A short story about lying

Sick or injured people today usually cure themselves in bed - whether at home when they have the flu or in hospital after an operation. In the Middle Ages and the early modern period, however, hospitals were intended less for the sick than for the old and poor. Even their own bed is not a matter of course: People often share a simple wooden bed or lie half upright on leaf sacks. A change only sets in with the enlightenment and the ideal of healthy sleep asserts itself. Doctors assign their patients their own hospital bed and prescribe recumbent cures. In the second half of the 20th century, however, critical voices also increased: They point out that lying down has no positive effects on recovery in many cases and thus problematize strict bed rest.

From the wooden box to the metal frame

The bed - a central place in the hospital: The patients lie in their beds. Doctors and nurses also treat the sick there. For centuries, however, people did not cure themselves in hospitals, but at home in box-like wooden beds. It was not until the 19th century that the modern clinic was built as a sanatorium. This is accompanied by the development of a special hospital bed. Increased hygiene measures and new manufacturing processes favor the establishment of new metal furniture. These will soon be seen as signs of progress.

hygienic - rollable - good

By 1900, the industrially manufactured metal beds were already in every hospital. They are easy to clean and therefore meet hygienic standards. They are also mobile thanks to castors. A footboard prevents the patient from slipping out of bed. The nursing staff can change the patient’s position with an adjustable backrest. First of all, different manufacturers produce different beds. In order to make maintenance more efficient and cost-effective, hospitals made efforts from 1920 to standardize furniture.

Beds just in case

The catalogue of the Bernese company Schaerer AG from 1927 shows interesting custom-made products. Hospital beds already reflected the increasing specialization of medicine in the early 20th century. A bed for giving birth can be divided in the middle and is equipped with foot rests. A chamber pot is integrated into a bed for severely weakened and paralyzed patients. The beds in psychiatry are used to monitor patients: there is no escape from the advertised “protective bed for the madman”.

Comfortable machines

In the second half of the 20th century, beds became more and more mobile and developed into multifunctional machines. They can of course be pushed through the aisles on rollers, are continuously adjustable, work with waterproof motors and are equipped with entertainment systems. The design and comfort are also increasingly coming into focus – the beds should not only work, but also contribute to a pleasant atmosphere.

From the bed to the room to the building

The focus of any hospital planning is not the operating room, but the bed: The modern hospital bed not only shapes the relationship between nurses, patients and doctors, but its size and construction also determine the course of action. Thus, the dimensions of the bed have a direct impact on hospital planning. Thus, the mass of the bed directly affects the planning of hospitals. Since the late 19th century and to this day, architects have based the design of corridors, rooms or elevators on the masses of beds. So, you literally build the hospital around the beds.

Berner beds and buildings

When the Inselspital was rebuilt (1881-1884) on the Kreuzmatte, the bed was already a key factor. The planners are increasing the space per bed from 6 to 8.5 square meters. In the following buildings, too, as in the case of the surgical clinic or the Lory hospital, the architects take the dimensions of the beds into account in order to arrange rooms and paths sensibly.

The high-rise bed building - smooth processes

In the second half of the 20th century, the existing premises of the Inselspital were no longer sufficient. In the construction of the high-rise bed building (1965-1970), the planners oriented themselves to the latest developments in hospital construction and built upwards. This means that there is space for more than 700 beds in a small area. In this way, short distances are guaranteed. Before completion, the medical staff checks on a sample floor whether all processes are running smoothly. A working group is even developing a new bed for the striking building: Together with the Bigla company, nurses as well as production and civil engineers are designing a model that is tailored to the needs of Inselspital.

Patient pathways

In the last few decades, outpatient treatments have been funded, not least for economic reasons. That is why the idle time has been shortened since the 1970s. The number of beds is decreasing, while the demand for single and twin rooms is increasing. However, the patient bed remains an important part of the planning - even with the current new construction of the main building (2019-2023). In close consultation with medical experts, the architects include the number and size of the beds in their designs and strive for short distances for inpatients. The new hospital should be operated as efficiently as possible and thus cost-effectively.

Get out of bed!

Around 1900 patients at Inselspital spend an average of up to 45 days in bed. These long periods of lying-in bed put some patients under stress both mentally and physically. In the second half of the 20th century, the hospital is therefore increasingly taking measures to mobilize patients. They should experience variety in everyday patient life and become healthy faster through targeted exercise.

Movement while lying down

In the second half of the 20th century, hospitals were looking for ways to keep their patients busy and at the same time maintain their “will to work”. To do this, Inselspital imported looms from England in the 1950s. They are designed for work in bed and can be attached to the bed frame with four long cords. Today’s occupational therapy develops from such occupational and work therapies. It is not only aimed at keeping the patient occupied, but at restoring the ability to act.

Turn the wheel?

As early as 1931, the Surgical University Clinic in Bern had a small “mechano- and physiotherapeutic institute”. Here, patients support their recovery through exercises. Two years later, Inselspital hired a therapeutic gymnast for the first time to work in the children’s and Lory hospital. In addition, a swimming pool for hydrotherapy has been available in the Medical Clinic since 1937. Since the 1950s, Inselspital has been increasingly focusing on targeted rehabilitation with aids. A powerful physiotherapy wheel was still used as a therapy device for the arms in the 1980s.

Lying: up and down

Until well into the 19th century, patients sit on a chair or lie in an ordinary bed during an operation. If there is a complicated procedure that requires a special posture, assistants can help, for example by lifting the pelvis. Surgical innovations in the course of the 19th Century also have an impact on the material and construction of the operating tables. For the first time, they are no longer made of wood, but of metal. This is an advantage because metal is easy to clean. Movable special tables are gradually gaining ground. They make it easier for surgeons to operate in a controlled manner.

An innovation from Bern

In 1912, the Bern surgeon Fritz de Quervain designed the “universal operating table” together with Schaerer AG. This offers numerous advantages: Patients lie comfortably, surgeons can easily reach all parts of the body and the metal can be easily cleaned of germs. The operating table is developing into an international bestseller and is the starting point for a successful cooperation between Inselspital and Schaerer AG.

Table developments

The de Quervain operating table is just the starting point for Schaerer AG: the X-Ray Nova table comes onto the market in 1957. Its radiation-permeable lying surface allows the patient to be X-rayed during an operation. The Schaerer S-200 operating table followed in 1973. For the first time, the telescopic column is no longer attached centrally, but eccentrically so that the surgeons and nursing staff have the greatest possible freedom of movement. To this day, the flexibility of operating tables is a key design criterion.

Of tubes and bathtubs

Medicine experienced a strong mechanization in the 20th century. A variety of instruments and devices are developed for various therapies and diagnostics. This has consequences for patients: they are now more often surrounded by large and complex machines. In the 1940s, they were ventilated in iron tubes, and since the 1980s they have been in tight MRI machines or in a large bathtub for kidney stone treatment. Apparatus medicine opens up new possibilities, but is also criticized: It is considered expensive and the epitome of technical and impersonal medicine.

How a steel coffin saves lives

The "Iron Lung" is a medical sensation: The first mechanical ventilator was used from 1930, especially for "polio" patients. The patient lies up to his neck in a metal tube. The head is outside the device and a foam ring surrounds the neck. This means that no outside air can get into the device. The hydraulics of the machine now alternately generate an overpressure and a negative pressure in the chamber, so that air flows out and in through the patient's nose and mouth. When overpressure ventilation with intubation became established in the 1960s, the devices lost their importance.

Shock waves against stones - the expensive miracle machine

Until the 1980s, surgeons had to resort to the knife for the removal of kidney and bladder stones. In 1985, the Inselspital puts the first kidney stone smasher into operation. The huge device treats kidney stones completely bloodlessly: A crane lifts the patient into a large tub filled with water. The staff use X-ray machines to locate the stone before firing shock waves. These impulses smash it. The device is celebrated as a miracle of technology as a means of reducing costs.

Sun, air and deck chairs

Already in ancient times, doctors attributed light and air to a central importance for individual health. But it was only with the Enlightenment that the idea of healthy mountain air became established. In the 19th century, the higher earners first made a pilgrimage to the Swiss mountains to treat tuberculosis, then poorer sections of the population were given access to recumbent cures in "popular sanatoriums" such as the Bernese sanatorium Heiligenschwendi. The warming sunlight is also being upgraded with the life reform movement. It is considered to be health-promoting, so doctors also resort to it in the treatment of tuberculosis.

On the sundeck

Both the Surgical University Clinic and the Lory Hospital have several sun terraces. There the patients sunbathe in fine weather and enjoy the open-air treatment. However, lying in the sun in the city of Bern does not replace a stay in clinics, especially for tuberculosis sufferers. The doctors refer their patients to the Heiligenschwendi tuberculosis sanatorium or to Leysin, Montana and Davos.

Artificial suns

At the end of the 19th century, both naturopaths and doctors described sunlight as health-promoting. In the early 20th century, artificial high-altitude suns and light showers became popular consumer goods. They enable full-body sun therapy in the misty plains. In the case of sun euphoria, the dangers of this therapy are initially forgotten: Only gradually do the sun's rays become suspected of causing skin cancer. However, the positive evaluation of sunlight persists. To this day, many people consider tanned skin to be a sign of health.

Selective bibliography

Karrer, Tanya, Pascal Zehnder (2014): Vom Operationsstress zum Vibrationsbad – der klinische Alltag schreibt Medizingeschichte, in: Schweizerische Ärztezeitung 96/50, S. 1925-1927.
Keil, Maria (2016): Über eiserne Bettstätten: Zur Geschichte des Krankenhausbettes (1700-1900), in: Gunnar Stollberg et al. (Hg.): Patientengeschichte in Hospital, Heilstätte und Krankenhaus, Berlin, S. 542-552.
Hasler, Véronique (2019): Drehpunkte: 100 Jahre PhysioSwiss, Sursee.
Ingold, Niklaus (2015) Lichtduschen: Geschichte Einer Gesundheitstechnik, 1890-1975, Zürich.
Monet, Jacques (2009): La naissance de la kinésiothérapie (1847-1914), Paris.
Stämpfli, Stefan Andreas (2011): Prof. Fritz de Quervains Beitrag zur Entwicklung des Operationstisches 1900-1940: Auswertung des Fotoarchivs der Firma Schaerer AG Bern, (Diss. med. dent.), Bern.
Welti, Sabine (1997): Massage und Heilgymnastik in der ersten Hälfte des 20. Jahrhunderts: Zur Professionalisierung der Physiotherapie, Wabern.
Williams, Gareth (2013): Paralysed with Fear: the Story of Polio, London.