However, we think the Petit diplobacillus excluded, because these cases presented the typical appearance of a pneumococcus serpentic ulcer, complicated with diplobacillus catarrh.

On account of the great tendency of the diplobacillus to attack the conjunctiva adjoining the lid edges, it is not surprising that an extension to the integument of the lid frequently occurs.

We are able to classify 16 cases in which the skin of the lower lid and in the region of the external canthus participated in the disease process, usually in the form of a dermatitis.

These were all in neglected cases of trachoma or chronic conjunctivitis, in which the individuals had acquired a degree of apathy to the disease and an indifference to treatment. Accordingly the diplobacilli were present in great numbers, not only in the conjunctival secretions, but also in the excoriations of the skin.

That these germs can grow upon eczematous areas of dermatitis, we have twice convinced ourselves. We repeatedly made preparations from moist and erythematous areas of skin and found numerous diplobacilli which had evidently been introduced from the eye and had found a suitable soil for growth.

In surprising contrast to this stands the fact that we have never been able to find these germs in the secretion from the nose, nor in the pus from a dacryocystitis. On the contrary, Biard has found them 28 times in 30 such

cases.

Even in cases where the lachrymal sac contained an extraordinary variety of germs and in which the diplobacillus was in the conjunctiva, we were quite unable to demonstrate them in the pus from the sac. Our observations are based on 12 cases and we cannot evade the impression that the mucous membrane of the nose and tear sac is not very prone to infection by this bacterium. We would by no means deny that they may be found upon it, but we think it is simply as a result of secondary infection.

All observers who have seen many cases of diplobacillus conjunctivitis, agree that the germs attack by preference the portion of the membrane bordering on the lid edge, while the deeper portion and especially the bulbar portion remains immune.

It is certain that the germ is inclined to exhibit its greatest energy at the junction of the mucous membrane and skin. So it is intelligible why at times it should be foun] in an eczema of the border of the nostril and not deeper in the nose. As it is rare for the affection to spread to the ocular bulb, in our opinion it must be correspondingly rare for it to spread to the mucous membrane of the nose or lachrymal sac.

We must mention the occurrence of ectropien in cases of diplobacillus catarrh combined with dermatitis. Axenfeld considers it very rare, as but one case had been reported (Peters). It cannot be denied that a very protracted diplobacillus blepharo-conjunctivitis may result in ectropien of the lower lid.

On the other hand, it is very apparent that the conjunctiva in a case of ectropien may, with undue facility, be colonized by diplobacilli. In the eight cases of this kind we have studied, we cannot show any causal relation, as we could not learn the time of infection.

Mixed infection occurs. As in other cases of mixed infection, it is hard to decide what part is played by the different germs. The staphylococcus, ordinarily harmless in the conjunctiva, under some circumstances may become irritative. Its combination with diplobacilli may possibly, therefore, increase the severity of the inflammation. However, since the diplobacillus alone

may produce acute symptoms, our opinion on this point must be reserved.

In the many cases of diplobacillus catarrh which ran a typical course and which contained staphylococci, we regarded them as harmless intruders. Similarly, we cannot attribute any malignancy to the pneumococcus in the nine cases in which we found it combined with diplobacilli, unless indeed inflammation of the drainage apparatus may have been due to it.

Bulbar injection and corneal involvement, which occurred in one case, we saw more frequently in cases without the pneumococcus.

We have seen the diplobacillus combined twice with Koch-Week's bacilli, and twice with streptococci, and do not think they increased its virulency in the least. The stormy course of the Koch-Week's bacillus inflammation entirely concealed the presence of the diplobacillus.

In one case of mixed infection with streptococci, there was a silght keratitis, and in another there was a perforation ulcus serpens, followed by panophthalmitis. This disaster we attribute entirely to the streptococcus.

Mixed infection is not rare, and does not modify the commonly benign character of the diplobacillus. When virulency is developed by the other germs, the effect of the diplobacillus is entirely overshadowed.

In view of the fact that diplobacillus catarrh does not occur everywhere, its widespread occurrence here is remarkable. Patients come from Bonn and the region around it, from all the Rhein provinces and from the industrial purlieus of Westphalia. They come from city and country alike.

The poorer classes are mostly affected, for among them indifference and uncleanliness contribute to the spread of the disease, and serve to make it endemic. The slight discomfort which it sometimes causes is also partly responsible.

Age affords no protection against it. Children and adults are attacked with equal felicity. Hitherto there has been no report of the catarrh attacking children under one year of age. In our series we had one patient of the age of four months and one of the age of eleven months.

Therapeutically the zinc preparations stand in the highest favor. We have seen very little relief from solution of boric acid and solution of mercury oxcyanate. In acute attacks, silver nitrate does not act as promptly as zinc. With zine we have seen the germs disappear in four days, so that a cataract operation could be done.

In order to avoid the danger of recidivation, however, it is necessary to use it for two or three weeks. In clinic cases which sometimes resist the zine, it is because of improper or negligent use of the remedy. When we could give the patients personal attention, the prompt and excellent effect of the zine has never failed.

As we have had the best results from one-half per cent solution, we have never had occasion to employ a greater strength. The weaker solution causes less discomfort and the patient is more likely to carry out the treatment thoroughly.

In cases of esophageal stricture always examine carefully for aneurismal trouble of the aorta, as rough passing of instruments in such cases has led to rupture and sudden death. If the trouble should be due to malignant disease, an instrument might be forced through the esophageal walls. If, therefore, it does not pass readily, it is best to desist and perform a gastrostomy if necessary, in order to feed the patient.-Ex.

REMINISCENCES OF A RECENT TRIP ABROAD, INCLUDING VISITS TO THE LONDON, PARIS, BERLIN, ETC., HOSPITALS, CLINICS, MEDICAL MUSEUMS AND LIBRARIES, AS WELL AS

TO THE BRITISH MEDICAL ASSOCIATION.

JOHN PUNTON, M. D., Kansas City, Mo.

Professor Nervous and Mental Diseases University Medical College, Editor INDEX-LANCET, Etc.

Berlin University.

Leaving London for the Continent, the American physician usually has three objective points or medical centers in view, viz.-Berlin, Vienna and Paris. As the two former are much alike in their methods of teaching and general arrangements of clinics, a description of either suffices to give a good idea of their general characteristics, reserving medical Paris for a future letter.

It is unnecessary at the outset to state that both Berlin and Vienna, from a medical standpoint, are owned and controlled (figuratively speaking) by their universities. All medical law and opinion emanates from this one authoritative source, hence the national medical life and spirit of Germany is thus formed from one common mould. This has many advantages, but seems altogether too exclusive and patronizing for the average American, as it savors too much of favoritism on the part of those fortunate enough to receive its appointments, with all that this implies.

Nevertheless it suits the German medical student, and his long period of tutelage is accepted without a murmur. As the university forms the medical center from which radiates all the medical college life and spirit of Berlin, a brief reference to some of its special features may not be out of place.

It was established in 1810, and is in every respect one of the greatest literary institutions of Germany. The main building is a magnificent structure, richly carved and presents a fine appearance. In its interior it is beautifully decorated, and contains as one of its most important features, a fine library.

It has counted among its professors many of the most celebrated German scholars, such as Humboldt, Ritter, Tichte, Hezel, Schelling, Neander, Virchow, Koch, Jolly and many others.

Its various clinics are scattered throughout the city, but are under the control of the different members constituting the faculty of the University. It would be impossible, in the brief space allotted me, to refer to the many interesting clinical features to be found in Berlin, but that which overshadows all the rest in point of medical interest and value is the Virchow Pathological Laboratory. It was our misfortune to miss seeing the great medical master himself, but being armed with the proper credentials, we were allowed to visit his famous laboratory and witness the results of his own handiwork.

As Dr. Richard J. Tivnen, of Chicago, an honored and valuable member of our party, expected to remain in Berlin for several months in pursuit of special knowledge pertaining to ophthalmology, his adopted specialty, I have asked him to finish the remainder of this letter, believing his larger knowledge of the subject would be the more welcome and instructive.

*Continued from March number, Article VI of the Series.

HOSPITALS OF BERLIN,

RICHARD J. TIVNEN, M. D., Chicago, Ill.

When the name of Rudolph Virchow is spoken, all men of medicine and kindred sciences bow the head, so to speak, in token of admiration and respect. Wherever civilized institutions obtain; wherever the "beacon light" of science has penetrated, there also is the name of Virchow honored and revered.

To the American, his struggle to win recognition and fame is peculiarly of interest. Like many of the great men of our country, his origin was humble. A brief review of his life may be not out of place.

Rudolph Virchow was born at Schievelbein, in Pomerania, Prussia, on Oct. 13th, 1821. At the age of eighteen he entered the medical department of the University of Berlin. Shortly after obtaining his degree of doctor of medicine, he was elected a privat-docent. At this early period in his career he made important discoveries relative to the white blood corpuscle. In 1849 he assumed the professorship in the Pathological Academy of Wurzburg. In 1856 he returned to Berlin as professor of pathological anatomy, and became director of the Pathological Institute, which from that day has been identified with his name. His theories and discoveries on the "cell” and "cellular pathology," have completely revolutionized the older conceptions of the origin of disease. He also has taken, at different times, an active part in the politics of his country, serving with distinction as a member of the Berlin City Council, and as a representative in the Prussian House. He has been prominent in introducing measures for public health, notably laws for inspection of food, for regulating vaccination and suppression of epidemics. On Oct. 13th, 1901, the scientific world joined hands to celebrate fittingly his eightieth birthday. Seldom before has a physician been so honored. In Berlin the students of the university vied with Professors Von Bergman, Waldeyer and other eminent colleagues, in contributing their share to have the celebration a pronounced success. They appointed committees, posted announcements, arranged details and in a thousand ways testified their sincere loyalty and veneration for Germany's "grand old man” of science.

It was said the professor was deeply touched by these evidences of affection on the part of his "youngsters." The medical profession of Berlin tendered him a banquet, at which representatives of different countries and medical societies presented him with addresses of congratulation and good wishes.

The daily papers and leading periodicals published "sketches" of his life and work. The book-shops displayed lithographs and-borrowing a spark of Yankee enterprise-announced "special authorized" editions of his life. On the morning of the 14th a gathering of notables assembled at the Pathological Institute, where Virchow has labored so long and faithfully, and with appropriate cermonies unveiled a "bust" of the professor.

Virchow is, by nature, the most modest of men. To all the honors showered upon him, to all the addresses of praise and commendation the tenor of his brief replies was, "I am not worthy, I do not deserve it." Seldom is it given a manhood to look back from the pinnacle of "eighty years" and survey such a perfect structure of scientific attainment as his fertile brain and indomitable will has constructed to the glory of his name and benefit of his fellow-men; seldom is it granted a physician to receive the unsolicited honors and heartfelt appreciation of admirers from all parts of the civilized world and rare, indeed, have such testimonials been more appropriately be

stowed, more richly merited and more modestly received than in the case of Prof. Rudolph Virchow.

The Virchow Pathological Institute is located in the grounds of the "Charite." The exterior is not particularly imposing, though the lawns about are adorned with flower beds and kept in excellent order. The best hour for visiting the Institute is about 10 a. m. On presenting professional card every courtesy is extended. The different floors of the Institute are arranged into large rooms, in which are placed large glass cases. These contain the specimens. Perhaps no museum in the world compares with this for variety of pathological conditions, systematic arrangement of specimens and scientific accuracy of records. The first floor is given over, mainly, to a startling collection of monstrosities. This collection is unusually complete and includes, among others, some remarkable specimens of Acardiaci and Anencephali. On the second floor is the Osteal collection. Here one may observe the most unique cases of fracture-and, thanks to the orderly arrangement, study and trace the pathological processes, from their earliest perceptible stage, in tuberculosis, osteo-myelitis, syphilis and other interesting conditions. A collection showing the deformities following Osteomalacia and Rachitis is especially deserving of attention. Specimens of osteal necrosis, sclerosed conditions, exostoses, gun-shot wounds, bayonet thrusts, etc., are numerous and well repay study. The section on "Tumors" likewise deserves special mention. Perhaps every variety of morbid growth that has afflicted the human family has a representative here. Some exceptionally instructive specimens of Carcinoma, Fibroma, Cavernous Nævi, Osteoma and Chondroma are noted. In the "Abdominal Viscera" collection the specimens are beautifully grouped-showing the progressive intestinal and peritoneal changes ensuing in typhoid fever, tubercular peritonitis, etc., ulcer and malignant disease of stomach, cirrhosis of liver and various lesions of kidney, spleen and pancreas.

The mounting and preparing rooms and laboratories are located off the main collection rooms, and a hasty inspection of them completes the visit.

The Pathological Institute is one of the most interesting and instructive places of Berlin. It is an enduring monument to the fame and labors of Prof. Virchow and will ever be a "mecca" for the wandering medical man in quest of knowledge, inspiration and recreation.

To omit, at least a brief mention of the School of Anatomie, when reviewing the medical side of Berlin, would indeed be an unpardonable sin. This institution, built by Cremer in 1863, is located at No. 53 Luisen Strasse. Its exterior is not imposing-practicability evidently being the designer's intention rather than beauty. The interior is divided into several small clinical amphitheaters, a museum, dissecting rooms and a number of small rooms for professors, assistants and laboratories. It has an interesting history and within its halls at various times have been heard the voices of many of the "masters" of the medical profession.

The first professor of anatomy was the celebrated Johannes Muller. He also held the chairs of embryology, pathology and physiology. After his death these were divided, Reichart being assigned the chair of anatomy; Du Bois Reymond the chairs of physiology and embryology and Virchow that of pathology. What a triumvirate of intellects and what a power for good these three have wielded in their different departmnts.

The present professor of anatomy is Waldeyer. Recently our Harvard University conferred on him an honorary degree. He is one of the foremost living anatomists, a popular instructor and has enriched the literature on the subject with many valuable publications. His first assistant, Dr. Ferd.