especially on the physical examination and differential diagnosis. Neusser, of Vienna, is the only professor I have heard who does not have a student "on the rack." Erb, of Heidelberg, is by far the hardest, while v. Ziemssen, of Munich, is very considerate of the medical student's feelings and does not hold him up to the ridicule of the class as does Erb frequently and Nothnagel occasionally. In the Allge

meines Krankenhaus in Vienna the hærsaale are a blot on the clean page of modern hygiene. Imagine if you can a room not very large with the seats raised in the form of an amphitheatre with a small pit in front and the back seats almost reaching the ceiling, then six large double windows all stuffed with cotton, a blanket placed between to prevent "draughts" and a large red hot stove under the seats on one side of the room. Then add to this picture the effect upon the atmosphere of a large number of out-patients sitting in the passage under the student seats, and about three hundred medical students, and you may get some idea of Nothnagel's clinic. The only seats available for visitors and American physicians are on the top rows where the air is particularly foul and where one can hardly stand up on account of the low ceiling. It takes a great deal to compensate for enduring this atmosphere for two hours and to shake off an almost irresistible desire for sleep which steals over one. I feel that the privilege of hearing Nothnagel repays for the discomfort, but it is a great pity that better accommodations are not provided for one of the best teachers of medicine in the world. Professor Nothnagel is probably over sixty years of age and is quite active and stands throughout the entire clinic. This is somewhat in contrast with v. Ziemssen, who sits most of the time in an easy chair. Professor Nothnagel has a very pleasant face and expression and his white hair and beard give him quite a venerable appearance. When he enters the room the

students rise and one is called down to examine the patient who is brought in bed from the wards. The student asks the patient a few questions and an assistant reads the history.

Nothnagel makes a mental note of the main points and later brings out their importance and bearing on the case. One of his axioms is that when there is a difference between the history and the objective findings it is safer to discredit

the history and be guided by the examination. He goes over the patient from head to foot most carefully and systematically and examines first the organ or area complained of by the patient. He lays the greatest importance on the senses of sight and touch and claims diagnosis can very often be made by these alone. He grasps the main points of the case which he describes and illustrates with marvellous lucidity. He is like a master builder, who having made the foundations of the structure secure, adds to it stone by stone until the harmonious and stately edifice stands completed before the eyes. He makes no "snap diagnosis" and sometimes spends six hours in completing a case. His delivery is clear and distinct and not too rapid so that it is easy for a foreigner to follow his lectures. The clinic of Professor Neusser is rather different. Neusser succeeded Bamberger and is a much younger man. Very few students attend this clinic and the audience is composed mostly of medical men. He has an unfortunate delivery, speaking in a low tone with no inflections in his voice. He rarely looks up and seems to have a very nervous temperament. His clinic is more interesting than instructive and while there is no denying he is an excellent diagnostician yet he pays so much attention to the small points that it seems as if he went through the medical literature and learned only the foot notes and what appeared in small print. His memory is marvellous and in quoting cases bearing on the topic under consideration he will give the number of the bed and ward. The rivalry between the two clinics is amusing and the assistants, internes and nurses of one cannot believe that anything good can come out of the other and both hold their respective chiefs in the greatest adoration.

The K. und K. Gesellschaft der Aertze in Vienna have had a very handsome building erected for their use. It is near the General Hospital and is an imposing example of the Renaissance type of architecture. The K. and K. stand for Kaiserlich und Königlich, and anything to succeed in Austria must bear these mystic symbols. This society has succeeded as one will be convinced by attending their meetings and seeing how many physicians are present each week and hearing the excellent qualities of the papers read.

The auditorium seats

about four hundred and is well arranged. A visitors' gallery encircles the hall and down stairs it is surrounded by a corridor from which numerous glass doors open into the auditorium so that a physician can seek and speak with some friend without disturbing the others and it affords an easy mode of retreat when the papers become tedious. Around the ceiling are busts of famous deceased members of the society but occupying the posts of honor, one at each end of the gallery, are placed the marble busts of Skoda and Billroth as if they were the patron saints of medicine and surgery.

One hears of all sorts of "quack," bonesetters, osteopathists, etc., etc., but not until a few weeks ago did I hear of a sect of men without medical training who make their living by removing stones from the bladder. For want of a better term they might be termed stoneslicers. Dr. Preindelsberger recently enlightened the Gesellschaft der Aerzte as to their methods and armamentarium. He found one of these men in Bosnia who had inherited the secret of removing stones from his father. He had of late years performed over 160 stone operations with a mortality of 20 per cent. He was rather well versed in the symptoms and never operates until he has felt the stone bimanually by placing one finger in the rectum and pressing down over the symphysis. His instruments were only five in number, two knives, two forceps and a keyshaped instrument. He places the patient in the typical lithotomy position and has him held by strong men. He inserts the left middle and forefinger in the rectum and pulls down the stone as far as possible. He then cuts a little to the right of the median line and parallel with the urethra until he comes into the bladder. He then enlarges the opening and removes the stone. If it is attached to the bladder wall he loosens it with the key-shaped instrument and if it is very large he breaks it with the forceps and removes the fragments. In case of hemorrhage he injects hot oil or packs the wound with a hard boiled egg. The after treatment consists of hot water injections, strict diet, and application of a plaster. For the first three days he allows no water to be taken, nothing but rice and milk. Prolapses of the rectum occur frequently. He expects a good result only with the help of God, and if the death angel comes it does not trouble him.

The inspection of milk in Vienna is very strict and the people may be pretty sure of being supplied with the pure article. One of the largest dairies is that of the Wiener Mölkerei Gesellschaft, which has now in construction an enormous building in which they expect to handle 100,000 liters of milk daily. An opportunity was recently given me to visit this dairy with several physicians. All the milk is brought from the country where the cows are pastured and experienced men employed as milk testers sample each can. The milk is then strained and the greater part is run over ice cold coils and bottled in cold glass bottles, sealed, dated and stamped. Part of the milk is run through separators and the cream is Pasteurized, cooled and bottled. They also bottle the separated milk which is labelled "abgemagert Milch" and has quite a sale in the coffee houses. Another part of the milk is prepared for infants after the method of Professor Monti and is called "Säuglings Milch." This is very carefully prepared and Pasteurized. Throughout the entire establishment the greatest cleanliness prevails and the employes wear white duck suits and caps. This method of bottling the milk is greatly to be commended and its use should be more general in our country. For the mother who cannot nurse her own child a number of reliable fresh milk preparations are for sale throughout the city. There is the "Fettmilch" of Professor Gärtner, the "Kindermilch" of Dr. Backhaus, the "Säuglings Milch" of Professor Monti, and milk sterilized by the Soxhlet method. And yet eight out of every ten children who come to the dispensaries have rickets, or, as it is commonly called, "Englische Krankheit."

The Aertzliche Verein in Munich has issued a "Scherznummer" of the well known Münchner medicinischer Wochenschrift which is very funny. It is an exact representation of the Wochenschrift and the advertisements have the same form but are most cleverly worded. Among the original articles is one on "Der Antialkoholismus, klinischer Vortrag von Prof. Süfferlein" in which the antialcoholists are divided into two main groups: A, those who have had delirium tremens; B, those who have not yet had delirium tremens. These divisions are further subdivided and defined. Another laughable article is entiled "Die Laubfrösche im Darmtractus der

Katers" by Dr. Max Harmlos. The author claims to have carefully searched the literature to find something on the digestion of frogs in the stomachs of castrated tom cats but was not successful. His case was remarkable in that the tom cat was troubled with stomach disorders in fine weather. Palpation revealed two frogs in Thomas' stomach and their shape could be plainly mapped out by percussion and the characteristic croak was heard on auscultation. When the weather grew cold the tom cat suffered from bowel complaint and on one occasion during a thunder storm the frogs were detected in the colon. This remarkable case is worked up in a scientific manner and is quite humorous.

Der Lehrbuch der Serotherapie der Mondscheinheilkunde bei Dr. Mondkalb is very exhaustively reviewed. Among the reports of societies, etc., is found an account of the first Internationaler Feminälogen Congress with a synopsis of some of the papers. Fräulein Doctor Ohnelust occupied the chair and among the papers was one by Frau Doctor Männerlob on "die Schönheit des Männes." On closing, the Congress sang

Among the Therapeutische Notizen is one on the Therapie der Sterilität. H. Umbug, M.D., Arizona, U. S. A., reports a case in which he had performed the Porro operation and for which on account of sterility and climacterium praecox he had prescribed extract of the uteri of rabbits, one half gram t. i. d. in a little milk. The result was extraordinary, for after four weeks treatment the patient gave birth to a healthy rabbit. H. L. K. SHAW.

1o the ANNALS:

PHILADELPHIA LETTER.

PHILADELPHIA, December 15, 1899.

Upon first thought it would hardly seem profitable or interesting to many of your readers to hear of the medical life of a city so near home, especially after the many excel