SURVEY OF MEDICAL EDUCATION IN SWEDEN

 

In presenting a survey of medical education in Sweden I
have been inclined to dispense with the presentation of a number of
preliminary and, in a sense, secondary information, since this is
already available in the Preliminary Report of Sweden prepared by
the Information Service, and in the report of Mr, Gunn for the Inter-~ Masks
national Health Division upon Public Health in Sweden. I have also ‘bad
kept in mind the fact that through travelling fellows already accepted
from that country, we have obtained certain types of information and
are in a position to obtain more details very readily if need be,

It would seem desirable, however, to review certain distin-
guishing characteristics of the country, and the Swedish as a people,
and to point out distinctive characteristics of the field of mdical
education in Sweden, Rather than resorting for the moment to stat-
istical statemnts and figures, etc., I should like to present som
comparisons and remarks of a rather more general nature which are,
howsver, in the last analysis, more easily kept in mind,

Sweden is a amall country in point of population (6,000,000)
but extensive and scantily settled and therefore presenting problems
in transportation, communication and conditions of human life that are
markedly different from the other small countries of Europe, such as

Denmark, Switzerland or Belgium, It is a country, furthermore, on th
periphery of Europe, and,being separated by the sea from all but one
neighbour, enjoys, and has long enjoyed, a degree of independence and
protection against invasion that can be compared only with the British
Isles, In addition to this geographical independence which has its
political implications, Sweden has occupied in the economic development

of Europe a position which has for many years been secure, even if modest,
The agricultural organization in Sweden was never threatened by the cheap
food of the New World, as has been the case during the last 100 years in
France, nor has industrial development taken place in Sweden with the
almost dangerous rapidity that has characterized England or Germany.
Timber has become valuable slowly. Hydro-electric power has been deve-
loped relatively recently; the mineral wealth of Sweden has undergone

a slower exploitation than that of other countries with metallurgical
resource 8. At any rate, the social picture in Sweden is one of sta-
bility. In its slower growth has com a more generalized prosperity,
with less extremes of poverty or opulence than is the case of other
countries with more rapid development,

Sweden is a country racially more homogenous than are the
larger countries, and indeed more homogenous socially than such smaller
countries as Selgium, Ireland or the Baltic Provinces, Religion does
not divide the country against itself nor are there questions of language
or actual racial stock that preoccupy men's minds and result in sectional
pre judices,

In point of colonies and the réle played by colonies, Sweden
differs from Ireland, England or Holland and is more comparable to
Switzerland or Denmark, It is true that a large emigration to Anprica
has taken place. But Sweden possesses no outlet for its administrative
geniua and no source of handsome revenue from colonial possessions ana-
logous to those of Holland. The country is a where tradition and
conservatism are still powerful, and is not faced, as are Poland, Czecho-
slovakia or the Baltic countries, with the difficulties of establishing
self-governmnt among people long accustomed to domination from a
distant capital, Unlike England where one has the impression that
perfect familiarity with a foreign tongue is regarded with respectful
suspicion, Sweden, in its contact with the rest of Europe, resembles
Switzerland in that the educated people are at hom: in at least one
foreign language, if indeed not two or three,

One has the impression that the Swedish people are level-
headed, practical, moderate and rather slow in their mental operations,
which are none the less sound and compre hensive Swedes do not seem
to be bowled over by brilliance; nor do they like to dominate. J would -
suspect that they would question the poetic enthusiasm of Kipling's
references to the white man's burden, Without being cynical, hypocrit-
ical or bitter, they simply are not capable of those great waves of self-
depreciation or self-distrust which are the irresistible invitation to
dominance from abroad. I do: not refer mrely to political dominance,
which, as far as I am aware, has rarely, if ever, taken place in Sweden,

but also to the sort of enthusiasm for the culture of, say, Prance, which
one finds in Roumania or South-America. The race has never been spoilt
by too easy a living accorded it by nature. Distances are great and the
fields are stony, and one takes a very sober view of life on the Swedish
country-side, - patience and enduring will-power are called out, The
Swedes are solid, practical, kindly and patient. They seem to adjust
themselves to new conditions slowly but surely, whether it be as chauf-
feurs of automobiles or as administrators of city hospitals. Their
slowmmess is not from prejudice nor from fear, nor from conscious glory
in maintaining a tradition, but rather perhaps that they think slowly
and act slowly by nature.

Swedish mdical education is distinguished by the length of
the studies necessary to secure the right to practice, the practical and
thorough nature of the inatruction given, the distinctively university
flavour of thie education, the cosmopolitan and well informed point of
view of the teachers and the strong emphasis laid upon distinction as 4
student or scholar rather than brilliance as a lecturer or performer.

Ten years to becom a practitioner {1s not intolerable to a slow
and solid natures practical and thorough training a indispensable if
one must take the position of a district doctor with no professional
colleagues within miles,

A visit to Sweden gives the impression that ites universities
of Upsala, first, and Lund, later, were places to which every region in
the country has contributed, little by little, money and men, Upsala

seems a place to which intellects have com, not as in the case of
Florence, for example, a place in which the intellects have developed,
nor again a place which has sought to dominate intellectually, as is the
case now with Paris, One sees tangible evidence of such a condition in
the survival at Lund and Upsala of the mediseval custom of student life
divided by nations, In the Swedish universities these nations represent
what are now the provinces of Sweden, and the 450 stipends (scholarships
and prizes) at Upsala are largely provided through funds left to the
nations to be distributed for these ends, Upsala and Lund are natural
crystals in a homogeneous solution, Their relation to the rest of
Sweden has been intimate, unforced and natural. Neither of these towns
have ever been important politically and commercially. There is no
jealousy, no separatism, no regional quarelling.

Sweden does not suffer, as does Denmark, from having only one
university, nor does it suffer in another way, as does Holland or Ireland,
from having too many for its size, There is som interchange of personnel,
but without bitter rivalry or parochial jealousy. It has not been an
earthly paradise, however, for, without question, the development of the
Karolinska Institutet in Stockholm was inhibited to the best ability of
the two universities, In most other ways, howsver, the universities have
shown an admirable power to cooperate with other undertakings of social
import, without trying, under the guise of cooperation, to swallow them
alive, Thus the relation between all of the medical schools of Sweden
and their hospitals has arrived at being one of mutual trust and co-
operation rather than a bitter struggle for domination, or an over-emphasis

upon the valus of competitive effort,
There are, however, some characteristics of medical education
in Sweden which are concrete and distinctive although not individually
peculiar to Sweden alone. The pre-clinical studies are sharply set
apart from the years devoted to clinical work, A student having finished
the se pre-clinical studies obtains the title of Kandidat and is sharply
set apart from the group to which he has recently belonged. Another
characteristic of Swedish medical education, which it shares with the
other Scandinavian countries, is the nomination upon the committee to
choose a professor, of at least one representative from another of the
Scandinavian countries, whose serious and time-consuming responsibility
it is to aid in the selection of the new professor, |

In Sweden, the rules and regulations regarding the practice
of mdicine in some ways interfere more sharply with what is known as
individual freedom than in most countries, Professors are allowed to
take private cases in the university hospitals, but there is a definite
and indeed rigorous restriction of the fees they my charge. This,
together with careful hospital administration, results in a remarkably
low cost of medical care, There are a large number of doctors in the
employ of the State, and yet with all this preoccupation to make the
services of doctors meet the needs of the people, the social and financ-
fal status of the physician in Sweden is excellent, and the profession
is not seriously overcrowded.

: Training in mdicine is too long and costly *o be an easily

opened door to a career, {he sparse settlement of the country would
make haphasard or careless nmedical education almost immoral. Relatively
few young doctors in Sweden occupy the position of assistant to an older
man. Far from their nearest colleague, each physician must be self-
reliant-well trained. It is the university which is reponsible for
the thoroughness of the doctor's training in Sweden. The State accepts,
to all intents and purposes, the guarantee of the University.

It is not distinctive of Sweden that its teaching force, as a
result of failure to adjust to post-war prices, is inadequately paid,
and that the State budgets available to pay expenses of research are
entirely inadequate. These financial troubles, however, appear to have
less effect upon productivity and recruitment than is the case in other
countries. Sweden did not lose large numbers of young men in the war,
nor has its commercial and industrial life undergone as many changes 4s
have those of Germany and France. Consequently, there are not so many
parallel attractions to young men in Sweden which serve to draw them
away from academic careers.

We see then a stable effective form of medical education in
Sweden, meting social responsibilities effectively, satisfying the high
standards of a flourishing profession, and contributing to medical
progress in a degree indeniably creditable for a nation of only six

million people.
GEOGRAPHICAL AND SOCIOLOGICAL BACKGROUND

 

No description of the methods and tachnique of pedical
education in any country can be effective unless reference is made
to the conditions wnich these mthods have been devised to met, The

dominant fact about the Swedish doctor's training is that in most cases
he must be prepared to be part ofa scant population over a large
territory. More than one third of Sweden has a population of less
than 10 per square mile; another third has a population of between

20 and 50; there are only three areas where the population is really
dense, 1.6. over 200 per square mile, These are around Lund, between
Stockholm and Upsala, and around Goteberg.

This type of population means that the doctor in practice in
' Sweden has for the most part few professional competitors or helpers,
and it is of great importance consequently that he have a thorough and
generalized training and that his university degree signify an already
appreciable familiarity with his professional duties.

The telephone, automobile and the railway have done much to
diminish the difficulties of reaching patients scattered over a wide
areGe But still it remains true that even when supported by the facil-
ities of the cottage hospital and improved mthods of communication and
transport, the physician in Sweden has both the advantage and disadvantage
of having relatively little professional competition, The advantages

express themselves in a security of position both financial and social,
and the disadvantage, in one sense, lies in isolation and in the fact

*
that, as a young man, the Swedish doctor does not pass through a long
period of apprenticeship unless indeed in the largest cities, It there-

fore becomes necessary for him to spend a longer period of time in train-

ing before he takes up his practice.

There are few great fortunes in Sweden, and the economic picture
ig one of a rather equal distribution of wealth among an industrious and
a careful population, with neither conspicuous poverty nor very exceptional
wealth. The government is conservative and more highly centralized than
that of Norway, and the power of the Crow considerably greater. The
_ economic position of the country is, in general, very sound, since in
addition to forest products and a well-developed agriculture in the South,
Sweden possesses large quantities of hydro-electric power and deposits of
mineral ores, particulariyiron, of very great value. The country has
- possessed an excellent educational system for so long a time that in
technical education it is well able to compete with any of its neighbours,
One feature of the life in Sweden made a particular impression upon m,
namly that being to a certain extent politically neutral in the problems
of Europe, and at the sam tim able to take advantage of the cultures of
Bnglend, France and Germany, the Swedes were critical yet unbiassed by

political sympathies, well informed without being confused, and secure

economically without any danger of extremes of luxury.
10

ORGARIZATION OF SCHOOLS

 

The status of the three medical schools in Sweden is relatively
simple in spite of the fact that there are som differences between
Stockholm and the two universities of Lund and Upsala.

The University of Upsala dates from 1477, and the first professor
of medicine there occupied the eighth chair of the University in 1595,
Upsala is definitely the senior university of Sweden, and has a great
prestige, both in the past and at present. Lund is in a part of Sweden
that geographically and culturally is more nearly Danish than Swedish;
indeed for a long time Lund was in one of the provinces of Denmark. Its
position may be more readily understood when it is known that it takes
two hours to go from Lund to Copeniagen, but twelve hours to go from Lund
to Stockholm. There is, however, no trace of separatist feeling or poli-
tical ferment in Southern Sweden, and in the last analysis Upsala and Lund
as universities may be grouped together in contrast to the Karolinska
Institutet of Stockholm. About 110 years ago, in order to produce
military surgeons and fKiteherg the Karolinska Institutet was formed in
Stockholm, in an atmosphere that was severely practical. At that tim
Upsala was the seat of Hippocratic medicine, where academic theories were
learned and the weight of tradition was against experiment and the product-
fon of mre practitioners. It was hardly to the interest of Upsala to
relinquish its right to licence practitioners, and only in 1690 was the
Karolinska Institutet qualified to give the rank of Licenciator, and not

until about 1908 - the doctorate. But obviously during the past 50 years,
ll

with the growth of the city of Stockholm and the concommitent increase

in clinical facilities, the Karolinska Institutet has coms into 4 better
and better position from the standpoint of clinical instruction. 01d
prejudices have died out, and the development of medicine has kept the
medical faculty of Upsala preoccupied with own development and with less
time to hold back the growth of another teaching center. Traces of un-
controlled growth remain, however, in Stockholm, and one has the impress-
ion there far more sharply than in either Lund or Upsala that on the
clinical side teachera in Stockholm are ‘tiret hospital chiefs, and teachers
afterwards, This ig less the case at the Serafimrlazarett than else-
where, But in any event one can say that the wide dispersion of hospital
facilities prevents the unity that is so characteristic of Lund and Upsala.
Again in Stockholm, theoretical branches are inadequately housed and
struggling under conditions that it would be unfair to call hostile and
yet inaccurate to consider as a true university atmosphere,

‘There is nothing remarkable or exceptional in the organization
of these medical schools that distinguishes them sharply from similar
institutes in Denmerk, Norway or some other countries that are already
familiar to us, An exception might be made, however, of the role played
by the University Chancellor, His is an office politically independent
and one of great honour and influences, It is a life appointment and he
is chosen by the universities with, I believe, the concurrence of the
Karolinska Institutet. He has his own staff, and his work is to keep
Up the universities = and keep themeven. It so happens that the present

incumbent, Trygger, is Minister of Foreign Affairs in Sweden, and
12

consequently the real work falls upon the Pro-Chancellors, who are the
sishops of Sk&ne and Upsala. In spite of his other preoccupations,

the Chancellor has the last word on building questions in the univers-
ities and upon professorial appointments. He is expected to defend the
interests of the universities in the Rigstag, and has been found to be a
most valuable protagonist. He does not eneroach upon thea duties of the
Minister of Public Instruction, but rather supplements this official in

caring especially for the interests of higher education,

Dean. The office of the Dean is held for one year only and is rotated
among all the members of the faculty, All questions of great
importance are disoussed first by the faculty, second by the University
Ceuncil, or Konsistorium, and then are passed to the Bureau of the Chan-
cellor of the Universities. The judges appointed to choose professors
for vacant chairs are nominated by the faculty, the University Kondstorium
and the Chancellor, | It is rare that the choice of a professor is made

in less than a year.

Chancellor, The Chancellor of the Universities is elected by all full
professors at the two State universities, The candidate re-
ceiving the majority of the votes must be appointed by the Government,
or a new election mst be called for. Experience has shown that the
Principle of self-government in the universities is thus preserved very
satisfactorily since the Chancellor protects the universities against

detailed bureaucratic influences on the part of the government,

Karolinska Instituttet. The organization of the Karolinska Institutet
13

is somwhat different from that of a faculty. The governing body
consists of a Collegium of all professors, It regulates matters of
internal government, and takes the ordinary administrative decisions,
The chairman of the Collegium is elected for three years rather than
being as, in the universities, the Dean, under a term of one year only.
The Collegium appoints from its own members various committees for
specific purposes, such as management of library, etc, The Karolinska
Institutet is under the Chancellor of the Universities, There are no
trustees at the Karolinska Institutet and in this part it resembles the

universities,
14

COST OF THE SGIOOL AND BUDGET CONTROL

 

The cost of medical education in Sweden is difficult to
estimate, since the school budgets are not published, The budgsts
for institutes or departments are very much too low, varying between
1,000 and 3,000 Kronen annually per institute, The budget is made
up by the mdical faculty and submitted to the University, which, in
turn, submits its total budget to an officer not existing in other
European countries, but known in Sweden as the Chancellor of the Uni-
versities, The Chancellor is a person of considerable political
prestige, and it is his responsibility to fight the financial battle
for the universities in the Rigstag.

The status of medical research in Sweden would be extrenely
unfavourable if it were not for the assistance given from the Johann
Andersons Fond, a foundation with a capital of about 5,900,000 Kronen,
the income from which is distributed for the support of scientific
research among the two universities and the Karolinska Institutet, by a
special committee chosen from the members of the Karolinska Institutet,
The services of this fund in supporting scientific research in Sweden
are unanimously recognized as being of the very greatest value and
importance, But it is specifically designed only to take care of
material expenses and salaries or scholarships for scientific workers
and cannot be employed for buildings. In several cases, the budgets

for the clinical specialties are almost negligible,
For reasons of 8conomy the Swedish State Statistical Bureau
has published no accounts Since 1922 which would furnish material or
tables indicating school cost, budget control, number of students, ate,

It is, of course, possible for the universities to own real
estate, bonds, etc., and to receive legacies, The income at Lund

for the last year was about 100,000 Kronen from property of this kind,

much of it being ear-marked for uss as stipends for the students,
PHYSICAL EQUIPMENT, BUILDINGS, ETC,

 

The buildings and physical equipment of the three medical
schools in Sweden deserve a brief description. In Lund, the labor-
atories are a mixture of old and new, Anatomy, Physiology and Patho-
logical Anatomy are all from 30 to 40 years old, Pharmacology, Rio-
Chemistry and Hygiene are all housed together in a splendid new building,
The hospital, which is that of the province, contains buildings of various
ages - Medicine, Paediatrics and Orthopedics all being recent and wll-
appointed structures, tynecology and Obstetrics is also modern and in
6Xcellent condition, On the whole, Lund has an adequate physical equip
mnt in view of the number of students {400} and the relatively small
Classes which the long curriculum requires, One interesting feature
of the laboratory of Physiology is that the top floor cf this buildins
is given to bedrooms not only for the present staff of assistants but
for a few of the former assistants who are now in the inmore advanced stare
of their mdical training, In this way, Frofassor Thunberg secures the
interest and co-operation of his former assistants in the training and
guidance of his present helpers, and is thus anabled to continue an
excellent tradition among the younger men who frequently continue special
work in Physiology.

On the whole, the buildings at Upsala cive an impression less
favourable than that of Lund, The clinical branches are housed in
buildings much more modern than those of the medical sciences, The

Surgical Clinic dates from 1922 and the rest of the clinics have been
remodelled and are in excellent condition, except for that of Gynecology
and that of Otology. The hospital buildings belong to the government
of Sweden and are not provincial as at Lund or municipal as for the most
part in Stockholm. Anatomy, Histology and Embryology are housed in a
building erected in 1886, and that of Pathological Anatomy is of about
the same age, The Physiological laboratory dates from 1892, The
laboratory of Pharmacology is almost as old and is too small for its
present services,

Stockholm is rather difficult to describe. The clinics are
widely scattered and of a very different ages and ceneral effectiveness,
The laboratories housed in the Karolinska Institutet are badly over-
crowded, and quite inadequate in point of space and appointments,

A new plan is on foot in Stockholm to build on the western
side of the city a new medical center. The site has been definitely
chosen and the projected construction is planned first to take care of
the clinics and buildings for Pathological Anatomy. Special clinics,
such as Psychiatry, Dermatology and Neuro-Pathology, are not included in
the first stage of building. Also the theoretical institutes must wait,
The Government of Sweden would give the ground if the City and Province
of Stockholm approves and promises good buildings and maintenance, The
government would pay for 375 beds to be built if the City would pay for
315, and the Province for 110. The scheme for maintenance is that the
Province would pay what it costs for a patient in a local hospital minus
what a patient couid contribute. The State would further pay for
teaching and research work as it occurs in the hospital. It is immediately

clear that with the existent clinical facilities in Stockholm, the success
18

of a new teaching hospital would depend, in part, if not largely, upon
the willingness of patients, outside of Stockholm, to come to the city
for hospitalization, There are those who are very doubtful as to
whether patients of this category would com in very large numbers,
The existent hospitals in Stockholm include the General Children's
Hospital (85-100 beds), the St. Goran Hospital (250 beds), Skin and
Vene real Diseases, Sabbatsberg, a General Hospital, a special Ortho-
Pedic Hospital of 62 beds, the Serafimerlazarett (452 beds), and the

Mariasjukhuset of 160 beds in Surgery and 115 in mdicina,
19

HOSPITAL RELATIONSHIPS

 

In considering the relationship between the medical faculties
and the hospitals it is of interest to note that already in 1700 the
University of Upsala set up an Out-patient Department for the training
of students, which was probably one of the very first of its kind organ-
ized at any medical school, In 1752, a Ganeral Hospital for the whole
of Sweden was inaugurated in Stockholm, It was under the trust of the
Knights of the Seraphim Order, and was narmd Serafimerlazarett, ~ "Lazarett"
meaning in Swedish a general hospital for bodily disease in contrast to the
word “hospital” which has the sense of our word "asylum",

The number of beds scattered among the different services at Lund
is 728, at Upsala 585, The Serafimrlazarett has 452 beds, but the other
hospitals of Stockholm would bring the total teaching facilities in Stock-
holm up to a thousand,

The Karolinska Institutet, in its relation to various hospitals
in Stockholm, has the right to nominate the professor-in~chief of the
service and, in most cases, this means also the staff under him,

One half of the hospital costs, in the case of the two university
faculties, is carried by the Ministry of Ecclesiastics and Education, Birch-
Lindgren is the architect of several of the provincial hospitals, and is
familiar with conditions in many parts of Sweden, In his opinion it is
doubtful whether such hospitals as the one projected in Stockholm for the

Karolinska Institutet will be able to secure a large anough number of
20

patients from outside of Stockholm since the local so-called ccttag
hospitals, plus the provincial hospitals, are constantly improving both
jn facilities and perhaps also in staff, This difficulty would apply
principally only to a general hospital, since it is widely recognized in
Sweden that the government must assist in ths transportation of special
cases to special hospitals. Now, there are several special hospitals
in Stockholm which haw a surer future than a general hospital for the
Karolinska Institutet would have,

The outstanding features of the teaching hospitals in Sweden
are four; 1) Excellent nursing care and low cost, which does not exceed
10 Kronen in private rooms; 2) Even the/ patients in hospitals are
protected by the official limitation of thea fees that may be charged; no
fee for a surgical operation may exceed 300 Kronen and the maximum for
appendix operation is 50 Kronen; 3) Middle-class patients may attend
the Out-patient Department and may be charged by the physician in attend-
ance » direct fee for his professional services; in this way the facil-
ities for which the community has been taxed are put at the disposal of
the Comminity; 4) It was the general impression that the teaching
hospitals are understaffed with medical personnel, There is very little

*Pportunity for investigative work on the part of the younger doctors,
21

CURRICULUN

Students entering the mdical faculties in Sweden come from
two types of schools, one comparable to the Realschule, in which Physics
and Chemistry have been given for at least one year; boys coming from
these schools must take an entrance exanination, The other type of
school is described as being half-classical, presumably a compromise
with the old Gymnasium. From these schools an entrance sxamination
is not necessary, but the graduates take a special course at the Uni-
versity before being registered as full-pledged medical students,

There have been no significant changes in the curriculum of
the Swedish medical schools of late, and in the main the curriculum
follows the regulations of 1907, It is sharply divided into two
parta = pre-clinical and clinical, During the first zs - 4 years,
the student's attention is taken entirely with the pre-clinical sciences
of Anatomy and Snbryology, Histology, ~ which is taught usually separate-
ly from Anatomy although at the same tims, - Physiology, Medical Chemistry,
Pharzacology and Pathology - in which is included General Pathology and
Bacteriology,

One term is given to Comparative Anatomy and General Chenistry.
After that the students dissect the human body during three terms, In

t
he meantime they also take microscopical anatomy, In each of the

followie.
“+.0W'ng terms, Physiology, Physiological Chemistry and Pathological

Anatons
tory are taken, During one of theses three terms also a course of
Pharmacology is passed, The courses in Phystoloey and Phvsiolosical
Chenistry are combined with sxutensive luboraPory wractize, Tn tesrhing
General Pathology stress is laid or the oprortunity for the stusents to

get rich opportunities to attend vost-xortem examinations, Sifter

{2

in each of tress ccurses atisfact-

a

completing individual exeninatior.
orily, the student appears before the exaningtion session of the Paculty,
and the degree of Kandidat is formally conferred upon hin,

He the: begins the second half of his “edical education - a

Dies

period of tine that et the minimum is 4 years and may extend longer,

First, before taxing any other prescribed course or practical work, the

student must spend two wonths in ull in the propaedeutic courses of the
mdical or surgical clinics, studying the orincipal mathode <f surgical
technique, clinical examination and genersi care of the sick, fe then,
during a period of four months, must take a service in Fatholorival
Anatomy with, at the sere tims, clinical werk in Yedicine ang Surgery,
In the elinical work aach patient is turned over to a student
who makss the examination and writes up a history, the completeness of
Which varies with the nature of the case, Suitable cases aro used for
demonstrations at the clinical lectures; at this tim the professor
reads tise studentts report aloud and makes his ramarks or it, ulse
checking up the Cozrectness af the student's physical exasination, Lhe
Students then have vermisSion tc examine the patient after whieck the

Patient is taxen away and the professor gives a clinies! disecussics of

t
he case (diagnosis, prognosis, therapy), Two or three cases are often
23

taxen up in a single lecture, a "clinical lecture" usually lasting
several hours. When the student is more advanced he has to write
special discussions which are et tims read and commented on at the
lecture. The professor precedes his diacussion by presenting in
orief, results of laboratory examinations, etc., on the case, All

the students have to attend the professor's clinical reception of patients,
and make notes on the new CaBeS. Instruction at this tim is in
question and answer form, The student is throughout required to make
mary examinations of patients, but these are chacked up by the assistant
physicians, The professors try to arrang the theoretical work to be
undertaken next by the student,

In addition to the four months service in Medicine and four
nenths in Surgsry referred to above, the student must take, Simul taneously
er later, a two months clinical course in Neurology, two months service
45 gesistant in the Medical Clinic and one month as an assistant in a
hesvitel for infectious diseases, In Pediatrics, he must take a three
months service in a Pediatrical clinic, In Surgery, in addition to
the four months service mentioned above, he must have a two months course
in Ctology, Rhinology and Laryngology, and one month service as Surgical -
*ssistant in a Surgical clinic. For Ophthalmology, two mouths service
im a clinic ig required, For Obstetrics and Gynecology ~ four months,
Ta Pathological Anatomy, it has been already noted that four months
S@rvios ig required, simultaneously with the service in the mdical or

“irgical clinic, Two months additional service in the Pathological
24

Institute is usually done at the tim of being assistant in the mdical
oLindGe In Legal and State Medicine, a three months course is given
after the termination of services in Medicine and Surgery, Gynecology
and Obstetrics. Thus, this three months course is at the termination
of the medical studies, Furthermore, in Psychiatry, there is a short
lecture course in the Psychiatrical clinic, In Dermatology and
Syptilology, a two months course, not given in Lund or in Upsala but
nly at St.Goran‘s Hospital in Stockholm In Syphilology, in add-
stien to two months lecture course, (lecture and clinic) there is a
two weeks service as assistant, which does not, however, amount to mich.
In Evgiene, there is a two months course consisting largely of lectures
ant field trips. The clinical training is completed by two or more
menths of the so~called “assistant service” in which the student takes
a rore complete responsibility for cages. In medicine this service is
at least two months, in surgery at least one month.

Having finished all this training in different departments
‘ce student has to pass special final examinations in internal medicines,
surrery, pathological anatomy, ophthalmistrics, pediatrics, obstetrics
anc cynecology, forensic medicine, syphilidology, psychiatry and public
health, After these separate examinations he is declared "mdicine
licentiate” and immediately afterwards he will, by the state board of
macdicine, get his licence for practice. These clinical courses lead
to the degree of Licenciator. For the degree of Doctor of Medicine,

th
© Licenciate must first be obtained, and the applicant must choose,
25

write and publicly defend a thesis approwed by the faculty.

The students are obliged at the termination of their work at
the Gniversity to serve in certain hospitals in addition to their work
in the university clinics, This is the so-called practical year which
js edligatory for som state appointments, and the hospitals in which it
may be accomplished are chosen by fixed rules of the Medical Administra-
tien in Sweden, It should be noted also that in the case of Dermato-
legy, there is neither at Lund nor in Upsala a satisfactory service, 80
that the Dermatological Clinic in Stockholm is the only place where
students can receive satisfactory experience,

The student must take his lecture work and practical work in
each ‘subject at the sam time, and the possibilities of combining differ-
ent subjects. during the time of practical service are very slight.

Opt ttiel: logy and Psychiatry may be taken simultaneously; Hygiene and
Lecel. Medicine may also be combined and the Neurology lecture course
takefi-at the same tim as the practical work in Syphilology or Pediatrics,
wut This about exhausts the possibilities, The “continuation course"
in «e@4eine and surgery may be taken only in Stockholm or Lund; the
Legul Medicine, Syphilis Clinic, and Neurology course only in Stockholm;
alli the other work may be taken at any of these three schools,

A8 one of the outstanding features of the Swedish curriculum
is the length of tim involved, I tabulated the information given in the
Catclegue of the University of Lund Medical Faculty, and found that in
Kay 4989, there were following number of students still taking courses

fer the Licenciate who had entered in the yeara noted as follows:~
1915 - 1
1916 - 1
1917 - 8
1918 - 9
1919 - 23
1920 - Bo
1921 - 37
1922 - 33
1923 - 34
1924 ~ 31
1925 - 41
1926 ~- 53
1927 - 43
1928 - 95
1929 - 13

26

This brief table indicates that, apart from the few stragglers,

the medical course takes about 10 years, The number is slightly
diminished in the last year or so of study, since som of the nen
leave Lund to take the degree in Stockholm,

I further carefully sxamined the Catalogue of Lund to see
at what age Swedish medical students were beginning so long a period
of training. 10 had entered the Medical Faculty at the age of 17;
85 at 16; 1231 at 19; 93 at 20; 62 at 21; 26 at 22; 23 at 23;

Pat 24; 9 at 25; 4 at 26; 2 at 27 and 4 at 28,
27

The teaching methods in Sweden are characterized by thorough-
ness and length of time given for each course of instruction and by the
fact that the teaching is more practical and more closely controlled by
professor or instructor than in Germany, and yet more academic than is
the case in the faculties of England or France,

Classes are not large. It is rare to have over 100 students.
The number of assistant teachers is reasonably large, but perhaps not
quite. sufficient. There is considerable emphasis upon individual labor~
atory work and there is everywhere clear evidence that such laboratory
work is carefully controlled,

One receives the impression that, thanks to the elasticity of
organization in the curriculum and the length of tim usually accorded
to medical studies, there is very little cramming or hasty memorizing
and that the students, realizing how long is the study of medicine, are
going at it in a patient, slow and sound way. The equipment without
being luxurious, is adequate. It is perhaps unusual to see so little
discrepancy between the quality of the work done in different institutes
of the same faculty, In the pre-clinical studies there is, in general,
& Sane balance between lecture, demonstration and individual work, In-
creased emphasis during the past 15 years has been placed uyon the Physio-
logical side somswhat at the expense of pure Morphology. Through the
“harp differentiation which is marked by the Kandidat examination at the

end
of the first four to five years, the clinical courses obtain a certain
 

28

gistinction and maturity of point of view which is not common in mst
other countries of Europe. And the clinical course being taken in a
slow and thorough way produces a graduate from the medical faculty whose
clinical experience, not only in the "tripod of medicine", but in the
specialties is as good as any in #urope, A few notes on teaching methods
in some of the representative institutes or clinics may be useful as

giving typical examples of conditions observed:

Anetoriy (at Lund):-

Anatomy is taught together with Embryology, Histology is
taught at the sam time of the student's career Sut by another professor,
Owing to a lack of material, and as a matter also of pedagogic method,
students are obliged, before doing any dissection themselves, to study
dissected preparations and pass a rigid examination upon them. There-
after, each student dissects each part of the body once, Four seresters
are given to Anatomy and Zmbryology. The professor is assisted by
student assistants, who are given the title of "Amanuens", These are
young fellows who have already passed the Kandidat examen and are well
in advance of the other students, Scattered among the four semesters
there are 200 students, half of whom are dissecting new material, in

‘hig way the 50 cadavers available are made to serve satisfactorily for

& large number of students,

Dh
<tysdolozy (at Lund) :-

The classes number about 20. The course is given twice a year,

F
oT two and ¢ half months the students spend all day in physiology. They
29

gre obliged to keep "Journals" which have records of experiments made
that are among the best that I have seen anywhe re. The selection of
themes for experimental verification is broad and careful. Four times
a week during this course the professor gives a lecture followed or
accoxpanied by a demonstration, the whole taking about two hours. Once
a week the lecture is given by the first assistant. The teaching force
jis composed of; the professor, first assistant, an "amanuens" and two

extra or subordinate "“amanuenses",

Internal Medicine (at Lund) :-

Internal Medicine begins after the Kandidat''s examination, i.e.
when entire pre-clinical work is finished satisfactorily. The first
course in Medicine is a six months systematic course of lectures, There
follows two months in medicine and two months in surgery devotad to
physical aiagnosis and nursing, Then coms a five months course all day,
every day in the week, in the medical clinics, with three clinical lectures
a week, During this time the students are at work as clinical clerks,
and are obliged to keep full records of their cases which are reviewed by
the assistant and returned to the student with corrections and suggestions,
A further course of two months as intern with responsibility for cases

and for the histories taken upon them, completes the training.

Obstetrics and Genecolo:; (at Lund) :-
The course begins with two weeks of introductory lectures and
Teading, There is also work on the phantom and attendance at normal cases

d
*livered in hospital, The clasa is then divided into sections; eight
30

students at a time live in the hospital for four months and do nothing
but the work of obstetrical clinic. Two of this team of eight are on
duty for twenty-four hours at a time, every four days, and during this
tims food is provided for them and thsy live substantially as interns,
They begin with delivering normal cases under the supervision of an
assistant, There is always on duty a trained midwife as nurse, Zach
student gets 45-50 deliveries under these conditions, together with
attendance at abnormal cases, and ward-rounds, and experience in hand-
ling the routins laboratory work, The hospital is one of 108 beds with
possibility of change in the proportion between obstetrical and gyneco-

logical .cases, There are about 1900 births a year,

General Pathology (at Stockholm) ;-

About 50 students in a class, The course is repeated twice a
year. It lasts two and a half months and is given just before the
Kandidat examination. There are lectures and demonstrations but no
individual laboratory work, The material from som 350 autopsies is
divided among the class for careful study, The course acts as a ste p-
ping-stons between Physiology or Pathological anatomy, and the clinical
work soon to follow, The staff is composed of professor, one prosector

and two assistants,

Orthopedics (in Stockholm) :~

A two-months course which is repeated three times in the years
There ia a general course of lectures by the professor, a practical course
in bandaging and orthopedic technique by the first assistant, No ofe rating

experience is given to students since this is reserved for the assistants,
There are from 20 to 30 students per course, The staff consists of:
first assistant, who stays a term of six years; a second assistant, who
stays for two years, and a third assistant, who is on a one-year appoint-

mente

Medicine. (at Stockholm) :-

Medicine at Stockholm is much as it is at Lund. There is
definitely more bedside work in the medical teaching than is the case in
Germany, and the cases are thoroughly discussed in small groups. The
best preparation for the work in medicine is considered to be the post
| of second assistant, in either pathology or physiology, previous to
taking the course in medicine. This is, of course, reserved for very
few, but. in general, in Sweden, the custom of having student assistants
in nearly all of the courses. serves to select and further train the moat

promising material.

Medicine (at Upsala)
The mdical course has 150 free beds, 24 private beds. There

are about 10 new cases in the Polyclinic per day. The professor has
four assistants who stay with him 4 to 5 years each. The course begins
with seven weeks introduction in the chest clinic for a general review
of pathology and for training in physical diagnosis, Then follows a
15 weeks course including ward-visits and systemtic lectures, Then 12
students at a tim are taken as assistants on the ward for four months
-each; the usual "journals" or records of cases are carefully kept

api criticized by staff assistants,
Be

Hygiene (at Upsala)

About 30 students take a two months course, 2 hours lecture
and demonstration, five tims a week, in addition making visits to
sewage disposal plants, etc, If the mrks of a student are un-
satisfactory, he is required to make special reports on schools,
hospitals and other institutes related to Publie Kygiene, until his
comprehension of the subject is considered to have been improved,

Bvery 3=4 years, when ten to fifteen provincial doctors join
together in asking for a special course, Professor Wirgin gives such
@ Course for six months, It is of the seminar type, consisting of
lectures, , a long excursion and criticisms of studies prepared by

students of special institutions or Statistical atudies,
33

EXAMINATIONS AND LICENSURE

At the end of each course a Tentamen, or examination for the
course, is given, This is usually practical and oral, and lasts for
14-2 hours. At the end of 354 years a genera) examination is given ~
the so-called Kandidats~Exanen, This in effact covers all of the pre-
clinical subjects in the medical curriculun, If a student fails in one
of the tentamens, he is remanded for further study and can take the
examination again without taking the course over, It is left for him
to decide when he will vcresent himself, By spreading the tentamen exan-
inations over the year, the professors are relieved of a great accumulation
of examinations,

Following the Kamlidats-Examen, the successful examinse has the
title of Kandidat and pursues, for another six to seven years, his studies,
this tims, however, entirely in clinica: “ranches. He is then given a
final examination for the Licenciate and, if successful, he may file his
certificate of being a Licenctator with the State Board of Medical Control
which, without further examination, gives him the licence to practice
medicine in Sweden,

After this university work and before obtaining his degree as
Licenciator, he must, if he is to take any government or local post, work
as assistant eight months in a hospital approved by the Karolinska Insti-
tutet, the University of Lund or of Upsala, in a medical, surgical or
mixed service, Since these posts provide both room and board free, this

terminal clinical year is not a severe burden to the student,
In ths point of different deyrees, the three redical schools
of Sweden are related in a peculiar way due to the fact that the univers-
ities of Lund and Upsala are obliged to limit the number of cl {nical
students to 30, whereas the hospital facilities in Steckholm are much
more abundant. Consequently, out of 442 clinical students at Stockholm,
we see that 28% have been prepared in Stockholm, that 118 are fron. Upsala
and 41 from Lund, The students who remain in the clinics at Upsala or
Lund, are neither better nor worse than those leaving for Stockhdlm since
many other factors besides intellectual qualifications determina their
decisions in this point.

The clinical facilities in Stockholm are such as to draw som
men from Lund and Upsala. This ig indicated by the fieures for Stockholm
in 1926, There were 384 medical studants in the first half of their
mdical training, i.e. previous to receiving the decree cf Kandidat,

There were 544 students in the second half of their medical studies, and
this increase was due to additions from Lund and Upsala, Upsala sending

about 118 men and Lund 41,
35

COST TO SIUDENTS
eS

Taking ten years as an averages length of the medical training,
the student's expenses for this period are calculated as being be tween
50,000 and 40,000 Kronen, This includes university charges, together
with living expenses, The laboratory fees for the pre-clinical courses
total 3=4,000 Kronen, Although the Krone has the value of 5,72 Kronen
to the Dollar, I was told that 2,70 was the buying value in Sweden of
one Dollar in America, Many of the students ZO into debt, Indeed
for 145 Swedish physicians licenced in 1920-21, the following table
from the "Meddelander fran Medicinska Forenningen" 1923, No. 4, gives
as having

No debts 27%

Less than 10,000 Kr, 23%

From 10 to 20,000 24%
" 20 to 40,000 215
" 40,000 or above i

The best rate obtainable for borrowing money from the banks
is abe, The usual rate is 5% and it is noteworthy that a very consider-~
able number of student loans are furnished by the banks, Bankers
consider that the character and financial position of practitioners in

Sweden is such that they may safely place money upon a large number of

mdical students.
SELECTION AND RECOMPSNSE CF TEACHERS

The professors are chosen only from the Dozent class, This
is already a selected group, since only 2-4% of those whom we should call
graduates in medicine, and who are known in Sweden as Licenciators, go on
to take the higher degree of Doctor of Medicine, and not more than half
of the doctors of medicine attain the Dozentship. Furthermore, in the
examination for the Dozentship, which consists of a prepared lecture and
test of practical work, manipulation, etc,, the successful candidates
must have a mark of 2 or more on a scale of 3, Direct calls to the
vrofessorship are few, The judges appointed to choose professors for
vacant chairs are nominated by the Faculty, the university Konsistorium
and the Chancellor, It is a committee of 4~5 judges, which usually
includes a Dane or a Norwegian or a Finn, To this committee the candidate
tor the chair must present his thesis, Zach member of the committee is
obliged to read all of the published scientific works of every candidate,
wich takes considerable time, but finally the committee select and publish
(with reasons given) in the order of their preference, three names which
ave then presented to the faculty and, when approved, to the University
Senste, and again to the Chancellor of the Universities and to the wWinister
of Public Instruction, It is rare that reversals of judgement take place,
and the Candidate having first preference is usually nominated, It is

*ald that "when you know the committee you know who will be their first
cha ice,
37

Men arrive at the chairs of medical faculties of Sweden at
arout the age of 45, It is definitely stipulated that all professors
in Sweden shall be chosen on the basis of the following three qualifi-
cations:

1) Scientific ability as an investigator,

2) Ability as a teacher of medicine, and

3) Youth, 1.6. in case of choice between two

candidates the younger man shall be favoured,

This policy is adhered to with a good deal of tenacity and
the publication of the committes's decision is a custom which aids in
ebserving the three qualifications mentioned.

In practice this method of selection of professors works
extrzordinarily well if one may attribute to it the quality of the pro-
feesors in Sweden at present, The presence cf a Dans or a Norwegian on
the committee helps occasionally to guarantee freedom from local political
Considerations, The difference from the method in force in Denmerk is
that candidates for the professorships are not obliged in Sweden to take
Part in an open contest, such as presentation of a lecture on short notice .
etcy I cannot avoid the conclusion that the requirement which submits
@:1 of the published work of any candidate to the searching examination
ve group of his professorial confreres acts as a deterrent to hasty or
Yelt-i-cous though shallow publications on the part of any young Swede who
7 Contemp] ating a university career. Another item in the method of

Se]
ecting Professors, which is of som importance, is that the committee

Is, ,
bligea to publish their choice and give the specific reasons for their
38

choice. This directly acts as a control of criticisms that might be
made of any bias, favouritism, etc. In the examination for the Dazent-
ship, there is a curious feature which dates, it is said, from the Middle
Ages. The prospective Dozent is obliged to defend his thesis for three
hours before a public assembly as well as one critic appointed by the
faculty and two critics chosen by himself, I attended one of these
examinations, It was extremely formal and the technical discussion
arreared to be rigorous, It has been found, apparently since the Middle
Ages, thet this ceremony tends to becons overciisregsd with emotion, and
hence it has become the custom that of the two critics chosen by the Dozent
one is likely to be a local wit, often having no technical qualificetions
for the discussions of the thesis, His function in the ceremony is to
‘ring the entire discussion within the bounds of reason and general commnon-
sense, Since the thesis must have been published at least two weeks before
its public defense, he has an opportunity, along with his technical colleagues,
to prepare himself upon the subject, but his remarks are intentionally
“verting and intended to remove any traces of permanent bitterness or ill-
“eling which often accompanies criticisms offered in public by specialists,
The salaries of professors in the medical faculties in Sweden
vary from 12,000 to 14,000 Kronen in the Sciences to 15,000 and upward in
the Clinical branches, Since clinicians receive additional pay for clinical
work in the hospitals or from other work which they are able to do, there
are no full-time clinical positions, Forsell was of the opinion that the
~cMeclinical professors are very poorly paid, One of his colleagues he

znsw to be paying 5,000 Kronen only for rent out of a 14,000 Kronen salary.
It requires 2 ~ 4,000 a year to xeep a boy in the medical facult-r, The
rank of Laborator or, in Anatouy, Frosector, ig the equivalent of the
Professor extraordinarius in Cermany. Laboretors receive 10,990 Kronen o
First assistants receive 4,006 to 6,000 Kronen,

There are u few fellowships at Lund which ar restricted to
Dozents and four of which are in feree in the medical faculty, The se
fellowships are tenable for three years end renewable onca for three years,
and pay 7,000 Kroner thus, Serving an excellant Purpose since it ts widely
acknowledged in Sweden thet the Pay of both the professors and Subordinate
teaching personnel is inadequate, A curious feuture of the arrance ments
at Lund is that the first asSistant in Surgery is allowed to charve for
his services in the Out-patient Department and may, in this way, get as
mich as 15,000 Kronen additional to his 5,000 salary, With the force
of tradition behind it, this arrangerent continues undisturbad ani é¢ has
the virtue of securing first-rate talent in the position of first asSistant,
The "amanuens” (or assistant) receives 315 Kronen monthly from tha nije
versity during the academic yeur, Professors in Sweden retimon 70% of
their academic salary, Nordensson, in Upsala, told m that his salary
a8 professor of Ophthalmology Was 12,000 Kronen and that from one hour's
private consultation work a day he receives 6 - 8,000 Kronen a year, The
Pathologist at Upsaia is oblived to do private work in tissue disgnosis
apart from his University responsidilities, in order to makes €,000 which

is absolutely necessary ag an addition to this salary,
40

PROFESSORS IN STOCKHOLM

 

 

Kungl, Ksrolinska Med iko~Kirurgiska Institutet
LILJi#S'TRAND Géran Pharmacology
AKG RMAN Jules H, Survery

Vacant: Phys iology

GADELIUS Bror 3, Psycniatry
DALEN J. Albin Ophthalmology
HEDREN Gunnar Legal Medicine
ELOLMGREN N. Gunnar Utiatry
ALLKVIST Johan Re Syphilis
HOLAGREN Israel Intern, Medicine
HAGLUND S.0. Petrik Orthopedics
JUNDSLL Isak Peciatrics
FORSSSLL Co Gosta Med. Hadfology
JACOBASUS H. Christian Int. Medicine
FORSSNER Hjalmar Obstetrics, Gyn,
SIOQVIST John aA, Chemistry, Pharmacy
PULTTERSSUN Alfred Hysiene
AHLSTROM Erik, 0.M. Obstetrics, Gyn,
HENSCHEN Folke Pathol .-~Ana tony
WLRNSTSDT Wilhelm =, Pediatrics
HAGGVIST Gosta, P.E. Histology
KEY Binar S.H. Surce ry
41

Professors in Stockholm (continued)

MARCUS Henry I, Neurology
BERCSTRAND K.J, Hilding Pathol,.~Anatomy
HESSER A. Carl 4H, Anatomy

Prose ctors
BACKMAN Gaston (Prof,) Anatomy

Vacant Pathol .—-Anatomy

Chiefs of Laboratories

KORAEN Gunnar M, Bacteriology

GERTZ Hans V, Physiology
HAMMARSTEN Einar Chemistry, Pharmacy
OHNSLL He Clinical research
REUTE RWALL 0. Pathol .-Ana tomy

Lecturers
KINSER, Olof V, Legal Psychiatry

LICHTENSTEIN Adolf £pidemiology

Docents

LEVIN Ernst J, Bacteriology

J OSBFSON Arnold R, Medicine

3103E RG Ludvig Dermatology
WALDENSTROM J, Henning Orthoped,. surgery

TROBLL N. Abraham Surgery
42

Stockholm
Docents (continued)

KLING Karl A, (Prof.) Serology, Inmunology
MARCUS Karl Syphilis
T ILLGREN Josua Medicine
LINDST£DT E. Folke Int. Ledicins
SODERLUND N. Gustaf Surgery
PLOMAN Karl Gustaf Ophthalmology
HULT Olof T, History of Medicine

REENSTISRNA John L. (Prof.) Dermatology, Syphilis
LICHTENSTEIN Adolf Pediatrics

SCHAUMANN Jorgen Nielsen, Derratology, Syphilis

HEYMAN E. James Cbstetrics, Synecology
OBNELL Harald Internal Medicine
LINDBOM E. Oscar Medicins

BERGLUND Hilding Medicine

ANTONI Nils Neurology

PRRMAN Einar Surgery

STRANDBERG James V, Dermatology, Syphilis
FAHRABUS Robin S, Experim.~Pathology
LUNDQVIST Birger Obstetrics, Gyn.
MALMBE RG Nils M, Pediatrics

HOJER J. Alex Experim, Pathology
STZNSTROM Nils Medicine

SAHLCREN Ernst Neurology
PROFESSORS IN UPSALA

MORNER

QUENSEL
WIRGIN
BSRGMARK
GOTHLIN
NYSTROM
THORLING
OLOW
BACKMAN
BARANY
AGDUHR

NORDENSON

AHLGREN

BLIX
LAURELL

Vacant:

 

Medical Faculty

Karl Tore Graf

Johan Ulrik Teodor
Germund

Gustaf

Gustaf Fredrik
Erik Gunnar
Andere Ivar

John Olof

E. Louis

Robert

Brik

Je We

Chiefs of Laboratories

Johan Gunnar

Gunnar Frithiof

Hugo Fredrik

43

Medtine and Physiol.-
Chemistry

Pathol,- Anatomy
Hygiene, Bacteriology
Practical medicine
Physiology

Surgery

Pediatrics

Obstetrics, Gynecology
Pharmacognosy
OtoeRhino-Laryngology
Histology, Embryology

Ophthalmology

Exp. Physiology, med.
Physics

Ned, physiol, chemistry
Ned, Radiology

Anatomy & Exp, Pathology
Upsala

Medical Faculty (continued)

SJOBRING
NABSLUND
HAGGSTROM
KRISTENSON
NAESLUND
BIURE
SUNDBERG
DOBLMAN
DAHL3ERG

BOSASUS

Docesnts

Per Henrik Nils
Carl, Albert
Paul Robert
Anders Vilhelm
John Petrus
Johan Alfred
Carl Gustaf
Costa Fritz
Gunnar

Wilhelm Birger

Psychiatry

Hygiene, 3acteriology
Surgery

Pract, medicine
Pathol.-~Anatomy
Pract, mdicine
Physiology
Cto-Rhino-Laryneology
Eugenics

Pathol .-Anatomy
PROFESSORS IN LUND

 

45

Kungl. Karolinska Universite tet

Medical Faculty

FORSSMAN Magnus John Carl Aug.

ESSEN-NMOLLER Gustaf Elis

BROMAN Ivar

THUNSERS Torsten Ludvig

OVERION Charles Ernest

SJOVALL Per Gustaf Einar

KLERCKER Rutger Kjell Otto

PETREN Ertk Gustaf

WIDMARK Erik Matteo Prochet

HeéLLMAN Torsten J,son

WIGERT Victor Hjalmar Hugo
Vacant: 1 professor for.....

ASK Fritz Gustaf

Docents
TORNE Frans Vilhelm
HOLMDAHL David Bdvard

Gen.Pathol. Bacteriology
Hygiene
Obstetrics, Gynecology

Anatomy
Physiology

Pharrecolosy

Pathol,.-Anatomy, Legal
Vedicine

Pediatrics, Pract.Med.
Surge ry
Med. & Phys. Chemistry

Anatomy, Histology &
Histogeny

Psychiatry
Pract, mdicine

Ophthalmology

Oto-Rhino~Laryngology

Anatomy
pocents (continue d)
EDLING
INGVAR
LJUNGGREN
LINDAU
HOJER
SIWE
ENGHOFF

BERGGREN

Mecical Faculty (continued)

Lars Henrik August
Sven

Gustaf Axel Carlsson
Arvid Wilhelm

Johan Axel

Sture August

Sven Albert Henrik

Svan Sture

46
Lund

 

Med, Radiology
Neurology
Chemistry
Pathol .-Anatomy
Hyeiense
Anatomy
Physiology

Oto~Rhino-Laryngology
47

GENERAL REMARKS ON RESEARCH

 

Nesearch in the medical sciences in Sweden, although it
encounters som difficulties which will be diminished eventually,
4s on the whole e phase of medical school work to which much attention
is given and which compares favourably in quality with what is done
anywhere else in the world. The great emphasis upon scientific
research which is explicitly stated in the regulations for the choice
of professors, appears to have had a palpable effect. The Swede in
temperament is rather more likely to be slow, steady and late-mturing
than ara his colleagues further south in Surope. T had the impression
from most of those with whom.I talked that their individua] interests
were deep and permanent,

It is, in my opinion, an excellent rule in their schemes for

selecting professors which provides that all of the published work of

 

It may be useful to note that the problem of publication of
research work is met in a rather satisfactory way by the Karolinska
Institutet, which undertakes the publications of the following journals:

Acta Medica Scandinavica
Acta Chirurgica Scandinavica
Acta Oto~Laryngologica

Acta DermatoeVenereologica
Acta Pediatrica

Acta Radiologica

Acta Gynecologica
48

any candidate for a professorship must be read by all of the members

of the selection conmittes. This has, I was told, (and I can well
pelieve it) a definite effect upon the young Dozent who contemplates

an academic career, It makes him prefer to publish though, compact
and careful papers, more probably upon related thems, and to set less
value upon hurried communications put out for the sake of securing
recognized priority. At any rate, the production of medical literature
in Sweden is within moderate limits and the quality of the papers, on
the whole, is quite superior to those either in France, Germany, Austria
or Italy.

There is one characteristic phase of Scandinavian mdicine
which is worth recalling in a consideration of research work in Sweden,
This is the fact that a wide-spread and, in many cases, thorough famil-
farity with from one to three other languages than Swedish, is usually
mt with, and consequently a professor in Sweden is unusually well
informed regarding the literature or current activity in at least one
and frequently three other countries than his own,

Professor Barany, whose thorough familiarity with Vienna in
pre-war timss enables him to make a comparison from a more thorough
knowledge than is usually possible, made the following comments upon
Tesearch and teaching in Sweden:- The preparation for the practice
Of mdicine is better done in Sweden than anywhere in Austria or Germany.
The difficulties in research work are two, (and this referred more

Particularly to Upsala). There is much prejudice against animal
49

experinentation, There is no place provided even to ksep animals,
Physiology, Pharmacology, Medicine, Surgery and Fathology all suffer
from inadequate accomodations for animal experiments, The second
obstacle to research work lies in the fact that the financial status
of the physician in Sweden is so good that scientific work is less
attractive as a career than, for example, in Germany where scientific
distinction possesses not only intellectual but financial recompense,
Barany further believes thet the medical course in Sweden is so long
that the time of a man whose interests are special and crystallized
somwhat early is wasted in getting the regular degree, Ny ow
impression is that these difficulties are by no means insuyerable,

One hears occasionally that so strong is the emphasis upon scientific
attainment as a qualification for professorships, that good teachers
of only moderate ressarch ability are again and again passed over and
lost to the teaching force of the faculties, Inadequate budgets for
investigative work together with meager salaries for scientists, and
especially the younger Scientists, appear to me +o be more directly a
hindrance to madical research in Sweden than any other factors, This
is borne out by the universal ackncwledgement of the fact that, if it
Were not for the Johann Anderssons Fond, investigative work in Sweden

Would be at a standstill,
S

RESEARCH BY SUBJSCTS

 

I should like to present under the headings of different

medical disciplines the nams of men whom I mst or of whor I heard

a great deal, indicating their special interests and such useful inform

ation as I was able to obtain regarding them. My impression is that

previous surveys have neglected this method of recording impressions

received during visits, I am furthermre inclined to think that this

information is perhaps of more use for subsequent reference than almost

any other single item that could be presented in a survey,

Ivar BROMAN

Erik AGDUHR

Anatomy and Embryology

 

Born 1868. Professor at Lund since 1901, Especially
interested in Embrvology. Has a collection of 100 human
embryos down to 2-3 mn. which he referred to as being
his life work and which is unfortunately not protected
against the risk of fire. His laboratory facilities
are rather limited, and the building is old, In add-
ition to human embryos he has a large collection of
specimans in comparative embryology. 3roman is a
friend of Moll and Duesbere. Special interest: compar-
ative vertebrate embryology. Largest collection of
seal embryos in the world. Sveaks German and English.

Born 1886, Professor at Upsala since 1926, Agduhr is
professor of Anatomy and has teaching responsibility also
for teaching of Histology and Embryology, At the present
time Agduhr‘s quarters are inadequate, but the next build-
ing project in Upsala will include an extension and renov-
ation of his quarters, Agduhris one of the few examples
of a professor in the medical faculty whose training has
been largely in the faculty of veterinary mdicine, This
gives him a wider point of view in that he is familiar with
comparative anatomy, histology and embryology. He is
distinctly interested in experimental work, and has published
valuable papers on the histology of the nervous system,
Also has done some interesting work on apparently toxic
substances in cod liver oil. Speaks a little English

and German,
Thorston Ludvig
T HUN BS RG

Gustaf Fredrik
GOTHLIN

Charles Ernest
OVERTON

Eugene Louis
BACKMAN

Sl

Histology

Born 1891. Professor at Stockholm in 1923. Speaks
English and German, Pupil of Holmgren and Broman,.
Pure morphologist. Interested in histology of muscles,
Apparently no pupils and very little activity in the
laboratory. Large collection from the time of Retzius.

Physiology

Born in 1873. Professor at Lund in 1905. Pupil of

Hammprsten and Holmgren. An excellent teacher. Kaa
worked much on the physiology of special senses, but

is now especially interested in oxidation phenomena,

especially in Wieland'’s hypothesis, and the mthylin-
blue test. English and German,

Born 1874, Professor at Upsala in 1918. Has done
accurate and very carefully controlled work on the
physiology of vision with instruments designed by hin-
self. The Nedical Board of Sweden recently entrusted
to Gothlin the study of Vitamin C. in Northern wild
berries, as a possible control for certain nutritional
disorders in Northern Sweden. G. has two or threa
excellent assistants and though the building that he
is in was erected in 1886, the laboratory gives an
impression of orderly, careful and intelligent manage-
ment, G. speaks English and German,

Pharmacology

Born 1865, Professor at Lund in 1907, Speaks German
and English, An Englishmen by birth, long a pupil of
von Frey. Retiring in two years, Studied intensively
for the past ten or fifteen years the role of different
esters in producing narcosis, He has a curious failing
of finding publications almost impossibly difficult.
Possesses voluminous notes on extraordinarily long series
of experiments, Has used a large part of his budget for
the purchase of esters of weaker acids, He does not
wish either assistants or students,

Born 1883, Professor at Upsala - 1925, Cecuples very
cramped quarters but is much devoted to a group of 10
or 15 "Candidates” i.e, men still in their clinical
years, to which he assigns short problems which are done
under his close supervision. The State budget is such
as to cover only light and heating of his small labor-
atory. Ee obtains from the Johann Anderssons Fond the
rest of his budget for his work. He is hard-working
and unselfish towards these younger msn. Probably a
valuable man for students in their earlier years of
investigative work, Not equipped for advanced students,
céran Lil jestrand

Liner HAM@RSTEN

Erik WIDMARK

Gustaf SJOVALL.

Hilding BERGSTRAND

Pharmacology (continued)

Born in 1886, Professor at Stockholm - 1927, Labor=
atory entirely inadequate for receiving other workers,
Principally a question of space, Liljestrand is
Secretary of the Nobel Prize Committee and is conse-
quently very familiar with medical science in meny
countries. Gives me the impression that the mdical
sciences in the Karolinska Institutet are isolated and
depressed. Speaks German and English and, I believe,
Frenche

Born in 1889, Professor in Stockholm ~ 1928, Pharma-
cology is here combined with Chemistry, Hammrston's
quarters badly overcrowded but extremly busy. H.
like Liljestrand is a capable scientist working under
great difficulties, Gives m the impression of being
seriously ill (I was later told that he had endo-
cerdiatis). Speaks English and German.

Bio-Chemist

Born in 1889, Professor in 1920 (at Lund). Has
excellent quarters in new building. The youngest
professor at Lund, capable and willing to receive
advanced students, Successor of Bang, pupil of
Thunbe rg. Speaks English and German. Interested
in alcohol absorption and micro-methods for detection
of alcohol in blood, Budget about 9,000 Kronen -
3,000 from State, 3,000 supplementary from State and
3,000 from laboratory fees.

Pathological Anatomy

Born in 1879. Professor at Lund in 1914, Absent
during my visit. Laboratory fairly active. Excellent
assistant (Lindau). (For description of laboratory see
"Methods and Problems").

Born in 1886, Professor at Stockholm in 1924, Speaks
English and German. Interested in isolation of bacte-
riophage by high power centrifuge. Studied with Ross
Harrison in New Havem., Friend of Fahreiis and Gunnar
Holmgren, Active and ambitious. Not possessing,
however, very good facilities for advanced work at
present,
Folke HENSCHEN

Magnus FORSSMAN

Robin Sanno
FRHRABUS

Arvid LINDAU

Carl A. KLING |

53

Pathological Anatomy (continued)

Born in 1861, Professor at Stockholm in 1920. Speaks
French and Germn. Quarters at the Karolinska Insti-
tutet; buildings are too small. Not a large amount
of pathological material. Henschen is a great admirer
of Danes, Especially interested in blood-forming organs
and in comparative pathology.

General Pathology

Born 1868, Professor at Lund in 1900. The senior
professor at Lund. Especially interested in bacterio-
Logye Director of a hospital and the leading figure

in Lund. Was unfortunately ill at the tim of my visit.

Born 1888, Professor in 1928 (Upsala). There ig no
professor in pathological anatomy at the present tim,
only an assistant professor with the Swedish title of
Laborator, whose name is Wilhelm Birger BOSAEUS, so
that to F. falls the responsibility of leading in the
general field of Pathology at Upsala. F. has distin-
guished himself as being the first to call attention to
the phenomena of sedimentation of red blood corpuscles
in different diseases and in different animals, Very
favourable impression, in addition to the uncommonly high
commendation from several people in Lund and Stockholn,
including Forsell. Fahreus had a stipend from the
Johann Andersson Fond of 19,000 Kronen a year, before
coming to Upsala. He now has 12,000. Tries to do
what he can privately with tissue diagnosis from
practising physicians,

Bacteriology

Born 1892. Dozent in 1926 (Lund). Speaks English and
Germen. Pupil of Sjovall and Forssman, Studied with
Aschoff. Highly recommended by Harvey Cushing for his
work on cerebral angiomatea,. Is to work in 1930 with
Madsen in Copenhagen. Interested also in other forms
of brain tumors and in bacteriology, A very probable
candidate to succeed Forssman who retires in five years,

Born 1879. Dozent in Serology and Immmology in 1919,
At present Chief of the State Bacterioldgical Laboratory.
(Stockholm). I did not met Kling but heard from

num rous people the very high opinion which is held of
him. Especially interested in vaccination for vari-
cella, and in infantile paralysis and encephalitis
lethargica. Pupil of Oscar Medin. Has collaborated
with Levaditi on polyomyelitis.
Internal Medicine

Sven _Ingver INGVAR Born 1889, Dozent in 1925, Speaks English and German,

Gustaf BERGMARK

Israel HOLMGREN

EeJ.C. JACOBAEUS

Brik Gunnar
NYSTRoM

Pupil of Karl Petren, Harrison of New Haven, Brouwer
and Kappers of Amsterdam, Knows Stanley Cobb and de
JONBe Especially interested in neurological onto-
genetics in nsuro-pathology especially of mid-brain

and in the mningitis phenomena of Zoster and Tabes,

Is substituting as the chief of the medical clinic
until the selection of Professor Petrén's successor,

He is the leading candidate for this position, Ingvar
is definitely interested in research in connection with
clinical problems, .

Born 1881. Professor at Upsala in 1921, I did not
have the impression that B,. was particularly active in
investigative work, nor that he was, in general, quits
equal to som of his other colleagues in Upsala,

Born 1871, Professor at Stockholm in 1913, Speaks
English, German and French, Interested in tuberculosis
therapy and in surgical problems, Quite familiar with
foreign medical practice, BircheLindgren finds him
progressive and original but probably very obstinate,

My impression was that he was quite isolated at the
present times in the Karolinska Institutet, and certainly
not close to either Forsell of Key, but good critical
judgement and independent,

Born 1879, Professor at Stockholm in 1916, Especially
interested in chest diseasas, Has devised a mthod of
cutting pleural adhesions through trocars as a part of
pheumo-thorax treatment, Speaks English, French and
German,

Surgery

Born 1877, Professor at Upsala 1921, Pupil of
Lenander, Worked also for a year at the Mayo Clinic

in 1905. Speaks excellent English as well as German,
Has a new surgical clinic built in 1923, beautifully
built and maintained, Is younger than his years
indicate, and apparently occupies a position of consider-
able importance in ths University. Is Director of the
University hospital. N. would be, I think, the best
adviser on surgical matters in Sweden, Is interested
in experimental work and his university position gives
him a better opportunity to follow and direct research
work than is the case with most of the men in Stockholm,
Einar KEY

a. H. OLIVECRONA

Gustaf ESSEN-MOLLER

John Olof OLOW

Fritz Gustaf ASK

Johann Wilhelm
AURCENSON

55

Surgery (cont'd)

Born 1872, Professor in 1923 (Stockholm). Speaks
English and German. Interested in renal surgery and
surgery of blood vessels, also in thoraco-plastics,
Director of the Mariasjukhus. Interested in hospital
construction and management, Birch-Lindgren thinks
that in this he is intensely conservative, Had
Augustus Thorndike of Boston as pupil in about 1926,
Not ideal circumstances for surgical investigative
work or advanced teaching. For this, perhaps, I
would prefer Nystrom at Upsala.

Born 1891, Dozent 1924 (Stockholm). Interested in
brain surgery for which he has a small section of 12
beds at the Serafimriazarett. Very little teaching
but excellent records of his cases, for the mainten-
ance of which he receives grants from the Johann
Anderssons Fond. Speaks English and German,

Obstetrics and Gynecology

Born 1870, Professor in 1901 (Lund). Speaks
English, German and French, Friend of Hirst in
America and of Gameltoft. A good administrator
and operator, I did not see much of his investigative
work, but teaching of Obstetrics seemed very well done.

Born 1883. Professor in 1923 (Upsala). Olow speaks
German and English. Has one of the older buildings
in the University hospital - not particularly active
in research work, but intelligent and well informd,
100 beds - 53 for Obstetrics,

Ophthalmology

Born 1876. Professor in 1928 (Lund). His long period
as dozent without assistance for investigative work,
together with the fact that the Ophthalmological section
of the hospital at Lund is in the oldest of the build-
ings (60 beds) diminishes the significance of his work
on the side of medical research. He has not, as far
as I could see, any special interests which he is pur-
suing on the research side,

Born 1883. Professor in 1927 (Upsala). An exception-
ally sensible and broad-minded individual who would be
useful as an adviser on general conditions in Sweden,

Well informed upon medical education and public health
both in Sweden and out of it, Has independent incomes
3.8. Nordenson (ct

Goran af KLERCKER

Anders Ivar

THORLING

Isak JUNCELL

Johann Axel HOJER

ee

Ge

Tmund WIRGIN

Ophthalmology (cont'd)

*a)
which enables him to travel and keep in touch with
many individuals. Is the successor of Gullstrand,
Has clear and sound ideas upon the importance of
investigative work as applied to clinical ophthalmo-
logy. Speaks excellent English, Germen and French.

Pediatrics

Born 1871. Professor in 1916 (Lund). Has an excel-
lent hospital, is said to be extremely well read and
possessing very good judgement of men. Dees not
speak English; excellent German. Interested in Bio-
chemistry.

Born 1878. Professor in 1923 (Upsala). No surgery
or orthopedics. Takes premature deliveries and
weaklings directly from the Obstetrical Departrent,

60 beds, 1500 new Out-Patient Department cases a year.
Not moch investigative work. Malnutrition cases are
very rare. Speaks English and German.

Born 1867, Professor in 1914 (Stockholm), Interested
in rickets, scarlet fever and, more especially of late,
psychiatry as applied to children. Speaks English,
French and German. 85 bed-hospital "Allm, Barnhuset”
of which he is chief. Good judgement and well inform
ed. Not actively at work in research at present.

Hygiene and Public Health

Born 1890, Dozent in 1924 (Lund). Pupil of Fetersson
in Stockholm Especially interested in goiter. His
studies in Sweden in this connection do not seem to
implicate iodine deficiency, Speaks English and
German.

Born 1866, Professor in 1914 (Upsala). One cf the
two professors of Hygiene in Sweden, since there is
only a Dozent in this subject at the University of
Lund, My impression would be that he is more
interested in Hygiene, as the term is understood
gensrally, than in Bacteriology or Serology, lLabor~
atory not large, nor are facilities for work in
Hygiene considerable, W. speaks English and Germen
and som French, He is certainly the best adviser on
teaching of Hygiene in Sweden,
57

Hygiene & Public Health (cont'd)

Alfred PETERSSON Born 1867, Professor in 1919 (Stockholm), Almost

— exclusively interested in Bacteriology and Serology.
Very poorly informed on the subject of what in most
countries is considered Hygiene and Public Health,
He is teacher of C..A. Kling who is very highly
regarded in Sweden. Retiring in 1932. Mot much
investigative work being produced at present.
Speaks German,

Orthopedics

Patrik HAGLUND Born 1870. Professor in 1913 (Stockholm), Very
little research work going on. Interesting hospital
in that it is really a combination of hospital and
trade-school and "factory" providing employament to
a large number of cripples under observation and
treatment. Inadequate facilities for advanced
students. Speaks English and German.

RADIOLOGY
Hugo Fredrik Born 1864, Title of Laborator (Associate Professor)
LAURSLL Upsala, in 1927, Does not speak English; good German.

Excellent X-ray departuent. Original and stimulating
person, Has a first assistant and one amanuens.
About 30,000 plates a year. L. very highly thought
of in Sweden,

Gésta FORSELL Born 1876, Professor in 1916 (Stockholm). Excellent
English, German and probably French. Exceptionally
able and well informd., The most authoritative figure
in Swedish medicine. Director of the Radiumhemmst and
of the Roentgenological Institute of the Serafimr-
lazarett, Member of the Medicinalstyrelsen,

Bar, Nose and Throat

Gunnar HOLMGREN Born 1875. Professor in 1912 (Stockholm). New and
remarkably well organized clinic at Sabbatsberg Hosp.
50,000 visite a year in the OPD. Apparently great
ability as an organizer and administrator, but very
eager also to have younger men doing good investigative
work. I had the impression that he would provide
more facilities than direction or fragestellung,
Speaks English and German.
per Henrik Nils
SJOBRING

Psychiatry

Sorn in 1879, Dozent in 1920, Is Chief of

Service at the Upsala Asylum. Interested especially
in abnormal psychology. The importance attached to
Psychietry as a subject does not appear to be very
great in Sweden, and it may be due to this fact that
Sjobring gives the impression of being sorpewhat in
eclipse, He has a 1200 bed-hospital. Told m
that he had to pack the instruction in Psychiatry

into 17 lectures over a two month period, With
larg administrative responsibilities there is not

a very great investigative activity in this department.
59

SUPPORT AND EQUIPMENT OF RESEARCH

 

As in many other countries, the regular budget for institutes
or clinics for the maintenance of their regular work has failed to keep
up with the increased costs of animals, material, etc., so that, from
the standpoint of the professors, the State budgets for their work are
entirely inadequate, There is unanimous agreemnt that, if it were
not for the Anderssons Fond, they would be unable to do any investigat~
ive work, since the budgets would be entirely consumed in light, heating
and routine expenses of student instruction,

The THERESE AND JOHANN ANDERSONS MINNE (Foundation) was founded
in 1922, Its capital is 5,621,000 Kronen which provide about 250,000
Kronen annually. This money cannot be used for buildings, It is
designed for specific research expenses on presentation by the invest-
igator of a plan of his research together with a request for assistance,
It is not limited strictly to the mdical faculty, It can be used for
materiel or for stipends. There is no limit fixed to the amount allowed
for any given undertaking. Allotments are made by a committee of the
Karolinaka- Institutet in Stockholm - the membership of the committes
changing from year to year, There are no permanent officers or trustees,
It has proved an extremely useful support to research work and I was
struck by the types of comment made throughout Sweden upon its Significance,
Since it was usual to hear some such remark as: "It is not an easy
task to select themes or individuals who will contribute greatly to

Progress in medicines, but the committee of the Anderssons Fond have
peen as wise and careful as we could desire, and we could not do
petter in their place.”

Another source of occasional support for research work is
the Medical Board of Sweden (Medicinalstyrelsen) which, as in the
instance of Professor Gothlin in Upsala, subsidizes investigative
work by certain professors on specific problems upon which the Nedical
Board wishes work done. This ad hoc type of research work is acce pt-
able in many cases since the choice of invwstigator is largely deter-
mined by previous knowledge of his interests and qualifications; the
difficulty, of course, is that such support as this is not for an

indefinite period nor under elastic and easily adjustable conditions,
61

HOSPITALS

The Swedish hospital organization is predominantly official
and gowrnmental, which is show by the last official computation (1927)
to the effect that 46,625 beds belong-to official hospital institutions,
while private hospitals had an accomodation of only 3,300 beds, Start-
ing in many cases with a few governmental hospitals, the development in
Sweden has been first in the mitiplication of provincial and later of
district hospitals. The provincial hospitals (there are 25 provinces
in Sweden) are on the whole the predominating institutions although the
six largest towns have numerous hospital accomodations which, in the
case of Stockholm and Géteborg, are the most important in the country.
In spite of the relatively small importance of the private hospitals,
thare are three important spheres where private associations have taken
upon themselws very important tasks, These are the care of cripples,
the treatment of tuberculosis and radio-therapy. In all three of these
fields, private agencies have been greatly helped by liberal and highly
effective government cooperation in the transport of patients; for
example, it is possible for a patient in any part of Bweden to have his
railroad fee and even the fee of a friend or attendant paid to Stockholm
and return in-connection with his visits to the Radiumhemmet, It is
noteworthy that the number of hospital beds in Sweden has almost doubied
during the past twenty years. The supreme: jurisdiction over the
official hospitals rests with the State Medical Board, Its approval

is nacessary for all new buildings or enlargements of buildings. Hospital
superintendents throughout the official institutions are appointed by
the gowrnorent. Assistant medical officials in the hospitals are
appointed by the State Medical Board, at the recommendation of the
Board of managers of the hospital in question. The nursing personnel
is engaged and dismissed by the hospital superintendent, but the State
Medical Board maintains inspectors to control the general level of
nursing and treatment in the hospitals. Wees in the provincial
hospitals are laid dow by the provincial legislatures (Landsting),
and are therefore not uniform. Only one group of patients, namly
venereal patients in the infectious stage, are given, if it is necessary,
hospital treatment free of charge. The average fee in 1927 of the
provincial hospitals, in the general wards, was 1,75 Kronen per daye
The lowest was 1 Krone, and the highest 5 Kronen, In the semi~private
wards of 2-4 patients for a room, the charges varied between 5 and 6
Kronen, In the wholly private wards charges were between 7 and 10
Kronen, These charges include all necessary nursing and the patient
is not called upon to pay any fee to the medical officer for the
treatment received.

The general authority over the medical profession is
exercised by the State Medical Board, called the Medicinal-Styrelsen,
Consisting of the Chairman and five members, four of whom mist be

physicians and one veterinarian.
63

NURSES

The general impression received of nursing in Sweden is
excellent. The women appeared to have come from very good families.
The number of older nurses is somewhat higher, one would suppose, than
in America, aad the type of work entrusted to the nurses is such a6 to
make their cooperation an important element of medical cares

I visited the Nurses Training School in Lund, The matron
was a very superior person, 4 member of a titled family, Lady Elizabeth
Wachtnms ister. The course lasts for two years, and the teaching force
consists of the Matron, one Sister-Tutor, and three assistant Sister-
Tutors. A Lycée preparation is required for entrance, and the candi-
Gates must be between 20 and 27 years old. They pay for the two years
course « It is usual for them to stay for a third year, during which
time they are paid by the hosvital, The course begins with a two
months practical course in the wards, accompanied by lectures and
practical demonstrations. A report is then made upon every student,
and those considered unsuitable are eliminated, Then follows a year
as probationer, Zach ward is under an experienced head nurses

The nursing home was a beautiful building and contained both
a class-room and a room for practical exercises, ineluding cooking and
diet preperation. Bach bedroom was for two pupil nurses. Lady
Wachtmister has filled the building with beautiful furniture belonging
to her own family, and the effect was superior to any nurses’ home that
I have ever visited.

In Upsala, for a Pediatric ward of 24 patients there was one
head nurse, six nurses in training and one maid. The increasing
nunber of provincial and cottage hospitals creates 4 satisfactory
demand for nurses now being trained. It is perhaps useful to note

in this connection that in Lund there is a special institute for the
training of masseuses, This institute is apart from the medical
faculty or the hospital administration, although it works in excellent
cooperation with both the professors and the nursing force of the
hospitals. It is entitled the "Sydsvenska Gynmmastik Institutet",

and is under the combined direction of Major Thulin, Director of
Gymnastics in the Swedish Army, and the chief of the Orthopedic Clinic,
Dr. Frising, of the University. The girls are received at the age
of 18 to 20, and spend two years in theoretical study of Anatomy and
Physiology, together with a large amount of physical training and
carefully supervised learning of massage, passive exercises, etc.

They are admitted together with their teachers on the wards of the
hospital, and learn not only how to do massage, but in what types of
Cases massage or passive exercise is indicated, and exactly what the
limitations of this form of treatment are. I have seen nowhers a
more intelligent appreciation of the services of physical therapy

than is realized at this institute in Lund,
65

DISTRISTION OF DOCTORS

AD

At the end of 1920 there were 1715 practising physicians
in Sweden, distributed as follows:
24 Departmental Health officers,
336 provincial Medical Officers (ordinary and special)
187 Doctors in Cities, Towns and Urban Districts,
64 Tuberculosis Hospital Medical Officers,
357 General Hospital Medical officers,
63 Insane Asylum Doctors,
39 Prison Doctors,
121 Doctors in the Ministry of Communications,
122 Professors in the Medical Schools,
402 exclusively in private practice.

Distrdet Physicians, Hospital Physicians and Medical School
Professors must retire at 65, There is at present sous over-production
of doctors in Sweden, the number of graduates per year being between 110
and 150, The number required to renew the present number of practi-
tioners in‘ Sweden would be more nearly 110. At any rate it is very
hard now for young graduates to find places, There is virtually no
emigration. Most of the provincial medical officers are in private
practice at the same tim, receiving from 3-4,000 Kronen from the

government and from 10~20,000 Kronen from practice. There is no
66

marked limitation geographically for the graduates of Upsala, Lund
or Stockholm, although, in gensral, the Northern part of Sweden is
supplied from Stockholm and more particularly Upsala, whereas the
Southern provinces are supplied by men largely from Lund and in part

from Stockholm,
67

RECOMMENDATIONS

 

I should recommend that :

1) The present policy of foreign fellowships in mdicine,
for young Swedish doctors of medicine, be continued and that
this program be explicitly stated to the authorities of the

two faculties and the Karolinska Institute,

2) That contact be mintained in the future so that
possible research needs of Professor Forsell's Radiumhermst
and of the pre-clinical branches in Stockholm and Upsala may
be thoroughly familiar to the officers of the Medical Sciences,
It is at present impossible to advocate definite action in any
of these fields since much depends upon the action of the

Rigsdag in February - March 1950,

3) It seems reasonable to observe that medical education
in Sweden is well-balanced, advanced in its orientation and

effective both in its influence upon the practice of redicine

HauAungy.

and the side of research.