Correspondence. DR.ETHAN H. SMITH'S LETTER FROM GERMANY. POTSDAMER ST., 13, BERLIN, GERMANY, EDITORS OF THE PACIFIC MEDICAL JOURNAL, SAN FRANCISCO, CAL.: Dear Sirs: I shall write this morning concerning a number of institutions and clinics. Two weeks ago this morning I had the pleasure of visiting the Royal Institution for Infectious Diseases. Too much cannot be said in praise of the spirit which actuates the German Government to provide so excellent an institution as this. The building is strictly fireproof, three stories high. It is situated in the outskirts of the city where there is plenty of space. The laboratories are particularly light and well adapted for work. The supply of apparatus and materials is lavish. The discipline of the institution is such that both materials and apparatus are constantly in good order for work. To-day the excellence of German bacteriological work, is not in the new methods being employed, nor in the line of research work. In this direction the United States is clearly ahead. But the thing which strikes the visitor to this institution favorably is the thoroughness of the work now being done. They have mentally digested the great mass of facts and methods of the past 20 years, and their work is superb. The culture media are all of the best. Particularly good is their litmus agar. Their work is so systematic as to cause it to be very accurate. The department of the Institute devoted to the study of "Plague," is rigidly closed, by order of the Government, to all except the individuals detailed to do this work. Even those employed in other departments of the Institute are excluded. The library is large and complete. The student finds everything that he requires under one roof. The picture of Prof. Robert Koch hangs in a conspicuous place and is reverently pointed out. "He is the master," is the expression which the visitor most often hears. Across the street from the Institute is the new Rudolph Virchow Hospital in course of construction. It consists of a large main building, with several score of cottages. When complete it will accommodate 2,000 patients. It will be ready for occupancy in about a year. It will be one of the finest hospitals ever constructed up to the present date. One of the best gynecological clinics in Berlin is that of Prof. Landau. His asepsis is fairly good, and his operative technique is above reproach. At this hospital is given a course in cystoscopy, of particular excellence. Dr. Thuman is in charge of the work. He speaks English, and very quickly addresses a mixed class of Germans and English-speaking physicians, first in one language and then in the other. His skill with the cystoscope, and in catheterizing the ureters, is such as to provoke both comment and admiration. The supply of patients is abundant. The course may be taken in a month or less and is very popular. The cystoscope used here is a particularly good one. Prof. Dührssen has a very fine gynecological clinic also. His clinic is private, as are many of the clinics here, but he is very courteous to visiting physicians. A very pleasing gentleman to see and hear is Prof. Lexer. He has the chair of minor surgery in the University. He is a teacher of particular talent. He is a clever operator. He impresses not only the student, but the experienced surgeon, with the importance of minor surgery. While it has been given a subordinate place in surgery, yet it makes up by far the major part of a surgeon's work. Too often a surgeon makes serious and complicating blunders in his minor surgical cases, which he cannot atone for in his major cases. Some of the most excellent work done in Berlin is the tendon transplantation as practised by Prof. Hoffa. In this he is a master. He has had the foresight to apply his knowledge of anatomy and mechanics to a class of semi-paralytic cases, heretofore considered as not worth bothering about, with astonishingly good results. He has shown the possibility of a muscle, or portion of a muscle, shifting its function to its transplanted position and enabling a previously worthless limb to become a more or less useful one. His dealing with old contractures and adhesions is particularly bold and free, but he gets results which warrant his boldness. I had a delightful chat a few days ago with that pioneer in accurate work in stomach and intestinal diseases, Professor Ewald. His work at the Augusta Hospital here is well worth seeing, whether the visitor is a surgeon or a physician. Last Friday I saw Professor Koenig operate. He is one of the oldest of the Berlin faculty. He is frequently referred to as "Berlin's grand old man." He deserves the reputation. While his methods are somewhat old, yet his hands have not lost the cunning of a clever operator. He had a most trying case of enormous umbilical hernia, complicated by a sloughing cyst, as large as a goose egg, at one side of the umbilicus. This cyst was adherent to a knuckle of the transverse colon, which was partially occluded by adhesions. The patient was a large, stout woman, with very flabby abdominal walls. The manner in which Professor Koenig waded through this tedious mass and completed his work was something admirable to see. Last night I attended a meeting of the Anglo-American Club at the Heidelberg Restaurant. For the benefit of future American visitors to Berlin, I will say that the club always meets in room 1 of the Heidelberg Restaurant, on Dorotheen St. N. W., just off Frederich St. All English speaking doctors are freely welcome. The club meets every Saturday night at half-past 7 o'clock. A long table is set and each comer pays for his own food or drink and orders from the card what he likes. The expense is nominal. The fee for joining is one mark. A lecture by some member of the Faculty of the University, or by some distinguished resident or visiting member of the profession, is given each night. Last night the lecture was by Professor Cohnheim on the "non-medicinal treatment of obstinate constipation." Professor Cohnheim said in part: "The causes of constipation are either local or general. The type must be accurately determined before any treatment can be of use. Having accurately diagnosed the sort of intestinal condition present, the treatment would consist of regulation of diet, first getting accurate knowledge of the habits and peculiarities of the patient's diet and then insisting on a change to meet the requirements. In cases where there existed a spastic condition of the bowel muscle, massage and gymnastics are indicated. In an atonic and relaxed condition of the bowel, massage and such practice would invariably do harm, hence the necessity for an accurate diagnosis. In the latter condition he recommended the alternation of hot and cold douches to the abdomen, with regulation of the diet, so as to relieve the musculature of the bowels from work as much as possible." This is only a fragment of his most excellent lecture. As I have already made this letter long, I will now bring it to an end. UNITY FAMILIEN-PENSION. I. RANGES. Yours truly, ETHAN H. SMITH. DRESDEN, den March 1st, '04. Lüttichaustrasse 26 1. EDITORS OF THE PACIFIC MEDICAL JOURNAL, SAN FRANCISCO, CAL.: Dear Sirs: The past few days I have been enjoying the advantages of the new hospital here in Dresden. However shrouded in doubt the matter of the first Cæsarian section may be, the man who stands first to day in the performance of Cæsarian section is, no doubt, Professor Leopold, of Dresden. He has performed six within the past six weeks, and has another for the near future. Professor Leopold is one of the most pleasant medical men I have ever met. While he is busy from morning until night, he always has time to be kind and courteous to the visiting physician, whomsoever he may be and from whatever land. The new "Königlische Frauenklinik," just completed a trifle over a year ago, is without doubt the best woman's hospital in existence. The building is three and four stories high, thoroughly fireproof, even the door and window casings being of steel. The floors are of stone and cement, for the most part. Where of wood at all, the wood is laid in cement, over cement and steel bottom. The building is in the outskirts of Dresden, in a beautiful location, with a good-sized birch grove at one side. The wards and rooms are beautifully lighted and ventilated. The whole building is heated by steam. The septic wards are isolated at one end of the building, and all attendants in these wards are excluded from the rest of the building. There are six operating rooms, several rooms for confinements and an incubator room. Each operating room has a stone floor and porcelain tile to the ceiling on the side walls. The ceiling is of steel and cement. The window frames and sash are of steel. No angular corners to catch filth. The equipment of the operating room is elaborate, even lavish in some respects. The cost of this structure was 6,000,000 marks-$1,250,000. Professor Leopold is required by the Government to live in the hospital, as are also his assistants. Their rooms are elegant. It is a pleasure for a person to serve in such an institution. The material at this hospital is plentiful, and as there are no undergraduates here, the advantages for post-graduate work in obstetrics and gynecology are first class. More than this, the cordiality of Professor Leopold is reflected in his staff. The whole institution is delightful to the visitor or to the student. Adjoining the Frauenklinik grounds is the new "Stadtkrankenhaus." This is an enormous hospital for general surgery and medical cases. It was completed about two years ago. To give an idea of its immensity, the underground conduits for passage from one department to another, together with facilities for steam pipes, electric wires and water pipes, are nearly 3,600 yards in length. The architecture of this hospital, as well as that of the Frauenklinik, is beautiful. It is constructed on the same general plans as the Frauenklinik. It is the best hospital I have ever seen. Here the visitor has the good fortune to meet Professor Crede, one of the most able surgeons in Europe to-day, and a most kind and courteous gentleman. His results from the use of collargol, of which he is the discoverer, and of kindred. silver salts, justify their being used much more extensively than in the past. The catgut prepared according to Professor Crede's methods, is the strongest and most pliable I have ever seen. He says that he has never seen a particle of suppuration from this catgut in over eight years constant use. He believes in a combination of aseptic and antiseptic methods. Asepsis for the present, and antiseptic precautions to guard the future. With the collargol in various forms, he gets most excellent results, and under circumstances which go to prove the great value of his drug. |