restore reason in a diseased mind by either arousing feelings like anger, fear, pain or by influencing the psyche by theatre plays enacted by the staff of the asylum.
Schneider worked more with mechanical devices such as draw-bridges which opened up suddenly, immersing the patient in cold water or machines which made him rotate, which was intended to shock the brain into better functioning.
Traces of such treatment ideas can be found in descriptions of patients hospitalised at the Illenau in the 1860s, but they did not 71 seem to playa major part.
Whether this was due to such methods being increasingly perceived as "cruel" is at the very least doubtful it is more likely that they cost too much effort and did not produce sufficient therapeutic success.
The label "cruel" which historians have been quick to apply to such therapeutic attempts and subsequent Illenau-ideas, is absent from the primary texts.
These primary texts show, however, a high degree of awareness of what is ll IIhumane and what is "cruel".
This was highly disagreeable and the expected effect was to heighten selfcontrol of the patient who could thus avoid further treatments.
KrafftEbing used Leuret's douche on a 34 year old woman blackjack casino free from a hallucinatory love-obsession.
She had been increasingly bedridden and invalid for many years and finally showed signs of psychosis in particular she heard voices.
Shortly after admission the patient was taken to a far-away ward and left to her own devices.
She was therefore, as Krafft-Ebing put it, given the choice to stay in a cold corridor or else to make her own way back to her bed in the other ward.
The patient started to drag herself along the walls, immediately coming to a standstill when she saw herself 72 observed, but finally reaching her bed.
These experiments were repeated, the patient talked to, and after 8 days at the Illenau she was capable of walking around in the house on her own, at the same time cheering click to see more noticeably.
The patient was thus treated with psychology, good diet and plenty of fresh air from March to the middle of June, at which stage she could be discharged home in good health.
Half a year later December 1867 she suffered a temporary revival of her anxiety and hallucinations, but no paralysis, and these symptoms disappeared within weeks.
KrafftEbing, in 1869, considered the case as cured.
Krafft-Ebing treated a variety of patients at the Illenau.
There were certainly chronic as well as acute cases hospitalised in the asylum.
For example, of the three patients quoted in the medical dissertation of 1864, two had been there for seven, or eight years and one was quoted as having been admitted in October 1863.
Krafft-Ebing also treated children and he published two cases during his Illenau period: one was a boy of 12, whom he might not have known personally since he was hospitalised in 1857, but whose case he wrote up later, and the other was a boy aged 10.
Since the IIlenau extended its activity to home visits in the region for example to patients who had been formerly hospitalised and were then followed upit may well be that not all the patients treated were actually inmates of the asylum.
The most influential of these were Griesinger and Morel.
Some of these books were not only read and digested but also used for practical research on the wards, for example Fechner's Psychophysik led to experiments on the sensibility of patients, which were carried on for years on the wards.
Morel inspired them in two ways: by his stress on the importance and role of blood vessels, and through his ideas on heredity, the latter usually called an anthropological method.
The postulated link between blood circulation and the functioning of the brain became a recognised model for explaining psychological functioning.
Clinically, it took the form of observing an increased bloodflow to the head and therefore to the brain, as the reasoning went together with observation of the emotional state.
A patient in a manic phase would have a hot and flushed apperance.
There was also an anatom ico-pathological aspect to the model, based on the observation that the brains of some patients contained more blood than those of others when examined on the dissecting table.
This thought-model was to playa substantial role in Krafft-Ebing's work it was later also important for the explanation of sexual disorders, some of which were for him due to increased circulation into the pelviC organs.
He here followed directly in Morel's footsteps.
The French psychiatrist Morel had first stressed the importance of hereditary factors in the development of mental disease.
His system - that is the degeneration theory with its claim that mental disease got progressively worse over generations - had both a diagnostic and a prognostic significance.
His ideas led to a careful compilation of family trees of patients.
Clinical symptoms established in this family history were then compared to the symptoms of the patient.
These included both stigmata physical signs such as misformed earlobes and the exact clinical description of the psychological problem.
Krafft-Ebing spent much time from the start compiling very extensive family-histories.
On the 75 contrary, the impression one gets from Krafft-Ebing's early publications from 1864 to 1869, is that much of his time was invested in a thorough study of the psychiatric literature.
The legacy of the Illenau Krafft-Ebing's later work was to be significantly influenced by the Illenau approach.
Most generally there is Krafft-Ebing's Weltanschauung: his intention to carry out a fundamentally moral - rather than a strictly natural-scientific - enterprise.
The naturalscientific enterprise seems for Krafft-Ebing to have been more of a means to a different end than an end in itself.
This cannot docslot portal physio taken for granted because there existed at the time a psychiatry based on purely natural-scientific principles, that of Griesinger.
In spite of his indebtedness to Griesinger Krafft-Ebing would never have considered himself to be his disciple.
Characteristically the young Krafft-Ebing was influenced by two psychiatric models that were incompatible in many ways, those of Griesinger and Roller.
His later work represented a convergence and development.
In keeping with the general development of psychiatry during the century, KrafftEbing's work was about "scientific psychiatry" - at least superficially.
Underlying this, however, was a distinct moral model and a conviction which he did not question- at least not publicly.
There is a distinct discrepancy between the paradisial world of the IIlenau with its idealist vision of lunatic cure and care, and KrafftEbing's later specific interests that included the sodomists and necrophiliacs of Styria.
In his sexual case-histories Krafft-Ebing 76 always maintained a descriptive style, but he was, of course, far from value-free.
The moral judgments he made simply remained hidden.
Krafft-Ebing's own private asylum on the lines of Illenau, named Mariagrun, in Graz, is described in chapter 3.
It is a practical expression of his continuing interest in this kind of psychiatric care.
One can, for example, hardly imagine that a Griesinger, Meynert, Kraepelin or Wernicke, who were all involved in a more abstract kind of psychiatry, would acquire a small private asylum.
By contrast Krafft-Ebing did just that, and his ability as well as inclination to do so was a direct legacy of his Illenau days.
Lastly, Krafft-Ebing's training at the Illenau later showed in his approach to patients.
The same attitude to patients - called "individual case-approach" - also had its reflections in Krafft-Ebing's many written and published case-notes.
Schule called this attitude slightly defensively a "method" and claimed that it was something specific which he and Krafft-Ebing had learnt from Hergt at the IIlenau: Here the method of his work received its direction by the traditional way of observing the patient: not to neglect even the minutest symptom, to evaluate each psychological and physical symptom, to capture the inner causality of psychological events through frequent history taking, to always attempt to link the psychological condition to the physical in order to arrive by way of strict induction at a comprehensive clinical picture, which does not stop at a classifying general diagnosis, but rather tries to explain the case through source individual features.
This is a method which was above all used by our honourable Hergt.
Today 77 this method and the strictly individualising approach to patients appear self-understood after they have been commonly accepted - but then, at the beginning of the 1860s, these were pioneering ideas.
These cases were used in different ways: they appear, for example, as mere figures in statistical arguments.
They would be fairly extensive, https://tayorindustry.com/blackjack/blackjack-vs-spongebob.html average taking up the equivalent of two pages normal book size, normal print often the cases are, in fact, printed in smaller print.
The patient's name or initials, age and current occupation are followed by a brief family background, including those members of the family who had a psychiatrically relevant diagnosis such as melancholia or alcoholism.
Somewhere in the case notes, usually at the beginning, there is a precise admission date or date of consultation.
The personal history is followed by the reason for the patient's hospitalisation consultation.
Then there is a description of how the patient appeared psychologically and physically to Krafft-Ebing: some of the patient's statements are usually quoted verbatim.
Where applicable the therapy is given and a summary of how the case developed.
In many, but not all the cases that died, the report ends with a summary of the findings on dissection.
This format sounds so very logical in many respects today that we have a difficulty similar to that of Schule in convincing ourselves that it was novel.
However, Krafft-Ebing had a reputation for his case-histories; and by comparing the textbooks of various authors 78 of the time we can see what made him unique.
Older authors such as the French idols Pinel and Esquirol would not render individual case-histories at all.
They would make an abstract point - say draw up a list of symptoms - and then illustrate these symptoms with examples from their clinical experience.
Griesinger used his cases in a similar way - again he would not supply a full story of one particular individual, but produce many anecdotal findings that are obviously based on direct experience gained on psychiatric wards.
The goal of these older textbooks, it seems, was to construct a theoretical framework, to outline a general theory - and then to illustrate it with live examples.
By contrast, for Krafft-Ebing the examples themselves were put centre stage.
Scc als cllapter I.
The quote itsclf was unurigillal :llld has also bcen attrihuted to Esquirol scc cg.
ThlTc arc 110 dircct memoirs or letters of the time hy KraITt-Fhillg.
SCl' also rcmarks ill chapter 1.
IS74 Rulkr mentioned an "allack laullchcd agaill.
IIkllau in dell sechs erstcll.
Mit lwei Dildern und zwei Lagepl illell.
Further the contemporary Sl,llutes alld descriptions of the Illenau: Anon.
Statut, Hausordnung, Krankl'llwartdil'llst, Dl'111erKUIIl!
H~il- und Pflegeanslalt Ilkllall.
Mit AIlSiclltl'll 1I11d Pliillell ill 74 DUttern.
I have uSl'd rl'krl.
Fischer 1902 on Roller alld l'lltril's: Roller, Ikrgt alld Schute, ill Kirchhoff 1921124.
Ilknau in lkll -;l'l'lh l.
Dut abllvl' all scc till' prilllary litcr,lturc 7lJ Be c k ILJ H3 p I 2.
Sl'C Szcps 1938 pp 13.
A clear exposition of "humanity" - and tilL: difficulty for society to pay for a sufficient sL:rvice - call hL: found in Krafn-Ebing's description of GhL:el.
SL:L: KralTt-Fhing IX67 I~'ill Besuch in Gheel.
For a general history of the lwn-rL:straint Ilwvelllent in Germanspeaking countries SL:L: the medical-historical dissertation by Gcduldig.
P 367 and Kral'f't-Ebing I X6LJ Se.
It can be added that llthl'r historians l'or example Max Neuburger 1945 saw Reil's therapeutic sllggestiulls as cruel and these were at least for Reil - psychological.
The main point seems to be that as far as therapies go.
Tht: hlbd C eIii ss psyc II opa I holo gie psychopathology bused 011 the fUllction of vessels scems, docslot portal physio far as I can tell.
SchUtc's contemporary summary of the mudd was that "the vasomotor system, which accompanied every emotion n.
~presented the true 'psychic' nerve.
S contailh lll~llly cases where tile results of the dissections arc added.
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Graz 1873 - 1889 : 3 institutions and their patients Introduction Krafft-Ebing was at Graz from 1873 until 1889.
During this period of 16 years at Graz his activities were varied and complex: he was involved in three different institutions and acted as a clinical psychiatrist for hospitalised and outpatient patients as well as a university teacher.
The three institutions were: 1 Feldhof a large provincial asylum on the outskirts of Graz where Krafft-Ebing was medical director between 1873 and 1880.
The clinic opened in May 1874 and Krafft-Ebing was in charge until he left Graz in 1889.
It opened in 1886 and he continued as a consultant after he moved to Vienna in 1889.
These three settings differed considerably in their explicit goals, type of administration and the numbers, diagnoses and characters of their patients.
Each therefore posed different problems to KrafftEbing and provided him with different https://tayorindustry.com/blackjack/caught-counting-cards-in-blackjack-illegal.html experiences, subsequently reflected in his written work.
This chapter will explore the histories of each of these institutions, their buildings, staff and their patients, because - I suggest - they represent the key to understanding how Krafft-Ebing was trying to shape psychiatry.
On the contrary he actively tried to change things, for example by using faculty politics.
He thus managed to get out of one institution, Feldhof.
He fundamentally changed the second, the clinic, and created the third, MariagrGn.
He tried to get those patients he wanted and actively tried to dispose of those he did not want.
In the language of the time he strove towards "good patient material", a term he used repeatedly.
Krafft-Ebing's perception of a "good" or a "bad" patient, of course, directly links up with his view of psychiatry's goal.
The criteria he used appear to be whether he could publish case reports on them and whether he could use them for teaching purposes, but also whether he could cure them.
Working in Feldhof, a drab and always out-dated country asylum with about 300 beds, was an 86 obligatory duty to be taken on together with the chair of psychiatry.
Its chronic inmates gave him the opportunity to confirm his views on degenerative heredity and to study a large number of forensic problems.
He tried at first to renovate Feldhof and improve the situation, but managed in 1880 to hand the asylum over and concentrate exclusively on his clinic.
This clinic was much smaller, had a greater turnover of patients, learn more here greater variety of diagnoses and medical activity.
He further modernised it by the adding a ward for nervous disorders which catered for many hysterical patients.
The Graz clinic was in many ways the ideal surrounding for KrafftEbing's teaching and research activities.
MariagrUn, his private sanatorium, lastly, was his own brainchild.
It reflected his taste he had a say in the architectural design and his ideas about at least one sector of psychiatric care.
The creation of MariagrUn was, effectively, a means of combining Krafft-Ebing's vision of an ideal asylum a la Illenau MariagrUn was a small Illenau with his increasing preoccupation with one of the most fashionable diseases of the time: neurasthenia.
History of medical teaching and medical care at Graz Graz was a university with little medical tradition.
In spite of numerous attempts at integrating medical teaching it did not possess a medical faculty until 1863.
The Graz medical faculty, 87 which Krafft-Ebing joined in 1873, was not a place of high prestige at the time.
But the discipline of psychiatry was not particularly prestigious anyway and a psychiatrist might take up a university post in Graz simply because there were few other options.
In addition, Graz, in spite of its barely established medical faculty and its geographical situation very close to Hungary -thus turning it into a cultural and social outpost of Germanic civilisation - could still serve as a springboard to something better like Vienna.
The buildings were built onto an old cloister and numbers of beds ranged from 80 for the general wards to 55 for the orphanage to about 35 for the madhouse.
Subsequently, numbers of mental patients started to build up around the turn of the century: the initial ward of the general hospital had consisted of 35 beds in 1788; by 1819 there were over 100.
But within this development Sty ria and its capital Graz was lagging behind, even compared to the 88 rest of Austria where asylum-construction began later than in, for example, Germany.
Under the pressure of increasingly overfilled wards and the deteriorating conditions of care, the local health authorities were finally forced to react in 1827.
Their first attempt to solve the problem of mental care was the acquisition of the Rockenzaun'sche Hauser, a formerly aristocratic private residence in the middle of the town.
These buildings catered for about 150 patients and served as an asylum till as late as 1872 - increasingly badly, since patient numbers continued to grow.
The construction of a proper, separate, mental asylum became steadily more urgent and was finally agreed upon by the local government in a Landtagsresolution of 19th February 1863.
Much of the initial optimism had vanished and asylums started to degenerate into stagnant custodial places fighting an increasingly hopeless battle against the overflow in incurable patients.
Plans were changed repeatedly, the initial building site was dropped as unsuitable, new explorations conducted and construction works finally began at the end of 1871.
Johann Czermak was offered the post of medical director and moved to Graz to oversee the work.
Unexpectedly he died in July 1872 and Dr Koestl, the retired director of the Prague asylum, had to take over.
It was under him that Feldhof opened its doors - unofficially and rather dramatically: in December 1872 a variola epidemic hit Graz and the now 200 mentally ill, living under totally unhygienic and hopelessly overcrowded conditions, had to be transferred in an emergency action into the unfinished buildings.
Inadequate buildings and patient overflow Not only the beginnings of Feldhof were difficult.
It soon became apparent that the buildings were outdated and misplanned from the start.
In its architecture it followed the style of Brno Brunn in Moravia, built in 1863: like that asylum it was intended to cater for about 300 patients housed in different pavilions.
There is no detailed description of Feldhof and no plan of its original shape: the only available plan, published together with a picture of the asylum, shows Feldhof at a later date before 1912, no date given and already considerably enlarged.
The main problem was the miscalculation of space needed, but there were also problems with the character of the wards.
Feldhof had opened with 203 patients in 1873, but by 1880, the last year of Krafft-Ebing's directorship, it had 516 patients, and n umbers increased steadily with 310 new admissions but only 248 patients discharged by referrals or death that year.
The first of these was Lankowitz 1877 for 120 women, followed by Kainbach 1883 for 100 men, Hartberg 1887 for 30 men and 30 women and Schwarzberg 1892 for 200 patients.
One of these modern tenets was to refrain from using restraint such as straight jackets.
In Feldhof there were only 4 isolation cells, which proved to be far too few and - initiated by Krafft-Ebing and followed up by his successors - more such isolation wards were added over the years: 2 wards containing 34 cells in 1882, increased to 74 cells by 1888.
In addition, Feldhof was far 92 from providing a healing environment: it lacked all the facilities that other, better asylums - like the Illenau - were so proud of, such as a park.
There were also insufficient baths - and warm baths designed to calm patients were at the time one of the few therapeutic interventions possible.
Such architectural mistakes in size and character may have partly been due to misguided optimism as to the type of asylum actually needed; partly they may reflect the simple fact that Styria had not enough public money to invest in its healthcare.
In summary, Feldhof was too small, too outdated and insufficiently equipped for modern psychiatric care of the time.
In addition, as the main asylum for Styria, an area underserved with psychiatric beds, it could admit only the most disturbed patients.
Krafft-Ebing at Feldhof Krafft-Ebing started his job as medical director at the end of May 1873 and resigned from it at the end of October 1880.
His tone was bitter and even he, whose style was usually very factual, resorted to satire and polemic.
Ein Nothstand The state of psychiatric care in Styria.
A crisis - written shortly before he managed to retire as medical director, he concluded that Feldhof could only be used as a careand not a cure-institution.
It was therefore not living up to its original purpose and ought to be replaced by a new asylum.
Whilst it cannot be denied that the very simple architectural design of this asylum could well serve a masscatering of chronic, mostly incurable patients, it is hardly suited for an institution aiming to cure.
All the above mentioned categories of patients cannot safely be kept in any other ward of the asylum than the isolation ward, since the building is designed for an open style of care.
In addition there is a further drawback: those patients who are only temporarily excited and are then not tenable in a quiet environment because of screaming, noisiness.
They also need to be referred to the isolation ward.
This ward, already overfilled with screaming and disturbed individuals, is not contributing at all towards calm ing these potentially curable patients, on the contrary it vvorsens their condition if not rendering them incurable.
He had probably accepted his position at Feldhof in the first place because it was the only available opportunity to get a lectureship in psychiatry.
At the time one had to be the medical director of some asylum in order to be a professor, because the patients were needed for demonstrations during lectures.
The patients There exist in print several tables with patient statistics of Feldhof referring to the years 1877 and 1878.
These are of interest because they contain information which backs up Krafft-Ebing's opinion and which merits further analysis.
Since there exist similar tables for the other two institutions explored - the clinic at Graz and MariagrOn - it is also possible to compare these institutions.
The tables presented here show the following: 1 2 3 4 5 6 total of patients and outcome of their treatment age of patients length of stay diagnoses of admissions diagnoses of exits reasons for admission 95 The first three tables are numerical, whilst the last three describe the type of patients cared for or rather: they contain the contemporary psychiatric judgements on these patients.
All six tables were compiled by Johann Zach, at that time first assistant to Krafft-Ebing at Feldhof, and published in the Jahrbucher fUr Psychiatrie.
Methodology All information is Zach's but the tables have been graphically adapted, in order to simplify and clarify them; in particular I have added percentage figures printed in go here font.
Although technically speaking the tables are Zach's, I think it justifiable to treat the information as reflecting Krafft-Ebing's opinions.
It is unlikely that he, as the medical director, would have allowed his assistant to publish official statistics with which he disagreed.
Diagnostic categories used vary widely between Zach and others and so some caution is advised.
Zl 266 678 190 222 412 126 129 255 19 38 57 22 25 47 38 23 Β§l 36 27 63 228 667 1878 The ever-increasing total of patients has been discussed above.
The statistics for the years 1877 and 1878 showing increases of 20 1877 and 27 1878 bear out this read more />The average increase per year in the four years between 1873 and 1877 was higher at more than 40 patients a year, and the subsequent increases were even higher - 77 patients in 1879, and 62 in 1880.
The table shows a relatively stagnant flow of patients with 60% of those cared for already in the asylum at the beginning of the year.
This will be compared to the more dynamic clinic below.
Of the 266 228 patients who left in 1877 1878 - which corresponds to 36% of all patients cared for - more than half showed no improvement or died.
The overall death rate was 10 % in 1877 and 9% in 1878 but may have been as high as 16% in 1873.
It is not totally clear whether this corresponded exclusively to the category "cured" used in these tables or to the sum of "cured" and "improved".
The contemporary opinion was that there were more women in asylums as a rule; this was explained by the longer life-span of women rather than a higher morbidity.
Less than 6% were under 20 98 with less than 2% children under 15 and Feldhof was definitely not over-aged with less than 5% only over the age of 60.
It was not unusual to hospitalise children in asylums, but it was not numerically significant.
The high death rate can not be explained by old age, as so few patients were over 60, but must be explained by the nature of the conditions treated.
Note that the patients listed here were those who left Feldhof, either by being discharged 26% or because they died 10 % - we are therefore only dealing with a third or 36% of the patients cared for.
The remaining two-thirds who stayed, clearly stayed longer.
In other words, an average of 145 of 673 patients cared for - that is 22% left the asylum within one year with only 16Β°0 leaving alive.
These figures confirm the chronicity of the asylum.
The highest difference in gender distribution was in paralysis.
By contrast, more women than men were diagnosed as manic and melancholic with an especially significant difference in melancholia.
Although the figures vary too much between the two years described to allow for general conclusions as to diagnostic differences between in-coming patients and those leaving the asylum, it should be noted that within the categories mania, paralysis and epilepsy a roughly equal number of patients were admitted and also discharged.
This means that the diagnostic categories were used in an inflexible way - once diagnosed a manic, always a manic.
Mania, the tables indicate, had a high curerate, so many patients would be discharged under this label.
Paralysis, too, was a diagnosis which was given once and for all, but in this case the most likely outcome was death.
On the whole, however, the tables show very similar figures for admissions and exits.
This indicates that theory and practice were not identical.
Krafft-Ebing's theoretical text gives the impression that the process of diagnosing patients was a rational enterprise based on the actual clinical picture displayed at any given time.
For example he said that the end result of mania was agitated dementia and the end results of both melancholia and fits of rage was an 101 apathic form of dementia.
The figures seem to indicate that diagnostic activity was almost as unchanging as the potential fate of the patients.
Ollt the gender differences.
That more than a third of all admissions were - in Krafft-Ebing's view - caused by heredity, is yet another indication for how prominent degenerationist thinking was in his model.
Unfortunatly, in view of Krafft-Ebing's specific interest in sexual factors, the category given here is combined with alcohol which was also very frequent at the time.
This may be interpreted as modesty.
It is probably not the result of sloppy history taking, since the many printed case-histories demonstrate how much effort was put into finding out possible reasons for the illness.
Most likely this high percentage of "not-known" was a reflection of the already established chronicity of patients at the time of admission.
Questions asked could no longer be answered either by the very deranged patient or by his relatives, who would just report that the patient had been like that for a long time.
Only seriously ill patients were admitted and 10 % of all patients died.
But from the point of view of managing the asylum, it was worse in that it was a very stagnant place.
Of a total of 673 patients average 402 or 60% were more or less chronic and changes only occurred with the remaining 40%.
The fate of these 40% was far from positive; most of them left the institution either unchanged or dead.
As for the 60% of chronically ill patients, only a few top deviations blackjack 20 may be derived.
Since the table with patients' ages relates to the whole of the asylum population, we know that they, too, were not over-aged.
However, they cannot be categorised diagnostically from the data given.
Lastly the many criminal lunatics, also mentioned by Krafft-Ebing in his description of Feldhof, are important here.
They were sectioned to the asylum after their crimes which had been committed - in the eyes of the psychiatrists - under the influence of mental derangement and that could mean any of the used 6 diagnostic categories.
Many of these patients may well have recovered from their temporary condition, but still had to be locked up for the rest of their lives.
Since they stayed on, they may distort the statistics significantly.
Hence the asylum fulfilled the role of a prison and a major part of its custodial nature was due to this category of patients.
The deeper and sadder irony, of course, is that it was Krafft-Ebing's personal interest in forensic psychopathology that presumably got him involved in such a disproportionately high number of cases of criminal lunacy.
Although technically speaking he did not section these people to his asylum, he wrote the forensic reports which resulted in their getting sectioned.
He must thus have created in Feldhof a daughter institution to the main prison in Graz.
The psychiatric clinic In Graz When in December 1872 the 200 mentally ill of Graz had to be transferred to the not yet finished Feldhof asylum, their former home, the Rockenzaun'sche Hauser became empty.
These houses were initially turned into a ward for obstetrics, but later 24 beds took on the status of a psychiatric clinic, also called a psychiatric observation ward.
This psychiatric clinic opened on 2nd May 1874.
This clinic, in other words, was an entirely different practical set-up from Feldhof: there were far fewer beds and the ward was part of the general hospital of Graz.
The medical staff here consisted of Krafft-Ebing and two assistants.
The first assistant was Hugo Gugl, 105 who was certainly there in 1880.
From 1886 Gugl - together with one Dr.
Stiehl - was in charge of the private sanatorium Mariagrun.
He was also later to edit the last revision of the Psychopathia Sexualis.
Focusing first on the psychiatric ward only: the ward consisted of 39 beds occupied at the beginning of 1886 50 at the end of the year and had a considerable turn-over, given that 883 patients hospitalised patients plus 844 admissions went through Krafft-Ebing's hands during that year.
Although there was a gain of 11 patients, this looks much less dramatic than the situation at Feldhof, since with 833 exits the figures distribute more evenly.
Also the increase in beds over the years was not comparable to the situation at Feldhof.
The main statement of the table lies in the different outcomes of those patients that left the psychiatric ward: it shows that Krafft- Ebing's patient population was remarkably ill.
Of the 883 patients treated, 362 - or as many as 41 % - remain specifically non-cured; an additional 4,1 % die.
This figure is still exclusive of the 15% who get referred to other wards of the hospital.
There is a theoretical possibility that they were patients on the mend, but it is more likely that they were not.
This leaves a success-rate in about a third of all patients seen cured and better: 299.
We do not, of course, know how and by whom Krafft-Ebing or Fossel?
On the other hand the same labels were used for other wards of the hospital and we therefore gain a comparative impression in any case.
In 1886 the whole hospital, which consisted of 10 wards, had 504 patients and 8,429 admissions, thus catering for 8,933 patients.
The 10 wards ranged in size from 9 beds for gynaecology to 117 for surgery; Krafft-Ebing's ward with its 39 to 50 beds was somewhere in the middle of the range.
The outcome of patients' treatment for the whole hospital was: 68% of all patients get better or are cured - if the psychiatric ward is excluded the success-rate goes up to 72%, i.
The psychiatric ward is, in other words, pulling the hospital statistics down as far as cure is concerned.
The inhabitant of Graz who was suffering from any medical, surgical, dermatological or other condition that had brought him into hospital in 1886, had a statistical chance of 3 in 4 to come out cured, and a 5% chance to remain uncured.
All this looked very much dimmer once he set foot into Krafft-Ebing's clinic.
He or she, did however, have a higher chance of surviving the experience than his friend on a medical or surgical ward.
Death-rates for the whole hospital were: 6% - without psychiatry: 7% - and for psychiatry see above : 4,1 %.
Psychiatry was less of a lethal discipline than source the big killer was internal medicine with 12% 3 different wardsbut not surgery, which had a death-rate only slightly higher than psychiatry 4.
The safest problem to have was an eye-disease 0.
Although his psychiatric clinic was dynamic in terms of patients' flow, only a third of these patients showed any improvement.
Fossel's statistic carries on with a breakdown into diagnoses.
There is a list of 73 diagnostic categories into which the 883 patients of 1887 fall.
These diagnoses are, of course, very different from Zach's for the patients at Feldhof.
Not only are there - with 73 instead of 6 many more categories, but they also differ in character from those used by Zach.
Unlike Zach's, Fossel's labels do not correspond to the psychiatric textbook classification of the day, in particular they are different from Krafft-Ebing's terminology.
The impression one gains is that Fossel used more old-fashioned terms which were 109 blackjack simulator ipad still valid currency for hospital statistics, but which did not reflect contemporary scientific opinion.
For example, he used the term IIvesaniall frequently, a term rarely used by Krafft-Ebing and others.
The table is moreover simplified; for example, I have only given totals of patients, irrespective of gender.
Hysteria is then closely followed by dementia paralytica.
It certainly is by definition of the table a disease vvith a relatively high mortality and a distinctly high rate of incurability, which, of course, fits the later description.
The clinic, as becomes apparent from this example, functioned as a passing-through ward: patients with dementia paralytica did not accumulate in it at all, but rather were discharged; not within the hospital in this case, but we know from Laehr's description that they were referred to Feldhof.
But the cure may have been shortterm.
Whereas paranoia and at least one of the vesanias seem to belong to today's domain of psychiatry, many diagnoses on Fossel's list would be categorised as "neurology" today.
Some of these are beyond the cut-off point here because they were infrequent, and included labels such as "paralysis spastica spinalis" or "paralysis nervi facialis" further divided into occulomotori, hypoglossi, median i or "para - mono- and hemipareses".
These are diseases which relate to peripheral, anatomical nerves as opposed to nerves in the abstract.
This shortened table makes them look less frequent, because they were diagnosed within a more precise system than mental illnesses.
Vesania was presumably an learn more here term full of distorted thinking in combination with unspecifically mad behaviour - all of which was gathered together under this heading.
Certain diseases showed a typical gender bias, above all hysteria, which was almost by definition a female disease - with 80 women and only 4 men.
In the case of alcoholism and related problems like delirium tremens the reverse was true: 49 men and 2 women; other diseases showed a balance, such as paranoia: 32 men and 28 women.
Laehr's description of the clinic in 1880 expressed in words what the figures have shown: The observation ward accepts delirious and psychologically excited patients of all sorts from the other wards of the hospital.
It serves as an observation ward for individuals of Styria, whose mental condition appears abnormal.
It also serves as a cure-institution for acute psychological disorders, as long as the duration of these illnesses does not exceed two months.
Patients who are chronically mentally ill are admitted to the provincial asylum.
The university clinic is linked to this observation ward both by sharing the same rooms of the hospital and also by being under the same director.
The professor is allowed to use the patients for teaching purposes.
For those patients used for teaching, the educational fund will contribute towards daily care by paying 33 Kreutzer per day into the fund of the country Styria.
By contrast Feldhof as an asylum fell under different and incomparably more complicated 1 13 admission rules.
Asylums obeyed elaborate legal regulations and clinics - at least some clinics - did not.
This was also the case for patients who would have liked to undergo treatment voluntarily.
It always took a minimum of docslot portal physio days to admit a patient and often considerably longer up to 6-8 weeksand this was heavily attacked by contemporaries.
For example, Kraepelin pointed out that the accepted goal of starting treatment at an early stage of the illness was made impossible.
These bureaucratic formalities were not only tedious but also circular because they did not necessarily involve a second opinion on the patients, but the certification written by one doctor was sent round to different offices for adm inistrative stamps.
The medical concern was, of course, that by the time the patient got into care, the situation had deteriorated and not much could be done.
By contrast admission to clinics was a matter of few hours.
Krafft-Ebing commented positively on these rules at Graz clinic in a later article written at Vienna, in which he stated that there had never been any difficulty with either the public or government officials arising out of lack of rules at the clinic.
Similarly, Krafft-Ebing repeatedly commented on problems of administration.
For example there was a publication on Feldhof, which came out of a speech delivered to the society of psychiatrists in Vienna during the session 25-27th July 1878: "Ueber Nutzen und Ausfuhrbarkeit der eigenen Regie in osterreichischen 114 Irrenanstalten.
Feldhof was not one of these asylums, unlike, for example, the Illenau.
Feldhof's governing body was the Landes-Ausschuss fUr Steiermark apparently a regional section of the department of Health and there was a OeconomieVerwalter economic administrator in Feldhof.
KrafftEbing's publication was an attempt to change the administration of Feldhof.
Krafft-Ebing started to lecture at Graz in autumn 1874 as an extraordinary professor and was then made into an ordinary professor in 1885.
He was only the second professor of psychiatry after Josef Czermak who had held the chair from 1870 when it was created until his death in 1872.
After 1876 Krafft-Ebing was able to teach more centrally, in the observation ward.
In the early 1870s we know that it served for clinical demonstrations taking place once a week and that there was a two months ' course in psychiatry on offer for future doctors, for example those who were writing a dissertation in psychiatry.
When Wagner-Jauregg had taken over from Krafft-Ebing in 1889, he still took his students out to Feldhof several times during the academic year.
Writing in 1890 and looking back on his experiences in Graz, Krafft-Ebing mentions that he had demonstrated over 3,000 patients during 17 years of clinical teaching including Strasbourg.
Unlike classical asylum psychiatrists, Youtube tournament did not believe that this practical teaching did any harm to the patients but stressed that it was not a good idea to take the patient's history in public and said that students sometimes had to be warned with a "risum teneatis amici" not to laugh about a funny situation.
Most importantly he believed that the demonstration of chronic patients and of the whole course of their illness, was crucial in order to depict clinical reality for the students.
This was, in effect, a defence of asylum teaching, or at least presents an attempt to counter-balance the fashion to demonstrate acute patients only.
MariagrLin The third institution Krafft-Ebing was involved in was his own private sanatorium Mariagrun.
This was very different from Feldhof or the clinic.
The history In 1884 Krafft-Ebing approached his former assistants Hugo Gugl and Anton Stichl with the idea, apparently born a few years earlier, to found a private sanatorium for nervous disorders.
In spring 1885 construction work commenced on the main building, a house of more than 20 rooms in the style of a small renaissance castle.
In practice this meant that the rooms were high and spacious, the corridors generous and that there was a system for ventilation as well as a modern central heating system.
All in all there were 26 rooms for 40 patients, plus several common rooms: a dining room, a music room, a room for conversation, a reading room and a billiards room.
The first of these is a short commercial brochure published by Gugl, Krafft-Ebing and Stichl shortly before the sanatorium opened: Prospect des Sanatoriums "Maria Grun" nachst Graz, 1886.
The second is a more academic publication by Gugl and Stichl summing up their experiences after five years at MariagrOn: Neuropathologische Studien, 1892.
As well as talking about various aspects of neurasthenia, Gugl and Stich I also published patient statistics of Mariagrun.
The publication had both a propaganda and a commercial purpose and was written in the hope of convincing other doctors of the importance of sanatoria for nervous disorders.
Mariagrun served as a haven and idyllic retreat from the world for those who could financially afford it and were not too ill; those who were seriously ill, especially in such a way that others might take offence, were expressly excluded.
Patients were considered after forwarding their medical history and promising to stay for a minimum of two weeks.
They were then screened before admission and over time probably with increased demand admission became more selective.
There was the healing effect of nature and the peaceful and spoiling environment of the institution.
Contacts with difficult relatives were forbidden on the premises and generally the patient was shielded from all demands and possible worries.
As Gugl put it "they were of the opinion that a copious diet should be the rule, and would in any case be less harmful than the enthusiasm for a light dief'.
Krafft-Ebing and his assistants merely argued in tandem with authors like Mobius, Eyselein, Holst - that is the Germanic Beards - who all saw diet as a crucial part in the treatment of nervous disorders in the 1880s.
The use of narcotica against sleeplessness was handled generously 1 19 and the reduction of morphium in cases of morphium-addiction was done slowly and gradually as opposed to the faster procedure in closed institutions.
This global permissiveness was however balanced with distinctly strict house-rules, which were seen as an integral part of therapy: From the very start the patient has to be relieved of the burden to make the right decision - he has to learn to subordinate himself.
Particularly valid for this trainer free optimal blackjack is a set of functional house-rules, which is often resisted at first, only to be praised and warmly defended later after some battles when its benefits have been recognised.
Some will never see the value of such cumbersome rules, because they do not fit their indolence and habits.
Thus a constant battle must be fought.
This is how the patient finds support in a protective scaffolding till he can re-find himself.
At a later stage some even need a weaning off from tutelage after one has thus spent much and intense time with them.
In view of Freud's later invention of the "talking-cure" docslot portal physio is interesting to see to what extent talking is here already advocated.
Not only are patients recorded for statements such as IItrust has loosened my tongue, which gave me enormous relief", but there is also some theorising about verbal, cathartic communication.
Rather the ability to talk as such was seen as a diagnostic sign.
Unlike the melancholic patient, who is shy, secluded, hostile towards the doctor, the neurasthenic patient seeks conversation and because he has the ability to trust, he feels comforted as a resultJo The patient's prognosis - we read between the lines - really depends on his own will-power, but also on his ability blindly to trust the doctor.
This latter is an outspokenly passive process: one patient characteristically improved after she became more amenable to psychological treatment - and the causality is thus expressedJ' In keeping with this model Gugl in his conclusion deplored the fact that often not even youngsters, who should still be formable and impressionable could be healed these days because ".
By 1892, the time Gugl and Stichl were writing, hypnotism had certainly been used in Mariagrun - successfully according to Gugl - and in aid of re-enforcing medical power: We see ourselves as pupils of Bernheim's school.
It is only to be deplored that in many cases where autosuggestions are overpowering, suggestive influence is made very difficult.
But if, with patience and persistance, we achieve nothing but a deepening of the subordination under medical authority there is already obvious benefit.
We have to thank 73 suggestion therapy for numerous remarkable successes.
In addition to the use of his personality the doctor had a number of more specific remedies up his sleeve.
These consisted of various 121 pharmaceutics and physical treatments.
Amongst the latter there was the use albeit to a modest degree https://tayorindustry.com/blackjack/blackjack-gambling-losses.html massage and a whole variety of different baths.
Baths cost extra and were advertised in the brochure, which listed six different versions: full, warm bath with laundry and service; half-bath; sitz-bath; rubbing-down; packtreatment and electrical bath.
All information is Gugl's he is the author of the relevant chapter but the tables have been adapted graphically.
The only case of death is, incidently, carefully explained in the text and occurred in a relativethe mother of a patient, who very much insisted on staying in the sanatorium.
The woman was diagnosed as hysterical, tuberculous and as dying of a lung oedema.
Aust ria-H LI ngari a Germany Russia Italy Switzerland France England Sweden Belgium Serbia Greece Egypt East-India North America 152 13 21 3 total 203 1 2 3 125 7 13 2 3 1 3 2 2 277 20 34 3 2 4 2 3 1 1 3 3 3 154 357 Mariagrun, it seems, was an international place and there was surely some pride taken in this fact.
Most patients were, however, Austrian with Hungary and given the geographical closeness to what is today Hungary, many presumably spoke Hungarian.
There is no further comment on patients' nationality in the text and we are therefore left to speculate how the more exotic- like the one Greek or the three Egyptians - found their way to Graz.
They must have been attracted by Krafft-Ebing's name.
Krafft-Ebing also spoke of middle and upper class patients in his publication of 1895 when making statements about his private patients generally.
Most importantly it was concrete proof of Krafft-Ebing's interest in neurasthenia, the new and fashionable disease.
Nervous disorders and in particular their subgroup neurasthenia were first described by the American, Beard, in 1880.
Translated into German within a year,82 the topic had an immense influence and was to enlarge the boundaries of the psychiatric professsion for good.
For the German-speaking world Krafft-Ebing was, after Mobius and Eyeselein, one of the first to take up this popular field.
Mariagrun, then, was built in order to put into practice what KrafftEbing had formulated theoretically in his 1885 book.
According to the brochure that described it to the public and that was signed by Gugl, Krafft-Ebing and Stichl its aims were the sentence in bold font is the stress of the authors : The sanatorium, which strictly excludes all mentally disturbed patients, poses itself the task to put into practice what one of the undersigned doctors has recommended in his book "On healthy and diseased nerves" 3rd ed.
Everything will be summoned to render the separation from home and family not too difficult; it will be a place of temporary rest in a wooded rural spot, far removed from the hassle of the worldyet in easy reach for those who need assistance, and equipped with all means for cure and help.
He never forgot his psychiatric training at the Illenau, that model asylum of Baden.
He kept quoting Illenau and referring to himself as its disciple throughout his life and SchOle, at that time medical director of the Illenau, was still his best friend.
In many ways Krafft-Ebing really remained the asylum psychiatrist he had once been.
He believed proper training as a up game card blackjack pick 7 could only take place at - or at least in close conjunction with - an asylum.
That was not quite self-understood given that the teaching of psychiatry had already moved into the universities and that others.
Stuck at Feldhof with its dim success-rate and inadequate facilities that compared so poorly to what he was used to from the IIlenau, KrafftEbing presumably thought back longingly to better days.
Abandoning Feldhof in 1880 meant abandoning a lot of fruitless and depressing work, but it also meant that he now was without an asylum.
The idea of Mariagrun here filled an important gap: although not an exact replica of the IIlenau, which had catered for a broader spectrum of problems and distinctly iller patients than the new sanatorium was to do, there were still many identical features: both places were idyllic and emphasised the healing forces of their environments, the various bathing facilities, the family atmosphere and the many entertainment options such as the billiards-room.
Mariagrun was a small IIlenau for an exclusive clientele.
Krafft-Ebing's private practice Although it is very likely that Krafft-Ebing had a private practice in Graz apart from Mariagrun - and an extensive one at that - it is infuriatingly difficult to find facts which directly prove this.
There may well have been records of private patients, but if they have not been destroyed their present location is not known.
In different places through his work, and particularly in various editions of the Psychopathia sexualis.
Vas no exception to this rule: Krafft-Ebing's direct successor to Graz, Julius von WagnerJauregg, mentioned in his memoirs that he had a private practice, which apparently was quite large.
No figures or other details of these patients are known, but we know that at least 50% of WagnerJauregg's salary was earned with the treatment of private patients.
His public patients were seen at his out-patient clinic in Vienna attached to the psychiatric clinic and called: Klinisches Ambulatorium fUr Nervenkranke im allgemeinen Krankenhaus Wien.
These public out-patients amounted to 4,385 patients in 1893, a figure which is in itself remarkably high.
It meant that Krafft-Ebing, all in all, saw 5,716 outpatients in one year and he also ran a clinic with hospitalised patients!
So the ratio for private: public patients was about 1 : 4.
Krafft-Ebing was an flash game tutorials blackjack man.
More important here is that not very much time could have been spent with each individual patient.
Of the 128 4,385 public out-patients about 25% were neurasthenic and of the 1,331 Pr ivat epa tie n t s 45 %.
MariagrunI think it most probable that he had such a practice.
The extent of it is difficult to guess: 4 patients per day would probably be too high for Graz in the 1880s.
Krafft-Ebing himself stressed repeatedly - as did most other authors - that neurasthenia was more frequent in big towns such as Vienna.
Nevertheless, the foundation of Mariagrun itself is a strong indication since Krafft-Ebing founded his private sanatorium as a place to which to send his own private out-patients, who needed check this out intense treatment: In a few years his name literally spread through the whole world, and patients from all countries undertook their pilgrimage to him.
Therefore Krafft-Ebing saw the necessity to found a home for hosting his numerous foreign clientele and thus Mariagrun was founded.
The answers to these problems were sought in the surgeries of psychiatrists into which patients flocked in increasing numbers.
Apart from the sheer number of patients, the difference in percentages of those neurasthenics, who were affluent and therefore private patients, 129 compared to those who were of the lower classes and used the public out-patient clinics, is revealing.
It was, of course, the rich patients, who first opened up a market gap for a new kind of institution - the sanatorium for nervous disorder, or Nervenheilanstalt.
Since Mariagrun, which catered for an exclusive layer of society, was almost certainly a lucrative enterprise, it is tempting to discover in Krafft-Ebing traits of a gifted and successful businessman.
These may well have been there, but it would be misguided to see him above all as an inspired entrepreneur and someone who simply wanted to make money.
The business aspect of Mariagrun must be put into the perspective of his work throughout his life.
Krafft-Ebing was actively involved in Mariagrun from 1886 to 1889 when he moved to Vienna.
During this time he continued acting as a consultant whilst Gugl and Stichl were in charge.
We know nothing about the profit made by the sanatorium, nor about how the net-income was divided between Krafft-Ebing and his two medical directors.
Krafft-Ebing seems to have channelled his energies elsewhere; money-making can therefore hardly be seen as docslot portal physio prom inent driving force in his personality and it is more accurate to see him as an overworked doctor and academic.
This view is to some extent confirmed by Krafft-Ebing's statements about the goal of sanatoria.
It appears that he was primarily interested in furthering a particular type of 130 institution with a more idealist vision in mind.
He was absolutely convinced that sanatoria for nervous disorders were both a novelty and a necessity.
It appears that his aim was however not to keep this kind of new sanatorium limited to the rich: rather he suggested that the government should get involved and that such institutions should become more accessible to those with less money.
Spas had fewer doctors per patient and a shorter average stay of patients, and Gugl bemoaned the fact that initially patients had wanted to stay for much shorter periods of time, because they obviously mixed up MariagrOn with a spa.
Mariagrun, it seems, moved into a grey-area between psychiatric care and holiday resort with medical attention.
As a rule they were run by psychiatrists who had also, like Krafft-Ebing, published on neurasthenia at an early stage.
Oscar Eyselein 1847-1892in spite of his involvement with health-issues, died at the early age of 45 because of "long-term morphinism and cocainism".
Valentin Holst 1839-1904 from Lithuania, owned a sanatorium in Riga, Russia, which was opened on 1 January 1884.
He did not attempt to produce a theoretical framework, but simply described hundreds of patients.
The different cases at Feldhof, the clinic and MariagrOn therefore continuously modified his ideas.
From his books it appears that the forensic interest is intrinsically linked to Feldhof, where criminal patients were chronically hospitalised.
Accordingly the extent of Krafft-Ebing's forensic activity gradually diminished after he had left Feldhof.
He began to be involved with very different types of patients and moved away from forensic psychiatry.
This is not to say that he lost his expert status, as he carried on writing his annual reviews, but in his daily life, the topic took up less time.
Where it did, it was in a more focused sense, for example, in his work on sexuality.
On the one hand we are here speaking of nerves in the anatomical sense today called neurology.
On the other hand he met at the clinic many hysterical women on whom he practiced hypnosis and in addition to very grave psychiatric illnesses such as vesania, which were referred to Feldhof, he also got to know neurasthenics.
There are several indications of Krafft-Ebing's growing interest in nervous disorders since the early 1880s.
The timing of MariagrOn as an idea conceived a few years before 1884 coincided with KrafftEbing's struggle to open a ward for nervous disorders as part of his existing clinic.
Putting these two plans together, we get a feel for the direction Krafft-Ebing wanted to go into.
Dealing with very ill and very psychiatric patients at Feldhof and the clinic, he tried to become more of a doctor for nervous disorders and to attract patients who were less ill.
In MariagrOn then, he started to specialise in middle class neurotics.
Krafft-Ebing here certainly, did not practise mainstream psychiatry, but rather saw himself at the forefront of the neurasthenia field.
As in the clinic he had the opportunity to hypnotise.
His underlying model was that worse mental diseases can emerge from untreated neuroses, but if these are treated at an early stage, much prophylaxis can be done.
Thus Klillik meant a concrete set-up and a particular fUllction.
The contemporary literature e.
Laehr I X7 5 P 3Sl also speaks 0 I' Feldhof "being used as a Klillik which hl're purely indicates that its patients were used for teaching.
Of thL' o Ill' wllo has SOllll'thillg spccial if you want to study rare and l'xotic disurdcrs.
Sec Egglmaier 1980 p 1 and passim.
The history of early medical teaching at Graz from the opening of the Ulliversity in 15S5 to IX63 is covered best there ; see also Kronl's IXS6 for thl' ISlth century.
II - 5 Fosscl lXX9 P 47.
Schrenk ISl67 and ISl73 and l3lasius 1980 for Germany.
Porter and Shepherd cds.
Kronl's I XX6 aud Hassmann 1912.
KwlTt-Ebillg I X7tJ Der St.
IS UIlC I ear w Iwt Laellr ,s II.
~ure rei:tles to, cither that the buildings can now catl'r fur 5{ patiL'llts, or this is a figure of actual patil:nts.
By that til11c there were three assistants instcad or two.
Instead, Fl'Idh f 11Iuddkd 011 and underwent considerab1l: changes and reconstructions, as wL:I1 as collaborating with daughter institutions, as has ~dready bl.
See Hassmann 1912 for a history or Feldhur slighlly latl.
Krafft-Ebing's clinic" or tht: like.
Decker's comments 011 this: Ikl'kl.
He qUIlted 4 7~ pat kilts cared for 203 already in the asylulll: 270 lIewly ~ldlllilll'd or which 75 died during 1873.
It certainly n:krs 10 a IllSS Ill" illtl'lkctllal ailities and therefore dellH:lllia is 1101 a had lill.
This is not a n:prl.
What would be needed for an induclivl.
Ihat thl" two statistics are ten years apart.
Riese's article is generally vcry helpful 011 classificalion.
One example or the tl.
Krones I XX P IlJ I.
I H76 relates to this.
The co III I1H:rcial hrochure Gugl, Krafft-Ehing and Stiehl I XX6 P 7 had annouIH.
Paraldehyde and SulfllllHI; p 30.
I female morphium addict alld I lllall wilh spillal disl'asl'.
Aul1 New York 1880 ins Dl'lltschl' libl'l'tragl'll ulld mit cillem icleitwort versehen von M.
Tlll'Tl' is apparl'lltly llll archival material of any sort kept at MariagrUll.
Very often hut not always Kral"l't-Ehillg rt:ndered the admission date to a clinic, sOl11dil11l's statillg till' llallll' of the clinic.
With tile private patients he earned anothcr 2.
SL:C Gugl and Stichl I XLJ2 P 7 ~llld alst hsclll'r l.
Sl'd a glidillg sc;t1c: I'rlllll ncurosis into proper psychialric iIIIICSS.
Vienna and the Society for Psychiatry and 140 Neurology' Krafft-Ebing was elected to the chair of psychiatry at Vienna University in the autumn of 1889.
Krafft-Ebing was first in charge of Vienna I and in 1892, after Theodor Meynert's death, followed Meynert on his chair in Vienna II.
Vienna I and Vienna II were two parallel chairs of psychiatry at Vienna University: Vienna I the Niederosterreichische Landesirrenanstalt was an asylum-type institution with 150 chronic patients and Vienna II seen as more desirable was a ward of 40-70 acute patients within the general hospital.
As with his time in Graz, Krafft-Ebing was almost continuously engaged in battles with the adm in istration particu larly over lack of finances and resources.
Vienna I particularly provided little opportunity for cure and its very ill patients were under custodial care.
Daily psychiatric life in Vienna was, if anything, less attractive than in Graz.
The Verein fiir Psychiatrie und Neurologie 4 Initiated by Leidesdorf, Meynert and Josef Riedel.
From the start the Verein viewed itself as an organisation with both a medical-scientific goal as well as an organ to postulate political and practical aims such as the creation of a new psychiatric clinic within the general hospital in Vienna.
The latter goal was achieved in 1870 thanks to the help of Rokitansky who was one of the early honorary members of the Society - and the new psychiatric clinic was opened under Meynert.
Certainly from 1894 meetings were held at monthly intervals on every second Tuesday of the month.
The official protocol of the meetings was published in the newly founded organ of the Society, the Psychiatrisches Central blatt, which in 1879 was replaced by the Jahrbucher fUr Psychiatrie JP.
Krafft-Ebing had been officially associated with the Society since 1887 when he had become a member of the editorial board of the Jahrbucher fUr Psychiatrie.
He started to attend the meetings regularly in autumn 1889 when he succeeded Leidesdorf in his chair at the University.
In 1892 he was elected president to the Verein succeeding Meynert after his death on 31 May.
Krafft-Ebing soon initiated changes designed to an open up the Society towards other disciplines.
Most fundamentally he encouraged a more neurological focus, which was typical for the 1880s and 1890s.
In addition to the official announcement of the meetings in the Jahrbucher fUr Psychiatrie, the sessions were more fully described in the Wiener klinische Wochenschrift WKWa general medical newspaper.
Meetings were held regularly whilst they had been irregular under Meynert.
Figures of attendance at the meetings during these years clearly proved that the Society became odds natural blackjack attractive: membership numbers which had been as low as an average of 10 to 12 doctors per meeting in the early 1870s almost doubled in two years from 56 members in 1893 to 100 in 1895.
Figures increased further over the next years, so that there were 150 members by the time of KrafftEbing's resignation in 1902.
These divisions were used, for example, in the annual literature review of the Allgemeine Zeitschrift fUr Psychiatrie.
Whilst there were talks on psychological topics such as hypnotism the majority of talks were increasingly organic 142 and neurological.
This was seen as vital in order to enhance the 143 scientific status of psychiatry.
The meetings usually consisted of 2 to 3 contributions, partly lectures, partly demonstrations of patients, but also of animal experiments or anatomical preparations.
General discussion took place at the end of the evening and sometimes had to be postponed to another date.
German-speaking psychiatrists in the last decades of the 19th century were very aware that there were too many contradictory classifications.
Whether or not it was actually experienced as chaotic by contemporaries as judged by Decker is not easy to make OUt.
But in spite of the classificatory confusion there seems to have existed a methodology behind the definition and re-definition of illness models.
By methodology is meant what seemed to be the general consensus within the psychiatric community of how to go about things.
What was seen as proper methodology can best be studied in Krafft-Ebing's works and in the activities at the Society.
Not only was he - as the established professor - a main representative of psychiatry at the time, but he also shaped the sessions of the Verein to a high degree through his dominant leadership.
He frequently participated in the meetings, both with demonstrations of patients and talks; work done in his clinic or policlinic https://tayorindustry.com/blackjack/blackjack-in-casinos.html his assistants was overrepresented at the sessions; he was a very active chairman.
Throughout his career Krafft-Ebing not only contributed to creating new illnesses as in the Psychopathia sexualisbut he also had a clear notion about how this should be done.
One main principle was that the process of creating disease categories obeyed a specific chronOlogy.
One could only speak of a disease as opposed to symptomatic descriptions once one had collected a sufficient number of cases.
A good example is his work on the disease category "obsessional disorders", which stretched over many years.
From using the term obsessional ideas Zwangsvorstellungen first in 1867, he moved on to write four articles on the subject 1870, 1878, 1883 and 1892.
This has come out of numerous observations made by me and should also serve as an angle under which to study further observations.
Disease categorisation began by studing cases already described in the literature that had something in common which might serve as a new criterion for classifying them.
Next, one had to start collecting one's own cases and publish these naturally few cases to begin with as illustrative examples.
It was important at this stage that no generalisation was made since there were not "enoughll cases.
Usually some years and much clinical observation later, the stage was reached where there were "enough" cases to make general statements, for example as to the aetiology of the disease.
We are, in other words, dealing with a purely numerical or statistical model of disease explanation: when Krafft-Ebing wanted to claim in the early1890s that tabes is caused by civilisation he did so based on the observation that there were many patients in towns and few in rural areas and he provided statistics to back this Up.
What he saw as a sensible range must be deduced from examples quoted in his texts: figures are usually around 100 observations for a particular disease.
His work on multiple sclerosis, for example, which he presented at the Verein on 10 Dec 1895 published the same year was based on 100 cases; Krafft-Ebing's talk on the aetiology of paralysis agitans, held at the Verein on 14 Dec 1897, quoted 100 cases observed over a period of 10 years published 1898 ; lastly he found a specific aetiology of paralysis agitans in 88 cases and presented this at the Verein on 13 Dec 1898 published 1899.
Quoting only a few cases seemed to be accepted procedure for a frequent illness when these cases were used in an illustrative sense and no general claims deduced.
Examples are his demonstration of two girls with a hysterical tremor at a meeting of the Verein on 10 May 1898,19 or indeed the presentation after Freud's lecture of 15 Jan 1895 of a male patient who had suffered an attack of fear three months previously and who was unable to walk unless he could spot a base nearby.
Krafft-Ebing called this condition Basophobie, a term which did not make much impact.
Krafft-Ebing had seen and published one single case in 1889.
Krafft-Ebing and Freud Freud knew Krafft-Ebing personally for several years and attended the sessions of the Verein regularly.
He played an active part in the Society by becoming a member on its committee in 1895 and giving two talks in 1895 and 1896.
The talk which has been reported first by Freud and subsequently by historians is the lecture he delivered on 21 April 1896: liOn the Aetiology of Hysteria".
Freud felt that he had met with an "icy reception" and reported Krafft-Ebing, who chaired the session as having said: "it all sounds like a scientific fairy tale".
Instead he had enthusiastically summed up Charcot's research on male hysteria, research that was moreover well known to the Viennese doctors he was addressing.
The critical discussion, experienced by Freud as a rejection, was the customary style in the Society.
What happened at the Verein in 1896 can be seen as a parallel experience: again Freud did not comply with the traditional style of the circles he was addressing.
This time it was not so much lack of original work but rather the use of a methodology that he must have known was not acceptable.
It appears that perhaps the main problem with Freud's ideas of those days was not so much that they represented unorthodox views, but rather bad methodology.
Krafft-Ebing's personal acquaintance with Freud There is no positive indication that Krafft-Ebing knew Freud in the 1880s.
On the other hand it is a matter of course that Freud was acquainted with Krafft-Ebing's work: he must in particular have read his textbook, at that time the standard textbook, during his only 148 direct experience in psychiatry, the five months Freud spent at Meynert's clinic in Vienna from May to Sept 1883.
According to the case notes of the Sanatorium Bellevue Krafft-Ebing, who was at that time professor in Graz, visited Bertha Pappenheim once in Vienna around 15 April 1881.
It is at least possible that Krafft-Ebing also met Freud during these years, since Freud and Breuer, who had known each other since 1877, became more intense friends in 1882.
At that time Krafft-Ebing also seems to have been well aware of Freud's special interest in sexuality since he gave him a copy of his Neue Forschungen auf dem Gebiet der Psychopathia sexualis, 1890 New Research about Psychopathia sexualiswith a brief handwritten dedication.
The Freud library at the Freud Museum in Hampstead holds nine books by Krafft-Ebing, of which the six on sexuality contain a personal dedication, the three which do not and which Freud presumably bought for himself are editions of Krafft-Ebing's textbooks.
The dedications, incidently, become warmer over the blackjack plant in afrikaans from in collegialer Verehrung in 1890 and 1891, to in collegialer Hochachtung in 1892, 1893 to freundschaftlich in 1894.
It is unlikely that the two men interacted over common patients,33 but there is evidence that Krafft-Ebing was positively impressed with Freud1s ideas.
He first quoted Freud in a flattering way in 1896 in an article on hypnotic treatment where he spoke of the sinnreiche Methode ingenious method invented by Breuer and Freud to eliminate the psychological factors in hysterics.
The patient was a servant girl, who had repeatedly been admitted to Krafft-Ebing1s clinic in Vienna and was re-admitted in December1897, then aged 20, suffering from hysterical attacks.
It was discovered only during that hospitalisation that the patienfs hysterical attacks, known since the age of 12 and first occurring after a severe burn with a petroleum lamp, were due to particularly traumatic circumstances: the accident consisted of a big lamp fixed to the ceiling of a https://tayorindustry.com/blackjack/probability-of-picking-blackjack-with-2-cards.html, which had fallen onto the child.
We can deduce from the published case notes that KrafftEbing, somewhere between December 1897 and March 1898, tried to apply Freud1s method with the hope of letting the patient relive that dreadful scene under hypnosis and thus cure her of her symptoms.
This was a lengthy and difficult procedure that started officially with Nothnagel and Krafft-Ebing proposing Freud for professorship professor Extraordinarius in February 1897.
Freud mentioned the application in a letter to Fliess and added that Krafft-Ebing and Nothnagel were prepared to go ahead even against the wishes of the other faculty members.
For this Krafft-Ebing and Nothnagel had had to repeat their recommendation and Freud showed himself grateful in a letter to Fliess acknowledging that Nothnagel and Krafft-Ebing "responded wonderfully" to the request of renewing their original proposal.
Apart from giving two talks Freud also contributed to discussions, for example on 28 May 1895 on tabes or on 10 March 1896 on sleeping disease.
According to the statutes the Society was run by ten people of different functions: the president, vicepresident, economic advisor, librarian, two secretaries and four committee members.
Together they managed the financial organisation, elections of new members and honorary members, the programme of the talks at the meetings and had a say in the principal organisation of the journal.
It followed a democratic rule and decided issues with absolute majority in meetings of a minimum of four members.
The management was elected annually by an absolute majority of the members of the Society.
He was elected for several years and this during a time when the Society was flourishing.
Freud's first talk was on 15 January 1895 when he spoke on the IIMechanismus der Zwangsvorstellungen und Phobien" the mechanism of obsessional ideas and phobias published first in a French journal, the Revue neurologique 1895.
In that case the discussion of Freud's paper was to take place half a year later, on 11 June 1895, presumably because Krafft-Ebing was ill in the interim.

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Richard von Krafft-Ebing - UCL Discovery contrast the granting of the actual doctoral degree was in the hands of the medical faculty and.
Psychiatry and Forensic Psychology Krafft-Ebing in 1894 had the.
It seeks to paint a more accurate picture than is so far available by bringing together new biographical data including background information on the institutional settings in which he worked.
Above all, it explores the full range of Krafft-Ebing's written work and ideas over the whole period of his life.
This shows Krafft-Ebing as a man of many interests and is intended to counteract our present, limited understanding of his work.
Although Krafft-Ebing is, in fact, known to many, this knowledge is mainly based on the cursory reading of one book, the Psychopathia sexualis, 1886.
This has led to a seriously one-sided view of Krafft-Ebing, particularly in Englishspeaking countries.
Part one is about Krafft-Ebing's outer life: a brief https://tayorindustry.com/blackjack/blackjack-rules-how-to-win.html of known biographical data, followed by several chapters on those places where he lived and worked.
Different points are highlighted according to their relevance for Krafft-Ebing's ideas: for example, chapter 2 emphasises the general atmosphere of the Illenau one of the leading asylums at the timewhich shaped his approach to psychiatry lastingly; the chapter on Graz centres around the very varied patients he treated during that period.
Part two represents an intellectual biography.
Exploiting the full range of published work see appendixchapter 5 gives an overview over the topics Krafft-Ebing wrote on, followed by more detailed analyses of specific areas: sexuality including its important forensic aspecthypnotism and neurology.
Part three - the appendix - consists of a new and complete list of Krafft-Ebing's published works containing about 550 items; the few letters by Krafft-Ebing found so far have also been transcribed and reprinted here.
Table of contents Introduction p10 The image of Krafft-Ebing today p10 The sources P 14 The aim of the thesis p16 Chapter summary P 18 Part 1: 1 The career p 27 Medical Studies: 1858 - 1863 P 28 At the Illenau from 1863 -1869 P 30 The first academic post: Strasbourg in 1872 p 34 The years at Graz: 1873 - 1889 P 36 Vienna: 1889 - 1902 P 39 2 The IIlenau: an ideal psychiatric asylum p 54 Introduction p 54 The History of the Illenau p 56 Roller's understanding of mental illness and its remedy: the Illenau p 60 Krafft-Ebing's daily life at the Illenau in the 1860s p 68 The legacy of the Illenau P 76 3 Graz 1873 - 1889 : docslot portal physio institutions and their patients Introduction p 85 History of medical teaching and medical care at Graz p 87 Feldhof p 90 The psychiatric clinic in Graz p 105 Administration and teaching p 113 MariagrOn p 116 The driving forces behind MariagrOn p 125 Krafft-Ebing's private practice p 127 Summary p 132 4 Vienna and the Society for Psychiatry and Neurology The Verein filr Psychiatrie und Neur%gie p 140 The methodology at the time p 143 Krafft-Ebing and Freud p 147 Krafft-Ebing's personal acquaintance with Freud p 148 Freud at the Verein P 151 The discussion about methodology P 153 Summary p 160 Part 2: 5 Mapping his work P 167 The format p 168 Krafft-Ebing as a prolific author p 168 How did he manage it?
First, my thanks to Bill Bynum who has been such a sympathetic and patient supervisor.
Vivian Nutton gave me invaluable advice and also helped with editing suggestions, and I have taken up far too much of his time.
Roy Porter has been generous and inspiring.
I am deeply grateful for the constructive criticism, time investment and friendship I experienced from the other students and postdoctoral students at the Wellcome Institute.
I am indebted to many but most directly to Mark Micale, Alexander Zahar, Andreas Hill, Akihito Suzuki and Sue Morgan.
In researching this study, I have relied upon the resources and services of the following libraries most: the Wellcome Library, the British Museum library, the library at the Neurologisches Institut Wienthe University library in Basel and the excellent historical collection at the psychiatric University clinic, Basel.
Thanks to all their staff for their assistance and friendliness.
My research has been made possible thanks to grants from the Wellcome Trust and the Swiss National Fund, as well as the financial generosity of my parents.
Finally, my personal votes of thanks to some of those who supported me so generously: Michael Neve, Andy Foley, Amal, Sandra, Susan and Rus, Angela, David and Carola.
Introduction 10 Although Richard von Krafft-Ebingls name is well-known there is so far no full biographical account.
The following introduction gives a summary of what is known about him today before giving an outline and stating the goal of my own work.
The image of Krafft-Ebing today Not only historians of medicine, historians of sexuality and many Freud scholars, but also cultural and literary historians of fin-desiecle Vienna know of Krafft-Ebing.
His name appears in many historical texts, yet there are few attempts at elaboration and on the whole the secondary literature on him is sparse.
Given the repeated stress on Krafft-Ebingls professional importance, it is surprising that most general histories of medicine merely reiterate the same few facts: that he was born in 1840 and died in 1902, that he trained in Heidelberg, moved on to becom ing a professor of psychiatry in Strasbourg - later at the universities of Graz and Vienna - and that he was the author of the Psychopathia sexualis 1886the first classification of sexual disorders.
Some add that Krafft-Ebing also wrote the leading psychiatric textbook of his day and that he made his name as a forensic expert.
Despite the scarcity of information, Krafft-Ebingls name seems sufficiently important that even shorter overviews of the history of medicine give him a few sentences.
German examples range from Julius Pagells classic of 1915 up to more recent histories of medicine like Fischer-Hombergerls Geschichte der Medizin and Harig and Schneck's similar textbook of 1990.
There is no doubt that looking at Krafft-Ebing as a representative of degenerationist thought has proven very fruitful in many ways.
Such important historians as the husband and wife-team Leibbrand-Wettley5 or Lesky, amongst others, have stressed that Krafft-Ebing was the most influential German-speaking psychiatrist within the degenerationist tradition and that this theoretical model was the basis of his very categorisation of psychiatric disease.
Gefasspsychopath%gie - the attempt to explain psychological functioning by examining the physiology and pathology of vessels in the nervous tissue, especially in the brain.?
Those historians who singled out one of Krafft-Ebing's specific interests have, without exception, explored his work on sexuality.
This is very understandable and fully justifiable if we are mainly concerned with the history of influences as opposed to the history of the origin of ideas.
For many historians today Krafft-Ebing, after a", 11 made his name with the Psychopathia sexualis and it is doubtful whether he would be remembered, had he not written this particular book.
The body of literature which mentions that book is vast.
For the German historical literature it was again Leibbrand-Wettley who led the way in exploring Krafft- Ebing as the "father of sexology", both in an early work on the history of sexualit y8 and in their ambitious 2-volume project covering the complete cultural and intellectual history of the Erotic through several centuries.
They diverge more in their value judgements than in their information.
An untold proportion of the confusion which continues to surround the subject of sexual variation today stems directly from his writing.
On the contrary, he was interested in supplanting the waning power of the church with the waxing power?
The ability to enjoy and perform the sexual act, in the normal manner, appeared to be the most difficult of the arts.
It is obviously crucial that we remain aware of the fact that he has evoked such powerful feelings before attempting a more value-free account.
Most importantly he knew Sigmund Freud personally and apart from having a substantial influence on the latter's work on sexuality - he also interacted with him professionally.
Earlier Freud scholars have emphasised Krafft-Ebing's allegedly hostile refutation of Freud's views.
More recently and parallel to a more critical assessment of Freud's achievement, their relationship has also been seen differently and there is now more emphasis on the fact that the established Krafft-Ebing actively supported Freud's academic career and final professorship.
Some of the articles are difficult to obtain since they are buried in obscure Austrian journals.
The complete list of KrafftEbing's publications in the appendix to the thesis is designed to make them more accessible by newly providing full references.
In contrast to the vast amount of published material, I have found only a few manuscripts by Krafft-Ebing.
Some of these were 14 recorded in the libraries of Graz and Vienna, others in German libraries the University library of Berlin holds a central catalogue and a few postcards are still in the possession of Krafft-Ebing's family in Graz.
The letters and postcards found are reproduced in the appendix, although they do not appear to be of great historical value.
To my disappointment I have not come across any autobiography or autobiographical notes, diaries or candid correspondencewhich would undoubtedly be more interesting.
In addition to manuscripts by Krafft-Ebing there are other archival sources and although I know of their existence and have seen some of them, they have not been fully exploited here.
However, future research on Krafft-Ebing could well make use of two sources of unpublished material: 1 Graz University and apparently to a lesser extent Vienna University hold archival material which definitely sheds light on administrative aspects of his relationships to these universities and possibly on other aspects of his work, too.
The direct secondary literature has already been summarised above.
Whilst relatively little work relates directly to Krafft-Ebing, there exist, of course, many historical accounts which were relevant for this thesis.
Apart from books which provided a general-historical or cultural background,21 there are the histories of medical teaching, which are more fully quoted in the first part of the thesis.
It is not a study of sexology in the 1880s that is it does not trace the history go here the emergence of Germanic Sexualwissenschaft.
As the above summary of our knowledge has already emphasised existing accounts tend either to single out one abstract principle or to emphasise Krafft-Ebing's interest in sexuality only.
Yet, compiling and reading his considerable output on an impressingly broad range of topics, I thought that this kind of focus did not do him justice and resulted in his false reputation of a one-book author.
I have tried to undermine this view and instead of focusing on Krafft-Ebing as an early "sexologist" I have emphasised that he was a man of many interests.
If Krafft-Ebing's work is evidence of his own reluctance to be a single-minded specialist, this same principle is also reflected in his 16 life.
Following Krafft-Ebing through the various stations of his professional life - from his training at the University of Heidelberg and the "model-asylum" Illenau to his multiple functions in Graz and his chair in Vienna - it becomes clear that his intellectual broadmindedness was born out of his many different experiences.
In addition to neglecting substantial parts of his work, the more usual approach seems flawed in treating and subsequently judging Krafft-Ebing for being someone he never intended to be: a pioneer in sexology.
His supposedly seminal text of 1886 is neither original nor was it meant to be a contribution to what only later became sexology or Sexualwissenschaft.
Historians of sexuality may well see the book as a catalyst to their field in retrospect, but for understanding the original text it is more important to explore the context in which it was written.
My chapter on sexuality makes the point that this was at the time primarily a forensic context.
Contrary to Wettley, who argued that he took sexuality out of the context of general psychiatry I believe that he did no such thing but thought sexuality important because it was of forensic-psychiatric relevance.
On a more abstract level, the nature of the Psychopathia sexualis is explained precisely by Krafft-Ebing's other work.
Irrespective of how his classification of sexual disorders came to be interpreted later, the actual first edition of the text a small booklet of 110 pages is essentially a compilation of contemporary knowledge on sexuality.
To do Krafft-Ebing justice, although he says in the introduction that his book is novel - inasmuch as it is the first comprehensive medical book on sexuality,26 he nowhere claims that the factual content is original and new.
On the contrary, he 17 carefully refers to a vast number of sources many of them French and out of the 47 case-h istories on Iy 6 are h is own patients, the remainder being second-hand.
In essence the book is an over-view of the literature like the many others he had written such as his annual or bi-annual reviews of psychiatric-forensic literature or reviews on topics such as dementia paralytica.
There is an additional problem with singling out Krafft-Ebing's interest in sexuality and putting the Psychopathia sexualis centre stage: which of the 12 editions is actually meant?
Chapter summary The first part of my thesis chapters 1 to 4 deals with institutional and practical aspects of Krafft-Ebing's life.
The second part is an intellectual biography focusing on his main interests.
The appendix contains a full list of Krafft-Ebing's publications, the many different editions of the Psychopathia sexual is, and descriptions of several manuscripts.
Chapter 1 gives a survey of the important stations of Kraftt-Ebing's life.
After his final medical examinations in 1863, he trained for 5 18 years as a psychiatrist at the Illenau, a well-known mental asylum in Baden.
In the spring of 1872 he obtained his first lectureship at the University of Strasbourg, but left Germany after a year to accept a call to the University of Graz in Austria.
It is at Graz that Krafft-Ebing published his most important work and this is put into context, whilst the details of his clinical work are dealt with in chapter 3.
The remainder of this short summary of Krafft-Ebing's life mentions his election to the chair of psychiatry at the University of Vienna and lastly gives a brief analysis of his personality.
Krafft-Ebing's training-period at the Illenau - from 1863 until 1869 -was profoundly formative for his later work and significantly he called himself its disciple throughout his life.
The daily life and atmosphere of this asylum has therefore been studied in detail in chapter 2.
This chapter also clarifies the extent to which he remained indebted to its teaching.
The legacy of the Illenau permeated Krafft-Ebing's later approach to his patients - the individual case method - and most fundamentally his Weltanschauung, a view of medicine as a moral rather than a strictly natu ral-scientific enterprise.
The years at Graz chapter 3 were in free online blackjack tutorial senses the high-point of Krafft-Ebing's career: it was the longest period he spent in anyone place; he was there during his middle age.
At Graz he wrote his major work and became interested in all the topics with which he 19 was later to be concerned.
He was simultaneously involved in three very different institutions: Feldhof a chronic asylumthe clinic in Graz hospital a ward with more acutely ill patients and, from 1886, Mariagrun, his own private sanatorium.
This chapter examines the types of patients he treated by making use of contemporary statistics for all three institutions.
These patients, of course, directly influenced his work since they represented the material on which he based his psychiatric theories.
This material changed over time and I argue that the changes are the most direct reflection of how Krafft-Ebing tried to shape psychiatry.
He did not simply passively accept patients, but actively selected them.
Leaving Feldhof after a few years resulted in fewer chronic patients and adapting the clinic o and later buying and running a private sanatorium meant chctSing more acute patients suffering from hysteria and neurasthenia.
These latter groups of patients were more valuable to Krafft-Ebing because he could use them better both for teaching and for publishing.
Chapter 4 is about Krafft-Ebing's time in Vienna which in many ways was less rewarding for him than the time spent in the smaller Graz.
He found less time to do creative work, administrative problems were more disagreeable and he never obtained a ward for in-patients suffering from nervous disorders like the one for which he had successfully fought at Graz.
On the other hand, Vienna was incomparably more prestigious than Graz and KrafftEbing had finally "arrived" professionally when he was elected to the chair of psychiatry there.
In addition to completing the story of his professional life, this chapter is mainly about one key aspect his involvement in the society of psychiatry and neurology of which 20 he became the president in 1892.
His relationship with Freud is discussed.
The second part of the thesis is about Krafft-Ebing's work.
Chapter 5 gives a chronological overview of it.
The working methods which allowed him to maintain such a prodigious output are discussed.
Whilst the bibliography of his publications part one of the appendix is comprehensive, this chapter selects what I see as his most important contributions to the major topics: forensic psychiatry, sexual psychopathology, hypnotism and neurology.
Lastly, I comment on the translations in various foreign blackjack billy commodore and argue that Krafft-Ebing's reputation as the author of one book in the English-speaking world may be due to his works being translated into English only very selectively.
Krafft-Ebing's work on sexual pathology is both extensive and comparatively well-known.
Chapter 6 explores two of its most important aspects: the forensic connection and the psychologisation of sexuality.
Krafft-Ebing was from the start - not least due to the influence of his grandfather Mittermaier - interested in forensic psychiatry.
His main motivation in taking up sexual psychopathology was clearly a forensic one.
In other words, his famous classification of sexual disorders as put down in the Psychopathia sexualis with its characteristic subtitle lOa clinicoforensic study" was above all designed as a framework for discussing sexual crimes in court.
This goes a long way towards explaining the nature of this classification.
By choosing the important example, homosexuality, I elaborate on the legal origin of Krafft-Ebing's model and also follow the development of his 21 engagement in sexual- forensic questions.
The second part of the chapter then goes on to discuss the clear signs of a "psychologisation" of sexuality in Krafft-Ebing's later work.
There is a shift from understanding sexuality as a physiological phenomenon to seeing it as a psychological event.
The new terminology which Krafft-Ebing introduced - with terms such as sadism and masochism - bear witness to this.
Chapter 7 is about Krafft-Ebing as one of the pioneers of hypnotism in German-speaking psychiatry.
This chapter shows him as a practising therapist.
The extent to which he spent time as a therapist - illustrated with a lengthy case study of his patient lima - may help to counterbalance our current view that psychiatry at the time was above all non-therapeutic.
The main significance of hypnosis for Krafft-Ebing's general work is that it opened up a new outlook for his work on sexuality.
Krafft-Ebing became interested in hypnosis in autumn 1887 and having treated the homosexual lima during winter 1887 and spring 1888 he quickly began to draw general conclusions and integrated his new therapeutic convictions into the later editions of the Psychopathia sexualis.
The last chapter shows that Krafft-Ebing, who is known to us as a psychiatrist, was more of a "neurologist" than is generally reported and that he wrote on a broad range of organic disorders.
In particular he contributed to the "general paralysis" question, important at the time, but receiving little attention from historians subsequently.
Apart from adding new factual information, the exploration of Krafft-Ebing's work on the causal link between syphilis general paralysis and tabes dorsalis, is also meaningful because it touches on the broader issue of his disease model.
The "general paralysis" problem was finally solved in the late 1890s and early years of the new century within the model of bacteriology.
Although it looks at first sight as if Krafft-Ebing subscribed to modern bacteriological thinking - he argued successfully using inoculation experiments conducted on syphilitic patients - a closer analysis reveals the extent to which he remained rooted in a more traditional disease model - and gives the likely reasons for this.
In addition to dealing with organic conditions affecting the nervous system including peripheral nerves, KrafftEbing was also interested in nerves in a more "abstract" sense: he treated neurasthenic or nervous patients and he also wrote on hysteria.
Chapter 3 has already described the outer setting in which he did so.
Chapter 8 raises the question of his relationship with other psychiatrists-cum-neurologists at the time as well as fundamental questions about the boundaries of psychiatry and neurology.
Pagel 1915 p 542.
Stuttgart Enke he did Illt:ntion him in his Kurze Geschichte der Psychiatrie 1967Β».
For the Anglo-Saxon literaturt:: CJarrison llJ29 pp 648; 701, mentioned Krafft-Ebing as the author of the best German work on forensic psychiatry as wt:ll as for bt:ing a scit:ntific student of sexology.
Ackerknecht 1967p 55.
Bynum 1983 P 35 and idem llJ84 pp 61-62.
Pick 1989who concentrates on the French scene.
The literature on degeneration generally is vast.
Sec for example on Morel as the "father of degeneration" : Durgener 1964Friedlander 1973 and the classic work by Genii-Perrin 1913.
More recently and more generally: Mann 1985 and Dowbiggin 1985.
Haeberle 1983Hofweber I 69.
Mosse 1985Neumann 1974.
Weeks 1977; 1989Brecher 1969.
Phayer 1977 curio~sly docs.
Lastly, Ranke- Hel nemann s cu It u ral-t heo log ic al and ant i-c lerical history of 19H8.
~~ehman or the last German cd.
Sec also chapter 4.
For the background story or asylums and individual institutions, see.
Krafn-Ehing may not have known of its existence - at Il: 25 As a SCCOlH.
Tannahill 1980 p 382 quotes the book's date i.
The career 1 27 Richard von Krafft-Ebing was born in Mannheim, in the Grand Duchy of Baden in South Germany on 14 August 1840.
He died in Graz, Austria, on 22 December 1902.
He was the oldest son of Friedrich Carl Conrad von Krafft-Ebing 28.
On the paternal side the Catholic family was of the Austrian aristocracy and Richard von Krafft-Ebing's title was Freiherr from birth.
Arch ives supply the names and birthdates of his three younger siblings3 - but little else about Krafft-Ebing's youth, and nothing about the family atmosphere.
The family moved away from Mannheim, probably around 1842, and later settled in Eberbach, a small town close to Heidelberg, where Krafft-Ebing's father was a higher district administrator of Baden h6herer Amtmann.
One reason for this move was that there was no Gymnasium education possible in Eberbach.
It is also known that in this period Richard's mother died when he was only 14 and his confirm. counting cards blackjack how to opinion married her older sister Luise Katharine Mittermaierbut again we do not know how this affected the boy.
By contrast the granting of the actual doctoral degree was in the hands of the medical faculty and required an extra oral and written examination, a written dissertation, as well as a substantial amount of money.
Many students did not bother with this degree since it carried little advantage unless a university career was aspired to.
He submitted his dissertation on the topic of sensory deliria in December 1863.
Between the final examinations in May 1863 and the Promotion in August, Krafft-Ebing spent some 28 time in Switzerland.
The main reason for his stay was a bout of fever possibly typhoidwhich he had acquired during his medical training on the internal-medical wards of Nikolaus Friedreich 1825- 1882.
He seems to have been quite ill - he later used his personal experience of hallucinations in his dissertation 10 - but he recovered fully and took the opportunity to listen to Wilhelm Griesinger's lectures in Zurich.
He was not officially registered as a student there 11 and this must have been an informal arrangement, quite common at a time when medical lectures, even those with demonstrations of patients, were less closed to the public than today.
During that term Griesinger was covering the nervous system in his lectures on special pathology and therapy, and he also gave clinical lectures on mental illness,' 2 the latter almost certainly with practical demonstrations of patients at the Burghblzli.
Later KrafftEbing mentioned in his medical dissertation that he got to know a patient of the local asylum during his stay at Zurich.
In July of 1863 he wrote to Schule, informing him of his decision to take up psychiatry as a speciality.
According to Schule he said that this was due to the impression Griesinger had made on him - a reason which may represent a later interpretation of Schule.
Mittermaier published extensively and one of his favourite topics was forensic 30 psychiatry.
It was this legal aspect of psychiatry which attracted Krafft-Ebing from the start.
At the Illenau from 1863-1869 Once Krafft-Ebing had made his decision to take up psychiatry, he applied for a post at the Illenau, the best-known psychiatric asylum of South Germany, where Schule was already working.
Krafft-Ebing obtained the post probably through family connections: his grandfather Mittermaier was a good friend of the medical director C.
Krafft-Ebing started first as a volunteer, staying for three months from 1 September to 1 December 1863; after an interval he was appointed for five years as a junior doctor 21 May 1864 - spring 1869.
Thanks to Schule we have a list of the books, which impressed and influenced them.
Spielmann's Diagnostik der Geisteskranken 1855Pinel and Esquirol, Wilhelm Wundfs Vorlesungen uber die Menschen und Thierseele and Gustav Theodor Fechner's Elemente der Psychophysik,1860, which inspired them to make experiments.
Above all Krafft-Ebing was apparently impressed by Morel both for his ideas on the importance of vessels and his concepts of disposition and degeneration and Darwin, who was then becoming very popular.
From the beginning of his career Krafft-Ebing was keen to publish, and he was to keep up a steady and impressive flow of publications all through his life.
During his Illenau period he wrote many book reviews, in 1867, for example, publishing 14, mainly in two journals.
The first was the Allgemeine Zeitschrift fUr Psychiatrie, the general psychiatric journal of the time, co-edited by C.
The second was a medico-legal journal called Friedreichs Blatter fOr gerichtliche Medizin.
Here it was probably Mittermaier who paved the way for his grandson: he had close connections with the editors and wrote personally in the journal until he died in 1867.
From 1866 Krafft-Ebing was in charge of a part of the annual book review of the whole of psychiatric literature published in this medico-legal journal: he reviewed the section on forensic psychiatry.
When Friedreichs Blatter discontinued its annual review in 1880 - a major enterprise then taken over by the Allgemeine Zeitschrift fUr Psychiatrie - it was again Krafft-Ebing who dealt with forensic psychiatry.
Krafft-Ebing, in other words, not only knew all the recent 31 work on forensic psychiatry, but also shaped his colleagues' opinions for several decades since there was only one systematised book review of psychiatry at the time.
During the years at the Illenau he also started to write monographs on various topics as well as legal reports.
Krafft-Ebing left his first job at the Illenau in spring 1869 and moved to Baden-Baden, where he set up his own office as a specialist for nervous disorders praktischer Nervenarzt.
Krafft-Ebing was called into the 32 army with the rank of major on 20 June 1870 and put in charge of a medical service station to the Prussian troops situated in Rastatt, a military camp.
The patients suffered mostly from peripheral neurological lesions that is, organic conditions.
KrafftEbing published on his activity in that clinic and in a paper of 1871 described five soldiers suffering from paralysis of their arm-nerves after the prolonged use of crutches.
Germany, however, had only just created her first university chairs for psychiatry, asylums provided few posts and few of them offered any prospect - in fact, the Illenau was probably the best - so KrafftEbing's decision to settle in Baden may well have been born of necessity rather than choice.
By 1871 he had, however, published several forensic reports as well as a few monographs and he also seems to have established useful contacts such as with Franz von Holtzendorff, then a professor of law at Berlin, to whose Rechtslexikon legal dictionary he contributed 32 Helped by his 33 distinguished performance during the war, Krafft-Ebing started to look for an academic post which would give him some prospects.
The first academic post: Strasbourg in 1872 At first Krafft-Ebing approached the University of Leipzig, where Carl Wunderlich, dean of the medical faculty, was willing to appoint him.
This old university in Alsace had just fallen to Prussia as a result of the Franco Prussian war.
It appears that von Roggenbach, in fact, created this position, which had originally not been planned.
Krafft-Ebing was the first to leave, and although his chair was relatively insignificant, his decision would not have gone down well with his colleagues.
His deeper-rooted reason may have been that he as a South German Catholic did not agree with such an explicitly Prussian program.
His tasks in Strasbourg were twofold - lecturing and treating patients.
During the first term of 1872 the Sommersemester for example he delivered two courses of lectures 4 hours per week on general psychiatry with clinical demonstrations and one on docslot portal physio psychology 1 hour per week.
He did so despite difficult circumstances, above all the fact that with only 4 beds he had to rely on other wards in order to demonstrate any patients at all.
As psychiatry was an extracurricular subject, students were difficult to attract and more likely to attend when the teaching was of just click for source "modern" format, that is when patients could be shown.
Krafft-Ebing used to take his students to both the Illenau and to Stephansfeld, a nearby provincial asylum, where Pelman would show him his patients.
The most important works are two monographs which he later put together and published, updated and enlarged, as his forensic textbook.
The first of these monographs of 1872 dealt with the criminal law, the second of 1873 with civil law.
Both put down some principles of the psychological approach towards offenders for medical experts and lawyers.
He seems to have been very happy in Graz and later in Vienna, in spite of his relatively higher status there, he always longed for the beautiful and healthy surroundings of Graz.
It was also during his time at Graz that Krafft-Ebing married and started a family.
His wife Luise 184619.
They were married in Karlsruhe Baden on 16 Dec 1874.
They had two sons, Friedrich Josef 31.
He appears to have been a good and dedicated family man and father, stern, rigid, "Victorian" but also warm and good-humoured, at least if his style of talking to children as described in his "hypnotic experiments" is anything to go by.
Marion Krafft-Ebing, the daughter of Krafft-Ebing's second son Johann called Hans remembered how warmly her father always spoke of his father.
Not only did he hold down an academic post involving regular lecturing and publishing steadily in large quantities, but he also had different clinical functions.
From 1873 to 1880 he was medical director at Feldhof, a newly built provincial asylum of about 300 beds.
This position was linked to the professorship of psychiatry at Graz University.
This ward of 24 beds was officially opened by him on 22 May 1874;46 he stayed in charge until he left Graz in 1889.
Lastly, Krafft-Ebing became involved in a third and very different see more, his private sanatorium MariagrOn, founded in 1886 and kept on when he moved to Vienna three years later.
It was then run by the two directors and former assistants of KrafftEbing: Hugo Gugl and Anton Stichl.
In addition to his hospitalised patients, Krafft-Ebing treated out-patients.
Publications It was at Graz that Krafft-Ebing produced his most original published work.
Later, at Vienna, he elaborated ideas formed in Graz, and a significant number of his publications from this later period would be re-editions of earlier work.
The forensic textbook - Lehrbuch der gerichtlichen Psychopathologie mit Berucksichtigung der Gesetzgebung von Oesterreich, Deutschland und Frankreich Textbook of forensic psychopathology with reference to the legal codes of Austria, Germany and France is important for two reasons.
First, it characterises Krafft-Ebing's specific interest best; secondly, it was the first textbook of the legal aspects of psychiatry.
It was the culmination of Krafft-Ebing's long standing interest in legal questions.
Motivated by his early contact with jurisprudence in Mittermaier's circles, Krafft-Ebing had for many years been specifically involved in these -questions and was by the 1870s on his way to becoming the leading forensicpsychiatric expert for the German-speaking community.
He regularly acted as an expert medical adviser by writing forensicpsychiatric reports.
Even before the publication of the forensic textbook, Krafft-Ebing had begun to systematise his views in various articles covering specific legal aspects.
He wrote on questions such as criminal actions under the influence of alcohol 1872the legal responsibility of hysterical patients 1872the self-accusations of the mentally ill 1873and on the validity of legal testimony in different psychopathological conditions 1874.
These are on the principles of crim inal psychology 1872 and an essay on dubious mental states in civil law 1873.
This book also had a significant impact on German-speaking psychiatry.
It went through seven editions during Krafft-Ebing's lifetime, was translated into several languages including French, English, Italian and Hungarian, and indeed became the leading standard textbook for many years until it was replaced by that of Emil Kraepelin.
One of its most remarkable features is the number of case-histories collected in volume 3 159 cases in the first edition, later less.
In addition he was also an active contributor to journals, writing not only several articles per year, but continuing to produce the annual reviews of the forensic-psychiatric literature.
Most important, and a sure sign of his high status in the field, was his position on the editorial boards of such journals as the Allgemeine Zeitschrift fOr Psychiatrie from 1879 and the Jahrbucher fUr Psychiatrie from 1887.
Vienna: 1889 - 1902 In 1889 Krafft-Ebing was invited to succeed Max Leidesdorf, who had died on 9 October 1889 in Vienna.
He had been replaced as a lecturer by Julius von Wagner-Jauregg in a so-called 'interregnum' position for four terms i.
Wagner-Jauregg was to follow in Krafft-Ebing's footsteps again in 1892, when Meynert died, and lastly in 1902, after Krafft-Ebing's retirement.
The organisation of Psychiatry in the University of Vienna was complex.
The relevant institutions were the Niederosterreichische Landesirrenanstalt provincial asylum of lower Austria an institution with mainly chronic patients and about 150 beds in 1889.
This was connected with the 'Leidesdorf' chair and has also been called Vienna I or first psychiatric clinic.
Vienna II was seen as the more desirable position.
Its higher academic status was intrinsically linked to the availability of more "interesting" patients for teaching purposes.
Due to different admission procedures - Vienna II was a medical hospital, whereas Vienna I was a psychiatric asylum.
KrafftΒ· Ebing was first elected to Vienna I in 1889 and three years later to Vienna II, which means that he was first running a provincial 40 asylum-type hospital with a lot of adm inistrative tasks and chronic patients, and only later 1892 a university type clinic.
Krafft-Ebing, delivered his inaugural lecture at Vienna I on 21 October 1889.
It was entitled: "Die Entwicklung und Bedeutung der Psychiatrie als klinischer Wissenschaft " The Development and Significance of Psychiatry as a Clinical Science.
This society played a key role in the psychiatric life of Austria as a whole.
Originally called the Verein fur Psychiatrie und forensische Psych%gie Society for Psychiatry and Forensic Psychology Krafft-Ebing in 1894 had the name changed to Verein fUr Psychiatrie und Neur%gie Society for Psychiatry and Neurology.
All three books proved to 4 1 be in high demand and were re-published regularly, usually in a revised, enlarged and updated form.
The latter is particularly true for the Psychopathia sexualis, which changed significantly both formally and in content over the years.
In addition to the books, he published a collection of earlier articles in four volumes 1897-99 : Arbeiten aus dem Gesammtgebiet der Psychiatrie und Neuropathologie Works in psychiatry and neuropathology.
In this he followed the example of Paul Mobius, who had published his former neurological papers in five volumes a few years earlier, and to whom Krafft-Ebing referred in his preface.
But such collections also seem to have served as ammunition in priority disputes.
In Krafft-Ebing's case, this was certainly true for his concept of Zwangsvorstellung obsessional thoughts.
He gave credit to Carl Westphal for putting the term into a clinical context in 1877 but stressed the fact that he himself had already coined the term "obsessional thoughts" in 1867.
The general impression of Vienna as a dynamic centre of psychiatry requires some modification here.
Krafft-Ebing, certainly, hated many aspects of the professional climate of Vienna and felt engaged in an uphill struggle for many years.
In a letter 42 dated 26 Feb 1894 to a friend unidentified he expressed his frustration with Vienna in the following words: I merely told him.
He had many administrative duties, in particular during the first few years when he was in charge of Vienna I with its 150 beds of chronic patients.
University teaching, Krafft-Ebing's ultimate goal, was difficult, not only because of lack of finance, but even more because of a lack of enthusiasm for the subject.
Psychiatry, not yet a compulsory subject within the medical curriculum, was still some way from being a fully respected discipline.
Personal intrigues and border skirmishes with other disciplines such as neurology added to the difficulties.
Krafft-Ebing worked towards changing both administrative structures and psychiatric teaching practice and he.
He was widely known and praised as one of the leading names in psychiatry internationally.
One standard casino blackjack rules of his professional importance was the fact that he was allocated to speak in the plenary session of the international congress of medicine, held at Moscow in 1897.
On the whole he appears to have been widely respected.
Everybody agreed that he was a hard-working man, but he was also praised for such qualities as good breeding, good manners, respect for others, diplomacy and politeness.
His obituaries mostly stress his "truly aristocratic" character and strong sense of duty.
These obituaries - written by his close friends such as Schule or pupils such as Fuchs - are of course painting a one-sided picture, but there are also more objective indications: his style in talking to his patients was exceptionally tolerant and patient, if at times very patriarchal.
Those who did not like him accused him of being stiff and uncreatively formal; for example Kraepelin, who thought it typical of KrafftEbing's dullness that he always met his publisher's deadlines.
There was one outspoken "enemi' of Krafft-Ebing - Moriz Benedikt, who was professor of electrotherapy at Vienna and a notoriously difficult character.
He clashed professionally with Krafft-Ebing over forensic issues, hypnotism, and Lombrosian craniometry.
In his book on hypnotism and suggestion of 1894 he included a IIpsychological equation of Mr Krafft-Ebing", which reads like a tirade of hatred and professional envy.
Krafft-Ebing, we learn, is an "untiring collector who has acquired the false reputation of an expert".
He has a "fine instinct for worldly success" which allows him to "latch onto modern keywords such as neurasthenia, moral insanity, hypnotism, moral treatment, sexual perversity etc.
Although endowed with a certain "journalistic talent", he has remained a dilettante.
There is nothing to be hoped for in the clinics in Vienna for the next 10 years.
There is not only a lack of money, but a lack of other th ings, too.
For several years before his retirement, he had blackjack basic strategy chart symptoms of arteriosclerosis, which apparently did not affect his mental capacity but he increasingly suffered from migraine, a very painful trigeminal neuralgia and fainting spells.
He managed to re-edit the twelfth edition of the Psychopathia sexualis and the seventh edition of his 46 general textbook, as well as writing a substantial monograph on menstrual psychosis, a topic again of forensic significance since the disorder is periodic.
He was buried in the St.
Leonard -cemetery of Graz, followed by his wife who died a year later.
~urCl's: I l'lltril's lin Krallt-Ebing in NOll by Kindt llJ~O ; the OI3L by Holl-Ulltcfrainl'r llJ6lJ and I3cttelheim 1905each with further litnaturl'.
Much or the following is taken from either Schule or Fuchs: Anon.
Jauregg 18981902.
Joseph Friedrich Richard von Krafft-Ebing.
Another official version of thl' name plus rull titles - Anon.
He gave the date as May I X63.
Iing to the official entry in the University archive of Heidelberg leiter of 2S.
Il X8 from the University archive : the Personulakte of Ira:!.
University in Krafft-Etling's hand renders the dute of promotion as 6th August.
~ ~ 12 See Zurich.
Tlwy art: ct:rtainly not listed in the letter collections of German libraries and archivt:s.
In Austria psychiatry - together with nt.
He was a co-editor of tht: jOllf'llal Frkdrt.
New psychiatric research and experiences in their forensic applkation towards best judging the question of legal responsibility.
Friedrl'ichs OIHtter 17 5-22; 16385; 243-76; 323-58 and IX 3-37; 161-X9.
The preface was dated 25 November I X63: the thesis was submitted to the faculty on 11 December I X63 Hnd Krafft-Ehing suhsequently asked for permission to publish.
Il XX from the University archive in Heidelberg.
Krafft-Ebing lkdkated his medical thesis to his grandfather Mitlermaier i.
IS probably due to Miuermaier's influence.
Krafn-Ebing's boss at the 11lenuu.
P 307 stressed above all 13crlin; Fuchs.
Prague alld I3crlin as the places Krarn-Ebing visited early on ill his carcer in Fuchs 1902 pp 34.
Krafft-Ebing himsclr latcr Illelltiolled in a paper of 1867 Ein Besuch in Ghecl.
IXl 2- IlIell 24 vol.
Fischer 1935 p 319; also information from the Gcnerallandesarchiv Karlsruhe letter of 18.
I X65 see appendix.
Krullt-Ehing's pcrsonal connection with vun Holtzendorfl' may w.
~11 h~lve bcen estahlished at an earlier date sincl von Holtzendorfr was a friend and pupil of Miltermaicr.
An HXlr {onlill {rius although carrying the same title of Professor has considerably less security, kss power and also less which money.
For an interesting cOlltelllp rary description f Stephansfeld see the memoirs of Pcllllan llJI2.
He mcnti ns Kral'f't-Ebillg only in passing and does not add anything new.
J lly IXX7 p 7.
Turisten and KraITt-Ebing IX73 Die zweifclhurten GcisteszusUinde vor tlell1 Civilricllter.
No exact date is known.
~g llJ50 p 43.
Wagner-buregg 1t X p 2311.
Ball 1I1111 von dic Bl:itril~l:.
For a rcccnt histmy or ohsL'ssiollal disorders including accreditation Krafrt-Ebin~ I'm c illing thc tl:rm sce 19R5.
I havc not comc :ILTOSS allY othcr uutspoken remarks against.
I Krafrt-Fhing certainly collahoratcd directly and voluntarily with.
Jcwish docturs; cxamples an: Magnus Hirschfeld in later years.
Schiller 19X2 p -1- alsll C llll11l'lIts on I3cnl'dikt's pcr'ionality.
Fuchs 1902 P II spokL!
Wil'Ill'f klinisclll' RlInlischall, SL!
SllidieSl:l: appendix.
Einl: klinisch- 53 Chapter 2.
The Illenau: an ideal psychiatric asylum 54 I ntrod u cti 0 n Krafft-Ebing worked at the IIlenau, the leading South-German asylum, between September and December 1863 as a volunteer, then from May 1864 until April 1869 as a full-time junior doctor.
Psychiatry as a university subject was still a very recent invention and the topic was not yet part of the final medical exam it became so in Germany only in 1901.
The institution he had chosen, - or rather that he was very lucky to get into, - was a particularly powerful place with a tradition shaped by such important figures as the medical director Friedrich Wilhelm Christian Roller 1802-1878 and his co-director later successor Karl Hergt 1807-1887.
At the time when Krafft-Ebing joined the staff in the 1860s, asylum tradition, for which the IIlenau was such an excellent example, was undergoing important changes.
On the one hand, new ideas such as non-restraint or Morel's and Darwin's teachings were taken on board; on the other hand, the heyday of the asylum was over and Roller was getting older.
Nevertheless, this was a time of forward-looking change and enthusiasm.
In a sense the Illenau represented the best of two worlds: Roller, the successful patriarchal figure of German asylums, was still fully active, but his junior staff were also in touch with the latest ideas taught at the universities.
The IIlenau thus combined humanitarian ideas and an idealist re-educational programme for the patients, with "natural-scientific" methods promising to get at the root of madness.
Krafft-Ebing was to call himself a disciple of the Illenau for all his life: he stayed in close contact with the institution and with the two friends he had made there, Heinrich SchOle 1840-1916the later director of the Illenau, and Wilhelm Erb 1840-1921who became a leading German neurologist.
Most importantly, however, his way of thinking remained permanently shaped by the "lllenau-school" as it was called at the time.
It shaped his basic belief as to what psychiatry should be, namely that it was a moral enterprise rather than one that was strictly "natural-scientific".
In a revealing sentence in the preface to the Psychopathia sexual is 1886 he claimed that it was up to medicine to "save the honour of humanity in the forum of moralitl.
The physician, in other words, also had a moral task.
Lastly, he subscribed to a view that was highly characteristic for asylum-psychiatry and could, in fact, have easily been the formulation of Roller himself: 55 For psychiatrists the mental asylum, a place of horror to the lay person, is the most important remedy against disease.
This asylum, Mariagrun, had many features in common with the Illenau.
KrafftEbing, who by then was well established in his university position at Graz - which meant practising a different type of psychiatry - may well have sought to recreate the old atmosphere he had trained in by building up his own small Illenau.
Given the importance of the Illenau for the later development of Krafft-Ebing, this chapter will look closer at the history of that institution and Roller's influential ideas, as well as explore the general atmosphere at the time when Krafft-Ebing was there.
Thanks to Schule we also have some more personal memories of Krafft-Ebing during those days.
These works provide the most direct insight into the asylum as seen through Krafft-Ebing's eyes.
The History of the II1enau 6o The history of the Illenau starts in the 1820s, when the Ministry of the Interior of Baden decided to improve the unsatisfactory state of care for the mentally ill in its Grand Duchy.
The care of the insane had become a focus of specific interest allover Europe.
The 56 conviction that "madness is curable", born out of the philosophy of the Enlightenment and put into action during the French revolution by the famous Pinel, had by the 1820s led to a considerable effort on the part of German States to keep up with modern healthcare.
The typical institutions catering for a mixture of social outcasts orphans, criminals, the sick, the mad, paupers - started to be replaced by more specialised institutions.
At first, the lunatics were segregated and, wherever possible, the old buildings, often old monasteries, were replaced or at least renovated so as to serve as specialised asylums.
The small, but prosperous, Grand Duchy of Baden, ruled by a liberal and progressive government and furthermore heavily influenced by its close neighbour France, was one of the first German States to take on this challenge.
Since 1718 there had been in Baden such an institution for various groups of society.
Situated in Pforzheim, it catered mainly for orphans and crim inals but also for lunatics.
Between 1804-1808 these groups were separated: the criminals were sent to Mannheim and Bruchsaal, and Pforzheim put to the exclusive use of lunatics and the sick lrren- und Siechenhaus.
The medical director of the institution in Pforzheim was Johann Christian Roller, the father of F.
Roller, who later founded the Illenau.
Roller senior died in 1814 and was replaced by one Dr Groos under whom the final separation took place: in 1826 those with physical disorders stayed in Pforzheim but the mentally ill patients were transferred to Heidelberg and put into a former Jesuit convent Heidelberger Anstalt.
This final segregation of the lunatics from other classes of patients was only part of a more far-reaching plan drawn up by a special commission advising the government.
During these years 57 the ministry of Baden tried to draw up a health care system for its lunatics in close connection with the University of Heidelberg - at that time a novelty.
The asylum director should Simultaneously be given a chair at Heidelberg University.
Other proposals included an attempt to improve the actual asylum, and for this the Ministry sent Roller junior on an international asylum tour; he visited Esquirol and Foville in France and also spent some time with Pienitz, Langermann, Horn, Heim and especially Jacobi Siegburg in Germany.
On his return from this explorative trip in 1826, Roller took up his first job in psychiatry working under Groos in the new Heidelberg clinic.
Within a few years Roller, a man as ambitious and ruthless as he was talented, had managed to convince the Ministry of the Interior of his own abilities hit split blackjack stand, in fact, his superiority to Groos, and in 1835 was made medical director himself, whilst Groos was sent off into early retirement.
Over the next few years Roller secretly opposed the scheme originally drawn up by the commission and sabotaged it from within.
His hostility was directed particularly at the close link with the University, a hostility which went both ways, since the University had refused to accept him as a lecturer on the grounds that he did not possess a proper degree.
The Illenau, in other words, was built in hostile reaction to the existing plans of the University of Heidelberg.
Whilst the 58 faculty's intention was to turn psychiatry into a truly medical speciality, Roller's view was that psychiatry was a very special medical discipline and therefore needed a very special institutional treatment.
This controversy and the way it was solved in Baden go a long way to explaining the later split between asylum- and university-psychiatry, which was to shape German psychiatry for the coming decades.
To a large extent Roller managed to make his dream come true.
The Illenau can be seen as a direct reflection of Roller's views about the nature of psychiatric diseases, or as he characteristically called them, "disorders of the sOUI".
The term "psychiatrt is also contemporary and was used by both asylumand university-psychiatrists.
Roller's asylum was built between 1837-42 close click the following article Achern in idyllic countryside between the university towns of Heidelberg and Freiburg.
In the first place the sexes were strictly separated with the women to the left, the men to the right of the middle axis.
Another important principle was that of separating the noisy patients from the calm, and lastly there was a separation of social class.
Such 59 segregation were seen as therapeutical.
Illenau opened its doors in October 1842 with 291 patients, of whom the majority came from Heidelberg; a few were patients from the old Pforzheim clinic, which had served as an overflow for the inadequate clinic at Heidelberg.
Roller's understanding of mental illness and its remedy: the Illenau Roller's ideas on asylums and the essence of psychiatric care remained remarkably consistent over time although the outer situation and with it Roller's intentions in publishing changed.
We can thus here use both his major works published at an interval of some 40 years.
The first of these was his often quoted monograph of 1831: Die Irrenanstalt nach allen ihren Beziehungen The mental asylum in all its aspects.
Roller's early publication was the result of his international asylum-tour of 1826 and his few years of experience at Heidelberg.
The monograph had two outspoken goals: it argued against the idea of turning psychiatry into a university field and, second, Roller as many others attempted to convince the authorities that madness was indeed curable.
This latter conviction was, after all, a relatively new idea and the government was asked to invest a considerable amount of money into asylum construction.
The single most important point for Roller was the very indispensability of the institution "asylum" as he envisaged it.
With a first chapter on "necessity and value of mental asylums", the monograph covered a wealth of practical questions such as architectural details of rooms, heating systems, bathing facilities etc.
The 60 asylum was the only place, Roller argued, where the healing of the mentally ill patient could take place.
What he later called "the peculiar life of the asylum" constituted the remedy.
In the 1870s there was less of a need to justify psychiatric institutions and the existence of psychiatrists, but there was still an ardent debate on what psychiatry should be like.
Much of Roller's book was a contribution to this discussion, if not to say a direct attack on the university psychiatrists and their main exponent Griesinger.
In fact as far as the general political influence was concerned, Roller, who had successfully fought university psychiatry in the 1820s and 1830s was now, some decades later, on the losing side.
Roller's views were directed against Griesinger Griesinger's famous claim had it that mental illness was a disease of the brain.
He also accepted some of Griesinger's conclusions, for example, that doctors should be the ones to deal with mental illness.
Disagreement began when Griesinger implied that psychiatry was a medical speciality like others; for Roller it was something more than that.
Griesinger 61 arrived at a range of propositions concerning political, practical, architectural and legal aspects of psychiatry.
Roller disagreed vehemently with most of these and saw them as a consequence of that true, but unluckily narrow definition given by Griesinger.
Speaking of the fact that the majority of doctors understood IIdiseases of the soul as diseases of the brain", Roller made the following differentiating statement: It is not the mistake of the doctors that the term diseases of the soul is not explained fully by this: it is the nature of these phenomena that there are additional aspects which the usual nervous diseases lack, and that their knowledge and treatment is something peculiar.
Without taking into consideration these additional aspects there is no diagnosis and no therapy.
It is true that by calling the disorders of the soul diseases of the brain, we do indeed speak the undoubted truth, but if we do not know more, it is an unfruitful truth.
How poor would be our knowledge and treatment of certain forms of disorders of the soul, if we stopped at the phrase that they were merely diseases of the brain and the nerves!
Psychiatry should be a fully accepted medical speciality, but also only a medical speciality.
Therefore psychiatric patients should be treated in clinics that were within general hospitals, as other medical clinics, too.
The main goal of these clinics was to serve as a place of scientific research as well as providing teaching facilities for students.
They would subject patients to a medico-scientific treatment indistinguishable from that of other medical specialities and offer the same type of ward-round teaching.
Admission rules for psychiatric patients were to be the same as those for other medical patients.
These clinics would aspire to a high turn-over in patients in order to ensure varied teaching with patient demonstrations.
It is not difficult to see why Roller disliked Griesinger's vision of psychiatric university clinics - they were basically a serious threat to the asylums, effectively resulting in a degradation of the asylum.
The argument that psychiatric patients should be treated in the same way as medical patients was in Roller's eyes not practicable because he did not think they were the same.
Griesinger seemed to argue against the specialness of asylums and their peculiar characteristic of curing through isolation.
As far as Roller was concerned, Griesinger's suggestions carried the direct implication that the asylum was really a superfluous institution and he wrote sneeringly: In fact one hardly understands why asylums should be constructed in the first place and why the majority of patients should not be treated in their families like those patients suffering from nervous disorders.
His central claim was that the asylum was the remedy.
The asylum was a place of isolation.
It has been convincingly argued that there 63 were several factors behind the principle of isolation, for example: modern enlightened society distances itself from socially nonintegrated elements, and moral arguments such as those of Rousseau saw un spoilt nature as a major healing force.
Most arguments for isolation at the time originated in the views of Pinel and Esquiro!.
The latter in particular was extensively quoted by Jacobi, who was probably the most important German psychiatrist of the early 19th century.
Isolation, they pointed out, implied the removal of the patient from the damaging environment which made him go mad.
By putting him into a different surrounding, new ideas originated and order and new habits would be restored on a different leve!.
The asylum would become a place that offered such a special, healing atmosphere: It is not enough to take the patients out of their usual environment.
The new environment into which they are brought also has to be such that it fu rthers their treatment and cure.
The characteristic life in the asylum is an important help here.
All these were general characteristics of early 19th century German asylums.
The IIlenau was seen as a model, because it excelled in all these points.
It was during those years that first courses and detailed instructions for nursing personnel were drawn up.
They should be kind and tolerant, should not beat 6.
This discussion went on for decades before non-restraint was fully accepted in the German speaking world in the 1860s.
Its final acceptance was due to consistent efforts made by the psychiatrist Ludwig Meyer 18271900 and Griesinger, who was converted to it in the second edition 1861 of his famous textbookJ5 At the Illenau, too, the principle of non-restraint was put into full action during the 1860s, during the time of Krafft-Ebing's stay and partly due to his personal efforts.
Another important aspect of the humane treatment of patients that was much discussed at the time was the standard of the food.
The hazards of a one-sided diet were known and a need for fresh vegetables was emphasised.
Most physicians stressed the need for some meat, but too much animal food was seen as a stimulant, the latter principle particularly important for the various "nervous" diets in mental institutions.
Once more the Illenau did very well compared with other institutions: it was praised for its healthy food based on fresh home-grown vegetables.
It was the healing effect of an ordered, highly structured, large family that was seen as crucial.
This led to a strong feeling of community on the part of both the patients and the staff the latter were, of course, living on the premises.
The Illenau was 65 a home in the broadest sense of the word and this shows not least in the very emotional language used in the Festschriften or the descriptive brochures.
Hergt, the second medical director described his first impressions on arriving at the Illenau in 1842 as follows: This splendid man, who - together with his bosom friend Roller - saw the blossoming of our Illenau as the goal of his life, often described the unforgettable impression of the Illenau where the new arrivals at the portal were greeted by the new building, lit up by the evening sun against the background of proud silhouettes of the majestic Black Forest mountains in the warm colours of autumn.
Even the patients uttered many an involuntary exclamation of delight at the sight of this enchanting landscape and their new situation that appeared so homely compared to their former confinement in the town.
An abundance of facilities provided for them: individually tailored work with set working hours, opportunities to go for "refreshing" walks after their "well-cooked" meals and participation in "healthy" communal leisure activities in the evenings.
The Illenau employed special workmen to teach the patients skills, there were lessons in subjects such as reading, writing, botany and geography the latter two taught by Hergt J9 Billiard and card game evenings were organised for the male patients, there was a proper swimming pool for men, whilst the women limited themselves to footbaths in the " riverbath".
There is a stylish engraving of both these bathing facilities in a Festschrift of 1865.
But the most important leisure activities were the many musical evenings organised and run by talented individuals including a proper music 66 teacher on the staff.
Beck has taken the trouble to count and list no less than 174 musical events of 1867.
Services were held regularly on Sundays in the house-chapel and Christian religion was integrated into daily life adding another spiritual element.
One of their tasks was to bury both patients and staff in the house cemetery - a final rem inder of how deeply the bond to the community went.
Amongst existing asylums, it was one of the best equipped.
It was, however, not only self-contained, but had docslot portal physio links with the outside world, too.
The admiration with which the Illenau as an institution was regarded for many decades amounted almost to a cult.
Heinrich Laehr, the recognised expert on German asylums over many years described it in the preface to his Festschrift of 1892: The Illenau and its method of treating patients has attracted attention not only in Germany but also abroad.
The delightful features of its surrounding countryside, the location in the South of Germany close to the majestic Rhine further the inclination to direct one's steps there.
And then the spirit that pervades the place and is so visible in the personalities working there!
We can openly state that no establishment in Germany has welcomed more enthusiastic doctors than the IIlenau.
Younger doctors would pursue their studies, but senior colleagues, too, would leave increased in knowledge and enriched in their hearts, - to be warmly welcomed back 67 again whenever they felt the desire to renew old bonds of friendship.
The best known personalities from abroad were: Viszanik AustriaBrenner and Lehmann SwitzerlandVerhonteren HollandGoricke DenmarkMajor NorwayFalret, Foville and Morel France and Ray America.
Its intention was to make the life of the asylum in all its aspects public to anyone interested and to this purpose it published open reports on patients in letter form for the sake of their relatives, and as a means of inform ing other asylums.
It is likely that he had met Roller, the medical director, before, since Roller was a friend of his grandfather Mittermaier.
When a German in 1870 went to Italy it always seemed to recall the visits of Goethe, that most famous model of a German tourist to Italy.
Krafft-Ebing had planned to go for pleasure, but - unlike Goethe - he looked less at Italian art and women but instead visited psychiatric asylums.
The length of time a psychiatrist spent with his patients varied, depending on the type of ward he controlled.
Krafft-Ebing was at first given the ward for female care patients.
Krafft-Ebing's contacts with patients and the therapies he applied Since Krafft-Ebing was living in the Illenau he had ample opportunity for social contact with patients.
His way of relating was obviously very friendly: Schule later remembered as typical for Krafft-Ebing's personal warmth that for a while he used to bring a hand-picked flower every night to a hypochondriacal lady patient who said she could not sleep without it.
Krafft-Ebing seems to have been a competent player since he played with the surgeon Billroth in Zurich in the summer of 1863 Billroth was an excellent pianist.
According to Schule, Krafft-Ebing spent whole afternoons in the park in the company of very distressed patients showing the nurses that the new method was practicable.
The taking of histories was particularly important and very diligently performed.
It also led to Krafft-Ebing's main research interest: the hereditary components of mental illness, a research based on the compilation of family-histories.
Therapies were divided into the physical sort - diet, peripheral application of electricity and medication - and the psychological or 70 moral sort both words were used.
Physical therapies that KrafftEbing prescribed for his cases included diet,99 cold baths and iceapplications,100 luke-warm baths, 101 bloodletting,1 02 electricity,l 03 and a whole range of medication such as: quinine, morphium, chloroform, argentum nitricum and different syrups like 01 Jecoris or Syrup Chin.
More specific therapies were also applied and these partly reflected the moral tradition as laid down for Germany earlier in the century.
Reil made innumerable suggestions on how to restore reason in a diseased mind by either arousing feelings like anger, fear, pain or by influencing the psyche by theatre plays enacted by the staff of the asylum.
Schneider worked more with mechanical devices such as draw-bridges which opened up suddenly, immersing the patient in cold water or machines which made him rotate, which was intended to shock the brain into better functioning.
Traces of such treatment ideas can be found in descriptions of patients hospitalised at the Illenau in the 1860s, but they did not 71 seem to playa major part.
Whether this was due to such methods being increasingly perceived as "cruel" is at the very least doubtful it is more likely that they cost too much effort and did not produce sufficient therapeutic success.
The label "cruel" which historians have been quick to apply to such therapeutic attempts and subsequent Illenau-ideas, is absent from the primary texts.
These primary texts show, however, a high degree of awareness of what is ll IIhumane and what is "cruel".
This was highly disagreeable and the expected effect was to heighten selfcontrol of the patient who could thus avoid further treatments.
KrafftEbing used Leuret's douche on a 34 year old woman suffering from a hallucinatory love-obsession.
She had been increasingly bedridden and invalid for many years and finally showed signs of psychosis in particular she heard voices.
Shortly after admission the patient was taken to a far-away ward and left to her own devices.
She was therefore, as Krafft-Ebing put it, given the choice to stay in a cold corridor or else to make her own way back to her bed in the other ward.
The patient started to drag herself along the walls, immediately coming to a standstill when she saw herself 72 observed, but finally reaching her bed.
These experiments were repeated, the patient talked to, and after 8 days at the Illenau she was capable of walking around in the house on her own, at the same time cheering up noticeably.
The patient was thus treated with psychology, good diet and plenty of fresh air from March to the middle of June, at which stage she could be discharged home in good health.
Half a year later December 1867 she suffered a temporary revival of her anxiety and hallucinations, but no paralysis, and these symptoms disappeared within weeks.
KrafftEbing, in 1869, considered the case as cured.
Krafft-Ebing treated a variety of patients at the Illenau.
There were certainly chronic as well as acute cases hospitalised in the asylum.
For example, of the three patients quoted in the medical dissertation of 1864, two had been there for seven, or eight years and one was quoted as having been admitted in October 1863.
Krafft-Ebing also treated children and he published two cases during his Illenau period: one was a boy of 12, whom he might not have known personally since he was hospitalised in 1857, but whose case he wrote up later, and the other was a boy aged 10.
Since the IIlenau extended its activity to home visits in the region for example to patients who had been formerly hospitalised and were then followed upit may well be that not all the patients treated were actually inmates of the asylum.
The most influential of these were Griesinger and Morel.
Some of these books were not only read and digested but also used for practical research on the wards, for example Fechner's Psychophysik led to experiments on the sensibility of patients, which were carried on for years on the wards.
Morel inspired them in two ways: by his stress on the importance and role of blood vessels, and through his ideas on heredity, the latter usually called an anthropological method.
The postulated link between blood circulation and the functioning of the brain confirm. online blackjack winning strategy think a recognised model for explaining psychological functioning.
Clinically, it took the form of observing an increased bloodflow to the head and therefore to the brain, as the reasoning went together with observation of the emotional state.
A patient in a manic phase would have a hot and flushed apperance.
There was also an anatom ico-pathological aspect to the model, based on the observation that the brains of some patients contained more blood than those of others when examined on the dissecting table.
This thought-model was to playa substantial role in Krafft-Ebing's work it was later also important for the explanation of sexual disorders, some of which were for him due to increased circulation into the pelviC organs.
He here followed directly in Morel's footsteps.
The French psychiatrist Morel had first stressed the importance of hereditary factors in the development of mental disease.
His system - that is the degeneration theory with its claim that mental disease got progressively worse over generations - had both a diagnostic and a com cardplayerpoker significance.
His ideas led to a careful compilation of family trees of patients.
Clinical symptoms established in this family history were then compared to the symptoms of the patient.
These included both stigmata physical signs such as misformed earlobes and the exact clinical description of the psychological problem.
Krafft-Ebing spent much time from the start compiling very extensive family-histories.
On the 75 contrary, the impression one gets from Krafft-Ebing's early publications from 1864 to 1869, is that much of his time was invested in a thorough study of the psychiatric literature.
The legacy of the Illenau Krafft-Ebing's later work was to be significantly influenced by the Illenau approach.
Most generally there is Krafft-Ebing's Weltanschauung: his intention to carry out a fundamentally moral - rather than a strictly natural-scientific - enterprise.
The naturalscientific enterprise seems for Krafft-Ebing to have been more of a means to a different end than an end in itself.
This cannot be taken for granted because there existed at the time a psychiatry based on purely natural-scientific principles, that of Griesinger.
In spite of his indebtedness to Griesinger Krafft-Ebing would never have considered himself to be his disciple.
Characteristically the young Krafft-Ebing was influenced by two psychiatric models that were incompatible in many ways, those of Griesinger and Roller.
His later work represented a convergence and development.
In keeping with the general development of psychiatry during the century, KrafftEbing's work was about "scientific psychiatry" - at least superficially.
Underlying this, however, was a distinct moral model and a conviction which he did not question- at least not publicly.
There is a distinct discrepancy between the paradisial world of the IIlenau with its idealist vision of lunatic cure and care, and KrafftEbing's later specific interests that included the sodomists and necrophiliacs of Styria.
In his sexual case-histories Krafft-Ebing 76 always maintained a descriptive style, but he was, of course, far from value-free.
The moral judgments he made simply remained hidden.
Krafft-Ebing's own private asylum on the lines of Illenau, named Mariagrun, in Graz, is described in chapter 3.
It is a practical expression of his continuing interest in this kind of psychiatric care.
One can, for example, hardly imagine that a Griesinger, Meynert, Kraepelin or Wernicke, who were all involved in a more abstract kind of psychiatry, would acquire a small private asylum.
By contrast Krafft-Ebing did just that, and his ability as well as inclination to do so was a direct legacy of his Illenau days.
Lastly, Krafft-Ebing's training at the Illenau later showed in his approach to patients.
The same attitude to patients - called "individual case-approach" - also had its reflections in Krafft-Ebing's many written and published case-notes.
Schule called this attitude slightly defensively a "method" and claimed that it was something specific which he and Krafft-Ebing had learnt from Hergt at the IIlenau: Here the method of his work received its direction by the traditional way of observing the patient: not to neglect even the minutest symptom, to evaluate each psychological and physical symptom, to capture the inner causality of psychological events through frequent history taking, to always attempt to link the psychological condition to the physical in order to arrive by way of strict induction at a comprehensive clinical picture, which does not stop at a classifying general diagnosis, but rather tries to explain the case through its individual features.
This is a method which was above all used by our honourable Hergt.
Today 77 this method and the strictly individualising approach to patients appear self-understood after they have been commonly accepted - but then, at the beginning of the 1860s, these were pioneering ideas.
These cases were used in different ways: they appear, for example, as mere figures in statistical arguments.
They would be fairly extensive, on average taking up the equivalent of two pages normal book size, normal print often the cases are, in fact, printed in smaller print.
The patient's name or initials, age and current occupation are followed by a brief family background, including those members of the family who had a psychiatrically relevant docslot portal physio such as melancholia or alcoholism.
Somewhere in the case notes, usually at the beginning, there is a precise admission date or date of consultation.
The personal history is followed by the reason for the patient's hospitalisation consultation.
Then there is a description of how the patient appeared psychologically and physically to Krafft-Ebing: some of the patient's statements are usually quoted verbatim.
Where applicable the therapy is given and a summary of how the case developed.
In many, but not all the cases that died, the report ends with a summary of the findings on dissection.
This format sounds so very logical in many respects today that we have a difficulty similar to that of Schule in convincing ourselves that it was novel.
However, Krafft-Ebing had a reputation for his case-histories; and by comparing the textbooks of various authors 78 of the time we can see what made him unique.
Older authors such as the French idols Pinel and Esquirol would not render individual case-histories at all.
They would make an abstract point - say draw up a list of symptoms - and then illustrate these symptoms with examples from their clinical experience.
Griesinger used his cases docslot portal physio a similar way - again he would not supply a full story of one particular individual, but produce many anecdotal findings that are obviously based on direct experience gained on psychiatric wards.
The goal of these older textbooks, it seems, was to construct a theoretical framework, to outline a general theory - and then to illustrate it with live examples.
By contrast, for Krafft-Ebing the examples themselves were put centre stage.
Scc als cllapter I.
The quote itsclf was unurigillal :llld has also bcen attrihuted to Esquirol scc cg.
ThlTc arc 110 dircct memoirs or letters of the time hy KraITt-Fhillg.
SCl' also rcmarks ill chapter 1.
IS74 Rulkr mentioned an "allack laullchcd agaill.
IIkllau in dell sechs erstcll.
Mit lwei Dildern und zwei Lagepl illell.
Further the contemporary Sl,llutes alld descriptions of the Illenau: Anon.
Statut, Hausordnung, Krankl'llwartdil'llst, Dl'111erKUIIl!
H~il- und Pflegeanslalt Ilkllall.
Mit AIlSiclltl'll 1I11d Pliillell ill 74 DUttern.
I have uSl'd rl'krl.
Fischer 1902 on Roller alld l'lltril's: Roller, Ikrgt alld Schute, ill Kirchhoff 1921124.
Ilknau in lkll -;l'l'lh l.
Dut abllvl' all scc till' prilllary litcr,lturc 7lJ Be c k ILJ H3 p I 2.
Sl'C Szcps 1938 pp 13.
A clear exposition of "humanity" - and tilL: difficulty for society to pay for a sufficient sL:rvice - call hL: found in Krafn-Ebing's description of GhL:el.
SL:L: KralTt-Fhing IX67 I~'ill Besuch in Gheel.
For a general history of the lwn-rL:straint Ilwvelllent in Germanspeaking countries SL:L: the medical-historical dissertation by Gcduldig.
P 367 and Kral'f't-Ebing I X6LJ Se.
It can be added that llthl'r historians l'or example Max Neuburger 1945 saw Reil's therapeutic sllggestiulls as cruel and these were at least for Reil - psychological.
The main point seems to be that as far as therapies go.
Tht: hlbd C eIii ss psyc II opa I holo gie psychopathology bused 011 the fUllction of vessels scems, as far as I can tell.
SchUtc's contemporary summary of the mudd was that "the vasomotor system, which accompanied every emotion n.
~presented the true 'psychic' nerve.
S contailh lll~llly cases where tile results of the dissections arc added.
Tlll'Sl' WL'IT all KralTt-Fhillg's caSl!
S and it is oftl!
Graz 1873 - 1889 : 3 institutions and their patients Introduction Krafft-Ebing was at Graz from 1873 until 1889.
During this period of 16 years at Graz his activities were varied and complex: he was involved in three more info institutions and acted as a clinical psychiatrist for hospitalised and outpatient patients as well as a university teacher.
The three institutions were: 1 Feldhof a large provincial asylum on the outskirts of Graz where Krafft-Ebing was medical director between 1873 and 1880.
The clinic opened in May 1874 and Krafft-Ebing was in charge until he left Graz in 1889.
It opened in 1886 and he continued as a consultant after he moved to Vienna in 1889.
These three settings differed considerably in their explicit goals, type of administration and the numbers, diagnoses and characters of their patients.
Each therefore posed different problems to KrafftEbing and provided him with different clinical experiences, subsequently reflected in his written work.
This chapter will explore the histories of each of these institutions, their buildings, staff and their patients, because - I suggest - they represent the key to understanding how Krafft-Ebing was trying to shape psychiatry.
On the contrary he actively tried to change things, for example by using faculty politics.
He thus managed to get out of one institution, Feldhof.
He fundamentally changed the second, the clinic, and created the third, MariagrGn.
He tried to get those patients he wanted and actively tried to dispose of those he did not want.
In the language of the time he strove towards "good patient material", a term he used repeatedly.
Krafft-Ebing's https://tayorindustry.com/blackjack/blackjack-card-counting-method.html of a "good" or a "bad" patient, of course, directly links up with his view of psychiatry's goal.
The criteria he used appear to be whether he could publish case reports on them and whether he could use them for teaching purposes, but also whether he could cure them.
Working in Feldhof, a drab and always out-dated country asylum with about 300 beds, was an 86 obligatory duty to be taken on together with the chair of psychiatry.
Its chronic inmates gave him the opportunity to confirm his views on degenerative heredity and to study a large number of forensic problems.
He tried at first to renovate Feldhof and improve the situation, but managed in 1880 to hand the asylum over and concentrate exclusively on his clinic.
This clinic was much smaller, had a greater turnover of patients, docslot portal physio greater variety of diagnoses and medical activity.
He further modernised it by the adding a ward for nervous disorders which catered for many hysterical patients.
The Graz clinic was in many ways the ideal surrounding for KrafftEbing's teaching and research activities.
MariagrUn, his private sanatorium, lastly, was his own brainchild.
It reflected his taste he had a say in the architectural design and his ideas about at least one sector of psychiatric care.
The creation of MariagrUn was, effectively, a means of combining Krafft-Ebing's vision of an ideal asylum a la Illenau MariagrUn was a small Illenau with his increasing preoccupation with one of the most fashionable diseases of the time: neurasthenia.
History of medical teaching and medical care at Graz Graz was a university with little medical tradition.
In spite of numerous attempts at integrating medical teaching it did not possess a medical faculty until device blackjack peeking />The Graz medical faculty, 87 which Krafft-Ebing joined in 1873, was not a place of high prestige at the time.
But the discipline of psychiatry was not particularly prestigious anyway and a psychiatrist might take up a university post in Graz simply because there were few other options.
In addition, Graz, in spite of its barely established medical faculty and its geographical situation very close to Hungary -thus turning it into a cultural and social outpost of Germanic civilisation - could still serve as a springboard to something better like Vienna.
The buildings were built onto an old cloister and numbers of beds ranged from 80 for the general wards to 55 for the orphanage to about 35 for the madhouse.
Subsequently, numbers of mental patients started to build up around the turn of the century: the initial ward of the general hospital had consisted of 35 beds in 1788; by 1819 there were over 100.
But within this development Sty ria and its capital Graz was lagging behind, even compared to the 88 rest of Austria where asylum-construction began later than in, for example, Germany.
Under the pressure of increasingly overfilled wards and the deteriorating conditions of care, the local health authorities were finally forced to react in 1827.
Their first attempt to solve the problem of mental care was the acquisition of the Rockenzaun'sche Hauser, a formerly aristocratic private residence in the middle of the town.
These buildings catered for about 150 patients and served as an asylum till as late as 1872 - increasingly badly, since patient numbers continued to grow.
The construction of a proper, separate, mental asylum became steadily more urgent and was finally agreed upon by the local government in a Landtagsresolution of 19th February 1863.
Much of the initial optimism had vanished and asylums started to degenerate into stagnant custodial places fighting an increasingly hopeless battle against the overflow in incurable patients.
Plans were changed repeatedly, the initial building site was dropped as unsuitable, new explorations conducted and construction works finally began at the end of 1871.
Johann Czermak was offered the post of medical director and moved to Graz to oversee the work.
Unexpectedly he died in July 1872 and Dr Koestl, the retired director of the Prague asylum, had to take over.
It was under him that Feldhof opened its doors - unofficially and rather dramatically: in December 1872 a variola epidemic hit Graz and the now 200 mentally ill, living under totally unhygienic and hopelessly overcrowded conditions, had to be transferred in an emergency action into the unfinished buildings.
Inadequate buildings and patient is blackjack a zero sum game Not only the beginnings of Feldhof were difficult.
It soon became apparent that the buildings were outdated and misplanned from the start.
In its architecture it followed the style of Brno Brunn in Moravia, built in 1863: like that asylum it was intended to cater for about 300 patients housed in different pavilions.
There is no detailed description of Feldhof and no plan of its original shape: the only available plan, published together with a picture of the asylum, shows Feldhof at a later date before 1912, no date given and already considerably enlarged.
The main problem was the miscalculation of space needed, but there were also problems with the character of the wards.
Feldhof had opened with 203 patients in 1873, but by 1880, the last year of Krafft-Ebing's directorship, it had 516 patients, and n umbers increased steadily with 310 new admissions but only 248 patients discharged by referrals or death that year.
The first of these was Lankowitz 1877 for 120 women, followed by Kainbach 1883 for 100 men, Hartberg 1887 for 30 men and 30 women and Schwarzberg 1892 for 200 patients.
One of these modern tenets was to refrain from using restraint such as straight jackets.
In Feldhof there were only 4 isolation cells, which proved to be far too few and - initiated by Krafft-Ebing and followed up by his successors - more such isolation wards were added over the years: 2 wards containing 34 cells in 1882, increased to 74 cells by 1888.
In addition, Feldhof was far 92 from providing a healing environment: it lacked all the facilities that other, better asylums - like the Illenau - were so proud of, such as a park.
There were also insufficient baths - and warm baths designed to calm patients were at the time one of the few therapeutic interventions possible.
Such architectural mistakes in size and character may have partly been due to misguided optimism as to the type of asylum actually needed; partly they may reflect the simple fact that Styria had not enough public money to invest in its healthcare.
In summary, Feldhof was too small, too outdated and insufficiently equipped for modern psychiatric care of the time.
In addition, as the main asylum for Styria, an area underserved with psychiatric beds, it could admit only the most disturbed patients.
Krafft-Ebing at Feldhof Krafft-Ebing started his job as medical director at the end of May 1873 and resigned from it at the end of October 1880.
His tone was bitter and even he, whose style was usually very factual, resorted to satire and polemic.
Ein Nothstand The state of psychiatric care in Styria.
A crisis - written shortly before he managed to retire as medical director, he concluded that Feldhof could only be used as a careand not a cure-institution.
It was therefore not living up to its original purpose and ought to be replaced by a new asylum.
Whilst it cannot be denied that the very simple architectural design of this asylum could well serve a masscatering of chronic, mostly incurable patients, it is hardly suited for an institution aiming to cure.
All the above mentioned categories of patients cannot safely be kept in any other ward of the asylum than the isolation ward, since the building is designed for an open style of care.
In addition there is a further https://tayorindustry.com/blackjack/myvegas-blackjack.html those patients who are only temporarily excited and are then not tenable in a quiet environment because of apologise, 21 blackjack chart very, noisiness.
They also need to be referred to the isolation ward.
This ward, already overfilled with screaming and disturbed individuals, is not contributing at all towards calm ing these potentially curable patients, on the contrary it vvorsens their condition if not rendering them incurable.
He had probably accepted his position at Feldhof in the first place because it was the only available opportunity to get a lectureship in psychiatry.
At the time one had to be the medical director of some asylum in order to be a professor, because the patients were needed for demonstrations during lectures.
The patients There exist in print several tables with patient statistics of Feldhof referring to the years 1877 and 1878.
These are of interest because they contain information which backs up Krafft-Ebing's opinion and which merits further analysis.
Since there exist similar tables for the other two institutions explored - the clinic at Graz and MariagrOn - it is also possible to compare these institutions.
The tables presented here show the following: 1 2 3 4 5 6 total of patients and outcome of their treatment age of patients length of stay diagnoses of admissions diagnoses of exits reasons for admission 95 The first three tables are numerical, whilst the last three describe the type of patients cared for or rather: they contain the contemporary psychiatric judgements on these patients.
All six tables were compiled by Johann Zach, at that time first assistant to Krafft-Ebing at Feldhof, and published in the Jahrbucher fUr Psychiatrie.
Methodology All information is Zach's but the tables have been graphically adapted, in order to simplify and clarify them; in particular I have added percentage figures printed in bold font.
Although technically speaking the tables are Zach's, I think it justifiable to treat the information as reflecting Krafft-Ebing's opinions.
It is unlikely that he, as the medical director, would have allowed his assistant to publish official statistics with which he disagreed.
Diagnostic categories used vary widely between Zach and others and so some caution is advised.
Zl 266 678 190 222 412 126 129 255 19 38 57 22 25 47 38 23 Β§l 36 27 63 228 667 1878 The ever-increasing total of patients has been discussed above.
The statistics for the years 1877 and 1878 showing increases of 20 1877 and 27 1878 bear out this point.
The average increase per year in the four years between 1873 and 1877 was higher at more than 40 patients a year, and the subsequent increases were even higher - 77 patients in 1879, and 62 in 1880.
The table shows a relatively stagnant flow of patients with 60% of those cared for already in the asylum at the beginning of the year.
This will be compared to the more dynamic clinic below.
Of the 266 228 patients who left in 1877 1878 - which corresponds to 36% of all patients cared for - more than half showed no improvement or died.
The overall death rate was 10 % in 1877 and 9% in 1878 but may have been as high as 16% in 1873.
It is not totally clear whether this corresponded exclusively to the category "cured" used in these tables or to the sum of "cured" and "improved".
The contemporary opinion was that there were more women in asylums as a rule; this was explained by the longer life-span of women rather than a higher morbidity.
Less than 6% were under 20 98 with less than 2% children under 15 and Feldhof was definitely not over-aged with less than 5% only over the age of 60.
It was not unusual to hospitalise children in asylums, but it was not numerically significant.
The high death rate can not be explained by old age, as so few patients were over 60, but must be explained by the nature of the conditions treated.
Note that the patients listed here were those who left Feldhof, either by being discharged 26% or because they died 10 % - we are therefore only dealing with a third or 36% of the patients cared for.
The remaining two-thirds who stayed, clearly stayed longer.
In other words, an average of 145 of 673 patients cared for - that is 22% left the asylum within one year with only 16Β°0 leaving alive.
These figures confirm the chronicity of the asylum.
The highest difference in gender distribution was in paralysis.
By contrast, more women than men were diagnosed as manic and melancholic with an especially significant difference in melancholia.
Although the figures vary too much between the two years described to allow for general conclusions as to diagnostic differences between in-coming patients and those leaving the asylum, it should be noted that within the categories mania, paralysis and epilepsy a roughly equal number of patients were admitted and also discharged.
This means that the diagnostic categories were used in an inflexible way - once diagnosed a manic, always a manic.
Mania, the tables indicate, had a high curerate, so many patients would be discharged under this label.
Paralysis, too, was a diagnosis which was given once and for all, but in this case the most likely outcome was death.
On the whole, however, the tables show very similar figures for admissions and exits.
This indicates that theory and practice were not identical.
Krafft-Ebing's theoretical text gives the impression that the process of diagnosing patients was a rational enterprise based on the actual clinical picture displayed at any given time.
For example he said that the end result of mania was agitated dementia and the end results of both melancholia and fits of rage was an 101 apathic form of dementia.
The figures seem to indicate that diagnostic activity was almost as unchanging as the potential fate of the patients.
Ollt the gender differences.
That more than a third of all admissions were - in Krafft-Ebing's view - caused by heredity, is yet another indication for how prominent degenerationist thinking was in his model.
Unfortunatly, in view of Krafft-Ebing's specific interest in sexual factors, the category https://tayorindustry.com/blackjack/blackjack-wahrscheinlichkeitstabelle.html here is combined with alcohol which was also very frequent at the time.
This may be interpreted as modesty.
It is probably not the result of sloppy history taking, since the many printed case-histories demonstrate how much effort was put into finding out possible reasons for the illness.
Most likely this high percentage of "not-known" was a reflection of the already established chronicity of patients at the time of admission.
Questions asked could no longer be answered either by the very deranged patient or by his relatives, who would just report that the patient had been like that for a long time.
Only seriously ill patients were admitted and 10 % of all patients died.
But from the point of view of managing the asylum, it was worse in that it was a very stagnant place.
Of a total of 673 patients average 402 or 60% were more or less chronic and changes only occurred with the remaining 40%.
The fate of these 40% was far from positive; most of them left the institution either unchanged or dead.
As for the 60% of chronically ill patients, only a few facts may be derived.
Since the table with patients' ages relates to the whole of the asylum population, we know that they, too, were not over-aged.
However, they cannot be categorised diagnostically from the data given.
Lastly the many criminal lunatics, also mentioned by Krafft-Ebing in his description of Feldhof, are important here.
They were sectioned to the asylum after their crimes which had been committed - in the eyes of the psychiatrists - under the influence of mental derangement and that could mean any of the used 6 diagnostic categories.
Many of these patients may well have recovered from their temporary condition, but still had to be locked up for the rest of their lives.
Since they stayed on, they may distort the statistics significantly.
Hence the asylum fulfilled the role of a prison and a major part of its custodial nature was due to this category of patients.
The deeper and sadder irony, of course, is that it was Krafft-Ebing's personal interest in forensic psychopathology that presumably got him involved in such a disproportionately high number of cases of criminal lunacy.
Although technically speaking he did not section these people to his asylum, he wrote the forensic reports which resulted in their getting sectioned.
He must thus have created in Feldhof a daughter institution to the main prison in Graz.
The psychiatric clinic In Graz When in December 1872 the 200 read more ill of Graz had to be transferred learn more here the not yet finished Feldhof asylum, their former home, the Rockenzaun'sche Hauser became empty.
These houses were initially turned into a ward for obstetrics, but later 24 beds took on the status of a psychiatric clinic, also called a psychiatric observation ward.
This psychiatric clinic opened on 2nd May 1874.
This clinic, in other words, was an entirely different practical set-up from Feldhof: there were far fewer beds and the ward was part of the general hospital of Graz.
The medical staff here consisted of Krafft-Ebing and two assistants.
The first assistant was Hugo Gugl, 105 who was docslot portal physio there in 1880.
From 1886 Gugl - together with one Dr.
Stiehl - was in charge of the private sanatorium Mariagrun.
He was also later to edit the last revision of the Psychopathia Sexualis.
Focusing first on the psychiatric ward only: the ward consisted of 39 beds occupied at the beginning of 1886 50 at the end of the year and had a considerable turn-over, given that 883 patients hospitalised patients plus 844 admissions went through Krafft-Ebing's hands during that year.
Although there was a gain of 11 patients, this looks much less dramatic click to see more the situation at Feldhof, since with 833 exits the figures distribute more evenly.
Also the increase in beds over the years was not comparable to the situation at Feldhof.
The main statement of the table lies in the different outcomes of those patients that left the psychiatric ward: it shows that Krafft- Ebing's patient population was remarkably ill.
Of the 883 patients treated, 362 - or as many as 41 % - remain specifically non-cured; an additional 4,1 % die.
This figure is still exclusive of the 15% who get referred to other wards of the hospital.
There is a theoretical possibility that they were patients on the mend, but it is more likely that docslot portal physio were not.
This leaves a success-rate in about a third of all patients seen cured and better: 299.
We do not, of course, know how and by whom Krafft-Ebing or Fossel?
On the other hand the same labels were used for other wards of the hospital and we therefore gain a comparative impression in any case.
In 1886 the whole hospital, which consisted of 10 wards, had 504 patients and 8,429 admissions, thus catering for 8,933 patients.
The 10 wards ranged in size from 9 beds for gynaecology to 117 for surgery; Krafft-Ebing's ward with its 39 to 50 beds was somewhere in the middle of the range.
The outcome of patients' treatment for the whole hospital was: 68% of all patients get better or are cured - if the psychiatric ward is excluded the success-rate goes up to 72%, i.
The psychiatric ward is, in other words, pulling the hospital statistics down as far as cure is concerned.
The inhabitant of Graz who was suffering from any medical, surgical, dermatological or other condition that had brought him into hospital in 1886, had a statistical chance of 3 in 4 to come out cured, and a 5% chance to remain uncured.
All this looked very much dimmer once he set foot into Krafft-Ebing's clinic.
He or she, did however, have a higher chance of surviving the experience than his friend on a medical or surgical ward.
Death-rates for the whole hospital were: 6% - without psychiatry: 7% - and for psychiatry see above : 4,1 %.
Psychiatry was less of a lethal discipline than some: the big killer was internal medicine with 12% 3 different wardsbut not surgery, which had a death-rate only slightly higher than psychiatry 4.
The safest problem to have was an eye-disease 0.
Although his psychiatric clinic was dynamic in terms of patients' flow, only a third of these patients showed any improvement.
Fossel's statistic carries on with a breakdown into diagnoses.
There is a list of 73 diagnostic categories into which the 883 patients of 1887 fall.
These diagnoses are, of course, very different from Zach's for the patients at Feldhof.
Not only are there - with 73 instead of 6 many more categories, but they also differ in character from those used by Zach.
Unlike Zach's, Fossel's labels do not correspond to the psychiatric textbook classification of the day, in click to see more they are different from Krafft-Ebing's terminology.
The impression one gains is that Fossel used more old-fashioned terms which were 109 presumably still valid currency for hospital statistics, but which did not reflect contemporary scientific opinion.
For example, he used the term IIvesaniall frequently, a term rarely used by Krafft-Ebing and others.
The table is moreover simplified; for example, I have only given totals of patients, irrespective of gender.
Hysteria is then closely followed by dementia paralytica.
It certainly is by definition of the table a disease vvith a relatively high mortality and a distinctly high rate of incurability, which, of course, fits the later description.
The clinic, as becomes apparent from this example, functioned as a passing-through ward: patients with dementia paralytica did not accumulate in it at all, but rather were discharged; not within the hospital in this case, but we know from Laehr's description that they were referred to Feldhof.
But the cure may have been shortterm.
Whereas paranoia and at least one of the vesanias seem to belong to today's domain of psychiatry, many diagnoses on Fossel's list would be categorised as "neurology" today.
Some of these are beyond the cut-off point here because they were infrequent, and included labels such as "paralysis spastica spinalis" or "paralysis nervi facialis" further divided into occulomotori, hypoglossi, median i or "para - mono- and hemipareses".
These are diseases which relate to peripheral, anatomical nerves as opposed to nerves in the abstract.
This shortened table makes them look less frequent, because they were diagnosed within a more precise system than mental illnesses.
Vesania was presumably an umbrella term full of distorted thinking in combination with unspecifically mad behaviour - all of which was gathered together under this heading.
Certain diseases showed a typical gender bias, above all hysteria, which was almost by definition a female disease - with 80 women and only 4 men.
In the case of alcoholism and related problems like delirium tremens the reverse was true: 49 men and 2 women; other diseases showed a balance, such as paranoia: 32 men and 28 women.
Laehr's description of the clinic in 1880 expressed in words what the figures have shown: The observation ward accepts delirious and psychologically excited patients of all sorts from the other wards of the hospital.
It serves as an observation ward for individuals of Styria, whose mental condition appears abnormal.
It also serves as a cure-institution for acute psychological disorders, as long as the duration of these illnesses does not exceed two months.
Patients who are chronically mentally ill are admitted to the provincial asylum.
The university clinic is linked to this observation ward both by sharing the same rooms of the hospital and also by being under the same director.
The professor is allowed to use the patients for teaching purposes.
For those patients used for teaching, the educational fund will contribute towards daily care by paying 33 Kreutzer per day into the fund of the country Styria.
By contrast Feldhof as an asylum fell under different and incomparably more complicated 1 13 admission rules.
Asylums obeyed elaborate legal regulations and clinics - at least some clinics - did not.
This was also the case for patients who would have liked to undergo treatment voluntarily.
It always took a minimum of several days to admit a patient and often considerably longer up to 6-8 weeksand this was heavily attacked by contemporaries.
For example, Kraepelin pointed out that the accepted goal of starting treatment at an early stage of the illness was made impossible.
These bureaucratic formalities were not only tedious but also circular because they did not necessarily involve a second opinion on the patients, but the certification written by one doctor was sent round to different offices for adm inistrative stamps.
The medical concern was, of course, that by the time the patient got into care, the situation had deteriorated and not much could be done.
By contrast admission to clinics was a matter of few hours.
Krafft-Ebing commented positively on these rules at Graz clinic in a later article written at Vienna, in which he stated that there had never been any difficulty with either the public or government officials arising out of lack of rules at the clinic.
Similarly, Krafft-Ebing repeatedly commented on problems of administration.
For example there was a publication on Feldhof, which came out of a speech delivered to the society of psychiatrists in Vienna during the session 25-27th July 1878: "Ueber Nutzen und Ausfuhrbarkeit der eigenen Regie in osterreichischen 114 Irrenanstalten.
Feldhof was not one of these asylums, unlike, for example, the Illenau.
Feldhof's governing body was the Landes-Ausschuss fUr Steiermark apparently a regional section of the department of Health and there was a OeconomieVerwalter economic administrator in Feldhof.
KrafftEbing's publication was an attempt to change the administration of Feldhof.
Krafft-Ebing started to lecture at Graz in autumn 1874 as an extraordinary professor and was then made into an ordinary professor in 1885.
He was only the second professor of psychiatry after Josef Czermak who had held the chair from 1870 when it was created until his death in 1872.
After 1876 Krafft-Ebing was able to teach more centrally, in the observation ward.
In the early 1870s we know that it served for clinical demonstrations taking place once a week and that there was a two months ' course in psychiatry on offer for future doctors, for example those who were writing a dissertation in psychiatry.
When Wagner-Jauregg had taken over from Krafft-Ebing in 1889, he still took his students out to Feldhof several times during the academic year.
Writing in 1890 and looking back on article source experiences in Graz, Krafft-Ebing mentions that he had demonstrated over 3,000 patients during 17 years of clinical teaching including Strasbourg.
Unlike classical asylum psychiatrists, Krafft-Ebing did not believe that this practical teaching did any harm to the patients but stressed that it was not a good idea to take the patient's history in public and said that students sometimes had to be warned with a "risum teneatis amici" not to laugh about a funny situation.
Most importantly he believed that the demonstration of chronic patients and of the whole course of their illness, was crucial in order to depict clinical reality for the students.
This was, in effect, a defence of asylum teaching, or at least presents an attempt to counter-balance the fashion to demonstrate acute patients only.
MariagrLin The third institution Krafft-Ebing was involved in was his own private sanatorium Mariagrun.
This was very different from Feldhof or the clinic.
The history In 1884 Krafft-Ebing approached his former assistants Hugo Gugl and Anton Stichl with the idea, apparently born a few years earlier, to found a private sanatorium for nervous disorders.
In spring 1885 construction work commenced on the main building, a house of more than 20 rooms in the style of a small renaissance castle.
In practice this meant that the rooms were high and spacious, the corridors generous and that there was a system for ventilation as well as a modern central heating system.
All in all there were 26 rooms for 40 patients, plus several common rooms: a dining room, a music room, a room for conversation, a reading room and a billiards room.
The first of these is a short commercial brochure published by Gugl, Krafft-Ebing and Stichl shortly before the sanatorium opened: Prospect des Sanatoriums "Maria Grun" nachst Graz, 1886.
The second is a more academic publication by Gugl and Stichl summing up their experiences after five years at MariagrOn: Neuropathologische Studien, 1892.
As well as talking about various aspects of neurasthenia, Gugl and Stich I also published patient statistics of Mariagrun.
The publication had both a propaganda and a commercial purpose and was written in the hope of convincing other doctors of the importance of sanatoria for nervous disorders.
Mariagrun served as a haven and idyllic retreat from the world for those who could financially afford it and were not too ill; those who were seriously ill, especially in such a way that others might take offence, were expressly excluded.
Patients were considered after forwarding their medical history and promising to stay for a minimum of two weeks.
They were then screened before admission and over time probably with increased demand admission became more selective.
There was the healing effect of nature and the peaceful and spoiling environment of the blackjack tip />Contacts with difficult relatives were forbidden on the premises and generally the patient was shielded from all demands and possible worries.
As Gugl put it "they were of the opinion that a copious diet should be the rule, and would in any case be less harmful than the enthusiasm for a light dief'.
Krafft-Ebing and his assistants merely argued in tandem with authors like Mobius, Eyselein, Holst - that is the Germanic Beards - who all saw diet as a crucial part in the treatment of nervous disorders in the 1880s.
The use of narcotica against sleeplessness was handled generously 1 19 and the reduction of morphium in cases of morphium-addiction was done slowly and gradually as opposed to the faster procedure in closed institutions.
This global permissiveness was however balanced with distinctly strict house-rules, which were seen as an integral part of therapy: From the very start the patient has to be relieved of the burden to make the right decision - he has to learn to subordinate himself.
Particularly valid for this purpose is a set of functional house-rules, which is often resisted at first, only to be praised and warmly defended later after some battles when its benefits have been recognised.
Some will never see the value of such cumbersome rules, because they do not fit their indolence and habits.
Thus a constant battle must be fought.
This is how the patient finds support in a protective scaffolding till he can re-find himself.
At a later stage some even need a weaning off from tutelage after one has thus spent much and intense time with them.
In view of Freud's later invention of the "talking-cure" it is interesting to see to what extent talking is here already advocated.
Not only are patients recorded for statements such as IItrust has loosened my tongue, which gave me enormous relief", but there is also some theorising about verbal, cathartic communication.
Rather the ability to talk as such was seen as a diagnostic sign.
Unlike the melancholic patient, who is shy, secluded, hostile towards the doctor, the neurasthenic patient seeks conversation and because he has the ability to trust, he feels comforted as a resultJo The patient's prognosis - we read between the lines - really depends on his own will-power, but also on his ability blindly to trust the doctor.
This latter is an outspokenly passive process: one patient characteristically improved after she became more amenable to psychological treatment - and the causality is thus expressedJ' In keeping with this model Gugl in his conclusion deplored the fact that often not even youngsters, who should still be formable and impressionable could be healed these days because ".
By 1892, the time Gugl and Stichl were writing, hypnotism had certainly been used in Mariagrun - successfully according to Gugl - and in aid of re-enforcing medical power: We see ourselves as pupils of Bernheim's school.
It is only to be deplored that in many cases where autosuggestions are overpowering, suggestive influence is made very difficult.
But if, with patience and persistance, we achieve nothing but a deepening of the subordination under medical authority there is already obvious benefit.
We have to thank 73 suggestion therapy for numerous remarkable successes.
In addition to the use of his personality the doctor had a number of more specific remedies up his sleeve.
These consisted of various 121 pharmaceutics and physical treatments.
Amongst the latter there was the use albeit to a modest degree of massage and a whole variety of different baths.
Baths cost extra and were advertised in the brochure, which listed six different versions: full, warm bath with laundry and service; half-bath; sitz-bath; rubbing-down; packtreatment and electrical bath.
All information is Gugl's he is the author of the relevant chapter but the tables have been adapted graphically.
The only case of death is, incidently, carefully explained in the text and occurred in a relativethe mother of a patient, who very much insisted on staying in the sanatorium.
The woman was diagnosed as hysterical, tuberculous and as dying of a lung oedema.
Aust ria-H LI ngari a Germany Russia Italy Switzerland France England Sweden Belgium Serbia Greece Egypt East-India North America 152 13 21 3 total 203 1 2 3 125 7 13 2 3 1 3 2 2 277 20 34 3 2 4 2 3 1 1 3 3 3 154 357 Mariagrun, it seems, was an international place and there was surely some pride taken in this fact.
Most patients were, however, Austrian with Hungary and given the geographical closeness to what is today Hungary, many presumably spoke Hungarian.
There is no further comment on patients' nationality in the text and we are therefore left to speculate how the more exotic- like the one Greek or the three Egyptians - found their way to Graz.
They must have been attracted by Krafft-Ebing's name.
Krafft-Ebing also spoke of middle and upper class patients in his publication of 1895 when making statements about his private patients generally.
Most importantly it was concrete proof of Krafft-Ebing's interest in neurasthenia, the new and fashionable disease.
Nervous disorders and in particular their subgroup neurasthenia were first described by the American, Beard, in 1880.
Translated into German within a year,82 the topic had an immense influence and was to enlarge the boundaries of the psychiatric professsion for good.
For the German-speaking world Krafft-Ebing was, after Mobius and Eyeselein, one of the first to take up this popular field.
Mariagrun, then, was built in order to put into practice what KrafftEbing had formulated theoretically in his 1885 book.
According to the brochure that described it to the public and that was signed by Gugl, Krafft-Ebing and Stichl its aims were the sentence in bold font is the stress of the authors : The sanatorium, which strictly excludes all mentally disturbed patients, poses itself the task to put into practice what one of the undersigned doctors has recommended in his book "On healthy and diseased nerves" 3rd ed.
Everything will be summoned to render the separation from home and family not too difficult; it will be a place of temporary rest in a wooded rural spot, far removed from the hassle of the worldyet in easy reach for those who need assistance, and equipped with all means for cure and help.
He never forgot his psychiatric training at the Illenau, that model asylum of Baden.
He kept quoting Illenau and referring to himself as its disciple throughout his life and SchOle, at that time medical director of the Illenau, was still his best friend.
In many ways Krafft-Ebing really remained the asylum psychiatrist he had once been.
He believed proper training as a psychiatrist could only take place at - or at least in close conjunction with - an asylum.
That was not quite self-understood given that the teaching of psychiatry had already moved into the universities and that others.
Stuck at Feldhof with its dim success-rate and inadequate facilities that compared so poorly to what he was used to from the IIlenau, KrafftEbing presumably thought back longingly to better days.
Abandoning Feldhof in 1880 meant abandoning a lot of fruitless and depressing work, but it also meant that he now was without an asylum.
The idea of Mariagrun here filled an important gap: although not an exact replica of the IIlenau, which had catered for a broader spectrum of problems and distinctly iller patients than the new sanatorium was to do, there were still many identical features: both places were idyllic and emphasised the healing forces of their environments, the various bathing facilities, the family atmosphere and the many entertainment options such as the billiards-room.
Mariagrun was a small IIlenau for an exclusive clientele.
Krafft-Ebing's private practice Although it is very likely that Krafft-Ebing had a private practice in Graz apart from Mariagrun - and an extensive one at that - it is infuriatingly difficult to find facts which directly prove this.
There may well have been records of private patients, but if they have not been destroyed their present location is not known.
In different places through his work, and particularly in various editions of the Psychopathia sexualis.
Vas no exception to this rule: Krafft-Ebing's direct successor to Graz, Julius von WagnerJauregg, mentioned in his memoirs that he had a private practice, which apparently was quite large.
No figures or other details of these patients are known, but we know that at least 50% of WagnerJauregg's salary was earned with the treatment of private patients.
His public patients were seen at his out-patient clinic in Vienna attached to the psychiatric clinic and called: Klinisches Ambulatorium fUr Nervenkranke im allgemeinen Krankenhaus Wien.
These public out-patients amounted to 4,385 patients in 1893, a figure which is in itself remarkably high.
It meant that Krafft-Ebing, all in all, saw 5,716 outpatients in one year and he also ran a clinic with hospitalised patients!
So the ratio for private: public patients was about 1 : 4.
Krafft-Ebing was an industrious man.
More important here is that not very much time could have been spent with each individual patient.
Of the 128 4,385 public out-patients about 25% were neurasthenic and of the 1,331 Pr ivat epa tie n t s 45 %.
MariagrunI think it most probable that he had such a practice.
The extent of it is difficult to guess: 4 patients per day would probably be too high for Graz in the 1880s.
Krafft-Ebing himself stressed repeatedly - as did most other authors - that neurasthenia was more frequent in big towns such as Vienna.
Nevertheless, the foundation of Mariagrun itself is a strong indication since Krafft-Ebing founded his private sanatorium as a place to which to send his own private out-patients, who needed more intense treatment: In a few years his name literally spread through the whole world, and patients from all countries undertook their pilgrimage to him.
Therefore Krafft-Ebing saw the necessity to found a home for hosting his numerous foreign clientele and thus Mariagrun was founded.
The answers to these problems were sought in the surgeries of psychiatrists into which patients flocked in increasing numbers.
Apart from the sheer number of patients, the difference in percentages of those neurasthenics, who were affluent and therefore private patients, 129 compared to those who were of the lower classes and used the public out-patient clinics, is revealing.
It was, of course, the rich patients, who first opened up a market gap for a new kind of institution - the sanatorium for nervous disorder, or Nervenheilanstalt.
Since Mariagrun, which catered for an exclusive layer of society, was almost certainly a lucrative enterprise, it is tempting to discover in Krafft-Ebing traits of a gifted and successful businessman.
These may well have been there, but it would be misguided to see him above all as an inspired entrepreneur and someone who simply wanted to make money.
The business aspect of Mariagrun must be put into the perspective of his work throughout his life.
Krafft-Ebing was actively involved in Mariagrun from 1886 to 1889 when he moved to Vienna.
During this time he easy rules blackjack card game acting as a consultant whilst Gugl and Stichl were in charge.
We know nothing about the profit made by the sanatorium, nor about how the net-income was divided between Krafft-Ebing and his two medical directors.
Krafft-Ebing seems to have channelled his energies elsewhere; money-making can therefore hardly be seen as the prom inent driving force in his personality and it is more accurate to see him as an overworked doctor and academic.
This view is to some extent confirmed by Krafft-Ebing's statements about the goal of sanatoria.
It appears that he was primarily interested in furthering a particular type of 130 institution with a more idealist vision in mind.
He was absolutely convinced that sanatoria for nervous disorders were both a novelty and a necessity.
It appears that his aim was however not to keep this kind of new sanatorium limited to the rich: rather he suggested that the government should get involved and that such institutions should become more accessible to those with less money.
Spas had fewer doctors per patient and a shorter average stay of patients, and Gugl bemoaned the fact that initially patients had wanted to stay for much shorter periods of time, because they obviously mixed up MariagrOn with a spa.
Mariagrun, it seems, moved into a grey-area between psychiatric care and holiday resort with medical attention.
As a rule they were run by psychiatrists who had also, like Krafft-Ebing, published on neurasthenia at an early stage.
Oscar Eyselein 1847-1892in spite of his involvement with health-issues, died at the early age of 45 because of "long-term morphinism and cocainism".
Valentin Holst 1839-1904 from Lithuania, owned a sanatorium in Riga, Russia, which was opened on 1 January 1884.
He did not attempt to produce a theoretical framework, but simply described hundreds of patients.
The different cases at Feldhof, the clinic and MariagrOn therefore continuously modified his ideas.
From his books it appears that the forensic interest is intrinsically linked to Feldhof, where criminal patients were chronically hospitalised.
Accordingly the extent of Krafft-Ebing's forensic activity gradually diminished after he had left Feldhof.
He began to be involved with very different types of patients and moved away from forensic psychiatry.
This is not to say that he lost his expert status, as he carried on writing his annual reviews, but in his daily life, the topic took up less time.
Where it did, it was in a more focused sense, for example, in his work on sexuality.
On the one hand we are here speaking of nerves in the anatomical sense today called neurology.
On the other hand he met at the clinic many hysterical women on whom he practiced hypnosis and in addition to very grave psychiatric illnesses such as vesania, which were referred to Feldhof, he also got to know neurasthenics.
There are several indications of Krafft-Ebing's growing interest in nervous disorders since the early 1880s.
The timing of MariagrOn as an idea conceived a few years before 1884 coincided with KrafftEbing's struggle to open a ward for nervous disorders as part of his existing clinic.
Putting these two plans together, we get a feel for the direction Krafft-Ebing wanted to go into.
Dealing with very ill and very psychiatric patients at Feldhof and the clinic, he tried to become more of a doctor for nervous disorders and to attract patients who were less ill.
In MariagrOn then, he started to specialise in middle class neurotics.
Krafft-Ebing here certainly, did not practise mainstream psychiatry, but rather saw himself at the forefront of the neurasthenia field.
As in the clinic he had the opportunity to hypnotise.
His underlying model was that worse mental diseases can emerge from untreated neuroses, but if these are treated at an early stage, much prophylaxis can be done.
Thus Klillik meant a concrete set-up and a particular fUllction.
The contemporary literature e.
Laehr I X7 5 P 3Sl also speaks 0 I' Feldhof "being used as a Klillik which hl're purely indicates that its patients were used for teaching.
Of thL' o Ill' wllo has SOllll'thillg spccial if you want to study rare and l'xotic disurdcrs.
Sec Egglmaier 1980 p 1 and passim.
The history of early medical teaching at Graz from the opening of the Ulliversity in 15S5 to IX63 is covered best there ; see also Kronl's IXS6 for thl' ISlth century.
II - 5 Fosscl lXX9 P 47.
Schrenk ISl67 and ISl73 and l3lasius 1980 for Germany.
Porter and Shepherd cds.
Kronl's I XX6 aud Hassmann 1912.
KwlTt-Ebillg I X7tJ Der St.
IS UIlC I ear w Iwt Laellr ,s II.
~ure rei:tles to, cither that the buildings can now catl'r fur 5{ patiL'llts, or this is a figure of actual patil:nts.
By that til11c there were three assistants instcad or two.
Instead, Fl'Idh f 11Iuddkd 011 and underwent considerab1l: changes and reconstructions, as wL:I1 as collaborating with daughter institutions, as has ~dready bl.
See Hassmann 1912 for a history or Feldhur slighlly latl.
Krafft-Ebing's clinic" or tht: like.
Decker's comments 011 this: Ikl'kl.
He qUIlted 4 7~ pat kilts cared for 203 already in the asylulll: 270 lIewly ~ldlllilll'd or blackjack auto san antonio 75 died during 1873.
It certainly n:krs 10 a IllSS Ill" illtl'lkctllal ailities and therefore dellH:lllia is 1101 a had lill.
This is not a n:prl.
What would be needed for an induclivl.
Ihat thl" two statistics are ten years apart.
Riese's article is generally vcry helpful 011 classificalion.
One example or the tl.
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Vienna and the Society for Psychiatry and 140 Neurology' Krafft-Ebing was elected to the chair of psychiatry at Vienna University in the autumn of 1889.
Krafft-Ebing was first in charge of Vienna I and in 1892, after Theodor Meynert's death, followed Meynert on his chair in Vienna II.
Vienna I and Vienna II were two parallel chairs of psychiatry at Vienna University: Vienna I the Niederosterreichische Landesirrenanstalt was an asylum-type institution with 150 chronic patients and Vienna II seen as more desirable was a ward of 40-70 acute patients within the general hospital.
As with his time in Graz, Krafft-Ebing was almost continuously engaged in battles with the adm in istration particu larly over lack of finances and resources.
Vienna I particularly provided little opportunity for cure and its very ill patients were under custodial care.
Daily psychiatric life in Vienna was, if anything, less attractive than in Graz.
The Verein fiir Psychiatrie und Neurologie 4 Initiated by Leidesdorf, Meynert and Josef Riedel.
From the start the Verein viewed itself as an organisation with both a medical-scientific goal as well as an organ to postulate political and practical aims such as the creation of a new psychiatric clinic within the general hospital in Vienna.
The latter goal was achieved in 1870 thanks to the help of Rokitansky who was one of the early honorary members of the Society - and the new psychiatric clinic was opened under Meynert.
Certainly from 1894 meetings were held at monthly intervals on every second Tuesday of the month.
The official protocol of the meetings was published in the newly founded organ of the Society, the Psychiatrisches Central blatt, which in 1879 was replaced by the Jahrbucher fUr Psychiatrie JP.
Krafft-Ebing had been officially associated with the Society since 1887 when he had become a member of the editorial board of the Jahrbucher fUr Psychiatrie.
He started to attend the meetings regularly in autumn 1889 when he succeeded Leidesdorf in his chair at the University.
In 1892 he was elected president to the Verein succeeding Meynert after his death on 31 May.
Krafft-Ebing soon initiated changes designed to an open up the Society towards other disciplines.
Most fundamentally he encouraged a more neurological focus, which was typical for the 1880s and 1890s.
In addition to the official announcement of the meetings in the Jahrbucher fUr Psychiatrie, the sessions were more fully described in the Wiener klinische Wochenschrift WKWa general medical newspaper.
Meetings were held regularly whilst they had been irregular under Meynert.
Figures of attendance at the meetings during these years clearly proved that the Society became more attractive: membership numbers which had been as low as an average of 10 to 12 doctors per meeting in the early 1870s almost doubled in two years from 56 members in 1893 to 100 in 1895.
Figures increased further over the next years, so that there were 150 members by the time of KrafftEbing's resignation in 1902.
These divisions were used, for example, in the annual literature review of the Allgemeine Zeitschrift fUr Psychiatrie.
Whilst there were talks on psychological topics such as hypnotism the majority of talks were increasingly organic 142 and neurological.
This was seen as vital in order to enhance the 143 scientific status of psychiatry.
The meetings usually consisted of 2 learn more here 3 contributions, partly lectures, partly demonstrations of patients, but also of animal experiments or anatomical preparations.
General discussion took place at the end of the evening and sometimes had to be postponed to another date.
German-speaking psychiatrists in the last decades of the 19th century were very aware that there were too many contradictory classifications.
Whether or not it was actually experienced as chaotic by contemporaries as judged by Decker is not easy to make OUt.
But in spite of the classificatory confusion there seems to have existed a methodology behind the definition and re-definition of illness models.
By methodology is meant what seemed to be the general consensus within the psychiatric community of how to go about things.
What was seen as proper methodology can best be studied in Krafft-Ebing's works and in the activities at the Society.
Not only was he - as the established professor - a main representative of psychiatry at the time, but he also shaped the sessions of the Verein to a high degree through his dominant leadership.
He frequently participated in the meetings, both with demonstrations of patients and talks; work done in his clinic or policlinic by his assistants was overrepresented at the sessions; he was a very active chairman.
Throughout his career Krafft-Ebing not only contributed to creating new illnesses as blackjack strategy game the Psychopathia sexualisbut he also had a clear notion about how this should be done.
One main principle was that the process of creating disease categories obeyed a specific chronOlogy.
One could only speak of a disease as opposed to symptomatic descriptions once one had collected a sufficient number of cases.
A good example is his work on the disease category "obsessional disorders", which stretched over many years.
From using the term obsessional ideas Zwangsvorstellungen first in 1867, he moved on to write four articles on the subject 1870, 1878, 1883 and 1892.
This has come out of numerous observations made by me and should also serve as an angle under which to study further observations.
Disease categorisation began by studing cases already described in the literature that had something in common which might serve as a new criterion for classifying them.
Next, one had to start collecting one's own cases and publish these naturally few cases to begin with as illustrative examples.
It was important at this stage that no generalisation was made since there were not "enoughll cases.
Usually some years and much clinical observation later, the stage was reached where there were "enough" cases to make general statements, for example as to the aetiology of the disease.
We are, in other words, dealing with a purely numerical or statistical model of disease explanation: when Krafft-Ebing wanted to claim in the early1890s that tabes is caused by civilisation he did so based on the observation that there were many patients in towns and few in rural areas and he provided statistics to back this Up.
What he saw as a sensible range must be deduced from examples quoted in his texts: figures are usually around 100 observations for a particular disease.
His work on multiple sclerosis, for example, which he presented at the Verein on 10 Dec 1895 published the same year was based on 100 cases; Krafft-Ebing's talk on the aetiology of paralysis agitans, held at the Verein on 14 Dec 1897, quoted 100 cases observed over a period of 10 years published 1898 ; lastly he found a specific aetiology of paralysis agitans in 88 cases and presented this at the Verein on 13 Dec 1898 published 1899.
Quoting only a few cases seemed to be accepted procedure for a frequent illness when these cases were used in an illustrative sense and no general claims deduced.
Examples are his demonstration of two girls with a hysterical tremor at a meeting of the Verein on 10 May 1898,19 or indeed the presentation after Freud's lecture of 15 Jan 1895 of a male patient who had suffered an attack of fear three months previously and who was unable to walk unless he could spot a base nearby.
Krafft-Ebing called this condition Basophobie, a term which did not make much impact.
Krafft-Ebing had seen and published one single case in 1889.
Krafft-Ebing and Freud Freud knew Krafft-Ebing personally for several years and attended the sessions of the Verein regularly.
He played an active part in the Society by becoming a member on its committee in 1895 and giving two talks in 1895 and 1896.
The talk which has been reported first by Freud and subsequently by historians is the lecture he delivered on 21 April 1896: liOn the Aetiology of Hysteria".
Freud felt that he had met with an "icy reception" and reported Krafft-Ebing, who chaired the session as having said: "it all sounds like a scientific fairy tale".
Instead he had enthusiastically summed up Charcot's research on male hysteria, research that was moreover well known to the Viennese doctors he was addressing.
The critical discussion, experienced by Freud as a rejection, was the customary style in the Society.
What happened at the Verein in 1896 can be seen as a parallel experience: again Freud did not comply with the traditional style of the circles he was addressing.
This time it was not so much lack of original work but rather the use of a methodology that he must have known was not acceptable.
It appears that perhaps the main problem with Freud's ideas of those days was not so much that they represented unorthodox views, but rather bad methodology.
Krafft-Ebing's personal acquaintance with Freud There is no positive indication that Krafft-Ebing knew Freud in the 1880s.
On the other hand it is a matter of course that Freud was acquainted with Krafft-Ebing's work: he must in particular have read his textbook, at that time the standard textbook, during his only 148 direct experience in psychiatry, the five months Freud spent at Meynert's clinic in Vienna from May to Sept 1883.
According to the case notes of the Sanatorium Bellevue Krafft-Ebing, who was at that time professor in Graz, visited Bertha Pappenheim once in Vienna around 15 April 1881.
It is at least possible that Krafft-Ebing also met Freud during these years, since Freud and Breuer, who had known each other since 1877, became more intense friends in 1882.
At that time Krafft-Ebing also seems to have been well aware of Freud's special interest in sexuality since he gave him a copy visit web page his Neue Forschungen auf dem Gebiet der Psychopathia sexualis, 1890 New Research about Psychopathia sexualiswith a brief handwritten dedication.
The Freud library at the Freud Museum in Hampstead holds nine books by Krafft-Ebing, of which the six on sexuality contain a personal dedication, the three which do not and which Freud presumably bought for himself are editions of Krafft-Ebing's textbooks.
The dedications, incidently, become warmer over the years from in collegialer Verehrung in 1890 and 1891, to in collegialer Hochachtung in 1892, 1893 to freundschaftlich in 1894.
It is unlikely that the two men interacted over common patients,33 but there is evidence that Krafft-Ebing was positively impressed with Freud1s ideas.
He first quoted Freud in a flattering way in 1896 in an article on hypnotic treatment where he spoke of the sinnreiche Methode ingenious method invented by Breuer and Freud to eliminate the psychological factors in hysterics.
The patient was a servant girl, who had repeatedly been admitted to Krafft-Ebing1s clinic in Vienna and was re-admitted in December1897, then aged 20, suffering from hysterical attacks.
It was discovered only during that hospitalisation that the patienfs hysterical attacks, known since the age of 12 and first occurring after a severe burn with a petroleum lamp, were due to particularly traumatic circumstances: the accident consisted of a big lamp fixed to the ceiling of a theatre, which had fallen onto the child.
We can deduce from the published case notes that KrafftEbing, somewhere between December 1897 and March 1898, tried to apply Freud1s method with the hope of letting the patient relive that dreadful scene under hypnosis and thus cure her of her symptoms.
This was a lengthy and difficult procedure that started officially with Nothnagel and Krafft-Ebing proposing Freud for professorship professor Extraordinarius in February 1897.
Freud mentioned the application in a letter to Fliess and added that Krafft-Ebing and Nothnagel were prepared to go ahead even against the wishes of the other faculty members.
link this Krafft-Ebing and Nothnagel had had to repeat their recommendation and Freud showed himself grateful in a letter to Fliess acknowledging that Nothnagel and Krafft-Ebing "responded wonderfully" to the request of renewing their original proposal.
Apart from giving two talks Freud also contributed to discussions, for example on 28 May 1895 on tabes or on 10 March 1896 on sleeping disease.
According to the statutes the Society was run by ten people of different functions: the president, vicepresident, economic advisor, librarian, two secretaries and four committee members.
Together they managed the financial organisation, elections of new members and honorary members, the programme of the talks at the meetings and had a say in the principal organisation of the journal.
It followed a democratic rule and decided issues with absolute majority in meetings of a minimum of four members.
The management was elected annually by an absolute majority of the members of the Society.
He was elected for several years and this during a time when the Society was flourishing.
Freud's first talk was on 15 January 1895 when he spoke on the IIMechanismus der Zwangsvorstellungen und Phobien" the mechanism of obsessional ideas and phobias published first in a French journal, the Revue neurologique 1895.
In that case the discussion of Freud's paper was to take place half a year later, on 11 June 1895, presumably because Krafft-Ebing was ill in the interim.

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