Hesterberg's Rule for Assigning Wards by Severity of Illness

Hesterberg’s ward-assignment system made severity visible in the hospital’s architecture: lighter cases were placed below, more severe cases in the middle, and the most severe patients above. For the narrator, who grew up in the institution, these levels became more than administrative labels. They formed a childhood language in which letters carried height, illness, and threat.

The Ward Map

The buildings were arranged in two rings around the director’s house. The inner ring contained buildings A through G, the outer ring H through P; workshops and some fields lay outside both. Each building had three floors, and each floor was a ward. Their names described their position: Unten for the lower floor, Mitte for the middle, and Oben for the upper. Overcrowding produced exceptions such as Keller and unterm Dach, adding basement and attic wards to the system. A ward could consequently be identified by a building letter and a floor, as in A-Unten, J-Mitte, or B-Oben.

The spatial labels did not merely help locate patients. Within each building, lighter cases were on the lower floor, severe cases in the middle, and the most severe, described in the narrator’s account as hopeless, on the upper floor. His father referred to these wards as working units: he might report that someone had set a fire in G-Oben, or that M-Unten was so overcrowded that four cases had to be transferred to D-Unterm Dach. The system joined clinical distinctions to the practical pressures of capacity and relocation.

Architecture and Institutional Life

The severity hierarchy operated within an expansive, largely self-contained institution. Many of its dark brick buildings dated from around the turn of the century; rooms could hold as many as twenty patients, and four-storey bunk beds had ladders. The upper beds could be locked to prevent patients from falling out, making them resemble small cages. The arrangement of patients by floor thus belonged to a broader environment in which buildings, beds, and boundaries organized daily life.

The hospital also contained a nursery, a large kitchen, a carpentry shop, a tailor’s shop, a steam laundry, a coal-heating plant, and a locksmith’s workshop. Patients worked at some of these sites in a mixture of occupational therapy and exploitation. The institution’s population and routines extended beyond children: older and very old patients remained there when leaving surroundings familiar from early childhood was considered unreasonable. At its gates, the narrator witnessed people resisting both admission and departure, showing that movement into or out of the hospital could be a source of acute distress. The floor plan was therefore one part of a larger system that shaped residence, work, movement, and attachment.

The Narrator’s Heightened Letters

The narrator absorbed the ward vocabulary so thoroughly that he imagined letters themselves had different heights. While learning to write, he wondered whether the H in a word such as dog should be written as H-Unten or H-Oben. The hospital’s classifications had become a private grammar: a letter’s position could suggest how dangerous or serious the word it began might be.

He used a raised initial letter to give a word particular force. The notorious locked ward K-Oben made words beginning with a high K seem wild and difficult to control: cheese, illness, crumbs, coffee, kindergarten, or cat could acquire menace through that elevated letter. By contrast, an illness assigned K-Unten became a mild, non-life-threatening condition; a cat marked K-Mitte might scratch, but did not necessarily do so. This was not a formal hospital practice applied to written language, but the narrator’s imaginative extension of the ward system into the act of writing.

The association between letters and patients could also make words fragile. In L-Unten lived girls with anorexia; outlines of bodies were sometimes drawn in chalk outside the building, where the girls had to lie down and be traced so that they could see they still existed. For the narrator, words beginning with the low L—light, curls, leather—shared that vulnerability and seemed at risk of disappearing. Words he feared or disliked could be sent, in his imagination, to the relevant locked ward and kept from getting out. At school, this private system contributed to outbursts of rage: teachers and classmates did not understand what he wrote in his exercise book or on the blackboard.

Change and Afterlife

Years later, the narrator returned to the Hesterberg grounds and found the institution radically altered. Its roughly three-kilometre wall and both gates were gone; buildings C, D, and M had been demolished, while K stood empty, its windows smashed up to the upper floor. Later buildings remained in use, but tall opaque fences blocked his view, and the grounds seemed deserted. He saw a few patients moving behind the thick-looking windows of the newer clinic and learned later that fewer than three hundred remained.

He recognized that the earlier institution had been overcrowded and harsh, with inadequate medical care and extensive use of sedating drugs; the surviving patients, he understood, had a more appropriate and humane environment. Yet the changed grounds made him grieve for the vanished world in which he had grown up. His longing was not an endorsement of its conditions: he knew the old institution had needed to disappear. The ward system’s afterlife lies in this tension. Its hierarchy had classified patients by severity, but its letters and floors had also become part of the narrator’s home, memory, and way of imagining words.