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Ruth Silberberg – Oral History Transcription

Dr. Estelle Brodman, librarian and professor of Medical History at the Washington University School of Medicine, interviewed Ruth Silberberg as part of the School’s Oral History Program. The interview was recorded on January 16, 1976.

DR. ESTELLE BRODMAN: We’re very happy to have you here, Dr. Silberberg. Dr. Silberberg was born in Kassel, Germany on March 20, 1906 and got her M.D. at Breslau in 1931, having in the meantime studied in a great many other universities in Europe, including Freiburg, Berlin, Goethe and Vienna as well as Breslau. She took her internship at the Department of Pathology at the University of Breslau in Municipal Hospital and then was an assistant at the pathological institute there from 1930-33, as well as in the Jewish Hospital in Breslau. In 1934 she came to the United States and was a volunteer research worker in Pathology . . .

DR. RUTH SILBERBERG: No. It was Canada.

BRODMAN: Yes. You came to North America, to Canada, and were in Dalhousie from 1934-36, then spent one session of the time from 1937-41 here at Washington University School of Medicine before going back to New York to be assistant and H.G. Dean fellow at NYU from 1941-44. Since 1945 she has gone through all the cursus honorum at Washington University, having become full professor in 1968. She has been acting pathologist at Jewish Hospital and pathologist at Barnard Hospital, and senior pathologist for the City of St. Louis as well as having been president of the St. Louis Pathological Society in 1950. You’re so distinguished I’m a little embarrassed! Her interests are in experimental pathology, particularly skeletal growth and aging and the pathogenesis of osteoarthritis, among other things.

It’s very good of you to come and talk to us. I’ve been reading some of your articles – Dr. Silberberg’s list of articles runs to almost 30 pages and go right to the present [date]. She has continued her work both here and at the University of Zurich.

Could you tell us, Dr. Silberberg, what you think is the difference between medical education and medical practice in Europe and in the United States, since you’ve been involved in both.

SILBERBERG: To speak about medical education first, I think this really applies not only to education in medicine but also to education in all academic subjects. In this country we have a much stricter organization of the educational curriculum. In Europe they still have much more freedom as students. Although they are checked for attendance, they have an [option] of taking courses of their choice, to a large extent at least. There is a certain number of courses that they have to take, but the order in which they take [them] is somewhat different from ours and also the stress is probably more on the academic lecture and the formal course than it is in this country.

BRODMAN: Do you think that’s good or bad?

SILBERBERG: Well, I think it has its good aspects. I personally am in favor of the academic lecture because it helps the student to get an overall view and a view of correlations within different fields of medicine or pathology, [or] whatever it is. What they get when they learn a lot of detail as they do under our system here has a bad aspect in sometimes becoming too academic and depending a little bit too much on the quality of the teacher. If you have, as is true for many universities in Europe now, the old professorial system, then there is a danger of the teacher getting stale.

BRODMAN: Are the classes there larger than they are here or has that died out?

SILBERBERG: The classes are very much larger because you do not have to register as you do here. The number of students in medical schools is not limited, so anybody who wants to go into the study of medicine just registers and pays his dues and attends classes. From what I know from the University of Zurich, the courses are so crowded that certain courses have to be held twice or even three times, which is really very hard on the teaching staff.

BRODMAN: Do the teaching staff get to know any of the students if they have such large classes?

SILBERBERG: I suppose that depends on the individual teacher. I suppose there are people who make a special effort to get in close touch with the students. For instance, Dr. [ed. note: name is inaudible] who was here the other day is one of those. The one who really is in charge of the course and who gives the lecture has very little individual contact with the students.

BRODMAN: So the more important people rarely get to know the younger ones?


BRODMAN: Do you think that’s an advantage or a disadvantage?

SILBERBERG: I think it’s a disadvantage, definitely. I think the better you know your students, the better teacher you are and vice versa.

BRODMAN: Who pays for the education? If medical education here is considered so expensive that no student’s tuition could possibly pay for all of it, is this as true in Europe where they have such large numbers of students? Who pays for that education?

SILBERBERG: So far as the system in Switzerland, Germany, Austria and these countries is concerned – France, I suppose, would have to be included – the universities are all state-owned. The state pays the professors, who are at the same time officers of the state. They draw salaries which are comparatively low but they have all privileges of officials. They draw a pension later on in life and so on. Also, they are entitled to charge fees, not to the individual student, but they get paid additional fees [for] students who take the examination, not for students that attend the courses. They are so-called examination fees, which are considerable, when you think that 250 students may be taking the examination at one time, twice a year. Also, they are permitted private practice in medicine. The pathologists are entitled to act as consultants to private pathologists or, in some places, they are entitled to have some examinations carried out in the university laboratory. That depends on individual agreements between the school, the hospital, and the individual pathologist.

BRODMAN: The universities on the Continent are so very different from the British universities that it’s hard to realize that they both evolved from the same medieval university system. We in the United States seem to have taken over more of the British system than of the Continental system. Do you think this has been good for us or do you think we should try to get closer to the Continental system?

SILBERBERG: I would imagine that there are disadvantages to both systems. Economically, certainly the European system is preferable in that the student has to pay a minimal amount of money as university fees. I don’t know exactly, but I know that it would be way, way below a thousand dollars per year. I understand that some people expect free tuition before very long in some of the European countries.

BRODMAN: Yet, they probably don’t need as many physicians as they have students. How do they get around to winnowing out those who are not very good or keeping the number of physicians down so that there are not more than needed?

SILBERBERG: I’m not too well acquainted with details of this problem, but I don’t think there are any restrictions on anybody. They just go out and practice.

BRODMAN: As soon as they pass their examinations. [Do] they have state examinations which license them to practice?

SILBERBERG: Yes, they do, certainly. And there are restrictions. Licenses for one country do not apply in another country unless there is a certain degree of reciprocity which may exist – I don’t know about that.

BRODMAN: We have the same thing here. You have seen both the education and the practice of medicine on the two continents. Is there much difference in the way in which medicine is practiced?

SILBERBERG: Actually, I haven’t seen too much of the practice of medicine. I have seen some of the practice of pathology. I would say that there are a certain number of excellent physicians on both sides; there are a certain number of average physicians and a number of those that aren’t very good. Whether the percentage is different, I do not know. The problem is that medicine has made so much progress and there have been [so many] changes within the last generation that it’s very hard to say what is due to local differences and what is due to developmental differences. Certainly, it is true that some of the European hospitals practice excellent medicine. There is perhaps a little more attention paid to the patient as an individual.

BRODMAN: In Europe or here?


BRODMAN: Isn’t that just the opposite of what used to be? They used to say that Vienna was a wonderful place for Americans to study medicine but a terrible place to be a patient because they were treated so poorly.

SILBERBERG: I don’t know anything about Vienna, or Austria in particular. I would imagine that it’s just a generalization, maybe arising from the experience of a few individuals which doesn’t apply generally. I don’t know, really.

BRODMAN: Like Claude Bernard, you keep going back and forth from one culture to the other. Why is that – what do you get out of this?

SILBERBERG: This is really more or less a matter of personal choice – a convenience. I’m not functioning too well in the heat of St. Louis, and on the other hand, we did have a group of people who worked in the same field as we [did] who had very similar interests in certain scientific problems. So, one day we received an invitation [saying], “Why don’t you come to Switzerland and work with us?” That was in the early 1950s. In 1959 it became possible for us to go over for a prolonged period of time and ever since then they have told us, “Why don’t you come back next summer?” So we did.

BRODMAN: You mentioned already that medicine and pathology have changed very greatly in your lifetime, [particularly] in the last decade or so. What are the main changes, do you think?

SILBERBERG: Do you mean in this particular department or in general?

BRODMAN: Why don’t we start in general and then secondly in this department.

SILBERBERG: Well, pathology has really developed from a relatively uncomplicated part of medical science into a highly sophisticated branch. The invention of the electron microscope, the study of disease with the help of radioactive tracers, the whole development of molecular pathology, has really boosted the development of pathology during the past 20 years to a point that was unimaginable a generation ago.

BRODMAN: The three things that you have mentioned include two methods: electron microscopy and radioactive tracers, and one theory: molecular pathology.

SILBERBERG: I was just trying to hurry it up. (Laughs)


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