VIENNA AFTER THIRTY-FOUR YEARS. WILLIAM OSLER, M.D. Itegius Professor of Medicine at the University of Oxford. OXFORD, ENGLAND. I spent the first four months of 1874 here. I came from Berlin with Hutchinson, an Edinburgh man (Sir Charles F., who has recently died), and we lived together near the Allgemcines Krankenhaus. As illustrating the total blotting out of certain memories, particularly for places, I may men- tion that strolling to-day up the Alserstrasse I could not recall the street, much less the house, where we had lived for the four months. I found my way readily enough to the Riedhoff, where we were in the habit of dining, and where I first met my old friends, Fred Shattuck, E. H. Bradford, E. G. Cutler and Sabine of Boston. An extraordinary development has taken place in the city within thirty years, and I scarcely recognized the Ringstrasse. Then, only the foundations of the new university buildings and of the Rathaus had been begun. Now these, with the parliament house, the courts of justice, the twin museums of art and natural history and the new Bourg Theater, form a group of buildings unrivaled in any city. TIIE GERMAN CONGRESS FOR INTERNAL MEDICINE. The primary object of my visit was to attend the Congress fitr Innere Medizin, and I had the pleasure of having with n my old student and friend, Dr. Joseph IT. Pratt of Boston. We reached Vienna in time for the preliminary Sunday even- ing social gathering in the Kursalon of the City Park. Here we found a greeting in true German fashion and a hearty wel- come from the president, Professor Miiller of Munich. The work of the congress began at sharp 9:30 on Monday morning with a discussion on the “Relation of the Diseases of the Female Generative Organs to Internal Maladies.” Unfortunately, the large University Hall, in which the meeting was held, was most unsuitable. Though seated not very far away, Profes- sor Rosthorn’s remarks were almost inaudible. It is a miser- able mistake in introducing a discussion on any subject to speak for more than half an hour, but to continue for an hour and a quarter is too much for human endurance, and a great many did not wait for Professor Lenhartz’s discussion of the problem from the standpoint of internal medicine. 2 Nothing new was brought out, and so far as I could gather. Professor Rosthorn took much the same ground as Clifford Allbutt in his well-known Goulstonian lectures dealing with the intimate relationship through the sympathetic nervous sys- tem of the generative functions with those of the other organs. Quite an animated discussion followed, in which Stintzing, Turban, Klemperer and others took part. Dr. Singer read a most interesting paper on “Intestinal Diseases in the Climac- teric,” calling attention particularly to frequent hemorrhages which he had known to arouse suspicion of malignant disease. In the evening the city fathers gave a magnificent banquet to the congress in the superb hall of the Rathaus. At three long tables were seated some 600 guests. On Tuesday morning Professor Neisser of Breslau opened the discussion on the “Present Position of the Pathology and Therapy of Syphilis.” This was a splendid address, delivered without notes, in a good clear voice, and the subject matter arranged in a most orderly manner. He dealt particularly with the three points brought out by recent investigations—- Schaudinn’s discovery of the spirochete, the discovery of Metchnikoff that apes could be infected, and the discovery of Sehaudinn that the fluids of infected persons reacted specifi- cally. He dealt very fully with his own experimental work in Java, much of which has appeared, but it was particularly interesting to hear the relation of the extraordinary influence of atoxyl on the infected animals. It acts as a specific and prevents the development of the spirochetes, so that if given soon the disease could be completely stopped, and later the animal reinfected. Neisser wras followed by Professor Wasser- mann, who described with great clearness his studies on the specific reaction. We have now apparently a diagnostic means by which the presence of the disease may be definitely deter- mined at a very early stage. As the reaction may be present before secondary symptoms appear, it will have a very impor- tant influence in early treatment. The general expression of opinion is very favorable to the method. Professor Finger spoke of it to me in the warmest terms. It persists after all clinical symptoms have disappeared, and a positive response in locomotor ataxia and in general paralysis clinches the ques- tion of the true syphilitic nature of these maladies. Both Neisser’s and Wassermann’s addresses were models. One of the most important communications of the con- gress was from von Noorden’s clinic. Two of his assistants have been carrying on researches on the “Mutual Relations of the Pancreas and Thyroid.” For many years von Noorden has had the idea that there was some important mutual influ- ence between these two organs. The remarkable fact comes out that in animals from which the thyroid gland has been removed it is impossible to produce diabetes by any of the 3 known methods, not even by the Claude Bernard puncture of the medulla. Of the third day of the congress I saw but little. Professor Schmidt of Halle introduced a discussion on “New Clinical Methods of Investigating the Functions of the Intestine,” in which he went over his recent work very fully, most of which has already been referred to in The Journal. DINNER TO THE CONGRESS. At the dinner of the congress His threw out the interesting suggestion (apropos of the presence of Griinbaum and Trevel- yan from Leeds, Pratt from Boston, Barr from Portland, Ore., and myself), that the time had come to have an International Congress for Internal Medicine. The physiologists, the laryn- gologists, the alienists and others have such gatherings, and there now exist in France, Germany and Italy, England and the United States special societies devoted to internal medi- cine. A congress once in four or five years would be most helpful. We should get to know each other and be able to appreciate better the work done in different countries. Pro- fessor Schultze of Bonn gave his usual humorous sketch of the proceedings of the congress, which was greatly appreciated. A ripple of excitement spread around the tables when it was noticed that the places in the orchestra of the pianist and the first violin had been taken by von Neusser and His. The mem- bers gathered around the elevated gallery and the distin- guished artists were greeted with loud applause and had a vigorous encore. THE VIENNA LIBRARIES. Prof. Max Neuburger, whose name is so well known m association with Pagel as editor of the “Handbuch der Geschichte der Medizin,” very kindly arranged to show me the points of interest in the Vienna libraries. I may mention, by the way, that Professor Neuburger’s new work on the “History of Medicine,” of which one volume has appeared, is being translated and will be published from the Oxford I ni- versity Press. He expects to have Volume II completed this year, and we hope to issue the English edition complete in one volume within the next fifteen months. I was greatly inter- ested to see the new home of the Wiener medizinische Gesell- schaft, built under the presidency of Billroth, which combines features of a library, a club and meeting place. The audi- torium is exceptionally well arranged with seats for 300. and there is a large gallery. The library now numbers more than 40,000 volumes and is very rich in current periodicals. The university library is one of the largest in the city, and the arrangement in it for the accommodation of the medical stu- dents seems to be excellent. At the time of our visit the section of the reading room assigned to them was nearly full. A room has been set aside in connection with the medical 4 faculty for the collection of all the literature relating to the history of the school, for the collection of the works of all the famous old men connected with it, and a repository for pic- tures and instruments, etc., the whole to form a collection illustrating the evolution of the history of the medical depart- ment of the university. This example could very well be fol- lowed in all of our medical schools. It has been done to some extent at the University of Pennsylvania, as William Pepper III. has already made large collections for this purpose. The Hofbibliothek is unusually rich in manuscripts and early printed hooks. I was anxious to see the copy of “Christianismi Restitutio” of Michael Servetus, 1553, in which for the first time the lesser circulation is described. This is one of the only two known copies in existence. The entire edition was confiscated, and the author, at the time a practi- tioner in the little town of Vienne, near Lyons, fled for his life to Geneva. Here his heterodoxy was quite as obnoxious to Calvin, into whose hands he fell, and he was burnt at the stake in the same year. The “Restitutio” is one of the rare books of the world. Only two of the 1,000 copies known to have been printed have survived. The one in the Biblio- theque Rationale originally belonged to Dr. Mead, and the his- tory is fully given in an appendix in Willis’ work, “Servetus and Calvin.” The Vienna copy is in excellent preservation, beautifully bound, and states on the title page that it came from the library of a Transylvanian gentleman living in Lon- don. It fell into the hands of Count de Izek, who presented it to the emperor of Austria. It is a thick, small octavo of about 700 pages. The first one to give credit to Servetus for his discovery of the lesser circulation was Wotton, whose “Reflections Upon Learning, Ancient and Modern,” 1094, is a most interesting book, for an introduction to which I have long been grateful to my friend, Dr. Norman Moore. The other work that I was most anxious to see was the famous manu- script of Dioscorides, prepared at the end of the fifth century for Julia, daughter of the Emperor Flavius. It is one of the great treasures of the library. Now to us in the West only a name, Dioscorides, an army surgeon of the time of Nero, fills a great place in the history of medicine, and is still an oracle in the Orient. He was not only a great botanist, but he was one of the first scientific students of pharmacology. Scores of fine editions of his work, with commentaries, were issued in the fifteenth and sixteenth centuries. Two years ago this Vienna manuscript was reproduced in fac simile at Leyden. Though very expensive, the two volumes costing $150, it is a work which all the larger libraries should get, and it is just the sort of present librarians should make our wealthy con- sultants feel it a privilege to give. 5 I was surprised to hear Professor Muller say that he thought iu hospital architecture Vienna led the world, and that there was here a group of architects who were adepts in all matters relating to hospital construction. I have come to his conclu- sion, on what may appear to be very hastily acquired data. It is not often that in the same day and in the same institu- tion one passes from eighteenth to twentieth century condi- tions. Dr. Ivoessler took us to the old medical clinic, now in charge of von Neusser, where I found the old wards very much the same as I remember them in 1874. Except in minor details, not only Oppolzer and Skoda, but probably also Peter Frank and de Haen could return to the Allgemeines Kranken- liaus and not be surprised by any very unfamiliar sights. There is the same extraordinary wealth of clinical material. I must say it was a surprise to. see the old type of nurse; not. of course, that she is necessarily either unintelligent or inattentive. Indeed, as we passed a bed in which there was a new patient whom the junior assistant had not seen, he turned to one of the nurses, who in reply to his question said, “Yes, Herr says she has mitral stenosis and insuf- ficiency!” I was interested to see in the ward a case of Pick’s disease, the pericardial pseudocirrhosis of the liver. The old question conies up here as to priority of description. In the special number of the Wiener klinische Wochenschrift, issued for the congress, Professor von Neusser describes it as “Morbus Bamberger.” He states that in 1872 Bamberger described the condition as a special malady which he had already known for a long time and which up to that time had not been recognized in the literature. Certainly Pick deserves credit for having brought together all the known facts relating to a clinical condition to which very little attention had been given before his paper. I had a most interesting talk with Pick and Brauer and Wenckebach on the whole question, which is not one simply of pericardial adhesion. Wenckebach has helped to solve the problem in a recent number of Volkman’s Vortrdge in an article on the “Relation Between Respiration and Circu- lation.” Brauer of Marburg, who is coming over to the ses- sion of the American Medical Association, will discuss the subject in connection with his operation of eardiolysis. If anyone interested in hospitals—in every possible detail, construction, situation, general arrangements for the comfort of the patients, for the convenience of the students, for the advancement of science—if such an one wishes to have a Queen-of-Sheba sensation, let him visit the first group of the new buildings of the Allegemeines Krankenhaus. They have begun the rebuilding with the departments for women, and two of the three clinics, for midwifery and gynecology, are completed, one for Professor Schauta and the other for Pro- fessor Rosthorn, recently called from Heidelberg. About THE HOSPITALS. 6 10,000 deliveries a year take place in the three clinics, one of which is for midwives. The new clinics are exact duplicates of each other, and each has accommodation for about 200 patients. The buildings are of four stories, a central build- ing with wings, built of brick and stucco, with spacious corri- dors, large windows, tiled floors and white oil-finished walls. Inside and out they form the most attractive hospital buildings that 1 have ever seen. But it is not so much this aspect that gives one that sinking of the heart of which the Queen of Sheba complained when Solomon showed his treasures—it is. the organization and the completeness of the arrangements for teaching and for the scientific study of disease. One large floor is assigned to students, who all live in the building while attending the midwifery cases. Each clinic has its own laboratory, a special museum for teaching pur- poses, a library and a fully equipped small laboratory adjoin- ing the gynecologic operating room, so that an opinion may be given immediately as to the nature of a growth. Down to the smallest detail every care has been taken to make these two clinics the most perfect of their kind, and if the hospital is completed on this elaborate plan it will, indeed, be worthy of the fame of the Vienna school and there will be nothing like it in Europe or America. *The government foots the bills, and the total cost of the two buildings has been 9,000,000 kronen ($1,800,000). Professor Schlesinger very kindly took us to the Franz Josef Hospital, also a new building, on a less elaborate scale but very complete in all its appointments. It is particularly well arranged for the acute infectious diseases, and the most elabo- rate precautions are taken to isolate and disinfect the pa- tients. Professor Schlesinger is very popular with American students, and we found working in his wards Dr. George Cheyne Shattuck III. of Boston, and young Dr. Fischel of St. Louis, both of whom have for some months been acting as voluntary assistants. It was interesting to see two wards devoted entirely to erysipelas; as far as possible all the cases in the city are sent here. Connected with this hospital is a beautiful new children’s department, built by Professor Schlesinger’s father-in-law. It looked to be an admirable model for the new Harriet Lane Johnston’s children’s depart- ment at the Johns Hopkins Hospital. In the arrangement for isolating cases, in the simple and easily worked character of the wards, in the laboratory arrangements and in the special incubators for feeble babies the hospital seemed much in advance of anything I had ever seen. The scientific laboratories of the medical school have been completely transformed. Dr. Frohlicli took us through Pro- fessor Meyer’s Pharmacologic Institute and through the new physiologic laboratory and the anatomic department—such a contrast to the old days! 7 CRITICISM OF WORK OF CONGRESS. The general impression one gets of the work of the congress is very favorable. Too much, perhaps, is attempted. There are too many papers, but the keenness of the men and the scientific interest are most stimulating. As I remarked about the congress two years ago in Munich, there is a strong tendency in internal medicine to-day toward physiologic and chemical problems.* On the long list of papers, eighty-eight in number, there were only about five dealing \vith bacterio- lo