[The emergence of the German 'Anstalt': lunatic asylums and hospitals competing].

Based on the wider thesis of the "grand renfermement", psychiatric asylums as well as hospitals (and prisons) should have developed to "total institutions" from late 18th century onwards by gaining public space and further resources devoted to the healing of the (mental) ill who had to be isolated from the healthy citizen following criteria of the modernising medicine. But vis-a-vis to the enormous problems of the early general hospitals to separate the curable based on strictly medical criteria one is astonished, why modern medicine developed two types of institutions and thus doubling its claims on public resources. The article aims to take a look at an early 19th century psychiatric asylum in the town of Dusseldorf from the perspective of the general hospital. That way it tries to get into account the difficult allocation of ill people to one or another hospital. As both had to prove their ability to effectively cure their patients they had to be quite aware whom to let in--and whom to refuse. As they were financed, organised and administrated on different political levels and thus dependent to different governmental bodies (town vs. region) a couple of conflicts become visible which had to be solved in order to establish institutionalisation. Finally, in the long run both had to gain public recognition and acceptance, which only could mean the acceptance of potential patients. The perspective opened by the theorem of the "total institution" seems not to be all-to helpful to that purpose, as it tends to neglect institutional competition as well as the process of gaining the potential patients' acceptance. A more useful perspective could be a comparative analysis based on local examples, which could open the view to the competing establishment of prisons, psychiatric asylums and general hospitals as "useful" types of organizations in a modernising society.