On polish interwar hospitals
In human consciousness the hospital is a place of immanent presence of death. Despite efforts to marginalise all that is sick, bad and final, it is regarded as a place where life is suspended, where the fates of each patient who crosses the hospital border hang in the balance. Although this image is sanctioned by reality, it also springs from a misty sphere of fundamental questions about death and its ‘elusiveness’; it is equally difficult to define death as a term and the space which it takes within a hospital. On the one hand, the ‘presence of death’ is connected with the rooms where the act of dying takes place, i.e. sick people’s rooms and operating theatres. On the other hand, there are also places where the dead body is placed and all post-mortem rites are performed: the morgue, mortuary, and, in the first decades of the 20th century, often a chapel or a hospital cemetery.
Death is not only always present in the hospital, but it happens there much more often than in everyday existence from which, in the European culture, it is clearly separated. As Zygmunt Bauman states in his Mortality and Immortality, the institution of the hospital is a figure of social practices of isolating death; together with all techniques of taking it away it expresses the same wish to establish a ‘safe’ distance from it. In the hospital the fact of isolation primarily concerns illness itself, and sometimes also death but only as a consequence. Since around 1800, with the gradual transformation of hospital ‘shelter’ into a rationalised healing place, the process of separation of the space it covers has accelerated. Since then two inseparable phenomena: isolation and rationalisation of death have affected the image of hospitals, including interwar hospitals in Poland.
It was at the time of the Second Polish Republic that the most revolutionary changes happened in Poland’s hospital service. The most important process which took place then was crystallisation of the processes of isolation and rationalisation of hospital space. All spaces were designed based on the latest developments in hospital service and sanitation standards. These were partly a ‘heritage’ of the time of the partitions because the 19th century, when medical sciences developed and specialised particularly fast, was the time when Poland was not independent. The infrastructure inherited from the time of captivity was especially well developed in the former Prussian partition. In hospitals in the independent state modern solutions, adapted together with innovations in civilisation, were promoted as a sign of the modern country’s development and care for the welfare of its citizens. In this propaganda illness was not linked with death; conversely, it was presented as a temporary state which could be successfully overcome by means of hospital treatment. The progressive specialisation of hospital institutions determined the practices and means which could be used to separate illness from death. The ubiquitous isolation of the two took different forms in psychiatric institutions, general hospitals and sanatoriums. Looking at them from Bauman’s perspective, the ‘existential anxiety’ inspired by the idea of death was lost in everyday hustle and bustle around health. The means taken to prevent death were supposed to restore the balance which had been upset. That is why the main purpose of the hospital activity which aimed to isolate the two spheres of life was to maintain hygiene as a panacea for all lethal effects of illness. Hygiene meant both preventing the disease from spreading and ‘visual hygiene’, i.e. removing the dying person from other patients’ sight. Contrary to old standards, principles of cleanliness started to be applied even in psychiatric institutions. Contagious diseases which sometimes occurred there had reaped a deathly harvest. The director of the institution in Gniezno-Dziekanka wrote down in his notes, ‘Beneficial hygienic conditions […] bode well so the mortality rate may be expected to fall’1. Preventing suicidal death, common in psychiatric institutions, was supposed to be supported by modern therapy through work and play.
Corresponding attempts to promote ‘visual hygiene’ could be seen in everyday practices of separating terminally ill patients in hospital rooms. That was why in shared rooms deathbeds were screened, which in itself was considered by the other patients as a symbol of the final sentence on a sick person. However, the fictitious separation from death could not protect from the awareness of its close presence. In Szpital Czerwonego Krzyża2 [The Red Cross Hospital] ‘[…] sick people were thinking about the same, about death and the screen which was hiding the last moments of the sick no. 5, the old bookbinder Kwiecień. […] everybody knew that it was Kwiecień’s personal business, and were trying to make it stay his personal business’.
For the very same reason mortuaries and morgues were located in the most remote parts of hospital buildings. In designs for hospitals they were placed solely in basements, as was the case with contest designs for extending the Midwives’ Clinic in Poznań. In the above mentioned 19th century institution in Gniezno the morgue building was located on the edge of the whole complex so that it could not be easily seen. Burying the dead on the cemetery belonging to the institution was a telling sign of the continuity of social exclusion which the mentally ill had experienced already in their lifetime.
The awareness of death was even more vigorously rejected in sanatoriums, which functioned and were perceived as places of relax. Terrifying images of people dying of tuberculosis did not fit in with the quiet lives of temporary residents who were expected to gradually regain full health surrounded by nature. Probably also in Polish sanatoriums it was a common practice, like in The Magic Mountain, to remove bodies of the deceased in the absence of next door inmates. It was only after a while that Hans Castorp noticed the absence of one of the patients, ‘That poor chap Reuter in number twenty-five, whom I saw through the door when I first came, he has most likely long ago been gathered to his fathers, and been spirited away on the quiet. His eyes were so enormous even then.’3.
If the isolation of agony was supposed to hide the undesirable view from the other patients and not to disturb their recovery, the rationalisation of death in hospital, equally characteristic for the interwar period, consisted in securing its sphere in the name of the development of medical science. It was becoming more and more common to establish the causes of the patient’s death. That is why apart from a morgue, interwar hospitals also housed a mortuary. The chapel in turn was starting to lose importance, as it was being gradually eliminated from post-mortem practices towards the body. A key procedure for the development of medical knowledge, performing autopsy started to be regarded as humanitarian activity. Although in everyday life it belonged to the hidden sphere of death, it existed in the common consciousness. One of the buildings of the 1929 General Country Exhibition was Collegium Anatomicum of the University of Poznań. The auditorium of the mortuary served as an exposition space for artists’ works during the exhibition, and after it finished, following the original plan, the building was turned into a place where medical students could learn anatomy. In this way, an art exhibition open to the general public was replaced by an exposition of the human body which served as a research object for scientists. Up-to-date specialist equipment was ordered from Berlin.
Due to progressive developments in medical science and consistent improvement of standards of hygiene, illnesses which had mostly been incurable before, such as influenza, tuberculosis, typhoid fever or venereal diseases, now ceased to be so dangerous. However, the danger was not fully eliminated; the rationalisation of the approach to death, which was a foundation of the new system of medical practices and of the organisation of interwar hospitals, in fact could not (and still cannot) prevent death successfully.
Regardless of attempts at the modernisation of interwar hospitals, the words of the medical orderly, Ignacy, from the above mentioned Szpital Czerwonego Krzyża, still rang true, ‘[…] the sick come to hospital not to be cured but to w a i t i t o u t. Because the period between health and death was limited, as everything, sometimes, the worst time had to be waited out, while medicine’s role was only to help in the wait’ 4. To Ignacy, then, a hospital invariably meant a state of ‘limbo’.
On the one hand, the hospital isolated illness and death from the society; on the other, death was further isolated on its premises. Numerous individual struggles with disease and life threats contributed to the overall image of struggle against death. That is why despite general awareness of death’s omnipresence, Polish interwar hospitals, which followed the principles of modernism, were not places where death completed its work, as in mediaeval shelters, but institutions working a g a i n s t d e a t h.
Translated from Polish by Anna Mirosławska-Olszewska