History of medicine and concepts of health.

It was not until the exemplary social reform of the 19th century and the introduction of modern health insurance schemes that people started to consider health as some kind of basic right which could be ensured by insurance and doctors, rather than by individual responsibility. The recent explosion of health system costs in countries like Germany has given rise to an unprecedented situation whereby the limited capacities of insurance systems and state organizations are becoming more and more evident. Health economists are now questioning the feasibility of optimal medical treatment for everybody. One consequence of this situation is that people are being forced to recall the old virtue of individual responsibility for one's own physical and mental well-being. This article examines the nature of health from a historical point of view. The point is made that health is not the same thing as a life free from complaints, although this erroneous belief is wide-spread today. Galen himself identified a neutral physical state between health and illness (neutralitas), that could be observed in many people who could not be described as being either healthy or ill. It is necessary to accept this state as part of the natural fate of humankind and to understand that individual responsibility and the demands on society and insurance companies for well-being or absolute freedom from ailments are not one and the same thing.

[Evaluation of qualification regulations for medical faculties of German universities and recommendations for standardization]. / Uberprüfung der Habilitationsordnungen Medizinischer Fakultäten an deutschen Hochschulen und Vorschläge zur Vereinheitlichung.

The original reason for using the German "Habilitation" degree to mean that a candidade had qualified and could conduct research and teach at a university is no longer really valid, as this is being threatened by its importance to further careers. Medical faculties must discuss how this development can be curtailed. In order to check the current situation, the Habilitation degree systems of 36 medical faculties of German universities were compared with the aid of a scoring system. They differed dramatically. Conformity existed only in the demand for a doctoral dissertation, scientific publications and a lecture on approval. Concerning other criteria for qualification there was decreasing consensus in the following order: Habilitation thesis, commitment to teaching, further professional education, participation in congresses, inaugural lecture, qualification to teach, scientific activity, broad background in the discipline, and introduction to the faculty. Application of the scoring system with a maximum of 33 score points resulted in a mean value of 15.2 points and a range from 6 to 29 points. A significant decrease in the score values occurred with increasing age of the Habilitation degree (P = 0.002). Even if scoring systems are ambiguous and unfair, our analysis revealed serious differences in the quality of the Habilitation degree. Presuming that the German Habilitation degree should be maintained as a high-level qualification, we developed proposals that might be used to standardize this academic examination.

[The mentally ill artist--a historical retrospect]. / Der psychisch kranke Künstler--ein historischer Rückblick.

The painting of the mentally ill has fascinated artists and their public throughout the 20th century. Yet the psychologically as well as art-historically interesting topic can be traced back over a long period in the history of Western culture. Aristotle emphasizes that all men who create great works, such as artists, philosophers, poets and politicians, are prone to melancholy, that excess of black gall which is characteristic of artists and depressive. Although Plato distinguished between creative and clinical mania, the topos of "genius and madness" prevails up to our century. The cult of melancholy is taken up bei Marsilio Ficino and becomes fashionable among the artists of the 16th and 17th centuries. During the Romantic period of the early 19th century the psychologically unstable or even sick intellectual and artist becomes the focus of attention. Artistic madness is glorified in an almost mystical fashion. However, disillusionment was soon to follow. Schopenhauer, Lombroso and many physicians stress the close relationship between genius and madness. However, they judge madness to be merely morbid and negative. During the 20th century the artists of the avantgarde show much interest in psychoanalysis and in the art of the mentally ill. The rise of National Socialism brought about a drastic break in the appraisal of the art of the mentally ill, which today is an acknowledged factor in contemporary art.

[Petrarca and the plague]. / Petrarca und die Pest.

The author presents a synopsis of Petrarch's reflections and experiences during the plague of 1348 and the following alterations in Italian society. The great humanist and celebrated poet was an excellent observer of the reactions of his contemporaries and the various cultural and moral consequences of the "Black Death" catastrophe. He feels deep desperation but emphasizes stoic acceptance of fate and Christian humility. His letters concerning plague and death are impressive documents of the "interior life" of European intellectuals in midfourteenth century. They reveal the helplessness of scholastic medical doctors and the crisis of contemporary medicine.

[Criticism of the physician in the middle ages--examples and trends from the 6th to the 12th century]. / Die Kritik am Arzt im Mittelalter--Beispiele und Tendenzen vom 6. bis zum 12. Jahrhundert.

The author presents examples of a critical attitude towards medicine and physicians which may be observed, with changing tendencies, throughout the Middle Ages. First, medicine was despised as a mechanical art or suspected of paganism because of its literary sources. Later, the divine nature of disease and healing on the one hand and the uselessness of medicine on the other were stressed. Finally, the integration, at the universities, of medicine in the system of scholastic learning was criticized by more practically minded men. Similar criticism may be observed in the Islamic world. As valiant defenders of medicine, the author quotes the learned Isidore of Sevilla (d.636) and the famous Rhazes (b.865) as well as the anonymous author of the "Lorscher Arzneibuch" of the 8th century.

[The visual process as a theological analog of Roger Bacon's eye anatomy and physiology]. / Der Sehvorgang als theologisches Analogon Augenanatomie und -physiologie bei Roger Bacon.

The author presents Roger Bacon's conception of the anatomy and physiology of the human eye. The knowledge of ocular function is a precondition to understand the laws of the "perspectiva", the science of seeing. But Bacon doesn't stress perspective per se. The physical laws of light, which are to be analysed in geometrical forms, are analogous to those of the infusion of divine grace. Optics (in the Middle Ages synonymous with perspective) seemed to be the model by which God spread his grace to the world. To understand the physical laws of optics meant that one might gain insight into the nature of God.

[Congenital fistulae of the lacrimal gland--a case report (author's transl)]. / Die angeborene Tränendrüsenfistel--Fallbericht.

Congenital fistulae of the lacrimal gland are rarely reported. In the case described here, a 5-year-old girl presented with the orifice of the lacrimal duct situated outside the temporal canthus. Although complications (ascendant infection or skin maceration) are unlikely the treatment of choice is operative correction (excision of the tract or transplantation to the conjunctival epithelium). The fistula may be a result of invagination of the surface epithelium before the lid folds have formed or by the rupture of a cyst of the lacrimal gland.