Reprint: The Medical Fortnightly, St. Louis, November i, 1894. 
The Hospitals of Europe. 
By M. a. Goldstein, M. D., 
ST. LOUIS. 
Read before the St. Louis City Hospital Medical Society, October nth, 1894. 
IN THE consideration of a subject of so wide a range, it will be scarcely 
possible to enter into detailed descriptions of hospital construction, sani- 
tation and statistics of the numerous European institutions referred to. 
My endeavor, therefore, will be to present a medley of observations, gath- 
ered during a recent sojourn abroad; to sketch comparatively, the advan- 
tages of the hospital systems of Europe and America; to note a variety of 
new methods adopted, and to offer for consideration a few suggestions for 
the improvement of our own hospital management. 
In the preparation of this sketch, 1 have selected the representative 
towns of the different countries visited, usually the capitol city. The 
hospitals of Germany and Austria, England, France, Switzerland, Holland 
and Belgium, Italy and Scandinavia,-all have been visited, and an effort 
made to note the characteristic features of each. 
Perhaps the most scientifically and systematically conducted, most 
richly equipped, accommodating the largest number of patients, represent- 
ing the greatest variety of diseases-are the hospitals of Germany and 
Austria. Berlin, as the acknowledged queen of the scientific world and of 
exact scientific work, offers to the student of medicine most brilliant advan- 
tages in hospital experiences. Opportunities of appointments on the 
hospital medical staff are rarely offered to the foreigner, yet the many and 
special privileges accorded him are numerous; the wards are always open 
for inspection; admission to the special departments is easily obtained. 
The density of the population in Germany demands very large hospital 
accommodations, as evidenced by the numerous hospitals of Berlin, Ham- 
burg, Leipzic, etc. This necessitates, to a certain extent, the grouping of 
diseases for treatment, thus surgery, gynecology and obstetrics, pediatrics 
and the other specialties, all have their representative hospitals. The direct 
benefit to the patient, as a result of this "specialization system,'' is at once 
apparent, as the equipments of such institutions are far superior to those of 
general hospitals, and the work accomplished usually of a higher grade. 
The teaching in the hospitals of Germany and Austria is eminently 
practical as well as scientific. The direct relationship of the anatomical 
and pathological institutes with the hospitals facilitates the most thorough 
instruction in these important branches of medical science. Legal provis- 
ions are made permitting an autopsy on all patients who die while inmates 
of the hospitals. These post-mortem examinations are usually performed 
before the classes in pathological anatomy, with some members of the 
hospital staff present to cite the history of the case; thus, the most advan- 
tageous opportunities are offered for studying disease in every clinical and 
anatomical phase. Pathological anatomy is a branch of medicine to which 
great importance is attached in European Universities, and most detailed 
study demanded of the student. 2 
The system of construction and arrangement of hospitals in Germany 
and Austria is thoroughly in accordance with the demands of modern medical 
science. Perhaps less stress is laid on arrangement than on equipment. 
The condition of many of the wards may not bear the test of a rigid sani- 
tary inspection, yet every provision is made for the comfort of the individual 
patient. The food is substantial, but somewhat coarse. An excellent 
feature of the dietary system is the accompaniment of that valuable tonic 
and strengthening agent, good wine, which, owing to the cheapness of that 
luxury, can be furnished the patient in abundance, when required. 
The tub-bath as an antipyretic in typhoid fever still ranks as a favorite 
method of treatment. Iodoform in gauze and powder, and hydrarg. 
bichlorid. in gauze and solution are the antiseptics used; the sterilization of 
instruments with the steam-sterilizer immediately before operating, is at 
present in vogue, and ether is the favorite anesthetic. 
The principles of practice in the hospitals of England vary considerably 
from these popular measures in Germany and Austria. Thus, the cold 
sponge has been substituted for the tub bath; Lister's double cyanide of 
mercury and zinc gauze is most extensively used; in addition to the steam 
sterilization of instruments, they are kept during the operation in a 5 per 
cent carbolic acid; Prof. Watson Cheyne, Surgeon of King's College Hos- 
pital, closes all clean wounds completely, without drainage, and I have seen 
amputations of the leg closed absolutely, with a continuous suture, not even 
the smallest drainage tube or gauze strip being inserted; Lister's double 
cyanide gauze applied with compression, and the dressings remain intact 
and undisturbed until removal of sutures. On removal of sutures, a fresh 
dressing is applied, and allowed to remain for several weeks. No discharge 
ensues, the dressings being removed perfectly dry. Temperature chart 
during entire period indicated but slightest rise. This is a radical, ideal 
Lister's dressing, and has been recently adopted by some of England's most 
prominent surgeons. 
Too much cannot be said in praise of the Nursing System of the Eng- 
lish hospitals. Here is undeniably a proof positive of the succesful results 
of strictest discipline and careful training. The patrons of the hospital and 
members of the medical staff take a lively interest in the welfare of the 
Training School, and a perfect harmony exists, rarely seen in our own 
hospital management. 
The scope of work of the officers of the English hospitals is limited, 
partaking more of the nature of a division of labor. The ward physicians 
attend to the wants of the patients exclusively, not being encumbered by 
the additional work of history, writing-and other routine. This agreeable 
task is assigned to "clinical clerks." "Dressers" on the surgical side are 
assigned to work in the amphitheatre, the surgical staff operating, assisting, 
and attending the patients in the surgical wards. 
The rules of the ambulance system requiring a physician to accompany 
each ambulance, as recently adopted in St. Louis and other American cities, 
have been in operation in the metropoles of England for many years. 
A novel system of ambulance is carried out in Italy by the ancient 
order of monks, "The Misericordia." They may often be seen in their 3 
dismal-looking black garments, completely enveloping their bodies with the 
exception of two holes for the eyes; running along the streets, carrying 
their stretchers and instruments on their shoulders, while responding to an 
emergency call or burying the pauper dead. 
In the past decade Italy's improvement in hospital systems has been 
great; and the large hospitals of San Spirito and San Salvatore in Rome, 
though of very ancient origin, have been modernized, remodeled and com- 
pletely equipped for exact scientific work, and stand today as fitting 
memorials of Italy's energetic demands for the accommodation of her pauper 
poor. The Nursing Service is in charge of the ever active Sisters of Mercy, 
whose work by the bedside, at home and abroad, is always a credit to 
womankind. 
The greatest advancement in Italian medical circles, however, was the 
construction of the Grand Polyclinico, perhaps in size and furnishings, in 
design and finish, the finest series of clinic buildings in the world. The site 
on which this magnificent hospital is built is situated beyond the Porta Pia 
in the highest portion of Rome. The imposing block of stone buildings 
cover an area of nearly 200,000 square feet. Each department is amply 
provided for in separate buildings; the accommodations are perfect, and 
nothing which art and science could supply has been omitted, to make this 
grand enterprise, guided by the ability of a Baccelli, a brilliant success and 
a credit to the Italian nation. The Eleventh International Medical Conven- 
tion convened, section for section, in these spacious quarters of the new 
Policlinico. 
Italy and Germany are at present engaged in a spirited rivalry as to 
the efficiency and practicability of their respective new military hospitals. 
The claim of the German Military Commission of subtantiability of their 
hospital pavilions is counterbalanced by the Italian idea of simplicity in 
construction. Both have the latest improvements in pavilion-fittings and 
accommodations, the German pavilions being, perhaps, more comfortable 
and elaborately furnished, the Italian more compact and practical. The 
general arrangements and hygienic details carried out in the construction 
of these military hospitals may be considered one of the most decided 
advancements in sanitation and hygiene of the present era. 
In the statistics of decrease in disease, exophthalmic goitre plays an 
important role in the hygienic improvements of the Alpine valley. An 
investigation in many of the hospitals of Switzerland failed to substantiate 
the frequently described prevalence of cretanism in this section. Even in 
the well-known localities of Rapportswiel and Appenweier, but few cases of 
typical exophthalmic goitre are now known. The marked improvements in 
sanitation in Switzerland the past few years, and the isolation of these 
unfortunates, has finally cleared the country of a heritage which, at one 
time threatened to undermine the strong constitutions of these sturdy 
mountaineers. 
Simple goitre (uncomplicated enlargement of the thyroid gland) is still 
prevalent in Switzerland. I have seen Professor Kocher of Berne, (con- 
sidered by many the most skillful operator in continental Europe,) remove 
the greater portion ot the thyroid gland without administration of an anes- 
thetic. Even the days of preanesthesia in surgery could be recalled in wit- 4 
nessing a powerful Swiss peasant submit to an amputation of the upper third 
of the leg unflinchingly, while perfectly conscious. Notwithstanding the 
high altitude of Switzerland, and the pure, rarified air, it is surprising and 
distressing to find phthisis pulmonalis making its inroads with almost the 
same severity and steady pace as in other sections of the country. 
In the hospitals of Zurich and Geneva 1 have noted a marked conserv- 
atism in the introduction of new methods of treatment. 
It may be of interest to note that medical coeducation has been adopted 
in Switzerland, and the University of Zurich is becoming quite popular in 
its reception of medical students of the gentler sex, flocking thither from all 
parts of Europe. 
As the mountains and valleys of Switzerland differ from the lowlands 
of Holland, so does the radicalism of the latter differ from the conservatism 
of the former, as applied to medical progress. The Hollander has been 
aptly termed the '''Yankee of the North," and in the commercial aspect, 
industrial and charitable enterprise, and sanitary condition of the country, 
this title is a merited one. Nowhere in Europe is there a greater regard for 
cleanliness, and even the hospitals partake of the general scrupulousness 
and tidiness; nowhere in Europe is a stricter regard shown for the welfare 
of the patient. The newest methods of treatment, the most modern 
surgical technique-all receive full consideration. 
Paris, as one of the great, recognized medical centres of Europe presents 
to the scientific investigator a vast field for work and observation. The 
hospitals are conducted on a more private basis; the individual patient is 
not regarded solely as so much scientific material; the laboratories, however, 
and work in the clinics, especially in ophthalmology and neurology, are of 
the highest order; original research is warmly encouraged. 
In conclusion, permit me to pay a small tribute to the energy and 
industry of the busy workers on the Scandinavian peninsula. Nowhere in 
Europe have 1 seen an institution for the care of the sick more delightfully 
situated; so handsome in structure and appearance; more complete in 
hygienic details and general arrangements, than the ''Commune Hospidale" 
of Copenhagen. The building is modern, and is a perfect treasury of latest 
sanitary and scientific improvements; the wards are arranged in rotunda 
style, five and six in a series; each ward is well lighted, every bed standing 
between two windows. At each bedside is an electric bell, communicating 
with an indicator in the nurse's quarters in the centre of the rotunda; the 
surgical operating room is a "thing of beauty," and judging from its sub- 
stantial construction, will be "a joy forever." The disinfection and cleans- 
ing of the room is by means of hot water. A hose of steaming hot water 
washes ceiling, walls and contents of the room daily. The building is prac- 
tically fireproof; ventilation by rotating fans in numerous air shafts is 
perfect; in short, no effort has been spared to construct an ideal hospital, 
With this medley of observations 1 have endeavored to add a slight 
stimulus to the interest in our own hospitals, and if a stray suggestion may 
develop some activity and encouragement in local hospital proceedings, the 
mission of these lines has been fully accomplished.