[Doctor and death]. / Arzt und Tod.

Doctors are instilled with the need to avert and repress death. By virtue of their profession, death is considered the enemy, their mortal enemy. In modern-day hospitals in particular there is a tendency to reduce the mystery of death to a biological and technical algorithm. A critical revision of fundamental medical conduct is underway as a compensatory countercurrent to this age-old way of thinking and acting. This shift in attitudes involves a humane concept of the physician. His task is not limited to healing and reconstruction, but sometimes merely requires discriminatory restriction to palliation and accompaniment. Ever more physicians are becoming aware of the fact that they are equally responsible for the quality of dying. In coping with death, ethical imperatives are effectively juxtaposed against technical ones. Educational deficits relating to care of the terminally ill and dying have been recognized and are being rectified. This major ideational revision has led to concrete signs of turnaround which are blazing the trail toward more humane and dignified dying: palliation, adapted in accordance with modern science, is experiencing a renaissance. The essential features of a comprehensive palliative therapy are outlined. Assistance during dying (accompanying the dying, passive euthanasia) is contrasted with assistance to die (active euthanasia).

[Successful aging]. / Gelingendes Alter.

Age: an annoying burden or a priceless gain? The ancient physicians differentiated between senium and senectus to describe old age. In modern-day terminology, the former corresponds to the deficit model, the latter to the competence model of old age. Its success or failure is dependent on biological, psychological, social and mental determinants. In the first part, these four determinants will be compared from the perspectives of competence and deficit, success and failure. The second part will outline selected meaningful aspects of the art of living that are relevant for successful ageing, namely, an awareness for the transient nature of life, attention to life, conciliation with oneself, F. Nietzsche's higher state of health, attention to god and humor.

[Mental image of the human being and of the physician in future-oriented medicine]. / Das Menschenbild und Arztbild einer zukunftsfähigen Medizin.

Modern medicine owes its impressive successes to the predominantly mechanistic picture of the human being and the prevailing idea of the physician as a health technician. Neglects of modern medicine, however, are also founded on this one-sided, incomplete sight of the human. A future medicine, able to survive and to answer human needs, has to follow the call of the complementary and has to correct its bias by a four-fold development: by forging links between scientific-technical intelligence and humanities and human culture, by mutual approach between academic and complementary medicine, by a respectful attitude, and by recalling the complementary reality of physicians as experts and partners.

[Greatness and hazards of medicine]. / Grösse und Gefährdung der Medizin.

A critical and constructive discussion of the Janus-face of modern medicine is presented. Its image of the human being and of the physician are viewed as a source of grandeur as well as a threat. After sidelights on the grandeur of modern medicine and its impressive advances, attention is focused on the threats hanging over it: the predominance of patriarchal norms with corresponding neglect of matriarchal paradigms, headlong technologic progress with atrophy of the spiritual dimension, and the dangers of inflated knowledge and specialization. Finally, an attempt is made to look ahead to a humane future medicine which has evolved in three ways: a bridge has been thrown between the scientifico-technologic and spiritual culture; it has broadened its present predominantly pathogenetic view into a restorative view, and it has also broadened the image of the physician.

[The other heart--pictures and thoughts for a farewell]. / Das andere Herz--Bilder und Gedanken zum Abschied.

This is an attempt to draw attention to the demanding and complementary reality of modern medical doctors by confronting cardiology and cordiology (symbolism and mythology of the heart). After a survey of the symbolic and mythological world of the heart, the question of compatibility between the apparently opposing poles of cardiologic curative technology and cardiologic emotionalism is posed. With respect to a comprehensive medicine of tomorrow, it is crucial whether modern doctors will be capable of a two-fold synthesis, namely the harmonious interaction between a rational basic position (raison de la mathématique) and an emotional standpoint (raison du coeur) and the increasing harmony of male and female norms.

[Bridge between scientific medicine and complementary medicine--utopia?]. / Brückenschlag zwischen naturwissenschaftlicher Medizin und Komplementärmedizin--eine Utopie?

In this keynote presentation on a complex and controversial subject, I attempt to answer the following questions: 1. What is scientific medicine, what is alternative medicine? 2. Why is there in our days an increasing trend in the population towards concepts and methods of alternative (complementary) medicine? 3. Why are many scientific physicians defensive, sceptical and opposed to alternative medicine? 4. Are traditional and alternative medicine fundamentally irreconcilable worlds? The author believes that complementary medicine is beneficial and justified especially in private practice, above all in the many patients suffering from psychosomatic, psychovegetative, neurotic, depressive, functional disorders, with feelings of ill-health and often with marked subjective symptoms but in which no severe organic disease is present. In these types of patients alternative methods are often 'more gentle' and cost-effective. The doctor's personality, his empathy, his willingness to communicate are decisive factors for their effectiveness. Certain methods of complementary medicine should be increasingly integrated into our hospitals and be learnt and critically assessed locally by the scientific physicians. Scientific medicine is and remains the indispensable solid foundation for correctly indicating the use of alternative therapeutic methods.

[Picture of Paracelsus, the physician--and we today]. / Das Arztbild des Paracelsus--und wir heute.

This article features the question whether Paracelsus and his dark, sometimes contradictory doctrine still includes some messages for modern physician. The lonely, pugnacious fighter from Central Switzerland remains today 'confused between favour and hatred from the parties'. Some contradictory examples shall outline controversies lasting for centuries. Subsequently Paracelsus' picture of nature, man and medicine is outlined, particular his meaning of nature and work of a good physician, but also his furious often unjustified overwhelming criticism about those physicians who went astray "in the labyrinthus medicorum". Sheep-physicians and wolf-physicians are confronted mercilessly and in a black and white scheme by this Lutherus medicorum. This likewise strange as well as also fascinating picture of a physician by this man of Hohenheim does not imply a clearly conceived temple inviting for an easy academic stroll. The sketch of a temple, however, serves as a symbol for the paracelsic science of healing: Philosophy, astronomy and alchemy are the three columns for the physician. These three columns are founded on virtue, the ethos of the physician. Religion the love for god, serves as a celestial roof. Finally the author expresses his opinion, that even today 500 years later, a modern, scientifically educated physician may profit from the philosophic and ethic principles of Paracelsus, who himself was a contemporary of a time of change like we are in our days.

[Complementary realities of physicians]. / Die komplementäre Wirklichkeit des Arztes.

The patient expects his doctor on one hand to be a reliable expert on the other hand to be an empathetic partner. Union of both polar qualities is fundamental for a doctors complementary reality. Global medicine of tomorrow is only possible if modern doctors successfully achieve a fourfold synthesis: 1. synthesis in harmony between a cortical-rational attitude (mathematical reason) and a cordial-emotional devotion (reason of the heart) 2. equal promotion of science and humanity 3. equilibrated use and culture of medical technics and medical diction and 4. increasing harmony between male values and female norms. Future medicine has to follow complemental calls expressed by technological know-how and by reliable partnership. Exemplary physicians of former times and today may guide us to such synthesis.

[Heart disease or sick at heart]. / Herzkrank oder krank am Herzen.

It is attempted to draw attention to the demanding and complementary reality of the modern cardiologist by confronting cardiology and cordiology (symbolistic theory of the heart). After a short survey of the symbolic and mythological world of the heart, the question of compatibility between the apparently opposing poles of cardiologic curative technology and cordiologic emotionalism is posed. With respect to the comprehensive cardiology of tomorrow, it is crucial whether the modern cardiac specialist will be capable of a difficult quadruple synthesis, namely: (1) the harmonious interaction between a rational basic position (raison de la mathématique) and an irrational-emotional standpoint (raison du coeur), (2) the increasing closeness of science and humanity, (3) the balanced care and culture of technology and medical language, and (4) the increasing harmony of male and female norms. Future cardiology must follow the call of the complementary, which reflects the apparent contrast between the scientific and the poetic heart; between having a symbolic heart condition and being heartsick.

[Medicine between technique and ethics]. / Die Medizin zwischen Technik und Ethik.

In modern medicine technical and ethical questions develop continuously into a tension-loaded relationship. The actual controversy between technical and ethical imperative concerns primarily the fundamental dichotomy and dialectics of modern medical technology. In a second part the ethical challenge for physicians and nurses operating in our increasingly perfect hospitals is analysed. An outlook for future conditions for more harmony between medical technology and ethics is finally presented. A new medical spirit is needed to animate medical technology and to expand it to real art of healing.

[Therapy of chronic heart failure]. / Therapie der chronischen Herzinsuffizienz.

Symptoms of chronic cardiac failure depend on four determinants: The initial event concerns a decrease in contractility. The resulting complex neurohumoral regulatory mechanisms are essentially sympathicomimetic and stimulate the renin-angiotensin system. Accordingly, pre- and afterload will increase and symptoms may become aggravated by dys- or arrhythmias. Symptomatic pharmacotherapy of cardiac failure is directed to these four determinants. The actual rationale for its use is presented, putting emphasis on the renewed controversy on digitalis and on the importance of vasodilators, in particular ACE inhibitors. The relevance of diagnostic evaluation before and during treatment is indicated. The adaptation of treatment according to different causative disorders leading to cardiac failure is outlined. Finally, open questions and unsolved problems are brought up.

[Goethe's struggle with depression]. / Goethes Ringen mit der Depression.

Goethe was subjected during his whole life to extraordinary psychic threats and polar tensions often to the limits of destruction. For long periods of life he travelled in the mist of depression. By steady patience, constant endurance, disciplined diligence, self-control and self-denial as well as restless activity inward and outward he resisted serious depressive threats and did not get paralyzed. He rather faced his spiritual sorrow creatively and forced it into curative poetry. While being completely uncommon, his wise but old-fashioned recipes on ways to master one's depression are a psychotherapeutic bequest and remain valuable up to our days as complement to our modern concepts.

[The clinical diagnosis of lung embolism]. / Die klinische Diagnose der Lungenembolie.

The clinical classification, pathophysiology and often difficult diagnosis of acute pulmonary embolism are reviewed. The diagnostic power of subjective and objective clinical symptoms and the diagnostic procedures (electrocardiogram, chest X-ray, echocardiography, pulmonary arteriography, pulmonary scintigraphy, determination of arterial blood gases) are evaluated and an actual investigative plan outlined. Diagnostic problems and frequent pitfalls are discussed. The often non characteristic and masked course in acute and chronically recurrent pulmonary embolism is emphasized.