History of the Psychiatric Clinic in Prague

The history of the Psychiatric Clinic of 1^st Faculty of Medicine (1^st FM) and General Teaching Hospital (GTH)

 

Beginnings of psychiatric care in Prague

 

It was the year 1783, which was important for a systematic care of mentally ill people. Joseph II., the Austrian emperor (Czech and Moravian countries were ruled by the Austrian monarchy since 1620 till 1918) legislated on March 19^th, 1783 by his court edict an establishment of a hospital department for mentally ill priests, which was attached to the Hospital of Merciful Brothers in Prague. As early as in 1784, this regulation was extended on all groups of population. Later, in 1789, the whole building in a newly established hospital on Karlov is dedicated for a treatment of calm mentally ill old people.

 

The most important action of Emperor Joseph II., in the field of health service in Prague was establishment of a General Hospital (GH) on the Place of Charles, which later became a General Teaching Hospital (GTH). The hospital was opened on November 1^st, 1790 and in the same day an independent institute for mentally ill people in Prague was also opened in the building on its courtyard. It was obligatory for a director of the GH to perform also a function of a head physician. In 1806-1826, Dr. Jan Theobald Held operated temporary (three times altogether) in the GH and helped to improve substantially a level of care for mentally ill people. The next step of the development is building of a new, larger institute for mentally ill about a year 1826. As a suitable for this purpose, the current Augustine monastery of the St. Catherine (military quarters in this times) was chosen. Its buildings were bought in 1826 and became definitely autonomous in 1829. The first head physician became Prof. Karel Damian Schroff, follower of therapeutic approach created by Philippe Pinel from France.

 

 

Development of psychiatric care – “New House”

 

In following years (1832-1836), Dr. Rilke functioned as the director of the clinic and later on, Dr. Josef Riedel, who was in the head of the hospital for next 15 years. He as the very first in the whole Austrian monarchy started to teach psychiatry with practical demonstration of patients and thus caused the psychiatry to become an independent branch of academic study of medicine. Soon after his nomination, he began with extended and systematic building-up of the clinic.

 

The Hospital of St. Catherine was of a capacity about 250 patients this time which was due to still increasing number patients insufficient. That is why Dr. Riedl started in 1837 to prepare a construction of an entirely new institute. The new hospital was built during 1840-1844 and was opened as so called New House which has remained as a central building of the Psychiatric Clinic of 1^st FM and GTH till now. The building was two-storied, 150 meter long, with two one-storied 40 meter long wings; left for men, right for women. On the ground floor, there were flats for employees, medical rooms, workrooms, dinning rooms, social halls for patients, offices, kitchen, purgatory bath and a room for hydrotherapy.

On the first floor, there were first class and second class rooms, on the second floor, there were third class rooms. In both sidelong wings, there were rooms for unquiet, quarrelsome, unclean patients and for those with a predisposition for escape. The full functioning of the New House begun in January, 1846 and from this time, the St. Catherine Institute has been assigned to chronic patients. Dr. Riedl became the pioneer of a work therapy. Later on, he introduced a recreation therapy, a music therapy, a therapeutic physical training, a school teaching of patients and an education therapy with the background in a large own institute library. He also introduced a systematic pharmacotherapy (he discovered a positive influence of opium on melancholic patients) and an electrotherapy (he bought an electro-magnetic device with a moveable rheostat in 1847). In 1840-1850, the Prague Institute used to be known as the best administrated and as the most modern equipped institute in the whole Europe. Dr. Riedl habilitated as a private associate professor of psychiatry at the Prague University in 1840. In 1846, he implemented an absolute administrative independence of the hospital for mental ill people from the General Hospital. In 1849, he was also nominated as a director of the Prague General Hospital and he worked in both functions till 1951, when he was called to Vienna by the director of a newly built institute for mentally ill. He definitely undertook the leader of the hospital 1853 there. He acquired ennoblement and he has never returned to Prague.

 

1852-1869: Dr. František Köstel became a follower of Prof. Riedl and successfully continued in further extending capacity of the institute. He adapted a neighbouring former monastery for hospital purpose. In 1857 he also bought a homestead called Popelářka and in following years, he bought the House of Voračických z Paběnic (so-called House of Herz), where the Centre for Addictology, Centre for Neuropsychiatric Research of Traumatic Stress and Psychiatric Research Laboratory are located. It was just Dr. Köstel who founded the first psychiatric school (Dr. Kutil, Dr. Křížek), he left behind him the first textbook of psychiatry and his lectures were repeatedly published in the Czech language. In 1864, he was nominated as the first professor of psychiatry at the University of Prague.

 

1869-1885: Dr. Fischel was the last medicine director of the German nationality. He continued in extending the hospital, he finished reconstruction works of the former Piaristic monastery in Kosmonosy and in 1875 he acquired a building of an old maternal hospital by Apolinář. During his leadership, he went on in expanding of the hospital to the top of its historical capacity - 800 beds (including subsidiary buildings).        

 

1885-1889: Dr. Kratochvíl was the director of the hospital. During his administration, an independent Czech psychiatric hospital for an independent Czech university was established. On the April 11^th, 1881, the university was divided into two independent universities, Czech and German ones. Czech lectures were opened in the winter semester in 1882 on the faculty of philosophy and on the faculty of law, a year later on the medical faculty. Psychiatry in the Czech language was lectured from the winter semester 1885. As a date of the very beginning of the Psychiatric Clinic of the Czech University, the November 19^th, 1886 is considered. 

 

1889-1929: Dr. Benjamin Čumpelík became the director of the Prague institute for mentally ill in 1889; he was the first head physician of the newly established psychiatric clinic. From 1886, he is the first temporary, deputed professor of the psychiatry at the Czech medicine faculty in Prague. Before he left his function, he habilitated Dr. B. Hellich a shortly after him, Dr. Karel Kuffner.

 

1895-1929: Dr. Karel Kuffner who is considered to be the founder of the Czech scientific psychiatry became the head of the clinic and in 1900; he received a title of the full professor of psychiatry. He was working as the head physician of the hospital till 1929. During 1889-1890, he went to Vienna on trainee-ship leaded by professor Meynert and he became his devoted student. He was interested in pathophysiology of psychoses and his inaugural dissertation referred to pathological anatomy of psychoses. He was follower of biologically and organically oriented school and he founded liquorological, biochemical a histological laboratory on the clinic. He implemented a complex investigation (both physical and laboratory) of patients and he is also the founder of the Czech psychiatric terminology. Kuffner was a smart fellow of exquisite behaviour, good-hearted, hard working, and systematic and gifted. By his personality, he was modest and even “anxiously deprecatory (hostile) to one each personal advantage and personal benefit”. But around about 1900, he markedly started to change himself. His former strict self-criticisms changed into loss of self-confidence, he stopped publishing of his works, and he became shy, uncommunicative and diffident. He avoided to public and to his colleagues. His student, Prof. Mysliveček and others suppose him to fall probably to chronic depression and touchy sensibility. It is not sure how far the professional disputes with his student Prof. Heveroch influenced his psychical health. Prof. Heveroch was even nominated as a head of a newly established second psychiatric clinic (which came to an end after his death).

 

Prof. Antonín Heveroch, M.D. (1869-1927). Even if he never became a head physician of the psychiatric clinic, he was excellent scientist and besides to Prof. Kuffner he was a leading personality in the Czech psychiatry in the first decades of 20^th century. He substantially contributed to development of the Czech neurology. Even if he was habilitated by Prof. Kuffner, their relationship was tense as it has been already listed. From 1904, he could no more work on the Prague psychiatric clinic. In 1906, he was nominated as a full professor of psychiatry and in 1924 he pushed through an establishment of an autonomous chair of psychiatry and of the second psychiatric hospital, which was abolished three years later after his death. His outstanding work was the diagnostic of mental diseases for medical students and practical physicians, elaborated by form of case reports. His personality was of a strong temperament and he was known by his intense public scientific activity; opposed to shy Kuffner.

 

1929-1957: Prof. Zdeněk Mysliveček, M.D., Ph.D. If Prof. Kuffner laid the foundations of the Czech psychiatry, professor Mysliveček extended it and together with his students influenced it in a substantial manner. He is considered to be a founder of not only the Czech but also of the Slovak psychiatry. His broad influence was caused not only by the personality of him but also by his age. In 1901, when the Queen Victory died, Mysliveček was of age 20. He was habilitated in 1917 and in 1919 he founded a psychiatric hospital in Bratislava. After 10 years in 1929 (1930), he began to work as a head physician of the psychiatric clinic in Prague and stayed in this function (only with interruption by the World War II.) till 1957. He died in 1974 in the age of 93 years. In his time, the psychiatry was a modest medicine branch, healing only difficult diseases and patients socially unhealthy (dangerous to themselves and to their surroundings). There were no diagnostic, serological, biochemical or electro-physiological methods and the psychological ones were in the stadium of slow beginnings. Professor Mysliveček was able to combine both morphology and psychology. He also introduced   psychology as a teaching topic. Even if he was unexcitable and not very emotional person, on the first place in his ethical scheme was always a patient. His organizational, pedagogical and scientific merits are described in detail in works of his students which were published in 1966 in the Journal the Czechoslovak Psychiatry to his 90 jubilee. During the May Revolution in 1945 at night from May 5^th to May 6^th, professor Mysliveček together with professor Henner occupied each of them his clinic and despite shooting of hidden Nazis they preserved them till the end of war.  

 

 

The Psychiatric clinic in post-war period

 

Soon after the revolution, the new laboratories, new departments and new lecture hall were built. A new Brain Research Institute projected by Prof. Haškovec, Dr. Gutman and Dr. Fišer started to be formed. The institute was abolished after Prof. Haškovec was arrested. He because of loyal taking care of Klement Gottwald only by a hair breadth escaped from capital punishment. Prof. Mysliveček could finally work in an independent histological laboratory, but still without an assistant. A little bit bigger space was given to liquorological laboratory.  There was established also neurophysiological laboratory under the rule of Antar Čedík, which was later extended by Ass. Prof. Milan Černý.  In 1947, Ass. Prof. Jiří Roubíček began to perform EEG in the clinic as the first physician in the republic. Based on an initiative of Prof. Mysliveček a psychological laboratory administrated by Ass. Prof. Nevole was established in the same time as well as photographic laboratory, x-ray laboratory, endocrine laboratory (Ass. Prof. Skaličková) and general ambulatory care centre. There were established several new departments: alcoholism treatment department, the famous Apolinář, which reached the world top level thanks to Ass. Prof. Skála, child department (Ass. Prof. Apetauer (1947) had a big merit in its foundation) and finally open departments, the leadership of them Mysliveček committed to Prof. Vondráček. Prof. Mysliveček habilitated many of his students and in autumn of 1957 after 25 years of leading of Psychiatric Clinic he retired.     

 

1957-1970: Prof. Vladimír Vondráček, M.D., Dr.Sc.

He was born on February 23^rd, 1985 and died on May 5^th, 1978. He became a legendary head physician of the Psychiatric Clinic, famous with his dry humour and bright remarks. Even if he has still been in a relatively lively memory and because his remembrance has been assured by his numerous books and memoir chronicle of his life, we can limit ourselves only on a brief description. From 1923, he published many works not only from the field of psychiatry, sexology, psycho-pharmacology and medical psychology but also from the area of neurology, internal medicine, biochemistry; about general questions of medicine and other topics. He also published series of books which began in 1937 with Pharmacology of the soul. He published together with O. Riedl and others Clinical toxicology reaching even five editions.        

A lot of monographs he devoted to psychology and psychopathology, namely e.g. Action and its disorder, Evaluation and its disorders from the viewpoint of psychiatry etc. Prof. Vondráček is considered to be a founder of several medical branches in our country: medical psychology, psychopharmacology, dietetics (altogether with Prof. Prusík) and psychiatric sexology. In spite of his abstract character, he was unexpectedly emphatic in serious moments. He was the kind and wise head of clinic. An important event for the clinic was establishment of a research laboratory. In the beginning of 1958, the laboratory was at least de facto created, occupied with research workers and equipped. In time of the largest extent, the laboratory had a department of pathophysiology CNS, department of biochemistry and EEG, the cybernetic group was created and more over electronic laboratory in 1963, in the beginning common both for the department of psychiatry and neurology.  

 

1970-1984: Prof. Jan Dobiáš, M.D., Ph.D.

He was born on November 11^th, 1914 in Opatovice in the family of Schwarzenberger bailiff and died in 1990. He entered the clinic in the age of 41 in 1955. He was an excellent organizer, thinker and psychiatrist with a great erudition in all branches. His abilities were quite extraordinary. His knowledge was deeply organized, philosophically and psychologically elaborated and presented with an outstanding empathy. Prof. Vondráček compared him even to Socrates. He promoted a development of the research laboratory, which during his leadership probably acquired the largest extent, in spite he used to be always sceptic to possibility of great recoveries in our conditions. During his period, a teaching of medical psychology for medical students started. As already in Vondráček´s era, mainly in the Dobiáš´s one, there was possible to find a department of electrophysiology in the laboratory led by Ass. Prof. Milan Černý, who was also the head of the laboratory as a whole. The biochemistry laboratory was extended; Ass. Prof. Krulík helped to establish a very good instrument equipment background there. The next part of the research psychiatric laboratory created a unit of genetics (Prof. Zvolský, Dr. M. Dvořáková, Dr. H. Drábková,). The main interest of it was a research of genetics of affective disorders and also a unique research of Dr. Drábková who was for many years examining IQ development by twins with an effort to grasp the heredity of individual parts of intelligence. In a closed cooperation of the clinic and the research laboratory, Dr. Pavel Grof introduced a prophylaxis of affective disorders by lithium salts in Czechoslovakia. It was enabled by introducing a laboratory examination of lithium in plasma. This topic which is still open is even now being investigated in cooperation with IGSLI (International Group for Study of Lithium Prophylaxis) also on a molecular genetic level (Prof. Zvolský, Ass. Paclt). We cannot mention the establishment of a hot line service in 1964 by Miloslav Plzák M.D., Ph.D. together with Františka Martonová, Ph.D. Ass. Prof. František Faltus, M.D., Ph.D. established a special unit for treatment of eating disorders which is prestigious and world-famous even nowadays. In time, when sexual deviations were punished by criminal law, a department for sexual deviations was established after the war, headed in the beginning by Dr. Kurt Freund who is working in Canada now. He made the clinic famous by introducing phalography which objectify the real sexual preference of sexual deviants by measuring changes of the volume of penis after an exposition to different sexual stimuli. The department of sexology, which was guided by Ass. Pavel Zemek, later and now by Prof. Jiří Raboch continues in this research and publishes numerous research works. The very original result of their work was a computerization of phalographic examination.

 

1984-1990: Prof. Jan Mečíř, M.D., Dr.Sc.

He was in the function of a chairman of the Czech Psychiatric Society for four periods and as a director of the department of psychiatry, of the clinic and of the research laboratory he tried to extend contacts with foreign clinics and research societies as much as possible (he was the chairman of the Czech Psychiatric Society who has been worked in this function the longest time so far). He was the first child psychiatrist in the head of clinic and he that is also why he paid attention to further development of child psychiatry and trained other specialists in this field. He kept trying to improve the teaching of clinical psychology.

 

1990-1999: Prof. Petr Zvolský, M.D., Dr.Sc.

After social changes in 1989, Prof. Petr Zvolský, M.D., Ph.D., student of professors Vondráček and Dobiáš became the director of the clinic. Under his leadership, the tradition of psychobiological approach to psychiatry was still preserved while the psychotherapeutic training which used to be practiced in the clinic was also not neglected. He as a chairman of the Czech Psychiatric Society also contributed considerably to broadening of international relationships in our branch. 

 

1999-until present: Prof. Jiří Raboch, M.D., Dr.Sc.

 

According to the text: P. Zvolský, J. Florián, T. Uhrová, M. Sikorová: The 150^th  anniversary of foundation of the Psychiatric Clinic of 1^st Faculty of Medicine and the General Teaching Hospital in Prague (1846-1996).

 

 

The Psychiatric clinic of 1^st FM and GTH is the oldest psychiatric clinic in our country, in the current building it has been operating more than 150 years already. A lot of outstanding and world-famous psychiatrists worked here, e.g.

-         Prof. Riedel who introduced psychiatry as an independent branch in academic study of medicine

-         Prof. Arnold Pick, the discoverer of degenerative disorder of brain “Morbus Pick”

-         Prof. Jan Janský, the discoverer of the fourth blood group AB

-         Ass. Prof. Jiří Roubíček who as the first introduced the EEG examination in our republic

-         Ass. Prof. Kurt Freund, the discoverer of phalopletysmographic examination method.

 

§         The hot line, which has been in operation in the clinic from 1964, had originated here as the first in Europe.

§         Prof. Ass. F. Faltus established the unit for treatment of eating disorders in 1983 as the second in Europe and as the first one in the Central and Eastern Europe. This unit has been the only one in our republic so far. Ambulatory, the clinic has been dealing with problems of eating disorders more than 35 years.

§         From 1991 to 1999 there was a crisis centre for emergent crisis intervention events established at the clinic.

§         Data banks for CR ALEM-AS and LEX-SYS – the system of controlled using of atypical antipsychotic (Alemoxand and Leponex).