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Auguste D 100 years on: The person not the case

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Auguste D 100 years on: The person not the case

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Auguste D
One hundred years on: ‘The person’ not ‘the case’
SEAN PAGE Wythenshawe Hospital,Manchester,UK
TRACEY FLETCHER St. Bartholomew’s Day Assessment and
Treatment Centre,Roby, Merseyside, UK
Abstract Auguste D. is regarded as being the first case described by
Alois Alzheimer to highlight the disease that would later be named for
him. Auguste is described in terms of her illness, of her disturbances
and ultimately of her neuro-pathology. In the past 100 years since her
death in 1906 there has been almost no attempt to consider her as a
person or as a fellow human being outside the context of illness. This
article takes a social research approach to place those things we know
about the person Auguste and places them in an appropriate social
context for a working class woman of Imperial Germany at the close
of the 19th century. By doing so her status is raised beyond that of a
pitiful victim of disease and we begin to appreciate her lived
experience before the onset of dementia.
Keywords Alzheimer’s; Auguste D.; personhood; social history
Introduction
‘Each of us has a life story in which illness will certainly play a part, but illness
will never be the whole story’.
(Cayton, 2004)
In November 1901, a 51-year-old German housewife was admitted, in
crisis, to her local mental hospital. She never left and five years later on
8 April 1906 she died. Her experience, the clinical case of Auguste D.,
subsequently described and presented by Alois Alzheimer, is almost univer-
sally accepted as the first description of the illness that now bears his name.
The life and career of Alzheimer are well documented and the phenom-
enon of Alzheimer’s disease the subject of a diverse and extensive litera-
ture. However, as we live through the centenary of her death, one is minded
to ask how much we know of Auguste herself.
The answer, sadly, is very little. Within her case file there is a story, but
it is a story of illness, much more is known about deficits, disturbed
de
men
tia
dementia
©2006
sage publications
www.sagepublications.com
vol 5(4) 571583
DOI: 10.1177/1471301206069939
behaviour, and ultimately neuropathology, than is known about Auguste
the person. We believe there is another story waiting to be told and that
through its narration we may glimpse Auguste as being more than a just
pitiful victim of Alzheimer’s disease. Consequently in this article we
attempt to start the story-telling process by placing those things we do
know into an appropriate social context for a woman of Imperial Germany
at the close of the 19th century. It is a context that is crucial to the story
and our understanding of Auguste; we therefore begin by taking a step back
and considering the creation of this Imperial Germany.
Imperial Germany
Before the 18th century, Germany presented as a somewhat petty and
provincial European backwater. Its territories were a collection of small
principalities, the rulers of which vied to outdo each other in the develop-
ment of a frivolous and lavish courtly culture (Fulbrook, 2004). In the mid-
18th century, the Prussian dynasty under their ‘soldier King’, Frederick the
Great, turned away from this and began a process of military expansion
which would lead, a century later, to Prussia being regarded as ‘an army
without a country’ (MacDonogh, 1995). The ‘country’ was soon acquired.
By 1871 Prussia was the dominant military power of the region and the
whole of Germany, willingly or otherwise, was unified into a Prussian-
influenced Empire largely under the control of its ‘Iron Chancellor’ Otto
von Bismarck.
It is from this period, and the subsequent imposition of a National
German identity by Bismarck, that the popular image of the German as a
well-ordered, meticulous and sober individual is constructed, and humor-
ously described:
The German loves birds, but he likes tidy birds. A bird left to himself will build
his nest just anywhere. The nest finished, the bird proceeds to live outside it,
he drops things on the grass, he is indelicate, he makes love, quarrels with his
wife and feeds his children in public. The German is shocked. (Jerome, 1900)
This image represents a stereotype based around the fundamental Prussian
virtues of ‘nuchternheit’ and ‘pflichterfullung’. Nuchternheit refers to simplicity,
sobriety, spartanism and a horror of outward pretension or show, and pflichter-
fullung to modesty, thrift, self-discipline, hard work, decency, honesty and a
readiness to serve or to do one’s duty (MacDonogh, 1995). Displaying these
virtues had originally defined one’s place in a social order that was rigid. The
ruling classes, the Junkers, were arrogantly dismissive of any other class. They
were envied and aped by the middle classes, challenged by the growing
industrial classes and equally feared and despised by the working classes.
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dementia 5(4)
In the years following unification Prussian values came to dominate
German culture, and all tiers of society. In many areas their imposition was
unwelcome and it is accepted that the further away one moved from the
apex of power the more vulnerable these values were to dilution
(MacDonogh, 1995).
Imperial Germany therefore presents at one level as a class-driven hier-
archical society and at another as a melting pot of anti-Prussian resentment
with the potential for social revolution. Bismarck countered much of this
by introducing the first truly coordinated welfare state that encompassed
unemployment insurance, old age pensions, workers’ compensation and
health and safety at work regulations. Quite candidly he acknowledged that
such a policy of ‘state socialism’ was offered not from any real desire to
improve quality of life for the working classes but to bribe the lower orders
and divert attention away from the increasingly seductive influence of
socialism (Ozment, 2004).
Despite pockets of resistance most Germans underwent, to some extent,
a process of socialization through which both ‘nuchternheit’ and ‘pflichter-
fullung’ virtues came to offer a template of correct behaviour for the citizens
of Imperial Germany (MacDonogh, 1995). As it is against such a template
that Auguste would have been measured for most of her life, we now turn
our attention to considering what we can of her specific lived experience.
Auguste: ‘The early years’
Born on 16 May 1850, Auguste lived through the best and worst of
Imperial Germany. Her home city, Cassel, underwent great economic and
social change during a period of time in which the whole country was
transformed from an agrarian society into a prosperous giant of industrial
capitalism. Cassel was one of the few original medieval cities of Germany.
Until its forced assimilation into the empire in 1870, Cassel was the capital
of the Hesse region situated in the south of the country with Berlin to the
east and the Rhine to the west. Its citizens were predominantly protestant
(as was Auguste) and generally regarded as independently minded, to the
extent that they had formed an unsuccessful alliance with Austria in the
1866 Austro-Prussian war. In the late-19th century Cassel saw its industrial
base grow, alongside its development as a major junction for the expand-
ing rail network. The profile of its workforce changed from mostly home
workers, small traders or artisans to more mobile factory workers.
The city which Auguste would recognize is now almost entirely gone.
During October 1943, in an exercise of precision allied bombing, the city
was razed to the ground and 10,000 inhabitants killed, whilst the intended
target of nearby heavy weapons factories escaped largely unscathed. Sadly,
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a further casualty of wartime appears to be any records to inform us about
Auguste’s specific social history. German population census records, along
with most civil and church registrations documents, were largely destroyed
and any remaining from the late-19th century are merely a head count with
no mention of individuals by name. We do know that her father died
young, that she had three siblings and that Auguste spent her childhood
years in Cassel (Maurer & Maurer, 2003).
When Auguste was a child in the 1850s the concept of ‘childhood’ was
still fairly new. Aries (1960) has suggested that throughout most of history,
and in almost all societies, children have been in all respects regarded as
‘little adults’. It is only in the late-18th century that Germany, along with
most of Europe, is seen to become ‘enlightened’ and to move away from a
‘pre-child-conscious’ state towards one which ‘discovered’ childhood
(Stargardt, 1998). Such a discovery led to a redefinition of the parent as ‘all
powerful’ and possessing no needs that a child could fulfil. As there was no
dependence on the child the parent was free to unselfishly show love and
affection as never before (Habermas, 1998).
There are, however, possibilities that this may have been short lived.
DeMause (1974) controversially suggests that any enlightened ideas gained
by the start of the 19th century were lost by its close, as industrialization
led to a further redefining of relationships within the family. Children as
workers essentially became ‘units of production’ on whom parents were
now in part financially dependent, their value below working age dropped
to almost nothing, and they became regarded as non-contributing or
burdensome members of the family. Under the pressure of industrial capi-
talism the Prussian virtue of sobriety became perverted into emotional
detachment (Livingstone, 2001) and the working-class parent could no
longer love the dependent child. Consequently, parental behaviour towards
the youngest children changed for the worse (Habermas, 1998). Studies
of autobiographical accounts from the time have revealed a pattern of child-
hood exploitation, neglect, abuse and cruelty occurring in Imperial
Germany (Ende, 1980a, 1980b) that was arguably worse than anywhere
else in Europe (Scheck, 1987).
Auguste attended school and may, intriguingly, have been a student of
Alzheimer’s grandfather, Johann, who was schoolmaster in Cassell (Maurer
& Maurer, 2003). She was literate and in later life able to complete simple
mathematical tests set by Alzheimer. Auguste would never have contem-
plated the concept of higher or further education and in this she was not
unique. Whilst Prussian children had enjoyed a right to schooling since
1717 it was generally felt that a little education was sufficient for the
majority, access to higher education was therefore based not upon ability
but upon social class and gender (MacDonogh, 1995). Even though
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Auguste would have been denied a secondary education she would, along
with 70 per cent of children, have had the opportunity of eight years’
compulsory ‘volksschule’ which represented three hours a day of primary
education (Boswell, 2000).
By the European standards of the day this was excellent access to
education, but the reality was often different. With household economies
for the majority of working-class families being partly reliant upon the
wages of children (Stargardt, 1998) some simply never went to school
(Wolbring, 2003). For those children aged eight and above, school usually
occurred after the completion of a morning’s work of some six hours
(Wilson, 2003). Not surprisingly, many children had no energy to play and
most daughters would be kept inside either to assist with household tasks
or simply to remain under surveillance, particularly by some of the stricter
protestant families (Kaplan, 1993).
Auguste: ‘The middle years’
By 1870 Auguste was 20 and would have been aware of significant social
changes occurring around her. With the rise of Prussia, social class distinc-
tions had become both complex and rigid. The dominant function of the
new State was to preserve the social order and its orientation around a hier-
archical class structure with an autocratic monarch, Kaiser Wilhelm I, at its
apex.
Slightly below the Kaiser was Bismarck’s own class, the Junkers or aris-
tocratic land owning magnates, mostly Prussian, who were possessed of
great political power but were economically weak. Whilst first-born sons
inherited titles, and land, the non-inheriting sons had almost sole access
to occupations within the senior civil service, diplomatic corps, army
officer corps and the judiciary. Sitting at a level below this were the politi-
cally weak, but economically powerful, middle classes and the post-indus-
trial capitalist classes that grew in prominence towards the end of the 19th
century.
Auguste was however a member of the working classes and would have
been mostly familiar with two distinct social groups. The first group is
Angestellte’, or non-manual public sector workers essentially defined as
‘white collar’ workers, who represented a very conservative group. They
were socialized into the belief that duty to the state was greater than indi-
vidual enterprise, and were highly obedient to prevailing social values and
norms. The second group are Arbeiter’, the manual or blue-collar workers,
who generally experienced poor working conditions. However, the intro-
duction of the German welfare state under Bismarckian state socialism
considerably improved their condition.
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Imperial German society was not only preoccupied with Prussian
virtues and social status but also with gender differences. The status of men
was considerably higher than that of women and throughout German
society there was clear prejudiced behaviour by men towards women. This
was not uncommon amongst many contemporary cultures where the roles
of men and women were divergent, men being regarded as more compet-
ent and independent, women regarded as more dependent but also warmer
and nurturing. The template for the feminine role as constructed during
Imperial Germany would remain unchanged until at least 1945 and could
be essentially circumscribed by three words kinder, kirche, kuche’ or children,
church and kitchen.
Commonly daughters worked until they married and on completion
of her schooling, aged around 14 years, Auguste would have been sent to
work full-time. For her peers in Victorian England this predominantly
meant heavy labour in a mill or factory (Wilson, 2003); however, the
industrial revolution came later in Germany and whilst Auguste would
have been employed it is unlikely that, as a child, she worked in industry.
Employment for a young woman of the 1860s encompassed such things
as entering into ‘service’ for middle-class families or taking up a ‘trainee’
role often as a seamstress (Baader, 1901). Marriage was, of course,
regarded as the only honourable career for a woman and in 1873, at the
age of 23, Auguste married Karl and moved 180km south to Frankfurt
where she lived for the remainder of her life.
Her last home address was an apartment on Morfelder Landstrasse, a
broad city street on the south side of the river Main situated within easy
travelling distance of the Hauptbahnhof railway station where it is likely
that Karl had worked since its opening in 1888. As a railway clerk (first
class) Karl belonged to the traditional and conservative Angestellte class that
was strongly influenced by those ‘nuchternheit’ and ‘pflichterfullung’ virtues.
His wife would also be expected to reflect these virtues and conform to
certain social rules of behaviour not only for her social class but also for
her gender.
Auguste would have been defined, and evaluated, through the related
social identities of woman, wife and mother. In accordance with beliefs
about the role of women (kinder, kirche, kuche) she would have been expected
to marry, to produce and morally educate children, to keep a tidy and
orderly house and to be obedient to her husband. Auguste, as far as we
know, appears to have complied with this; certainly by marrying and
producing a daughter, Thekla, she fulfilled her social obligations. She and
Karl were married for 33 years; he states they were ‘happy and harmonious’
that she was ‘rather amicable’ and ‘constantly hard working and orderly’
(Maurer & Maurer, 2003).
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Like all German women of the time she was a victim of the historical
prejudice against women and their place in society. Auguste’s life was there-
fore one of male domination by father, subsequently husband and latterly
doctor, with her social identity clearly one of supporting ‘her man’, raising
her child and keeping her house. Her husband, who had the right to decide
if his wife could work and if so for whom, how household finances would
be spent, what the children would be named and what religion the house-
hold would follow, may have controlled her whole life.
Beliefs about this male-dominated society have created a modern
stereotype of ‘miserable unions between oppressive husbands and violated
wives’ and there are contemporary accounts that appear to support this.
Cheston and Bender (1999) cite the following from 1895:
It is surprising that the wedding night does not have pathogenic effects more
frequently, since unfortunately what it involves is so often not an erotic seduc-
tion but a violation. (Breuer & Freud, 1955 [1895])
Such a view may however be criticized as being unreliable, perhaps too
heavily influenced by a particular perspective or by beliefs regarding male
and female sexuality. German society held the ‘Victorian’ perception that
women were sexually active from only a moral sense of duty to reproduce,
and otherwise were vulnerable to the more wanton and primitive behaviour
of men (Phillips, 2003). The reality is probably somewhat different and less
about sexual oppression. Some early and contemporaneous feminist
accounts describe marriages as often being close and loving relationships
combining mutual respect and strong affection (Mahood & Wenburg, 1980).
The ‘happy and harmonious’ marriage between Karl and Auguste seems
to reflect this and it may be highly relevant that, as far as we know, they
only had the one daughter. As such Auguste was saved from the experience
of multiple pregnancies and frequent confinements that were certainly a
significant factor in souring some women’s experiences of marriage and
which did lead the early feminist movement to describe marriage as
‘legalised prostitution’ (Brody, 1992).
Auguste: ‘The later years’
By the late-18th century the Prussian ideals for Imperial German society
were starting to fragment and commentators were daring to suggest that
behind the façade of imposed virtues many citizens lived in a turmoil of
tension and strain. The ‘civil realist’ novels of Theodore Fontane (1976a
[1893], 1976b [1895], 1979 [1882]) capture a sense of this and suggest
that hidden away behind the rigid social conventions of the day German
families, of all classes, were often in, or on the verge of, crises.
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Perhaps we see signs of this through the experience of Auguste and Karl
when, in the spring of 1901, Karl became concerned about a change in his
wife. Auguste was suddenly suspicious of him and made accusations about
him having a relationship with a female neighbour. Shortly after this she
began to neglect her housework, hide household objects and make mistakes
with cooking. It appears that her decline was rapid and over the next few
months Auguste became increasingly restless; she disturbed neighbours by
ringing their doorbells, she slammed doors and increasingly expressed
fearful and paranoid ideas to, and about, others.
Auguste was now behaving out of character and in ways that challenged
the conventions for expected behaviour. She acted in ways that were
contrary to ideals of self-discipline, hard work and decency, she accused
her husband of infidelities rather than submitting to him and their home
life became disordered rather than well ordered. Whilst much of this could
be kept hidden within the apartment and a façade maintained (there is no
record of Karl seeking help for some eight months) Auguste’s later behav-
iours involved disturbance and nuisance towards her neighbours that
perhaps shattered the façade. By November 1901 they were in crisis and
eventually sought help from their family doctor who stated:
Mrs Auguste D . . . has been suffering for a long time from weakening of
memory, persecution mania, sleeplessness, restlessness. She is unable to
perform any physical or mental work. Her condition needs treatment from the
local mental institution. (Family Doctor’s admission note 1901, cited in Maurer
& Maurer, 2003, p. 19)
Consequently, on 26 November 1901,Auguste was admitted to the Munici-
pal Asylum for the insane and epileptic in Frankfurt am Main.
A further casualty of allied bombing, the Municipal Asylum no longer
exists but in the late-18th century it was sufficiently grand in its Gothic
architecture to have earned the local nickname ‘the castle for the insane on
the hill’. The Municipal Asylum was spacious, built without high walls and
the emphasis placed upon light and space. The rear of the building was
designed as a tree-lined promenade whilst the front was framed by exten-
sive gardens. These gardens once again reflected the rigid class structures
of the day with separate areas for: the paying class, the normal class, the
troubled or epileptic and the ‘raving mad’. Its 37 acres of land provided
the space for vegetable gardens, a tailor’s shop, bookbinding and
carpenter’s workshops and offered productive work to a third of the resi-
dents (Maurer & Maurer, 2003).
By 1901 the Municipal Asylum was influenced by ideals as grand as
its architecture. Alzheimer, and his senior colleague Emil Sioli, strived
towards achieving both the scientific study of severe mental illness and
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compassionate care for those afflicted. In this we see evidence of the pater-
nalistic nature of German society operating within the institution. The
physician held a position of authority, devolved through the staff (repre-
senting the descending social orders) with the lowest order, the patient,
expected to be passively obedient. Authority carried responsibility and a
duty of care, which Alzheimer appears to have willingly accepted. Both
Alzheimer and Sioli believed in principles of ‘non-restraint’ and ‘open
treatment’ aiming to achieve:
Care for every individual patient being of the kind that completely precludes
the coercion usually attached to all tasks . . . and in the most gentle, careful
direction of the acute cases, in more careful physical nursing, which must
exceed the steps taken by other hospitals. (Sioli, 1889, cited in Maurer &
Maurer, 2003, p. 56)
Such aspirations reflect the broader changes in psychiatric care seen during
the period of Imperial Germany. At this time the status of the ‘mad’ was
transformed from those lacking in morals and in need of redemption,
towards a new status of the ‘patient’ deserving of, and requiring, direct
medical intervention and scientific inquiry (Engstrom, 2003). Alzheimer
and Sioli had some success in introducing policies aimed at improving the
quality of care and treatment; they restricted the use of isolation rooms and
banned straitjackets. They scorned the location of the autopsy room, taking
action to move it away from the actual living space of the ‘raving mad’
patients, offered small excursions into nearby areas and encouraged
evening concerts be performed in the asylum (Maurer & Maurer, 2003).
Into this enlightened atmosphere Auguste arrived in what must have
been a bewildered and fearful state. With the benefit of hindsight her
admission can be seen as a momentous event in the subsequent creation
of what came to be known as Alzheimer’s disease. At the time it was simply
a routine event and the junior physician, Dr Nitsche, completed her admis-
sion. Terrified that she faced harm she resisted any physical examination.
However, Nitsche notes that apart from being underweight, probably as a
result of eight months agitated behaviour, Auguste was otherwise in good
physical health. Descriptions suggest that she was a tall woman with long
brown hair, brown eyes and elegantly long fingers. However, the only
known images of Auguste are a series of four asylum photographs taken
around 1902, the most well known being sepia stained which makes
Auguste appear to be dirty and her features somewhat swarthy, with a
sorrowful expression and dressed in the asylum nightshirt she is denied
the more modest attire for a lady of the time.
In the weeks and months following admission Auguste did present as
a pathetic figure, who was rarely free from fear and agitation. She courted
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physical aggression from other patients by grasping and groping their faces
as if she were blind. At other times she screamed loudly, accusing the staff
and doctors of wanting to stab, cut or violate her. In calm periods she
responded with courtesy to others around her, acting as if surprised by
visitors to her home who she may have forgotten were coming or who had
arrived early. Such calm periods were sadly rare. Auguste spent most of her
days in the bath (bathing of long duration believed at the time to soothe
the agitated patient) and, despite the restrictions on its use, most of her
nights in an isolation room (Maurer & Maurer, 2003).
Alzheimer left Frankfurt in 1903 to join Emil Kraeplin and undertake
scientific research in Heidelberg. Despite this he maintained an interest in
Auguste and his intention to examine her neuropathology at post mortem
was known to Sioli. This intention was probably an influential factor in
keeping Auguste at the Municipal Asylum when in 1902 and 1904 Karl,
unable to pay his contribution of two marks per day towards her fees,
requested transfer to a different institution. Such a transfer would have
removed Auguste from Alzheimer.
From 1892 statutory health insurance GKV (Gesetzliche Krankenversicherung),
was mandatory for anyone earning less than 2000 marks per year. By 1901
it had been extended to transport office workers and their families. If the
social welfare office funded Auguste then sickness fund officials would have
determined where, and by whom, she would be treated. Records suggest
that this would not have been Frankfurt but nearby Weilmuenster. It appears
that in 1902 Alzheimer directly intervened to prevent this from happening
as did Sioli again in 1904, twice informing the welfare office that Auguste
had no hope of recovery.
Karl did not have to support Auguste; legally he could have easily
sought a divorce, section 79 of the 1900 Civil Code, the BGB (Das Burg-
erliche Gesetzbuch), states:
A spouse can sue for divorce when the other spouse has succumbed to mental
illness, the illness has lasted three years during the marriage and has reached a
degree that precludes spiritual companionship, and the prospect of re-estab-
lishing the companionship is precluded.
Despite this opportunity Karl continued to struggle to make his contri-
bution towards her fees, and the fact that he also frequently visited Auguste
appears to show his desire to stand by her whilst both actions make a
powerful statement about his affection for her. Karl must have been affected
by her decline as over the next few years Auguste underwent significant
physical changes. Around 1905 the disturbed behaviour was less frequent
but casenote entries describe her as being:
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dementia 5(4)
. . . completely stupefied, always lying in bed with legs drawn up. Regularly
soiled with urine and faeces: never says anything, mutters to herself, has to be
fed. (Maurer & Maurer, 2003, p. 154)
Her final few months must have been particularly miserable for Auguste.
The agitation returned and did not respond to sedatives, consequently she
was put into the bath everyday. In her last days she was very frail, had pneu-
monia and developed bedsores that became infected. Mercifully, on 8 April
1906 at a quarter to six in the morning, and suffering from septicaemia,
Auguste passed away.
Auguste: ‘The final chapter’
With her death we lose Auguste from the story. Attention moves to the
examination of her brain tissue and the detailed description of its pathol-
ogy that becomes central to the later creation of Alzheimer’s disease. There
has arguably been more attention given to Auguste after death than when
she was alive, and it seems that her value as a person has never been
particularly regarded. It is therefore poignant to recall that in an early
interview with Alzheimer she was asked to write her own name and could
not recall it, Auguste commented:
I have, so to speak, lost myself. (Maurer & Maurer, 2003, p. 8)
Sadly, and despite spending much time in the company of Alzheimer and
Sioli (who in the paternalistic fashion of the day appear to have been
compassionate), she was offered little in the way of assistance to find her
‘self’ or to uphold her sense of selfhood and her unique personal identity.
Having had our eyes opened to a ‘new culture’ of dementia care we can
look back and see that Auguste was very much a victim of the ‘old culture’
(Kitwood & Benson, 1995). Her whole history before 1901 was disre-
garded as having no relevance to the behaviours with which she presented;
consequently, she was regarded as changed by her illness and beyond
repair, her case was described in the ‘here and now’, and there was no
attempt made to hear her voice or to consider the person behind the illness.
In attempting to redress this we have tried to view the person who was
Auguste as first and foremost a fellow human being, albeit of an earlier
time. She was a lady of average looks, literate, used to hard work and a
polite and welcoming hostess. Stifled by Prussian values and by the wide-
spread attitudes towards women, Auguste appears to have remained
amicable in her disposition. She was a good wife who enjoyed a happy and
harmonious marriage for over 30 years and was sufficiently successful in
choosing a husband who stood by her to the end of her life. She was a
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woman, wife and mother who was perhaps typical of her time, but what
a time it was. In a relatively short life Auguste experienced first hand a fasci-
nating period of social change, as a child seeing Prussia rise to power and
as an adult having its values imposed upon her. All around her in the
growth of factories, the railroads of Cassel, the work of her husband and
the trams passing by her apartment, Auguste witnessed the start of the
German industrial revolution. In the years immediately prior to 1901 she
would have seen signs of Imperial society beginning to break down.
Economic changes created a new post-industrial class who began to chal-
lenge the established order, ultimately leading to things Auguste would
never have dreamed of, including votes for women and a world war.
We hope that this story offers a new way of looking at Auguste, that it
raises perceptions of her status beyond just an objective clinical case, and
that it may stimulate further social research attempts to reach back and truly
discover Auguste ‘the person’.
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Biographical notes
SEAN PAGE is Clinical Nurse Specialist at the Manchester Memory Clinic based at
Wythenshawe Hospital, Manchester, UK. Address: Memory Clinic, Wythenshawe
Hospital, Manchester M23 9LR, UK. [email: sean.page@nhs.net]
TRACEY FLETCHER is Clinical Nurse Specialist in the Memory Clinic based at St.
Bartholomew’s Day Assessment and Treatment Centre on Merseyside. Address:
Memory Clinic, St. Bartholomew’s Day Assessment and Treatment Centre, Roby,
Merseyside L36 4HU, UK. [email: Tracey.Fletcher2@sthkhealth.nhs.uk]
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page & fletcher: auguste d: one hundred years on
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