Examination performances of German and international medical students in the preclinical studying-term--a descriptive study.

INTRODUCTION: Medical students with a migration background face several specific problems during their studies. International surveys show first indications that this group of students performs worse in written, oral or practical exams. However, so far, nothing is known about the performance of international students in written pre-clinical tests as well as in pre-clinical State Examinations for German-speaking countries. METHOD: A descriptive, retrospective analysis of the exam performances of medical students in the pre-clinical part of their studies was conducted at the Faculty of Medicine of Heidelberg in for the year 2012. Performance in written tests of the final exams in the second (N=276), third (N=292) and fourth semester (N=285) were compared between German students, students from EU countries and students from non-EU countries. Same comparison was drawn for the performance in the oral exam of the First State Examination in the period from 2009 - 2012 (N=1137). RESULTS: German students performed significantly better than students with a non-EU migration background both in all written exams and in the oral State Examination (all p<.05). The performance of students with an EU migration background was significantly better than that of students with a non-EU background in the written exam at the end of the third and fourth semester (p<.05). Furthermore, German students completed the oral exam of the First State Examination significantly earlier than students with a non-EU migration background (<.01). DISCUSSION: Due to its poorer performance in written and oral examinations and its simultaneously longer duration of study, the group of non-German medical students with a country of origin outside of the European Union has to be seen as a high-risk group among students with a migration background. For this group, there is an urgent need for early support to prepare for written and oral examinations.

[Historical aspects concerning the symptom of itch in the German-speaking region (1850-1939)]. / Medizinhistorische Aspekte zum Symptom "Pruritus" im deutschsprachigem Raum (1850-1939).

Since the establishment of dermatology as an independent discipline of medicine in the middle of the 19th century, pruritus or itch has been a subject of research. The goals were to discover the etiology of pruritus, to develop useful therapies and to achieve a classification within the system of skin diseases. Looking at historical aspects of pruritus demonstrates just how difficult it has been to approach this problem. The difficulties even influence present day pruritus research. For example, there is no definite international standard of pruritus. Etiology-oriented classifications have dominated, but have recently been supplemented by a clinical classification.

[About Itching and scabies. Pruritus in medical history--from ancient world to the French revolution]. / Uber Jucken und Krätze. Pruritus im Lauf der Medizingeschichte--von der Antike bis zur Französischen Revolution.

Pruritus (itching) as a disease state and especially as a disease symptom has been object of medical and scientific descriptions and examinations in all epochs since the antiquity and in different cultural periods. Antiquity was dominated by observations and descriptions but during the course of medical history and particularly since the establishment of dermatology, more and more emphasis has been placed on classification and etiologic research.

[Victims of Nazi euthanasia, the so-called T4 action. First results of a project at the German Federal Archives to disclose records of killed patients]. / Die Opfer der nationalsozialistischen "Euthanasie-Aktion T4"Erste Ergebnisse eines Projektes zur Erschliessung von Krankenakten getöteter Patienten im Bundesarchiv Berlin.

In 1990, previously unknown documents dated from the Nazi era were found in Berlin. They had been preserved in the central archives of the Ministry for State Security (MfS), the secret service of the now former German Democratic Republic (GDR). Nearly 30,000 psychiatric patient files turned out to comprise the smaller part of the records of patients who had been murdered in the 1940/41 "T4 action". More than 70,000 patients of psychiatric asylums were killed by gas in this first campaign of extermination during Nazism, and their files were believed to have been lost. Based on a project to be funded by the German Research Association, this paper offers a brief survey of the developments in historical research about Nazi "euthanasia" and the theories interpreting historical information. The paper will also present a research project dedicated to the memory of the victims of the "T4 action" and to the rediscovered files now conserved in the German Federal Archives in Berlin. The aim is to offer a systematic analysis of 3,000 records in an effort to contribute to the perception of the victims as individuals. The analysis will also include an examination of the selection criteria stipulated by the Nazi psychiatrists (hereditary illness, incurability, and incapacity to work productively) to select patients for extermination. In this way, the decision-making process, criteria, and motives that led to the killing should become more clear. This empirical analysis will help to answer questions concerning the proportion of eugenic and economic motivations and the Nazi rationale behind the extermination campaigns. The project will build upon an earlier preliminary study of a nonrepresentative sample of 185 files. As a preliminary result, it can be said that most of the victims had been hospitalised over long terms and classified as schizophrenic or feeble-minded. A third of the patients killed were considered invalid and not working, and almost 50% were described as working "mechanically". Five per cent of the victims were working "productively".

[Motivation or burden?--Illness and health in the elderly from the historical perspective]. / Lust oder Last?--Alterskrankheit und Altersgesundheit in historischer Perspektive.

Medical theories and practices concerning illness and health in old age as well as several aspects of society that do influence the aging process are described from a historical perspective integrating classical antiquity, middle ages, and modern times. From the present state of research it is distinguished between "primary illnesses in old age" and chronical diseases which might principally also begin in younger ages but take a different course in old age. Even if the frequency of disease and multimorbidity is increasing, negative stereotypes of the aging process have to be invalidated. Advances in medical sciences are a good pre-condition for increasing physical and mental health in old age.

Malaria and World War II: German malaria experiments 1939-45.

The epidemiological and pharmacological fight against malaria and German malaria research during the Nazi dictatorship were completely under the spell of war. The Oberkommando des Heeres (German supreme command of the army) suffered the bitter experience of unexpected high losses caused by malaria especially at the Greek front (Metaxes line) but also in southern Russia and in the Ukraine. Hastily raised anti-malaria units tried to teach soldiers how to use the synthetic malaria drugs (Plasmochine, Atebrine) properly. Overdoses of these drugs were numerous during the first half of the war whereas in the second half it soon became clear that it would not be possible to support the army due to insufficient quantities of plasmochine and atebrine. During both running fights and troop withdrawals at all southern and southeastern fronts there was hardly any malaria prophylaxis or treatment. After war and captivity many soldiers returned home to endure heavy malaria attacks. In German industrial (Bayer, IG-Farben) and military malaria laboratories of the Heeres-Sanitäts-Akademie (Army Medical Academy) the situation was characterised by a hasty search for proper dosages of anti-malaria drugs, adequate mechanical and chemical prophylaxis (Petroleum, DDT, and other insecticides) as well as an anti-malaria vaccine. Most importantly, large scale research for proper atebrine and plasmochine dosages was conducted in German concentration camps and mental homes. In Dachau Professor Claus Schilling tested synthetic malaria drugs and injected helpless prisoners with high and sometimes lethal doses. Since the 1920s he had been furiously looking for an anti-malaria vaccine in Italian mental homes and from 1939 he continued his experiments in Dachau. Similar experiments were also performed in Buchenwald and in a psychiatric clinic in Thuringia, where Professor Gerhard Rose tested malaria drugs with mentally ill Russian prisoners of war. Schilling was put to death for his criminal research in 1946, Rose was condemned to lifelong imprisonment in 1947, though, not for his malaria research but for his dreadful experiments with epidemic typhus sera which he also had performed in concentration camps and with prisoners of war in Russia.

Malaria and colonialism in the German colonies New Guinea and the Cameroons. Research, control, thoughts of eradication.

German malaria research during the colonial period took place between medical and political interests. In the field of zoological and clinical research of malaria Germany was not a pioneer. Nevertheless, Robert Koch forced by impressive Italian results tried to participate in malaria research on the field of acquired malaria immunity and by optimizing the therapeutic doses of quinine in German New Guinea. In the German Cameroons, on the other hand, the fight against malaria was completely dominated by racial and political arguments. The paper tries to shed light on this dichotomy, which turned out to be not very productive.

[Not Available]. / "Und setzet eure Worte nicht auf schrauben." Medizinische semiotik vom ende des 18. bis zum Beginn des 20. Jahrhunderts - Gegenstand und Forschung.

There is no doubt that medical semiotics are having a revival at the moment. Different aspects of yesterday's and today's interest in semiotics and in the historical interpretation of signs of disease in the context of theory and history of medicine can be illuminated: their deciphering as the history of the sign in medicine by historic science, their overestimation by philosophy during the Age of Enlightenment, their reduction to a phenomenology of medicine and natural science during the first half of the 19th century and their transformation to medical diagnostics since the middle of the 19th century and recently even their functionalization as methodical instrument within the history of science. The following will show the change in meaning of medical semiotics. Modern development and especially the transition to medicine, based on natural science, will be emphasized.