Before 1870 the Germany we know today did not exist as a single nation - it was actually a series of loosely aligned states speaking a common language, albeit with minor regional differences. And yet despite the commonality of language between the states there were still some instances of completely different words being used for the same thing - for example: kartoffel and erdapfel both mean potato! Bizarrely these oddities were not resolved for a further 40 years or so, and to this day it is still not unknown to hear the odd old word in some rural areas, especially in Bavaria, which was still an allied state with it's own ruling family, rather than a part of the new Germany as late as the First World War. Riding the wave of public euphoria immediately after Prussia had inflicted a crushing defeat on France in the Franco-Prussian war, the Iron Chancellor Otto Von Bismark, seized the moment and united the states. And with the birth of the new German nation an overwhelming desire for empire was born. In order to grow into the world power she sought to be Germany needed to dramatically expand her industrial and agricultural capabilities; and to do so she needed to increase her population to serve that growth.

The birth rate duly soared, but with growing population numbers, exacerbated by crowded and often insanitary living conditions in the cities, a vicious problem reared it's ugly head in the form of tuberculosis. Today we can cure TB relatively easily with little more than antibiotics, and it is seldom necessary to resort to surgery; though with the increasing number of cases of new antibiotic resistant bacteria appearing almost daily the disease is rapidly becoming a problem once again. That said it is very unlikely to ever reach the plague levels of the late 19th and early 20th centuries when it was to all intents and purposes the Black Death of it's day - figures of one fatality for every three contracting the disease are probably quite conservative.

With the appalling fatality rate - particularly when the disease was left untreated such as was almost always the case with the working class and the poor who did not have the money to pay doctors fees - man power to service the growing empire was falling woefully short and work days lost to illness rapidly reached crisis point. Clearly something had to be done, and for this reason Germany soon led the world in it's treatment of TB, and in it's provision of health care for the working classes, long before the advent of socialism in other countries. In Britain we had TB sanatoriums too, but they were nothing like those in Germany. Our standard of  health care for TB patients also lagged way behind the relatively successful German system right up until antibiotics appeared, rendering sanatoria a thing of the past almost over night. It is fair to say that the "English way" of treating TB was crude by comparison - the well known requirement for fresh air and bed rest in the treatment of Pulmonary TB was met in Britain by burying patients in thick layers of blankets in rooms which were almost completely open to the elements; tales of brushing ice off a patient's rubber bed spread in the morning are quite common! The fresh air and bed rest approach was used in Germany too, but in a rather different manner. Air was cleaned by filtration and then warmed before being piped into the wards where the Pulmonary TB patients were being treated. Stale air was vented so that a constant through flow of clean, warm air was supplied to the patients without the need for the wards to be open to the elements.

There are many misconceptions regarding Tuberculosis, the most common of which is that the disease only attacks the lungs - in fact the reality is rather different. Pulmonary Tuberculosis (the term pulmonary means of, or pertaining to, the lungs) is contracted when the bacterium Mycobacterium Tuberculosis  - LEFT -  is inhaled in contaminated air born droplets which have been expelled by a cough or a sneeze from an  infected person. In the same way that the common cold and influenza are spread rapidly in close confines, TB also proliferates in areas of dense population. It is thought that up to a third of the human population today is actually infected with TB, but most infections in humans are asymptomatic; only one in ten latent infections eventually progresses to active disease.

When the disease appears the symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and severe weight loss, the last symptom giving rise to the colloquial name for the disease - "consumption". The lungs are severely damaged by the disease and they do not recover functionality to any great degree. A comparison of a healthy lung with a lung damaged by Pulmonary TB can be seen - RIGHT.

A further problem is that once TB has reached this stage the infection can, and almost always will, spread throughout the patient's body by way of the lymphatic system, and secondary sites of infection, also known as systemic infection, soon begin to appear. An extremely wide range of symptoms can therefore be seen in patients suffering from secondary TB infections, the nature of which will depend upon the organ, or organs, affected. An example of a tumour caused by a secondary TB infection under the jaw on a patient's neck  can be seen - BELOW LEFT - this particular infection was one of the more common occurrences due to the large number of lymph nodes at this point, and it even had it's own name - Scrofula.

Secondary infection within the bones was not at all uncommon either and many patients were paralysed if they were unlucky enough for the spine to be the seat of the infection. A personal friend tells of how his father had spinal TB as a child in the 1930s. He spent most of his teen years in a wheelchair but luckily the damage he sustained from the infection did not leave him paralysed. He only grew to 5 and a half feet (1.63 m) however and in view of the fact that his son stands well over 6 feet now it would appear to suggest that the disease severely restricted his growth. An example of the damage a spinal Tuberculosis infection can cause may be clearly seen on the X-Ray photograph - RIGHT.

Before the discovery of antibiotics in the mid 20th. century the various treatments for TB were at best only partially effective; and more often than not if the disease had not been caught in it's very earliest stages then the cure, involving extensive surgery, was almost as traumatic as the disease itself. Pulmonary TB was primarily treated by the administration of a strict rest regime with continuous exposure to abundant fresh air, all the while improving the strength of the patient with an appropriately balanced diet. The action of the bacteria will cause further lesions to appear on the lung surface until the body's own defence mechanism has countered the infection. Furthermore, the continual movement of the lungs through the simple mechanism of breathing, causes the lesions to bleed constantly; think if you will how difficult it is for a scab to form in a moist environment, then add in to the equation something continuously rubbing across the top of the wound thereby continuously removing any clotting long before it can begin to harden into a scab under which the body can begin to repair the damage. The rise and fall of the lungs whilst adhering to the walls of the chest cavity causes the rubbing action in this case. Minimising the work load of the lungs by enforced rest will therefore reduce the lung's depth of movement and the number of inhale-exhale cycles most dramatically - a lung at rest shifts roughly 1.5 litres of air, 10 to 12 times a minute. But undertaking even relatively light exercise can shift that volume load up to 3 litres (and more!) at a much advanced rate of 25 to 30 breathing cycles a minute. The dramatic reduction in lung movement by enforced rest encourages the lesions to scab over, and in the process reduces the amount of bleeding dramatically, thereby allowing the lesions to begin to heal. Fresh air carries little in the way of pollutants or irritants, and it is also naturally rich in oxygen, so this too helps minimise the amount of work the lungs must do.

Once a patient's own immune system finally managed to beat the infection and the healing process, together with surgery, had allowed the lungs to recover as much as possible, then a progressive exercise regime was implemented to restore as much functionality and strength to the patient as possible before his or her eventual discharge back into society once more.

Surgical management of Tuberculosis...

The first successful treatments for tuberculosis were surgical in nature. The theory behind all these treatments was based upon the observation that lesions had only healed when lung movement had been suspended or dramatically reduced, closing the air cavities in the lung in the process. Surgical management was therefore directed at closing the open air cavities, together with prevention of movement of the lung, in order to encourage healing. These procedures were all used before the discovery of antibiotics. There exists a myth that surgeons believed that the purpose was to deprive the bacteria of oxygen: it was however well known that the organism survives anaerobic conditions. Although these procedures may be considered barbaric by today's standards, it must be remembered that they were the only potential cures for a disease that at the time had a mortality rate at least as high as lung cancer today.

Recurrent or Persistent Pneumothorax...

Pneumothorax is the term for a condition where air is trapped within the lung cavity. The air breaks down the adhesion of the lung to the chest wall which is normally maintained by the pleural fluid, and the lung will then partially or fully collapse until that air is removed again so that the action of adhesion can restore itself. The simplest and earliest surgical procedure was manual introduction of air into the pleural cavity in order to collapse the affected lung, thereby preventing movement and closing the airway. There was always a spontaneous resolution of the pneumothorax so the procedure had to be repeated every few weeks. A further problem was that for obvious reasons only one lung could be treated at a time.

Phrenic nerve crush...

The Phrenic nerve (which controls the action of the diaphragm) was cut or crushed so as to permanently paralyse the diaphragm on one side. The paralysed diaphragm would then rise up and the lung on that side would collapse, thus closing the cavity and preventing movement.

Thoracoplasty...

Six to eight ribs were broken and pushed into the thoracic cavity to collapse the lung beneath. This was a grossly disfiguring operation, but it at least avoided the need for repeated operations.

Plombage...

Plombage reduced the need for a disfiguring operation. The procedure involved the insertion of porcelain balls into the chest cavity to collapse the lung beneath.

It can clearly be seen then that the scale of the Tuberculosis epidemic vs. Germany's desperate need for man power, was the principle driving force behind the construction of so many state of the art sanitaria for the treatment of the working class people. In addition to the sanitaria building programme the Germans also conducted extensive research to seek at best a cure, and at the very least better methods of treatment; indeed they were at the forefront of TB research in the world at that time. Berlin being the capital of the new Germany, and the largest city, would of course need proportionally more treatment capability than elsewhere. As a result two sanatoriums were constructed, one at Grabowsee, and this one at Beelitz-Heilstätten.

Beelitz-Heilstätten Sanatorium...

LEFT & RIGHT - The Powerhouse Complex at Beelitz...

The requirements of the time meant that several "pavilions" (we call them ward blocks nowadays) would be required. Each pavilion was built with multiple floors, and was laid out on a north south axis. Huge, open verandas were built on the south facing sides to capture the maximum sunlight possible. In addition the architecture was extremely pleasing to the eye so that the initial sight of the buildings would  imbue a sense of calm in newly admitted patients at possibly their most stressful time.  A further concern was moralistic in nature - Victorian values of chastity et all were not peculiar just to Britain at that time and as a result the female treatment areas of the sanitaria were strictly segregated strictly from the male. Beelitz is laid out in four very distinct quadrants with male areas to the east of the main road which cuts through the site from north to south, and female areas situated to the west. 

There were seven pavilions in total for treatment of:  

1. Male Pulmonary TB patients... 

2. Female Pulmonary TB patients...

3. Male Systemic (secondary infection) TB patients...

4. Female Systemic TB patients...

 

 

The overriding requirement for clean air and bed rest meant that all sanatoriums would have to be constructed away from the cities, in rural areas which are by nature, free of industrial pollution. In addition the need for peace and quiet to promote a restful atmosphere meant that noise needed to be kept to an absolute minimum. To that end all the sanatorium's services were isolated as far away from the ward pavilions as possible. Thus the laundries, the main kitchens - SEEN RIGHT - and the central power generating complex, are all situated in areas on their own, which might at first seem to fly in the face of efficiency considerations.

In the case of Beelitz-Heilstätten the heating and electrical supply for the entire site was centralised in a building which was the first of it's kind, and the services were piped to the individual buildings through a vast network of underground tunnels, through which it is supposed to be possible even now to access the cellars of all the buildings on the site. Sadly we did not find that to be the case!

So in addition to the pavilions, but in splendid isolation, we have:

5. Kitchens...

6. Laundry...

7. The Powerhouse complex...

8. Entry lodges...

9. The Head Doctor's Villa...

 

The final pieces of a sanatorium jigsaw puzzle German-style are the medical service buildings:

The sheer amount of surgery carried out at that time meant that the surgical building was very big indeed. No less than three major operating theatres were built at Beelitz together with attendant recovery rooms and other minor surgical theatres. A laboratory complex was built close to the theatre, presumably to allow rapid examination of infected tissue hot off the table. And finally a building dedicated to pulmonary medicine was built at the south east end of the site immediately opposite a large medicinal treatment baths complex.

9.  Surgery...

10. Laboratories...

11. Pulmonary Medicine...

12. Treatment Baths...

In order to get an idea of what the buildings at Beelitz used to look like in their heyday one does not require an enormous amount of imagination. It is only a short walk up from the railway station to the north-east sector of the site where a former male pavilion - RIGHT - has been completely restored, and together with a suite of modern buildings on the eastern extremity of the site, it is now a modern hospital for the treatment of neurological conditions, specialising in Parkinson's Disease. Even the airing courts have been restored and yet it in stark contrast it faces another practically identical male pavilion. This one though is neglected and tightly boarded up...

 

 

Construction of the new sanatorium by the Berlin State Insurance Company began at Beelitz in 1898 and it was originally known as the "Worker's Consumption Sanatorium". Many of the most eminent German architects of the time were involved including Heino Schmeiden, Julius Boethke and Fritz Schulz. The site covers a vast area and by completion the buildings and gardens were spread out over an area of roughly 200 hectares. To put that figure in perspective it is more than 1,200 yards from door to door as the crow flys between the surgery building up at the north west end of the site down to the baths complex in the south east sector - that's just short of seven tenths of a mile!

The buildings were laid out in a "pavilion system", something very familiar in the design of some mental asylums in the UK, and as already explain the site has four distinct "quadrants" with the main road bisecting the site north to south and the railway from Berlin bisecting the site east to west. At the time of construction the forest was felled and intricate gardens were laid out between the buildings with beautifully appointed airing courts and shelters where the patients could wander or sit quietly. Now the forest has reclaimed much of the land so not very much of the original gardens are left, apart from around the airing courts - RIGHT - which run between the bombed and totally derelict female pavilion up towards the second female pavilion just to the north. The bombed female pavilion is quite bizarre because the trees have grown back almost completely, not only in the surrounding area but also on the roof tops. Wandering around four floors up becomes a totally surreal experience because you still appear to be on the forest floor - indeed it is all too easy to actually forget that a few feet beyond the tree you are stood against is an enormous and unguarded drop to the forest floor proper!

Initially the sanatorium was very successful in treating the victims of "the moths", as the TB epidemic was colloquially referred to, however it's time serving it's true purpose was extremely short lived, amounting to just 16 years. In August 1914 Kaiser Wilhelm plunged Germany into the catastrophe of the Great War and Beelitz-Heilstätten was pressed into service as a military hospital. On the 1st. July 1916 Great Britain, alongside the French, launched a disastrous and ill conceived "push" against the superbly reinforced German lines in the area of the River Somme in France, and although allied casualties were appalling so too were those of the Germans. During the 5 months or so of the Battle of the Somme, which finally petered out in the winter of the same year, the appalling allied casualties amounted to roughly 195,000 French and 420,000 British soldiers. The German figure of almost 650,000 killed, lost or wounded included one particular individual who had been shot in the leg. He arrived at Beelitz and was treated successfully there, returning back to active service in 1917 with the Iron Cross Second Class for his bravery. How different the world may be today had he failed to survive, for his name was Adolph Hitler (<- back row, second from right).

By 1919 more than 12,800 wounded soldiers had been treated at Beelitz-Heilstätten. Following the Great War the hospital never returned to it's original purpose, and it continued to serve as a military hospital treating  military pulmonary cases and the occasional wounded soldier. The Second World War saw a resumption of treatment for war wounded and it was during this time that the British Royal Air Force bombed one of the former female pavilions mistaking it for a military barracks. This particular building was never re-built and serves today as a stark reminder of the deadly devastation which is wrought by high explosives.  During the Russian occupation post 1945 the site was designated the central military hospital of Soviet Army Group West and it was the largest Russian military hospital outside of Russia. Over 50 years of continuous military service would end only after the departure of the Russians from east Germany in 1994, but shortly before that in April 1990 the much hated Erich Honneker - RIGHT - fled the sanctuary of a church in Lobetal near Bernau to live for a time in the safety of the hospital with his wife. The press would appear on the road by the main entrance with step ladders and try to catch a photograph of the disgraced former East German President over the walls as he wandered around the gardens with a close body guard of two Soviet soldiers.

Beelitz is a beautiful place - nature meets aesthetic architecture creating a paradox - despite, or perhaps precisely because of it's original conception as a place of treatment for a terrible plague of it's time, Beelitz is serene and eminently peaceful. Even the bomb-torn women's pavilion has beauty where the environment has progressively veiled stark destruction with a deep and comfortable green cloak of foliage. The quiet is complete with only the passage of an occasional car on the quiet road beyond the walls, and at the time of our visit the slow change from verdant green to the reds, browns and gold of autumn was well advanced.

How sad then to hear that Beelitz suffered terror not only in time of war. Between 1989 and 1990 attacks began upon female workers and residents of the area and soon the first of a string of serial murders was committed. This particularly sick puppy always left a calling card - an item of pink women's underwear abandoned on the body which he first used as a restraint during rape and then as his ligature to strangle the unfortunate woman. The horror of his modus operandi soon led to him becoming dubbed Die Bestie von Beelitz (The Beast of Beelitz). In March of 1990 he attacked the wife of one of the senior Beelitz physicians as she was taking her infant son for a walk through the grounds. He tore the child from her arms and crushed his head on a tree then he gagged her with a pink bra, raped and finally strangled her. Later in the year two young women were jogging through the woods and he struck again, however attacking two people together was his undoing for they were able to overpower him and end his reign of terror. Wolfgang Schmidt - RIGHT - was given a 15 year prison sentence together with indefinite detention in a psychiatric hospital. Most of these attacks happened in the vicinity of the surgical block and one of the female pavilions and although we were not aware of the story it is odd to report that we felt slightly uncomfortable in both of these buildings.

Coincidence? I think that's more than likely!

Due to the fact that the hospital was a restricted military site from 1914 until 1994 many of the buildings were not altered particularly much in that time. That and the fact that the site was only recently acquired by private enterprise in a period of relative financial depression means that the site has many of the qualities of a time capsule. By the same token many of the buildings were unused during the 96 years from it's cessation as a TB sanatorium in 1914 to date so they have suffered badly by the actions of the weather coupled with neglect and a singular lack of maintenance. That said the Powerhouse complex and one of the male pavilions have been restored recently and all the gate lodges and the villa of the Head Doctor have been sold off into private ownership as dwelling houses. We also saw signs of work being carried out within the Badehaus (Central Baths).

And the urb-ex aspects of this magnificent site? Well, the minute you step onto the platform off the train from Berlin at the Beelitz Bahnhof you are surrounded by boarded up semi-derelict buildings and it's extremely difficult not to charge off to the nearest looking for a way in as you feverishly drag your camera out of your pocket!

If you'd like to see a good quality professionally shot video of Beelitz-Heilstätten before you open our photo offerings then here's a link to a documentary which was recently added to YouTube. Although it is in German it is not difficult to follow what is being said and there are some great film clips from the hospital when it was still in use, going as far back as the Great War, and as recently as Honneker's time in exile there in the 90s. Of particular interest are the interviews with people who experienced Beelitz, both as staff and presumably as patients. There is also a superb scene shot in the only active original building on the site showing clearly how the entire hospital would have looked in it's heyday. Very little has been changed internally beyond the inevitable modernisation so the tiled interiors reflect how the main bath house would have looked, and also the many exercise halls.