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GLIMPSES OF
MEDICAL EUROPE
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GLIMPSES OF
MEDICAL EUROPE
BY RALPH L. THOMPSON, M.D.
Professor of I'jitholojiy, St. Louis University School of Medicine
ILLUHTltATEU Flio.M PHOTOGHAl'llS AND FROM DH A WINGS BY
TOM JONES
rHiLADp:i>rniA & rx)NDON J. B. LIPPINCOTT COMPANY
1908
Copyright, 190.S By J. B. LiPPiNCOTT Company
Published April, 190.S
Tifc
Kkrtrotijped and printed by J. B. Lippincotl Company The WaMiiglon Hquare Press, Philadelphia, U. S. A.
TO
K. W. M.
INTRODUCTION.
One who lays no claim to being a literary man should not write a book to begin with. And of all subjects that miglit be cliosen, a book on Euro})e is the one tliat most requires an apology. However, I am not going to apologize for the present volume, because I didn't want to write it, anyway. It began by my sending home a few letters to an editor who wanted to fill up a certain amount of space. Once started, it just naturally gi'ew into its present form.
There has been no attempt at making this book a guide-book in any sense, although things of importance to a man who is going to study medicine abroad have crept into it despite the author. It does not intend to describe anytliing accurately (mock^rn art doesn't allow that), but it tries to sketch the things medical in Euro])e that I have happened to see, as they appeai-ed to me: connnc jc Vai vn.
All books should ]iav(^ a ])ur])ose, and if tliis book didn't have one 1 wouldii'l have sj)ent my evenings writing these chapters instead of joining my fi-iends in the more coii-
5
INTRODUCTION
genial occupation of holding down a chair in one of the famous cafes on Friedrichstrasse or the "Boul' Mich.'' If you see the pur- ])ose, then you will pack your steamer trunk at your first opportunity, and perhaps we'll touch elbows in some of the places to which these pages may attract you.
The author is indehted to the St. Louis Medical Review for permission to reprint such of these chapters as first appeared in that publication; and to the Anglo-American Medical Association of Berlin for the in- formation concerning courses offered in Berlin for American students.
R. L. T.
CONTENTS
wS=~
I. Introductory — Christiansand — Christi-
ANIA HOLMENKOLLEN 11
II. Copenhagen — Municipal Hospitals 22
III. Copenhagen — The Finsen Institute 31
IV. Stockholm — Noteworthy Medical Insti-
tutions 39
V. Upsala — The University of Sweden 48
VI. St. Petersburg — Its Numerous Hospitals . . 59 VII. Berlin — Anglo-American Medical Society 74 VIII. Berlin — Charite and Pathological Insti- tute GO
IX. Berlin — Hospitals and Clinics 103
X. Berlin — Dr. Pick— A Pathological Pil- grimage 11.")
XI. Vienna and Budapest 127
XII. Paris — St. Louis Hospital — Scenes at the
Skin Clinic 140
XIII. Paris — The Parisian Life — The Surgical
Clinics 1 .52
XIV. Paris — The Pasteur Institute — Metchni-
koff 1 ()5
XV. London — The Hosimials - Siu A. K.
Wright's Laboratory IHO
XVI. Liverpool— The University The School
OF Tropical Medicine 190
APPENDICES.
I. A List of Medk^al Courses for Americans
i.\ Berlin '^0.5
II. German Universities '-222
7
The First Glimpse Front in piece
Sanatoria Seen From the Norwegian Fjords... 15
Oslo Hospital — Christiania 17
Holmenkollen 19
Friederik's Hospital — Copenhagen 24
Municipal Hospital — Copenhagen 27
Niels Finsen SI
The Royal P.\lace — Stockholm 40
The Opera House "Cellar" — Stockholm 45
Carl von Linnaeus 49
House of Linnaeus 51
Anatomical Institute — Upsala. '. 5,3
University Hospital — Upsal.\ ^i'*
Russian Droschke r>0
Pawlow (57
Russian Peasants 09
MONU.MENT to PeTER THE (iUE.Vr 72
The Anglo- A.m eric an Mkuical Sociki y oi- Hehlin 75
Royal Charite Hospital S.'J
Park ok The Chariik 92
Grounds of tiik Ciiaki ik 9(5
]{( ixn.i'H Vnu'iiow 97
g
ILLUSTRATIONS
SUKGICAL ClINIC-ChAKITE 100
Nerve Clinic — Chariti: 101
Okih 104
Grounds of Moabit Hospitai 106
l*iiiMi'PSTHASSE — Berlin 110
Dr. Pick's Laboratory 117
LrnwiG Pick 123
A Wiener Type 128
The University — Vienna 129
Allgemeines Krankenhaus — Vienna 132
Administration Building General Hospital —
Vienna 136
Park i\ General Hospital — Vienna 137
The Paris Morgue 141
A Collector of Cigar "Butts" 146
Visite a l'Hopital (Lu'xembourg) 1,30
Hotel Diet', From Notre Dame 161
Pasteur Institute 166
Pasteur 169
Chemistry Institute— Paris 173
Metchnikoff 177
Bloomsbury Square 181
The Last Glimpse 201
University of Bfju.ix 206
Friedrick Wilhelm Hospital — Berlin 215
Johannstadt Infirmary — Dresden 225
The Univkkshv— Munich 229
The University-— liiaiv.u; 231
f 1^
Glimpses of
Medical Europe
THE CROSSING CHRISTIAXSAND CHRISTI-
ANIA HOLMENKOLLEX.
Whatever city may be the objective point for medical study abroad, tlie important thing is to choose the most indirect route for reach- ing it. Too frequently one takes a steamer for Hamburg and is walking a hospital in Berlin before one has lost his sea legs. The result is usually a rapid decline of interest in tlie clinics, and a desire to know more of the life of the cafes. Especially is this true when, as is frequently the case, one is just over the grind of the final examination at home, or is taking a few montlis off from a busy jn-actice. Far wiser is it to take down the map and, after sticking a pin in Vienna, or Berlin, or wherever one wishes to go, to plan a trip that will take about a month to reach the selected city, after you yourself and your several pieces of luggage liave been landed on Euro[)ean soil.
11
MEDICAL EUROPE
If you are an old and experienced traveller and know just what you want and why you want it, this doesn't apply, and you should go to your particular place as quickly as steam and rail will carry you. I know a man, for example, who considers that every moment of liis travelling life that isn't spent in Paris (and a certain quarter of Paris at that) is wasted, and wlio rushes from his last class exercise in tlie Spring to the station, catches tlie first steamer sailing for Havre, and is (h-iven like fury from the dock to the Paris Express. Tlien he doesn't wriggle out of his ])articuhir quarter of Paris until the last ])ossil)le moment, when he is forced to re- verse the previous j^rocedure and get back to his class-room.
The first trip over, however, should be undertaken with a good deal of care and forethought. The easiest thing to do is to take one of the big direct liners that will 1,1 nd you on English, French, or German soil, as you j)refer; but that, as I said in the beginning, is to be avoided if possible. It's too easy. Tlien there is the IJverpool trip, which used to be a favorite on account of the better boats once on that service, but wliich now has lost rn'ound.
The Soutliern i-oute is nlways a favoi'ite
12
THE CKOSSIXG
avenue of approach. Tlie Mediterranean is usually good-natured, and the lazy linger- ing at Naples, Rome, Florence, and Venice has its charms. Then, if you are going to Vienna there is the ride through the Eastern Alps, which is one of the most beautiful of railroad trips. Many choose this route, and they are wise. But if you have taken it once and wish for a change, you will be none the less pleased should you choose the approach by way of Norway, Sweden, and Denmark. A stanch steamer will take you to Christian- sand in ten days. The next day you are at Christiania, a typical Norwegian city, and, if you wish it, the day following finds you in Copenhagen, the "Paris of the North."
Having taken both of these latter trips, 1 should recommend that you choose accord iuir as you prefer salads or sandwiches. If salads be preferred, take the Southern route by all means. There is no proper place to eat a salad, except in sight of the trees that furnish the oil for the dressing; and a salad in Italy is a thing to live for. However, if you care little for salads but do like real food, take the Northern route. The Scandinavian food is unexcelled, and the acme of the Scandinavian cuisine is the sandwich. At home a sandwich is a sort of lottery at best. It looks the same
i;)
MEDICAL EUROPE
from l)()tli sides. Wluitever may be within is left to faith to cHscover. But the Scandinavian sandwich is open-faced. There is nothing about it tliat is asliamed. First is the deH- cately sHced piece of bread; next a generous, smootlily hiid hiyer of sweet Danish butter; and, a})ove all, your thin, appetizing slice of meat or fish or cheese or what not. When I get back I am going to agitate the raising of the "lid" from the American sandwich.
There are a few things worthy of note regarding the hygiene of ocean travel. On the whole, the health of the passengers is well ])rotected. Quarantine rules have gone a great way towards limiting disease, but there is still room for improvement. For instance, a steamship would be held up in- stantly on suspicion of cholera, smalljjox, or yellow fever, but apparently no attention is paid to tuberculosis. On our boat there were two bad cases of the latter. A man in the second cabin sat at the table with other pas- sengers and coughefl at will into his napkin. lie was assigned to a state-room with another passenger, bnt owing to the strenuous objec- tion of his room-mate he was asked to sleep in the hospital. A girl in the steerage, how- ever, was not so fortunate in disj)osing of her cabin companion. This girl, who had failed
14
CHRISTIANSAND
to pass the immigration officers in New York for some reason and had to be taken back to Denmark, was made to sleep in the same room with a woman in the last stages of
Sanatot!IA skkn rnoM -iiir. X.ii:\\ r.ci \n 1'.
tuberculosis. When one considers the ex- treme crowding of passengers in the steerage, the shutting up of a young girl for twelve days with a case of advanced tnl)erculosis seems little short of ci-iininal.
15
MEDICAL EUROPE
Tlie fjords of Norway, seen for the first time, are beautiful. Neat little villages with i-ed-tiled roofs are set at intervals in the black and green of the hills. The first of May is warm, as warm as St. Louis at the same time of year, which is a surprise to many travellers. Norway is a favorite country for summer travel, in this respect rivalling Switzerland, wliich it is not unlike.
We stopped at Christiansand, — a painted stage picture in chiaro-oscuro in the early morning light, — but a few minutes, to debark })assengers. I would have liked to have stayed for weeks. Then we steamed down the fjord to Christiania, and the dark-browed hills (hat saw the fleeing of the Finns before Ilarald Ilarfagar and Erik the Cruel, looked down on us.
Those were great old fellows, the Norse- men. Back in my school-boy days, I remem- ber I used to declaim with great gusto the "Skeleton in Armor," — and dream of those old chaps.
"Ar;iny ;i w;is,s;n'l-l)out AVoro llic loiitr Winter out; Offon our midniglit sliout Set the cocks crowinc As we the Berserk's tale iMeasured in cups of ale, Drainiii<f llie oaken pail, Filled to o'erflowing."
CHRISTIANIA
I wonder liow many of them died from cirrhosis of the liver.
Christiania is a sleepy looking town, l)nt has all the modern improvements. Frederick VI fonnded the University here in 1811, and we fonnd it still flourishing. As our time was limited we pitched a penny to determine whether we would see a surgical clinic, or the
Oslo IIuspital— CirisisTiAXi'A
Viking Ship which is tlie main attraction of the Museum. The Viking Ship won. This most interesting and awe-inspiring mass of kindling wood is adequately described l^y Baedeker, so I won't rave about it here.
Of most interest to medical men, perluips, are the numerous sanatoria for tul)crcul()sis wliicli are situated in the neigliborhood of Christiania. At Ilolmenkollen one gets a good idea of the situation and style of these institu-
2 17
]\rFJ)ICAL EUROPE
tioiis. irolineiikollcii is reached by trolley Ccar, plus ii short walk, from Christiania at an expense of ten cents. The road is cut for a great part through the living rock. A beauti- ful view of Christiana and its harbor, and an excellent lunch at the Holmenkollen Hotel, can be had before visiting the sanatoria.
Tuberculosis is treated here, as everywhere else, by fresh air, sunshine, and wholesome food. And I have never seen a place where I thought the combination could be more enjoy- ably obtained than here. In the winter the Iiemlock boughs of the surrounding forest are weighted with snow, and huge, high snow- banks at times block the road that leads up the mountain. But the sun shines ever in at the great broad glass windows of the enclosed piazzas.
A little distance back of the hotel is the course for the ski races which are held here annually. It makes one shiver just to look at that pi-ecipitous mountainside, with the big "set off" a])out half way down that throws a man into tlic air tlu'rty to forty feet. I have heard of Americans "getting skates on," but if Norwegians ever "get ski's on" they nuist have an awful time explaining to their wives the next morning:.
^^e were dropped down tlie mountainside
18
HOLMENKOLLEX
safely by our faithful trolley, and as the cottonseed oil and lard that are imported for the manufacturing of "pure Danish creamery butter" were unloaded, we climbed back on board our ship, and steamed out into the fjord on our way to Copenhagen.
II.
COPENHAGEN FABER AND ROVSING, HOS- PITALS AND HOSPITAL MANAGEMENT.
It was a glorious morning tliat saw us entering tlie liarbor of Copenliagen, wliicli is one of the prettiest of all the harbors of Europe. Ov^ei* to the right tlie castle of Elsinore, the manor of the mythical Hamlet, had been pointed out to us. "You can't see tlie pile of stones that marks his grave yet," said the deck steward, "but they will pile them up before the tourist season opens. The tourists carry off so many that they have to make a new pile each year."
.Vs I w{is standing by the rail a fair-haired Dane, who had sat at my table, came to say good-bye, "Are you abroad, like all the rest, just to travel.^" she asked. "No," I replied; " I came for two very serious purposes. First of all, to secure a broader medical education; and, second, to make other acquaintances as pleasurable as ours has been."
"That is a very nice thing to say," she replied. "]5ut I don't see the seriousness of the first ])urj)()se. "
Copenhagen, the capital of Denmai-k, a
COPENHAGEN
busy city of some half a million or more inhabitants, has eight municipal hospitals. Tlie largest is the Kommunehospital, with a thousand beds. There are two hospitals for tuberculosis, one for infectious diseases, and so on. It is needless to say that these institutions are used for teaching purposes, and the chiefs of departments are professors in the University. All European hospitals fulfil three functions: care of the sick, teach- ing, and research. Every ward in every hospital has its laboratory. In addition, there is a main laboratory. If patients have money they ])ay for their treatment. The prices range from fifty cents to a dollar a day, ac- cording to the circumstances of tlie patient. Those who are poor do not pay. Whether one pays or does not pay one is put in the same ward. All are treated absolutely and exactly alike.
It might be mentioned, in passing, that all the medical men we met in Copenhagen were apologetic. They seemed to think theii' insti- tutions were inadequate. "If you come again in two or three years, you will see our great new public hospital that is now being built," they told us.
The courteous iiiaiiiuM- in which wc^ were treated everywhere in Denmark made us feel
2;?
MEDICAL EUROPE
embarrassed at times. From the humble gate- keeper of a hospital to the chief of service, everything was done that could be done to show us what we desired to see. The Danes, without exception, will go out of their way to show a foreigner a favor. You are the guest of the man you speak with. You need no letters of introtluction. An unknown Ameri-
FuiEnEmK's Hosimtal — Copf.miagen
can country practitioner would be shown the sauie consideration as an acknowledged leader of the profession.
Our first visit was to the Friederik's Hos- pital. This is the oldest hospital in the city. It was l)uilt in 17;>2, over one hundred and fifty years ago, and yet it is in remarkably good condition, and in its hygienic construc- tion is far ahead of many of our modern insti- tutions. This hospital has about six hundred
24
COPENHAGEN
beds, and the patients in their pink checkered pajamas, with their individual sponge and tooth-brush at the head of each bed, look remarkably clean and happy.
Here it was we met Faber and Rovsing, the leaders in Denmark in medicine and surgery respectively. Professor Faber has the clean, kindly face, with little wrinkles at the corners of the eyes, that is common to so many men who have successfully combated disease. In the depths of his blue eyes lurks also a trace of humor that makes one think of Osier.
We made a round of the wards with Faber, accompanied by the usual retinue of assistants and nurses, and noticed nothing in his manner of handling the patients that differed from the ordinary routine of one of our better class American hospitals,
Rovsing, of whom everybody speaks as the admitted leader of surgery in Denmark, is a splendidly built, handsome man, with blond curly hair and moustache. He is a worker, and there are lines in his face that show it. The day we met him he had begun operating at eight o'clock in the morning; he was still operating when we left the hos})ital at one o'clock, and he had three major kidney operations yet to do at liis ])rivnie hospital in the afternoon. The sun sols late at
ZO
MEDICAL EUROPE
Copenhagen in May, and one can pnt in many Iiours' work a day.
We watched Rovsing do an appendix oper- ation. It is not uncommon for medical men wlio return from Europe to say there is no surgery there. They should see Rovsing operate. His technique compares favorably witli that of any American surgeon you care to
mention. He is swift and skilful. He has his details arranged to a nicety that is astonish- ing, and his assistants know exactly what to do without being told. In ackhtion he makes his diagnosis before he operates.
A picturesque featiu-e of the o|)eration we saw was the yellow oilskins and rubber boots of tliose who })articipated. It made us think of the deck of our ship in a storm. However, we all iigreed that it was pretty work— as })retty work as any of us had ever witnessed.
26
COPEXHAGEA^
The Kommunehospital, which we next vis- ited, is built in the form of the letter H, with an extra bar across the top. Inside are courts, beautiful with trees and shrubbery and flowers and green grass. The Ijuildings of the new St. Louis City Hospital could be set in one of these courts, and there would still be some of the shrubbery left. This hospital was erected
o^,:^X.
^MiNiriiAi, lIiispiTAL — Copenhagen
in 1S()3, but is essentially modern in all partic- ulars, except for the fact that in many of the wards there are stoves. The hospital has a central heating plant, })ut somehow or other they do not manage those things well over here. If one wants a good cfpiabh^ warmth one must liave a stove.
In general, hospital management here is the same as in the T^iiil(>(l States. One thing, however, may ])e mentioned. Tliei-(^ is a wai'd
27
JNIEDICAL EUROPE
here for delirium tremens, but in it are no iron-barred doors, no thick leather straps, and no strait-jackets. The ward is the same as the other wards, except that in connection with it there is a drawing-room with plush- u})holstered furniture and a piano. Then there is ii garden enclosed by a high fence, where convalescents may walk.
"But what do you do when the D. T.'s are violent.^" I asked. "Don't you ever strap them down .^"
"We never use any force," was the reply.
Now I don't know anything about handling such cases, but as I had seen the iron-barred doors and straps in St. Louis, and in Boston had seen a burly policeman jump on a man's abdomen with botli knees and throttle him till he was black in the face, while the house officers were putting on the strait-jacket, I admit I was surprised. If ever I become an alcoholic, I think I'll take my treatment over here.
Another feature of tiiis hospital is the ear, nose, and throat chiiic of IVofessor Mygind, which is iK^w. Mygind liimself is a large, rather stern-a})pearing man, at first glance. But his face lights up when a child approaches, and it was delightful to see the kindly way he petted the children in his ward. There is
28
COPENHAGEN
proba])ly no better equipped clinic of its kind in the world than this of Mygind's. Every- thing is absolutely new and of the best. He waited till he could have everything he wanted before he allowed the erection, and we saw here dozens of new ideas, many of them original. Dr. Mygind's assistant, Dr. Hald, is an especially prepossessing young man. We watched him do a paraffin injection to fill up a hole in the forehead of a man who had fallen some fifty feet and pushed the whole of his forehead over to one side. The man left happy after the injection, with a synmietrical face and the brow of a Jupiter. Dr. Hald told us that men were much more particular about the appearance of their faces than w^omen. In fact that most of his "beauty patients" were males. He had just fixed uj) a horse-dealer who insisted on viewing tlie operation on himself with a mirror and con- trolling results by his own suggestions.
Withal, we were royally treated here. We were the guests of the staft' at dinner. In a neat speech they thanked us for our interest, and extended the good feeling of Denmark for America. We were too embarrassed to respond fittingly, I fear, but there will always be a warm spot in our lieails for llie doctors of the Kommunehospital. AVe shall carry
29
MEDICAL EUROPE
back to America and keep always the memory of our visit, including the coffee, and punsch, and cigars, In the garden.
'' SkaaV to Dennuirk, and Copenhagen, and the doctors we met at the Kommunehospital !
The house physicians in Denmark hospitals are mature. A medical course in Denmark takes six years. Then it is necessary to sig- nify one's desire for a hospital appointment early in one's career and to wait for a va- cancy. Men are frequently out five or six years before they receive their appointments. There is no danger here of a patient in a municipal institution falling into unskilled hands. Not only is there skill and efficiency, l)ut there is universal kindness used in the liandling of patients. There is always a kind word and a smile; a pat on the shoulder or a grasp of the hand for the patient. We saw a lodgekeeper put his arm about a ragged urcliin who had lost his wav, and lead him to the ward he desired, and the doctor met him with ;i smile, and the nurse beamed on him. And we, outside in the warm sunshine of the court-yard looked at each other, but we were silent.
III.
MORE ABOUT COPENHAGEN THE FINSEN
INSTITUTE AND ITS FOUNDER.
A VISIT to Copenhagen is not complete, even if yon are not medically inclined, with- out a view of the Finsen Institute. There is proba})ly no name more generally known
throu";hout Scandinavia than that of Xiels Finsen. There is j)rol)al)ly no remote hamlet, tucked away in the interior of Denmark, that does not contain some individual who can testify to the efficacy of the Finsen light in the treatment of lupus.
When Finsen died here in Copenhagen
31
MEDICAL EUROPE
on Scj)tein})er 24, li)Oi, the Journal of the A.jNI.A. printed tlie following editorial:
"In the death of Niels R. Finsen there passed away one of the heroic figures in modern medicine. In spite of chronic and incurable disease, Finsen, with rare persist- ence, developed phototherapy on a strictly scientific basis so that it became definitively established as a successful means of cure in lupus vulgaris. He early recognized that if the great forces contained in light ever could be used in the science of practical medicine it would result only from investigations of })]iysical, chemical and biologic nature, to- gether with practical experiments in different diseases. Apparently, his earliest publica- tions concerning light and its action on the animal organism date from 1893. In 1896 the results of his scientific researches led to the establishment in Copenhagen, as the out- come of private and public support, of ' Fin- sen's Medical Liglit Institute.' Subsequently this institute, which soon became known everywliere, was greatly enlarged. In 1899 Finsen began the issue of a series of re|)oi-ts {M eddclclser fra Finsen' s medicinske Lysin- fititue) in which are })ublished the results of tlie scientific and practical work of the insti- tute. In the meantime, there appeared im-
32
COPENHAGEN
portant monographs by Finsen in the Danish, French, and German languages. Here were considered especially the role of the chemical rays of light in medicine and in biology, and the treatment of lupus vulgaris by concen- trated chemical rays. The report covering the first 800 cases of lupus vulgaris treated at Finsen's institute (November, 1895, to November, 1901,) shows that 407 were cured, 85 had interrupted the treatment, while 308 were still under treatment. This report may be taken as a model of thoroughness and exactness in dealing w^ith matters of this kind; one is particularly impressed with the careful- ness to avoid premature and exaggerated statements as to the value of the method. To Finsen belongs the credit of having placed phototherapy on a firm and scientific ])asis. But no one must think for a moment that this was accomplished without persistent eft'ort. In reading Finsen's writings and the publica- tions of others working in his institute, one at once finds the keynote to the continuous extension of our knowledge of the action of liglit on living matter, and itnprovements in the practical application of the chemically active rays. Finsen was ever conservative in his own estimation of the thera})euti(' powers of light, and never advanced claims which •.i 33
MEDICAL EUROPE
sulisequently proved to be without jidequate foundation. In his short but fruitful career, Finsen consistently illustrated that unselfish- ness and modesty which medical men love to see in their best types. He cared not for personal gain. When he was awarded the Nobel prize in medicine, in December, 1903, he generously turned the money received over to the use of the institute. From what- ever side we look at Finsen and his work, tliere comes only the impression of a noble character."
The ultraviolet rays are too well known to need description here, but the manner of tlieir use is interesting to the visitor who sees them applied for the first time.
The Finsen Institute is located amid the shady boughs of great trees in the edge of the town. About it are numerous private villas. Rovsing's clinic is nearby. Tlie insti- tute consists of only two buildings; one, the laboratory, is an old villa. The clinic build- ing was especially built for Finsen's work. At tlie left, as one enters the grounds, is a little low red building tliat one does not notice until attention is called to it. This was the place where F'insen first worked out his ideas. 'I'lic building was brought here from another part of {lie city, and serves as a memento of
3-1
COPENHAGEN
the beginning of Finsen's efforts. If you enter the chnic suddenly you are somewhat startled at first. There are })erliaps half a hundred patients in the big room, waiting their turn at the light machines. The faces you en- counter make you shudder. It is like a first view of Boleslas Biega's sculpture. Even the white, expressionless, cicatricial faces of the cured cases one has to get used to. But the horrible disfigurement of advanced, untreated lupus vulgaris is terrible. One face was a blank, reddish-white mass, ringed with two pink circles, from which dull eyes glanced staringly; there was no nose, and a ragged hole with everted, granular border, served for mouth. No wonder they honor the name of Finsen, when he has given to his people the means whereby so hideous a human being can be restored to a fair semblance of his original self.
The patients, many of whom have come from distant parts of the glo])e, are first photo- graphed and then seen by a physician, who rings, with a wax pencil, the exact spot to which the light is to be applied. Then they are taken to the operating-room for tr(\itniont, after which a simple ointment and a bandage are applied. '^Fhat is all. Some cases need only a few treatments, others nuist remain for
35
MEDICAL EUROPE
many weeks. Patients are advised to come back in six months or a year to have some spots that may have escaped the rays cleaned up. Each treatment costs from fifty cents to a dolhir according to the circumstances of the patient. Although the institute is a privately conducted affair it receives aid both from the city and state. Most of the Danish townships pay for the treatment of the cases tliey send.
A pleasant-faced lady, who speaks excellent English, and who has much the appearance of an American school-teacher, has charge of the operating-room. There are seven of the light machines in the room. Six are kept in use, and one is taken a|)art and cleaned each day. Each of the machines consists of a central electric arc which furnishes light for four lone; brass tubes fitted with quartz lenses. A bed on which the patient lies is wheeled under each tube, aufl a lady assistant is provided for each patient. The ringed area on the face of the patient, to which the rays are to be apphed, is first covered with a water compress, to prevent l)urning, and then the light is kept constantly on the spot by the attendant for one hour.
The lady attendants ai-e all remarkably good-looking. I asked Dr. l^usk whether thev were especially selected for therapeutic pur-
3U
COPEXHAGEX
poses, and suggested that I would not mind having lupus myself for an hour witli such attendants. Dr. Busk said that a great many patients found their fate here. I could readily see how such might be the case. Take a man, who for cosmetic reasons, has probably kept himself away from society for a lono; time, and let him find himself the fortunate possessor of a new face, into which a charming young lady looks steadily for an hour each day, is it unreasonable that he should ask the charmino; lady if she would always look into his new face across the breakfast-table ? i
In addition to the Finsen y li^ht there is a room for Ront- gen-ray treatment here and a room for universal liglit baths. The latter are given by means of an arc light of I'^O amperes. Preparation for the bath consists only in the substitution of a pair of automobile goggles for one's ordinary raiment. Experiments which have been carried on in the Finsen laboratory seem to show that this universal liglit bath will j)rove efficacious in tlic ti-eatment of ciironic cardiac affections, and a new building is soon to be ])uilt especially foi* tliis ti'catment.
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The laboratory of the Finsen Institute is well equipped, and general research is con- stantly carried on by several trained labora- tory workers. Dr. Busk, who took us about, is a young man, enthusiastic, a worker and a cosmo})olite. He knows, it seems, all the cities of the world. He told us that an American medical concern some years ago advertised Finsen-light treatment. They claimed to be working in cooperation with Dr. Finsen and to be backed by the Danish Government. As a matter of fact they were not using the Finsen lig-ht and of course their treatment amounted to nothing. Dr. Busk said that he tried to get a denial printed in some of the leading newspapers, but they were too busy api^arently to print it. We explained to him that looking after the business of their adver- tisers did keep the American newspapers, as a rule, very busy.
IV.
STOCKHOLM THE HOME OF GREAT INVENTORS
NOTEWORTHY MEDICAL INSTITUTIONS.
If one has time to spare there is no better way of killing it than by taking the trip by water from Copenhagen to Stockholm, np the coast and throngh the canals which cross Sweden. One takes a boat np tlie Kattegat to Gottenbnrg, passing on the way the fine old castle of Kronborg, bnilt by Frederick II. From here to Stockholm the canal trip takes about three days.
The direct route, which we took, is only a night's journey by boat to IMalmo and thence by train to Stockholm. These night trains are managed simply in Europe. The back of the seat, that forms one side of the compart- ment, is pushed up to make a shelf. You get on to the shelf, and that is all there is to it. There may be a lady on the next shelf, but nobody seems to mind.
We did not sleep very well on our shelves, and so landed in Stockholm in a rather bad humor. IVIy feelings were not improved ])y the unkind remark of my friend, who referred to my nether garments as " accordion-pleated
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trousers." However, a brush up and a pot of excellent coffee at the Rysdale soon put us to rights and we were ready for adventure.
A man who had travelled much told us that to him Stockholm was one of the three finest cities in the world. The other two places he mentioned were Edinburgh and Hong-Kong. I have never been to all the cities in the world and, unfortunately, I have never seen either
■•"CsssarsiLw -^ :
'I'll I, l.'-i'i \ I, I' \ I
-locKHoLM. St. Pktersbiro Steamer at left
of the two latter places, so I am not in a posi- tion to pass judgment. However, I can truth- fully affirm that Stockholm is a fine city. It is less clean than Berlin, less beautiful than Budapest, less interesting then Prague, and less picturesque than Venice. But it has one product that makes it stand out distinctly above all these other cities, and that is its Caloric Punsch.
I never knew what it could have been that made the chap in "Hedda Gabler" have
40
STOCKHOLM
"vine leaves In his liair" until I visited Scandinavia. Now I know Ibsen must have referred to Swedish punch.
The 300,000 people who live here are un- doubtedly proud of their islands, their plains, and their rocky hills, which serve to make this "Venice of the North" so picturesque.
Compared with many European towns Stockholm is modern, for the settlement was not founded till 1^255, and it was not until 1857 that the old wooden houses were replaced by the present stone structures. Probably, therefore, Berzelius, the great chemist, whose statue stands in the little park which bears his name, at the end of the Hamun-Gatan, never knew the discomforts of these later edifices.
One of the first things we did in Stockholm was to look up the headquarters of tlie Nobel Fund, which we found in a buikhiig with an odd copper-covered tower near the Observa- tory. "It wouldn't do," one of our party remarked, "not to know exactly where to come when our turn anives for receiving the Nobel Prize." So we sauntered iij) tlie Observatorii-Gatan and stood before the ])uilding, trying to imagine liow it would feel to be making a s})eech of acceptance to some twenty or thirty thousand dollars, while the
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telegraphs and cables were flaskiiig our fame around the world,
Stockholm seems to have been a great place for inventors. There was Nobel, who first invented dynamite and then invented a peace prize to counteract it; there was John Ericsson, who invented the screw propeller, which enables us to come to Europe so easily and so quickly; and there was Sheele, the discoverer of oxygen, hydrofluoric and tartaric acid; all brought up in this crook of the Baltic.
The hospitals of Stockholm deserve as high a jjlace as those of any city in Europe. Even after the surprise we got in Copenhagen, we were forced to admit that the medical insti- tutions here were fully as noteworthy as in the latter city. Many of the larger medical buildings are situated at Kungsholmen, a West suburb of the city. Here are to be found the Karolinska Mediko-Kirurgiska Institut, which was erected in 1811, for the practical training of physicians. Here, also, is a large lying-in- liospital; a military hospital; the infirmary of St. Goeran, and the Sjukhem; and the Conradsberg lunatic asylum.
In another part of tlie city we found Sab- l)atsberg, a l)ig, up-to-date nnmicipal hospital, beautifully situated, as so many European
42
STOCKHOLM
hospitals are, in the midst of extensive grounds, where there were no "Keep off the Grass" notices for convalescent patients.
But it is tiresome to walk through hospitals dav after dav, and tiresome to write about them afterwards; so I may perhaps be par- doned if I merely say that if you are sick there is a bed in a hospital for you in Stock- holm (you may pay seventy-five oere, — i.e., twenty-one cents a day, for it if you are wealthy, or you can get it free if you are not). I will speak of the food to be found here, instead of the hospitals.
"Americans enjoy making money," said a Swede to me; "Swedes enjoy spending it." And he added, "Americans know how to work; Swedes know how to eat."
Four of us Americans travelled together in Sweden, and one of the party was fortunate enough to know a formel* Chicago man (a Swede) who now lives in Stockholm. This man invited us to a Swedish dinner.
Now a Swedish dinner begins with Aqua- Vitw and Pihener, and ends witli Caloric PunscJi, and there are many things in between. 1 should not like to be assigned tlie writing u}) of such a dinner, and be required to have my co])y in for the next day's ])a])er. I would ratluM- do my writing for a niontlily inagaziix'.
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"" Sirnx'Tf/os hord,'" witli wliicli one begins a meal, is similar to a laiUer aufscJrnitt or hors d'cpuvres, and is composed of any old thing that happens to be lying about handy. It includes nnmy varieties of cold meats, and fish," caviare, sardines, pickles, salads, jellies and cheeses. (At one dinner I had twenty- eight varieties.) After you have eaten enough of this stuff to fill three men, then dinner really begins. There is soup; next the fish; and then a good, healthy meat course— steak, poi'k chops, or what not. On top of this a dessert, somewhat richer than New England mince pie, is served.
As Mulvaney might say: " 'Tis scand'lus." But this is not all. In order to see just how much the human organism can stand adjourn- ment is made to some cafe in order to drench the mass with coffee and Swedish punch, and to smoke big black cigars. I never happened to order Swedish punch at home, so I am not familiar with the way it is served at Rector's or the "Annex," but in Stockholm it is given you in much the same manner that pink lemonade is dished out at a church sociable.
The Opera House "Cellar" is a favorite place to finish a dinner. The Oj^era House at Stockholm cost six and a-lialf million krona, Tiot including the decorations. The
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STOCKHOLM
ceiling of the "Cellar" cost twelve thousand krona. It is a pleasant place in which to finish a dinner. There is nuisic, and lights, and laughter. The music is as good as that of the best cafes of Dresden, and a certain Swedish air runs for about four l)ars the same as "My Old Kentucky Home." "Oh, the sun shines bright in my — , " and I heard someone in our ijartv mention the "sad-eyed
'I'll i: ( M'i:i; \ Ilm -i ' i i i \ k
cows standing knee deep in tlie clover." We extend the cordon bleu to the cJief.s of Stockholm.
Oh, these dinners that wc all have eaten, })oth at home and abroad! What delightful memories they give us as we look back on them. Class dinners, wedding dinners, society dinners; dinners fartic carrc and ictc a fdc. There was tlie farewell dimier that our friends gave us when we sailed, perhaps. Then there was the Captain's dimier on the
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boat coming over, at wliich we sealed new friendships that we feel will last for many years. How many of us remember a great number of the places we have visited merely because of the food we have eaten there! Berlin is simply Ivempinski's to us; Paris is Marguery's and Foyot's. We don't care to see the Abbey at Mount St. ^lichael again, but we
would like to have another of Madame Pou- lard's omelettes. Venice is recalled, not by the canals and St. Mark's, but by that delicious cup of coffee we got at Florian's.
We who perhaps are living in the age of Fletcher, Chittenden, and otliers who would have us lunch on a lettuce leaf and a glass of Poland water, may be somewhat uncertain of the state of our gastric mucosa after our European dinners. It is well, at any rate, to have at home a copy of Ekkehard, and if you have gastric misgivings, turn to the chapter
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wherein the monks are entertaining the Her- zogin Hadwig and read : " Wohl erscliien zuerst ein dampfender Hirsebrei. . . . sich daran ersaettige; aber Schuessel auf Schuessel folgte, bei meachtigem Hirschziemer fehlte der Bae- renschinken nicht, sogar der Biber vom obern Fischteich hatte sein Leben lassen muessen; Fasanen, Rebhnehner, Turteltauben und des Vogleherds kleinere Ausbete folgten, der Fische aber eine unendHche Auswahl, so dass schHessHch ein jeghcli Getier, watendes, flie- gendes, schwimmends nnd kriechendes, auf der Klostertafel seine Vertretung fand."
After which reading, one may go to sleep with a clear conscience.
V.
UPSALA THE ROYAL UNIVERSITY THE TOMB
OF LINN^US.
The Royal University of Sweden is situated at Upsala, a sleepy old college town, sixty-six kilometres from Stockholm. Leaving Stock- holm at ten o'clock in the morning one can see the town and University pretty thoroughly and get back at seven in the evening. Besides the University there is a great Cathedral at Upsala that was begun before Columbus started for America and which has only recently been finished. There is also an im- mense Sloft (which may be translated palace or castle as you choose). Both of these are worth the seeing. One can see here also the home of IJnna^us, for here it was the great botanist lived and worked. The main build- ing of the University, the library, and the students, with their white velvet caps and canes, flitting about, constitute the chief at- tractions of the town for ordinarv tourists.
The matter of making calls is in many instances a solemn one, but the custom of leaving a visiting-card in the silver tray that stands before the bhick marble which marks
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the tomb of Linnseiis was almost as cheer- less as repaying certain dinner calls. We would not have been surprised if the sacristan had said, "Mr. Linnaeus is in, but is not receiving." How this unique custom of leav- ing your card for the dead originated no one
I \ I; 1 \ mn Lixn.kvs
seemed to know. But cards are left here bv the hundred each year, and when the silver tray is filled they are filed away in the library. Carl von Linuieus, the father of Botanv, died here in Upsala in 1778. When he first came to Upsala, as a youth, his main stock in trade seemed to be a desire for an education, for it is said that he lived for many nioutlis
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on one meal a day. Dr. Celsius, a professor of divinity, happened to discover his pro- ficiency in botany and gave him a start. He made good with such rapidity that his first published works aroused the jealously of the Professor of Botany, Dr. Rosen, and upon some pretext Rosen had Linnjeus dismissed from the University. This dismissal didn't seem to affect Linnaeus' work, for we soon hear of him as President of the Royal Acad- emy, and in 1741 he returned to Upsala to take the Chair of Botany and turn the laugh on Professor Rosen.
While Linufeus was able to make his department in the University of Sweden the most famous in the world, and to keep foreign nations and learned societies busy in con- ferring medals and degrees upon him, he was never able to classify his own little home herbarium. His wife was reported to be given to "frivolity and dissipation," and, notwith- standing tlie fame of her husband, she was finally denied admission to the Court. The five children of these two incompatibles went for tlie most part the way of the mother, altliough one daughter made some important experiments in ])hnit life, and a son, who never (fid anything out of tlie ordinary, suc- ceeded Linnaeus at the University.
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Linnseus was apparently a man who should not have married, for he did not have the happy faculty of mixing emotion with intel- lect, and it was undoubtedly his neglect of his wife that caused her to seek companion- ship in those whose knowledge was less cryptogamous than her husband's.
IIi>usE OF Linnaeus
We found the medical department of the University of great interest. There are about a hundred and sixty students of medicine here, and their needs are amply provided for. It is interesting to compare some points in the med- ical training here with those at home. Take, for instance, the course in ])athol()gy. T\\c student here has pathology I'ubbed into him
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foi- tliree years, and lie can get more if he wishes. There is a kirge building devoted wholly to pathology. It contains lecture- rooms, museum, post-mortem room, and nu- merous rooms for individual researcli. There are two professorships in this subject. Ulrik Quensel, who is chief of the department, is a pleasant man to meet. He has a pleasing smile and a nice little way of throwing back his head when he laughs, which he does fre- quently. All the time he was showing us about he held tenaciouslv to the butt of a small cigar. There was perhaps two centi- metres of it in all. Occasionally he would manage to get the end of it in the corner of his mouth, but would withdraw it quickly and look at it reproachfully. I could almost fancy he was chiding it for not giving him a longer smoke. Professor Vealberg, who has the chair of experimental pathology, is a short, somewhat fat, enthusiastic man. Rather quick in his actions, he is, as the Germans would say, not })OSsessed of siizfieisch. The students at Upsala are surely getting lots of good path- oloo-v under these excellent men and their assistants.
What is true of j)atliol()gy is no less true of the other de})artments. There is a fine ana- tomical institute here, of which Professor
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UPSALA
Hammar is the head. It is modern and finely equipped. In chemistry, Ilammarsten is too well known to need comment. Most of us who have studied medicine at home have used his text-book. After we had finished our round of the lal)oratories, we were taken to the University Hospital. This is a large, roomy building, situated in a beautiful park, in
A.NAiiMiiiAi, J.\.~irn ii.~l
which convalescents may wander about to their hearts' content. The hospital has some- thing over three hundred beds; patients are drawn from all over Sweden. Both Professor Petren, in medicine, and Lennander, in sur- gery, were away, so we did not meet them, but we obtained a good idea of the work that was bein<r done here from their assistants. Here at TIpsala it was that we h.id to get out our })est (lerman and air it. ]*reviously we
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liad conversed in English with nearly every- one we met. It really is remarkable how universally English is spoken here in Scandi- navia.
Again were we surprised at the excellence of the surgery here. Appendicitis is very common in Sweden. In one ward nearly every patient was minus his appendix. Many of the patients had also a general peritonitis. We saw one man, a student, who was a monu- ment to the care and skill of Swedish surgery. He had had a gangrenous appendicitis with diffuse purulent peritonitis. Several metres of gangrenous small intestine had been re- moved and he had been thoroughly cleaned out and plenty of fistuhie left so that he would have no work to do for himself. He was being fed tlirqugh a gastric fistula and evacuated through a faecal fistula. There was also a hepatic fistula. It was the third dav after the o])eration that we saw liim, and he con- versed with us in English. He said he had a sister in Cornell University, at Ithaca, New York. He w^as being fed on a well-known American infant's food. The combination made us feel much at home.
"We do better surgery here in Scandinavia than is done anywhere else in Europe," said Dr. Lennander's assistant to us naively, "but
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it is hard work." And he shriio-ired liis shoulders, as tlioiigh he thought the game was hardly worth the candle.
Not the least interesting part of our visit to Upsala was Professor Gullstrand's eye clinic. Gullstrand is a tall, thin man, not handsome, l)ut one who wins your confi- dence in a very few moments of conversation. You feel intuitively after being with him that you have met a great man. He s})oke English. At least he said, "If you will wait two moments, I w^ill dispose of you."
There is no better eye clinic in all the woild than this of Gullstrand's in this sleepy old town of Upsala. There is no detail lacking in equipment; nothing that is not essentially modern; nothing but the best. Things tliat Gullstrand has himself given to science were shown to us modestlv.
We looked at ourselves in the uncanny glow of the mercury vapor light tliat (iullstrand uses for determining hiemorrhages of tlie retina. We saw nuicli complicated aj)paratus that we were inca})able of understanding, for this laboratory is in trutli a wizard's shop.
On the whole one may say that Scandi- navian methcine is as good as tlie best. There is just as good work being done in America as there is here, l)ut tlie ])ity of it is there is so
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much bad work being done in America, Here there can't be much bad work; the training necessary to secure the degree of doctor of medicine is too severe. Uniformity of train- ing is wliat we lack at home. Surgery here is as good as American surgeiy, and that means it is way ahead of the rest of Europe. General medicine I should say was hardly up to what one might see in Germany, but never- theless very good. Medical science has here a high place. There are as many research laboratories, proportionately, perhaps more, than in Germany. And Scandinavia has surely given more than her ])ro]:)ortionate share of research work to medical science.
VI.
ST. PETERSBURG FEATURES OF THE RUSSIAN
CAPITAL ITS HOSPITALS.
From a medical point of view our visit to St. Petersburg is scarcely worth the writing, for we saw little that was medical. However, we will mention the journey if only to pre- vent others from going the same way, for personally Russia did not appeal to us. The sail from Stockholm to St. Petersburg, how- ever, is beautiful and is perhaps worth the trouble and discomfort of the days s})ent under the shadow of the Czar. We took passage in a dinky little boat, not so large as many of the Mississippi River boats, for our trip across the Baltic. There were (juite a number of passengers on board, and we felt that if we were foolish in going to Russia (as everybody in Stockholm told us we were) we had lots of company. Imagine our feelmgs, then, when on getting to Ilelsingfors, every- body save ourselves left the boat. Wc were the only ])assengers for St. Petersburg. Put, as I said, the sail is beautiful. First the ])ictures(jue coast of Sweden; IIkmi all day Ioujj: throuuh the thousands of islands that
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(lot the Baltic and are a part of Finland; and, finally, the magnificent and imposing approach to the heart of St. Petersburg itself, past the frowning forts of Kronstadt and the l)ig Russian battleships.
It was surprisingly hot for May, and we sweltered on the deck while at least two dozen uniformed and bemedalled officials examined,
KrssiAN DUOSCIIKE
signed, sealed, and countersigned our pass- ])()rts, and finally allowed us to leave the boat and be driven to a hotel.
The Russian droschhe (cab) is much smaller than its name {IswoscJifscJtik) would iniply, and the horses are smaller still, but tougher than wire nails — and they go at a great speed. The drivers, however, make up in size for the smallness of the rest of the outfit, and in
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their padded kimonos with a rear l)readth of something hke two metres somewhat obscure the view ahead.
St. Petersburg itself is a city worth seeing. The Nevskoi Prospekt is a wonderful street. I know of no other with which it may be compared. There are beautiful buildings along the Neva. The city is crowded with splendid churches and immense palaces; and in the Hermitage is one of the finest col- lections of paintings in the world. There are fine parks and theatres and comfortable hotels in abundance. But despite it all there is an odd feeling of oppression that strikes one the moment he lands on Russian soil, and one doesn't breathe freely till he is out of it all. Perhaps this passes away after a time; 1 should certainly hope so if I had to spend many days in Russia.
St. Petersburg is expensive. The prices are just about three times what they are in Scandinavia; a rul^le (53 cents) does not go as far in St. Petersburg as a mark (^-t cents) goes in Berlin. x\t the Hotel de I'Europe a man told me he had to pay a ruble foi- a Scotch high-ball. If tliat isn't a good tem- perance argument I don't know wliat is, and yet we saw more drunken pe()])le in tlie streets of St. Petcrsl)urg in tlu-ee days than
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I have seen in all Europe together in two siinuners' travel.
Vodha (a eonteni}jtiious diminutive of voda, "water,") the national drink, is a grain whiskey, pale, wliite. It is a little less burn- in<r than raw aleohol. Russians do not drink it, they gulp it down. They do not drink often; they cannot afford to; but when they do drink they get drunk. If you strike a small town on a holiday you find everybody in that town drunk. Desire for alcohol is a natural taste, and everyone takes all there is to be had when the opportunity offers. That is all there is to it.
The streets of St. Petersburg are fairly clean. Tlie city is very well managed from a sanitary standpoint. It cannot be compared in this respect to most of the other large Euro- pean cities, but is better than some of our American cities. There are twenty-six hos- pitals in the city, and several separate institu- tions in addition devoted to scientific medicine and research. The spirit in medicine is essentially German. All the better men, in addition to their five years' university course and liosj^ital service, go to Germany to finish their medical education.
One can take for a fair example of tlie avei'age liospital here the Marieii. AYe visited
0:2
ST. PETERSBURG
it, especially as it is one of the lios})itals solely for the poor. The patients in this institution pay nothing whatever. The l)uihlings are somewhat old, but spacious and well venti- lated. There is a central building (in which, as is always the case, there is a chapel) and two long wings on either side. There is a large well-ke})t court in the centre, rich in shade, in which the convalescents may wander. There is a large laboratory building for both clinical microscopy and gross pathology with autopsy-room and museum.
Seeing a Russian hospital is attended witli some formality. We made the arrangements for our visit with the head nurse, who spoke English, and who told us to come the follow- ing day at eleven o'clock and all would be prepared for us. The next day happened to be the Czar's birthday and we were somewhat euibarrassed by the remarkable uniforms tliat we found the attendants wearing wlien ^^(^ reached the lios])ital. The door-kee])er, for instance, was clotlied in a heavy robe of yel- low and red, wliicli was adorned witli rows of bhick double-eagles running from his shoulders to his feet. AVlicu we f()lk)wed him to the waiting-room we were very careful not to step on tlie ti-ain of tlie gown.
After we got by I lie lii'sl stages, liowever,
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and filially met the real medical men, we began to feel at home. We were taken from one department to another, and in each found the chief of the service awaiting us. iVll these men spoke German, but none of them that we met knew English. A detailed account of the visit is hardly necessary. Everything was essentially the same as in American or German hospitals. The patients were all clean, the beds were clean, the nurses were immaculate. In the gynai^cological wards, which we first visited, we saw over the beds (here the diagnoses are written in Latin script) the words, "Endometritis," "Myoma uteri," "Salpingitis," and so on. We did not see any operations but the operating-rooms were ade- (|uate and apparently aseptic. In every ward there were two separate operating-rooms; one for septic, and one for non-septic cases.
The nerve clinic interested us considerably. It was remarkably well equipped. In addi- tion to the ordinary electric, massage, and Rontgen-light apparatus, there was a large room for hydrotherapy. For the hose douche, there were installed engines in the basement which insured constant pressure of any de- sired degree. The neurologist (his card is in Russian and I'm sure the reader works hard enough as it is without having to translate it)
64
ST. PETERSBURG
told us that one hose douche was enough in a case of hysteria. After I saw the stream turned on I beheved him. The only thing I ever saw that compared with it in force was the stream from the nozzle of one of the New York fire-boat hoses that is arranged to hit the roof of a twenty-story building. No wonder the Russians hate to bathe if their idea of a bath is conceived from this appa- .ratus. One bath would ])e water enough for a lifetime. Seriously, though, there were ample bathing facilities in all the wards. The bath-tubs were large, with an ample supply of both liot and cold water and with inlet and outlet pipes of large diameter, so that no time need be wasted in filling and emp- tying the tubs.
We saw also in this depart- ment a patient treated for tri- facial neuralgia by means of the Rontgen ray. Such treat- ment was new to us, but we were assured that the idea was ''cms Avierika."
In the j)athological labora- tory I felt more at houie than in any })lace I have been since 1 left the States, for hardly
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had I entered when I noted two or three httle laboratory stunts in use that I happened to know originated in the hiboratory in which I used to work at home.
"Where did you get this idea?" I asked Dr. Schueninoff, who is chief of the hibora- tory, pointing to some material that was in process of preparation. "I got that from Chiari," he answered, "when I worked in Prague, and Chiari got it from Mallory wdien Mallory worked in Prague." Surely the pathological world is small!
There are about four hundred beds in this hospital, and yet Dr. Schueninoff averages six hundred autopsies a year. If a man wanted lots of pathological material I know of no better place in Europe to get it than right here. He would be welcome, and could do as much as he wished. He could have a seat in a large, well-lighted laboratory, with the autopsy-room at his elbow. He would find better technics practiced than in most German laboratories. But, sadly, he would have to live in Russia. Personally I wouldn't mind foregoing health, friends, and money, to fame; but if it came to a question of living in Russia, I would choose to die unknown.
However, we know in a general sort of way that mucli tliat is new in medical science
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ST. PETERSBURG
comes out of Russia. We are familiar with the recent work of Pawlow, and there is scarcely a physician in practice to-day who hasn't tried Kernig's sign in meningitis. Perhaps all physicians are not aware, how- ever, that Kernig is a St. Petersburg clinician.
r wvi.dw
There has been no greater name in chemistry tlian that of Mendeheff. Perlia})s it is true, as lias l)een suggested, that cut oil' from ])()litical activity, the energetic minds of tliis great empire devote themselves with especial vigor to science and ])articularly to me(h'ciiH\ It is stated tluit a more perfect medical
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faculty exists in Russia than is to be found In Vienna or Berlin. This may account for the hi(j;h standing of the average practitioner in this country.
Here in Russia there is no fee for medical treatment. Nobody ever asks a physician for the amount of his bill. It is universally under- stood that a gentleman pays his j^hysician a fair sum — such a sum as he can afford to pay within the limits of his income and his sense of generosity. The Russian mind cannot con- ceive how a man engaged in the holy pursuit of saving life and alleviating suffering can put a price on his services. This custom of generosity in giving service and trusting to a like generosity In receiving reward for the same is a beautiful one, and cuts out from medicine what William James would call "the Trades Union Wing of the profession."
The Russian country through which we travelled on our way to the German border was not without interest. We were met everywhere by children begging for coppers. Tliese children were tlie best natural actors 1 have ever seen. A ragged urchin who ap- proached me had the faculty of hlling his eyes with tears at will. It was wonderful to watcli his changing expression; the cunning gleam that he sized you up with, the tear-
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stained face of appeal, and tlie grin of satis- faction with which he departed after lie had grafted you for all your loose kopecks.
Another thing that surprises the traveller here in Russia is the large number of small hospitals scattered throughout the country. There is scarcely a town of any size whatever
EvssiAN Pkasants
but has its hospital. Certainly we would not look for hospitals in towns several times the size in America. The little hospitals arc situated on the edge of the town, usually wdiere there is plenty of open s})ace and shade. The buildings are of brick and arc one story high. Trained nurses in uiu'fonns and young physicians in white duck arc in cliargc. Everything about these hospitals is scriipu-
09
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lously clean. There is no dirty ])ed-linen, no (lisagreea])le odors, no unclean wood-work. Each of these hospitals has an adequate laboratory and surgical equipment.
All of this is far removed from what we would naturally expect to find in this con- tradictory country, but a reason for these hospitals may be sought in the desire of the zemstvos to lessen the economic plague incident to the ravages made by disease and epidemics on the poorly-fed and badly-housed peasants. The zemMvo, or territorial assembly, by the way, is a body composed of representatives of all classes which takes the place of the old nobility assemblies and concerts measures for the common good of the people.
The shortness of the life average (half the children born in Russia die before reaching the fifth year) makes the unpi-oductive age out of all proportion to the productive age, which is a bad thing economically for any nation.
The zemstvos have done everything they could naturally to decrease this mortality, but their lack of funds makes it difficult for them to secure first-class medical men. I was told that the pay of these physicians was not more than K)() or (lOO rubles a year (^200 to 800 dollars) and one can't drink Scotch high- balls on that salary in Russia.
70
ST. PETERSBURG
I was also told that lack of money was not the only tiling the zemstvos had to contend with. There was really an insufficiency of medical men for its needs. At the time of the death of Alexander II there were only 3000 medical students in Russia, and of these only about 300 graduated each year. Think of this for 140,000,000 people, and compare it with our medical (and so-called medical) fledslinirs that are turned loose on the com- munity each year. Is it any wonder that so many young Hebrews, who are cjuick to see a good o})ening, are going into medicine eacli year, and are crowding the German universi- ties, when they can go cheaply, to overflowing.
Not only men but a great many women are going into medicine here in Russia nowadays. For some reasons they are considered superior to the men. They do more, and they live on less. They have a way of overcoming the old medical superstitions and insinuating hygienic ideas.
The zemstvos themselves have founded modest schools, in adtlition to the Govern- ment female medical annexes, for the educa- tion of women physicians and surgeons. So that now these women, who seem to possess a real longing to be of use to the people, will find ample scope for their noble i)assion.
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We did not leave Russia witlioiit investi- gating the food question. We tried every- thing, and at times "got stung." But in general Russian food is the real thing. One has never drunk tea till one has tried it in Russia, and the caviare as one gets it here is something to live for. Caviare is the one thing in St. Petersburg that is comparatively
MciNUMKNT TO I'KTKIl 'JHE GrF.AT
cheap, and we nearly ruined our gastric mucosa with it in trying to get square for other deals. There is an interestino; restau- rant here, whei'e one is given a net and is allowed to scoop up from a big tank in the centre of the room the fish he desires to be served with. As St. Petersburg is a winter city, we did not see it at its best, when it is filled with the gayest society in all Euro})e. But it is away from St. Petersburg after a
72
ST. PETERSBURG
hard day's travel one really enjoys the food. The national dish of Rnssia is cabbage souj). It is made of sonr cabbage and water (empty ''shtshi"). With fresh fat beef and clotted cream added {smietana) it is a dish for kings. A bowl of this soup, a dish of buckwheat, baked porridge, and a pot of tea from the smoking samovar, which is found in every household in Russia from Tsar to mujik, is better than all the dinners the big hotels of the cities can supply.
VII.
BERLIN ANGLO-AMERICAN MEDICAL ASSOCIA- TION TYPES OF AMERICAN STUDENT.
The Friedriclistrasse Balmliof is in the centre of Berlin. On one side of it is the Central Hotel, and in the Central Hotel is the Restaurant Heidel))urger. A man at the door, clothed in a brown iniiforni, touches his cap to you and says, "Mahlzeit, " as you enter. You pass through a number of rooms filled with tables at which sit the types of men and women that will soon become familiar to you, and you glance enviously at the tall steins of Muenchener and Pilsener and the plates of wurst and cotelette and schnitzel. Then you lose your way, and you say some- thing to a waiter who doesn't understand your speech but who smiles and jjilots you to a stairway; you ascend and enter a big room and presto — you are no longer in Ger- many (except for the steins), for here is English sj)eech and familiarly cut clothes and smooth faces and the radiance of good cheer that can come only from a group of fellow- countrymen, far from home, who are united by the firm band of fellowship in medical study.
74
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»-4
BERLIN
This is the Anglo-American Me(Hcal Asso- ciation of Berhn, a society ore:anized in 1903 by Dr. J. H. Honan, of Berlin, for tlie pur- ])ose of promoting the interests of Anglo- Americans seeking courses in medicine in Berlin.
It is needless to say that Berlin is a big city; that its customs are not our customs; that its clinics and laboratories are not all in one place; and that a man, coming to Berlin for the first time, with no definite knowledge as to just what men or what courses he wants, can waste many valuable days, or weeks, in frettinc: settled down to his work. It is the idea of the Society to obyiate this waste of time as much as ])ossible by giving tlie new- comer a clear idea of the various courses given, both jjrivately and by the university; the cost, value, duration, and time of com- mencement of the same; to tell him what to avoid (for there are courses to be avoided, even in Berlin), and to extend the hand of good fellowship to the lonesome. Moreover one hears here on each Saturday niglit (which is the meeting time of the Society) an informal talk by some one of the great methcal men of Berlin. For the above enumerated j)rivileges the new-comer pays the sum of two marks, which makes him a })crpetual nieuilxM- of the
MEDICAL EUROPE
Society and entitles him to an annual report, which is sent to his home address.
There are, on an average, about thirty men present at these Saturday night gatherings. It is estimated that there are always present in Berlin from forty to seventy Americans who are here for the purpose of studying medicine. The average duration of stay is three to four months. Of course many men come for a year or two years' work lierc, but the number of practising physicians who have only a month or two of vacation that they wish to spend in study, cuts the average down. So it is that the faces at the club are constantly clianging. But one man goes on forever, and that is the worthy president, Dr. J. II. Ilonan.
It is largely due to the efforts of Dr. Ilonan that the clul) is the success it is. He is an American, a former resident of Chicago, and at present permanently located in Berlin witli a large American practice. It is rare indeed to visit the club on a Saturday night and not see Dr. Ilonan's face at the head of the table. Even if you have returned to Bei-lin for a second time, the club is as if vou left it vester- day, for Dr. Iloium, and his l)e]l with which he calls you to order, are just as you left them years l)eforc.
The Doctor is a large, well built man, with
78
BERLIN
luxuriant black whiskers. He wears always a frock coat, white waistcoat and tall hat. lie has a full, deep, resounding voice, and when he rises and says, "The society is especially honored to-night" (he never forgets to em- ])hasize the "especially") "by the presence of the world-renowned Geheimrath-Professor So- and-so, who will speak to us on that subject w^ith which his name is everywhere associated in the medical world, etc.," we all stand up and cheer and are (juite sure that we are getting (as a chap from Green Bay, Wisconsin, expressed it) "the right kind of dope."
And then when the Geheimrath-Professor So-and-so has concluded his remarks, and, in accordance with a motion of thanks feebly offered by some humble member in tlie back of the room, Dr. Ilonan rises and announces, "It is moved, and seconded, that the Anglo- American Medical Association of Bcrhn does hereby most emphatically and unanimously extend its cordial and sincere thanks for the exceedingly interesting and instructive lecture which we have had the honor and ])leasurc of listening to to-night," we all rise and bow, and the G.-li.-Professor bows, and we a|)- plaud a whole lot more, and finally sit down, feeliuir that the TJ. S. A. can surely <lo the proper thing al IIh^ projx-r lime.
MEDICAL EUROPE
No one can know Dr. Honan without feel- ing that he has met a real man; an earnest, enthusiastic, unselfish, whole-souled lover of medicine and medical education in its best and broadest sense.
It is not every man who, for no compensa- tion save the knowledge that he is helping his fellow men, would devote the time and energy to such a thankless task as has Dr. Honan. For remember, the men that constitute the club come and go. They get only a thin cross- section of the structure that Dr. Honan has built and which needs constant attention to keep from crumbling. Only a few stay long enougli to appreciate and to thank him for the work he is doing.
And the officers of the Society are also deserving of much praise. No one except a man who has been associated with the club in an official capacity realizes how many evenings are spent in looking up courses and writing letters and making up sections for the many men who are constantly writing to the club for lielp. But these men all do their work cheerfully, and I hope they will know tliat one American at least appreciates all that they have done to make Berlin the best city in the world for an American student.
There is always a formal business meeting
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BERLIN
after one of these Saturday lectures, wlu'eli includes such reports as those of the Orien- tieren, Program, and Library committees, tlie announcement of new courses, and what not. I had nearly forgotten to state that the two marks' membership fee includes the use of the reading-room and library. The latter is
Al tlic next rLf^iil.ir weekly rtiectint; of the
Anglo-American Medical Association of l^erliii
'/
at the Restaurant MeidsJ^berger, Saturday vvpnnji^^t^^c^J.- i^
al 7,30 o'clock ^^
will address us. Subject-..-
Secretary
at Rothacker's book-store, Friedrichstrasse 1().5B. Here are to be found a very good list of PvUglish, French, and (ierman journals, which have been donated to the Societv by the ])ublishers. Stationarv is also furnished gratis, and is of that peculiarly arranged Gernum variety tliat weighs exactly one-half ounce foi- two sheets and tli<^ envelope, so that the addecl moisture of seeding the leller enables the post-office officials to charge up 6 81
MEDICAL EUROPE
ten cents overweiglit for the people at home to pay.
The lecturer of the evening speaks nearly always in German. Unfortunately tlie ma- jority of the club are somewhat short on German. They have the privilege of seeing a great man but they carry away little of what he says. One man who sat attentively through a meeting, after listening to an hour's lecture by Dr. Bruel, turned to me and said, " Well, I got one word out of that — Tuherlxulose!'"
The experiences of the men, as related over the beer when the meetings are officially over, are always of interest. They are as varied as are the types of Americans one sees here themselves. " This is a bum town, " says some fellow from the backwoods of the good old U. S. A., who has come over with the expec- tation of helping some prominent surgeon do laparotomies during a three weeks' sojourn; " I've been here darned near my time limit now and I haven't been near enouo:h to an operation to see it through an opera-glass." x\nother says, "What's the use going to these l)looming clinics when you can't tell what tlie fellow is talking about ? I should think tliey would learn to speak English."
I actually met a fellow here once who had by mistake got into a course in gross path-
82
X
BERLIN
ology (I haven't the least idea what lie thought he was getting). He watched the instructor nervously for a while, doing a rather difficult dissection of the thoracic duct in a case of miliary tuberculosis, and then dug his elbow into my ribs and said, "Say, what's he wast- ing so much time on that woman for? She's dead, isn't she?"
There are also men like a tall Westerner who stalked into Bier's operating-room one day, pushing aside nurses and assistants, and who having reached the centre of the room stopped, looked around and said in a loud tone of voice: "Say, I want to see IIyper?emia. "
But all Americans (Gotf -sri (J(mL') are not like the above, and the Germans know it and ap|)reciate it. There are always a good lot of clean, eager, industrious, luilliant workers here from our country, and some of them have turned out pieces of research from the Berlin laboratories of which the chiefs are })roud. There is always a chance here for such men to ir^t anv and all kinds of work; as well as intimate association with tlic leaders of (jierman surgery, clinical and scientific medicine.
To show the value of the wSociely, aside from its other good work llic following list
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of speakers for the Winter of '06-'07 is appended:
Septeni])er 29, 190G. Address hj the Presi- dent on development of the Association, followed by social evening.
October 0, 190(). Prof. Dr. Stoeckel— Some New Gynaecological Operative Methods of Treatment.
October 13, 190(5. Dr. Panl Cohnheim— Chronic Intestinal Catarrh.
October 20, 1906. Prof. Moeller— The Early Treatment of Phthisis.
October 27, 190G. Prof. Max Henkel— Therapy of JNIyomata of the litems.
November 8, 190G. Dr. Knorr — Cystoscopy and Catheterization of Ureters.
November 24, 1906. Dr. R. Cassirer— Path- ology and Treatment of Tabes Dorsalis.
December 1, 1906. Dr. Thnmin — Pnrpose of Cystoscopy in the Female.
December 8, 1906. Prof. Dr. Didirssen— Vaginal Hysterectomy.
December 15, 1906. ' Geh.-Rat Prof. Dr. Miller — Pacteria of the Month and their Relation to Internal Diseases.
December 22, 1906. Prof. Dr. Kranse— The Statns of ]*resent-I)ay Surgery of the Prain.
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BERLIN
January 5, 1907. Geli.-Rat Prof. Dr. Brieger — Hydrotherapeutics and Other Methods of Treatment.
January 1^2, 1907. Dr. C. S. Engel— Normal and Pathological Appearances of the Blood.
January 19, 1907. Prof. Dr. Rosenheim — Colitis.
February 2, 1907. Geli.-Rat Prof. Dr. Iloffa — Chronic Joint Rheumatism and Arthritis Deformans.
February 9, 1907. Dr. Frank — Sexual Neu- rasthenia following Gonorrhoea.
February 16, 1907. Prof. Dr. Baginsky— Tubercular and Simple Forms of Cerebro- spinal Meningitis.
February 2^2, 1907. Dr. Ritter— Surgery of the Frontal Sinuses.
March 2, 1907. Prof. Dr. Ko})lanck— Car- cinoma of the Uterus; Differential Diagno- sis and Treatment.
March 9, 1907. Dr. Edw. Saalfehl— Treat- ment of Skin Diseases with X-Ray.
Marcli 16, 1907. Prof. Dr. Nagel— Diag- nostic Significance of Haemorrliagc from tlie Female GenitaHa.
March 23, 1907. Dr. Paul Colnilicim— Ilyperclilorliych'ia of the Stomach.
March 30, 1907. Dr. Laiurstein— Infant
FcecHng.
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JNIEDICAL EUROPE
April 6, 1007. Prof. Dr. Schlelch— Theory of Pain, and Latest Development in Local and General Anaesthesia.
April 13, 1907. Dr. Karewski — Debatable Points on Anaesthesia.
April 20, 1907. Dr. Westenhoeffer— What to do with the lAuig in Tuberculosis.
April 27, 1907. Prof. Dr. Grawitz— Value of Blood Examination to tlie Practitioner.
May 4, 1907. Geh.-Rat Prof. Dr. Bumm— Gonorrhoea and Marriage.
May 11, 1907. Prof. Dr. Hildebrandt— Tuber- culosis of the Joints and its Treatment.
May 25, 1907. Dr. Albu— Differential Diag- nosis of Chronic Cholelithiasis.
June 1, 1907. Dr. Oestreich — The Position of the Stomach.
June 8, 1907. Prof. Dr. Borchardt— Cere- bellar Surgery.
June 15, 1907. Dr. Joseph — The Latest Facts About Sypliilis.
June 22, 1907. Dr. Fleishman — Serum Therapy.
June 29, 1907. Dr. Ludwig Pick— Some Facts About Tumors.
July 6, 1907. Prof. Dr. Blumentlial^Balneo- (Hetetic Treatment of Ki(hiey Diseases.
July 13, 1907. Geh. Prof. Dr. Senator— Lung Emphysema.
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BERLIN
July 20, 1907. Dr. Fritz Meyer— Progress in Serum Therapy.
July 27, 1907. Prof. Dr. Dietrich— Recent Researches in Causes of Carcinoma.
August 10, 1907. Prof. Dr. Klemperer — Recent Researches in Tuberculosis.
August 17, 1907. Dr. Ernest Fukl— Physi- ological Chemistry.
YIII.
BERLIN CONTINUED THE AVEST END VERSUS
THE LATIN QUARTER — THE ROYAL CHARITE HOSPITAL.
Before beginning work, it is of coiu'se necessary for a man to find a place to live, and that in Berlin, notwithstanding the thou- sands of pensions and furnished rooms, is not always an easy matter. Happy is he who comes provided with an address of a place in which some of his friends have lived and which they have found satisfactory. It is with no desire to advertise the following places that this list is included here, but these places are especially recommended by the Anglo-American Medical Association of Berlin :
Near the Clinics is the Pension Kurzhall, Luisenstr. 67; Pension Jendritza, Karlstr. 31; Pension Kromat, Charitestr. 9; Pension Iloeven, Charitestr. 3; Furnished Rooms, Al})rechstr. 2*2.
In the Resident District is the Pension Belmont (American), Victoria Luise-Platz 10; Pension Clare (American), Heilbronnerstr. 25, Miss Hunt (American), Kleiststr. 11; Pension
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BEllLIX
von Heuckmann, corner Wichmann- and Keitlistr. ; Pension Frau Prof. Neumann, Kalkreuthstrasse 5; Pension Tschensclnier, Kurfurstenstr. ll^.
The Pension Hoeven at Charitestr. 3, I know about personally. The Hoevens were for many years at Albrechstrasse 2!2, which place has always been a fa\^orite with Ameri- can medical men. In their new })lace there are four bath-rooms (just think of that in Berlin!) and they are not used for storing coal or for wash-tubs, as most Berlin batli- rooms are, but actually supply you witli hot and cold water every hour of the twentv- four. x\nd besides "Tilly" is there to mother you and to see that there are no holes in your socks. There are many of us who will always have a soft spot in our hearts for "Tillchen."
Roughly speaking there are two parts of the city where medical men live. Tliey either go far into the West End, or else camp down in the so-called Latin Quarter, at the doors of the principal clinics. The West End is beautiful; the houses are roomy and well ke])t, there are lots of fresh air and flowers, and everywhere about are open-air cafes and gardens where one can hear good music as one drinks his eveuing Ixmm-. l^il I lie
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West End is unhandy, It is so far from all the clinics. Street-car service in Berlin is adequate, but it is slow. If one lives near the Zoological Garden he can get to Friedrich- strasse quite quickly by the Stadtbahn, but then one must take a bus or a car to get to his clinic. When I lived in the West End I figured on killing an hour each tri]), and
I'ark 'IV •! II i: CiiAi'.ni' — (i
11 i:' II A r nil. Ill'
frequently I was longer getting to my work. The expense of urban travel is, however, veiy little. One can get a Stadtbahn ticket good for as many rides as one chooses to take from the first of one month to the first of the next, for three marks (72 cts.). The regular tariff on the street cars is a little less than half our fare (ten pfennigs). One can travel quite a distance on an omnibus for five Dfennis-s — a fraction over one cent.
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BERLIN
For convenience and pi-oxlmity to work it is perhaps wiser to live in the "Lateinisch Viertel," even thougli some of the houses be okler and (hirker, and — mayhap — more noisy. Nobody stays in the house in the evening here, anyway — unless it is some weak-minded American who has promised to write Berlin letters to his editor at home. We can bound this student territory rouglily ])y Invaliden- strasse and Dorotheenstrasse on the north and south respectively, and extending })etween Wilhelm Ufer and Grosse Hamburgerstrasse. Those who are working in anatomy or in the Charite find Luisen, Philipp and Karl streets convenient. Lusienstrasse is also handy for tliose who are attending Bumm's ol)stetri('al clinic. Olshausen's clinic is on Artiherie- strasse (those working in obstetrics must of course be near their work). The latter street is also convenient to Ziegelstrasse, where one finds Max Joseph, Bier, and Senator. Here, also, is the medical library in the Langen- beck Ilaus, in whicli one can read by getting permission from Prof. Ewald.
There are two methods of living, adopted I should say in about equal measure by Americans, i.e., full pension, or fiiiiiisli(Ml room wilh breakfast, wliich last leases one free to eat luiiclies and dinners wliei-e one will.
T^IEDICAL EUROPE
In tlie West End one is more apt to live en pension. In the students' quarter it is better to de})end on the various restaurants, which are convenient and comparatively inexpensive.
Wliat does it cost to live in Berlin ? One cannot answer such a question, any more than one can tell you what it costs to live in New York or Kalamazoo. Tlie booklet of the As- sociation tells you that tlie cost of living in Berlin is the same as in New York, London, or Paris. It costs just as much as you choose to spend. Perhaps the average cost of full pension (room, meals, and service) in Berlin is one hundred and forty marks a month (about thirty-five dollars). A lucky man may find a good pension for a hundred marks. It is rare that one pays over a hundred and sixty marks.
For a furnished room one i)ays from twenty- five to fifty marks. The dift'erence in price does not depend so much on the room as on whether you are short and fat and blond with a stringy Schnurhart and say: '''' Bittc, gnacdige Fran, Ich wue7iche gem ein moe- bliertes Zimmer zu bekomTnen," or are tall and lank and smooth-faced, and say, '^ Ilahen sie ein — ein — a room to let.^" This price, how- ever, includes only tlie room (unless two clean towels a week and a change of sheets monthly
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BERLIN
be worth mention). BccUcming (service),
liglit, heat (and anything else), are all extra.
Americans are inclined to kick at these extra
charges. For such people there are always
landladies who make you an "inclusive"
price. This is
usually about a
third more than it
would be if you
did the extra
arithmetic, but it
pleases the afore-
said average -r
American and he
assures you that he is
not getting soaked by
extra charges — even if i
he is paying double what r
you are by the otlier
method.
Having found your room and locked up your patent leather shoes (wliicli lallcr you will do at once if you are familial- witli Ger- man shoe })olish), it is well to take a turn about and see what Berlin has to offer in \\ic way of hospitals. Naturally one begins willi the Boyal Charite.
The Charite is by no means ;i ukkIcI lios-
'J5
JilEUlCAL EUROPE
pital. It impresses one as an ununiform village — and so it is, a collection of bnildings of various form and varied age, with no par- ticular grouping, scattered here and there amid trees and non-parallel streets, and sepa- rated from the busy whirl of Berlin, in one place by a wall, in another by a row of tene- ments, in still another by the yards that
Grounds (if the Chakitf.
buttress the Stadtbalm. There are beautiful new buildings here, notably the new Patho- logical Institute, which has for its equal only one other such building in the world and that the new Rockefeller Institute for Medical Research, in New York. There are also here buildings so old that you fear lest your feet go through the j)lanking as you walk the wards, and the smells that arise On a hot day
9U
Ki'iMji,ru Viuniiiw
BERLIX
make you wonder if they were ever ventilated. But it is tliese same old l)uildin2:s that call the student of medical history first to the Charite, for here was made much of the German medi- cine that we from the West come to seek.
Personally, I am not at all romantic, but when for the first time I came upon the old weather-beaten Iniilding, with its now cruml)- ling })laster-walls, where Rudolph Virchow erected the frame-work of cellular pathology for all scientific medicine to build u])on, I stood for a full hour with my hat in my hand, my mind struggling to grasp the secret of his achievements. And when finally I came back to earth 1 had no desire to jjo throu<i;h the new Institute across the way, but reserved that visit for another day and went slowly homeward.
The foundation of the Charite dates from the year 1710. Tlie cause of the erection of the first building was the outbreak of tlic plague in Prussia, in 1709, but the plague spared Berlin, and the l>uil(ling was used as a poor-house and garrison infirmary. In 17''2(> the Royal Charite really first became a heahng and teaching institution. The foundation of the University caused a need of clinics for medical instruction and led lo nu Mgrceniciil between the Um'versitv and the Cli.nili' wIkmc-
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'by one part of tlie Charite was turned into university clinics. The names of the men who have been chiefs of chnics in the Charite woukl ahnost be a hst of the men who have made German medicine what it is to-day. In surgery there was Johann Rust and Dieffenbach; and hiter Adolf Bardeleben (who was the first to introduce antiseptic
Surgical Clinic — Chaiutk
surgery into Germany), and Franz Koenig. The first director of the medical clinic was Johann Christian Reil, famous as a fighter for freedom in the treatment of insanity. Schoen- lein was one of the first to introduce micro- scopical and chemical methods into clinical diagnosis. Theodor Frerichs is known for his contributions to our knowledge of dis- eases of the liver aud kidneys, and diabetes.
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The fame of Ludwig Traiibe brought students to BerHn from many L^nds. In psychiatry and nerve diseases there have been such men as Griesinger and Westphal and Jolly.
The old Pathological Institute I have al- ready referred to. It was founded in 18.5G. Here, Indeed, was a golden hive. First Johannes ^Mueller's proposal for a })rofessor
N I i;\ i; I I INir — I 11 \1;1T1.
of pathological anatomy (a then unheard-of chair), then the filling of the chair by \'ir- chow and behold — the development of a new epoch in medicine. Besides Virchow, here were also Cohnheim, Obermeier, and I.icb- reich. And of Virchow's assistants wlio wen I out from here to take professorships in other universities may be mentioned (Jrolic. Klcbs, Bccklinghausen, lIuchM-, Cohnheim,
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Roth, Ponfick, Orth, Grawitz, Iloppe-Seyler, Kueline, Liebreicli, and Salkowski.
But the men of the Charite are not all of the past. Here it Is that to-day one finds many of the men famous in the world of medicine. At the head of the new Patho- logical Institute is Johannes Orth, a worthy successor to the great Virchow, and associated with him are Kaiserling and Davidsohn. In medicine there are von Leyden and Kraus; In surgery, Hildebrand; in children's diseases, Heubner; in nerve diseases, Ziehen. Really, the list is too long to detail.
IX.
BERLIN CONTINUED HOSPITALS AND CLINICS
LASSAR AND HIS WORK HOFFA.
There may be cities that have hospitals of finer construction tlian those of Berhn, and there are others that have hospitals larger tlian any Berlin yet possesses, but there is no city that has so many, so fine, and so large hos|)itals as are to be found in the German capital.
The Charite, which is perhaps of most interest to Americans owing to its connection with the University, we have already referred to. But of no less interest are the great groups of buildings, scattered throughout the city, known as "Die Staedtischen Kranken- haeuser." These city hospitals in Berlin do not stand in direct relation with the Univer- sity, as they do in many other German cities, but they serve their ends for teaching purposes. The prosectors (patliologists), for example, are all university docents or })rofessors, and instruction in this branch is given to students and graduates, as well as research ])hK'es being provided for suitable men. These hospitals also offer numei-ous places for assist- ants, botli in mediciiH^ and surgery.
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These city hospitals are the Moabit, Tiirm- strasse 21; Am Friedrichsheim, Landsberger Allee 159; and Am Urban, Urbanstrasse ISO- ISO. By the time this is read the new Rudolph Virchow Hospital will be open. Then there is the new City Hospital in Char- lottenburg, which is essentially a part of Ber-
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lin's o:i'eat West End. The Moabit and Friedrichsheim hospitals are old in a sense, having been founded in 1873 and 1874 re- spectively, but are essentially up to date in all respects. One can get lost amid the trees and flowers of the grounds of the Moabit, although it is in the heart of the citv. Each of these liospitals has over a thousand beds.
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It is the new Rudolph Vircliow Krtinken- haiis, liowever, that attracts the attention of the visitor, and even after you have been tohl all the wonders of this institution by a friend, your surprise is none the less keen on your first visit. This place is not an institution — it is a town in itself; a beautiful village, with wide streets and beautiful gardens and mairni- ficent trees. There are fifty-seven buildings in this village, all representing the highest de- velopment of architectural and hygienic skill. There are large buildings divided into wards for patients that are temporary and do not demand the care and ex})ense of isolation. On the other hand, there are small buildings, to give most careful detailed treatment to such patients as demand special care. There are laboratories without number; chapel and con- servatory; everything, in fact, that one can think of. This hospital will care for eighteen hundred sick. It covers so much ground that the cost of land alone would make the erection of a similar institution in New York C'itv, in any accessible })lacc, ])r()hi])itive.
Then aside from these great city hosj)itals there is a list of private institutions too long to chronicle. In some of these })laces, how- ever, the Americans find their ])est o|)p()rtunity for work. In the Augusta Hospital lli("i(> is
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Krause the surgeon, and Ewald the internist (he does not Hke to be called "a stomach man"). The Jewish Hospital has Israel in surgery and Lazarus in medicine, two of the leading men of Berlin. At St. Hedwig's there
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is Rotter in surgery and Wirsing in medicine. How can an American physician who is just over on a sightseeing trip and does not wish to stay in Berlin for extended work, see what these hospitals have to offer .^ Simply hy "butting in." Go to the jxyriicr, pass out your card, and a mark (two bits), and you
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may rest assured tliat you will see all there is to see. It is really remarkable, how German physicians and surgeons, some of world-wide fame, keep their good nature and maintain a uniform courtesy, interrupted at all times and all hours as frequently as they are by American visitors; yet I have not known of a single instance where courtesy was failing to a visitor. In fact the American usually complains of the detail with which an institution is shown him, and comes away from a hos})ital at which he has expected to spend thirty minutes only after a three or four hours' personally con- ducted tour.
In regard to hospital calls or personal calls on particular medical men one wishes to see, a word can l)e said reo-ardino; cards. The cards that some American })hysicians carry with them are ludicrous. They are lai'ge pasteboard affairs (I have seen one that was engraved on aluminum) covered with tele- ])hone numbers, office hours, memberships in county medical societies, and perha])s also j)rofessorships in some one-horse medical college. Such cards niay impress the po/'//V/\ I remember explaining to a certain porticr that the telej)hone number re])resented the number of major operations the man liad (ione, and the office hours represented his fee
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for consultation in dollars. If anyone who has a telephone number in the thousands, and office hours from 9 to 12, strikes that partic- ular porfier, he will "cut ice."
If you are going to see a Berlin professor's clinic present only your simple engraved visit- ing card, with your city written in pencil in one corner. The Germans, it is true, use big cards with the story of their life thereon, but, notwithstanding, they know that such are not the proper thing for Americans.
Interesting and instructive as are the hos- pitals of Berlin it is really the Polyklinik that offers the greatest attraction for the Amer- ican. The Polyklinik corresponds to our out- patient department. Here these clinics are tucked away almost anywhere. You find them at every turn. A narrow stairway over a little shop, that looks like the thousands of other stairways leading to the apartment of the Berliner (and it might be added sotto voce the Berlinerin) may lead you to the clinic of some man who is famous throughout the entire medical world.
Many chapters might be written concerning these clinics and their chiefs, but we will only visit a few.
Max Jose})h is not a ])rofessor in the University, but he is one of the most popular
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teachers of skin diseases in Europe. lie is a large, well built man, with full beard. When he talks, he se})a rates his lips widely so that two even rows of teeth are seen, and vou hear what he is saying. There is nothing of Ger- man deliberation about Max tToseph's clinic. It is a three-ring circus and Joseph is master of all three rings.
The clinic-rooms are small and dirtv and poorly lighted. They are overcrowded witli pu})ils, who are for the most part Russian Jews and have a formation for surrounding a patient that " Hurry-up " Yost's foot l)all team couldn't break through. Into this crowd the patients are poured l)y the dozen, and tlien the performance begins.
Treatment, diagnosis, examination, pathol- ogy, are being hurled at you all in a bunch. Wliile you are feeling a herpes, Jose})h is giv- ing you the treatment of alopecia, and as you jump for the alopecia, you find Josepli has dropped that and is demonstrating an epithe- lioma. Before you get to the ei)itlielioma you are caught up in a crowd that is rushing madly into another room wliere Joseph is already talking about an infantile eczema.
"If Josepli had not been a greal dciiiia- tologist," said the Amei-ican who caiiK' out with me, as we walkc<l down Ziegclslrasse,
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*'lie would have been a fine man for a side- show barker."
Just across Friedrichstrasse and down Karl- strasse is the chnic of Prof. Oskar Lassar.* Here is a hirge, well constructed clinic-room, with projection apparatus and well arranged seats for the students. The walls of the room are hung witli diplomas without number, which have been sent to Lassar from all over the world. And Lassar deserves them. Las- sar should go down in history as the greatest man, or at any rate the most marvelous man, Germany has ever produced. We hear of Goethe and Frederick the Great and Bismark. But what did tliey ever do .^ A few poems; a few battles won; Germany unified. Almost any man of ability could have done those things, given the opportunity. But Lassar entered upon a campaign the stupendousness of which can only be conceived by those who are familiar with the great mass of Germans, and who has met them in a crowd on a hot day. Lassar has made the majority of middle- class Germans recognize the value of a bath. Since Lassar began his campaign there are men and women in Berlin who now wash themselves. Therefore the diplomas.
* Oskar Lassar died from injuries received in an automobile accident, December '■23, 1907.
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Lassar Is himself a clean, well-groomed man, with ever the merriest twinkle in his bright eyes. His hnmor is delicious, and an hour in his clinic is a delight worth the ex- pense of a trip abroad to experience. One forgets he is learning dermatology in the pure joy he gets from seeing Lassai* liandle his patients.
A poor little girl comes in to the clinic with xerosis pigmentosa. Those disfiguring freckles must be burned away with tlie red- hot cautery. Lassar greets the girl as though she were a princess. "Shall we try the face to-day, or the hand.^" he asks, in a way he might say to a friend " Will you have s})arkling burgundv, or moselle?"
The girl averts her face and you can see the tears start in her eves. She stretches out her hand.
"Ah," says Lassar, "the Land. Tliat is good. And we are not going to cry, for here are ten ])fcnnings. "
There has been a slight sizzling sound and we get a faint odor of l)urnt fiesli. Tlic girl has bit her lip, })ut the tears have come no farther. In her free hand she grasps a bright new ten-pfennig piece.
"You are a brave girl niid you inusi buy an ansichts Karte." There is the sizzling
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sound a2:ain. "An ansichts Karte with the picture of tlie Httle Crown Prince on it." Again we smell the flesh. "Perhaps that will cost twenty pfennigs; here are ten more."
The tears have stayed exactly where they started, save for one that lies on the freckled cheek, and the girl smiles up at Lassar as he pats her on the shoulder and tells her to come back next week, and perhaps he will have some more ten-pfennig pieces.
We go out of Lassar's clinic feeling de- pressed. It is quite a strain on the average human, meeting at once so rare a type, a great and jjjood man. And that's what Oskar Lassar is.
Not far from Lassar's, at the corner of Lui- senstrasse, is Frank's genito-urinary clinic. Frank is a brilliant and energetic young Ger- man. He is a splendid speaker. I heard him s})eak for three hours once without a break. It was a terrifically hot night and the room was like a furnace, and we who were listening damned the prostate gland. We had known somewhat about it before, but that night we got its most intimate life history, from em- bryology to senile atrophy. We learned its liistology, its gross and microsco})ical anatomy and pathology, the palliative and operative treatment of all its diseases in detail. While
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we cursed at the length of the talk and while we perspired quarts of Pilsener, nevertheless we could not help but admire the fluent and direct sj)eech of the lecturer, who never paused for a word or repeated a syllable in all those three hours.
Here in the same quarter, Am Zirkus 9, is the orthopaedic clinic of Prof. x\.lbert Iloffa.* Hoffa is a man sought out by every orthopje- dist who goes abroad. He is a big and busy man with perhaps the most remunerative practice of any surgeon in Berlin, if not in all Europe. He drives up to his clinic in a motor-car, in quite American style, for he has been in America and has learned that one can't be a real surgeon in the U. S. A. without owning a motor-car.
If you have a letter to Hoffa from one of his very intimate friends in America (a friend of mine had such a letter) he gives you the run of his clinic and you can see his assistants operate and his dieners put on apj)aratus. After you have been there a month lie may sur})rise you by coming in some morning and instead of ignoring your existence as usual, throw his arms around your neck and devote his full forenoon to v<)U exclusivelv. Then
* Albert Hoffa flie<l January 5, 19U« Iroiu aa allack of aii^jiiia pectoris.
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you are again Ignored for some weeks. You are about to chuck up Hoffa and go over to AVien, when you receive an Invitation to dine at his house. You get into your Tuxedo, hire a droschke, and with beating heart are dropped before the door of a magnificent West End home.
Hoffa in his home (this is the report of my friend) is a royal host. He (my friend) came home at three a.m. with a load of Hoffa's autographed text-books on the seat beside him, and with that exuberance of spirit under his belt that made him wake me up just as I was getting my beauty sleep, to get my aid in a proper rendition of the " Star Spangled Banner," which he was not wholly able to differentiate from the more subtle movement of "Die Lustige Witwe'' waltz.
And to cap it all, I had to spend the greater part of the next day explaining to my friend's wife that it was an insult to the host to refuse anything offered you when being entertained in Germany, so that it really wasn't her hus- band's fault. Since then she has regarded her spouse as a martyr to barbaric German ideas.
X.
BERLIN CONTINUED — A LITTLE PILCJRTMAGE IN PATHOLOGY LUDWIG PICK.
Berlin is surely a Mecca for pathologists. Probably there is no better place in Europe for a man who has liad a poor course in pathol- ogy at home to work up this important branch of medicine. At several of the big hospitals there are from five to ten autopsies a day, with courses so arranged that a man can do the postmortems himself or make use of what material he desires. Then the courses in pathologic histology are numerous and par- ticularly adapted to tlie needs of men who are stale and wish to brush up. For tlie advanced worker in pathology — for the man who lias a })roblem he w^ishes to work out, or wlio is looking for a ])roblem to work out — the chances are e({ually good. Here arc all kinds of material at one's (lisj)osal, and pU'iity of irreat men to mve one counsel.
1 am going to pass over some of the greater men and the larger lios])ita]s, however, in this chapter. The man who couies liere tor a week sees Oi-tli, for instance, and llie gi-(>al Pathologic Institute at tlie Cliarite, and writes
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thereof. We all know that Johannes Orth is a great man; perhaps the greatest pathologist living to-day. Benda is also a name to con- jure with in pathology. Hansemann and Kaiserling, Israel and Oesterreich and Wes- tenhoeffer, are all men who have an interna- tional reputation in pure pathology. Any one of them is worth a trip to Europe to see. With all due respect to these men, I am, as I
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say, going to pass them by, and take you on a little i^athological journey that many of you, j^erchance, have made yourselves.
There is a very quiet street in the north- western part of Berlin which you can get to either by one of the new automobile busses on Friedrichstrasse, aided by a short walk, or more directly by a Luisenstrasse tram. This street is l*liiHppstrasse. If you have come by the tram you have only to walk a few steps,
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when you come to a door flanked on one side by the dangling brass j^hite of a Friseur and on the other by the equally arrestive brass sugar- loaf cone of a Delicatessen. The number over the door is "^l. You go through the door and on through a court-vard to a red brick dwelling covered with green vines. You enter this building, turn to tlie left, and walk up four very long flights of steep stairs, and enter
a small room, lighted from the roof by small windows. In tliis room there are some loiiir unpainted tables and a dozen or so i-ougldy fashioned three-legged stools.
Away off in TJttle Rock, or in Bombay, or in Glasgow, oi- in 15uenos Ayres, or In Mos- cow, or ill (^ipe Town, oi' in Tokio, ov in ;niy place in the woi-ld where some ni;in lias recognized the fact that ^FcdiciiK^ is ;i bc.iii- tiful woman l)Ul a woman wlio reveals her
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charms only as knowledge advances to meet and appreciate them — away off there, the man is packing his grip and is going to seek for knowledge that he may become more worthy of his chosen mistress. He will sail the seas in a big ship, and he will take the automobile bus on Friedrichstrasse or the tram on Luisen- strasse, and he will pass the brass plate or the arrestive sugar loaf, and he will climb the four flights of narrow, steep stairs, and sit on the three-legged stool at the unpainted table. For here shall they all meet; they who have lived in the half light of a beautiful mistress, whose charms they are now more fully to realize.
Far be it from me to characterize Dr. IakI- wig Pick as merely the High Priest of the Temple. Dr. Pick is very much a man. He is short and fat (you may insert the quali- fying adjective "very" before each without ex- aggerating). His hair is closely cropped and he wears a "Kaiser Wilhelm" moustache with well-trained ends pointing upward. (Is it true that the upward trend of thought character- istic of Germany is symbolized by the direction of the hair of the upper lip .^) He flashes on you a keen and penetrative eye, which has a hirking gleam of humor in its depths, and he greets you in perfect English, if you are an
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American, or in equally good French if you are a Frenchman.
On his cheek and forehead, if you look closely, you will see the scars of his old Mcii.sur days, for Dr. Pick admits that he was once young and foolish. I would say more about these scars but I pride myself on the fact that I am the only man who ever wrote of Germany without ringing in a student duel. (The artist couldn't suppress himself, however, and
threatened to stop work if I didiTl giv(^ him a chance to illustrate such an (^vcMit.)
Dr. Pick is a worker. Kvciy morning he is in his laboratory at six o'clock, and he does not leave it till seven or (Mglil o'clock a I ni<dit, exce|)t to go out to do liis antopsies, and to get shaved al fi\<' o'clock. His lime is dividcfl between leaching and research. The average Amciican palliologisi would con- sider himself swampc(l if lie had lo dcvolc
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the amount of time to teaching that Pick does. But a German pathologist must teach to earn a living. Between the teaching hours, then, are grasped the moments in which Pick has to do his research work. The a})ility to generate the amount of energy required to accomplish what he has done is a rare quality.
Pick has produced over forty articles on a wide variety of pathological subjects, and all the articles are exhaustive and weighty. Pick has made no great discoveries. Great dis- coveries are more or less a matter of luck. But the work he has done has been of great importance to pathology. Space is too brief here to go into his work in detail, but his classic studies on hypernephroma and on chorion epithelioma should be mentioned. He has added much to our knowledge of gynaeco- logical pathology; he has given us many new facts in the field of malignant new growths; he has settled many moot points in general pathology.
Pick has found time, moreover, to put together one of the best, although by no means the largest, collections of gross patho- logical specimens in Europe. These speci- mens are all preserved in their natural colors by Pick's own method of color preservation.
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Every specimen Is a gem; far different from the motley mass of nseless and poorly pi-e- served material one sees in so many museums. The part of this collection embracing gynaeco- logical pathology represents work done at the Landau clinic. The general pathological anatomical material was obtained from the Juedische Krankenhaus and the Friedrich Wilhelm Hospital. For Dr. Pick was prosector to both these institutions — work enouirh in itself, in the mere doing of autopsies, to content the average man. I5ut Pick is not one of the average men; he is one of those individuals of more vigorous mental and physical powers than the others, of whom, as Darwin puts it, a new species is made.
Personally, Dr. Pick admits that he has )>ut two primary interests in life — scientific inves- tigation and teaching. And though still a young man (he is yet some years short of the forty-year limit) he has seen already tangible results from his labors. Ilis scientific work is known wherever there are j)athologists; his success as a teacher is sliowu l)y the men wlio come to liim from ,'il] over llic world, if lie should come to America tliere W()ul<i hardly be a city of any size from Xew ^^)rk to San Francisco in which he would tail to find a former pupil.
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Although Pick rarely gets away from his laboratory (except at long intervals for a day's fishing in the country) he is one of the most cosmopolitan of men. The reason is that he fairly bristles with (what Ehrlich might term) receptors.
He gets something from every man who comes to him, besides the few marks they pay for their courses. He knows what is going on everywhere, and he remem})ers what he is told. He can talk with you intelligently about Tammany Hall or the Russian Duma. He knows who sings in grand opera in Buenos Ayres, and what America is doing in the Philippines.
In regard to literature, one would think from the broad grasp he has on scientific work (which work is now so massive that the ordinary man does not attempt to keep up on more than the head lines) that he would have time for nothing else. But he can talk to you about Dickens and Shakespeare (which he reads in the original), and Sherlock Holmes is one of his heroes.
Dr. Pick is a single man. If you discuss marriage with him he will tell you, perhaps, that all women worthy of consideration are intelligent or beautiful and that either class is equally successful in distracting ymi from your
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work. He also says, that "love Is an acute psychosis that may always be given a good prognosis." Notwithstanding these frivolous remarks Pick has a deep respect and regard for women and he said to me seriously one
evening: "1 am in my hihoratory from six in the morning till seven or eight at niglit. It would not he fair under those conditions for me to marrv."
Pick is an e":otist. IVrsonallv I tliiiik a man who has made good, as Pick lias made good by sheer ability and work, has a right
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to be an egotist. A man who is better than the average man and does not know it, or doesn't show it, is either a fool or a hypocrite; and in either event eqnally uninteresting. By being an egotist I mean that Pick beheves in himself; in the high quality of his scientific work; in his ability to teach pathology, and that he brags about what he does. I do not mean that he has no consideration for others. On the contrary, he is one of tlie most altruis- tic men I know. He will give you the best he has of knowledge and advice. He will save nothing for himself if it will help you. He is considerate of those beneath him. He takes off his hat to the scrubwoman when he meets her on the stairs.
None of us will climb the four flights of stairs again at the Landau clinic to meet the hearty hand-shake of Dr. Pick or to sit on the three-legged stools at the ))are tables, for Dr. Pick has recently been ap})ointed to the directorship of Friedrichshain, to succeed von Hansemann, a great honor for so young a man. When we go to see him again it will be to one of the largest hospitals in Europe, but Dr. Pick will meet us with the same cordial welcome as of old. The men in St. Louis who have been his pupils recently sent him a loving cup, in honor of liis election to his new
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position. A part of Dr. Pick's roply on the receipt of the gift, is as follows:
"I have in my treasure more than one letter from your countrymen which shows me that many threads of sympathy and friendshij) join me with your country over the large sea. I am sorry only that my arm is not so long as my gratitude, otherwise every one of you would feel my personal hand-shake. 1 take the beautiful cup in my hand and thank you for all your kindness in German manner. I fill the cup with golden wine of our beautiful Rhine and drink it to the health and the personal prosperity of my St. Louis j)upils. "
Here, then, is a lovable man. A man who, although he has devoted his whole life to sci- ence, radiates a personality that makes every- one who meets him keep in touch with him and come back to him again at the first o])p()i- tunity. There have been men like him in olliei- lines of life, men who left behind them some- thing more than the bare bones of their work for the world to rejoice in. Sucli men were Whistler in art, A'oHaii'c in hl(M'ahii'(\ Liiicohi in statesmanship; men whose names i-ecall a fund of incident and anecdote thai makes us more anxious to read biography than docs the
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work of ecjually great but personally uninter- esting men. Probably Pick will never have a Boswell, for pathologists are " no thin red line of heroes," and nobody outside a very small coterie knows that the class exists, anyway. But if Pick were a great artist or a great statesman or even a modern novelist, his epi- grams and delightful mannerisms could be written into as interesting a volume as I would ever ask to read.
Ludwig Pick, however, doesn't want any biographer. All he wants is a "two millimetre apochromat" with a piece of diseased tissue at one end of it and his eye glued to a compen- sating ocular at the other end. And here we will leave him, with our best wish that it will be a great many years before that eye and the compensating ocular get a divorce.
XL
VIENNA AN IDEAL PLACE FOR MEDICAL
STUDY STUDENTS A GAY SET.
Vienna has always been associated in my mind with a piece of music; an air, tliat you all know, and all associate witli your youth. I remember it first as a tune I was comj)elled to beat out of a wlieezy melodeon wlien 1 was ten years old.
I remember it hiter, in my college days, as the tune the band played when I waltzed with the girl I loved. And who doesn't always love the girl he is waltzing with, wlien the band phiys the "Beautiful Blue l)aiiul)e!" Even in my more sedate, medical-stu(kMit days, I was likely to get sentimental when Max Zach started that old waUz, whicli always lias a place on the program at the Boston Sym- phony Pops.
I didn't hear the tune, however, wiiile I was in Wien, tliough I saihvl down the "Beautiful Blue Danube," wliicli is iicillicr blue nor beautiful. In fact, it is decidedly muddy and ordinary. Bnt tlie tii]) is I'nll of interest. On the little steamer (lliiil I li.id lo turn ont abont fiv(^ o'clock in llic nioiiiing
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to catch) were a number of Austrian army officers. They were gay dogs, a dozen of them, in their briUiant uniforms, flirting out- rageously with a red-headed girl who was on board and who was wholly indifferent to their multiple attentions. Then, there was the most excellent Magyar wine, which I met for
the first time, and real Hungarian Goulash (not Irish stew with paprika) . Best of all, was the entrance just at sunset into Buda- pest, the most beau- tiful city in Europe. Budapest, with its mao;nificent water front, its wonderful palaces and public buildings, its well- A wiiNEK Tin. ordered hospitals, its
splendid streets, its gay cafes and strikingly })eautiful women, is a joy and delight. The medical men wlio are working in Vienna never fail to make an occasional trip down to this beauty spot to spend a Sunday.
I did not go to Vienna for medical work, and, therefore, this cha|)ter is mostly a very inadequate sketch of a city that, from a medi-
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cal standpoint, should have a whole })ook to itself. Berlin and Vienna are without ques- tion the two greatest medical centres of the world. Which should have first place is a matter of opinion. One man will tell you that Vienna has had first place in the past, hut has seen her best davs, and that she is now rather dead. Another will tell you, just as sincerely, that Vienna has just begun to come, that there is no city in the world that has shown such a marked progress in the last few years; that if you want a live, up-to-date town, you must come to Vienna.
Of these opinions, you can take your choice. Personally, I found here a pleasing mixture of old and new. And as far as first ])lace in medicine goes, there is ten times as nuich material as you could use in a lifetime, and ten times as many brilliant young and faui- ous older men, as you could ever expect to work with, both in Vienna and Berlin.
While the pnst fairly bristles with great names (and Rokitansky, Ilyrtl, Ilcbra, Hill- roth, and Xolhnagel may be mentioned among this number), nevertheless, the present offers its full share of I'aiiioiis men in all })ranches of medical work. Wvvc nvc to be found Eiselsberg, Schauta and Wertheini in surgery, obstetrics and gyna'cology res])ec-
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lively; Lorenz the orthopedist; Neusser, Von Noorden, Ortner, and Kovacs in medicine; Escherich in children's diseases; Fuchs and Schnabel in ophthalmology; Wagner and Chvostek in neurology; Riehl, Finger and Ehrmann in dermatology.
.S'.;h
^4i
A i.i.i : F.:\i r. 1 \ Ks 1\ i; a n k k m i ms — \i y.s xa
In the laboratories are Toldt and Zuker- kandle in anatomy, and Shaffer, Ebner, and Rabl in histology. There are Weichselbaum in general pathology, and Paltauf in experi- mental pathology. Exner is chief of the department of physiology.
Of Exner, a very good story is told. And one might mention, incidentally, that Vienna is rich in medical stories. At the Univer-
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sity, a joke book is kept in which is written the amusing answers that students have given from time to time, as well as jokes that have been turned on the professors, as in tlie present instance. Exner, as everybody knows, suffered from goitre, which had received tlie usual treatment. One day at recitation, Exner asked in the course of a quiz on goitre, "What is the result when the thvroid oland is removed.^" "Why," replied the student, "the patient becomes an idiot." "In all cases .^" asked Exner. "Yes, Professor," the student replied, earnestly; "in every instance."
Another storv is told of a well-known Vienna ])rofessor that points too good a moral for medical teaching in general to be passed by. This Professor brought to the class one day a most rare kidney lesion, one that a man, witli all kinds of material at his (hsposal, would run across onlv once in a lifetime. The kidney was exhibited to the class, with all the wealth of (K^tail that the Professor could lavish upon it, for a full hour. After the lecture, one of the students came np and asked very naively: "By the way, Piofcssor, would you mind telling inc whcthei- the kid- ney is normally situated aboNc oi- lu'low the diaphragm ?"
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The medical centre of Vienna is the Cafe Khnik; and the Allgemeines Krankenhaus owes its fame to being situated in its neigh- borhood. This hospital of 2G00 beds is one hundred and thirty years old, but is now in process of reconstruction. While some of the new buildings are already occupied, still it will l)e fifteen years before the whole replace-
Dear Doctor.
The next meeting of the American iVIedical Association of Vienna will be held Saturday evening May IS"" at »Restaurant zum Senator« No. 19 Reichs- rathsstrasse.
Supper a la carte at 7 P.M.
Prof. Hermann Nothnagel will address the mee- ting on 1he progress of medicine since my student days: (1854.)"
Every body come and bring your american medical friends.
H. H. KLEINPELL
Secty.
ment is completed. The centralization of work and grouping of post-graduate courses, made possible by the great amount of material at this one hospital, make Vienna so ideal a ])lace for medical study. In Berlin, London, and Paris, much time that can be spent to better advantage is wasted in getting to remote parts of the city.
As in Berlin, there is i\ society of American
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students wliicli you affiliate yourself with at once; all good fellows, who make you feel at home immediately. The office of the club is at the Cafe Klinik, Spital und Lazarath Gasse. I quote the following from their constitution:
" The purpose of the society is to promote the social intercourse of its members ; to furnish information for (lie rapid orientation of new members in regard to boarding- houses, rooms, restaurants, etc.; to ])rovide information in regard to the scope and relative value of courses : to promote the scientific advancement of its members."
One of the fine things the American Med- ical Association of Vienna has done is the arrangement with the dean of the post-grad- uate department of the University whereby courses are given on every desired branch of medicine and whereby the prices of these courses remain definite.
The following })ost-gra(liuite courses are offered :
I. Nornud and Pathologic Histology of the (a) alimentary tract; (b) blood; (c) circul- atory system; (d) ear; (e) eye; (f) gem'io- urinary tract in botli male and feiiiale; (g) nervous system; (h) ]H)sc and throat; (i) respiratory system; (j) iiiteguiiUMihiiy system; (k) osseous system.
II. Kmbrvol()(i|:v
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III. Bacteriology; principles of immunity (antitoxin, cytotoxins, agglutinins, precipitins, serodiagnosis), and forensic blood examina- tions.
IV. Gross Anatomy, general and regional.
V. Internal Medicine.
VI. Diseases of the stomach and intestines.
VII. Diseases of the blood and blood- making apparatus.
AdmINISTUATIoX ]1i II.IUNC. GkNF.UAI. lldSl'ITAI. — YlKNNA
VIII. Diseases of the mind and nervous system.
IX. Surgery: (a) diagnosis; (b) operations on the cadaver; (c) orthopaedic work.
X. Radiography and radiotherapy.
XI. Gyntecology and obstetrics.
XII. Ophtlialmology.
XIII. Otiatry.
XIV. Rliinology.
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XV. Pediatrics: (a) diagnosis; (b) intuba- tion and tracheotomy.
XVI. Diseases of the integumentary system and syphiHs.
These courses are offered to sections of two to ten men for a fee ranging from ten to twenty doHars a course.
Now that I have gotten all this out of my system, I can speak of a few other things about Wien that interested me. First of all,
I'a l:K IN 1 1 1 \ I i: \ I II
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1 found that at ten o'clock the outer door of my pension was locked and that 1 had to pay the portier 20 hellers (4- cents) to be admitted. As nobody goes to bed in Wien before ten o'clock, I figured that the average portier could save enough to n^tii-e on, in a few years, and lead a life of luxury .iiid (>ase, provided he had the constilulioii to stand the strain of continuous loss of sleep incident to
his position.
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The Viennese are a very polite people; kissing the hand of a lady is far from an obso- lete custom. The greetings and departures are even more complicated than in Germany. ''Ich habe die ehre'' is the favorite form of greeting. This is elided by gliding over the first two words so quickly that I constantly felt as though the people I met were calling me "dearie"; for that popular song was just then in vogue.
Medical students everywhere are a jolly lot, and the atmosphere of Vienna tends in no way to diminish their gayety, so that an evening about the town with the fellows is an event not soon to be forgotten. A new- comer, however, is likely to be put through a course of sprouts that would equal the trials of a tenderfoot in a bunch of cowboys.
For instance, the visiting card, which a new arrival passes out to each man he meets, is frequently put to strange uses. Suppose a crowd of students have been out rather late and have made considerable use of a cab. Now, it is easy to have a row with the cabman and accuse him of overcharge. Matters of overcharge are settled by the police, and the student gives the cabman his card, saying he will settle with the jjroper authorities. In reality, he gives the cabman the card of the
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new arrival. The next morning, the Innocent stranger is awakened by a visit from the poHce and is dragged to the pohce station. There he learns in a vague sort of Tvay (for he usually doesn't speak much German) that there is something wrong in regard to his not paying somebody enough cab-fare, and, rather than have a row, he pays. You should guard your visiting cards while in Vienna.
-^m-
r^i
'-^-^a
C'AKiai.Mi Tuull iU l'.illE.NTS
XII.
PYRis THE SAINT LOUIS HOSPITAL SCENES
AT THE SKIN CLINIC.
Personally, there is a charm about Paris that a})peals to me. It is the one city above all otliers that has a personahty.
When I have finally succeeded in giving my cocher money enough — not to satisfy him, l)ut to escape from his presence without a following volley of curses; when I have agreed to pay my old landlady in the Rue Valette a franc a day more than I did the year before, for a worse room than I had the previous summer; and when I have purchased a four-inch brown rope, facetiously termed a cigar (the Parisians are great humorists), for three times the amount I pay for a real cigar in Germany, then I say, "At last after all my wandering I am really for the first time abroad. "
Frankly, I admit that Paris is a dirty, badly-kept city; that its amusements are plan- ned to meet the tastes of the average New England school-teacher; that the Moulin Rouge is no more wicked than Keith's Boston Theatre; that the majority of the restaurants
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are not fit to eat in, and the greater part of the wine served yon is not fit to preserve j)athological specimens in. I will admit that Parisian shop-keepers are the greatest grafters in the w^orld; that Parisian hotel-keepers are robbers; that Parisian cab-drivers and guides are worse than bandits. I will admit that in an Ano-ust afternoon you will see more xVmer- icans pass Cook's than you can count in tlie same time passing Mermod and Jaccard's in St. Louis. I will agree that Paris, as we have formed our idea of it, is the exact opposite of everytliing we believed — and yet I like Paris the best of any city in Europe and I do not feel, as I stated above, that I'm really abi-oad till I settle back in a voiture and feel the pulse of the Paris pavement softly transnu'tted tln-ough its rubber tires.
There is much of interest in Vnvls foi- the American physician and mecHcal scientist, al- tliougli medical men (h) not come liere to study as they go to Pcrhn and to Vienna. There are no courses arranged in the ueat packages whicli the Imrrying ])liysician c;iu take away witli liim for n small fee, like sand- wiches from a railway lunch-couiitcr, as there are at the latter places.
In France medicine is an ail, and it is on the whole much more scientific than in Amcr-
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ica, and the American who has a year or more to spare can learn much in Paris. The best proof of this is the fact that, for special branches at least (notably dermatology and genito-iirinary diseases), Gerinany sends her best men to France for special training. And Germany doesn't go to France for any- thing that she doesn't have to go for.
The hospitals, laboratories, and clinics of this great city are too numerous to chronicle in the way they deserve, and I must ask par- don for merely referring to such as were of interest to me.
In the eastern quarter of Paris, apart alike from the gay throngs of the boulevards, the distractions of Montmartre, and the vivacious life of the Quartier Latin, is an aggregation of buildings enclosed by a high brick wall, which includes several city blocks. The entrance to the grounds is through a low arch- way that suggests the gate of one of the old fortified French towns. This is the Saint Louis Hospital, famous throughout the world for its great skin clinic, its museum filled with wax reproductions of all known skin diseases, and its renowned skin specialists, Gaucher, Fournier, De Bourmann, Gaston, and Sa- boiu'aud.
I went there primarily to see the much-
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talked-of "bald-headed clinic" of Saboiiraiid. Everybody has heard of this clinic, where those who have lost tlieir hair come by hun- dreds, and of the great Sabouraud who pulls a hair (provided there is one remaining) from your head, glances at it, and says "Yes, I can cure you; go into the next room"; to another, "You may be benefited; wait here"; and to a third, "Go and buy a wig; noth- ino; can be done for vou." It is said that Sabouraud can tell your moral character, the amount of your yearly income, and what you have eaten for breakfast, by looking at a root of one of your hairs. We will admit that this is perhaps exaggeration, but we want to prove the point that he is a great man, a man every dermatologist in every civilized country has heard of. Therefore I was somewhat surprised when, stopping a uniformed attend- ant in the courtyard and asking for Sabour- aud's clinic, the attendant told me he didn't know of such a man. I saw a nurse hurrying past, however, and asked her. She, too, pro- fessed ignorance witli an extenuating smile, wliich I accepted at its face value. Finally I captured a young house piiysician ;ind lie directed me.
All this is aproj)()s of a |)r()pliet's honor in his own country. I icniember once trying to 10 14.-,
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find at the University of Pennsylvania a man famous in scientific medicine throughout the world. I made the mistake of going to the University Hospital instead of to his labora- tory, which is a building or two removed, and five officials had to be called in rotation before one was found who had ever heard of the eminent gentleman.
A CoLLErTOll OF ClHAK " I'UTTS '
However in to write daily skin that I wish room itself tables and It is large crowd into
it is not Sabouraud that I started about especially, but it is the great clinic of the Hojoital Saint Louis to attempt to picture. The clinic- is high-posted and bare. Three a few chairs are its only furniture, enough for a himdred people to at a pinch, though the adjoining
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waiting-room will seat six or seven hundred. Into this room pour daily from three or four to six or seven hundred })atients — children first, then women, then men. These peojole know what is expected of them. The children are quickly divested of clothing and brought naked to the chair of the examiner. Usually there are three examinations going on sinnd- taneously, with Gaucher, or De Bourmann, or whoever is on service at that i)articular time, going from one to the other ancl ])ickiiig out for special study a case that is obscure. Behind the chairs of the examiners are grou})ed the eager students, among whom will be found men from all over the world who at home would be classed not as students, but as eminent skin sj)ecialists.
The patients are disposed of with liglil- ing rapidity. A quick searching look, a skilful moving of the finger over the lesion, and tlien a green card here, a red card to the next, a yellow card to the third, with perhaj)s two words scribbled hastily on a prescription blank, serves to dispose of the gieat majority of the patients.
The room is c|uickly cleai-ccl of cliildicii and then come the womkmi. lleic is iudccMJ the whole ('oDicdic JliniKiinc of H.il/.ac com- pressed into a sli-aggling line lli.il .•ippioaches
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the examiner. Youthful faces, some beauti- ful and pure, some already bearing the lines of drink and debauchery. Soft eyes, in which the tears are just held back; hard eyes, meet- ing boldly those of the examiner and the crowding students; aged faces, reflecting a thousand vicissitudes of life. On they come clasping to well-rounded bosoms, with over- bejewelled fingers, dainty ribboned lingerie of costly lace; clasping to flat breasts, with bony talons, tattered shreds of dirty unname- able rags. They are all here — the gay beau- ties of the boulevards and of the ^' BouV Mich. "; the bent shape of a woman who ofters you matches before the steps of the Made- leine; the grisettes of the shops and of the factories, and respectable wives of the sub- merged— all touching naked shoulders in this great skin clinic of the Saint Louis Hospital. And the men! To describe them is beyond my pen. Here a flushed youth sufl^ering the anguish of his first indiscretion, holding a shaking hand to his trembling torso. Next a distinguished looking middle-aged man witli gray imperial, who guards his cufl^s and false shirt-bosom so carefully for fear of soiling. ]5eside him a "bum" in rags, w^ith face like sole leather. Then an artist, or perhaps a musician, to judge from his long black hair
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^
and delicately shaped fingers. Beside liim a workman with l)rown corduroy trousers tied up with a red sasli. All are here, witli per- haps the fear of the same dread disease staring at them from the pur})lish-red paj)ules that blotch their skin. For sy})]iilis is not the least frequent of the lesions that come to tliis clinic. This disease may be seen in almost any of its multiform manifes- l / tations, some of which are V *^^ hideous to look upon. Vl
]5ut there is comedy here, too, for many of these skin lesions are comparatively in- significant, and the })atients seem disappointed that it is no worse. An amusing thing is the tattoo marks one fre- quently sees here. In the ecstasy of his first love a man often lias tat- tooed on his arm a large heart pierce<l by an arrow and above the name of his adored one, as, for example, ''Marie jjour hi vie.'" 'J'lie course of true love, howevcM-, is evidcMilly not alwavs life endui'iiiir. iiotwillistaiKliiijj; the tattooed sentimciil, and so we may Ii.ivc llic "]\Iarie" eliminated by a lattooecl line .ind "Louise" worked in above. I lia\(' seen as manv ;is IIii'cm' n.-imes cr.-ised in lliis ni.inncr
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with a fourth flourishing in a quite elevated manner above the pour la vie.
The most common disease one sees here is la gale, the common, every-day itch, or scabies as we term it. A French dermatologist can spot this lesion as far as he can see the patient, and the quickness with which these cases are glanced at, given their bath card, and hustled away, is remarkable. A hundred such cases will be disposed of in fifteen min- utes at this clinic. It is when a somewhat rare or obscure lesion appears that time is consumed. Then there is something doing. Every physician is called, every student crowds eagerly forward. The patient is })assed about from one to another and a voluble discussion arises. It is hours perhaps before the sufferer regains his shirt (or her cheinise) as the case may be. All day long the patients pour into this clinic. Not only in the morning, but after a brief respite for lunch there are as many more waiting as were disposed of in the forenoon.
I came out of a morning session with a graduate of one of the largest medical institu- tions we have in America. " l^y Jove," he ejaculated, "I've seen more cases of skin dis- eases this morning than I saw in all my four years in medical school." I didn't dis])ute it,
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but Intimated that if lie would follow me to the Marguery, I would introduce him to a filet de sole and a variety of aperitif which I was sure he hadn't encountered between clin- ics in the course of his medical education, and which would take the taste of what we had seen out of our mouths.
XIII.
PARIS CONTINUED IN THE LATIN QUARTER
SURGICAL CLINICS
"Je Tappeir ma p'tit' bourgeolse. Ma Tonki, ma Tonki, ma Tonkinoise — ■ Y en a d'autr's qui m' font les doux yeux, Mais c'est ell' que j'aim' le mieux."
A MODEL, rather a pretty girl with purple velvet eyes, was humming the words to the ac- companiment of Schoemaker's violin. There were other girls, also with attractive eyes, and with big drooping-brlmmed hats from which fluttered attractively long lengths of fluffy veiling, resting frequently on masses of skil- fully coiffed hair of wonderful color, sitting about the room. Here and there with one of the girls, could be seen the interesting face of a youth too clean shaven to be other than American. For we were at Lavenue's, on the Boulevard Montparnasse, in the heart of the artist's Latin Quarter, where the American art students most do congregate. And artists, even though American, do not hesitate to ap- pear in public with their mistresses (or their friends' mistresses) to drink their evening Bock. Neither do prominent American sur-
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geons and physiologists al)solutely refuse to come to Lavenue's occasionally on a summer's evening — not to see the models of course, ])ut merely to hear the music.
"And you mean to tell me," I said to my friend, a chap from Chicago ^Yho had been for two years about the hospitals of
Paris, "that you can do any real irork in this environment?"
"I'll admit," he replied, "that the life of the cafes does get into one's blood, and lliat after the seriousness of medical courses ;is they are given in Berlin and Vienna, it would be a bad thing for a man to come to Paris, if he really wanted to do any heavy work in medicine. Put there is woik enough licic, ;in(l srood work. Tlic cliicf diiricnllicvs arc in (ind-
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ing it in the first place, and then buckhng down to it after you have found it."
And that is the whole story in a nutshell. As I have previously stated, medicine as a business proposition is not organized here as it is in Germany, to catch the golden windfall of American dollars by short, easily obtain- able, convenient courses, that one can take in two weeks or a month and go home a "trained specialist."
In Paris, one must find out things about medicine for himself. There is some of the finest work being done in medicine in Paris that is to be found anywhere in the world. And there are no better men anywhere to work witli than here. But you must get into almost everything as the guest of the instruc- tor, and this is not always an easy thing to do. To begin with, a man must know how to speak French. One can study medicine in Ger- many without a knowledge of German, but one cannot study medicine in Paris witliout a knowledge of French.
First of all one should go to a medical book- store and get a copy of " Ilbpitaux et Hospices de Paris, Composition des Services, " which details a list of all tlie hospitals of Paris and {dl the men in these hospitals from the chiefs of clinic down to the externes. It is well also
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to go to U Assistance Puhlique and get a card, which will admit you anywhere, although this card is seldom necessary. Then you can pick out your hospital and vour man, and do practically any work you desire, and this usually as a colleague, entirely free of cost. There is also the Ecole de Medecine, where one can take laboratory courses of any sort, regular or specially arranged. There is prob- ably no better place in the world for a man to learn the fine points of anatomy than right here. Plenty of instruction can be obtained for a very reasonable fee.
Another thing a man should know about in comino; to Paris is the American Art Student's Association at No. 74 Rue Xotre Dame des Champs. Here are always to be found a bunch of good fellows, mostly artists, who, if you are a scholar, a gentleman, a good sport, and have an artistic temperament and the literary touch (and haven't too much money), will see that your name is i)ut up for member- ship. If you lack all the above qualities, take a ])lug of good old American chewing-tobacco over with you and you will be iiiadc^ a ineinl)er even with greater raj)idity than on I he lirsl count. The dues of the club avc something like thirty francs (six .lollars) a year. The Art Student's ('Inb ccrlainlv brings back
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memories of many pleasant evenings, and I wish I could adequately express my appre- ciation to "Dutch" Goetsch, "Moskie, " "Heine," and all the rest of the fellows who were so good to such a rank outsider as myself.
VisiiK A i.'IIoriTAr. (Li .\K.MiiiirR(i)
But to return to our mutton, as the French say. What can an American, one who is over for a short time only, or one who has been working hard in Germany for a year, do in medicine while in Paris to make his visit profitable? In Paris one is pretty well
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contented to loaf; more so tlian in anv other city in the worhl, I beheve, but afternoons and evenings are quite sufficient for the "sights," the cafes, and the boulevards, and it is well to put in the mornings visiting clinics; all of which are open to any one, provided he can find them.
In surgery for instance there are a number of good men to see. First of all there is Pozzi, as well known in x\merica perhaps since his trip over here, as any of the French surgeons.
Strictly speaking, 1 shoidd, of course, refer to Pozzi as a gynaecologist, but I take tlie liberty of including operations of various sorts under surgery. Pozzi is to be found at the Broca Hospital. This is a cosily situated institution of moderate size, tucked away a little to the south of the noise of tlie Latin Quarter. The first thing that strikes one in walking through the wards of the Broca are the extensive and ornate nuiral decora- tions. Tliese were all painted, so I under- stood, by grateful patients, and some of them are not bad. No worse, at least, than tlie Chavannes frescoes in the Boston Public Library, remarked a man from Boston who was walking through the hospital with nio.
Pozzi's operating-room is small, and. in order that a consider;il)l(> iiiimbcM- of men can
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see a given operation, a sort of gallery has been erected on one side of the room. You put on a (once) sterile gown in a side room and walk up a flight of stairs. Then you turn and, voila I you find yourself on a sort of balcony with the gory field directly below you. Pozzi himself is a rather stout man with swarthy black whiskers, and if you introduce yourself to him he receives you most kindly. His balcony scheme is all right, only it em- barrasses one to look down and note that the assistants, the nurses, the anesthetist, and the attendants are all staring up at you instead of paying attention to their own business. But Pozzi doesn't seem to mind, or else he is used to it, for without comment he doubles across the table in his endeavors to reach an instrument extended towards nowhere by a languid assistant, who, to judge from the direction of his gaze, is interested in the neckties, or perhaps the American shoes, of those on the balcony.
Another surgeon who is well spoken of in Paris is Delbet, who operates at the Laennec Hospital, near the Bon Miirche. Delbet is a middle-aged man, deliberate in speech and action; remarkably so for a Frenchman. Nothing jars him in the least. For instance, one day when I was there, he happened to cut
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the ureter in takino; out a large ovarian cyst. He made no remark, however, nor scarcely a sign save the slight raising of the eyebrows, and went on and did an end-to-end anasto- mosis as though it were a part of the opera- tion. While not a rapid oj^erator his technic is finished, and as a consultant his word is of as great weight as that of any man in Paris.
While Delbet has no balcony to interest you, you can amuse yourself by watching his assistants wash up. He operates in a large room, the upper end of which only is used for the operation. Down the middle of this room, for its whole length, is a long table on which is a tremendous array of wash-basins filled with fluids of various colors, yellow predominating. While waiting for the patients to be brought in, the assistants amused themselves by washing their hands in these various basins. I tried to keep count of the number of times each man washed, but as I started, unfortunately, to tliink in French, my numerals were exhausted before a man got half way down the line.
I promised myself a special Ireal mic inorii- ino". I wouhl ixo to see Faure, wlioiii 1 had heard called the most skilful surgeon in rans; "the man who did a hysterecloniy in two minutes." 1 went to sec Fanrc, and un(l()ul)t-
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edly he is a clever operator, the best by all means that I saw in France. He did a hyster- ectomy that morning, and did it beantifnlly, but not in two minutes — not by something over an hour.
Here at the little Hospital Cochin is also to be found Widal, the man who made agglu- tination famous. And one can vary a fore- noon by making a ward visit with him. The Cochin is a small hos])ital, and new wards are in process of construction, so one should not criticise things one finds there too severely. But the ward which Widal has in charge, as it is at present, is pretty bad even for tem- porary c|uarters. It is a long, low, one-story wooden building, hardly such a place as one would expect to find presided over by a man as famous all over the civilized world as is Widal. And Widal's laboratory is even worse than the ward. I will spare the details. Strangely enough, it is under just such diffi- culties that the best work in medicine has as a rule been done, and Widal is still delivering the goods.
It is at the Cochin, also, that on certain evenings one can see the famous Lues Line, a long string of men reaching out into the Rue <hi Faul)org St. Jacques, waiting their turn for their mercury injection. The "Bread
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Line" of New York has been made famous, both by story and by picture, ])ut the chsease that has given rise to the Lues Line at tlie Cochin is too common in Paris to excite the pen or the brush of story-teller or painter.
So it is that one can pass any number of mornings in this way, going about from clinic to clinic. I should, of course, speak of Albarran, the great specialist in maladies du voies iirinaires, who has the only real operat- ing amphitheatre in Paris. The larger places, such as the Hotel Dieu and the Sal}>ctriere, I have also omitted as one would more naturally find such places for oneself. Espe- cially should one see Babinski's clinic at the Sal})etriere, for with the possible exception of Widal and Fournier, Babinski is the best- known practitioner of medicine in Paris, and it is a lil)eral education in itself lo see him extract his own reflex in the piopcr maimer, which, by the way, the average practitioner rarely does.
Then the beauty of it all is tliat aflcr you have salved youi- conscience willi your iiioru- ing visit to one of these |)laces, I here arc in a tliousand attractive restaurants a dclicions lunch awaiting you.
Jf you are not a Itloalcd pliitoc r.il willi ;i taste and a pocket-book for Foyot's or Mai-
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giiery's, and have been to the Broca or the Cochin, I shoukl advise you to drop into Garnier's, on the Boulevard Raspail, which is near, and see how cheaply you can lunch well in Paris. You need not spend over a franc or a franc and a half here at the most, and it is left to your honesty to go inside when you have finished and tell the lady at the counter how many sous' worth you have eaten. And if you are coming again, the lady will })ut your napkin away for you (but only for a week), and you can save two sous thereby. It is worth saving, for with that two sous you can buy a delicious cup of coffee on the corner, at the "Little Dome," just opposite the "Big Dome" where the American artists and story- writers play poker.
And in the evening there is Lavenue's again, and the artists and their models and the music, and tlie pretty girl with the purple velvet eyes may finish the song:
"Dans mon coeur j' garderai toiijours Le souv'nir de nos amours."
XIV.
PARIS CONTINUED THE PASTEUR INSTITUTE
METCHNIKOFF.
It was raining the morning I started out for the Pasteur Institute, and instead of cHmbing to the top of an omnibus, as usual, I took a seat inside. I did not know that tlie fare was twice as much for ridino; inside as it was for riding outside, and in consequence I liad a long and s])irited argument witli llie conchictor, whicli ended in my paying fifteen centimes more than I tliought I shouhl luive paid. Therefore I arrived at the gate of tlie Institute as mad as tlie collection of dogs that were howling in the little building at the right of the entrance.
As to buildings, the Pasteur Institution does not impress one greatly. It is the thought of what one man can do; the thought of the hundreds of research institutions tlial liave been erected in every (•iviliz(Ml couuliy just because Louis Pasteur live*! ;iii(l woikcd, Ihat makes you take off your hal as you go up IIk* steps of the old f n.sfiliif I>(iclrri()J<)(/i(/iic.
Inside there is notliiug j)aiti('nlaily sliiklng. There arc a number of \nvgc looins, in some
Kir.
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of which men may be seen at a desk before a microscope, or examining a test-tube. There is a hbrary in whicli you may see some one quietly studying one of the vohimes that fill the shelves about the room. There are rooms in which rabbits and guinea-pigs, in well-kept cages, nibble at carrots and oats contentedly. You will be shown a tomb, and be told that
Pastkuu Ixstiti'te
here, in the place where he lived and worked, Louis Pasteur sleeps. Nothing about all this to interest the Cook's tourist who is seeino: Europe in thirty days, and Paris in forty- eight hours. Why, over in the right bank of the Seine is a much more impressive tomb, built for that Napoleon chap, grand in pro- ])ortion to his rabid life. Moreover, there are the crypts of the Pantheon. One can see a
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whole bunch of sarcophagi, — Hugo, Voltaire, Rousseau, Carnot, — all in fifteen minutes, and so much time saved.
But for a man whose life is wrapped up in medical science and who feels so keenly, in the light of the mean, insignificant little work tluit he has done, what it means to be a great man in medicine, there is no greater, higher privilege than to pay one's respects to the honored ashes of such a man as was Pasteur.
Pasteur, a modest, simple, quiet little man who, I am (juite sure, must have been fre- quently insidted by his concierge and his epicier, as all great, but modest, men are; Pasteur, who had neither ])alace at Versailles nor chateau at Fontainebleau. His palace was a narrow room fihed with test-tubes and chemicals, and his life was a striking reverse to the medallions that bore on the obverse the likeness of Louis XIV and of Napoleon.
We are appalled when we read of the enormous sums of money that were spent, and thousands of lives that these latter men sacrificed, either (lirectly or indirectly. But do we sufficiently realize tluit this simple, modest scientist, Louis Pasteur, s;iv(m1 to the agriculturists of Franco, by his work on dis- eases of wines and of silk-woniis, more mil- lions than these men and .ill llicir kind look
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from the people, and saved more lives than the French Revolution and the wars of Napoleon cost! Pasteur sleeps, but his work goes on.
The Pasteur Institute was made possible by an international subscription started by L' Academie des Sciences, by which a sum of 2,500,000 francs was raised. The present service was inau^irated the 18th of Novem- ber, 1888. This was after Pasteur's study on rabies liad created a demand for his treat- ment that had resulted in his old laboratory in the Rue d'Ulm becoming wholly inade- quate for the patients who came to him for anti-rabic inoculation.
In 1894 the communication of Dr. Roux on the treatment of diphtheria by the serum of Behring and Kitasato again aroused public sentiment in regard to serum therapy, and a second subscription, started by the Figaro, resulted in a large sum by which additional buildings were built sufficient to immunize a laro^e number of horses for obtainino: anti- diphtheria antitoxin. A hospital of 100 beds was made possible by the donation of a million francs from a friend of the Institute, and later the contribution of Baron Hirsch made possible the erection of the physiological chemistry institute on the Rue Dutot.
The name Pasteur Institute has also legiti-
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matelv been given to otlier institutions in different parts of the world, wliere ])upils of le M ait re (as Pasteur is always referred to here) have been installed to give the Pasteur treatment against rabies. xVt JAWe is Dr. Calmette; at Constantinople is Dr, Nicolle; at Tunis, Dr. Loir.
The })crsonnel of the Institute is divided into services. First is the service des vaccins, directed by Dr. Chaniberland. Here are prepared vaccines against anthrax, liog chol- era, and glanders; and here also tuberculin is prepared. The second service is the ser- vice de la rage, the purjjose of whicli is to prevent the people bitten by mad dogs from l)ecoming themselves the victims of hydro- phobia. This service is under the direction of Dr. Grancher. Since the end of LSS.j more than 23,000 persons have su])mitted for anti- rabic treatment in this place. The mortality of those treated is less than fiv(^ in each thou- sand. Before this treatment was instituted fifteen out of each Imndred persons billcn by mad dogs died.
Dr. Roux is head of the scrr'tcc dc In niicrohie tec}uii(p(e. Two courses in biiclci'iology are iriven her<' each vear; the (iisl In Xovcmber- December, the second in {''(binary March. Tliese courses are open lo Americans, bnl
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application for a place should be made some time in advance, for the number of men in the course is limited.
The fourth service is called the service de M. MetchiiikoJJ. Here are found the men engaged in original research — research that covers a wide range of medical thought, and has been of the greatest service to mankind. Mesnil, Besredka, Laveran (the discoverer of the mala- ria Plasmodium) and other great men are found v^orking at the benches in this department.
The Chemical Institute we are taken across the street to see. If we are fortunate, Jupille himself may be our guide and may point out to us the bronze statue representing his own struggle with a mad dog. Jupille has the honor of being the only concierge in Paris who has his own statue within the portal which he guards. At the Chemical Institute we visit first the laboratories of Etard and Bertrand, which are used only for research work. But here are also the teaching laboratories in charge of Professor Duclaux. The course in bio-chemistry was transferred here from the Sorbonne in 1889, and here are given courses in practical analysis of physiologic and patho- logic })roducts. A number of Americans have availed themselves of the opportunity offered for work here.
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I had no letter of introduction to Metclini- koff, but he received me most graciously. lie is a fine physical type of man and most genial. He wears long hair and a beard. Both are well streaked with gray. He impresses you as a strong man botli mentally and physically.
The career of Metclmikoff has been an interesting one. He was born in Russia, sixty- two years ago. It was in Russia that he received his preliminary schooling, but his advanced study he did in Germany. In 1870, when twenty-five years of age, he went back to Odessa to take the chair of Zoology. He had done the ordinary things well. The great things came twelve years later. In ISH'-^, at Messina, lie made the first observations that have led to the most brilliant and interesting chapter that we have in pathology; phagocy- tosis. This conception of battle between the white blood corpuscles and bacteria has been one of the most dramatic pictures in the whole history of medicine.
This discovery came at a most o])p()rtune time. Virchow had established the impor- tance of the cell. Paslour had discovered the invadiuir microl)e. Mctchnikon" linked the two. It was natural that such a man was needed in medicine, and I'asteni- callcMl M<>t('h- nikoff to Paris in ISSS. The rest of the
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story we know. Every medical man Is famil- iar with Metchnikoff's two great works — the first, on Inflammation; the second, on Im- munity. And his later work, "The Nature of Man," is widely read outside of medical circles. When Metchnikoff went to work on a scientific study of old age, based on funda- mental principles of phagocytosis, the Ger- man scientists said he was crazy. They were wrong. Metchnikoff had attacked a big })roblem. No one realized that fact better than him.self, for he was no fanatic seeking a life elixir. When he kept at his side in the laboratory a bowl of yogJiurt, from which he drank occasionally, he had a reason for it. In this sour milk were bacteria which he con- sidered would "do things" to the flora of his gastro-intestinal tract that were trying to hand his arteries a lemon. And we use the term "lemon" advisedly, for the l)ody may l)e compared to that much-maligned fruit, which consists of pulp and juice. When we are young we are "full of juice." Old age is the replacement of juice by fiber. Just as a fruit goes "woody," so in old age the paren- chyma of the liver, kidneys, and other organs is replaced by fibrous stroma. We know that the yeast germs in wines, beer, and other liquors help this process along. "Why not,"
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says Metchnikoff "combat these organisms by introducing bacteria of an opposite sort?" However, INIetcluiikoff merely amuses him- self with these tilings. While all this old-age talk and "craziness of the good old man" was circulating, Metchnikoff had been busy-
Ml M 1 1 s I K " r 1
ing himself with studies in ape inoculation with syphilitic virus, and found that tiie chimpanzee was susceptibk' to this disease and, inoreover, that inoculations could be carried from aniin;il to nniiual of the same species, but witli decrease of \ iiiil(Mic(\ So tli;ii an ape could be i(Midcrc(l iiuniuiic lo syphilis. 12 177
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Theoretically this gives us, then, a method of vaccination against syphilis akin to the Pasteur method of treating rabies, and Metch- nikoff suggests that all prostitutes step up and protect themselves from the danger of this disease, which is an almost certain accom- paniment of their trade.
It was too bad that Metclmikoff did not discover the spirochetop pallida. He had the chance, considering the w^ork he was doing at the time that Schaudin published his famous article. It should have been Metclmikoff who gave the cause of syphilis to the world. What a great and fitting climax to the life work of this great man that would have been!
I left Metclmikoff, after seeing his syphil- ized apes, and being presented with slides of the spirochetre from the same, without tasting his yaghurt. I was afraid that if I took any I might mix up with that omnibus conductor provided I met him on the way home, for I was still sore about my fifteen centimes.
Paris is an interesting city at night, perhaps the most attractive in all the world. One dines in a brilliantly-lighted restaurant filled with beauty and with the laughter and vivac- ity that come from a mingling of perfectly groomed men and decollete women who have
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forirotteii all save wine and soul and freedom.
After such a dinner one likes to light a cigarette and with cordial and coffee listen to the music that is always good in such a place and dream of the pure joy of life.
But the eveniup; after mv visit to the Pas- teur Institute I was not content. The dinner had been perfect. I had my cordial and coffee before me, and an artist of the violin was playing Gounod's "Ave Maria," but I was uneasy. The night attracted me, and I walked out on to the Avenue de I'Opera. It was a perfect balmy, moonlight evening. Down the Avenue w^as the obelisk that marked the historic Place de la Concorde. In the distance rose the Eiffel tower, a huge giant of the night. I did not know where I was going, but I called a voiture and told the cocJicr to drive me down the Avenue. Tlien I kept on; I crossed the Seine, and drove on through the lone deserted streets that lie west of the Latin Quarter until I came to the two large build- ings that I had visited tliat morning. I bade the cocher stop, and I sat siU'iitly and won- dered at the genius of the modest little man that had made possible all that those buildings represented throughout tlie civili/cd woild. Then, through tlic descried slnv-ts. I <ln)ve back to the midnight noon of the l)onle\ ai-ds.
17!t
XV.
LONDON SIR A. E. WRIGHt's LABORATORY —
PURSUIT OF THE OPSONIC INDEX.
There would be no fun going abroad un- less a man got "stung" occasionally, if only to have the experience to relate after getting back home. I got mine in London. Some one had given me the address of a lodirino;-house in Bloomsbury Square which he said was fine. Arriving late in the evening, I found that the place was "full up," and the girl at the door in answer to my enquiry pointed out another house down the street, to which I went. I will spare the gentle reader the horrors of that London lodging-house, but if he has been in London he can fill them in for him- self, for I am not the only one who has thus suffered.
Perhaps it was this lodging-house experi- ence that jjrejudiced me against London to begin with; or perhaps it was because I never struck anything save cold and rainy weatlier there; or perhaps it was because I missed the out-of-doors cafes of Paris and Berlin; or perhaps it was because I didn't understand the language. I asked a man one day how
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to get to " Ludgate-IIill. " After some ex- change of words, a liglit suddenly dawned on him and he exclaimed, "Oh, 1 see; you want Lugget'll," whereupon the congestion of traflBc incident to the discussion, was relieved. Anyway, at present I feel as though London were no place for me. If ever I get rich or famous, so that I can live at the Kitz
BLODMSni'UY ScjCAKF,
and have a card to the Carleton Club, and a box at the opera, and be invited to meet the royal family, I'm going back and give the place a fair try. But I'm not going till then. And this is where London dill'crs tVoni tlie other great European (•a|)itals. In Ucilin and in Paris yon donl want lo l»e rich, and if you think ot" prosp(M"ity al all, its in llic same terms that Harvard thinks of ^ ale. ('I'he
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exact expression used to be printed on the stationery.) In Berlin and in Paris you are perfectly contented with things just as they are, and pity the misguided American mil- lionaire who stays at the swell hotels and never knows the joys of cheap, but eminently respectable, student-pensions, and the good hearts of those you find there. In London, on the contrary, you cannot help associating poverty with dirt and ignorance.
But all of this has nothing to do with medi- cine, and London is, in truth, one of the greatest medical centres in the whole world. I fear we do not know enough of the great work that is being done here. Of course the more popular medical advances, such as Wright's opsonic work, come to us very quickly, but there is a lot of much more truly scientific work being done, that we do not know about because the articles describ- ing it are buried in society ])ulletins, hospital and laboratory reports, and what not, that we never hear of. German and French scien- tific publications are so easy of access that we can't help reading them, and we give these latter ])cople a credit for leadership in certain lines of thought, which, perhaps, they do not deserve. On tlie other hand, all that relates to medical and surgical teachino; — the g-reat
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hospitals, medical museums, and laboratories, are wide open in London and you have but to walk in and help yourself. London is so big that you can scarcely list the more im- portant institutions, much less go into detail concerning them. There are over twenty- five free hospitals of considerable size, where you can get instruction. The principal hos-
^^
pitals, witli medical schools attached, are as follows — I hope the information is correct. I have never been to any of them. I was too busy trying to explain to a tailor, lo whom J was foolish enough to give ;iii order, how an American desired his clothes lo (it: —
St. IJartiiolomew's is on the edge of the City, and easily i(>;ielied IVoin all parts of London. The hos|)ital contains Til- beds. The libiarv and the |)hvsical science and
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bacteriological laboratories have, now, at their side, a very large building which includes club-rooms for the Student's Union, a writing- room, and luncheon and dining halls.
Charing Cross is situated in the very centre of London, and gives instruction in all sub- jects of the medical and dental curriculum. The Hospital, with its Convalescent Home at Limpsfield, contains 287 beds.
St. George's, an institution with 248 beds, is at Hyde Park Corner. The school pos- sesses an Amalgamation Club, with well- fitted reading, smoking, and luncheon rooms, on the hospital premises.
Guy's contains G02 beds. Thirty-one beds are set apart for diseases of the eye, and 40 for the most urgent and interesting medical cases, which form the subjects of the weekly clinical lectures. There is a special ward of 32 beds for the treatment of diseases of women, and for cases of difficult labor. The new Gordon Museum of Pathology is worthy of note.
King's College has 220 beds in daily use.
The London, which contains 914 beds, is in Mile End Road, Whitechapel. All the arrangements are very complete and modern. The new departments of Bacteriology, Pu})lic Health, Chemistry, and Biology, the new
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Pathological Institute at the Hospital, and new Out-Patient and Special Departments, have been added within the last few years.
The iNIiddlesex is in Mortimer Street, W., and close to Oxford Street and Portland Place. The IIosj)ital contains 340 beds. A wing, containing 40 beds and special labora- tories, is entirely devoted to patients suffering from cancer. It offers unrivalled o])p()rtuni- ties for the study of this disease, ])<)tli in its clinical and pathological aspects. In addition to the arrangements for teaching ordinary students all subjects of the medical curricu- lum, a bacteriological and public health lab- oratory has been added for the purpose of providing instruction for women desirous of carrying out research work in Pul)lic Health, Bacteriology, and (leneral Patliology.
St. Thomas's is faciiiir the Houses of Par- liament, and forms one of the well-known architectural features of London. A large library and reading-room and a very com- plete museum are open to all. 'I'lie n()sj)ital contains (lOo beds, and, in addilioii lo llie oi'diuai'v pi'ovisions of a gi"ca( Iiospilal. lias connecte<l willi its ( )iil-pali<Mil I )<'parliii('iil two lai"<re, \\(']l-\(Mil ilalcd clinical llicalrcs provided willi ample sitting accoiiiiiiodalioii, so tliat larirc mimbcis of sliidcnis arc enabled
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to follow closely the practice and teaching of the out-patient staff.
University College is at the bottom of Gower Street in a new building, erected by the late Sir Blundell Maple. The Medical School is likewise a new building, provided by Sir Donald Currie. It offers excellent accommodation for all the needs of under- graduate study and advanced research.
Westminster is situated in Broad Sanctu- ary, opposite Westminster Abbey. The Hos- pital contains upwards of 200 beds.
London School of Medicine for Women is in the Gray's Inn Road in connection with the Royal Free Hospital. The entire school has in late years been rebuilt and greatly enlarged. The laboratories are roomy, well lighted, and fully equip])ed. The Hospital has 165 beds, all of which are available for clinical instruction.
St. Mary's is situated in Praed Sti-eet; the total number of beds is 34 L During the past year, as a result of the increasing scope of the Department for Therapeutic Inoculation un- der Sir Almroth Wright, F.R.S., a block of consulting-rooms, waiting-rooms, and labora- tories has been equipped in the new wing of the Hospital, and is now in use.
I will take back a l)it of what I said about
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never having ])een to any of these hospitals. I did go out to St. Clary's to see the great glass-blowing establishment of Sir A. E. Wright. The works are in operation from some time after midday till the small hours of the mornlna;. The onlv reason I know for this schedule is that the good, husky men who come here from all over the world, are a little diffident about doino; this Mass-blow- ing stunt at a time a visitor might be expected to call. There happened to be one man there, however, when I dropped in a little after twelve o'clock one day. But he apolo- gized for being at work so early. lie said he had only been at the laboratories for a few days, and, therefore, it shouldn't be lield up against him. He showed me a fine collec- tion of glassware that lie had constructed, and said he hoped lo have a ])acking-case full to take back to America with him. He also said that he dreamed cxcvy uighl of llic way his local medical society would open its eyes when he got uj) and showecl all ih.il glass- ware.
"15ut the oj)sonic index," 1 said; "are you having any (hfHcnlly in learning tlie IcMlniic .-"
"Not t]i(> least ill the world," he replied; "don't you see how iiiiieh glassware I've made ali'cadv .^"
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I wasn't quite satisfied that the gentleman had fully grasped the true scientific spirit of laboratory work, and so I sought further information. After wandei-ing about the de- serted rooms for some time, I finally came upon a diener, who said if I liked he would show me the technic of determinino; the opsonic index while I was waiting, as it was really a simple matter. He had easily picked it up while helping about the laboratory. I thanked him and sat down as he started in to work. First he took several pieces of glass tubing and cut them into convenient lengths. Then he started in to make pipettes. After he had used up all the glass he had, he hunted up some more and continued to blow pipettes. Suddenly he stopped, looked at his watch and said, "Will you excuse me while I go and get my tea ? It's a bit after my hour; I'll finisli when I come back." I told him by all means not to miss his tea, and as I had come several thousand miles to beard the index in its lair, I waited. At the end of an hour or so, a bare-armed, rosy-faced, intelligent look- ing scrubwoman came along. She was a good-hearted soul, and as she said it might be late in the afternoon ])efore the doctors got there, she would show me all about the work herself. She had done quite a bit of it
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in odd lioiirs. So she wiped off her hands, picked up a lengtli of ghiss tu])ino;, and started in to make a pipette. Then slie blew a second and started in on a third. I made my escape, ran down the stairs, out on to the street, and jiassing tlie euplionions "Load of Hay" hotel I found my way back to the City, where I at once ordered a long and cooling drink with special Instruc- tions to the waiter not to put a straw in it, for I had no desire to be reminded of glass tubes.
Really I have no right to scribble so frivolously regarding so remarkable a work as that <leveloped by Wriirht and his associates in the last few years. But a man like Sir Abnroth, who can do things that will set the whole medical world on edge, and establish a vac- cine theraj)y tlial promises to have a })ernia- nent place in our modem scientific thcra- })eusis, won't be disturbed, 1 am sure, by a little good-natured raillery. And besides, they do use up a good many nules of glass tubing out at new St. Mary's.
XVI.
LIVERPOOL THE SUNDAY EXODUS THE
GREAT UNIVERSITY — COOPERATIVE METHODS.
There were several hundred passengers on the boat that landed me in Liverpool one Saturday at about eight o'clock in the even- ing, and not one of them, so far as I could ascertain, except myself stayed over night there. The others, who were wiser than I, hustled to the railway station and caught the first train out for Chester, Wales, London, or some other place fit to spend a Sunday in.
I dined alone that evening, and the next morning breakfasted alone. So far as I could see I was the only guest at the big Adelphi Hotel. I asked the clerk what the necessity was for hotels in Liverj)ool, anyway, and he told me that boats occasionally sailed so early in the morning that people were compelled to get to town the night before. Otherwise he (juite agreed with me that hotels could easily be wiped off the Liverpool map.
Imagine a city the size of Liverpool, with over a million people, the second largest city in the British Empire, so deserted that I (and
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a friend who came to my rescue and bore me off to Chester for the day) walked from its heart at midday for over a mile to the Biken- head Ferry without meeting a dozen people.
But on week days Liverpool is a Inisy town, and I saw here one of the finest medical institutions in all Europe.
The Liverpool School of Medicine was established in 1834, although before then clinical instruction was given at the Royal Lifirmary. On the foundation of University College, Liverpool, the Royal Infirmary of Medicine was incorporated with it. That became a part of the Victoria University in 1884, and in 1903 the present University was established in place of the latter.
The four names most prominent on the medical faculty of the I^niversity are: W. A. Herdman, Professor of Zoology; C. S. Sher- rinirton, Professor of Phvsiologv and Ilistol- ogy; Sir Rupert Boycc, Professor of Pathol- ogy, and R(jn;(ld Ross, Trofessor of Tropical Medicine. Of these mhmi probably Ross, he of the mos(|uito fame, is })cst known to Americans, although Slierriugton, on account of Iiis brilliant woik in ncni-oj)atIioi()gy, runs a close second. llcr(bna!i and Uoycc, Iiow- ever, arc names to conjni-c willi licrc in Liver- pool, for tliey have done many worthy things.
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The buildings and laboratories of the medical school are extensive and up to date. I doubt if there are any better in Europe. The Chemical Department; the Hartley Bo- tanical Laboratories; the Zoological Depart- ment; the George Holt Physics Laboratory; the New Medical School Building of five floors; The Thompson-Yates Laboratories, (a large block of buildings in itself), and the Johnson Laboratories, devoted wholly to post- graduate teaching and research, all form a group of structures of which Liverpool is justly proud.
I spent most of my time here wandering about the research laboratories. Benjamin Moore, the dean of the school and Professor of Bio-Chemistry, is a charming man to meet. I know an American who dropped in there one day and asked Moore if there was a chance for him to work. The next day he was working on a problem in bio-chemistry. In Germany it would have been the next week or the next month.
Sherrington's laboratory is interesting espe- cially for the black-board method he has of teaching histology. There is a black-board at each microscope, and under each micro- scope is fixed a certain ])art of the section he wishes to show. Then Sherrington goes from
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microscope to microscope making drawings of the particular thing at each. For instance, if he is teaching the structure of the kidney, one microscope will show glomerulus only, the next convoluted tubule, the next straiirht tubule, and so on. As soon as a student has seen and drawn one part he goes on to the next.
In the Cancer Research Laboratory we were shown by Dr. Walker the long-tube microscope and the mono-chromatic light which they use exclusively. The combina- tion gives a picture that is truly remarkable, and cell structure is revealed that it is abso- lutely impossible to see under ordinary con- ditions. The work of Moore and Walker along cytological lines in relation to malig- nant growths is too well known to need dis- cussion here.
Liverpool offers a remarkably attractive array of clinical material, and this is admir- ably presented to the student at the Royal Infirmary and the United II()S|)itals (Minical School, which comprises eight liosj)itals wilh a total of 840 beds.
The Royal Infirmary was founded in the middle of the eighteenth century, and first erected on tlie site now o((ii|)ied by St. George's Ilall, and was oixmhmI in 1 710. In
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1821 the institution was removed to its pres- ent situation, where a Large buikUng, fronted by a heavy stone colonnade in dassical style, was erected, and with additions and alter- ations remained in use until 1887, when it was pulled down to make room for the present building, which was opened in 1890. No care was spared to make the present Infirmary as perfect as the science of hospital construction at the time made possible, and various im- provements have since been introduced, so that the building still remains a model of its kind, and is looked upon as such by authori- ties on hospital construction all over the world.
The wards are arranged in separate clinics, with a physician or surgeon, and a resident medical or surgical officer attached to each; each clinic having a clinical room in which to interview patients, and conduct microscopical and chemical tests.
The United Hospitals Clinical School, Liverpool, consists of the following institu- tions associated for purposes of clinical in- struction; The Royal Southern Hospital; The David Lewis Northern Hospital; The Stanley Hospital; The Eye and Ear Infirmary; The Hospital for Women; The Infirmary for Children; St. Paul's Eye and Ear Hospital; St. George's Hospital for Skin Diseases.
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The object of the scheme of cooperation which these hospitals have adopted is that of utihzing, to the greatest advantage, tlie large amount of clinical material which they contain. The regulations which govern this cooperation have received the approval of the University.
One of the most interesting features of the University is the Liverpool School of Tro])ical Medicine, which is governed by a counnittee from the University of Liverpool, the Koyal Southern Hospital, and the Merchants and Shipowners of Liverpool. The aim of the school is not only to train uieu on the special subject of tropical diseases, ])ut to promote research along these lines.
That great progress has been made in tlie latter aim can be seen from a recent re})ort of Sir Rupert Boyce upon the treatment of Sleep- ine: Sickness and other forms of trypanoso- myasis by arsenic and mercury. These dis- coveries, as ])ointed out by Royce, may save millions of lives and make vast tracts of terri- tory now useless, on account of trypanosoiiie- bearing pests, iidud)itablc and (•apal)l<> of cultivation. Investigation is cairiiNl on nnder Ronald Ross, who is IunkI of I lie (l(>parl incut, both at Runcorn, a few miles onl of Liver- pool, aufl also in the Johnson Tropical Lab- oratory at the University.
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This work in Tropical Medicine attracts men to Liverpool from all parts of the world; especially from the tropics. There is one American working here on a fellowship which supports him, and he is turning out some high-grade work.
The John W. Garrett International Fellow- ship in Pathology and Physiology of one hun- dred pounds ($500), awarded annually and tenable for one year, is open to members of universities and medical schools in the United States.
It was my good fortune while in Liverpool to live in commons or, as it is more stylishly printed in the catalogue, "Hall of Residence." I say good fortune, not on accoimt of the food, or the tiny attic room lighted by a single feeble gas-jet, that I occupied, but rather on account of the experience. I have eaten in Italian, French, German, and various other foreign pensions, but I have never been so out of my natural element as I was here.
Pile proper costume for breakfast was bath- robe and slippers. The maid did not appear at this meal, but we took our plates to the buffet and helped ourselves to porridge, bloaters, and 'am and eggs, which were set out in al)undance; and filled our cups with tea, or with that mysterious mixture of luke-
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warm dishwater and l)urned veo-etal)!!^ of iin- known source wliicli the great British nation jolly themselves into believing is coffee. Dur- ing breakfast hour the maid is busy polishing our shoes, and we select them from the long row in the hall (provided some one else hasn't already done so) and go back to our room to
L'i C^'
smoke a pipe and lliiuk about dressing some time before lunch. Tlici-c .ire no early hours here as in Gernuniy. If ;iiiy one ;ipp(Nir(M| in a lal)oratory before Icii o'clock ihc I iiixersitv wouhl exp(^l him.
Diimer is rendered c\(mi more dism.il lh:in breakfast, owing to Ihc l.icl Ih.il one h;i> to descend to the silling-room lo wail Ihc (hniici'
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call and return to the sitting-room after dinner for coffee (I again use the English terminology).
If an English boarding-house sitting-room wouldn't drive one into the last stag-es of homesickness the conversation that is carried on in one would. And when the deadly drug above referred to is finally passed around, you take a cup, for you have reached the stage when you don't care what becomes of you.
I thought the whole thing was as bad as it could be the first evening I put in there. But the second evening my American friend, who was responsible for my being there, told a funny story and the gloom that settled over that assembly in consequence was to the gloom of the previous evening as is the blackness of a London fog to the aiu'iferous halo of a virgin saint.
This friend of mine, by the way, never could be serious. One of the fellows was telling at l^reakfast about pawning a watch and chain. The chain had a gold guinea on it, and the chaj) explained that "the blooming pawnl)roker, don't-you-know, " had "pared" the gold piece so that it was a great deal smaller than when he " put it up." " Perhaps it wasn't really smaller," my friend said quietly, 'M)ut perhaps money looked bigger to you wlien you pawned your watch."
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"Oh, no," the Englisliman replied. "They really do that sort of thing." And a very serious volley of confirmatory affirmations went around the room. In trying to keep a straight face I choked on a bloater and had to leave the table.
Really it isn't fair to talk this way about English lack of humor, for tliat evening I went to a Music Hall and heard much better jokes than we get in vaudeville at home. And all of them set the house in an uproar. An especially popular one seemed to be a remark of Harry Lauder's. " Do you know," he said, " my poor uncle lost all of his luggage comincf from Manchester down 'ere." 'Ow did it 'appen.- W'y, the cork came out of his whiskev flask!" Tlie house was doubled up with laughter before I got the full effect of the joke myself. 1 remarked to my friend on the quickness with which they cauglit it. "Well, they ought to get it fairly (piickly," he replied. "Lauder has been springing that joke to the same audiciicos for i\\'[cvu years."
Liverpool is a gi'c.it pl.ice in wliidi to bny books. There was a second-hand book-ston^ here that I raniblcil into one morning and didn't leave until late in lli(> aflenioon. Not content with exhibiting the thousands of volumes in the main sho|), the old bookseller
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took me to liis store-house and it was there, with a pocket full of candles, I spent my day amid countless piles of old volumes gathered from the ends of the earth. And my day was by no means wasted, for when I emerged from this old loft, covered with cobwebs and dust and candle grease, I bore in my arms a load of volumes that I had long been searching for and which the old l)ookseller j^arted with for a very modest sum.
As a matter of fact I believe the good- hearted old chap rather pitied me when I asked him if he had charged me enough, for he said: "This is all clear gain to me, sir. I've been in this business for a good many years and you are the first man who ever came here looking for old Pathologies. I have to take the things in, in the way of lots, but I never sold any of them before." Alas^ for my honored specialty! I felt depressed, despite my unearthed treasures.
Buying books, by the way, is the least bothersome thing one can do abroad, they are so quickly disposed of. When I buy a book I have it done up securely, write my name and home address on it, stamp it, and deposit it in the nearest post-office. That's all there is to it, and when I get back home the l)ooks are there waiting for me. All old books
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in English, and all books not in Englisli, go in (Inty free, so there are no customs to ])other one. It's an Jiw-ful temptation to include in tliis chapter a little pilgrimage that a small hut select party of good Americans, whose in- terests are medical, made down into Wides. I low they stayed at one of the cleanest and coziest of Welsh inns ever, whose name, "The Angel," w^as not the least of its doliglits. I low they w^ent to an old parish church and saw the culmination of an episode that began in a Berlin pension which happened to house at the same time a youthful American medical man and a young and charming Welsh lady. J5ut all of this is a secret. And far ])e it from the writer to betray confidences.
Liverpool is not only '" journeys beginning" but sad to say it may be likewise "journey's end." I do not wish to write a final chapter for this book, for books of travel should have no final chajiter. No more, 1 iiiaijitain, tlian slionld books of love or of science. Jusl as no life is wholly (•om])lete, so no storv of hmI life ought to be endecl. Leave iii(\ if you will then, on <•! bo;it Ih.il h.is s.iilcd lor liotiic. looking )»;icl\\\;i i"<l tor .'i gliiiips<> ot ;i Limi |h;it is iiol 1)\' ;iii\' mc-iiis hciiig tell Ioicnci' behind.
APPENDIX I.
BERLIX MEDICAL COURSES FOR AMERICANS.
The Year Book Committee of the Angk)- American Medical Association of Berhu has compiled a list of the courses * most f refjueiitly taken by British and American physicians studying in Berlin, which is given here in full.
Most of these courses begin on the first day or during the first week of each month and last for four weeks. Unless otherwise indicated the fee quoted is ])er man. Asterisks indicate the Instructors who speak English.
A. Univerb-itij Courses.
Kemilar student courses at the I niversitv of Berlin are designed more for student tlinii for postgraduate work. An occasional visit
*('()in|)l('t(' lists of tlic Ucrliii Mcdicjil ('(Hirscs arc lo Ik- fouiul ill the following j)ul)li<ati()iis:
1. Das iiuMJizinisclio Berlin. I'lico inks. I.
'i. Schaclil, Ral^clxT uiid Wt-gwciscr f. 'rciliicliiiiir an
ar/.tliclu'ii Forlhildiiii^rskcn. Price inks. 1. .'{. \'rr/.<-i<lini> ilcr \ i)rlc^mii,'cii (Li^l of I iii\fr>ilv (oiirse.s).
Price, |)f^. (>0. 4. \ frzeiehnis der Motialsl;urse. <riatis .">. Knrse fnr ])raktisclie Aer/te, gratis. (I. N'erein fur A<T/teknrse, gratis. 7. I'Vrien- 1\ in>e fiir jir'aktisclie .\erzte, gratis a! H'llliaeker's
book-.storc, Friedrichslr. iO.J. I{.
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to these courses is welcomed without formal- ity. To attend regularly one must matricu- late.
The University work is divided into a Winter and a Summer Semester, the Winter Semester lasting from Octol)er 15th to March 15th and the Summer Semester from April
University of Berlin
15th to August 15th. The time for matricu- lation is comprised in the two weeks preced- ing the opening of the Semester, and the first two weeks of the Semester. The matricula- tion fee is 18 marks. Diploma and passport nuist be shown. B. Vacation Courses (Ferien-Kurse).
Are given twice a year (March and Oc- tober) during the University Holidays. These
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COURSES FOR AMERICANS
courses are for graduates in medicine and can be very highly recommended, so they are usually overcrowded. C. Voluntarij ifisistant.sJiips.
Mav occasionallv be obtained at some of the clinics. Application must be made in person.
COURSES.
Internal Medicine.
Prof. Dr. :\licliaelis, Poliklinik, Karltsr. IS 1; 4 weeks; daily, 12-1. Monthly from March to October. Practical course iu Diagnosis and Thera})y of Internal Dis- eases. Fee, mks. 40.
Prof. Dr. Brandenburg, Poliklinik, Karlstr. 18a; 4 weeks; 3 hours weekly. Physical Diagnosis. Fee, mks. 40.
Prof. Dr. Strauss, l*olikliiiik, Karlstr. ,58; 4 weeks. Mon., Wed., Fri., 9.30-10.30. Given any month upon agreement. 1, Stomach and Intestinal Diseases; '■2, Dis- eases of Metabolism; 3, Internal "\redicM- tion; 4, Rectoscopy and examination of fa'ces. Fee, mks. ."iO per con rs(>. S|)e(ial course: Diseases ot" LivcM- and Kidneys, Monday and Friday, .") (> p.m. 1m'<\ n)ks. 40.
Dr. F. Klempei-, I'oliklinik, Lni.scnsli-. I!);
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4 weeks; daily, 12-2. Monthly. Especial attention to Diseases of the Heart and Lungs. Fee, mks. 75.
Dr. O. Jacobson, Jewish Hospital, Auguststr. 14/16; 4 weeks; daily, 1-2.30. Given in April, May and June. Bedside and Clini- cal Observation. Fee, mks. 75.
Dr. Mosse, first assistant to Prof. Senator. Institute of Prof. Senator; 4 weeks; daily; hours by arrangement. Bedside work. Oberartz Dr. Steyer, assistant to Prof. Krause. II. Medical Clinic Charite. Time, character of course and fee by arrange- ment.
Prof. Lazarus, Charite, "Leyden Wards." Time, character of course, and fee by ar- rangement.
Stoviach and Intestines, Dr. Gliicksmann, Luisenstr. 15; 4 weeks;
4 days weekly, 10.30-12. Every montli.
Diseases of the Stomach, Intestines and
Liver. Diagnosis and Therapy. Fee, mks.
50. Drs. Eisner and Ury, Elsasserstr. 39 ; 4 weeks ;
daily 11-1. Monti ily. Diseases of tlie
Stomach and Intestines. Fee, mks. 60. *Dr. Cohnheim, Karlstr. 20a; 4 weeks; 3
times weekly, 10-12. Monti ily. Diagnosis
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COURSES FOR AMERICANS
and Treatment of Diseases of the Stomach and Intestines. Fee, mks. 50. Privatdozent Dr. Al})u, Ziegelstr. "20; 4 weeks; 4 times weekly, 12-1, by arrange- ment. Monthly. Diagnosis and Treatment, Diseases of tlie Stomach and Intestines. Fee, mks. 50.
Surc/eri/.
Dr. W. Bail, Augusta-Hos])ital. ()])crative Surgery, Abdominal and Brain. On tlie cadaver. Fee, mks. 75, for each man in class of 4-6 men; mks. 100 for each man in class of 2-3 men.
Oberarzt Dr. Braun, Krankenhaus Fried- richshain; 4 weeks; 2 hours 3 times weekly. Monthly except August. Operative Sur- gery. Special Abdominal Surgery. On the cadaver. ViH\ mks. 75, inks. 5 for attendant.
Prof. Dr. Borchardt, Virchow-Krankcidiaus. Surgical Diagnosis and Tlierapy. By ar- rangement.
Dr. Zondels, Polikliiiik, ^Fiinzslr. 1(1; 4 weeks; 3 times weekly; 12.30-2.00 p.m. Surgical Diagnosis and Tlici-aj)y. Fee, inks. (!().
Dr. IIcll)ing, llofVa's KHnik. Am ("iicns !). ()rthope(hc Surgery, willi practical c\ci-- cises on the patient. Hocnlgcn lay dcniun-
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strations. Fee and time according to arrangement.
Dr. Wolff, Chausseestr. 3; 4 weeks; 2-3 times weekly; 7.00-9.00 p.m. Surgical operations upon animals and upon phan- tom. Fee, mks. 60-80.
Prof. Dr. Schmieden, Prof. Bier's Klinik; 2 weeks; daily except Sunday. By arrange- ment; number in course 4-6. Fee, mks. 50. One week, six days beginning Monday, 5 to 6 men. Hypersemia. Fee, mks. 25.
Dr. Eugen Joseph, Prof. Bier's Klinik, 1 week; six days beginning every Monday. Hypersemia. To 5-6 men. Fee, mks. 25.
Gynaecology.
Prof. Dr. Nagel, Luisenstr. 14; 4 weeks; days and hours by arrangement. Monthly. Gynaecological Diagnosis and Therapy, for Practitioners. Fee, nilvs. 60.
Dr. T. H. Landau, Pliilippstr. 21; 4 weeks; 3 times weekly. Monthly when sufficient number of men to take the course. Gynae- cological Diagnosis and Treatment. Oper- ations before the class. Fee, mks. 100.
Dr. Runge, in Prof. Bumm's Klinik, Charite; 4 weeks; 5 times weekly, 11.00- 1.00. Monthly. Gynaecological Diagnosis and Treatment. Fee, mks. 100.
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COURSES FOR AMERICANS
Dr. Blumreicli, Liiisenstr. 13; 4 weeks; 3 days weekly, 1.30 3.00 p.m. Monthly. Course in practical Gynjrcology upon the living subject and phantom. Fee, mks. 40,
Dr. Rumpel, Kgl. Klinlk, Charite, Ziegelstr. 5a; 4 weeks; twice weekly, 6.00-8.00 p.m. Time given indefinite. Course in Gyna3- cology. Fee, mks. CO.
Obbieti'ics.
Dr. Martin, Charite-Krankenliaus; 4 weeks; daily. In March and September. Practical 0})stetrics. Number of men in course, .5. Fee, mks. 300.
Dr. Bosslar. Charite-Krankenhaus; 4 weeks; daily. In October and April. Practical (Obstetrics. Number of men in course, 5. Fee, mks. 300.
Skin (uid VcncrcdI. *Dr. Max Jose})h, Pohklinik, Ziegclstr. '■2();
4 weeks; daily, 0.00 11.00 a.m. Monthly.
Diajj^nosis and TrcatmenI of Di.seases of
the Skin. Fee, mks. 40. Dr. SaallVld, Poliklinik, Ki-()n|)riiiz(Mi-Fr(M- .");
4 weeks; 3 times weekly. Moiillily. I'rac-
tical course in DeiMiialology. Piaclical
cour.se in Cosmetics. Fee, mks. 1') per
course.
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*Dr. Ernest Frank, Karlstr. 38; 4 weeks; 2-3 times weekly. Monthly. Fee, mks. 50.
Dr. Blaschko, Nene Jacobstr. 1-3; 4 weeks; 3 times weekly. Monthly. Skin and Vene- real Diseases. Fee, mks. 40. Microscopical work in laboratory for the semester. Daily, 8.00 A.M.-4.00 p.m. Fee, mks. 100.
*Dr. J. Cohn, Friedrichstr. '2'25; 4 weeks; 5 times weekly. Monthly. Skin and Vene- real Diseases. Fee, mks. 100.
Dr. Arthur Lewin, Oranienbnrgerstr. 45; 4 weeks; 5 times weekly. Monthly. Vene- real Diseases including Cystoscopy. Fee, mks. 100.
Dr. Ledermann, Friedrichstr. 131-a; 4 weeks; twice weekly, 10.00-11.00 a.m. Monthly. Venereal Diseases. Fee, mks. 30.
Nose, Tliroat and Ear.
*Dr. Max Halle, Elsasserstr. 1*2"^; 4 weeks; daily except Sunday, li^.OO-i^.OO p.m. Dis- eases of the Nose and Throat. Fee, mks. 75; with operations, mks. 100.
*Dr. Meyer, with Prof. Dr. Heymann, Poli- klinik, Luisenstr. 17; 4 weeks; 3 times weekly. In April, May, and June. Practi- cal course in Laryngoscopy and Rhinoscopy. Fee, mks. 60. Histology of the Accessory Sinuses. Arranged at anytime. Fee, mks. 50.
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COURSES FOR A.AIERICAXS
Dr. Max Sclieier, Poliklinik, Joliaiinisstr. 14/15; 4 weeks; 4 times weekly. At any time by arrangement. Laryngology and Rhinology with practical work and minor operations. Fee, mks, 60.
*Dr. G. Ritter, Luisenstr. 11. By arrano-o- ment. Operatiye course on the Ear. At least 3 men in course. Fee, mks. 60.
*Dr. H. J. Wolff, Poliklinik, Reinickendoi-fer- strasse 7; 4 weeks; 3 times weekly, 6.00- 8.00 P.M. Monthly. Operatiye course on the Ear. Fee, mks. 60.
*Prof. Dr. Jansen, Karlstr. 17; 4 weeks; 3 times weekly. Diseases of the Ear. Fee, mks. 50. Information concerning opera- tions by Prof. Dr. Jansen can be obtained at his clinic.
Eye.
*Prof. Dr. Gutmann, Schiffbauerdamm '■20. *Priyatdozent Dr. Ilelbron, Uniyersity Eye
Klinlk, Ziegclstrasse 5. *T)r. Oppenlieimer, Saarbriickerslr. 17. *Dr. Pollak, Karlslr. bS. Kliiiik of JVof. Dr.
Silex. For details coiisiill I lie I iisl iiictoi-s.
Xciirolof/j/.
*Prof. Dr. ZicluMi, willi Prof. Kiippcn, l^oli- klinik f. Xcr\(Mikraid<li('ilcii. ( "haril('-Kraii-
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kenhaus. Course in research work to experienced neurologists. For details see Prof. Ziehen at the Nervenklinik, Charite, 12.00 M. daily.
Prof. Dr. Oppenheim, Poliklinik, Karlstr. 27 I; 4 weeks; 3 times weekly. In November, December, April and May. Course in Nervous Diseases with demon- strations on patients. Fee, mks. 40.
*Dr. Cassirer, Klinik of Prof. Oppenheim. Time by arrangement. Course in Nervous Diseases with demonstration on patients. Maximum number in course, 4. Fee, mks. 40.
*Dr. Flatau, Klinik of Prof. Oppenheim; 4 weeks; 3 times weekly. Psychotherapy and Hypnotism. Fee, mks. 40. By ar- rangement. Electro-diagnosis and Electro- therapeutics. Number of men in course, 2. Fee, mks. 50.
Dr. Toby Cohn, Poliklinik, Karlstr. 18a. Time by arrangement. Electro-diagnosis and Electro-therapeutics. Fee, mks. 50. Diagnosis of Nervous Diseases. Fee, mks. 50. Dr. Cohn holds his Polyclinic from 12.00-2.00 P.M. daily.
*Dr. Jacobsohn, Luisenstr. 19. Daily for one month. By arrangement. Histological, topographical anatomy of tlie cerebro-spinal
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COURSES FOR AMERICANS
system. Fee, mks. '■200 for 1 man, mks. 150 each for 2 men, mks. 100 each for 3 men. Maximum number of men in course, 3.
*Dr. Jacobsolm, lAiisenstr, 19. By arrange- ment. Patliok)gical lIistok)gy of the Nerv- ous System. Fee, mks. ,50.
*I)r. Ivcwandowsky, Pliysiological Institute, Dorotheenstr. 35. Bv announcement.
liaililMiK WrUIKl.M IldSl-ITAI, — liKItl.lN
Physiological i'athology of the Nervous System with domonsti-ations on aiu'mals. Must ])c four in course. Fee, mks. 100.
Pediati'ics-.
l^rof. IIeul)ner, KiiKh'rkhnik i]cv T'nivcM-sItiit
(CIiai"itc-Krankcnliaiis). Prof. A. liaginsky, UciiiickcMKlorlVislr. .'J^?. Dr. E(H) Lantjstcin, I\iii(l(Mkliiiik dcy Ivoiu'ir-
lichen <^'li;iril<'.
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Dr. Ludwig Meyer, Kurassierstr. 21, 22. Sanitatsrat Dr. Cassel, Elsasserstr. 27.
Cystoscojvj.
*Dr. Casper, Friedriclistr. 125. Every month
by arrangement. 2-3 men in class. Fee,
mks. 100. *Dr. Frank, Pollklinik, Karlstr. 38. For four
weeks. Twice weekly. Each month. 2-4
men in class. Fee, mks. 100. *Dr. Thumin, Prof. Landau's Hospital, Phil-
ippstr. 21. Every month by arrangement.
Fee, mks. 75. *Dr. Jacobi, Poliklinik, Konigstr. 51. Every
month by arrangement. Fee, mks. 60 100. *Dr. Karo, Koniggratzerstr. 43. 10 lessons
by arrangement. 2-3 men in class. Fee,
mks. 100.
PatJiology.
Dr. Oestreich, Privatdozent, Augusta-Hos- pital; 4 weeks; 3 times weekly. Monthly except August. Macroscopic Diagnosis of diseases of the organs. Fee, mks. 40. Pathological histological diagnosis. Fee, mks. 50. Diagnosis of diseases of the Stomach and Intestines. Fee, mks. 40. Patliological Technic. Fee, mks. 60.
Dr. Westenhoeffer, Privatdozent. Kranken-
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COURSES FOR AMERICANS
liaus Moabit; 4 weeks; daily, 10.00 a.m. till 2.00 P.M. Every month. Gross Pathol- ogy and Antopsy Technic. Fee, mks. .50.
*Dr. Pick, Privatdozent, Krankenhaus Friedrichshain; 4 weeks; 3 times weekly. Monthly except August. General and spe- cial Pathology. Fee, mks. 75. At Landau's Hospital, Philippstrasse 21, general and special Pathology. Fee, mks. 75.
Prof. Dr. Dietrich, Stadtkrankenhaus Charlottenburg. Courses in pathological Histology. Sections and Demonstrations.
Bacte7'l()l()(/i/.
Prof. Dr. Ficker, Hygienisches Institut; 4 weeks; daily, 9.30-2.00. In November, Fe])ruary, May and July. Demonstrations of the making; of culture media. Pacterio- logical examination of milk and watci-. Cultivation, staining and examination of various forms of ])actcria. Serum diagnosis. Infection of small animals. Testing of new culture media, stains, and methods of serum diagnosis. Ibrmolysin, Pi-a'ci])ilin and Opsonin work. Fee, inks, (I."), inks. 5 for attendant.
Prof. Dr. Wassermami, Institut i'iir liit'ck- tions-krankcilcn. Daily t'of three nioiilhs. Once a year beginning in ()(ioi)cr. Making
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of culture media. Cultivation, staining and examination of various forms of bacteria. Serum diagnosis. Infection of animals. Experimental bacteriology. Fee, mks. 65 per month.
*Dr. Klopstock, Institut fiir medizinisclie Diagnostik, Scliiffbauerdamm 6/7; 4 weeks; 2-3 times weekly. Every month but August. Clinical Microscopy with especial attention to the examination of urine, ffeces, etc. Fee, mks. 60.
Practical instruction in the Theories of Immunity may be obtained at the Hy- gienisches Institut or the Institut fiir Infek- tions-krankheiten. Upon application to the secretary of either of the above Institutes all information will be supplied.
Men wishing to do research work can usually obtain working places in the differ- ent laboratories upon personal application. Fee varies.
A knowledge of German is absolutely neces- sary if one wishes to do bacteriological work.
Blood.
Prof. Dr. Grawitz, Stadtkrankenhaus Char- lottenburg. Clinical pathology of the blood.
Dr. Hans Winterfeld, Krankenhaus Moabit. Practical work in methods of blood exami-
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COURSES FOR A.AIKRICAXS
nation with opportunity to acquire tecli- nic on patients.
Prof. Dr. Pk^lin, Charite. Patlioloii;v of tlie blood, with demonstrations and j)ractical exercises.
Dr. von Bergnninn, Oherarzt, II. Med. Ivlinik der Charite. Practical course in clinical ILxMiiatology. As these courses are given irregularly, it is necessary to apply to the Instructors for further details.
Anaiomij, ITi.stoIogij, Emhryolocjy.
Royal Anatomical Institute. Matriculation and information at the Universitv.
Dr. Ilein or Dr. Prohse, Royal Anatomical Institute, Luisenstr. oQ. 1, Topographical Anatomy. ^2, Descriptive Anatomy. Demonstrations upon previously dissected cadavers. Those desiring this work nmst a))|)lv to either Dr. ir(Mn or Dr. Prohse. Xot more than 8 in couise. Pee, mks. "^OO for one man, nd<s. '^OO I'oi" (•(»in"s<^ foi' '■2 men, iii]\s. "iiiO for course for ,'5 men, t'oi- <\ich couise.
Dr. V. Kopsch, Royal Anatomical Instilnle, ('"ives lh<' followiiii: courses, hv arran<re- menl: 1, (JcMieral Histology; ^1, Sj)ccial Histology. Student is given SO !)() s|)(>ci- iiKMis in cncli course. Vcv, niks. ^,'0(1 j'op one man, mks. 100 ('.icli loi- i. men, for each
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course. 3, Microscopical teclinic in all its forms. Every day for eight weeks under direct supervision of the Instructor. Fee, niks. 200 for eacli man, mks. 100 each for 2 men. 1, General Embryology; 2, Special Embryology. By arrangement. Fee, mks. 200. Price according to work. General Anatomy of the Brain and Spinal Cord. Stained specimens of cross sections of the cord and medulla ol)longata. Study of the general relationship of the tracts and cell groups in the Cerebro-spinal System. By arrangement. Fee, mks. 100 for one man, mks. 150 for two men, mks. 300 for three men; more than 3 men not taken.
Dietetic Cooking.
Fraul. Elise Hanneman, Lette-Verein, Vic- toria-Luisenstr. 6; 4 weeks; twice weekly. By arrangement. Class limited to 10. Fee, mks. 30.
Hospitals and Lahoratories.
Charite, Charitestrasse. Konigliche Klinik, Ziegelstr. 5-9. Krankenhaus am Friedrichshain, Lands-
berger-Allee 159, Friedrichshain 2. Augusta-Hospital, Scharnhorststr. 11. Krankenhaus am Urban.
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COUKSES 1 OR AMKKiC AXS
Kraukeiiluius Moabit, Tiinnstr. 21. Stadtkrankenhaus CharlottcMi])iiro\ Kirclistr.
20. Kaiser und Kaiserln Fricdricli-Kiiulcrkran-
kenhaus, Reinlckendorfersti-. 'V2. Kraiikenliaus der jiidischen Gemeinde, Au-
custstrasse 14 16. Rudolph Vii-c'liow-Krankeidiaus, Aiigusten-
biirger Platz.
Lahoratoric.'i. Koniffk Anatonilschcs Institut uiid Rioloff-
isclies Institut, Luisenstr. 50. Physiologisc'lios Institut, Dorotlieenstr. 32. Ilvirienischcs Institut, ITossiscliestr. 4. Institut ftir Infections-kranklieiten. Nordufer,
Fohrcrstr.
General Information.
ra.s.sport.s. It is imperative llial i-ilizens of tlie United States of America bring \\\\]\ lliem })assports from llie State l)ej);iiiiiuMil at Washington, as passports are no longer issued by Ambassadors or Consuls. Tliey nmst also register at their Consubile in conipli.ince with :i HH'ent Act of Congress llie (lel;iil> of wliidi will be expl.'iined ;it the ( 'oiisiihile.
Police luuinlolioiis. HegisI r;il ion of I'or- ei<>"ners will be e\|)l;inie(l by Iionsekecpcr npoii recpiest and shonld be piomplly eomplieil w illi.
221
APPENDIX II.
GERMAN UNIVERSITIES.
A COMPLETE account of the German Uni- versity, its nature, function, organization, and historical development, is given by Paulsen in his book, "The German Universities," and I quote freely from Thilly and Elwang's translation of that work, by kind permis- sion of Charles Scribner's Sons, certain points that may be of interest.
The German universities are state institu- tions and the university teachers, with the title of professors, are salaried officials of the state. As state institutions they are founded, su})ported and administered by the Govern- ment. From it they receive their organiza- tion and laws. The regulations governing the universities and the faculties are passed by the Government, usually with the advice of the corporations. In Prussia the faculty statutes are prescribed by the Ministry of Education.
But the universities are not only state institutions, they are also independent cor- porations of scholars. The head of the uni- versity, the rector, is always chosen annually
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GERMAN UNIVERSITIES
by the full body of professors, and is one of their number. He represents the university in its external affairs; the university officials are subject to his orders; he has charge of the immatriculation of students; and he controls the societies and the meetings of the student body. The German rector is the visible symbol of the corporative independence of the university.
The different faculties also possess impor- tant functions as self-governing bodies. The full corps of professors, who are the faculty's administrative body, annually elect one of their number as dean, to act as tlieir pre- siding officer.
The instructor in a university enjoys an independence in the form and content of liis duties that is not c((ualled ])y that of any other government office. Upon his appoint- ment a professor receives a \\liolly general commission to teacli certain brandies, and lie is allowed to interpret tliis commission for himself; lie decides for himself wliat lectures and exercises are lo be offered, the number of hours to be devoted to every subject, the loj)ics to })e treated, and the inelhods to he followed. He is merely bound to deliver at least oiu' private and one ])ublic course of leclui-es dur- iiiir each semester. There are uo official
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courses of study as in the schools. There is no supervising of the efficiency of the instruc- tion; no revision by supervising officials, and no statements of account, except by the laboratories.
The teaching corps of a German university comprises two kinds of teachers, whose legal status is thoroughly distinct: 1, j^rofessors, who are appointed and paid by the state; 2, private docents, or independent instructors, upon whom the faculties have bestowed the privilege of teaching, but who have no official duties and receive no salaries.
A distinction is also made between pro- fessors: the ordinary {prdentlichc) or full professors constitute the administrative body, while the extraordinary (ausserordeiitliche) professors take no part in the administrative affairs of the university or faculty.
A professor's official stipend comes from two different sources : he draws a salary from the state and also receives compensation from attendants upon his private lectures. The most recent regulation in Prussia, dating from 1897, fixes the initial salary of an ordi- nary professor at 4000 marks (Berlin 4800), of an extraordinary professor at 2000 (Berlin 2400). These figures are increased five (at Berlin six) times, at intervals of four years, by
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the addition of 400 marks each time. There is, in adcHtion, an extra allowance for domicile of 540-900 marks. The income from the honorarium or fee varies exceedingly, depend- ing npon the subject taught, the attendance, and tlie number of lectures, as well as the personal drawing-power of the teacher; it fluctuates l)etween a few hundred and many thousand marks. The large incomes from
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the honorarium are found es])ecially in the large law and medical faculties.
In addition to their salary iuid lionorarium they get decorations.
Originally coiifinctl to })()litical and military circles, tlie decorations, titles, and patents of nobility began to invade the academic world ill the eighteenth century, and have imiltij)lied to such an alarming extent during the nineteenth that they are ainiosi in <laii<rer of losing their distinction. The Ilofnit is
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indigenous to the modern court-university. The Geheimrat did not become common until the hist generation, his appearance Ijeing connected witli the development of the laboratory system.
The private docent is a scholar to whom the faculty has extended the privilege of teaching, but who is not a member of the official teaching body, and is under no official obligation to teach. He has the use of the university buildings and laboratories; his lectures and exercises are announced in the catalogue, and are, In case the student is formally enrolled in the course, accepted as regular work. As a general thing the private docent of to-day looks forward to a professor- ship; for the individual the position of private docent is a stepping-stone to a salaried profes- sorship, and for the universities it is a training- school for professors.
According to the German view the univer- sity professor has a double function to per- form: he Is both a scholar or a scientific investigator and a teacher of knowledge.
The teacher must have learning, he must possess extensive scientific knowledge and understand the methods employed in his field, and he must have an original mind, the power to see things from an Independent point of view, and to handle them In an original way.
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The complete possession of these two quali- ties characterizes the ideal university teacher.
Academic circles are at present governed in their estimate of a man ])rimarilv 1)V his scientific prodnctivity; his ability to teach is a secondary consideration, or rather, it is looked n})on as an accident of the former quality. The university has a tendency to regard itself primarily as a scientific institu- tion; the function of teaching is not apt to be emphasized.
The university student selects his field of study, his university, his teachers, and the lectures to be taken. .Vnd he also assumes an independent mental attitude towards what the teacher offers him. lie can, if he chooses, stay away from the lectures altogether; no one is going to call him to account for that; no one is coinc; to ask him whv he is doin<x it or how he is s])ending his time, at least no one is officially charged to d<> such a thing.
15ul a high relation to the ti'uth is (hMuanded of the student: when he enters the universitv he theoretically places himself in the s(M-vice of the truth. To seek for it and appr()j)riate it is the first duty, to aj)])ly it and make it fruit- ful if he can, the furllicr task of cxciy one who considers himself worthy to be couutecl among the elect of the nation.
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Gci'rnan TJiiiversiiies Other tJian Berlin.
Wiirzburg, in Bavaria, is a medium-sized university town. Among the men on its medical faculty are Stohr, anatomist, Von Leube in medicine, Hofmeier in gynaecology, and Slioenborn in surgery.
Tubingen, in Wiirtemberg, in the Black Forest, has a university which was founded in 1477. Baumgarten in pathology, Doeder- lein in obstetrics, Romberg and Vierordt in clinical medicine, are among the men to be found here.
Strasburg, in Alsace-Lorraine, is a consider- able city, whose university, which w^as the only complete one in F'rance except that at Paris, was founded in 1621. It was abolished by the French during the great revolution, but was restored by the Germans in 1872. Chiari, who made Prague so popular a centre for American pathologists for so many years, is now here; he having taken the place left vacant by Von Reckingshausen. Then there is Schmiederberg, Fiirstner and Hofmeister, all well known. Krehl and Naunyn are also good men to work with in medicine.
Munich, in Bavaria, is considered by many peoj)le the most charming city in Europe. Its universitv absorbed that of Landshut in 1826. It is a centre of German fine arts and
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here are found luinclreds of Americans wlio devote themselves to things other than chnics. I confess that the Boeckhn paintings I fonnd here interested me more than even ^fiiller's Hving pictures. MUller is one of the first cUnicians of Europe, however, and most internists get around to ^Nlunicli in the course of their travels, to see him conduct his famous clinic. Then there is Krapelin here, also.
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who all the neurologists have lo s(>e lo make their European trip complete. (irulxM-, whose name is linked with Widal's in the (inilxM-- Widal reaction; Voit, the j)hysi()l(>gisl ; Kiick- ert, the anatomist; HollingcM- and l)iir«k. j)athologists; Winckcl. lli<' gyiKrcologi^l. and Everhush, llic oplilhalmologisl, aw iiii|.(ulaiil memhers of tlic iiuMlical faculty.
Rostock, in M(>cklciil)nrg-Scliwcrin, lias an ancient nni\(M>ily, fonndc*! in I H!>. 'I'liis is
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a semi-mediaeval town, but little frequented by Americans for medical work. One can get very good rooms in this town for five dollars a month, and dinners for an equal sum. Tlie average cost of living for a student is about fifteen dollars a month.
Marburg, in Nassau, Is beautifully situated. It Is a small city, and its University was founded in 15''27. The great Von Beh ring's name is enrolled on this faculty.
The University of Leipzig, in Saxony, is made use of by a few Americans for medical study. Leipzig is one of the most interesting of German cities, and one finds there many Americans In various lines of work outside of medicine. On the medical faculty, however, are many worthy men, among wliom may be mentioned Curschmann, Trendelenburg, and Marchand.
Konigsberg, In Prussia, founded in 1544, has a number of good men on its faculty. A student's club, the Palaestra Albertina, made possible by the gift of Dr. Fritz Lange, of New York, is along the same lines as the Harvard Union, and Is open to the entire student body.
Breslau, the most populous city in Prussia after Berlin, Is situated at the junction of the Ohlau and the Oder. The university was
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founded in llO'l, and its medical scliool is in a flourisliing condition. Here are to })e found a num])er of famous men: Ponfick, in jjatliol- ogy; Fluegge, in bacteriology; Striim})e]l, in medicine; Kuestner, in gynax-ology; Garre, in surgery; Huertlile, in physiologic chemistry; Czerny, in pediatrics.
Greifswald, in Prussia, was founded in 14.50. Loeffler and Grawitz are the two names best known to us on this medical faculty.
Halle, in Prussian Saxony, on tile Saah\ was united with Wittenberg; in 1817. Tliis very pretty town, not far from Leipzig, is well worth a visit. Ilarnack's laboratorv is of interest to all physiologic chemists, and Ki- berth, whose name is associated witli I he typhoid bacillus, is here. Friinkel also sliould not be passed by without mention.
Giessen, in TIesse Darmstadt, fouiidcMl in 1007, is situated in a ])lain some lliirly miles from Frankfort am ^Nlain. Po>lro('iii in pathology, Strahl in anatomy, and IM'aniKMi- stiel in obstetrics, arc \\«'ll-kno\\ ii jnotVssors in this universitv.
GottingCMi, in llanovcM-, was roniid(>(l in 1734. Here arc (juitc a mimbci- of well- known men; for c\anij)l(\ I'bslein in medi- cine, Bi-ann in snrgery, (rainer in neniology, and ]5orsl (llie anilior d" lli«' big book on
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tumors) in pathology. Elirlich lectures here for three weeks each year on the most recent progress in immunity research.
The different faculties award prizes each year for special work. The problem for 1906 was, "The state of alkalinity of the blood, and red and white corpuscles in nervous and mental diseases." The faculty naively state that the problem is not literary, but is to be solved by investigation of the patients.
Heidelberg, in Baden, founded in 1380, is known by name to everyone. So are Arnold, Czerny, Fuerbringer, Erb, Knauff, Roshtorn, Kossel, Gottlieb, and Nissl, to say nothing of a number of lesser lights, for Heidelberg does not have its great reputation for name alone. You will surely go there, if only to say you have been; and if you decide to stay it will be well worth your while. It's a great temp- tation to write a chapter about Heidelberg alone, but then Mark Twain has written of it so perfectly in his "Tramp Abroad" that anything after that would fall flat.
Freiburg, in Baden, was founded in 1456, and is beautifully located near the Black Forest. The university was best known, per- haps, because of the great pathologist Ziegler, who was here for so many years before his death. He has been succeeded by Schmorl.
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In eye diseases liere Is Axenfeld; In gyna'col- ogy and obstetrics, Kronig, and In surgery, Kraske. Weismann, tlic famous zoologist, is also here.
Jena, in Saxe Weimar, a small town, whose university was founded in 1.558, is famous not so much for its general faculties, perhaps, as it is for sin":le individuals. First of all there is Ernst Haeckel, the great zoologist, who has done so much, among other tilings, to inter- pret Darwinism and spread the theory of ])r()- gresslve development. Ilaeckers "Natural History of Creation" has been translated into twelve languages and has reached its fourth Eno;lish edition.
Then there are the great Jena glass and lens factories here. It is to Abbe, who fiilcMl the chair of applied mathematics, naliiral philoso})hy and astronomy in the Tnivcrsily of Jena, thai wc owe the modern mieioscope. lie interested himself in the then modest lens work of Carl Zeiss, hiving down ex.iel matlie- matical foiMnuhe for ihe giin(nng of Kmiscs and atlempting to esl;ibji>li (>\;i<l cheniieal formulcL' for glass-making lo do ;i\\;iy willi ine<iniilities in ihe product, liy llie iiid of llie Prnssimi ( iovernnienl this goal was (inally reached, aiul now (ieiinany leads llie world in the mannfaeliire of line optical ins! iiiiiieiil>.
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Erlangen, in Bavaria, is ten miles from Nuremberg. The university was founded in 1743. The medical faculty here is com- paratively small and the men composing it less well known than in many of the other universities.
Bonn is of great antiquity, though the present university dates only from 1818. It is situated in Rhenish Prussia on the left bank of the Rhine, some fifteen miles from Cologne.
It was from here that Bier was called to Berlin to take Von Bergman's clinic. Such well-known men as Pfluger in physiology, Ribbert in pathology. Tinkler in hygiene, Fritsch in obstetrics, and Nussbaum and Schiefferdecker, who have added much to our knowledge of the central nervous system, are at Bonn.
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R Thompson, Ralph Leroy
4.84. Glimpses of medical Europe
T56
Biological & Medical
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