MEDICAL NEWS.
[The following beautiful tribute to Dr. CnAPMAN was addressed to
him many years ago, by his early friend, Dr. J. K. Mitchell, who
afterwards accepted and still worthily fills in the Jefferson Medical Col-
lege, the same chair which was illustrated for so long a period by Dr.
Chapman in the University of Pennsylvania. Its republication, at the
present time, will, we are satisfied, be interesting to our readers.]
dedicated to n. chapman, m. d.
Dear Doctor, though I hae the will,
I fear I want poetic skill
To do ye muckle credit;
But yet I’ll imp my youthfu’ wing,
And o’ my guid preceptor sing,
Though ye y’ersel may dread it.
I’ve aften wished for Burns’s pen,
And thochts frae Ramsay’s fairy glen,
To do ye fitting honor,
But tak the will and no the deed,
My muse, the jade, awa will speed,
Sae I maun e’en get on her.
Ah I weel I mind when first I saw
Ye laying down the morbid law
O’ nature to the student;
To dry detail and dusty lore,
Brocht frae y’er inexhausted store,
A new enchantment you lent.
Frae worthies o’ the aulden time,
To those wha yet were i’ their prime,
Ye drew y’er rich resources;
And last, not least, frae y’er ain sei,
Baith thochts and words o’ magic spell
Adorn’d y’er ripe discourses.
Wi’ easy grace and potent sense,
Clear order, a’ without pretence,
And learning without show, sir,
Ye charm’d the eye, and pleas’d the ear,
And made y’er thochts sae richly clear,
The darkest truth did glow, sir.
But faith, I scarce believ’d my eyes;
Ye took me, sir, wi’ sair surprise,
When mang y’er friends I saw ye
Let loose the wit by science chain’d—
Humor that nae ane ever pain’d—
Oh ! thus I’d like to draw ye !
They little ken ye wha hae known
Y’er science and y’er skill alone,
Though they are mair than ample ;
The racy pun, rich repartee,
The gushing joke frae malice free,
Wad na complete the sample.—
But better far, a heart that ne’er
Did o’er a human ill forbear
To heave a feeling sigh,
That readily forgave a foe,
And never dealt a jealous blow,
In keenest rivalry.
Mair I might say, but this I fear
E’en frae a friend ye’ll hardly bear,
Sae I’ll nae mair offend ye;
Though if ae man beside y’ersel
Says that the truth I dinna tell,
That man has never kenn’d ye.
J. K. Mitchell.
Comparative Healthiness of England, France, Prussia, &c.,
—The annual rate of mortality in England may be best understood by
saying that there are 46 persons living to 1 dead. That is, the mortali-
ty as 1 in 46. In 1841, the annual mortality per cent, was 2207, or 1
in 45. In France there were 42 living to 1 death; in Prussia, 38 ; in
Austria, 33 ; and in Russia, 1 person in 28 died annually. In the lat-
ter country, the mortality per cent, is 35^0, or in other terms, out of
every 100,000 Russians living, 35^0 died in one year; while out of
ever 100,000 British living, only 2507 died in the same period. In
several Italian cities the annual mortality of the inhabitants is from 3 to
4 per cent.. In the city of Naples, which has been shown to be one of
the unhealthiest in Europe, it appears that 40^6 persons died out of
every 100,000 of its inhabitants. From these facts, it is evident that
there is a lower rate of mortality among the inhabitants of this country
than in either of those enumerated, and that in some instances the mor-
tality falls little short of one-half the same as existing in less favored
regions.—Lancet.
The Jenner Testimonial.—It is fully determined to execute with
every possible despatch the well-merited testimonial to the memory of a
man whose discovery of vaccination has immortalized him. With that
object subcriptions are being raised throughout every kingdom. The
United States raised for that purpose 1600 dollars,—a larger sum than
any other country subscribed.-—lift?.
Asiatic Cholera in Copenhagen.—A London daily paper states,
11 We have received information that this dreaded disease has re-ap-
peared in an epidemic form in Copenhagen, where cases of it have ex-
isted, proving rapidly fatal ever since the middle of June. From that
period the disease has been slowly but steadily increasing; and the offi-
cial return for the 8th of the present month states that on that day there
were 51 new cases and 18 deaths. From the first appearance of the
disease, there have been registered in all 270 attacks and 142 deaths;
so that this formidable pestilence, which for several months has been
lingering in St. Petersburgh, has now approached to within less than 500
miles of the coast of Norfolk. On Tuesday last there were 53 new
new cases of cholera, and 36 deaths. Since the 12th of June, 427 persons
have been attacked, and 234 have died.—Ibid.
Frightful Mortality in Calcutta.—Owing to the great heat and
the absence of rain, eleven hundred persons were carried off, at Calcutta,
in the course of two days.—Lancet, from Overland Athenaeum.
Royal Acknowledgment of Medical Services.—On the 8th
August last, her Majesty was graciously pleased to confer the honor of
Knighthood upon Dr. John Forbes, and Dr. James L. Bardsley, of
Manchester.—Lancet.
The Medical Chronicle, or Montreal Monthly Journal, edited by
William Wright, M. D., and D. C. Mac Callum, M. D., made its debut
in June last. It promises to be an interesting and spirited journal.
The first number of the Medical Reporter, a quarterly Journal,
published under the direction of the Chester and Delaware County
Medical Societies of Pennsylvania, was issued in July. The editorial
committee consists of Drs. Wilmer Worthington, Isaac Thomas, and
Jacob Price, of Chester county, and Drs. George Martin and John T.
Huddleson, of Delaware county.
The Astley Cooper prize of £300 for the best Essay on the “ Struc-
ture and Functions of the Human Spleen,” has been awarded by the
physicians and surgeons of Guy’s Hospital to Henry Gray, Esq., F. R. S.,
Wilton-street, Grosvenor-square.
The Cholera.—The Dutch Government have received the official
notification from the Dutch Minister Plenipotentiary at Stockholm, that
the Swedish Government have declared that the cholera prevails in Abo,
Elsinore, St. Petersburg, Cronstadt., Narrva, Reval, Riga, and Copen-
hagen, and that the following places and territories arc “ suspected to be
infected : ”—All the Finnian harbors from Christianstadt inclusive to
the Russian frontiers; all the Russian ports of the Gulf of Finland and
the Baltic, and the ports of Zealand. Copenhagen, July 31.—The
cholera seems to have diminished here somewhat in intensity, as there
are only 237 new cases, and 115 deaths. Up to the present time the
45th part of the population has been carried off by the malady. Our
accounts from Copenhagen, up to the 4th instant, show the cholera to
be somewhat on the decrease, the new cases seldom exceeding 150 per
day. The whole number at present announced amounts to 5996, with
3219 deaths. It is to be observed, however, that now that the disease
has attacked the middle-classes, who, for the most part, were treated at
their own houses, the number of cases published would always be con-
siderably under the truth.
The Cholera.—The last news from Persia announces, that the
cholera is making great ravages in Astraband, Mazraderam, and the
desert of the Turcomans. In one of these provinces, the number of
deaths amounted to 150 a day. The Shah and his Court had retired to
Imama. To complete the distress, the towns of Shiraz and Surham had
been nearly destroyed by earthquakes, the Zaindowod was dried up, so
that, from its muddy bed, innumerable bands of grasshoppers proceeded,
destroying everything in their progress.
Death of Dr. Pereira.—We are permitted to extract the following
reference to the death of this distinguished physician from a private
letter to Dr. Duck of this city. The writer says :	“ Poor Pereira, his
loss is felt by all; he was buried at the Kensalgreen cemetery, and was
followed by the whole school of the London Hospital and also by be-
tween thirty and forty practitioners, many of them, including myself,
coming a distance of between six and seven miles. Dr. Billing kindly
took me in his carriage coming home, when I had the advantage of hear-
ing his opinion as to the cause of death. Dr. B. thinks that when Dr.
Pereira slipped on the back stair case of the College of Surgeons, in ad-
dition to the rupture of the tendon of the left quadriceps extensor
femoris, he also ruptured the two inner coats of one of the sinuses, at
the origin of the aorta, and that on exerting himself to relieve his at-
tendants while lifting him into bed, a fortnight afterwards, he ruptured
the remaining coat and died from internal hemorrhage. His friends
objected to a post-mortem examination, and it was not urged. A com-
mittee of four or five physicians are completing the second part of the 2d
volume of the learned Doctor’s Materia Medica, which Dr. Billing says
ia a perfect encyclopedia. The greater part was already finished and in
the press.’’—N. W. Journal, August.
Death of William Beaumont, M. D.—He died at his residence in
St. Louis, on the 25th of April last, in the 68th year of his age- Dr.
Beaumont was a native of Lebanon, Connecticut, where he was born in
1785. In 1812, after studying medicine at St. Albans, Vermont, for
two years, he joined the Sixth Infantry, with the appointment of As-
sistant-Surgeon. For more than twenty years he was a member of the
medical staff of the regular army, being stationed at various points on
the northern frontier, and through the war of 1812, with distinction—
being present, among other occasions of interest, at the capture of Fort
George, in May, 1813. In 1830, he was stationed at Jefferson Barracks,
and afterwards in the Arsenal at St. Louis, taking up his residence in
this city about 1834. Two or three years later he resigned from the
army, and subsequently has resided constantly in St. Louis, enjoying an
extensive practice and high professional reputation up to the period of
his late illness.
Dr. Beaumont is widely and most honorably known in the literature
of our profession by his “ Physiology of Digestion and Experiments on
the Gastric Juice ”—based on and containing an account of experiments
conducted by himself upon a Canadian (Alexis St. Martin,) whom he
attended at Michilimackinac, 1825. The work has been reprinted in
Great Britain, France, and Germany, with the highest commendations
from the profession, and has become an acknowledged authority in
matters where speculation had hitherto taken the place of observation.
Dr. Beaumont had lived in St. Louis for many years, engaged in
arduous professional duties, and wherever he was known, it was as the
kind-hearted, generous gentleman. In his social relations, he was most
happy, diffusing at all times cheerfulness and contentment to those
around him.—IV Y. Journ. Med.
Death of G. W. Richards, M. D.—Dr. Richards died at Dubuque,
la., on the 22d of April, aged 53 years. He was for a short time con-
nected with the Rush Medical College in Chicago, as one of its Pro-
fessors, and afterwards became Professor of the Theory and Practice of
Medicine, in the Medical College at La Porte, Ind. At a later period,
he assisted in organizing a Medical School at Rock Island, and but two
weeks before his death, was elected President of the Northwestern
Medical Society, organized at Dubuque.—Ibid.
Death of Charles Caldwell, M. D.—From the Louisville (Ky.)
Courier, we copy the following synopsis of the principal events in
the life of Dr. Caldwell, whose decease took place in July last,
together with some just comments on the literary and scientific cha-
racter of that remarkable man.—“ He was about ninety years of age,
and probably the oldest physician in the United States, and enjoyed the
greatest celebrity as a medical writer and teacher. He did more than
any one to enlighten the public and the profession on the origin of yel-
low fever, and clearly illustrated the absurdity of quarantines. Some
years before the Asiatic cholera invaded Europe as an epidemic, Prof.
Caldwell predicted that in one respect cholera would prove a blessing to
mankind, by teaching the worthlessness of quarantine regulations, and
the vital necessity of attention to all the laws of sanitary science; and
this prediction, as full and clear as the history of the epidemic can be
made now, has been verified in every particular. This prophetic pre-
diction of the venerable teacher was recently made the conclusion of an
invaluable report on cholera, published by the British Parliament.
“ At the commencement of his medical career, Prof. Caldwell settled
in Philadelphia, and won great distinction. Among the writers and in-
vestigators of that period, Dr. Caldwell was the greatest. He towered
above his contemporaries, as a tall monument springs from the plain.
“ In addition to Dr. Caldwell’s luminous and voluminous labors upon
all the important questions of medical science, all subjects of public in-
terest felt the benefit of his intellect. His papers on Quarantines, Ma-
laria, and Temperaments, are among the best in the English language
on those topics. His treatises on Physical Education, on the Unity of
the Human Race, and on Phrenology, have rarely been equalled. Every
thing he touched he adorned. We doubt whether the English language
contains a biographical sketch equal to Dr. Caldwell’s tribute to Fisher*
Ames, published in the American edition of Rees’s Encyclopedia. A
recent edition of his work on the Unity of the Human Race, displays a
remarkable instance of intellectual vigor in one who had passed that
period at which mental power usually begins to falter. In that work
Dr. Caldwell reviewed a recent work on the Races by Dr. Knox, of
England, and the criticism is one of the ablest and most conclusive we
know of. Quite recently, Dr. Caldwell published a paper in the West-
ern Journal of Medicine and Surgery on Liebig’s theory of Animal Heat;
and the distinguished Professor of Giessen has not received such a blow
from any other quarter. But time and space would fail us if we were to
attempt an enumeration in this paper of the works of Professor Caldwell.
“ The great reputation of Dr. Caldwell as a medical scholar, teacher
and writer, induced the friends of western enterprise in medical teachings,
to invite him, about 1818, to a chair in the Transylvania School of Medi-
cine. He accepted the trust, and entered upon the discharge of its duties
with a zeal, intelligence and power that were determined to know no
such thing as failure. He was the bright particular star of Transylvania,
and during his connection with the institution it prospered. The labors
of himself and of his colleagues, who caught inspiration from his ex-
ample, made the Transylvania School of Medicine equal to any in the
Union, and he had much to do with its proud pre-eminence.
11 When he discovered that the spirit of the age demanded means for
clinical instruction, and a larger field for medical observation than a vil-
lage could furnish, he promptly entered into arrangements for transfer-
ring the Transylvania School to this city. Upon the failure of that at-
tempt, he entered zealously into the project for establishing a school of
medicine in Louisville, and by his labors, talents and eloquence, the pro-
ject was forwarded. And to the same great powers the school was
mainly indebted for its remarkable success.
“ Dr. Caldwell was one of the most temperate men we have ever
known. His science enabled him to keep a true sentinelship over his
appetites, and the result was an exceedingly long life, far beyond that
allotted to man by the royal Psalmist, with an almost entire exemption
from sickness. Even in the closing scenes of life, disease did not invade
his frame. He was nearly free from physical suffering; all the functions
of his system were as well performed on his death-bed as during his
highest health, and his mind was clear to the last. His life and death
are impressive commentaries upon the truth of physiological doctrines
which he taught for half a century, and by which he regulated his life
and ordered its last scenes.”
Medical Institutions of Berlin. By W. H. Hingston, M. D.,
L.R.C.S. Ed., Honorary and Corresponding Member of the German
Medical Society of Paris.—It is often a question as to which of the me-
dical schools of Germany holds the highest rank. The question is one
of importance, as it has frequently to decide or regulate the time to be
spent in each by those seeking professional education; yet is it odc
which cannot be answered generally or definitely. Thus, Prague and
Vienna have long held pre-eminence in midwifery. More recently medi-
cal pathology is a branch which has been cultivated with great success in
the latter. Physiology has made rapid strides in Berlin, Wurtzburg,
and Bonn; Giessen has advanced chemical science, &c., &c.; but when
speaking of surgery alone, the question is divested of most of its diffi-
culty.
In this department of science, Berlin has for some time stood pre-emi-
nent, and still claims the foremost rank. During the residence here of
Graeffe, surgeons and students from all parts of the continent, and many
from Britain and America, were attracted to the Prussian capital. His
world-renowned successor, Dieffenbach, added new lustre to the chair
(already famous) until death removed him also from the scene of his
usefulness and success. It was here tenotomy was first extensively and
and successfully practised.* It was here also rhino-plasty was first given
to the world. Graeffe’s success in practice was very great. Dieffenbach’s
memory is still fondly cherished by the great mass of the people. In-
deed it would be difficult to conceive greater affection for one nearly four
years dead. The rich speak of him in terms of fondness, respect, and
praise; the poor mention his name with reverence. Like John Hunter,
his death was sudden and unexpected, and took place in the theatre of
his greatest usefulness. One day when seated on a sofa, observing a
student making an examination of a patient, he quietly expired. He
was attended to his final resting-place by thousands. His requiem was
the prayers and lamentations of those to whose comfort he had minis-
tered. Dieffenbach was succeeded by Langenbeck; but I shall mention
the present surgeons in connexion with the various institutions to which
they belong.
* Tenotomy (by subcutaneous section) was first practised by Stromeyer of
Kiel ; but to Dieffenbach is due the credit of having brought it prominently be-
fore the British public.
The University.—A very fine building, built by Fred. Wm. III.
opened in 1810, when, by order of the Prussian government, or rather
the king, the University was removed from Frankfort-on-the-Oder to its
present situation—Berlin. At first the number of students who were
attracted to the Prussian capital was not very great, for although pro-
fessors of acknowledged ability were here to be met with, yet the advan-
tages afforded to military over civil students proved extremely distaste-
ful to the latter, and prevented many from attending its sessions.! By
a wiser policy of government, by gradually yielding to the wishes of the
people, and by granting to civilians all the privileges they accorded to
others, the University began to flourish. At the present moment it
f These remarks apply only to students of medicine. On those studying arts,
law, or divinity, were placed no restrictions, for such are not usually educated
for the army.
numbers 2200 matriculated students; of these about two-ninths are
medical.
There is no school in Germany where so many students are collected
together. Prague, the oldest, has 1272; Munich, 1957; Bonn, 866;
Wurtzburg, 722. It would occupy too much space to enumerate all the
German universities, amounting to twenty-four, and their statistics. I
have mentioned these merely to show the flourishing condition of the one
about which I am writing. Labor is there divided among the various
professors in their several departments. In theology there are five ordi-
nary, and four extraordinary professors, besides two privatim docentes ;
In law, nine ordinary, four extraordinary, and three privatim docentes.
In the department of medicine there are eleven ordinary, six extraor-
dinary, and nineteen privatim docentes. In philosophy twenty-seven
ordinary, twenty-nine extraordinary, and thirty-one privatim docentes.
In modern languages five.
The largest building for the relief of the sick is the Charite. It does
not belong to the University. It was built by Fred. Wm. I. entirely for
the education of surgeons for the Prussian army. It continued as such
till 1810, when the University was brought from Frankfort-on-the-Oder
to Berlin. Previous to that time there were professors of the Military
Academy, who gave lectures to young men studying for the army. In
1810 the professors of the University were allowed wards for their clin-
ique, and students then matriculated. In 1848 government made still
greater concessions, by permitting civilians to become assistants to the
professors in one medical clinique. The Charite, governed by two di-
rectors, one medical and one administrative, is divided into old and new.
In all, it contains 900 beds, but could accommodate nearly double that
number in urgent circumstances. The new contains all the syphilitic
patients, insane persons, and prisoners, and also those sent from the pri-
sons. The old contains medical, surgical, and obstetrical cases, and
children.
From the medical wards, four are selected for the clinique, two male
and two female, one for each professor. From the surgical are taken
four wards for clinique, two of which are for ophthalmic surgery. These
are attended by the same professor. Drs. Schoenbein and Wolff are the
professors of medicine. The former, although pretty well advanced in
years, is still active. From oedema glottidis, or some other affection of
the throat, he is with difficulty understood. Strangers to the language
or those who do not understand it thoroughly, will derive no advantage
from attending his instructions, as a large portion even of his own coun-
trymen find great difficulty in following him. His therapeutics, however,
are excellent. He has been the king’s physician for years, and is highly
esteemed by the profession. A work appeared many years ago, under
the title of “ Therapeia von Schoenbein,” but he denied the authorship*
I believe some students had taken notes of his lectures, and published
them in a continuous form. His assistant, Dr. Traube, devotes several
hours a day to giving instructions on auscultation and percussion. He
has written many excellent papers; one in particular, on “ Critical
Days,” is highly valuable. Inenken is the professor of surgery. High
praise cannot be bestowed either on his operations or after-treatment;
tedious in the former, meddlesome in the latter. He has been rather
unsuccessful in the administration of chloroform. On dit that he has
lost seven patients in this way. As it is an on dit, it might be well to
take it cum grano satis. I saw a patient in January last, from whom
he was removing the orbit, expire on the table. Inenken attributed the
death to the shock of the operation, as he had done on previous occasions.
This theory he has endeavored to maintain publicly, in opposition to
Langenbeek, but much against the notions of the profession generally.
As an oculist, Inenken holds, and deservedly too, a very high rank. He
operates on the eye with care, dexterity, and precision. His diagnosis
is almost infallible, his after-treatment good. He still holds to the old
operation for cataract—the low incision. In this respect I believe he
stands alone.
The obstetrical department, by a very unwise and prejudicial arrange-
ment, is open to students only in the summer season, and to midwives
in the winter. There are but thirty bjds, which are seldom fully oc-
cupied. About 400 births take place in the year. Berlin makes no
pretensions to midwifery; her claims are more easily substantiated in
consequence. Young military surgeons are the resident accoucheurs in
this branch.
Dr. Simon has the charge of the syphilitic patients. He is also lec-
turer on syphilis and diseases of the skin in the University. His works
on those subjects bear evidence of considerable research. The females
in the syphilitic wards are examined three times a week, the men twice.
Those who have witnessed the examination of females in the hospitals
of Britain, might be somewhat shocked at the manner in which patients
are required to mount the steps, and uncover their person from the ab-
domen downwards. This is both extremely indecent and demoralising,
the more so as it is unnecessary.
Apart from the Charite, and in connexion with the University, are
three cliniques for medicine, surgery, and midwifery. They are all sup-
ported by government, and consequently admit patients from all parts of
Prussia. Dr. Busph is the professor of midwifery. He is not much seen
by the students, except at lecture. He has gained his laurels, and now
seems to enjoy his otium cum dignitate. Besides these, there are poly-
cliniques for each of these branches. Those patients who are not desirous
of entering hospital, can be attended at their own houses by the students,
and when necessary, by the assistants. In the hospital of the University
about 300 births take place in the year; in the polyclinique between
800 and 900.
It was in the polyclinique in Ziegel Strasse that Graeffe gave instruc-
tion. It was here, also, where Dieffenbach held forth ; and what is still
more to the purpose, it is here that Langenbeck may be seen daily, with
a large number of cases for consideration. In no clinique I have yet
visited, have I seen so many operations as are here to be witnessed. The
hospital is not a large one, but only such cases as demand operation aro
admitted. Almost every day, persons in the city and neighborhood are
brought to be operated upon, and carried back again to their respective
domiciles. It has been stated that there are more operations performed
here than in any hospital on the Continent. Certainly Paris has noth-
ing to equal it. The reputation of the operator draws to the capital per-
sons from all parts of Prussia and surrounding duchies. As a lecturer
and teacher, Langenbeck is considered superior to his predecessor. As
I have not seen any similar treatment in British hospitals, I will occupy
a few lines in speaking of anchylosis generally.
In the words of Cooper, anchylosis denotes an intimate union or grow-
ing together of two bones, which were naturally connected by a moveable
kind of joint. In the true, the bones grow together so completely, that
not the smallest degree of motion can take place, and the case is posi-
tively incurable. In false anchylosis the bones have not completely
grown together, and their motion is only diminished, not destroyed.
Anchylosis is generally looked upon as a favorable and in many cases
a desirable termination of inflammation or ulceration. It is thought to
be as near an approach to health as it is possible, under many circum-
stances, to attain; or in the words of Miller, it is a compromise between
health and disease. Cooper remarks, “No attempt should ever be made
to cure, though every possible attempt should often be made to prevent a
true anchylosis.” The exertion to prevent, he further adds, is not
always proper, for “ many diseases of joints may be said to terminate when
anchylosis occurs.”
With such authority before us, and the authority of many more I
might quote, it would require no small amount of courage to interfere
with what has been designated “ a favorable termination,” “ a desirable
termination;” and a surgeon who would undo this wise provision of Na-
ture, might be pronounced reckless and bold. I confess that such would
have been my own opinion had I read and not seen the treatment—the
successful treatment, of true, and in many cases long standing, anchylosis,
by breaking up the callus. This mode of practice is not novel. It was
tried many years ago in France, but the result of these experiments was
such as to discourage others from repeating them. Violent inflammation
of the joint, and the most disagreeable consequences, generally followed;
and the patient was left in a worse condition than previous to those ex-
periments. But the French erred greatly. Instead of breaking up the
callus gradually and cautiously, they, restored the perfect flexion and ex-
tension of the limb immediately, and then kept up the motion of the
joint, in order to free the condyles of the abnormal adhesions. As al-
ready remarked, the consequences were frequently very serious. The
majority of surgeons would not follow the example, and writers on sur-
gery only mentioned this mode of treatment in order to caution the pro-
fession against adopting it.
The practice so successful under Langenbeek, and which has given rise
to those remarks, consist in breaking up the callus certainly, but in a
manner very different from that employed by Louvrier. The patient is
placed upon his back, and chloroform administered until complete anaes-
thesia is induced; until, in fact, the muscles cease to offer any resistance.
If the anchylosis be of the knee (the most favorable joint for the opera-
tion) an,assistant, or assistants, fix the pelvis, and the surgeon commences
gradual flexion, if the joint be in an extended state, or extension if
in a flexed state. The force to be employed must be regulated by the
surgeon himself. In cases of many years standing, the force required,
as might be supposed, is considerable; sometimes the whole weight of
the body is necessary, but it must always be applied with care. When
the callus yields to the external force, the amount of flexion is preserved
until the next trial, the limb being exercised, passively, during the in-
terval. A great degree of flexion is not to be desired at once ; and the
more cautiously and patiently the limb is managed, the less danger of
violent reaction, and the greater probability of success. Indeed, this
constitutes the great difference between the treatment of Louvrier and
that of Langenbeek, or between failure and success. When managed
with due care, the inflammation set up is very trifling, indeed seldom
sufficient to retard the cure. Frequently no reaction is perceptible.
Every two or three days the patient is again subjected to the same treat-
ment. Sometimes a couple of months are necessary to restore the func-
tion of the joint perfectly, but three or four weeks are frequently suffi
cient. Although many years may have elapsed between the occurrence
of the anchylosis and the attempt at restoration, yet in most cases the
callus may be broken up, and the integrity of the joint restored. It is
absolutely requisite, however, that the patient should exhibit no tenden-
cy to scrofula, and this the more especially if the anchylosis be the result
of scrofulous inflammation or ulceration.
From the want of exercise of the joint, the limb is usually much
smaller than the sound one. Sometimes almost total atrophy of the
musclesis the consequence, but a short time suffices-to restore them to
their original volume. In concluding these remarks, I feel perfectly
justified in supporting the claims this mode of treatment has to be ad-
mitted among the regular operations of surgery.* And as anchy-
losis, as a result of disease of, or injury to the joint, is unfortunately of
frequent occurrence, any mode of alleviating the subjects of it should
obtain a fair trial, especially when supported by experiments.
*1 have devoted more time to this matter than I originally intended ; but as it
is an imnortant one, and the mode of treatment peculiar to Berlin, I thought it
entitled to more than a passing remark.
In the same building in Ziegal Strasse, Romberg holds his clinique.
He is particularly distinguished for his treatment of nervous affections.
His admirable work on “ Diseases of the Nervous System,” said by some
to be somewhat unintelligible, has been translated into English, and is
no doubt familiar to many. There are several private institutions for
the education of young men that have no support from government, the
professors of which are recognised by the University as extra-academical
professors, or privatim docentes. I will only mention those of excellence.
In the Orthopaedic Institution of Dr. Buehring, almost every kind of de-
formity may be seen, and an infinite variety of apparatus. A few months’
attendance will suffice to show the most sceptical the great advantage
which frequently attends the judicious employment of mechanical means
for removal of deformity. I have there observed, and only there, curva-
tures of the spine in young girls, deformities of the femur, &c., brought
back to their original condition, while, at the same time, the young
patients were daily improving in health, and they have finally left the
hospital with rosy cheeks and robust health. The Doctor confines them
to the horizontal posture, only three or four hours daily. Some of his
little patients have been with him twelve, and some eighteen months.
Buehring has strongly advocated the bringing together by force of the
two superior maxillaries in congenital absence of the hard palate. He
was the first to practise and recommend this operation. Dr. B. is a
nephew of the late Dieffenbach, and edited his work on “ Operative Sur-
gery,” which appeared shortly after his death.
Dr. von Graeffe has a clinique for diseases of the eye. A great collec-
tion of cases may be seen at almost any hour, but especially from nine to
eleven A. M. He enters very fully, when occasion presents itself, into
the physiology of the eye, and the laws of optics. I may mention the
treatment of ulcerations of the cornea, by the solution of atropine, which
I have seen applied almost daily, with the greatest success. It is not
necessary to allude to all the remedies recommended. Nitrate of silver
in substance, weak and strong solutions, and sugar of lead in powder,
weak and saturated solutions, seem to be the favorites with the profes-
sion. Jacob, in his “Essay on the Morbid Anatomy of the Human
Eye,” p. 367, says that caustic sometimes becomes permanently fixed,
and constitutes an indelible dark speck. The same author, p. 369,
makes an equally grave charge against the use of acetate of lead. He
says that the obstinate and intractable nature of some ulcers, whose sur-
face presents an opaque white color, is due to the employment of the
acetate of lead. He seems to think that the acetate is decomposed, and
that a white precipitate is deposited in the ulcer, to which it adheres
tenaciously, and in the healing becomes permanently and indelibly im-
bedded in the structure of the cornea. To atropine in solution there can
be no such objection. It cannot leave any dark speck or precipitate to
be imbedded. Whether it exerts a specific action on the ulcer, or acts
indirectly through the capillaries, I cannot say; but certain it is, that
ulcers have been found to heal under this treatment much more rapidly
than under any other local application. I merely mention the fact, and
leave it to others to determine its action. Dr. Graeffe employs it also in
conjunctivitis. Dr. G. is son of Dr. G. whose name I have already men-
tioned. The money left by his father enables him to support an hospital
at his own expense. His acquaintance with French and English, and
his desire to impart instruction, by speaking in either language when
necessary, renders him a favorite, and his clinique is much frequented
by persons speaking these languages.
The following are not intended for the education of students :—Be-
thanien, founded by Frederick William IV., and opened in 1848, for
the education of Protestant Sisters of Charity as nurses (Diakonissen),
who here serve a noviciate of one year before becoming “ sisters.” Those
sisters are not composed of the lower classes, but frequently belong to the
first families of Prussia.* Unlike the sisterhood of the Roman faith, they
pledge themselves to a life of celibacy but for five years, at the end of
which, if Providence has thrown in their way some likely fellow, they
can doff the modest gray and white; if not, they may renew their vow
for other five years, or for life. They are paid a trifling sum yearly,
barely sufficient for clothing. They frequently serve in other hospitals,
and in the city, as nurses. The proceeds of their services is paid into
the treasury of the Bethanien, and they return to their Mutter Haus.
Like most establishments, where sisters of charity are nurses, everything
is very clean, and kept in the best order. The hospital contains but
three hundred beds. I have seen three times that number confined in a
smaller space. The roof is high, windows large, rooms light and cheer-
ful, floors beautifully polished, passages heated with air, by pipes brought
from the furnace. There are also pipes to convey away the foul air, and
introduce fresh. Each ward contains from twelve to sixteen beds, having
sometimes the length of a bed between them. There are four physicians
and surgeons. The directors and apothecary are both females, elected
from among the Diakonissen.
* The Countess of Stolberg, recently married from this Institution, had been
a nurse for many years.
Elizabethan: for diseases of women, generally contains ninety beds—
also attended by sisters of charity.
Kinder Hospital: for children of from 1 to 11 years of age.
Armen Haus Hospital : far vagrants, drunkards, incurably sick, in-
curably insane, and prostitutes, who are all kept separate. It contains
one thousand beds, which are well occupied in winter, but in summer
rather empty.
Before taking leave of the various hospitals, I feel bound to mention,
in the warmest terms, the admirable appointments that distinguish
them. Most of them are fitted up with every care to the comfort of the
inmates, some of them with elegance, at least elegance as compared
with what we usually meet in institutions of a like nature. The most
casual observer cannot fail to notice the very great cleanliness and
comfort that reigns throughout. Light, airy, and cheerful (one might
easily forget he was in an hospital), they form an excellent contrast to
the dark, dreary, dismal, overcrowded and ill-ventilated dungeons of the
so-called head of affairs medical, Paris; for there, as in many parts of
Britain, these are luxuries to which the eye is unfortunately not much
accustomed.
When writing of medical affairs in Berlin, it will not be out of place
to mention some of the most striking features that distinguish the medi-
cal police of Berlin, and Prussia generally; for the same wise and
salutary laws for sanitary purposes, are applicable to the whole Prussian
kingdom. I select Berlin for the sake of convenience merely. It is
divided into a number of wards or sections, each of which is attended
by a medical man, who is paid a regular salary for attending to all those
residing in his section, who may require his services. His prescriptions
are sent to an apothecary, who charges the medicine to the town, and
the poor are thus free of expense. All tradesmen, engineers, black-
smiths, carpenters, &c., are compelled to pay a small sum weekly when
in service, for the help of their own sick. This originated with them-
selves, in a bond resembling Odd Fellowship, but has now become a
law. The tax is regulated according to their wages, and is deducted
from the-ir weekly pay.
There exists another society, which is not fully under the surveillance
of the police ; and which, on account of its independent nature, stands
great chance of being broken up. This is the Hygienic Association.
It numbers upwards of 10,000. Members by paying two groschens
(about 2|<7.) monthly, receive the services of a medical man during
health and sickness.* It is necessary to announce the birth of every
child to the police, and to state whether born healthy or diseased.
After some months it must be vaccinated. For this purpose there are
institutions in every town, and at convenient distances in the country.
Every Prussian must serve three years in the army, and when enlisted
he is re-vaccinated. No person is employed in any service, civil or
military, without certificate of vaccination. There are a few houses
licensed by the city, which are visited twice a week. If the police have
reason to suspect that fair damsels receive the nocturnal visits of
persons illegitimately, they are waited upon and examined, and compelled
to go to the Safety Committee. The detection of these is rendered
easy by the fact that all houses licensed are situated in a certain quarter
of the city, the Koenigs Mauer, and the inmates are not allowed to
extend their haunts beyond it. I may here remark that the medical
police are in connexion with, but over the town police.
* This association has since been demolished by the police. It was thought
that the principles of hygiene they wished to introduce extended even to govern-
ment ; that it was, in fact, a secret political society.
Besides the physicians already mentioned, there are eight for the city,
whose duty it is to visit manufactories, workhouses, gaols, boarding-
schools, &c., to see that the inmates, have comfortable apartments and
sleeping rooms, sufficient clothing, and food of a proper quality; that
they have their regular hours of recreation, and that they are not tasked
either in work or study beyond their strength.
Physicians must announce to the police all the cases of cholera, small-
pox, epidemic dysentery, or supposed infectious disease, that may occur
in their practice, scarlatina and measles excepted. They must also
give to the parents or friends of any one dead in their practice, the
date of death, and the name of the disease of which he died. Every week
a list is published of all the deaths, with the diseases subjoined. The
names of the deceased are published in connexion with the church to
which they belong. I shall now notice very briefly the curriculum of
the study of medicine in Prussia.
Before being allowed to matriculate, students are compelled to undergo
an examination in classics, French mathematics, history, and German
literature. They have to write a thesis in Latin and German, on any
subject given them. The principles of philosophy, logic, and metaphy-
sics, are also entered into. This past, they are admitted to the University.
Their study must extend over a period of four years, or eight semestres,
four of which must be in a Prussian university. At the expiration of
two years, they are examined in physics, chemistry, botany, zoology,
mineralogy, and some branches of philosophy. This examination is
necessary before proceeding with further studies. These examiners are
not connected with the medical faculty. At the end of the four years,
they are examined by the medical faculty. The examination commences
with a thesis prescribed by the dean of faculty. When written and
approved of, the dean, who is annually elected from among the profes-
sors, examines the candidate on medical subjects generally. If success-
ful, each professor examines him in his particular department. This is
called examen rigorosum, but in comparison with what is to follow it is
not rigorous. He has then to write a thesis in Latin, and print, at his
own expense, a sufficient number of copies to enable him to send one to
every university in Germany, and three to each professor or teacher
attached to the University to which he belongs. This thesis is impugned,
and must be defended against three adversaries. The debate, which is
not usually very animated, is conducted in Latin, and is public. This
over, the title of M. D., is conferred.
But in order to be enabled to practise, a staats examen or cursus must
be undergone. It commences about six or twelve months after, but
may be deferred as long as the candidate wishes, and usually lasts five
or six months. In this cursus the following branches are gone over :
anatomy, surgery, medicine, and midwifery. In clinical medicine and
surgery, the candidate from time to time receives patients, and in
presence of professors and students make the diagnosis, offers a prognosis,
and prescribes the treatment. He is then locked up, and has to write a
complete history of the disease. In midwifery the candidate makes an
examination of several women, and states the stage of pregnancy, &c.
He has also to make deliveries in presence of the professors. On the
dead subject, he has to go through all the operations—amputations,
ligatures, &c., besides the more elementary parts of surgery, bandaging,
&c. In anatomy, the candidate is required to make a preparation of any
part given him, and of any system.
The staats examen from beginning to end is conducted by lottery. The
candidate draw3 from a number of others a paper, on which is written
what is required of him. He draws in each branch separately.— Glas-
gow Med. Jour.
Comments on the late Proceedings of the American Medical
Association.—The following spicy notice of a portion of the Proceed-
ings of the American Medical Association, is from the Virginia Medi-
cal and Surgical Journal. We copy it, to show the feeling in an
independent and respectable quarter, as regards the 11 masterly inactivity”
policy of the Association on the subject of medical reform :
“We come now to the measures of medical reform brought before the
Association. It was moved that Dr. Wellford’s suggestions touching
the licensing power, should be referred to a committee, who should
bring the matter fairly before the profession, and, if necessary, memo-
rialize the legislatures of the several States to carry out the wishes of
the Association. Immediately there was a professorial onslaught, and
the subject was laid upon the table."
It was then moved that no delegates be received in the Association
from medical schools, which give two courses of lectures annually, each
of which counts towards a degree. Again there was a flutter among the
ranks of the lower orders of professors, who teach (!) all the year round,
and, on motion of Dr. Atlee, of Pennsylvania, the resolution was laid
upon the table.	x
In this connection, Dr. Samuel Jackson mentioned an instance of a
mechanic of Phoenixville, Pa., who had unsuccessfully attempted the
vocations of cabinet-maker and grog-shop keeper, and had subsequently
practiced, with popularity, as a Thompsonian quack. It was suggested
to him that it was desirable that he should possess a diploma. He left
his residence, and returned in one week, with the diploma of a Phila-
delphia Medical School. In reply to interrogations from various dele-
gates, the eminent professor stated the name of his informant—a respec-
table practitioner of Phoenixville, and the name of the institution by
which this diploma was granted,—the Philadelphia College of Medicine,
commonly known as “ McClintock’s School.” Dr. Bryan announced
himself as the representative of this institution, but no motion was made
to deprive him of his seat.
Various efforts were then made to induce the Association to recom-
mend Medical Schools to require their graduates to subscribe to a pledge
to submit to the revocation of their diplomas upon conviction of having
knowingly violated the Code of Ethics of the National Association.
There was such an entire absence of concert among the friends of re-
form, that these efforts were easily frustrated.
The subject of amendments of the Constitution now came up, and the
delegates from Virginia presented the resolutions of the Society of that
State, urging such changes in the Constitution, as should exclude from
representation in the Association, all colleges and schools which do not
conform to its recommendations on the subject of medical education.
Dr. Stevens, of New York, moved the indefinite postponement of all
amendments, and it was decided that this motion was not debateable.
Accordingly, it was carried by a triumphant majority, and the schools
are left to the tranquil pursuit of their glorious objects for another year.
In thus reviewing the late session of the American Medical Associa-
tion, and arriving at the painful conviction that it accomplished nothing
of importance or value on that occasion ; that, on the contrary, its de-
liberations have had an injurious effect, in showing its impotence to
effect those radical reforms expected of it, we desire to impress upon our
readers the necessity for active and individual exertion in behalf of the
interests of the profession. The voice of public opinion will be far more
effectual in suppressing the evils which beset us, than the unheeded re-
monstrances of associations.
We know that it is far easier to tear down than to build up, to point
out defects than to correct them, and our expectations of improvement
are not very sanguine. Still, we believe it is in the power of individual
physicians, by properly cultivating the noblest and most useful of human
pursuits, by jealously guarding against every temptation which can lower
the dignity of their calling, by refusing to receive students whose char-
acter, or want of preliminary education, unfit them for scientific studies,
to elevate their profession in their own eyes, and in the opinion of the
world.”