In presenting a survey or medical education in Sweden I

ham been inclined to dispense with the presentation of a number of

preliminary and, ir; a sense, aecondary information, since this is

already available in the

the Information Service,

national Health Division

Preliminary aport of Sweden prepamd by
and in the report or m. G- for tb Inter- 'ie's

upon Public Health in Sweden. I have also cq<

XI w.

kept in mind the fact that through travelling fello~a already accepted

from that country, m have obtained certain typa of informtion and


are in a position to obtain more details very readily if need be.

     It would seem deairable, however, to review certain distln-
guishing characteristic8 of' tlm country, and the Snedish as a people,

and to point out distinctive characteristic8 of the field of mdioal

education in Sweden.  Rather than resorting for the momnt to stat-

istical statemnte and figures, etc., I should like to present SOD

comparisons and remarks of a rather more @nerd nature which are,

homver, in the last analysis, more easily kept in mind.

Smdm is a alllall country in point of population (6,000,000)

but extensive and scantily settled and therefore presenting problem

in transportation, comunication and conditions of human life that am

markedly different from the other small countries of Europe,  auch ae

Denmark, Switzerland or Belgium.

It is a country, furthermore, on tb

2

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  i3ritish

Islese In addition to this geographical independence which has its

political implications, Sweden has occupied in the economic developmnt

of Europe a position which has for many years been secure, even if modest.

The agricultural organization in Smden was never threatened by the cheap

food of the New World, aa has been the ccse during the last 100 years in

France, nor has industrial developmsnt taken place in Sweden with the

almost dangeroua rapidity that has characterized England or Germany.

Timber has becorn valuable slowly. Hydro-electric power has been deve-

loped relatively recently; the mineral wealth of Smden has undergone

a sloner exploitation than that of other countries with mtallurgical

resource8. At any rate, tho social picture in Smden is om of sta-

bility. In Ita slower growth has corn a mom generalized prosperity,

with lese extremes of poverty or opulence than is the case of other

countries with more rapid development.

Smden is a country racially more homogenoue 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 them questions of language

or actual racial stock that preoccupy mn's minds and result in sectional

PIW judices.

In point of colonies and the r6le played by colonies, Sweden

3

difiers from Ireland, England or Holland and is more comparable to

Switzerland or Denmark. It is trw that a large emigration to Amria

has taken place.

But Sweden posss~ses no outlet for its adminietrativs

genlua and no muroe of handsom, revenue from colonial possessions ana-

logous to those of Holland.

The country ier one when tradition and

oonservatiam are still powrful, and is not raCad, a8 are Poland, Czech-

alovakia or the Baltic countrio~, with the difricultiea or e~tabiishing

~ .,

_." ~. .--- _.

8elf-govsmment among people long accuetomd to domination from a

distant capitalr Unlike England where om has ths Imprearion that

perfect familiarity wlth CL foreign tongue is regarded with respectf'ul

suspicion, Smden, in ita contact with the rest of Europe, resembles

Switzsrland in that tb educated people are at home, in at least one

foreign language, if indeed not two or three.

One ha8 the impmseion that ths Smdiah people am level-

headed, practical, moderate and rather slow in their mntal operatione,

which are none the lee8 sound and comprehensive. Slledes do not aeem

to be bowled over by brilliance; nor do they like to dominate. I would

8uspeot that they would question the poetic enthusiasm of Klplbg'S

referencer to tha white man's burden. Without being cynical, hypocrit-

ical or bitter, they simply am not capable of those great wave8 of -1%

depreciation or self-distrust which are tbe irreeistible invitation to

dominance from abroad.

whioh, a8 far a8 I am aware, ha6 rarely, if ever, taken place in Sweden,

I a:. not refer merely to political dominance,

but ale0 to the sort of enthusiasm for the cultum of, say, France, which

4

one finds in Rounlania or South-Amrica, The race has never been spoilt

by too easy a living accorded it by nature. Distances am great and the

fields are stony, and one takes Q very sober vier of life on the Swedish

country-side, - patience and enduring will-power are called out, The

Svmdes are solid, practical, kindly and patient. They seem to adjust

themselvea to new conditions slowly but aurely, whether it be as chauf-

feure of automobiles or 8s administrators of city hospitals, Their

rlomsss is not from prejudice nor from fBar, nor from conscious glory

in maintaining a tradition, but rather perhapa 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 instruction given, the distinctively univsrsity

flavour of this education, the cosmpolltan and well infomd point of

view of tb  teachere and the strong emphasis laid upon distinction as a

student or scholar rather than brilliance a8 a lecturer or performr.

Ten years to becom a practitioner is not intolerable to a slow

and solid nature; practical and thorough training wema indispensable if

one met take the position of a district doctor with no professional

colleague s within mile 6,

A visit to Smden gives the impression, that its universities

of Upsala, rirst, and Lund, later, were places to which every region in

the country has contributed, little by little, money and mn, Upeala

8881118 a place to which intellects ham come, not as in the case of

5

Florence, for example, a place in which the intellect8 have developed,

nor again a place which has sought to dominate intellectually, as is the

case now with Paris. One see8 tangible evidence of such a condition in

the survival at Lund and Upala of the mdlasval 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 (scholarsjhips

and prizes) at Upaala are largely provided through funds left to the

nation8 to be distributed for them enda. Upsala and Lund are natural

crystals in a homogeneous wlutlon. Their relation to the rest of

Sweden has been intimate,  unforced and natiiral.

?bither of tbse towns

have ewr been important politically and comrcially, There is no

jealousy, no separatism, no regional quarelllng,

Sneden does not suffer, as does Demrk, from having only one

university, nor does it auffer 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, homver, for, without question, the developmnt of the

Karolinska Institutet in Stockholm was inhibited to tb best ability of

the two universities. In most other ways, homwr, the universities have

shown an admirable power to cooperate with other undertakings of social

import, without trying, under the guiee of cooperation, to swallow them

alim. Thus the relation betmen all of the mdical 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 value of conpetitivle effort.

6

There are, however, som characteristics of mdical education

in Sweden which are concrete and distinctive although not individually

peculiar to Snsden alone. The pre-clinical studies are sharply set

apart from the years devoted to clinical work.

these pre-clinical studies obtains the title of Kandidat and is sharply

A student having finished

-- I

set apart from the group to which hs has recently belongsd. Another

characteristic of Snedish mdical education, which it shares with the

other Scandinavian countries, ia the nomination upon the cormnittee to

choose a profe8sor, of at least one representative from another of the

Scandinavian countries, whose serious and tim-consuming responsibility

It is to aid in the selection of the new professore

      In Smden, the rules and regulations regarding the practice

of mdicine in som ways interfere more sharply with what is known as

individual freedom than in most countries, Professors are allowed to

take private cases in the uniwraity hospitals, but there Is a definite

and indeed rigorous restriction of the fees they my charge.    This,

togethem with careful hospital administration, results in a remarkably

low cost of medical care, There are a large number of doctors in the

employ or the State, and yet with all this preoccupation to lTlake the

eervicea of doctors met the needs of the pople, the social and financ-

ial 8btU13 of the physician in Sweden ia excellent, and the profession

is not seriously overcrowded.

      Training in mdicine is too long and costly to be an easily

opened door to a camer. rl'he sparse settlemnt of the country would

maks haphasard or careless mdloal education almost immoral.  Relatively

fin young doctor8 in Sweden occupy the position of assistant to an older

man. Far from their nearest colleague, each physician must be self-

reliant-ne11 trained, It is the university &ich 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 forca, as a

result or failure to adjust to post-war prices, is inadequately paidp

and that the State budgets available to pay expenses of research are

entirely inadequate. These financial troubles, however, appear to have

leas effbot upon productivity and recruitmnt than is the ea198 in other

countriee. Smdon did not lose large numbers of' young men in the war,

nor has its cormnercial and industrial life undergone as many changes 6s

have thoae of' Germany and France, Consequently, there are not so many

parallel attractions to young mn in SIseden which serw  to draw them

army from academic careers.

We see then a stable effective fora of mdical education in

Smden, meeting aocial msponeibilities effectively, satisfying the high

standard8 of a flourishing profession, and contributing to mdical

progrese in a degree indeniably creditable for a nation of only six

million people

8

(3IIoOGRBpHIcM, IWD SOCIOLOGICAL BACKGROUND

No description or the mthoda and technique of pdical --

eduaatloa in any country can be effective unlese reference  is made

to th6 conditione rnich them msthods ham been devised to meeto The

dominant fact about ths Smdieh doctor'a training is that in most cases

he mt be prepared to be part of a scant population over a large

terri$ory. More than one third of Smden has a population of less

than 10 gsr equara mile;

80 and 50; them are only three areas where the population la mally

anothsr third has a population of betmen

denw,, 1.8. omr 200 per square mile. These are around Lund, between

Stockholm and Upsala, and around GZteberg.

This type of population mans that the doctor in practice in

' Srsdsn haB for the met part fen professional competitors or helpers,

and It Is of great importance conaeqtaently that he haw a thorough and

mneralized training and that hie university degree signify an already

appreciable familiarity with his professional duties.

The telephone, autom~bile and tb railway have done much to

diminish ths dlfffcultlea of reaching patients scattered over a wide

area.. But at111 It mmains true that even when supported by the racil-

itb8 of tbe cottage hospital and improved xmthode of communication and

traneport, the physician in SlPeden has both the advantage and disadvantage

of having relatively little professional competition. The advantams

ems8 themaelma in a security of position both financial and social,

'9

and the disadvantage, in one senset, lies In isolation and in the fact

that, a8 a young man, the Snedieh doctor doe6 not pas8 through a long

period of apprenticeship unless Indeed in the largest citie$.

fore becorn8 nsceesary for him to spend a longer period of time  in traln-

ing before be takes up hi6 practice.

o

It there-

18 OIU) or

.,. . .

a careful

There am fer great fortunes In Sweden, and the economic picture

a ratbr equal distribution of malth among an Industrloue and

population, with ne lthsr conapicuoua poverty nor wry exceptional

malth. The governmsnt ie conservative and mre highly centralized than

-r-.

that of Nomay, and the porer of the Crown considerably greater, The

roonomfc position of tbe country le, in mneral, very sound, since in

addition to forest products and a uell-developed agriculture In the South,

Swden poeaesaes larm quantities of hydro-electric power and deposits of
mineral orea, partiauladron, of very great value,

TIM country ha6

' porreeeed an excellent educational system for 80 long a tim that in

bohnloal education it is well able to compete with any of its neighbours.

Om feature of the life  in Sweden made a particular impression upon m,

nambly that being to a certain extent politically neutral in the problems

of Europe, and at the 8am tim able to take advantaB of the cultums of

Bn&land, France and Germany, the Swedes wem critical yet unbiassed by

-- ~ -

wlitical 8ympathieS, uell inforrned without being confused, and secure

reonomically without any danger of extremis of luxury,

10

OFGAlQXZATION OF SCHOOLS

The statue of the three mdical schools in Srreden Is mlatively

8imple in spite of the ract that there are som differences between

Stookholm and the two universities of Lund and Upsala.

Tbs University of Upsals dates from 1477, and the first professor

of mdicine there occupied the eighth chair of the University in 1595.

Upsala Is definitely the senior university of Smden, and has a great

prortlge, both ir! the past and at present. Lund is in a part of Sweden

--

that geographically and culturally Is more nearly Danish than Swodlsh;

Meed for a long tlm Lund was in one of the provinces of Denmark. Ita

pooltion may be more readily underetood when it  is known that it tea

tro hours to go from Lund to Copennagen, but twelve hour8 to go from Lund

to Stookholm. Them is, however, no trace of separatist feeling or poli-

tloal fbrment In Southern Sweden, and in the last analysis Upsala and Lund

ab unlverrltiea my be grouped togsther in contrast to the Karollnska

Inetltutet of Stockholm.

military surgeons and &UbQreriq  the Karolinska Institutet was fomd in

Stockholm, In an atmsphere that ma severely practical. At that tim

Up8ala was the seat of Hippocratic medicine,  where academic theories were

learned and the weight of tradition mi8 against exprimnt and the product-

ion of -re practltlonere. It was hardly to the interest of Upsala to

r0llnqUl8h Its right to licence practitioners, and only in 1890 was the

Karollneka Institutet qualified to give the rank of Llcenciator, and not

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

About 110 years ago, in order to produce

11

th. growth of the city of Stockholm and the concoremitent increase

in clinical facilities, tba gamlinska Inatitutet ha8 corm into a better

and better poaition from the standpoint of clinical imtruction.
PIS judice8 have died out, and the bvelopmnt of mdlcine has kept tbe
asdlcal fadty of Upeala preoccupied with own derelopxmnt and with lea6

Old

ti= to hold back the growth of another teaching center.

controlled growth mnmln, homver, in Stockholm, and OXLO ha6 the imprss~~-

Tracer of un-

ion thsm far mom sharply than in either Lund or Upaela that on tbb

clinical side teachera in Stockholm are first hospital QhIeftS, and teachere

o

afterwardr. This is lea8 tbb cm at the Serarimbrhzarstt than elm-

where.

But, In any event one uan say that the rids dispersion of hospital

facilitier prevents tlre unity that is EO characbrietic of Lund and Upsala.

Again in Stockholm, tlrsorstical branchee are inadequately houmd and

rtruggllng undnr condition8 that it would be unfair to call hostlh and

yet inaccurate to conaidor aa a true univerrity atmaghers.

     Tbn, is nothing remarkable or ercsptlonal in the organization
Of the80 modlodl 6chool8 that diertinguiahea them sharply from eidlar
inrtitut.8 in Iknrearlr, Noray or 8ome other countrie8 that am already

famlllar to US.
by tbn Univerrrlty Chanoellor.

and one or pat honour and influants.

An exoeption mlght

mads, homver, of the role plagsd

His 18 an offlee politically independent

     It is a liis appolntmnt and he

- ----e

chonn by the universities with, I believe, the concurrence of the

xamllneka InstituM$.

Hs hae his om staff, and hie work I8 to bop

tho universities - and keep themeven,

It ao happsns that

prs&mt

incubant, Tryggem, is Ylnisbr of Foreign Affaire in Sweden, and

12

co~eqwntly the mal work tall8 upon the Pro-Chancellors, who am tbe
~lshopr of Skh and Upsala. In spife of his otbr'prsoccupatione,
tm Chancellor has the last mrd on building questions in the unlvers-

itier d upon plWfseSOfid Bppoinbnt8.  Hb ie expechd to dbiend tbe

inkmBtS Of th6 WiV?!mifi86 hl tb Rigsag, and ha8 been found to bs a

port valuable protagonist.   He daea not encroach upon the dutiee of tbe

Ministar or Public Instruction, but rather eupplemnts this official in

caring srp~eially for the interests of higher education.

DO-, ~b orrim of the Dean is held for one year only and is rotated

                             All question8 of mat

-

among all ths mmbera of the faculty,

importmu0 am disou8md first by the faculty, second by the Unieerelty

Council, or Konaiatorlum, and then am parsed to the  E3ureau of the Chan-

crllor oi tb Univemities. The judges appointed to chooee professors

for vacant chairs are nominated by t& iaculty, ths Univarslty Kombtorium

and tho Chancellor. It Is rare that the choice of a professor is made

in 1.8. then a year.

Ch.ncellsr,

The Chancsllor or tb Universitie8 ir elected by all full

prOibBBOr8 at the tW Stah univerritlea. The Candidah re-

ceiving tb majority of the votes must be appointed by the Governmsnt,

a ne1 elsotion muat be called for.

Exprienw ha8 shown that th6

Principle or eelf-govermmnt in tb universities io thue preeerved very
'atiafaUtorily since ths Chancellor protect6 tbe universities against
bhilea bumaucratic inilwncse on the part of tb gommnrent.

13

is somewhat diiierent from that of a faculty.

consirrta of a Collegium of all professors.

internal governmnt, and takes the ordinary administrative deciaionr,

TM chairman of the Collegium is elected for three years ratbr than

being as, in the universities, the Dean, under a term of one year only.

The CollegiUm appoint8 from ita om mmbers variour committees for

apeciiic purp0608, such a8 management of library, etc. The Karolinska

Institutet is under the Chancellor of the Unlversitiea, Thsre are no

trustee8 at the Karolinska Institutet and In this part it reeenbles the

uni mi ra It is PI.

The governing body

It regulates mtters of

COST OF THF: SWOOL AND BUDGET CONTROL

The coat of mdical education in Smden is difficult to

ertimate, since tb echool budgets are not published. The budgets

tor institutes or departmnte are very much too loa, varying between

1,000 and 3,000 Kronen annually per instituteo The budget is made

up by the mdical faculty and submi+,ted to the University, which, in

turn, aubmite its total budget to an officer not existing in other

Europban countries, but known In Sweden as the Chancellor or the Uni-

oereitiee. The Chancellor Is a person of considerable political

prestige, and it is his ~%8ponSlbil~ty to fight the financial battle

tor the universities in the Rlgatag.

The status of mdical research io Sweden would be extremly

unllamurable if it uem not for the assistance given from the Joham

Anderson8 Fond, a foundation with a capital of about 5,000,000 Kronen,

the income from which is distributed for the eupport of scientific

rowarch among the two universities and the Karolinaka Institutet, by a

rpoial coxnittee chosen from the mmbers of the Karolinska Institutet.

The services of this fund in supporting scientific research in Slreden

ero uuanimusly recognized as being of the very greatest value and

bportance. But it 1s specifically designed only to take care of

material expenses and salaries or scholarships for scient ific workere

and cannot be employed for buildings, In several cases, the budgets

tor the clinical speoialties are almost negligible,

For reason8 of economy the Swedish Stat.0 Statistical 3umau

ha8 published no accounts since 1922 which would furnish rmterial OT.

tables indicating school cost, budget control, number of students, e tc.

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 WBS about 100,000 Kronen from property of this kind,

much of it being ear-mrked for use as stipends Tor the students.

The buildings and physical equipmint of the three mdical

schools in Sweden deaarua a brief description. In Lur-d, the 1Rhor-

atorlea are a mixture of old snd new. Anaton:?, PhysioloEy ant? Patho-

logical Anatomy  re all from 30 to 40 -pars old. Pharniacoloc,y, Fio-

Chemistry and Hygiene are all housed toether in a splendid new building,

The hospital, which is that of the province, coztains buildinffe of various

ages - Medicine, hdistrics and Orthop?+ics all king recent and wll-

appointed structures, "lynecology and O5stetrics is also modem and in

excellent condition. On the whole, Lund litis an adeqaa+& physical eylip-

mnt In view of the number of students (400) and tnn relatively srimll

claaaes which the long carriculun requires. One i~terestiny; f'e'ettlm

of the laboratory of Physiolopy is thst the top floor of this huildlnn

is given to bedrooms not only for the present staff of sssistH7t.s but

for a few of the formr assistants who are now in tho ~r~lre advanced stage

of their rcsdical training. In tl~is way, Frofesmr ThmbAry secures the

interest and co-operation of his formr assistants irk t9:e tm.:nine

guidance of his present helpers, and is thus itnabled to co?tin:ie an

excellent tradition CI~LQX~ the younger wn who frequently continue scecial

work in Physiology.

On the whole, the buildings at Ilpsala rive an imym33ion less

favourablo than that of Lcnd. The clinical branches are im*~sed in

buildings much nore modern than those of the rriadicH1 sciecces. The

Surgical Clinic dates from 1923 and the rest of' the clinics have been

remodelled and are in excellent condition, exce$ for that of Gynecology

and that of Otology, The hospital buildings belonR to the governmnt

of Sweden and am not provincial as at Lund or municipal as for the most

part in Stockholm. Anatomy, Histology and Embryology am housed in a

building erected in 1886, and that of Pathological Anatomy is of about

the 8- age. The Physiological laboratory dates from 1892. The

laboratory of Pharmacology is almost as old and is too smll for its

preeent services .

Stockholm is rather difficult to describe. The clinics am

widely scattered and of a very different age and @neral effectiveness.

Tbe laboratories housed in the Karolinska Institutot are badly over-

crowded, and quite inadequate in point of sypcs and aypointmnta,

A new plan is on foot in Stockholm to build on the western

side of the city a new mdicsl center. The site has been definitely

chooen and the projected construction is planned first to take care of

the clinics and buildings for Pathological Anatomy. Special clinics,

such 88 Psychiatry, Dermtology and ?;euro-Pathology, are not included in

the first stage of building. Also the theoretical institutes nust wait,

The Government of Smden would give the ground if the City and Province

of Stockholm approves and promises good buildings and maintenance. The

govermmnt would pay for 375 beds to be built if the City would pay for

315, and the Province for 110. The scherne for :mintenonce 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 imdiately

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

18

of a new teaching hospital would dspend, in $art, if not largely, upon

the willingness of patients, outside of Stockholm, to corn to the city

for hospitalization. There am those who are very doubtful as to

whether patients of this category would corn in vsry large numbers.

The existent hoapitals in Stockholm Include the General Children's

Hospital (8!5-100 beds), the St. Goran Rospital (250 beds), Skin and

VeDereal Diseases, Sabbataberg, a General Hogpital, a special Ortho-

pedic Hospital of 62 beds, the Serafimrlazarett (452 beds), and the

Mariasjukhuset of 160 beds in surgery and 115 in medicine,

19

HaSPITAL RELATION3HIRS

In considering the relationship between the medical faculties

and the hospitals it is of interest to note that already in 1700 the

Univeraity of Upsala set up an Out-patient Departmnt for the training

of etudenta, which was probably one of the very first of its kind organ-

ized at any medical school, In 1752, a General Hospital for the whole

of Smden wa8 Inaugurated in Stockholm, It was under the trust of the

Knights of the Seraphim Order, and was named Serafimrlazamtt, - "La7arett"

meaning in Swedish a general hospital for bodily dlseaee  in contrast to the

word nhospital'' which has the sense of our word "asylum",

The number of beds scattered among the different ssrvices at Lund

is 728, at Upsala 585. The Serafimrlazarett has 452 beds, but the other

horpitale of Stockholm would bring the total teaching facilities in Stock-

holm up to a thousand.

The Karolinska Institutet, in Ita relation to various hospitals

in Stockholm, hae the right to nominate ths prof'eeeeor-in-chief of the

wrviw and, in moat cams, this mans also the staff under him.

One half of the hospital costa, in the case of the two university

faculties, is carried by the Ministry of Ecclesiastics and Education, Birch-

Lindglsn is the archibct of aeveral of the provincial hospitals, and is

familiar with conditione in many parts of Sweden.   In his opinion it is

doubtful whether such hospital8 as the one projected in Stockholm for the

Karolinaka Institutet will be able to secure a large anough number of

20

pa+..enta from outside of Stockholm Since the local so-called Ccttae
hospitale, plue the provincial hospitals, are constantly improving both
in facilities and perhape a100 in atafi.   This difficulty would apply

principally only to a general hoepital, since it is widely recognized in
Smbn that the gowrnmnt must aaeiet In the transportation of special

cam8 to special hospitals. Now, there are several special hospitals

in Stockholm which haw a emr future than a general hospital for the

KarolinSka Ins ti tute t would have.

The outstanding features of the teaching hospitals in Sajden

are four:

10 Kronen in private rooms;

protected by the off cia1 limitation of the fees that my be chargyd; no

fee for a surgical o eration my exceed 300 Kronen and the maximurn for

appendix operation ie 50 Kronen;   3) Middle-class patients may attend

the Out-Patient Departmnt and may be charged by the physician in attend-

1) Excellent nursing care and low cost,  which does not exceed

Pa7

2) Even ths/'patients in hoapitals am

Ahct fee for his professional services;

in this way the facil-

ities for which the community has been baed are put at the disposal of
the coP"rmnlty;
hospitals are unde-etaffed with medical personnel.
opportmitY for investigative work on the part of the younger doctors.

4) It was the general impression that the teaching

There is very little

21

CURRICULUN

students entering the mdical faculties in Sweden corn  from

two types of schools, one comparable to the Realschule,  in rrrhich Physics

and Chemist= have been gimn for at least one year;

these schools must take an eEtrance exanination.

school is described as being half-classical, presumably a conpromise

with the old Gynnasium. From these schools an entrance examination

is not necessary, but the graduates take a special course at the Vnl-

versity before being registered .as fill-pledged mdical studentso

boys coning iron

The other type of

M

Phere have been no significant changes in the curriculum of

tb Smdish mdicsl schools of late, and in the msin the curriculum

follows the regulations of 1907, It is sharply divided Into two

Farta - pre-clinical and clinical,

the student's attention is taken entirely with the pm-clinical sciences

or Amtomy and i3mbryologyD Histology, - which is taymt usually separate-
ly iron, Anatomy although at ths ~amq the, - Physiology, Idedical Chexistry,
Phar~cOlogy and Pathology - in which is included Caneral Pathology and
Bacte riolagy,

1

During ths first Zz - 4 gears,

one term Is given to Comparative Anatony and General Chenistry.

Ltter that the students dissect the hurcan body during three terms,
the they also take Illicroscopical anatowj, In each of the
"'' Ow '% terms, Physiology, Physiological Chemistry aTd Pathological
bto!v)- are taken,  During om of these three terms also a cow88 of

In

23

taf;2n up in a single lecture, a

"clinical lectum"

usually lasting

rOrrd hours.
spcid diacussiona uhich are at Wma read and comnted on at the

locf\lrs.

When the student is more advanced he has to write

The professor precedes his discussion by presenting in

brief, results of laboratory examinations, etc., on the case.

tb rtudenta have  to attend the professor's clinical reception of patients,

811

and e noba on the DBW cases. Inetruction at this tine is in

quoation and anallbr form,

~YJ- examinations of patients, but these am checked up by the assistant

pkysieians. The profeeaors try to arrane the theomtical work to be

urdortdmn next by the student.

The student is throughout required to make

In addition to the four months service in bledicine and four

rmths in Sugary referred to above, the student must take, simultaneously

lahr, a two months clinical courm in Neurology,  two months service

a8 Uabtant in the lbdical Clinic and one month as an assistant in a

h*nZital for lnfectioua disease8.

mntbl #rvice In a Pediatrical clinic.

th

In Pediatrice, he must take a three

In Surgery, in addition to

mntha aervice msntioned above, he mat have a tu0 months course

Gtalogg, Rhinology and Laryngology, and one month service as Surgical

arrishQt in a Surgical clinic,

    For Ophthalmology, two months Service

For Obatetrlcs and Gynecology - four months.

clinic is required,

I` pa~QIOglcal Anatomy, it ha8 been already noted that four mntb

mryim io required, simultaneously ulth the eervice in the mdical or

24

is usually done at the tixm of being assistant in the mdical

21in~cr

In Legal and State Medicine,  a three months course is given

termination of services In Medicifie and Surgery, Gynecology

and Obstetrics.  Thus, this three mntha course is at the termination

or tw mdical studies. Furthermre, in Psychiatry, there is a short

lectm course in the Psychiatrical clinic,

s~phii~ology, a tm months courBc), not gipen in Lund or in Upsala but

or,l)- at St,Gbran*s Hospital in Stockhoh In Syphilology, in add-

itios to two months lscttlre coume, (lecture and clinic) there is a

two meks mrvice as assistant, which does not, however, mount to mich.

In pgiene, there is a two months courbe consisting largely of lectures

ani field trips. The clinical training is completed by two or more

month of the so-called "assistant service" in which the student tab-s

a mr(t complete responsibility for cases. In rmdicine this service is

at leaat two months, in surgery at least one month.

In Dermatology and

Having finished all this training in different departmnts

2. student has to pass special final examinations in internal mdicine,

surgWp Pathological anatomy, ophthalnistrics, pediatrics, obstetrics

c

GZe oology, forensic medicine, syphilidology, psychiatry and public

-c -

halthe
licentiate" and inmediately afterwards b will, by the state board of
m'icine, get his licence for practice.
to the d6-e of Licenciator.
t'e Liwnciab must first be obtained, and the spplicant must choose,

After these separate examinations he  is declared wmsdicine

These clinical courses lead

For the degree of Doctor of Fbdicine,

wFi~e mcl publicly defend a thesis approved by the faculty,

The students are obliged at the termination of their work at

the gnimmity to serve in certain hospitals in addition to their work
in tl.5 university clinics,   This le the so-called practical year which

is ,&ligatory for 80- state appointmsnts, and the hospitals in which it
-:,- k 8ocomplished are chosen by fixed rules of the Medical Adminiatra-

tien In Slsden.   It should be noted also that In the case of Dermato-

logy, thro le neither at Luna nor in Upsala a satisfactory service, so
th4t tb Dernmtological Clinic in Stockholm Is the only place where

stuiirntn can reoeive eatiefactory experience.

The 6tudsnt must take his leotum work and practical work in

aach rubject at tb 8- tims, and tb poseibilitiea of combining differ-

ant subjbcta during tb tixw of practical service are very slight,

Op'TtLlr~l~gy and Psychiatry may be taken simultaneously;

hg*^l mdicine may ala0 be combined and the Neurology lecture course
ta::a:'l-ab the same tine as the practical work in Syphilology or Pediatrics,
but *hi8 shut exhausts the poselbilitiea, The mcontlnuation course"

Hygiem and

~~~4105xm and surgery may be taken only in Stockholm or LunB;

the

LaGI IbdICine, Syphille
a11 tb6 other work my be taken at any of these three 8choolB.

Cliniu, and Neurology course only in Stockholm;

A6 one of the outstanding featurea of the Swadish curriculum
hwth of' tlm involved, I tabulated the information given in the

is

u'tcl@lW Of the University of Lund mdical Faculty, and found that in
hy $989, thsm are follolring number of students still taking course8
''' %lm Licentiate who had entered in the yeare noted a8 foll0wa:-

P

26

1015
191 6
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929

1
1
e
9

23
33
37
33
34
31
41
53
43
95
13

Thle brief table indicate8 that, apart from t% few stramem,

the opsdicel course takes about 10 pars. The number is slightly

dininished In the last year or so of study,  since 80928 of the mn

leaorb Luna to take the degree In Stockholm.

I further carefully ,mined the Catalogue  of Lund to see

at what age Swedish mdical students were beginning so long a period

Of tl'ablng. 10 had entered the Msdical Faculty at the age of 17;

85 at 18; 131 at 19; 93 at 20; 62 at W; 26 at 22; 23 at 23;

9 at 24; 9 at 25; 4 at 26; 2 at 27 and 4 at 28.

27

     The teaching mthods in Sweden are characterized by thorough-
LlbBa and length of tim given for each course of instruction aEd by the
fact that the teaching is more practical and more closely controlled by
profearor or instructor than in GeXmEULy, and yet mm academic than is

thg case in the faculties of England or France.

Claases are not large. It is rare to have over 100 students.

';he number of assistant teachem is reasonably large, but mrhaps not

qEita sufficient. There is considerable emphasis upon individual labor-

atory work and them is everywhere clear evidence that such laboratory

work ia carefully controlled.

One receive8 ths impression that, thanks to the elasticity of

organization in the curriculum and the length of tim usually accorded

to mdical studies, there is very little cramming or hasty mmorizing

and that the students, realizing how long is the study of mdicine, are
going at it in a patient, slow and sound way.

The equipmnt without

1uxurious, is adequate. It is perhaps unusual to see so little

di8crepancy betmen the quality of the work done in different institutes
of the s~me racuity.  ~n the pre-clinical studies there is, in general,
a balance betmen lecture, demonstration and jndividual work. In-
'masad e~nphaaie during the past 15 yeare has been placed u?on the Physio-
l06iC%l Side Somewhat at the expense of pure Norphology.

Through the

differentiation which is mrbd by th Kandidat examination at the

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

28

distinction and ITiatUri+4 of point of view which is not comn in mst
otbr countries of E~ope,  And ths clinical course being taken in a
slow and thorough Kay pmduces a graduate hrc. the ,mdical faculty whose
clinical exprience, not only in the
~pcialtIeB is 88 good a8 my in ZUrOp8.
in sone of the representative institutes or clinics may be u~ml as

giving typical eSam?leB of conditions observed:

"tripod of nedicim", but ia the

A fer notes on teaching mthods

Anebrl;; (at Lund) :-

Anatomy is taught top ther with Embryology, Sistology is

taught at the sam tim of the student's career Sut by another professor.

owkl~ to a lack of material, and as a mtter also of pedagogic mthod,

rt~dents are obliged, before doing any dissection themselves, to study

dissected preparations and pass a rigid examination upon them. There-

biter, each student dissects each part of the body once.

Four semsters

given to Anatomy and 3mbryology. The rJrofessor is assisted by

rtudent assistants, who are gimn the title of
YOWg fellow8 who haw already passed the Kandidat 8-n and am mll
in advance of the other students.  Scattered among the four semesters

tkmm                                                     In
t"i8 mY the 50 cadavers available are made to serve satisfactorily for
a number of studerits.

"AInanuens".

These are

200 students, half of whom are dissecting new rmterial.

?b3ioi0~~ (at LW) :-

The classes number about 20,

The course is given twice a Par.

'Or

and a half mntb the students spnd all day in physiology,

They

29

obliged to keep *Journalsw which have records of experimnts made

tkat am among the best that I have seen anywhere.
tbm8 for eX€eriIIBntal verification is broad and careful.
a mek during this course the professor give8 a lecture followed or
rccoxpanled by a demonstration, the whole taking about two hours,

a we5k the lecture 1s given by the first assistant, The teaching force
is composed of: the ?rofessor, first assistant, an "aIIlanuens" and two

extra or eubordinate "BmBnuenses",

The selection of

Four tima

Once

Internal Medicine (at Luna) :=

Internal 'Yedicine begins after the &ndidat*'s examination, i.e,

when entire pre-clinical work la finished satisfactorily. The first

course in Wdlcine is a six months systematic course of lectures. Them

follows two months in medicine  and two months In surgery devotad to

physical diagnosis and nursing.   Then corns a five months cow99 all day,

evbry day in the week, in the mdical clinics, with three clinical lectures

a week.  During this tins the students are at work as clinicel clerks,

are obliged to Keep full records of their cases which are reviexed by

the aeelstant and returned to the student with corrections and suggestions.
A i=irther couree of two mnths as intern with responsibility for cases
and for the histories taken upon the& completes the training,

Obstetrics and ~~-r.ecoio L~

(at Lund) :-

--

The course begins with two weeks of introductory lectures and

madin&
delipemd in hospital,

There is also work on the phantom and attendance at norm1 cases

The clase is then divided into 8ections; eight

30

students at a tim 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 tlms, every four daya, and during this

tirm food Is provided for them and they live substantially as interns.

They begin with delivering normal cases under th3 supervision of an

assistant. There is always on duty a trained midwife as nurse. Each

student gets 45-50 delimriea under these conditions, togethsr with

attendance at abnormal cases, and ward-rounds, and experience in hand-

ling the routine laboratory work. The hospital is one of 108 bed8 with

possibility of chanm in the proportion betmen obstetrical and gpeco-

1ogical.cases. There are about 1900 births a par.

General PatholoRy (at Stockholm) :-

-

About 50 students in a class. The course is repeated trice a

year. It lasts two and a half months and is gimn just befoiw the

ICandidat exmirution. 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 step-

ping-stone betmen Physiology or Pathological anatomy, and the clinical

work soon to follow, The staff ia composed of professor, one prosector

and two asststants.

Orthopedics (in Stockholm) :I.

A two-months course which is repeated three tims in the year.

There is a gensral courw of lectures by the professor, a practical course

In bandaging and orthopedic technique by the first assistant. No operating

experience is given to students since this Is reserved for the assistants,

There are from 20 to 30 students per course. The stafr consists of:

first aasiatant, who sfaye a term of air years;

8-8 for two years, and a third assistant, who is on a one-year appoint-

mat.

a second aselatant, who

mdicine. (at Stockholm) :-

bZedicine at Stockholm i8 much as it is at LWdm Them Is

definitely mom bedside wofk in the medical teaching than is the cam in

Germany, and the cams are thoroughly discussed in slnall group8. The

beat preparation for the work in mdicine ie considered to be the post

or recond assistant, in either pathology or physiology, prevloua to

taking the tour- in mdlCinSm This Is, of course, reserved ror very

ffm, but in eneral, In Smden, the custom Csf having etudent assistants

in nearly all of the courbes serve6 to seleot and further train tbe mst

promising material.

mie$ae (at Upsala) :-

The mdical courae has 150 free beds, 24 private bas. There

are about 10 new oaaes in the Polyclinic per day. The proferssor has

four assistants who stay with him 4 to 5 years each. The courae begins

with mmn weeks introduction in the chest clinic for a general review

or pathology and for training in physical diagnosis,    Then follows a

15 -eke courae including ward-visits and systemtie lectum8. Then 12

rtubntcl at a time are taken as assistants on the ward for four months

-eaoh; the usual "journals" or mcords of cases are camrully kept

@ criticized by stafY aasistants,

32

Hygiene (at Upsale)

About 30 students toke a two months course, 2 hours lectum

and damanstration, five times a mek, in addition making visits to

aewage disposal plants, etc. If the marks of a student am un-

satlefactory, he is mqulmd to mke smcial reports on schoola,

hospitals and other Institutes related to Public Eyglens, until his

comprehension of the subject is considered to haw been impro-mde

Bvery 3-4 years, when ten to fifteen Drovincial doctors join

topther in asking for a special course, Professor Wirgin ~,lves such

a cour88 for six month8. It ia or tho seminar +,y-pe~, consisting of

leotureb,  , a long excursion and criticisms of studies ~mpared by

rtudsnte of special lnstltutiona or statistical studies,

33

At the end of each course a Tentamr!, or examination for the

COUPIB, Is given. This is usually practical and oral, and lasts for
14-2 hours.

the so-called Kandidats-Examen, This in effsct cover8 all of the pre-

clinical subjects in the mdical curriculum, If a student fails in one

of the tentamns, he is remanded for further study and can taks the

examination again without taking the course over. It Is left for him

to decide when he will present himelf. Sy spreading the tentamn exan-

lnations over the year, the professors are mlieved of a great accumulation

of examinat ions o

1

At the end of 35-4 year8 a genera exanination is given -

Y

Following the XarNdats-Examn, the successful examinee has the

title of Kandidat and pursues, for another six to seven years, his studlea,

thia tim, however, entirely in cl:r!ica- ?rani'i:es, Iis is then given a

final examination for the Licenciate and, if successful, he my file his

certificate of being a Licenciator with the State 3oard of T.'Rdical Control

which, without further examination, gives him tho licence to pectice

medicine in Sweden.

..

After this universlty work arid before obtaining his degree as

Llcenciator, he must, if he is to take any soverrmnt or local post, work

aa aesietant eight months in a hospital approved by the Karolinska Tnsti-

tutst, the University of Lund or of Upsala, in a mdical, mrgfcal or

mixed service,

terminal clinical year is not a severe burden to the student.

Since these posts provide both room and board free, this

In th3 point of diffeTent deyreeu, thg tkme wdrcel schoois

of Sweden are rolatdd in a poculiar way rlw to the fszt t\at the uni-mrs-

ltles of Lund and Cpsala am obliged to limit the nimber of clinical

students to 30, whereas the hospital fcicilities in Stcckholr! arc rrmh

mow abundant. Zonsequently, out of 442 clinical students at Stockholri.,

rn Bee that 283 hive Seen prepared in Stockholm, that 118 are frox. Vpsala

and 41 from Lund. Ths studer,ts ~ho reimir. In t!ie clinics at Ypsala or

Lund, are neither better nx vrorse than thase leuvjng for Stockhb, since

many other factors besides in?,?1lect,ial qualifications detsrrdne their

decielons in this point.

The clinical facilities in St~ekholrn am such tis to draa SORB

men from Lund and Upsala. Thlv is indicated b;r the fiwrgs for Ttockholn:

in 1928. There ere 384 mdical students in tke first ~islf cf -rheir

msdical trainizg, i.e. previous to receiving the decree cf 'r'andidut,

There were 544 students in the second half of t?ieir imdicnl stiidies, and

thib increase was due to additions frox Lund 8nd !Jpsala, TTpala senlting

about 118 mn and Lund -41,

35

COST TO S2TU313TS

Taking ten years as an averags length of the mdical training,

the student's expenses for this priod are calculated as being between

30,000 and 40,000 Kronen.

with livicg expenses, The laboratory fees for the am-clinical courses

total 34,000 Kronen. Although ths Krone has the value of 3,72 Kronen

to the Dollar, I was told that 2,70 was the buying value in :;weden of

om Dollar in Amsrica. Many of the students go Into debt. Indeed

for 145 Smedish physiciane licenced in 1920-21, the following table
from the "Y'ddelander Prgn Vedicinska Torenningen''

ar having

This includes university charges, together

1923, :to. 4, gives

No debts 2 756

Less than 10,000 ICr. 23,%

Prom 10 to 20,000 2-49

'( 20 to 40,000 215'.

tf 40,000 or above *$

Ths best rate obtainable for borrowlng money fron the banks

1

18 42%.

able numbr of student loans are Furcished by the banks. %nkw rs

con8ider that the character nnd flnvncial position of practitioners in

Smden is such that thsy may safely place money upon a large number of

rmdical students.

The usual rate is 57; and it is noteworthy that o very consider-

36

The professore am cbosen only frox the Dozent class. This

is already a selected paup, since only 2-43 of those whom we should call
gra&la*s in mdicim, and who ars known in Swedec as Lice2ciators, go OT!
to lake the higher deme Of Doctor 9f F.iedScim, and not EO= than 3alf

of the doctors of mdicirie attain the Dozentehip.   Furthemore, in the

emimtion for the Dozentship, which consists of a prepared lecture end

teat of practicsl work, manipulation, etc., the successful candidates

must haw a mark of 2 or mre on a scala of 3, Direct calls to t3e

professorship are few. The judges appointed to choose professors for

~acant chairs are nominat3d by the Faculty, the L'niwrsity Konsistorium

and the Chancellor. It is a committee of 4-5 judges, which usuallv

includes a Dane or a Korwgian or a Finn. To this committee the candidate

for the chair must present hie thesis. Tach mnber of the comTdttee is

obliged to mad all of the published scientific works of every candidate,
wk-ich take8 considerable time, but finally the committee select and publish

(with reasons given) in the order of thir preference, three nams which
ce then presented to the facfity and, when approved, t3 the University
SenP_b, and again $0 the Chancsllor ~f the Vniversities and ta the L-inister

Public Instruction.

It is rare fhat reversals of judgement take place,

the candidate having first preference is usually oominated.

It is

raid that%hen you know the cornittee you know who will be their first

choice",

37

mn arrive at the chairs of medical facultiea of Sweden at

tb as of 45,

             It is definitely stipulated that all professors
in smbn shall be chosen on the basis of the following three qualifi-

crtiom:

1)  Scientific ability ae an investigator,

2) Ability aa a teacher of medicine, and

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

candidates the younger mafl shall be favoqd.

     This policy is adhered to with a good deal of tenacity and

ths publication of the committee's decision is a custom which aids in

rbmming the three qualifications mentioned.

In practice this mthod of eelection of professors works

rxtr~ordinarily well if one may attribute to it the quality of the Fro-

f3OH)ra in Smden at present. The preeence cf a Dane or a Normgian on

tY-6 Committee helps occasionally to guarantee Preedom from local political

con~idsratlons, The diffemnce from the rmthod in force in Denmerk is
thht Candidates for the professorships are not obliged in Sweden to take

Part

Otc4

'I1 Or the Published work of any candidate to the searching emination
Or ' @OUP of his professorial confrbres acte as a deterrent to hasty or
''ls i:OUS though shallow publications on the part of my young Sarede who
Is 'ontamplating a university career.
wl'cthg PrOfes8or8, which is of SOD importance, is that the cornittee

1s

an open contest, such as presentation of a lecture on short notice,
f CaUOt avoid the cbnclusion that the requiremnt which submits

Another item in the method of

cbli@d to publish their choice and give the specific reasons for their

OhOiCe.

plab of any bias, favouritism, etc.

ship, then, ia a curious feature which dates, it is said, from the Fiddle

@a. The prospective Dozent is obliged to defend his thesis for t'lme

hour8 before a public assembly as well as one critic appointed by th3

iamlty and two critics chosen by himself. I attanded one of these

,laminations, It ms extremly forrnal and the technical discussion

~'~~ared to be rigorous. It has hen found, appaxetly since the h"idd1e

838, that this ceremony tends to becorrs overciIwged with emtion, and

hence it has become the custom that of the two critics chosen by the Dozent

om Is likely to be a local wit, often having no technical qualific~tions

for the discuseions of the thesis, His function in the ceminony is to

'ripg the entlm discussion within the bounds of reason and tgeneral comnon-

mnm. Since th thesis mist have Seen published at least two meks kfore

lk public defense, he has an opportunity, alone with his txchnical colleagues,

tJ pmpare himself upon the subject, but his remarks are ictentionally

This directly acts a8 a control of criticisms that night be

In the exanination for the Dozent-

ivsrting and intended to remDve any traces of prriranent bitterness 0:: ill-

f2Ollsg which often accompanies criticisms offered in public by swcialists.

The salaries of professors in the nsdical faculties in Sweden

wj hm 12,000 'to 14,000 Kronen in the Sciences to 15,000 and upward in

t:,; clinical branches. Since clinicians receive additional pay fcjr clinical

aJrk In the hospitals or from other work which they are able to do,  there

ure no full-tb clinical positions. Forsell was of the opinion that the

-.-n-cllnical professors are very poorly paid, One of his colleagues he

:..z?W to be paying 5,000 Kronen only for mnt out of a 14,000 Kronen salary.

It requires 3 - 4,OOQ a par to l,rs*.?p a boy in ths cu!ili:iil ficult.:r, !!he

rank of Laborutor or, in hatux::, Tmsec?3r, is tho equivalent of tb

Professor extraordinarius in Serraany. LzMrctors rece fire 10,000 F-rcnen.

First assistants receive 'E,OOG to G,XN Krr>mna

There are u few fellowships at Lmd which an? -r-st,ricted to

Dozents and four of which a-re in fcrce in tha riedical fr;cult:r. The se

fellowships ar? tenab1.r: for t,f?ree years and renewable otic8 for th-.e~ years,

and pay 7,OCO Froner. thus, serving tin ~xcellsnt pllrposs since it is widcly

aoknorledged in Swden thet th pay of both Uie professors and subndinate

teaching mrsoMe1 is inadequate, b curious fouture or the arranzemnts

at Lund is thnt th9 f'irst assistant in Sur:qrry is allowed t3 chazp for

his services in th Out-patient Departnsnt and my, in t?is wtiy, got. as

much a8 15,OGO I:mnen additiorisl to his 5,CGG salary. iVith the fCjrce

of tradition behind it, this armn@mr.t rontinues untllsturbsd and it has

tb virtw of seciiring first-rate talent in t3.e position of first assistant.

Tbs "amanuena"

versity during the academic 'yew.

their academic S8.larp. Nordensson, in Upsala, tzld IIB that kis salary

68 profeesor of' Ophthalzology was 12,000 Kmnen and %hat fmn one hg:-irfs

private consultation work a day 1:e recei7tes 6 - 6,000 ?;Tonen fi year,

pathologist at Upsa;a is obliLTd to rlo private work In tissue di,~,~~~s5~

apart from his Un:versity mspcnsibillties,  in Grder tu rmkw e,GOO which

i8 absolutely necessary as an addition $0 this snlar:ro

(or nssistantj

receives 315 i;ronen rrmnthly frclnl the T'ni-

  Professoi*s tn Sweden mtircj on 70;s of

'The

40

G'dran


Jules H.

Yror 3.

J. Albin


Gunnar


N. Sunr.ar

Johan Re


Israel


S.3. Petrik


Isak

C, auta

K, CkYiS t.ial2

Hjalw

John A.


Alfred

Erik, 0.3:.

Folke

!Vilhslm X .

GZsta, P.Z.

Slnar S.H.

Phr.mcology

Simg ry

Phys iOlO&:y

P s y c :I ia t ry

Oph thalmlogY

Le@ :!sdicine

Gt iatry

s y ph i 1 is

Intern . ;&d ic i ne

rJ r+ hope d i c 3

Pe c2 ia tr i cs

m3d. HndiolcgJ

Tct. :$dicJ ne

Obsta trics, Cyn.

Chemistry, Pharmcy

I~Ts; j e ne

Obstetrics, Gyn,

Pathol .-Am toay

Pediatric8

Iiistol or_y

Surce ry

41

Professors in Stockholm

WRCUS Hemy Io
SEF42STPm KaJa Hildiw
IXSiZR A. Carl 9.

Prose ctora

BACKMAN Goston (Prof o )

Vacant

(continued)

Ne u ro 1 o .gy

Pathol.-Anatomy

Anatomy

Chiefs of Laboratories

Anatomy

Pat hol .-Ana tomy

Le c turera

KLY!Xf#;, Olof v.

LIcHTE1:smIN

Adolf

Docen ta

Emst J.

Arnold R.

Ludvig

Ja Eenning

N. Abraham

Bacteriology

Physiology
C he mi s t ry , Pharma c y
Clinical research

Pathol.-Anatomy

Le @l Psychiatry

IT pldemiology

Bacteriology

Bdicine

De rma t ology
Orthoped. surgery

Surgery

Stockholm

Docent 8

( con t i nue d )

Karl A. (Prof'.)

Karl


Josua

E. Folke


N. Gustaf

Karl Gustaf

Olof T.

Ri3XNSTERN.A John Lo (Prof.)

LICrnSrn IN Adolr

28rgen Nielaen,

E, J-8


Hareld


E. Oscar

Eilding

Nils


23 inar

JWS V.

Robin S.

Birger

Nils Id.

J. Alex


Xila

Se ro lo a;, Sirmunolo,g

Syphilis

bled I c lne

Int. !.bdiclna

Surgery

Ophthalmology

Xis tory of his d ic ine

Dermatology, SDhil3.s

Pediatrics

De rm t olo gy , S yph il is

Cba te tr i cs, 3yne colo!g

Internal Mdicine


Bdicine


Wdiclne

Ne u r ol o gy

Surw ry

Dermtoloey, Syphilis

Exps rim. -Pathology

Obstetrics, Gyn.

Ped iatric8

Experim. Pathology

Iiedicim

Ernst Ne u YO logy

43

Medical Faculty

Karl Tore Graf

John Ulrik Teodor


Cermund


Gustaf

Gustaf Fredr ik

Erik Guar


Anders Ivar

nhn oior

E. Louis


Robert

Erik

Jo we

Madcine and Phys1ol.-
   Che mi s try

Fatholo- Anatomy

Hygiene, Bacteriology

Practical mdlclne

Physiology

Surgery

Pediatric8

Obstetrics, Gymcology

Pharmc ognos y

Oto-Rhino-Laryngology

Histology, Embryology

Ophthalmlogy

Chiefs of Laboratories

Johan Gunnar  EX^. PhySlOlOe;Y, mdo

Physics

Gunnar Frtthiof    Nisd. physiol. chemistry

Hugo Fredrik      B"8do Radiology

Vacant : . . . . . . . . Anatomy & Exp, Pathology

44

Upsala

IEsdIcal Faculty (continued)

Docents

Per Senrik Nils

Carl, Albert

Paul Elobert

Anders Vilhelm


John Petrue

Johm Alfred


Carl Gustaf

Gzsta Fritz


Gunnar

Wilhelm 3irger

Psych la try

Hygiene, 2acteriology

Surgery

Pract. msdiclne

Patho1.-Anatomy

Pract. m3icine

Physiology

C t o-2hino-Laryngology

Eugenics

Patho1.-Anatomy

45

PROPBSSORS IN LUND

Kun& Karollnaka Universitetet

WIGERI!

Vacant:

ASK

Medical Facultg

Magnus John Carl Bug.

Gustai Ells


IVar

Torsten Ludvig

Charlee Ernest

Per Gustat Linar

Rutger Kjell Otto

Brlk Guetaf

Xrik Matte0 Procbrst


Toreten 3. son

Victor Hjalmr Hugo

1 professor

Fritz Gustaf

for.. . . o

Docente

Frans Vilhelm

David %dvard

Gen.Patho1. 9acteriology
     Hggie ne
Obstetrics, Gynecology

Anatomy

Physiology

Phsrmcol o sy

Pat hol .-Anatomy, Le gal

M di c ine

Pediatrics, ?ract.Nled,

Surgery

Wd. & Phys. Chemistry

Anatomy, Hit3tology d

Histogeny

Psychiatry

Pract. mdicine

0 ph tha lmlogy

Oto-Rhino-Laryngology

Anatomy

46

Lund

SO".- (continued)

+

BDLING

JXGVAR

LJUNGCREH

LIKDAU

HOJER

EiJCHOFF

ERGCYEN

BdsCical Faculty (continued)

Lars Bnrik August


Svem

Guataf Axel Carlason

Arvld Wllhelm

Johan Axel

Sture August

Sven Albert Henrlk


Sven Stuns

tkd. iiadiology

Neurology

Chenis try

Pathol .-Anatomy

Ryg ie ne

Bnatoniy

P hys i o logy

0 to-Rhino-Laryrgolpgy

47

     aeeearch in the medical science8 in Sweden, although it

encounters som difficulties which will be diminlsbd eventually,

la on tb whole a phase of mdical school work to which much attention

is given az?d which compares favourably in quality wlth what  is done

anywhere elm in the world. The great emphasis upon scientific

rssbarch which is explicitly stated in the regulations ror the  choice

of profemora, appears to have had a palpable effect. The Smde In

krnpemmnt is ratbr more likely to be slow, steady and late-rasturing

than are his colleagues further south in Surope. I had the impression

from most of those with whom.1 talk-ed that their Individual Interests

-re deep md permanent,

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

mlectlng professors which provides that all of the published work of

It mag be ueeful to no-8 that the problem of pu

1 ica

ion of

research work is met in a rather satisfactory way by the Karollnska

Inetitutet, which undertakes tb publications of the following journals:

Acta hbdica Scandlnavica
Acta Chirurgica Scandlnavica
Acta Oto-Laryngologlca
Ac ta De rnmt o-Vene re ologl ca
Acta Pe d ia tr ica
Acta Radiologica
Acta Gynscologtca

40

candidate for a professorship must be read by all of the mesbers

of tb selection cornittee.

Mileve it) a defini% effect upon the young Dozent who contemplates

gn academic career.   It makes him prefer to publish t&ugh, compact

ad careful papers, more probably upon related tkBIn38, 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

Sneden is within mderate linits and tbe quality of the papers, on

the whole, ie quite superior to those either In Frmce, Germany, Austria

or Italy.

This has, I was told, (arid I car: well

There is one characteristic phase of Scandincivian mdicine

which is worth recalling ic a consideration of reaearch work in Smden.

This is the fact that a wide-spread and, in my cases, thorough famil-

iarity with from ow to three other languages than Smdish,  is usually

lpbt nith, and consequently a pToiessor in Sweden is unusually well

inform,d regarding the literature or current activity in at least one

and f'mquently thme other countries than his owno

Proiessbr Barany, whose thorough familiarity with Viema in

m-mr tksa enable8 hin to make a comparison from a mre thorough
howledge than is usually possible, made the following comnts upon

-march and teaching in Sneden:-  The weparation for the practice
Or mdiCine is better done In Smden than anywhere in Austria or Cermny.

difficulties in research work am two, (and this referred =ore

OarticUarly to Upsala) .

There is much pmjudice sgainst animal

49

erperimntation.

physiology, Pharmacology, Alsdicine , Sur@ry and Pathology all suffer

rmm adequate accomodatlons for animal exmrimnts. Ths mcond

obetacle to research work lies in the fact +.hat the financial status

of the physician in Smden is 80 good that Ecientific work is less

attmctim as a career than, for example, in Germny where scientific

dietinction possesses not only intellectual but financiel recolcpense.

Barany further believes thet the mdical course In Swden is so long

that the tim of a m89 whose interests am special and crystallized

aomrhat early is wasted in getting the regular degree. hiy om

impression is that these difficulties are by no m9cs insuprable.

One hears occaaionally that so strong is the emphasis upon acientiflc

attaimnt a8 a qualification for prof'essorships, that good teachers

of only moderate research ability are again and again passed owr and

loat to tbe teaching force of the facultiee.

btlrs8timti-m work together with mager 8alarIeS for scientists, and

especially the younger scientists, appar to IE fo be more directly a
hindrance to wdical research in Sweden than any 7Lhar fci~?ors.

There is no place provided even to keep animls,

Inadequate Sudeets for

This

borne out by the universal ackncwledpmnt of thc fact that, if it

not for the Johann Anderssons Fond, inwstigitive work in Sweden

would be at a standstill.

HESEARCIi 3Y SUBJ"nCTS

I should like to present under the headings of diifemr,t

mdical disciplines the nams of En whom I mst or of whon: I heard

pat deal, indicating their special interests and such useful inform

ation as I wa8 able to obtain regarding them,

My impmssion is that

previous surveys have neglected this rmthod of recording impressions

mceiwd during visits.

I am furthemre inclined to think that this

information is perhapa of mre use for subsequent reference than almoat

any otbr single item that could be presented in a survey.

Anatomy and Embryology

Ivar BROW Born 1868. Professor at Lund since 1901, %specially

interested in Embryology. Has a collection of 100 human
ezlibryos down to 2-3 m. which he referred to as being
his life work and which is unfortunately not protected
against the risk of fire. Kis laboratory facilities
are rather limited, and the building is old. In add-
ition to hunran embryos 50 has a large collection of
specimne in comparative embryology. 3rom is a
friend of Moll acd Duesberg. Spcial interest: compar-
ative vertebrate embryology. Largest collection of
seal embryos In the world. S-yeaks %man and English.

Erik AGDUHR ,%rn 1886, Professor at Upsala since 1926. Agduhr is

professor of Anatow and has teaching responsibility also
for teaching of Histology and Bmbryo1og)T. At the present
tlm Agduhr's quarters am inadequate, bus the next build-
ing project in Upsala will include an extension and renov-
ation of' his quarters. Agduhr is one of the few examples
of a professor in the mdical raculty whose training has
been largely in the faculty of veterinary mdicine. This
gims him a wider point of vier In that he  is familiar mith
comparative anatomy, histology and embryology. He is
distinctly interested in experimental work, and has ybllshed
valuable papers 0x1 the histology of the nervous system.
Also ha8 dcne some interesting work on spparently toxic
substances in cod llwr oil. Speaks a little English
and Germn.

51

Hiatology

UIST. Born 1891. Professor at Stockholm In 1923. Speak6
    English and German.   Pupil of Holmgren and Fkomn.
    Pure mrphologiet.  Interested in histology of macles,
    Apparently no pupils and very little activity in the
    laboratory. Large collection from the tim of Retziua.

Gii*u BB""<

Phys i ologg

Thoreton Ludvig Born in 1873. Professor at Lund In 1905, Pupil of

worked much on the physiology of special senses,  but
Is now eepeciallg Interested in oxidation phenomna,
especially in Vieland's hypothesia, and the mthylin-
blue test, Englieh and German,

THLJNB3AC Hamumsten and Holmgmn. An excellent teacbr. Has

Gurtaf Fredrlk Born 1874, Professor at Upsala in 1918. Has do-

COTXLXN

accurate and mry carefully controlled work on ths
physiology of vision with instruments designed by him-
s&llf. The Udical Board of Smden recently entrusted
to Gothlin the study of Vitamin C. In h'orthern wild
berries, aa a possible control for certain nutritional
diaordsre in Northern Sweden. G. has two or three
excellent assistants and though the building that he
is in was erected in 1886, the laboratory gives an
impression of orderly, carefil and intelligent manage-
mnt. G. 8peakS English and German.

Pharmacology

Charlea Ernes
OVBEITON

t Born 1865. Professor at Lund in 1907, Speaks Cemn

and Englisho An Xnglishnrsn by birth, long a pupil of
von my. Retiring in two pars. Studied intensively
for the paat ten or fif'teen years the role of different
eaters In producing narcosis. He has a curioua failing
of finding publications almoet imposeibly difficult.
Posaesse s voluminous notes on extraordinarily long aeries
of experimsnts, Has uaed a large part of his budget for
the purchase of esters of maker acids. FB does not
wish either assistants or etudenta.

Born 1863, Professor at Upsala - 1925. Gccupies very
cramped quarters but  is much devoted to a group of 10
or 15 "Csndidates" 5.6. mn still in their clinical
years, to which he assigns short problems which are done
under his close superviaion. The State budget is such
as to cover only light and heating of his small labor-
atory. He obtains from the Johann Anderasons Fond the
rest of his budget for his work. He is hard-working
and unselfish towards these younger mn. Probably a
valuable man for students in their earlier years of
investigative work.  Not equipped for advanced atudents.

52

Phamcology (continued)

~;6nn Lil jeatrand

Born In 1886. Professor at Stockholm - 1927. Labor-
atory entirely inadequate for receiving other workers.
Principally a question of spxe.
Secretary or the Nobel prize Codttee ad is conse-
quently very familiar wlth msdical science in many
countries. Give8 me the impression that the llledical
sciences in the Karollnaka Institutet are isolated and
depressed. Speaks German and English and, I believe,
French.

Liljestrand is

ginar mRSC&N _- Born in 1889. Proiessor in Stockholm - 1028. Pharma-

cologg is hem combined with Chemistry. HanmBrston's
quarters badly omrcrowded but extmmly busy.
like Liljeetrand is a capable scientist working under
great difficulties. Gives m tb impression of being
seriously ill
cardiatis). Speaka Englieh and German.

B.

(I -8 later told that he had endo-

Erik WlDUEiK Born in 1889. Prof'eaaor in 1920 (at Lund). Has
            excellent quarters in new building. The youngest
            professor at Lund, capable and willing to receiw3
            advanced atudenta, Successor of Rang, pupil of
            Thunberg. Speaks Bngliah and Gemn. Intereated
            in alcohol absorption and micro-m thoda for detection
            of alcohol in blood. Budst about 9,000 Kronen -
            3,000 from State, 3,000 supplemsntary Prom State and
            3,000 from laboratory fees.

Pathological Anatomy

cu star s JOVU . Born in 1879. Professor at Lund in 1914. Abaent

durlng my visit. Laboratory fairly active. Excellent
assistant (Lindau). (For description of' laboratory 888
"b%thods and Problems").

Eild% B&mTRBND Sorn in 1886. Profeseor at Stockholm in 1924. Speaks

English and Germ, Interested in isolation of bacte-
riophage by high power centrifuw, Studied with Ross
Harrison in New Haven. Friend of Fahreiis and Gunnar
Holmgren. Active and ambitious. Not possessing,
homver, very good facilities for advanced work at

pre-nt.

53

Pathological Anatomy (continued)

Folks HENSCHBN Born in 1881. Profbasor at Stockholm in 1920. Speaks
                      Quarters at the Karolinska Insti-

French and GeZpBn,
tutat; building are too small. Not a large mount
of pathological material.   Henschsn is a great admirer
of Danea. Xapecially interested in blood-forming organs
and in comparative pathology.

General Patholouy

Mae;aue FOIWMAN Born 1868. Profbasor at Lund in 1900. The senior

professor at Lund.
logy, Director of a hospital and the leading figure
in Lund.

Especially intereeted in bacterio-

Was unfortunately ill at the tim of my visit.

Robin Sanno Born 1888. Professor in 1928 (Up8ala). There is no
           professor in pathological anatomy at the present ti-,
          only an assistant professor with the Swedish title of
           Laborator, whose nam is Wilbslm Birger BOSBUS, eo
           that to F, falls the responsibility of leading in the
           general field of Pathology at Upmla. F. haa distin-
           guiahed himeelf as being tb  first to call attention to
           tbe phenonsna of eedixmntation of red blood corpuecles
            in diffbrent diaeaees and in different animls.   Very
          fawurable impression, in addition to tha uncommonly high
           commndation from -vera1 people in Lund and SDockholm,
          including Foreell. Pahreus had a atipend from the
          Johann Andereeon Fond of 19,000 Kronen a year,  before
          corafnn to Upsala. Bs now has 12,000. "ries to do
           what he can privately with tieeue diagnosis from

agaRasus

pmC tis ing PhyS iC 1-8 o

Bac te r io loa

Amid L-U Born 1892, Dozent in 1926 (Lund). Speaks English and

German, Pupil of Sjovall and Forsenan. Studied rith
Aschoff.  Highly reconmended by Harvey Cushing for his
work on cerebral angiomata.   Is to work in 1930 with
Madsen in Copenhagen. Intereated ale0 in other forma
of brain tumors and in bacteriology.  A very probable
candida- to succeed Foraeman rho retires in five years.

Carl A. MING

Born 1879,
At present Chief or the Statu Bacteriolbgical Laboratory.
(Stockholm).
numBrow 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 Zdedin. Has collaborated
with Levaditi on polyomyelitis.

Domnt in Serology and Tmnnlnologg In 1919.

I did not meet Kling but heard from

Internal bbdicine

INGVAFi Born 1889. Dozent In 1925, Spak8 English and Germinn

Pupil of Karl PetGn, Harrison of New Haven, Brouwer
and Kappra of Amsterdam.
Jong. Espcially interested in neurological onto-
gene tics in neuro-pathology especially of mid-brain
and in the meningitis phenomena of Zoster and Tabes.
Is substituting as the  chief of the medical clinic
until tb selection of Professor Pet&n*a successor,
He is the leading candidate for this position. Ingvar
is definitely interested in research In connection with
clinical pmblema,

KmW6 Stanley Cobb and de

GU8taf ERGiARK Born 1881. Professor at Upsala in 1921. I did not

have the impression that B. was particularly actim in

investigative rork, nor that hs waa, in general, quite
equal to so= of his othsr colleague8 In Upsalao

18r-i HOLMGRBN 30rn l87l. Professor at Stockholm in 1913. Speaks

English, German and French. Interested in tuberculosis
therapy and in surgical problemso suite faxlllar with
foreign msdical practice. Birch-Lindgren finds him
progressive and original but probably vary obstinate,
My inpression was that he was quite isolated at the
present time in the Karolinska Instituht, and certainly
not cloee to either Forsell of Key, but good critical
judgement and independento

bJ,C, JACOBhEuS Born 1879, Professor at Stockholm in 1916. Sspecislly

interested in chest dieeasae. Has devised a mthod of
cutting pleural adhesions through trocars as a part of
pneumo-thorax treatment. Speaks English, ,French and
German.

Surgery

Mrn 1877, Professor at Upsala 1921. Pupil of
Lenander. Worked also for a year at the hhyo Clinic
in 1905.
Has a new surgical clinic built in 1923, beautlf'ullg
built and mintained. Is younger than his year8
indicate, and apparently occupiea a position of consider-
able Importance in the University. Is Director of the
University hospifal. N. would be, I think, the best
adviser on surgical matters in Sweden. Ie intereated
in experiwntal work and his university position gives
him a better opportunity to follow and direct research
work than is the case with moat of the mn in Stockholm.

Speaks excellent English as well a8 Germin.

55

Surgery (cont `d)

Born 1872. Profeseor in 1923 (Stockholm), Speaks
English and Cemnan. Intereeted in renal surgery and
surgery or blood vesaels, ala0 in thoraco-plasticeo
Director of the Uriasjukhus.
conatruction and managemnt . Birch-Lindgren thinks
that in this he is intensely conservativ8. Had
Augustue Thorndike of Boston as pupil in about 1926,
Not ideal circumtan'ces for surgical investigative
work or advanced teaching. For this, perhaps, I
would prefbr NystSm at Upsala,

Interested in hospital

p. H. OLNECRW Born 1891. Dozent 1924 (Stockholm). Interested In
            brain surgery for which he has a small section of 12
             beds at the Serafimrlazarett, Very little teaching
            but excellent recorda of his cases, for the mainten-
             ance of which he receives grant8 from the Johann
              Bnders8one Fond.

Speaks English and German.

Obstetrics and Gymcology

Gu8taf ESSEN=MOILBR Born 1670. Professor in 1901 (Luna), Speaks

English. Garman and French. Friend of Hirat in

John Olof OLOW

dnrtrica-and of Ganmltoft.
and operator. I did not see much of hie investigatiw
work, but teaching of Obstetrics seemd very re11 done,

Born 1883. Pmfesaor in 1923 (Upsala), Olow epeaks
German and Engliah. Has one of ths older buildings
in the University hospital - not particularly active
in research work, but intelligent and we11 inforxwd.

A good administrator

100 bed8 - 53 for Ob8tetriceo

Ophthalmology

Born 1876. Professor in 1928 (Luna). His long psriod
as dozent without assistance for investigative work,
together with the fact that the Ophthalmological section
of the hospital at Lund is in the oldeet of the build-
ings (00 beds) diminishes the significance of his work
on the side of medical research. He has not, as far
ae I could see, any special intemste which he is pur-
euing 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 Smden.
Ne11 informd upon mdical education and public health
both in Smden and out of it, Has independent incom

56

Ophthalmolo~ ( cont `a)

(ct'd)

which enables him to travel and keep in touch with

many individuals. Ia tb successor of Zullstrand.
Hae clear and sound ideas upon the importance of
investigative work as applied to clinical ophthalno-
logy. Speaks excellent English, !Xrm and French.

Pediatrics

Gm ai HLgRCgER Born 1871. Professor in 1916 (Lucd). Has an excel-

lent hospital, Is said to be extremly well read and
posaessing very good judgement of men. Dms not
speak English; excellent German. Interested in Bio-
cbsmistry.

&der8 Ivar
THORLING

j3orn 1878. Professor in 1923 (Upsala). No surgery
or orthopdics, Takes premature deliwries and
weaklings directly from the Obstetrical Departmnt.
60 beds, 1500 new Out-Patient 38_mrtment cases a year.

Not much investigative work. Yalnutrition cases are
very ram.

Speaks English and German.

Born 1867, Professor in 1914 (Stockholm). Interested
in rickets, scarlet fever and, more especially of late,
psychiatry as applied to childmen, Speaks English,
French and G8rman. 85 bed-hospital "Allm.i3arnbusetR
of which he Is chier. Good judgemnt and well inform-
ed. :Jot actively at work in research at present.

Hygiene and Public IGealth

JOhana Am1 HOJER 30rn 1890. Dozent in 1924 (Lund). Pupil of Petsrsson

in Stockholm. Especially interested in goiter. His
studiea in Sweden In this connection do not seem to
implicate iodine deficiency. Speaks English Rnd
German.

had WIRGIN

Born 1866. Professor In 1914 (C`psala). One of the
two pof'essors of Hygiene in Sweden, since them is
only a Dozent in this subject at the University of
Lund. Ey impressian would be that he is more
intereeted In Iiygiena, as the term is understood
generally, than in Bacteriology or Serology.
atory not larpe, nor are facilities for work in
Hygiene comiderable. W. speaks gnglish and Germen
and som Frenoh. Ha is certainly the best adviaer on
teaching of Hygiene in Sweden.

57

Hygiene. & Public Health (cont 'd)

Patrik HAGLUNI

Hugo Fredrik
umu

%rn 1867. Professor in 1919 (Stockholm). Almst
exclusively interested in 3acteriology and Serology,
Very poorly informed 03 the subject of what  in most
countries Is considered Hygiene and Public Health.
He ia teacher of C..A. Kling who is very highly
regarded in Sweden. %tiring in 1932. Rot much
investigative work being produced at present.
Speaks German.

Orthopedics

Brn 1870. Professor in 1913 (Stockholm). Very
little research work going on. Internsting hospital
in that it is really a combination of hospital and
trade-school and "factory" providing employment to
a large number of cripples under observation and
treatmnt. Inadequate facilities for advanced
students. Speaks English and Germ.

Born 1884. Title of LaSorator (Associate Professor)
Upaala, in 1927. Does not speak English; good German.
Excellent X-ray departmnt. Original and stimulating
peraono Has a first aseiatent and one arnanuens.
About 30,000 plates a year. L. very highly thought
of in Sweden.

Born 1876. Professor in 1916 (Stockholm). Excellent
English, German and probably French. Exceptionally
able and nsll informd. The most authoritative figure
in Smdish medicine. Cirector of tha 9adiumhemmt and
of the Roentgenological Institute of the Serafimr-
lazamtt. Xember of the h!edlcinalstyrelsen.

Ear, Nose and Throat

HOWFEN 90n 1875. Professor In 1912 (Stockholm). New and
       mmarkably well organized clinic at Sabbatsberg Hosp,
       50,000 vlsite 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
             mre facilities than direction or fragestellung.
        Speaks English and Germano

per mmik Nils 3om in 1879, Dozent in 1920, Is Chief of

SJOE~~ Service at the Upsala Asylum. Intereeted espcially

jn abnorrral psychology. The importance attached to
Psychiatry as a subject does not appear to be  wry
great in Sweden, and it my be due to this fact that
Sjobring gives ths impression of being somrhaf in

that he had to pack the instruction in Psychiatry
Into 17 lectures owr a two mnth period. With
large adminiatratlw responsibilities there is not
a very great inveetigatiw activity in this departmnt.

eclipse. He has a 1200 bed-hospital. Told m

59

SUPPORT AND EQUIPhEhT OF =SEARCH

     As in many other countries, th =gular budget for Institutes

or clinic8 for the maintenance of their regular work has failed to keep

up with the increased costa of animals, material, etc., so that, from

tb standpoint of the professors, the State budgets for their work am

sntimly inadequate. There ia unanimous agrtremnt that, If it mm

not ror the Anderaaone Fond, they would be unable to do any Lnnsstlgat-

in, work, Bin- the budgets would be entirely consumsd in light, heating

and routills expenses of student instruction,

The THEmsB AND JOHANN BNERSONS MIN'NI! (Foundation) was founded

in 1922.

Kronen annually, This money cannot be used for buildings. It is

Q6ignsd for spcific research expenses on preeentation by the  invest-

igator or a plan of hie research together with a mqquest for aselstance.

It is not limited strictly to the medical faculty.

-brier1 or for stipends,

Its capital is 5,621,000 Kronen which provide about 250,000

It can be used for

There is no limit fixed to the amount allowed

for any given undertaking.
blinaka/Institutet in Stockholm - the mmbership of the committee

Changing iron! year to year.
It has proved an extremsly useful support to research work and I ma8
atruck by the tm or commnt =de throughout Sneden upon its sigmicmm,
she it was usual to hear some such remark as:
hak to select theme or individuals Imo will contribute greatly to
~~gr%ss in medicine, but the committee of the Anderssona Fond have

Allotmnts are made by a committee of the

Tbere are no permanent officers or trustees.

"It is not an easy

I

60

beon as viae and careful as we could desire, and w could not do

better in their place."

Anotbr 8ourc8 of occasional support for msearch work is

ths Medical Board of Sweden (&Bdfcinalstyrelsen) which, as in the

instace of Profbeeor Gothlln in Ugeala, subeidizes lnveatigitive

work by certain profeesors on spclfic problems upon which tbe Mdical

%erd wiehes work done.  This ad hoc type of research work is acceBt-

able in many aa86e since the choice or inmatigator is largely deter-

Eined by previous knowledge of his lntereets and qualifications;  the

difficulty, of Cour8e. is that such support as this is not for an

indefinite period nor under elastic and easily adjustable conditions.

51

HOSPITALS

The Slredish ho8pital organization is predominantly official

ad gowrhmntal, which i8 shorn by tbe laat official computation (1927)

to the effect that 46,625 bed6 belong-to official hospital inetitutiona,

while private hospital8 had an accomodation of only 3,300 beds.

ing in many ua#i8 with a fer gomwnm9ntal hospitals, the demlopmnt in

start-

Swoden has been first in the multiplication Or provincial and later of

dlrrtriot hospitals. The provincial hospital8 (there are 25 provinces

in Sweden) am on the whole the predominating institutions although the

six large8t tome have nmrow hospital accomdatfons which,  in ths

cam of Stockholm and G'dteborg, are the most important in the country.

In spite of tbe rslativsly small importance or ths private hospitals,

thszw are three important epheres when private aaaociations haw taken

upon tbmselma very Important tasks.   These are the care of cripples,

the treatment of tuberculoeie and radio-therapy. In all thme or these

fields, private agenciee have been greatly helped by literal and highly

rfrectim governroant cooperation in the transport of patients; ror

example, it ie possible for a patient in any part of Piweden to have his

railroad fee and even the fbe of a friend or attendant paid to Stockholm

and laturn in-conneotion with his visit8 to the Radiumbmrmet. It is

noteworthy that the number of hospital kds in Sweden has almost aoubled

during tba past trenty yeare.

The suprem jurisdiction over the

official h~spitals 2~8tS with tha State mdical Bard.

16 mceaeary ror all new buildinge or enlargements of buildings.

Its approval

Hospital

62

suprlntendents throughout the official institutions are appointed by

tb gowrhnt. ASSiStEnt medical officials in the hospitals are

appointeb by tbe State Medical Board,  at the recommendation of the

Board of managera of the hospital in question. The nursing personnel

i8 engaed and dlsrniseed by the hospital superintendent,  but the State

Wdical Board mintsins inspectore +a control the general level of

nursing and treatmsnt in the hospltale. Be8 in the provfncial

hoepitale are laid down by the 3rovincial legislaturea (Landsting),

and are therefore not uniform, Only one group of' patients, namly

venereal patients in the infectious stage, are given, if it ie necessary,

hoepital treatmsnt free of charge, The average fee in 1927 of tb

provincial hospitals, in thfa @leneral wards, was 1,75 Kmmn per day.

The lorrest me 1 Krone, and the higheat 5 Kronetn.

ward8 of 2-4 patient8 for a room,  the charges varied betmen 5 and 6

Kronen. In the wholly private wards charges =re betmen 7 and 10

grOneno These charges include all necessary nuraing and the patient

is not called upon to pay any fee to the nsdical of'ficer for the

treatment mce iwd

In the semi-private

TW egneral authority over the medical profeeelon is

emrcised by the State Bdical Board, called the Bbsdicinal-Stpelaen,

co~istine; of the Chairman and five mmbers, four of whom must be

PhY~loIaas and one veterinariano

63

NURSES

The general impression received of nursing in Sweden is

excellent. The womn appeared to haw corn from very good families.

TM number of older nurses is somwhat higher, one would suppose,  than

in Bmerica, and the type of work entrusted to the nurses is such as to

make their cooperation an Important elemnt of medical care.

I visited the Nurses Training School in Lund.

The matron

was a wry superior prson, a mmber of a titled family,

Uaehtmiater. The course last8 for tm years, and the teaching force

consists of the Matron, one Sister-Tutor, and three assistant Sister-

TutorB.   A Ly&e preparation is required for entrance, and the candi-

date8 must be betmen 20 and 27 years old. They pay for the two years

course. It is usual lor thsm to stay for a third par, during which

time they are paid by the hospital,, The course begins with a two

mnths practical course In the wards, accompanied by lectures and

practical demonstrations, A report is then made upon every student,

and tho- conaidered unsuitable are eliminated. Then follows a year

a8 probationer. Each ward le under an experienced bad nurse.

Lady ElizaSeth

     zrbe nursing home was a beautiful building and contained both

a Class-mom and a room ror practical emrciaes, including cooking and

diet premration.

wachtmister has filled the building with beautiful furniture belonging
to her own family, and the effect wa~ superior to any nurses' home that

1 ham emr visited.

In Upsala, for a Pediatric ward of 24 Fatlent8 them was one

Each bedroom Wa8 for two pupil nur88B.

64

hPad nwm, SIX nurses in training and one mid. The increasing

nunibr of provinci&l and cottags hospitals cmate~e a satisfactory

demand for nurses nor being tkinedo   It la psrhapa ueef'ul to note

in this conmction that in Lund thsre is a special Institute for the

training or miaseucms. This institute is aprt fromthe mdical

faculty or the hospital administration, althou$h it works la excellent

cooperation wlth both the professors and the nursing force  or the

hoegitals.

and le under the combinsd direction of Kajor Thulln, Director of

Gylwastics in ths Smdiah Amy, and tbe chief of the Orthopedic Clinic,

Dr. Prising, of the Unimreity. Ths girls are received at the ageJ

of 18 to 20, and spend two year8 In theoretical study of Anatomy and

Physiology, together with a large amount of physical training and

caref'ully supervised learning of maaaage, pes1m exercises, etc.

Thy are admitted togpther with their teachera on the nards of the

It is entitled the "Sydsveneka Gymnastik Institutetw,

hospital, and learn not only how to do maasage, but in what types of

cams masage or passive exercise is indiuated, and exactly what the

llmltations of this form of treatmnt are.

=re inylligent appreciation of the earvices of physical therapy

than is realized at this institute in Lundo

I have seen nowhere a

DISTRIXTION OF DOCTORS

At the end of 1920 there mre 1715 practising phyeicians

in Sweden, distributed a8 follows:

24 Departmental Health Off icers ,

336 Provlncial Msdical Offfcers (ordinary and special)

187 Doctore in Cities, Toms and Urban Districts,

84 Tuberculosis Hospital Mdical Officers,

357 Ceneral Hospital Wdical Officers,

63 Inaane Asylum Doctors,

39 Prieon Doctors,

121Doctors In the Mbistry of Communications,

122 Profeerrore in tbe mdical Schools,

402 exclusively in private practice.

Distrdet Physicians, Hospital Physicians and Bdical School

PmiBsaore must retire at 65.   Than ie at present som over-production
of doctors in Sweden, the number of graduates per par being between 110

and 150.  Tbe number required to renew the present number of practi-
tioners In'SIcrden would be more nearly 110,   At any mite it is very

hard now for young graduates to find places.   Tbre is virtually no
emigration. Uoat of the provincial mdical officers are in private
Practice st the sum tim, receiving from 3-4,000 Kronen from the
governmmt and from 10-20,OOO Kronen from practics.

There is no

66

marked limitation geographically for the graduates of Cpsala, Lund
or Stockholm, although, in general, the Northern part of Saeden is
supplied from Stockholm and more particularly Upsala, ahemas the

Southern provinces are supplied by mn largely from Lund and in part

from Stockholm,

67

Rg C 0 bi K$& D AT IO N S

I should recormoend that :

1) The present policy of foreign fellowships in mdicine,

for young Smdish doctors of mdicim, be continued and that

this program be explicitly stated to the authorities of the

two facultiee and the Karolinska Institute.

2) That contact be mintained in the future so that

possible reeearch meds of Profbasor Forsell*s Radiumhs-t

and of the pre-clinical branches In Stockholm and Upsala may

be thoroughly familiar to the officsrs of the bbdical Sciences.

It is at present impossible to advocate definite action in any

of them fields since much depends upon the action of tkie

Rigsdag in February - krch 1930,

3) It seems reasonable to obaerm that mdical education

in Sweden ia well-balanced, advanced in its orientation and

effective both in ita influence upon the practice of medicine

and the aide of research.