INSTITUT MAX-KASSOWITZ

From 1886 to 1896 Sigmund Freud was responsible for the department of nervous diseases at the Erstes Öffentliches Kinder-Krankeninstitute in Vienna (First Public Institute for Sick Children), known as the Max-Kassowitz Institute after its founder and director. Freud saw patients there three times a week without pay. The institute was founded in 1788 to provide free treatment to sick children of impoverished families as part of a public health program begun by Emperor Joseph II. It was the second children's clinic of its kind in Europe, the first being the Dispensary for Sick Children in London (1769).

Max Kassowitz (1842-1913), a professor of pediatrics in Vienna, took over management of the facility in 1882. A specialist in the physiology and pathology of bone formation, in 1883 he introduced a method for treating rickets using phosphorous in cod liver oil.

In 1886 the institute had only two rooms: a waiting room and a consulting office (Steindlgasse 2). That same year the institute inherited two new facilities from the Kassowitz family (Tuchlauben 8) and created two departments of internal medicine and five departments for specializations: surgery (Richard Wittelshöfer and later Ignaz Rosanes), dermatology (Eduard Schiff), nervous diseases (Sigmund Freud), ears (Josef Pollak), and nose and throat (Eduard Ronsburger). In 1889 a new department for eye diseases was created (Leopold Königstein); in 1894 the second department of internal medicine added a new doctor (Oskar Rie). All these "departments" provided care, as they would in a dispensary. Aside from the director and doctors, there were medical assistants (including Ludwig Rosenberg and Max Kahane). None of these positions was salaried. For the doctors the job had the advantage of providing access to a wide range of clinical material. In 1886 there were approximately 6000 office visits, which rose to 12,839 in 1892, and to 17,400 in 1898.

The possibility of working with children led Freud to travel to Paris and Berlin in 1885-1886. In Berlin he studied pediatrics with Professor Adolf Baginsky. In 1886, as privat-docents, Wittelhöfer, Schiff, and Freud asked the teachers college of the University of Vienna for authorization to provide lessons at the institute, an authorization that had been given to Kassowitz himself, using clinic patients for their demonstrations. Authorization was refused in order to maintain the distinction between university clinics and the institute. However, Freud gave—or at least publicized—lessons "on the nervous diseases of children with demonstrations" during the summer months of 1887, 1888 (near the institute), 1891, 1892, and 1893 (at an unknown location). Under Kassowitz's leadership the institute engaged in considerable scientific activity and, in 1890, published a collection of articles entitled Beiträge zur Kinderheillkunde aus dem I. öffentlichen Kinder-Krankeninstitute in Wien (Contributions to children's medicine based on research conducted at the first public institute for sick children in Vienna).

Freud's scientific activity was at the time directed exclusively at infantile cerebral palsy, with the single exception of a study on infantile enuresis. Between 1886 and 1892 he collected two-hundred seventy-five neuropathological observations on diplegia in children under ten years of age, which served as the clinical basis for nine publications during the years 1888-1900. These included three monographs, including the one he presented in 1897 to the prestigious collection "Spezielle Pathologie und Therapie," directed by Hermann Nothnagel. At the time Freud was considered to be one of the principal authorities on infantile cerebral palsy.

In 1896 Freud's position was turned over to Emil Redlich, who in 1898 in turn passed it on to Julius Zappert. In 1938 the institute celebrated its one-hundred-fiftieth anniversary with a publication that proudly stated that among its collaborators was "Sigmund Freud, a great thinker and the man who discovered psychoanalysis." The institute was dissolved that same year, following the annexation of Austria by the Third Reich.

Carlo Bonomi

See also: Rie, Oskar.

Bibliography

Bolzinger, André. (1997). Freud pédiatre et antipédiatre. Le Coq-Héron, 146, 61-69.

Bonomi, Carlo. (1994). Why have we ignored Freud the "Paediatrician?" Cahiers psychiatriques genevois, Special Issue, 55-99.

Gicklhorn, Josef, and Gicklhorn, Renée. (1960). Sigmund Freuds akademische Laufbahn. Vienna-Innsbruck: Urban & Schwarzenberg.

Hochsinger, Carl. (1938). Die Geschichte des ersten öffentlichen Kinder-Kranken-Institutes in Wien während seines 150jährigen Bestandes 1788-1938. Vienna: Verlag des Kinder-Kranken-Institutes.

Jones, Ernest. (1953). Sigmund Freud: Life and work. London: Hogarth Press.