The aim of the conference was not only to discuss the extent to which clinics contributed to changes to medical care in the largest town and university cities, but also attempt to reflect on the various patterns of hospitals and health care, whether home and community-based or natural and folk healing, that appeared in different places in Central and Eastern Europe during the long 19th century, said ZDENĚK NEBŘENSKÝ (Prague) in his introductory remarks. Moreover, the conference addressed the question of what role imperial, provincial, and local authorities played in the transformation of hospitals and how they shaped life and practice within the walls of the medical institutions.

The first panel devoted to Enlightenment health care policies was opened by IVANA HORBEC (Zagreb) who dealt with new standards of medical practice adapted in the Croatian lands under the Habsburg rule. On the military frontier, the Vienna government financed the health system. It focused mainly on epidemic control and the treatment of war invalids. The proximity of the Viennese military administration attracted foreign medical practitioners to the area. AISTIS ŽALNORA (Vilnius) described how professionals and medical doctors perceived early hospitals in Vilnius at the end of 18th century. He pointed out the intellectual transfer that contributed to the establishment of university clinics, especially Johan Peter Frank and his son Joseph, who belonged to the pioneers of clinical medicine in imperial Russia. MARTYNAS JAKULIS (Vilnius) presented the circumstances surrounding the foundation of the general hospital in Vilnius. The Russian imperial authorities initiated changes in the old system of health care and abolished different church hospitals. However, the case of the Vilnius general hospital followed the health care reorganization that had started already in the late 1770s.

According to INGRID KUŠNIRÁKOVÁ (Bratislava) hospitals founded in Hungary before the mid-19th century operated outside the supervision of the health care administration. State authorities were interested in hospitals only in connection with the regimentation of the mendicant religious orders as a preventive measure against the spread of contagious diseases or in times of epidemics. LUDWIG PELZL (Florence) focused on the microhistory of four urban hospitals in southern Germany that functioned as retirement homes in the late 17th century. Hospitals applied considerable resources to house well-to-do elderly citizens who paid healthy sums for their admission. This offered financial incentives to hospitals and catered to politically important burghers who feared old age in poverty.

In the second panel dealing with maternity and childcare, MARINA HILBER (Innsbruck) presented the history of the maternity hospital and its midwifery school in Czernowitz during the 19th century. The primary purpose of the maternity hospital was the practical training of midwives, who were to improve the standard of obstetrics in their communities. A professionally qualified midwifery teacher provided instructions in the various languages of the multi-ethnic Bukovina region. SVITLANA LUPARENKO (Kharkiv) revealed health care activities of children’s summer colonies, which have existed in the Russian Empire since the end of the 19th century. The summer colonies worked on a free basis or for a small fee and existed in many cities of the current Ukraine. Their aim was to give an opportunity for the weakest children from poor families and to strengthen their health in rural conditions.

Hospital agency was on the program of the second conference day. VLADAN HANULÍK (Pardubice) discussed the growing importance of the clinical environment and changes in 19th-century spa therapy. Based on the example of Priessnitz’s spa in Gräfenbeg/Lázně Jeseník, he explored unconventional medical practices and the different approach to the human body leading to the creation of new hydro-therapeutic treatment. Even though Transylvania was a peripheral part of the Habsburg Monarchy, it experienced a process of medicalization similar to other regions, as LUMINIȚA DUMĂNESCU (Cluj-Napoca) and NICOLETA HEGEDŰS (Cluj-Napoca) convincingly argued. Local hospitals such the “Carolina” hospital in Cluj created the basis of the modern public health system regulated by imperial legislation and placed under the auspices of authorities.

In a following panel on institutional care of the soul, JANKA KOVÁCS (Budapest) examined projects for the construction of asylums in Hungary, focusing on the transfer of psychiatric knowledge and asylum management within the Habsburg monarchy as well as between Central and Western Europe. Imperial aspirations and local adaptions created tensions that influenced the institutionalization of psychiatric care until the 1860s and 1870s. BABETA JURÁMIKOVÁ (Prague) described the activities of Jakub Fischer who then, as the newly elected primary physician of the Regional Hospital in Pressburg/Bratislava, initiated the establishment of a psychiatric ward. RUSLAN MITROFANOV (Munich) laid emphasis on the modernization of Russian psychiatric facilities along British lines and patterns of English country asylums for the socially vulnerable classes. Using the example of the Kazan Regional Hospital, he demonstrated the connections of Russian psychiatric services with West European developments.

DANIELA TINKOVÁ (Prague) presented the Prague hospital for mentally ill (Prager Irrenanstalt) as an example of the transformation of the hospital type “madhouse” or “lunacy asylum” into a “clinical” institution where university teaching was combined with at least partial research. The Prague “Irrenanstalt” was founded as an integral part of the state complex of medical facilities, changing during the second quarter of the 19th century. It inspired the architecture of other lunacy hospitals in Central Europe. External and internal layouts differentiated and specialized wards for the mentally ill were created. For treatment, adherence to discipline and work therapy was crucial. EVA HAJDINOVÁ (Prague) shed light on the history of the two leading Prague monastic hospitals in the first half of the 19th century – the Brother Hospitallers of Saint John of God and the Sisters of Saint Elizabeth. She summarized the more recent findings on the hospital care and physical disease treatment provided by both hospitals. Moreover, she looked at the hitherto not researched topic of the care for mentally ill priests, for whom a special department was established at the Brothers Hospitallers. PAVLÍNA PONČÍKOVÁ (Brno) reported on the provincial institute for the mentally ill in Tschernowitz/Černovice near Brno, the only institution of this type in Moravia whose existence resulted from the imperial attempts to replace the inadequate placement of mentally ill patients in hospitals and care institutions with state-funded provincial treatment facilities since the 1860s. With a similar theme and period HELENA CHALUPOVÁ (Prague) observed how Prague psychiatric institutions expanded into the Bohemian countryside. With regard to the surviving archival material, she selected several aspects related to institutional functioning, economic provision, and care of the mentally ill.

The last day of the conference consisted of panels dedicated to agents of hospital and healthcare infrastructures. PIOTR FRANASZEK (Kraków) mentioned a systematic upward trend in Galician health care at the turn of the 19th and 20th centuries. The number of patients admitted to public hospitals increased from year to year. Provincial authorities and legislative bodies supported financial subsidies to hospitals to improve the health level of society. PAWEŁ FIKTUS (Wrocław) characterized the contributions of Gustaw Roszkowski to changes of public international law relating to the organization of war hospitals and medical care of the wounded. ANDREAS JÜTTEMANN (Dresden/Berlin) examined the first mountain sanatorium for tuberculosis patients in Krkonoše/Riesengebirge founded by young physician Hermann Brehmer who himself looked for a place where tuberculosis had not appeared before, and which offered favourable spa conditions as well. For this reason, Brehmer designed the park of the sanatorium where patients with lung diseases were treated. ALEXANDER OBERMÜLLER (Erfurt) pointed out Vienna’s health care providers who had disseminated and dispersed both medical care and knowledge beyond the clinic and hospitals since the early 1880s. Using horse-drawn carriages, they went to medical emergencies and transported the sick to hospitals.

Based on memoirs of physicians as the main source of her research, BARBORA RAMBOUSKOVÁ (Pardubice) traced internal hierarchies and social practices within the Bohemian clinics at the beginning of 20th century. She discussed the patriarchal attitude of primary physicians towards medical students and wondered how male authority and the prestige of different medical specialties were working. In the last conference talk, heralding the final discussion, DARINA MARTYKÁNOVÁ (Madrid) and VÍCTOR NÚÑEZ-GARCÍA (Sevilla) compared the long and tortuous transformation of hospitals from charitable institutions, targeting mostly the poor and destitute, to interclass hospitals as centres of healing, teaching and research, in Spain and in the Ottoman Empire. Political freedoms in Spain, including a full-blown constitutional regime since the 1830s, might have, in fact, actually hindered the modernization of the hospital as an institution, as the moderates gave voice in parliament to the catholic church and other alternative power centres that did not wish the state to intervene in what they considered their field of action. This political and institutional pluralism, weaker in the Ottoman Empire, might have worked to the detriment of a more robust public healthcare infrastructure shaped by the public authorities.

Conference overview:

Zdeněk Nebřenský (Prague) / Daniela Tinková (Prague): Introduction

Enlightenment Health Care Policies I

Ivana Horbec (Zagreb): Hospitals in the Croatian Lands under the Habsburg Rule in the late 18th Century

Aistis Žalnora (Vilnius): The Professional Perception of the Early Hospital and Medicine in Vilnius

Martynas Jakulis (Vilnius): The Foundation of the General Hospital in Vilnius at the End of 18th Century

Enlightenment Health Care Policies II

Ingrid Kušniráková (Bratislava): The First Hungarian Hospitals: Founders, Financing and Patients, 1750–1850

Ludwig Pelzl (Florence): Harbingers of Change or Traditional Take-Over Crisis and Reform of Institutional Eldercare in Enlightenment Germany

Maternity and Child Care

Marina Hilber (Innsbruck): The Czernowitz Maternity Hospital and Its Midwifery School. Obstetric Care in Bukowina Between Social and Educational Aspirations, 1810–1918

Svitlana Luparenko (Kharkiv): Health Care Activities at Children’s Summer Colonies in Ukraine at the End of the 19th Century

Hospital Agency

Vladan Hanulík (Pardubice): Strategies and Tactics of Patients in the 19th Century´s Spa Environment

Luminița Dumănescu (Cluj-Napoca) / Nicoleta Hegedűs (Cluj-Napoca): Patients, Diseases, and Hospitalization in Transylvania in the 19th Century. Case Study: The Patient Discharge Register of the "Carolina" Hospital in Cluj, 1876–1877

Institutional Care of the Soul I

Janka Kovács (Budapest): The Birth of an Asylum: Discourses and Conflicts in Psychiatric Institutionalization in Hungary in the 1850s and 1860s

Babeta Jurámiková (Prague): Jakub Fischer and the Psychiatric Department of the Regional Hospital in Bratislava, From His Papers

Ruslan Mitrofanov (Munich): Isolation in the Name of Humane Concerns: The Establishment of the Kazan Regional Hospital and the Problem of the Modernization of Russian Psychiatric Services in the Mid-19th and Early 20th Centuries

Institutional Care of the Soul II

Daniela Tinková (Prague): A “Model Madhouse” for Central Europe? The Birth of a “Psychiatric Proto-Clinic” in Prague, 1790–1850

Eva Hajdinová (Prague): The Prague Convent-Hospitals of the Brothers Hospitallers of Saint John of God and the Sisters of Saint Elizabeth and Their Care for the Body and Soul in the First Half of the 19th Century

Institutional Care of the Soul III

Pavlína Pončíková (Brno): The Provincial Institute for the Mentally Ill in Černovice Near Brno

Helena Chalupová (Prague): Subsidiaries of the Prague Institute for the Insane in the Bohemian Countryside until 1914

Agents of Hospitals I

Piotr Franaszek (Kraków): Galician Hospitals at the Turn of the 19th and 20th Centuries

Paweł Fiktus (Wrocław): The Organization of War Hospitals: De lege ferenda Recommendations in the Polish Legal Considerations

Agents of Hospitals II

Andreas Jüttemann (Dresden): The First Mountain Sanatorium For Tuberculosis Patients in Krkonoše, 1854–1914

Alexander Obermüller (Erfurt): Vienna’s Early Frist Responders: Health Care Providers Before and Beyond the Clinic, 1882–1914

Healthcare Infrastructures

Barbora Rambousková (Pardubice): Life in Czech Clinics at the Turn of the 19th and 20th Centuries from the Memories of Doctors

Darina Martykánová (Madrid), Víctor Núñez-García (Sevilla): The Rise of the Modern Hospital: The Interaction Between Healthcare Infrastructures and Political Decision-Making in a Comparative and Trans-Imperial Perspective

Conclusions