Health Europa explores with those involved in managing and expanding the then-hospital for mental patients, Vienna’s Narrenturm (Fool’s Tower).
In September, Health Europa travelled to Vienna, Austria, to visit the Narrenturm (which translates as the ‘Fool’s Tower’), Europe’s oldest building for the accommodation of mental patients, in the esteemed company of Professor Susanne Kircher from Vienna’s Medical University. At the tower, Professor Walter Feigl and his colleague Magister Anatole Patzak – both of whom are intrinsically involved in the restoration of the building and the establishment of a wholly new exhibition of the pathologic-anatomical collection that the tower now holds – were kind enough to offer some of their time to discuss the history of this unique building and its preparations and exhibits, and to provide a tour of part of the new exhibition.
The Fool’s Tower
The building itself was commissioned by Emperor Joseph II and received its first patients on 19 April 1784. As part of the newly constructed general hospital, the Narrenturm – paid for by Joseph II himself – was to be solely dedicated to caring for the mentally ill (until now, those with mental illnesses – and it is worth noting that, at the time, many other patients at the tower would have in fact been suffering from physical disabilities, as distinctions were not as clear-cut as they are today – had been cared for at home or, in many instances, seen as pariahs and perhaps therefore ostracised from society; some being incarcerated in cellars or even cages). Some hospitals may have had departments which contained mentally ill patients. Yet these were more of a containment exercise, and little in the way of treatment would have been offered.
The tower, Patzak explained, therefore represented a step-change in the way mentally ill patients were viewed and thus cared for; the Narrenturm was the first place to realise that such patients can indeed be helped and perhaps even cured. And while, in comparison to modern treatment pathways, the impact of the treatment techniques offered at the Narrenturm were destined to be limited (centred as they were around medieval humourism, which posited that an excess or deficiency of any of four distinct bodily fluids (or ‘humours’) in a person – black bile, yellow bile, phlegm, and blood – directly influences their temperament and health), the tower was nevertheless the first time that such people were cared for in human conditions. Patzak also explained that there were very strict rules for the ‘guardians’ – the equivalent of modern-day care workers – who worked (and often lived) in the tower, in order to ensure the safeguarding of the patients.
The building also contained some innovative approaches to comfort and utility. For instance, a heating system was devised which channelled heat from four large ovens housed in subterranean chambers to vents in each of the cells – 28 of which were placed in a circle around each of the five floors. However, this was not as effective as had been hoped – and, according to Patzak, more smoke than heat was pumped into the cells – and so this was discontinued after just one winter. Additionally, a system of pipes to take sewage waste from the cells was also devised, but because the pipes turned at a 90-degree angle below each cell, these quickly became blocked and, as with the heating system, the pipe system was soon discontinued.
The tower itself housed two mental patients in each of the cells – as mentioned, there were 28 cells on each floor except for the ground level, where larger cells existed for patients who had paid to stay at the Narrenturm for treatment, and for soldiers who had returned from war and required psychological evaluation. They were arranged in a circular fashion around the tower, and in the centre of each floor were living quarters for a ‘guardian’, who would reside there with his family. This also acted as an additional level of security as, although the patients were not confined to their cells (except for those on the top floor, who were considered to be exceptionally ill and were therefore chained to the wall of their cell), they were not allowed to leave the building. And so, in addition to having to walk around the floor to find the only exit, patients would also then have to cross through the guardian’s apartment, and if they were on an upper floor they would have to do this several times.
Rumours and theories
The roof of the tower originally held a small octagonal room which, it is said, Joseph II would frequent several times a week, and while his activities there are not really known, there are many rumours and theories concerning what he did there, many of which stem from his friendliness towards freemasonry and other quite secretive societies. Patzak highlighted that within these beliefs and societies is a focus on numerology, and so many have inferred meanings into aspects of the tower – from the 28 cells per floor perhaps corresponding to the lunar cycle (and so relating to ‘lunatics’) to the number of windows, the diameter of the building, the fact that it had five stories, and so on.
In relation to the octagonal room at the top of the tower, there are rumours that the emperor believed the patients in the Fool’s Tower to have so much energy that they were unable to contain it within themselves and that it would therefore flow from them, outwards and upwards like invisible smoke. He would therefore position himself at the top of the tower to perhaps channel or absorb it. Others think that the emperor believed that he could act as a link between the celestial and the terrestrial represented by the deranged microcosms of the people below him, which he was striving to bring to order. For Patzak, though, there is little evidence to suggest that such rumours are true.
The tower over time
The Narrenturm was used as a mental institution until 1866, at which point the tower could no longer house enough patients to cope with demand, and this, coupled with an increasing realisation that patients with such diverse needs should not perhaps be housed together, meant that the patients were then sent to newly constructed, purpose-built buildings, one of which was situated close by.
As Feigl explained, since then the tower has served multiple purposes: it has been a storage room for the hospital, used as a hall of residence for doctors and nurses training at the general hospital, and then used as a repository for pathologic and anatomical preparations, the first of which came from the pathological institute in Vienna. This latter use was necessary as, before it became possible to use photographs to document the things found and seen by pathologists, anatomists of forensic experts, specimens were collected by those working in the field, and when this collection became too vast to be housed at the institute, they looked for an external storage solution, and the Fool’s Tower offered a perfect solution.
It was not long before other institutes and hospitals in Austria – and then elsewhere – became aware of this and also looked to house their specimens at this location. This has now resulted in one of the most impressive and comprehensive collections of anatomic and pathological specimens found anywhere in the world, which is showcased in
a museum.
For Patzak, perhaps one of the most interesting preparations contained within the museum is a taxidermy of a five-year-old human child who had suffered with ichthyosis, a skin condition which is often called ‘fish scale disease’ because the scales that characterise the condition look like fish scales, and which interferes with the skin’s ability to shed dead skin cells, causing extremely dry, thick skin. Patzak said: “There are only very few human taxidermies in existence, and we have two of them here in the Narrenturm.”
Moulages
Patzak also highlighted the moulages – painted wax casts – which, he said, “are very impressive because they are very life-like; they look like they could actually be parts of pieces of recent humans”.
Feigl agreed, adding: “This means that they are very different to the wet preparations that we have here, which have lost a lot of their colour because of the formaldehyde – although they too are very impressive.
“We have over 6,000 moulages in our collection, many of which will be on display when the exhibition is complete. And one of our colleagues, Mr Winter, the manager of the Fool’s Tower, is attempting to recreate the recipe and technique used by Charles and Theodore Henning (father and son) who had perfected the methods between 1860 and 1930, but who took the recipe for the material to their grave. We don’t really know what it is that they used; the Hennings called it ‘elastine’, and from Mr Winter’s work we are getting closer to discovering what it is that they used.”
Education
Discussing the moulages further, Kircher added: “The moulages were used as a way to help educate students because, in an age where there were no photographs, these models showed how the different diseases looked. They were a crucial tool in medical education, and many of the doctors and professors would take the models to other countries to show what they had found.”
Feigl added: “Of course, many of the diseases represented in the moulages are no longer found in Europe today (although you may still see some of them in other parts of the world), and many are snapshots of diseases in such an advanced state that, again, it is unlikely that they will be witnessed today as people would simply not wait that long before seeking medical attention.”
Patzak also revealed that the police had asked the Hennings to make moulages because some of the abnormalities or diseases that people had could be related to their profession. “For example,” he said, “someone who works with hot sugar will have visible differences to the nails on their hands, and if a victim was trying to identify a perpetrator, then the police would show them different moulages and ask whether they had noticed any such things.”
The moulages are still used for medical teaching today, and this is something that Feigl believes to be particularly important. He told Health Europa: “In today’s education environment, medical students are presented with pictures in textbooks or picture after picture on a website; they can’t be expected to be able to grasp what is actually being presented by simply staring two-dimensional images. They need to be able to hold something in their hands, to turn it around, to feel the texture; often, in order to grasp something mentally, you must first grasp it physically.
“This is especially true of pathological items. We have many real skeletons here, and you are able to actually touch the bones. But a plastic or plaster bone can serve much the same purpose because they can be made to look exactly like the real thing, while it is much more difficult to make a pathological item; it is much more difficult to explain what a tumour looks or feels like, and so the moulages remain very useful.”
Given the importance of the many specimens that are in the collection, it is important for Feigl and his colleagues for the full museum exhibition to showcase as wide a range as possible. “But we only have 17 rooms,” he said, “so this is a challenge given the sheer number of specimens that we have here.”
Renovation and restoration
Renovations to the tower have been ongoing since 2012, but the museum contained therein has remained open, attracting 34,000 visitors last year alone, and this is something the team at the Fool’s Tower expect to increase once the work has finished and the museum’s exhibitions are fully open.
Also since 2012, the Narrenturm, which was once the last federal museum in Austria, became a part of the Austrian Natural History Museum’s Anthropology Department, which, Patzak explained, has brought with it many advantages, including co-operative relationships with laboratories and their facilities, and a silencing of those voices which had called for the museum to be closed on the grounds that its contents are no longer ethical and that photographs of the samples and preparations should be taken before they are buried.
Indeed, while becoming a part of the Natural History Museum means that those working there are subject to navigating the bureaucracy that exists in any kind of large organisation, the benefits certainly outweigh the costs, and, as Feigl concluded, it has meant that they have been able to restore the Fool’s Tower to something akin to its former glory, and have been able to, hopefully, secure the pathological collection’s home in the Fool’s Tower for many years to come.
This article will appear in issue 7 of Health Europa Quarterly, which will be published in November 2018.
