Twinkle:Tokyo Women`s Medical University


Twinkle:Tokyo Women`s Medical University
Progress and Change in German Medicine
東京女子医科大学雑誌, 52(12):1403-1405, 1982
Twinkle:Tokyo Women's Medical University - Information & Knowledge Database.
Tokyo Wom Med Coll )
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-
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-
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
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}.
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:
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
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.
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,
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. Georgi: Intrakavitlire Kontaktbestrahlung von zystischen Kraniopharyngeomen
durch stereotaktisch appliziertes Y-90, in: Kombinierte chirurgische und radiologische Therapie ma-
(sc : fiE¥ptrv., MEI, 1976, MliS ftNik*:M).
7) Dohrmann, R.E., H.D. Janisch and M.E. Kessel:
Klinische Erfahrungen mit der kombinierten Kor-
ligrier Tumoren (Wannenmacher, ,M.; Schreiber,
H.W., Gauwerky, F., Ladner, H.A., KnUfermann, H.
tison-Strophantin-Therapie bei akutem Myokardin-
und Stanina, J., eds.), Strahlentherapie (Sonderb) 76
farkt (Ergebnisse einer Dreljahresstudie). Card Bull
Acta Cardiol 16117 143 (1978179)
8) Engelhardt, R., H. Neumann, M. von der Tann
20) Tellenbach, H.: Melancholie. 3rd ed. Berlin (1976)
and G.W. L6hr: Treatment of oat-cell lung carcinoma by thermochemotherapy. Strahlentherapie
157(9) 613 (1981)
9) Fichter, J., J. Doll, W. Schlegel, W.J. Lorenz, P.
(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

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