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VIENN \ AFTER
THIRTY- FOUR YEARS

WILLIAM OSLER, M.D.

Regitu Prqfettor of Medicine
at the Umvertity of Oxford, Oxford, England

VIENNA
AFTER THIRTY-FOUR YEARS*

I SPENT the first four months of 1874 here.
I came from Berlin with Hutchinson, an
Edinburgh man (Sir Charles F., who has re-
cently died), and we 1'" d together near the All-
gemeines Krankenhaus. \s illustrating the total
blotting out of certain memories, particularly
for places, I may mention 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 din-
ing, and where I first met my old friends, Fred
Shattuck, E. H. Bradford, E. G. Cutler and
G. K. Sabine of Boston. An extraordinary de-
velopment has taken place in the city within
thirty years, and I scarcely recognized the Ring-
strasse. Then, only the foundations of the new
university buildings and of the Rathaus had
been begun. Now these, with the parliament
house, the cour^^s of justice, the twin museums
of art and natural history and the new Bourg

* Reprinted from the Journal of the American Medical Association,
60: 1623. 1908.

VIENNA

Theater, form a group of buildings unrivaled in
any city.

THE GERMAN CONGRESS FOR INTERNAL MEDICINE

Tlie primary object of my visit was to attend
the Congress fur Innere 3fedizin, and I had the
pleasure of having with me my old student and
friend. Dr. Joseph H. Pratt of Boston. We
reached Vienna in time for the preliminary Sun-
day evening social gathering in the Kursu. jf
the City Park. Here we foc nd a greeting in tn--
German fashion and a hearty welcome from the
president, Professor MuUer of Munich. The
work of the congress began at sharp 9:30 on
Monday morning with a discussion on the "Re-
lation 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. Professor Rosthorn's remarks
were almost inaudible. It is a miserable 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. Noth-

AFTER THIRTY-FOUR YEARS

ing new was brought out, and so far as I could
gather, Professor Rosthorn took much the same
ground as Clifford Allhutt in his well-known
Goulstonian lectures dealing with the intimate
relationship through the sympathetic nervous
system 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 riimac-
teric," calling attention particularly to ' Vequent
hemorrhages which he had known to arouse sus-
picion of malignant disease.

In the evening the city fathers gave a mt-gnif i -
cent 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 Syph-
ilis." This was a splendid address, delivered with-
out notes, in a good clear voice, and the subject
matter arranged in a most order' ^ manner. He
dealt particularly with the three points brought
out by recent investigations — Schaudinn's dis-
covery of the spirochete, the discovery of Metch-

4 VIENNA

nikoff that apes could be infected, and the dis-
covery of Schaudinn that the fluids of infected
persons reacted specifically. 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 extraor-
dinary influence of atoxyl on the infected ani-
mals. It acts as a specific and prevents the devel-
opment of the spirochetes, so that if given soon
the disease could be completely stopped, and
later the animal reinfected. Neisser was followed
by Professor Wassermann, who described with
great clearness his studies on the specific reac-
tion. We have now apparently a diagnostic
means by which the presence of the disease may
be definitely determined at a very early stage.
As the reaction may be present before secondary
symptoms appear, it will have a very important
influence in early treatment. The general expres-
sion of opinion is very favorable to the method.
Professor Finger spoke o^ it to me in the warm-
est terms. It persists after all clinical symptoms
have disappeared, and a positive response in
locomotor ataxia and in gencidl paralysis clinches
the question of the true syphilitic nature of these
maladies. Both Neisser's and Wassermann's
addresses were models.

.FTER THIRTY-FO^'. "EARS 6

One of the most import*-; ; communications
of the congress was from von Noorden's clinic.
Two of his assistants have been carrying on re-
searches on the "Mutual Relations of the Pan-
creas and Thyroid." For many years von Noor-
den has had the idea that there was some impor-
tant mutual influence between these two organs.
The remarkable fact comes out that in animals
frc ^ which t} • thyroid gland has been rem vcd
it is impossibl o produce diabetes by any of the
known methods, not even by the Claude Ber-
rird pii. fjrure 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 Investi-
gating 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 pres-
ence of Grunbaum and Trevelyan from Leeds,
Pratt from Boston, Barr from Portland, Ore.,
and myself), that the time had come to have an
International Congress for Internal Medicine.

6 VIENNA

The physiologists, the laryngologists, the alien-
ists and others have such gatherings, and there
now exist in France, Germany and Italy, Eng-
land and the United States special societies de-
voted to internal medicine. A congress once in
four or five years would be most helpful. We
should get to know each other and be able to ap-
preciate better the work done in different coun-
tries. Professor Schultze of Bonn gave his usual
humorous sketch of the proceedings of the con-
gress, 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 members gathered around
the elevated gallery and the distinguished artists
were greeted with loud applause and had a
vigorous encore.

THE VIENNA LIBRARIES

Prof. Max Neuburger, whose name is so well
known in association with Pagel as editor of the
'' Handbuch der Geschichte der Medizin," very
kindly arranged to show me the points of inter-
est in the Vienna libraries. I may mention, by
the way, that Professor Neuburger's new work
on the "History of Medicine," of which one

AFTER THIRTY-FOUR YEARS 7

volume has appeared, is being translated and
will be published from the Oxford University
Press. He expects to have Volume II completed
this year, and we hope to issue the English edi-
tion complete in one volume within the next
fifteen months. I was greatly interested to see
the new home of the Wiener medizinische Ge-
sellschaft, built under the presidency of Billroth,
which combines features of a library, a club and
meeting place. The auditorium 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 students
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 con-
nection with the medical faculty for the collec-
tion 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 re-
pository for pictures and instruments, etc., the
wiiole to form a collection illustrating the evolu-
tion of the history of the medical department of
the university. This example could very well be

VIENNA

followed 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 Hofhibliothek is unusually rich in manu-
scripts and early printed books. 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 practitioner in the little
town of Vienne, near Lyons, fled for his life to
Geneva. Here his heterodoxy was quite as ob-
noxious 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
Bibliotheque Nationale originally belonged to
Dr. Mead, and the history is fully given in an ap-
pendix 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 London. It fell into the
hands of Count de Izek, who presented it to the

AFTER THIRTY-FOUR YEARS

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 circu-
lation was Wotton, whose "Reflections Upon
Learning, Ancient and Modern," 1694, 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 manuscript of
Dioscorides, prepared at the end of the fifth cen-
tury for Julia, daughter of the Emperor Flavins.
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 edi-
tions of his work, with commentaries, were
issued in the fifteenth and sixteenth centuries.
Two years ago this Vienna manuscript was re-
produced infac 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 consultants feel it a privilege
to give.

VIENNA

THE HOSPITALS

I was surprised to hear Professor MuUer say
that he thought in hospital architecture Vienna
led the world, and that there was here a group of
architects who were adepts in all matters relat-
ing to hospital construction. I have come to his
conclusion, on what may appear to be very has-
tily acquired data. It is not often that in the
same day and in the same institution one passes
from eighteenth to twentieth century condi-
tions. Dr. Koessler 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 re-
member 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 Krankenhaus 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 oi nurse;
not, of course, that she is necessarily either unin-
telligent or inattentive. Indeed, as we passed a
bed in which there was a new patient whom the
junior assistant had not seen, he tur icd to one of
the nuises, who in reply to his question said,
"Yes, Herr says she has mitral stenosis

AFTER THIRTY-FOUR YEARS

and insufficiency!" I was interested to see in tiie
ward a ease of Pick's disease, the pericardial
pseudoc rhosis of the liver. The old question
comes up here as to priority of descripti n. In
the special number of the Wiener klinische
Wochenschrift, issued for the congress, Professor
von Neusser desciibes it as "Morbus Bam-
berger." He states that in 1872 Bamberger de-
scribed the condition as a special malady which
he had already known for a long time and which
up to that time had not been recognii.ed in the
literature. Certainly Pick desei ves credit for hav-
ing brought together all the known facts relating
to a clinical condition to which very little atten-
tion had been given before his paper. I had a
most interesting talk with Pi :nd Brauer and
Wenckebach on the whole question, which is
not one simply of pericardial adhesion. Wencke-
bach has helped to solve the problem in a recent
number of Volkman's Vortrdge in an article on
the "Relation Between Respiration and Circula-
tion." Brauer of Marburg, who is coming over
to the session of the American Medical Associa-
tion, will discuss the subject in connection with
his operation of cardiolysis.

If anyone interested in hospitals — in every
possible detail, construction, situation, general

VIENNA

arrangements for the comfort of the patients, for
the convenience of the students, for the advancj-
meui, 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 Professor Rosthorn, recently called
from Heidelberg. About 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 building with wings, built of
brick and stucco, with spacious corridors, large
windows, tiled floors and white oil-finished walls.
Inside and out they form the most attractive
hospital buildings that I have ever seen. But it is
not so much this aspect that gives one that sink-
ing of the heart of v^hich 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 scien-
tific study of disease. One large floor is assigned
to students, who all live in the building while

AFTER THIRTY-FOUR YEARS

attending the midwifery eases. Each clinic has
its own laboratory, a special museum for teach-
ing purposes, a library and a fully equipped small
laboratory adjoining the gynecologic operating
room so that an opinion may be given immedi-
ately 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 elabo-
rate 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 build-
ings 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 vary complete iu all its
appointments. It is particularly well arranged for
the acute infectious diseases, and the most elabo-
rate precautions are taken to isolate and disin-
fect the patients. Professor Schlesinger is very
popular with American students, and we found
working in his wards Dr. George Cheyne Shat-
tuck 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;

VIENNA

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
Schlesin^^er's father-in-law. It looked to be an
admirable model for the new Harriet Lane
Johnston's children's department at the Johns
Hopkins Hospital. In the arrangement for iso-
lating cases, in the simple and easily worked
character of the wards, in the laboratory arrange-
ments 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.
Frohlich took us through Professor Meyer's
Pharmacologic Institute and through the new
physiologic laboratory and the anatomic depart-
ment—such a contrast to the old days!

CRITICIS :l OF WORK Ol CONGRESS

The general impression one gets of the work
of the congress is very favorable. Too much, per-
haps, is attempted. There are too many papers,
but the keenness of the men and the scientific in-
terest are most stimulating. As I remarked about
the congress two years ago in Munich, there is a
strong tendency in internal medicine to-day

AFTER THIRTY-FOUR YEARS

toward physiologic and chemical problems. On
the long list of papers, eighty-eight in number,
there were only about five dealing with bacterio-
logic questions. An extraordinary number dealt
with questions in physiologic pathology and
presented the results of experimental work.

INFLUENCE OF VIENNA ON AMERICAN MEDICINE

As a medical center Vienna has had a remark-
able career and her influence, particularly on
American medicine, has been very great. What
was known as the first Vienna school in the
eighteenth century was really a transference by
van Swieten of the school of Boerhaave from
Leyden. The new Vienna school, which we
know, dates from Rokitansky and Skoda, who
really made Vienna the successor of the great
Paris school of the early days of the nineteenth
century. But Vienna's influence on American
medicine has not been so much through Skoda
and Rokitansky as through the group of brilliant
specialists — Hebra, Sigmund and Neumann in
dermatology; Arlt and Jaeger in ophthalmology;
Schnitzler and von Schrotter in laryngology;
Gruber and Politzer in otology. These are the
men who have been more than others responsible
for the successful development of these special-

VIENNA

ties in the United States. Austria may well be
proud of what Vienna's school has done for the
world, and she still maintains a great reputation,
though it can not be denied, I think, that the
Aesculapian center has moved from the Danube
to the Spree. But this is what has happened in
all ages. Minerva Medica has never had her chief
temples in any one country for more than a gen-
eration or two. For a long period at the Renais-
sance she dwelt in northern Italy, and from all
parts of the world men flocked to Padua and to
Bologna. Then for some reason of her own she
went to Holland, where she set up her chic."
temple at Leyden with Boerhaave as her high
priest. Uncertain for a time, she flitted here with
Boerhaave 's pupils, van Swieten and de Haen,
and could she have come to terms about a tem-
ple, she doubtless would have stayed perma-
nently in London, where she found in John
Hunter a great high priest. In the first four dec-
ades of the nineteenth century she lived in
France, where she built a glorious temple to
which all flocked. Why she left Paris, who can
say? but suddenly she appeared here, and Roki-
tansky and Skoda rebuilt for her the temple of
the new Vienna school, but she did not stay long.
She had never settled in northern Germany, for

AFTER THIRTY-FOUR YEARS

though she loves art and science she hates with a
deadly hatred philosophy and all philosophical
systems applied to her favorite study. Her stately
Grecian shrines, her beautiful Alexandrian
home, her noble Roman temples, were destroyed
by philosophy. Not until she saw in Johannes
Miiller and in Rudolph Virchow true and loyal
disciples did slie move to Germany, where she
stays in spite of the tempting offers from France,
from Italy, from England and from Austria.

In an interview most graciously granted to
me, as a votary of long standing, she expressed
herself very well satisfied with her present home,
where she has much honor and is everywhere
appreciated. I boldly suggested that it was per-
haps time to think of crossing the Atlantic and
setting up her temple in the new world for a gen-
eration or two. I spoke of the many advantages,
of the absence of tradition — here she visibly
v/eak'^'-'^d, as she has suffered so much from this
poii 1 ihe greater freedom, the enthusiasm,
and tnen I spoke of missionary work. At these
words she turned on me sharply and said: "That
is not for me. We gods have but one motto —
those that honor us we honor. Give me the tem-
ples, give me the priests, give me t^e true wor-
ship, the old Hippocratic service of the art and

VIENNA

of the science of ministering to man, and I will
come. By the eternal law under which we gods
live I would have to come. I did not wish to
leave Paris, where I was so happy and where I
was sei-ved so faithfully by Bichat, by Laennec
and by Louis" — and tears fillea her eyes and her
voice trembled with emotion — "but where the
worshippers are the most devoted, not, mark
you, where they are the most numerous; where
the clouds of incense rise highest, there must
my chief temple be, and to it from all quarters
will the faithful flock. As it was in Greece, in
Alexandria, in Rome, in northern Italy, in
France, so it is now in Germany, and so it may be
in the new world I long to see." Doubtless she
will come, but not till the present crude organi-
zation of our medical clinics is changed, not until
there is a fuller realization of internal medicine
as a science as well as an art.