Pan-Germanism in Medicine — To What Will It Lead?
Boston Medical and Surgical Journal
perior to ours. This is due to the complete standardization of education, the close affiliation of schools with hospitals, and the laws relating to post-mortem material. Clinical teaching is admittedly their weakest branch. That this very weakness strikes at. the root of what is best in medicine as an art, will be shown below. We have much to be thankful for in the betterment of medical education in this country. The re>port of the Council on Medical Education shows gratifying progress. There
... g progress. There has been an astonishing decrease in the poor medical schools in the country and a corresponding development of the "A plus" and "A" groups. We still lead all countries in the number of physicians iK'r capita of population. Our average is about one to every 660 persons. In Germany the ratio is one to every 1912 persons, but this contrast is not so great when we consider that the title "praktischer Arzt" is much more safeguarded than here. Over one-third flic medical work in Germany is done by charlatans not registered as physicians, in this country a large number of them are so registered. The phenomenal amount e>f Charlatanism in Germany has received much comment anel study. One explanation of it, quoted by the Carnegie Foundation lteport on Medical Education in Europe, is that it is due to the compulsory adjustment required to fill the ranks depleted by the high standard of education which made such a great demand of time and money for the preparation of the physician. This is shown to be true in no degree, for there was formerly a much greater scarcity of physicians than now, at a time also when the general health was poorer. It is also shown that instead of being depleted the number of physicians has increased far more rapidly than the population. The true explanation is found in the inauguration of the "Kurierfreiheit" by which legisladon anyone is allowed to dispense drugs and treat disease, the title "prakt. Arzt" only being safeguarded from assumption by unqualified persons. Previous to this legislation there were very few charlatans. Now the situation is assuming such tremendous proportions that it. is resulting in a considerable financial loss to physicians, the income from proprietary remedies in Prussia alone amounting to over seven and a half million dollars. Whether the legislation is wholly responsible for this change or whether another factor may not be considered as causal is somewhat doubtful. There are certain tendencies in the evolution of medicine as a pure science as it is developed in Germany which are contributing to the increase of e-harlatanism. These tendencies are worthy of analysis to us who are so rapidly Germanizing our methods, as a warning, so that we may escape like evils. A medical school has two important, duties, one to medical science, tho other to tho public; one encouraging and promoting medical education and scientific progress, the other supplying to the public welltrained practitioners. The latter function is really the greater, for out e>f every graduating class 90% are practitioners and less than 10% are scientists and of these probably only one or two are so eminently fitted for scientific work as ever to accomplish much. The conditions in Germany are reversed. There, there are ninety physicians dawdling with sciene« to every ten doing practice. Of tills 90, fully 75% are wasting their time as far as permanent results are concerneel. There are thousands of investigators producing thousands of publications yearly, only a very few of which stand the test of time. The keen competition promotes such a desire for priority that the merest hints of new side-lights and theories are hastened into print, only to die ignominiously because of their shallow soil. The very strength of the teaching of theory and the weakness of clinical teaching in Germany produces a few scientists, a large number of pseudoscientists and few good practitioners. Tho scientific side is over-developed, the human side greatly neglected. Any American will testify to this who has had practical experience with German physicians or hospitals. They do not know how to treat the individual. They recognize only the disease. The comfort of the patient or the recognition of his personality is not considered. The extremely slow and very imperfect development of trained nurses shows that those have not been thought of. The real poverty of the people anel the paternalistic system of Krankenversicherung keep flic wards of (he general hospitals full. Hut they arc choorle'ss and gloomy and the patients show extraordinary lack of care. Intercurrent infections in tlie wards are extremely common. Even in the splendid new institutions it is easy to sec from the spirit manifested by the staff that the improved conditions were not for tin? comfort of the patients. In the finest equipped wards in Europe I have heard the Dozent on the morning rounds more than once say to a patient, whoso case did not interest him at the moment, "You liad hotter go home as we can't use you hero." The human side of medicino is undeveloped. Even in the manifold Anstalten and Kurorten, the physician rarely has a spontaneous interest in the personal equation, hut generally, when present, it is the result of psychological study based on theory. These conditions arc, T believe, a normal result of German medical standards and are real causes of alarm in copying them in this country. The common people are uncritical and simple When sick they want human interest more than scientific refinement and as long as they can got it they will pay for it. It matters little to them whether the human interest is prompted by Christian impulses or by commercial ones. Tills is a large factor in the strength of charlatanism in Germany and all over the world. Charlatans are enthusiastic, encouraging, interested, always offering now and promising cures to (lie discouraged invalid. The man of science is cold, non-committal, often discouraging, almost always temperamentally one-sided and Impersonal, if human nature wore scientifically trained, people would choose (he scientist. Hut human nature is not and never will be scientific, so people will always prefer the less scientific and more personal type», often admirably embodied in the charlatan. In our desire to encourage scientific progress and stimulate the scientific spirit for the benefit of future generations, the individual should not ho lost sight of. In many university centres, the well-trained physician who has an aptitude for practice is not only looked down upon, but he is being gradually debarred from Clinical hospital positions where he is not, only of immense value to tho efficiency and morale of the clinic but where his rubbing shoulders with medical progress renders him of constantly increasing value to thé community at large. These men are also invaluable in the teaching of medicine as they supply to the student what he cannot, get from any other source, the practical treatment of the sick,-the human clement in medicine, He learns to treat the patient and not the disease. God forbid that we should lose this human touch in medicine as it is lost in Europe. We have not reached it yet but unmistakable signs of its approach are evident in some quarters. .The passing of one generation is leaving a big gap in this respect. The filling of responsible positions witli young physicians well trained in the laboratory, is giving a great impetus to medical progress. Rut. in the rapid development of the spirit of research, the position of the old-time clinician is somewhat despised. I have heard it. stated within a month that clinical medicine lias nothing to offer the young man.