THE OPPORTUNITIES 
OFFERED BY 
PRAGUE, HEIDELBERG, AND DUBLIN 
TO THE 
AMERICAN MEDICAL STUDENT. 
BY 
A. O. J. KELLY, M.D., 
PHILADELPHIA. 
Reprinted from the International Medical Magazine for September, 1893. THE OPPORTUNITIES OFFERED BY PRAGUE, 
HEIDELBERG, AND DUBLIN TO THE 
AMERICAN MEDICAL STUDENT. 
A regular meeting of the Anglo-American Vienna Medical Associa- 
tion was held at the Riedhof, Friday evening, December 23, Dr. Walter 
L. Bierring, of Davenport, Iowa, the President, in the chair. The minutes 
of the previous meeting were read by the Secretary, Dr. Henry Kugeler, 
of San Francisco, and approved by the society. The business proper of 
the meeting was then proceeded with. This consisted of a " Discussion of 
the Relative Merits of Various Smaller Universities, and of the Advantages 
one might there enjoy." 
It was intended to compare Prague and Dublin as centres of obstetric 
teachings. Dr. Austin O'Malley, of Washington, D. C., was called upon 
to relate his experiences at the former place. In substance he said that the 
obstetric work in Prague is to be done in what is known as the Gebiirt 
Anstalt, Boehmische Abtheilung. Besides a department for midwives, the 
hospital has two sides, so called,-the Bohemian and the German,-the 
former of which only is accessible. And having once become an intern there, 
one's personal popularity and success depend in no small measure upon the 
vehemence with which he decries everything German; the stronger his 
condemnations, the more is he thought of. During the first six months of 
1892 there were six hundred and twenty-one deliveries in the Bohemian 
side alone. All abnormal cases are in the hands of the assistants; the 
primiparse are delivered by the interns; the multiparse by the Bohemian 
students and midwives. The interns, too, may conduct the delivery of 
these latter cases, if they so desire. During the six weeks the doctor was 
there he delivered several multiparse and fifteen primiparae. Had he not 
been otherwise engaged, he might have had several more of the latter. Of 
course, one is called to everything abnormal; and in this connection, a 
small fee to the attendant will not go amiss. The patients are always 
placed on their back for delivery. During the puerperium one has oppor- 
tunities for noting the condition of the patient from day to day, until her 
discharge from the hospital. The doctor thought that their method of 
repairing lacerated perineums might be improved upon, as the rent is but 2 
A. O. J. KELLY, M.D., ON 
very superficially approximated. They have the most sensible way of 
dressing the new-born infant; but their success with their children is not 
very great. One has opportunities for witnessing all gynaecological opera- 
tions, which are done by Professor Pawlik. During the six weeks mentioned 
the doctor saw eleven cceliotomies, three or four hysterectomies, a few col- 
porrhaphies and the like. Here one can see the various stages of the opera- 
tions much better than anywhere else; there are so few present, all are close 
to the patient. The manner of catheterizing the ureters is very carefully 
explained and taught by Professor Pawlik, who is justly celebrated for his 
dexterity in doing this operation, which is one of his own devising. Per- 
sonally the doctor did many finger curettements. But these were purely 
favors. One might not be permitted to do such operations. Asepsis and 
antisepsis are carefully practised ; the principal antiseptics employed being 
thymol, lysol, and mercuric bichloride. There are accommodations for four 
interns only. And in order to be sure of a place one should, before he goes 
there, write to Professor Pawlik, and later to the secretary or porter for the 
rooms. The expenses are very small; board is cheaper than elsewhere. The 
doctor was unprepared to state whether or not it would repay a man to go 
to Prague. He certainly need remain no longer than two months; one 
might be sufficient. If a man knew little of his subject, he might with 
advantage go there; but he thought a visit there would hardly repay one 
who was well informed on obstetrics. 
Dr. A. O. J. Kelly, of Philadelphia, was then asked to give the society 
the benefit of his experience at Dublin. He said, " What I shall say of 
the Rotunda Hospital are mostly words of commendation. A student, 
having been accepted by the master of the hospital as a pupil of the institu- 
tion, applies to the keeper of the list for assignment to days on which he 
shall be on duty. Each pupil of the hospital is on duty from 9 A.M. until 
9 p.m., or from 9 p.m. until 9 a.m. four days of the week, two days in- 
tern duty, two days extern duty; the days on which he is on intern duty 
precede those on which he is on extern duty. The student selects his own 
days; but he may not have an extern case until he has had an intern one. 
Those on duty during the night are mostly undergraduates,-students of 
Trinity College or elsewhere, who take this way of obtaining their practical 
obstetrics previous to qualification ; they do not live in the hospital. All 
others are on duty during the day, and have residence, if they desire it, in 
the hospital. The cases, both intern and extern, are allotted in turn to 
those students whose names appear on the list as being on duty for the day. 
Any one not present when called misses his turn. At night, when a call 
comes, if there are no extern men present, the interns conduct the case. 
During those days on which a student is on duty he may see all the cases 
of labor that are delivered in the wards, and has opportunities of becoming 
proficient in methods of obstetric diagnosis, by means of abdominal palpa- 
tion of cases in the wards, and vaginal examinations of those cases in labor. 
To all abnormal cases, at any time whatsoever, all the students are called. PRAGUE, HEIDELBERG, AND DUBLIN FOR THE AMERICAN STUDENT. 
3 
At about nine-thirty every morning, the master of the hospital, Dr. W. J. 
Smyly, goes through the wards. The pupils accompany him. At inter- 
vals he delivers a lecture, illustrated by some interesting case that may 
be in the ward, on placenta praevia, post-partum hemorrhage, deformed 
pelvis, and the like. They then repair to the surgery, as the gynaecological 
department is called. Here various cases are presented; some for diagnosis, 
others for medicinal treatment, others for operations. The students, of 
course, see all the operations; and the other cases are examined by them in 
turn. During 1892 the number of intern obstetric cases was twelve hun- 
dred and nineteen; extern obstetric cases about three thousand. The num- 
ber of intern gynaecological cases number five hundred a year; while those 
treated in the out-patient department amount to ten thousand yearly. I 
was there a month and saw thirty-one obstetric cases, about one-third of 
which were personal conductions. Being otherwise engaged, I missed seeing 
some. In a month one should see between forty and fifty cases. But a 
month is hardly long enough to remain. Many stay three months and see 
almost a hundred and fifty cases; while others prolong their stay to six 
months and become candidates for the degree of L.M. (licentiate of mid- 
wifery). There are accommodations in the hospital for sixteen students. 
But at times there are more,-others living outside. Especially is this so 
during the summer months, when the English and Scotch undergraduates 
go there for their obstetrics, just previous to the commencement of the fall 
terms at their medical schools. This is a poor time to go; the best time 
being during the winter and spring. The fee is six guineas for one month ; 
thirty guineas for six months. In addition to what I have mentioned there 
is a thoroughly practical course on gynaecology given by Assistant Master 
Dr. Glenn, and a quiz course on obstetrics by Assistant Master Dr. Tweedy." 
Dr. J. Page Massie, of Lynchburg, Va., being then called upon, spoke 
of the advantages offered at Heidelberg. In the course of his statements 
the doctor said that that branch of medical science for which a man might 
go to Heidelberg in preference to other places is pathology, both microscopic 
and gross,-the former of which is excellent, the latter fair,-very good for 
a small town. In microscopic pathology there are two courses, the better 
of which is by Professor Arnold, in whose laboratory one may work from 
7 a.m. until 7 p.m. The cost of this is nothing. But to take the labora- 
tory course one must matriculate for the professor's lectures on microscopic 
and gross pathology; this costs but twenty marks per semester. Daily in 
the laboratory each student is given two preparations, of which he may cut 
as many sections as he chooses. It is, however, possible for a man doing 
nothing but pathology, upon application, to obtain more than the two 
specimens daily. The preparations are given hardened on a block; the 
student must cut and mount them himself. Besides this, one may take as 
many specimens of gross pathology as he chooses, and himself perform the 
entire process of preparing them for microscopic examination,-that is, 
harden, cut, stain, and mount them. Professor Arnold teaches the method, 4 
PRAGUE, HEIDELBERG, AND DUBLIN FOR THE AMERICAN STUDENT. 
and every day carefully explains the specimens given. The second course 
of microscopic pathology is by Dr. Ernst, Professor Arnold's first assistant. 
The class meets twice a week, two hours each day. The preparations are 
given cut and stained; one has simply to mount them. Dr. Ernst demon- 
strates them by drawings on the blackboard, and then explains them to 
each one individually. In gross pathology there are from one to six sub- 
jects a day, with an average of three or four. Everything is well demon- 
strated, and one has opportunities of making post-mortem examinations, to 
the number of three or four a month. By Professor Leber and his first 
assistant, Dr. Waggerman, there is given a course on the pathology of the 
eye, which is said to be the best in the world. The work consumes two 
hours a day, during which time there are given two specimens ready for 
mounting. These are then very thoroughly explained. The course costs 
forty marks a month. Dr. Ernst gives also a course on bacteriology which 
is very good. One works in the laboratory the entire day. The material 
is enormous; personal attention fair. The course is given twice a year,- 
during March, and again during August, and costs forty marks; but one 
must furnish his own glass apparatus, costing from ten to seventeen marks. 
For a place the size of Heidelberg, Professor Czerny's clinic is splendid. 
One doing other work at the university may attend the clinics free, and 
may also, with the professor, visit the wards of the hospital, where he has 
two hundred beds. The lectures on diseases of the nervous system once a 
week-Wednesdays-by Professor Erb are also fine, particularly his remarks 
on diagnosis, on which he lays particular stress. On other days he lectures 
on internal medicine. In other branches of medicine a person can do much 
better elsewhere than he can at Heidelberg. Heidelberg is more of a place 
for a student than for a post-graduate, and in case of any distinction, the 
student has the preference. It is a fine place to prepare for a degree, for 
before one finishes he has opportunities of becoming assistant under nearly 
all the professors, doing this work of course during the vacations, when 
there are no lectures. 
Dr. Holland, of Chicago, then spoke a few words in praise of the bac- 
teriology course at Heidelberg; and Dr. Kugeler, the Secretary, in the same 
strain, mentioning also the very pleasant surroundings of Heidelberg. 
The thanks of the society having been tendered the gentlemen men- 
tioned, and some routine business having been transacted, the meeting was 
adjourned. International 
A MONTHLY 
Medical °evoted atn°dmed,cal 
t* < SURGICAL SCIENCE. 
Magazine. 
Edited by JUDSON DALAND, M.D., 
Instructor in Clinical Medicine, and Lecturer on Physical Diagnosis and Symptomatology in the University 
of Pennsylvania ; Assistant Physician to the University Hospital. 
THE development of medical science has proceeded at such an 
amazing pace as to outstrip all successful efforts hitherto to 
present its results in a form available for the profession at 
large. But the International Medical Magazine supplies 
for the first time this need by giving, as it does, authoritative 
expression to the results of the experience and investigations of the fore- 
most physicians, surgeons, and lecturers of the leading medical schools 
of the United States, together with those of the great medical centres 
abroad, such as London, Paris, Berlin, and Vienna. 
The contents of each number embrace Original Contributions and 
Clinical Lectures by leading practitioners, whose labors are exercising a 
directive and stimulating influence on the healing art and have given 
them an international fame. 
In addition to these departments and with a view to securing ex- 
haustiveness, thoroughness, and reliability, specialists, tried in the school 
of experience and tested by their success in their specialty, have been 
placed in charge of separate departments embracing the following subjects : 
Medicine, Therapeutics, Neurology, Pediatrics, Surgery, Genito-Urinary 
Surgery, Orthopeedics, Obstetrics and Gynaecology, Ophthalmology and 
Otology, Laryngology and Rhinology, Dermatology, Hygiene and Bac- 
teriology, Pathology, and Climatology. To this must be added translations 
of what is best from the medical literature of Italy, Spain, and Portugal. 
The department of Forensic Medicine, dealing with medico-legal 
questions, and the legal duties and responsibilities arising out of, and 
incidental to, the relation of physician and patient, as ascertained and 
defined by courts of last resort, has proved an interesting and valuable 
feature of the Magazine, and called forth many expressions of apprecia- 
tion and approval from its readers. 
The department of Book Reviews furnishes a brief critical analysis 
of all the more important medical books and periodicals as soon as they 
are published. 
The Magazine becomes, therefore, the medium by which all that 
is settled as best, in every department of medical and surgical science 
throughout the medical world, is placed within the means of every 
practitioner. And it is the purpose of the publishers to spare neither 
pains nor expense to keep the Magazine where it has already taken its 
stand,-at the very head and front of medical periodical literature. 
SAMPLE COPY J. B. Lippincott Company, 
SENT ON PUBLISHERS, 
APPLICATION. 
PH I LA ID EL I'll 1A, U.S.A..