Twinkle:Tokyo Women`s Medical University
Transcrição
Twinkle:Tokyo Women`s Medical University
Title Progress and Change in German Medicine Author(s) Journal URL 東京女子医科大学雑誌, 52(12):1403-1405, 1982 http://hdl.handle.net/10470/4937 Twinkle:Tokyo Women's Medical University - Information & Knowledge Database. http://ir.twmu.ac.jp/dspace/ 1 Tokyo Wom Med Coll ) <J52(12) 1403- 1405 (1982) Progress and Change in German Medicine Wolfgang Ade, M.D. Department of Thoracic and Cardiovascular Surgery (Chairman: Prof. Dr. Juro WADA) Tokyo Women's Medical College (Received 8th September, 1982) This year the German medical community cele- pathologists. brates the 100th anniversary of Koch's discovery of Unfortunately, many doctors-especially those the causative agent of tuberculosisi5). This discovery involved in clinical work are overburdened with a lot 24 years after Virchow's epoch-making treatise on "cellular pathology"2i> which had paved the way fbr of administrative duties. It is said that senior aca- demics at the universities -and that includes nearly all hospitals active in research- are kept away from a really scientific basis of medicine greatly stimu- lated medical research in Germany. This is not the place to deal with all the discoveries initiated by these two doctors. Rather, I want to examine how the spirit of these great pioneers has lasted up to the present time. In short, where does German medicine stand today? It is known that Koch partitioned his consulting room with a curtain in order to make space for his the bench except fbr the vacations which in Germany Iast from February to March and from July to September. In summer, however, most people also take a three- or four-week holiday. Let me now move from this overview to sorne of the particular activities which are focus of medical reseaTch in Germany at the present time. The labdratory animalsiO). Nowadays the cry is not about German word `Wissenschaft' means knowledge. It carries no connotation of a distinction between space as such but about a lack of research funds. science and art as in English and this leads me on to This year, fbr the first time since the Federal Republic was established, there will be a `de facto' decrease in research spending. This is a reflection of year, the 150th anniversary of Goethe's death. the stagnation in international trade in manufac- too. He considered his scientific work to be more tured・ goods which constitutes some 47% of the country's export trade, a budget increase of only 4% and an infiation rate which may come close to 6%. One factor which seems to stifle the creativity of important than his literary pursuits. Let me mentio4 here in passing his discovery of the os incisivumi2) and his theory of coloursii). Goethe's ideas, together with those of Gestalt philosophy, led Doerr, one of German scientists nowadays is the presence of an overwhelming number of students in the universities. In general, the number of students is more the leading proponents of German anatomical pathology who has done much work concerning cardiac malformations and the blood supply of the than four times higher than in 1'960. A further impediment is the balefu1 infiuence of bureaucracy. Governmental committees decide which posts are to be abolished and which are to be created. The MaxPlanck-Institutes, however, provide a good counter- heart to the conclusion that the spatiai order and at- point to this situation. In general they have better success than the universities in research, but there are onlY a few of them carrying out clinical research. phrase mathematically causes loss of the melody6). Everybody who wants to evaluate the results of psychiatric research will even today gain much reward This year the Max-Planck-Gesellschaft f6unded a `Klinische Forschungsgruppe' for studying the from reading Jaspers' now nearly classic book on pathomechanisms of multiple sclerosis (mainly the another anniversary that is being celebrated this Goethe was not only a poet but a `Wissenschaftler', tribution of organs or histological preparations should be grasped as a Gestalt in the sense of Gestaltphilosophy and cannot suMciently be described by physical means, as defining a musical general psychopathologyi4) which clearly shows the scope of the pathological changes of the inner life autoimmuneprocesses in demyelisation) and which and leads the reader into a critical analysis of it and is staffed by neurologists, neuroimmunologists and on to philosophical reflection. More recently, Tel- -1403- 2 lenbach's phenomenological oriented theory of melancholy has been puplished and this has also appeared inJapanese20). One may add to this Schafer's reflections on purely curative medicine showing the need for a preventive health education including Besides its studies in biomedical and statistical re- search, the German Cancer Research Centre in Heidelberg is involved in research into clinical nuclear medicine. Fichter et al. reported a computer algorithm for localization of pulmonary tumors according to scintigrafic scans9). For radiation therapy psychosocial and psychosomatic aspectsi8). There are many similarities between Germany new isotopes are under investigation. They are im- and the rest of the world in the fields of technical planted into brain tumors using computer-based and biomedical research and surgical and drug imaging methods which allow a precise localization therapy, but given my rather limited knowledge of my guest country, I have detected some differences of the tumorsi9). I myself was inyolved in the elucidation of the primary structure of tubulini6), one of in approach between Japan and Germany. In Germany the general approach seems to be avoidance of the main proteins of the microtubules which form the mitotic spindle, at the Institute of Cell and risks, whereas here it seems that risks are taken into Tumor Biology. It is interesting to note that in the account and then overcome. An example of this is Karthagener 'Syndrome the microtubules of the the treatment of deformities 'in the anterior chest w,all. In Germany the Brunner operation is favoured mucous cilia lack dynein arms5). As this syndrome as it is `risikoarm' (low risk)4). Please accept my apol- may give clues about the cellular mechanisms of morphogenesis. ogies for the ignorance of medical authors in Germany concerning the work being done inJapan. Let me now say a few words about cardiological research. In Germany it has been noted that the immediate application of g-strophantine perlingual and methyl-prednisolone in cases of cardiac infarc- exhibits situs inversus, elucidation'of this condition In theoretical medicine Beier's efforts in fbrmulating a mathematical interpretation of biomorphosis and aging processesS) are worthy of attention. Heidelberg is mainly concerned with elucidating the Befbre finishing, I would like to mention briefiy some of the highlights of medical care in Germany. There are no real bottlenecks except in cardiac and neurosurgery. Around Stuttgart it is common that a patient must wait for six months for a coronary by- tion reduces the lethality7). The Institut fUr Herzin- farktfbrschung of the Ruprecht-Karls-Universitat risk factors for this disease through studies on Iipid pass operation. This situation will probably not im- metabolism and epidemiological research. In the prove since cutting expenses has become the main main centres cardiac catheterization is carried out after hospital admission of infarct patients, and if possible, mechanical thrombus perforation using a soft guide wire is attempted. In all cases high dose coronary selective infusion of nitroglycerine and topic of discussion in medical and political circles. The German government intends to Iower the percentage spending on the health services and to spend more money on the development of new energies. The last `Arztetag' did not concern itself primarily streptokinasei7} or urokinase is applied. Recanaliza- with scientific problems, but centered rather on the tion is achieved in about 80% of the cases. Ardenne problems ofmedical ethics. Germany does quite well in cooperating interna- claims that his `02 multiple step regeneration process' for the cardiopulmonary systern yields a per- manent increase in arterial p02. This is linked to cancer research and cancer therapy as it is said that this process in combination with immunostimulation (N-2-cyanoethylurea) and sometimes in combination with hypertherrnia lowers the probability of metastasis2>. Hyperthermia in combination with chemotherapy is used at the tionally in the fields of particle and plasma physics and machine tool development. It is my hope that in the field of medicine, too, rather than looking with envy at America, there will be those who will cooperate internationally and who will strive not only for a career fi11ed with publications but will strive equally to improve the health of their patients. I hope also that there will be those who will struggle towards a University of Freiburg fbr the treatment of the oat deeper understanding of pathomechanisms, re- cell carcinoma of the lung8). Last year a German surgeon succeeded in performing an isolated liver search which may only bear fruit after a number of years. If these endeavours are combined with a wil- perfusion with cytostatica in which the organ remained in the abdomen and was perfused by a lingness to carry out interdisciplinary and international cooperation, success will be assured. I want to ask myJapanese colleagues to exploit the heart-lung machine for some hoursi}. -1404- 3 possibilities fbr contacting their Gerrnan counter- diskriminanzanalytischen Verfahren. Nuklearrnedizin 19(4) 191 (1980) parts in spite of any language barriers that may exist. Japan and Germany find themselves in a 10) FleiB, B.: Robert Koch: Nicht nur Entdecker des -- Arzteblatt, . Tuberkelbazillus. Deutsches Ausgabe C similar situation in attracting the attention of the 79(11) 61 (1980) 11) Goethe, J.W. von: Zur Farbenlehre, in: Deutsche Na- international scientific community. Together it would be easier. Let me close with a verse of Goethe: tional-Litteratur. Historisch-kritische Ausgabe (KUrschner, W..; ,ed...)., Vol. I161117 Coethes Werke "Wer sich selbst und andere kennt, (part 35136), Naturwissenschaftliche Schriften Wird auch hier erkennen: Orient und Okzident sind nicht mehr zu trennen" (Steiner, R., Ed.), vol. S, p. 71--vol. 4, part 2, p. 336. Stuttgart (1882--1897) Union Deutsche Verlagsgesellschaft. Reprint: Tokyo (1974) Sansyusha Publishers or inJapanese: Co,,Ltd. 12) Goethe, J.W. von: Dein Menschen wie den Tieren ist ein Zwischenknochen der obern Kinnlade zuzuschreiben. Zur Morphologie, 2. Heft, (1820) Reprinted in: Deutsche National-Litteratur. Historisch-kritische e fi t ftE .,k t igecn 6 Z et dC-(Ftsk.M)6E65. IHIfi t thJti t hg Ausgabe (Ktirschner, W., ed.), vol 114: Goethes as e*-Rp 5)・ th ts -D C E eD "(b * tsQ d t 6r. Werke, Naturwissenschaftliche Schriften (Steiner, R., ed.), vol 1, p. 277--819. Stuttgart (1882--1897) Union (Goethe, W. von: "West-6stlicher Divan") Deutsche Verlagsgesellschaft, and Tokyo (1974) Sansyusha Publishers Co., Ltd. References 13) Goethe, J.W. von: West-Ostlicher Divan. Leipzig 1) Aigner, K., in: Interarterielles Symposium. GieBen. (1957) Inselverlag. April 1982. in press 14) Jaspers, K.: Allgemeine Psychopathologie. 8th ed. Berlin (1965) Springer-Verlag 15) Koch, R.: Die Atiologie der Tuberkulose. Berl klin Wschr 19 221 (1882) 2) Ardenne, M. von: Grundlagen der SauerstoffMehrschritt-Therapie. 2nd ed., Stuttgart, 1980. Georg Thieme Verlag S) Beier, W.: Biomorphose, in: Biophysikalische Grundlagen der Medizin (Baier, W. and Rosen, R., eds.). 16) Krauhs, E., M. Little, T. Kempf, R. Hofer-Warbinek, W. Ade and H. Ponstingl: Complete amino 2nd ed., Stuttgart, 1980. Fischer, p. 502--545 acid sequence of fi-tubulin from porcine brain. Proc Natl Acad Sci USA 78(7) 4156 (1981) 4) Blum, U., E. Ungeheuer und E. Marz: Zur operativen Korrektur von ThoraxmiBbildungen. Chirurg 53 17) Rutsch, W. et al.: Perkutane, transluMinale, 4S6(1982) 5) Camner, P., B. Mossberg and B.A. Afzelius: Evi- koronare Rekanalisation: Methodik, Ergebnisse und Komplikationen. Z Kardiol 71 7 (1982) 18) Sch5fer, H.: Plidoyer ftir eine neue Medizin. Warnung und Appel. Mtinchen (1981) Piper 19) Sturm, V., K.E. Scheer, W. Schlegel, L. Strauss, H. dence of congenitally nonfunctioning cilia in the tra- cheobronchial tract in two subjects. Am Rev Respir Dis 112(6) 807 (1975) 6) Doerr, W., G. Schurnann and G. Ule: Atlas der pathologischen Anatomie. Stuttgart, 1975. Georg Thieme Verlag Penzholz und P. 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(ge : pt iY= V -, fiM (1978) &-;--t'ZE) 21) Virchow, R.: Die Cellularpathologie in ihrer BegrUndung auf physiologische und pathologische Gewebelehre. Berlin (1858) Georgi'and L. Edler: Bewertung quantitativer Auswerternethoden von Lungenszintigrammen mit -l405-