SPECTATOR'S LIBRARY.

Szerreves,

Austria: its Literary. Scientific, and Medical Institutions. With Notes upon the present State of Science, and a Guide to the Hospitals and Sanatory Establish- ments of Vienna. By W. R. Wilde, II.R.I.A.. Licentiate of the Royal College of Surgeons in Ireland. Sm. Sec.; Author of Narrati.e of a Voyage to Madeira and the Mediterranean." Longman and Cit.: Carey, Dublin. Farrar.

The Dream of Life. Lays of the English Church, audother Poems. By John Moultrie. MAN NMI/ AND CIGTOND, Pickering . Letters from the Virgin islands; illustrating Life and Manners in the West Indies. Van nerd.

MR. WILDE'S AUSTRIA.

TR the years 1840 and 1841, Mr. WILDE visited with professional objects the principal medical schools of the Continent, especially of Vienna ; but neither before his departure nor on his arrival could he find a single work which gave him any information respecting the state of the profession in Austria, the course of study prescribed to and the qualifications required from the medical man, or the public institutions in which he was trained. Having pursued this inquiry for himself, partly by means of books and the Imperial rescripts, partly by oral discourse and personal observation, he determined to furnish future travellers with a handbook such as he had felt the want of.

The main subject of this book is the medical profession and medical science in Austria. It presents a full account of the different classes into which the profession is divided, the preliminary and professional study necessary in each, with the examination to be undergone and the cost to the candidate. There is also an account of the principal hospitals, and a brief outline of their history, as well as a description of the regulations to which every thing and person connected with physic or physicians is subjected by the "paternal despotism." Much of this matter is derived from books or documents, and might have been ascertained without going to Vienna • and, besides the inherent dryness of statistics, it has somewhat of an encycloptedic lifelessness. But the more im- portant parts have been tested by actual inspection; and much remark or criticism, the result of personal observation, pervades the book, adding weight to the judgment and animating the narrative. There are also some sketches of the most eminent medical men of Vienna and their modes of practice ; together with a general view of the state of science and literature in Austria, and an exposition of the popular education by the state,—which, so far as the numbers taught are concerned, is as compulsory and extensive as that of Prussia.

Of high character in literature or science there is nothing in the Austrian dominions ; and medicine and surgery, especially surgery, are generally at a low ebb, notwithstanding the excellent rules laid down by authority for professional study and examination. Two oculists at Vienna (individuals with an innate ardour for the study) are eminent throughout Austria and Europe : beyond this, we infer, things approach the dead level. Mr. Wilms is inclined to attribute the want of high scientific and literary eminence to the absence of patronage on the part of the Government ; whose views are all practical. That the Government has much to do with it, seems true; not, however, by withholding encouragement, but by withering individual energy and destroying freedom even of indi- vidual will. And it is curious to see how shortsighted selfishness defeats itself. Practical efficiency is the object of the Austrian Government, yet they cannot attain their end; for the many are animated by the few. In true science there is nothing abstract. Even should its discoveries not directly add some new prin- ciple to practical art, its indirect results give keenness and eleva- tion to the general mind; which stagnates without its vivifying stimulus, and either declines altogether, or, if roused from time to time by foreign influences, reaches no higher than a mechanical mediocrity. It is not, however, the Austrian Government, but the regulations of the medical profession in Austria, which is the matter more im- mediately in hand; as front them something may be gleaned by which our Government Bill on Medical Reform may receive hints for its shape or improvement, so far as the circumstances of the countries are alike. Except in stringency and extent, the state of things described in the following extracts does not greatly differ from what Sir JAMES CLARK and other medical reformers would recommend for Great Britain.

DIVISIONAL ARRANGEMENT OF THE MEDICAL PROFESSION IN AUSTRIA.

As it now stands, the medical profession in Austria is divided into the first- Class physicians and first-class surgeons (Doctoren der Meditzin and Chirur- gie) ; the town and county surgeons (Civil und Land Wundiirzte)--analogous to the general practitioners in Great Britain ; those who practice specialities, as acconcheurs, (Geburishilfer,) oculists, (Augeniirzte,) dentists, (Zahniirzte); the Pharrnaceurs, who are divided into the apothecaries, (Apotheker,) and the doctors of chemistry, (Doctoren der Chetnie); and lastly, the veterinary sur- geons, (Thiertiirzte)--a class very superior to any other of a similar calling in Europe, and a large portion of whom are at the same time physicians and sur- geons of the first grade. The veterinary college and hospital now form a portion of the university direction, and come under the general oversight of the medico-chirurgical faculty. In addition to the above, there are a certain • number of educated licensed midwives, (Hebammen,) as shall he explained in describing the obstetric clinique of the general hospital. Each of these classes undergoes a certain fixed course of study.

Theoretically, this course of study is exceedingly well regulated; the courses being prescribed to teach the student those things first which he must first know in order to profit by what follows : a plan thus contrasted by Mr. WILDE with our practice in England-

" Thus we find, that according to this very extensive and well-arranged course, not only is the routine of subjects accurately defined, but the student is obliged strictly to adhere to theta in the manner and according to the order marked out by the board of medical directors. I cannot too strongly admire and recommend this practice, more especially as it is one whose adoption in Great Britain would be a rut improvement in the present system of medical education there. In England, with few exceptions, (and even in those ex- ceptions the kind of instruction is very meagre,) there is little or no prepara- tory education required by the different colleges and licensing bodies. The student is at perfect liberty to choose what lectures, and how many, he will first attend ; the object not being how he can best prepare his mind, by initiatory degrees, for the more mature branches of study, but how he CRA soonest, easiest, and cheapest, become possessed of the certificates of attend.. once upon these lectures; a large majority of uhich said lectures he has never heamd, nay, may never have seen the lecturer till he comes to purchase from bins the necessary certificate. There being no tests required 1113 to his knowledge of any of the subjects he is supposed to study till the hour of his examination' (still some years distant,) a great number of them have never cost him an hour's thought or reading ; and when this examination dues arrive, the chances that he 'is never asked a question, except upon anatomy and sur- gery, and a little physiology, are, in the chief licensing institutions in Great Britain, so slight as almost to amount to a certainty. Again, in the order (if the term can be so applied) of these studies, what difficulties do not hourly present themselves in the student's path. Hospitals and practical subjects are attended to long before their theory has ever been learned. Here the pupil really walks the hospital without acquiring a definite knowledge of any one thing; he witnesses operations of which he neither understands the rationale nor the cause, except by his grinder, during a few hard months' study prior to his examination, the result of which more frequently depends upon his memory than his practical knowledge ; he is never once called upon to test or exercise his acquirements until the hour before he receives a licence to practice, and too frequently he finds, at the conclusion of his studies, that he has begun at the wrong end. As matters now stand in this country, this is not the student's fault, but the fault of those who have, or ought to have, the direction of his studies and pursuits. The contrast with Austria, and the medical schools of the Continent generally, may be learned by an examination of the programme

of the different lectures. •

" The Professors can lecture from works published by themselves, or from some work of which they have made choice and which meets with the appro- bation of the constituted authorities. It is an established rule, not only in the medical but in all the other faculties, that each course of lectures is to be grounded upon some one text-book, not too voluminous, and within the du- dent's reach and comprehension, instead of being, as in this country, a com- pilation from numerous ancient and modern authors, the majority of which are but refutations of the hypotheses of the foregoing ones, and of which the student remembers but the names."

In these regulations there is little or nothing but what might be applied to the profession at home, either by law or the rescript of the licensing authority. In what with us is felt to be a very diffi- cult matter, the legislating for chemists and druggists, the Austrian example would have to be followed with more caution than Mr. WILDE seems to think, from the interference it would cause with freedom of trade and freedom of Mill.

PHARMACY IN AUSTRIA.

There is no division of medical science in Austria that is better managed, or that might with greater advantage be imitated in many respects by ourselves, than that of pharmacy, for it is there studied and practised as a separate and distinct branch of knowledge ; the apothecary neither aspiring to the character of a medical practitioner on the one hand, nor descending to the trade of a druggist or retail grocer on the other. There, the apothecary is solely a com- pounder of physician's and surgeon's prescriptions. Ile dare not, under the severest penalties, prescribe even the most simple remedies, nor perform the most insignificant surgical operations ; nay, more, he cannot sell a dose of physic without the written order of a physician or surgeon who is recognized by the university of his country. Under this order of things, the prescriber and the taker of medicine have the advantage of having that medicine accurately compounded by a properly-educated pharmacean, whose whole time and ability are devoted to the subject. Only a certain fixed number of apothecaries are permitted to dispense and sell medicine in the empire : in Vienna the number is limited to forty, and never varies; for the Apotheke' or shop, like the title of monarchy, never dim, but merely changes masters. These establishments are known by their signs, and not by the names of their owners; who may be, and often are, widows of apothecaries, or merely tenants of the relatives or executors or such. The apothecary has no connexion whatever with the patient : he never leaves his shop to apply his remedies or perform the minor operations of surgery, such as bleeding, cupping, leeching, &c. as with us ; these being, as I have shown, the exclusive province of the Wundiirzt. Each medicine has a certain stated price fixed by authority, and marked in the pharniacepceia and medical tax- book, so that no exorbitant demand can possibly be made; and, as has been already stated, no apothecary dare, under a heavy penalty, compound the pre- scription of any medical man whose name is not set forth in the printed list of authorized practitioners. The poor of this country being everywhere AD well provided for by the state, the great number of hospitals that exist, and the smallness of the fees received by the practitioner, enabling the middle classes to procure proper medical advice, render unnecessary the system of self-doctor- ing or quack-doctoring, in use in Great Britain. The department of pharmacy consists of doctors of chemistry and master apothecariea ; and these latter are again subdivided into the Apotheker, who is a bona fide possessor of a. shop, the Plichter, or tenant who hires such of an apothecary or his relatives, and the Provisor, who is a dispenser employed by an apothecary unable to manage his own concerns, or by his widow or friends, &c. • and, finally, the Gehillfe, or journeyman employed under any of these. NO apothecary or doctor ot che- mistry can hold two establishments.

The following are some of the principal rules concerning the duties of apo- thecaries, and the composition and sale of medicines—All poisons are required to be kept under lock and key, and can only be compounded by the head of the establishment. All powerful medicines, as emetics, drastic parges, strong mer- curial compounds, and narcotics, and all the preparations marked thus -F in the tax-book, are not permitted to be sold without the recipe of an authorized practitioner. No apothecary dare, under the severest penalties, alter any item in a prescription. It is likewise set forth in the regulations, that unless the prescription is clearly written, and the apothecary fully understands it, be is forbidden to compound it. On the death, sickness, or absence of an apothe- cary, the director sends a provisor at once to fill his place: until such is done, no medicine can be sold or compounded in the establishment. Apothecaries known to sell medicines that might procure abortion, without the order of a physician, are punished in the severest manner.

In the remote and country parts of Austria there are but few apothecaries; for, not being allowed to prescribe or practise themselves, andjthe law permitting their selling but a few simples without a written order, they arc almost wholly dependent on the medical practitioner. In such places, where both exist, the apothecary dispenses the medicines ordered by the practitioner for the poor of the neighbourhood; his accounts are audited and taxed according to the printed tariff at the end of the year, and he is paid by the local civil authorities.

What would an invalid, arrived at the age when every one is "a fool or a physician," or both, say at being refused the drugs he is in the habit of prescribing for himself? and the druggist might not greatly admire the regulation of his prices, or the public at large the close monopoly which the Austrian Government enforces and controls.

FEES IN easrara.

The usual fee to a doctor of medicine or surgery is a Gulden vainly (two shillings) for each visit ; but this sum varies, according to the business or the celebrity of the practitioner, to a ducat or even more. The consultation fee is always a ducat. IA ducat is about 98.6d.] The law makes strict provision for the remuneration of medical men : in posthumous cases the physician and the apothecary take precedence in this respect of the relatives and lega- tees. The highest sum made by any physician or surgeon in Vienna is from -fifty to sixty thousand florins a year. [About 3,0001.] This account, it will be observed, refers to the higher grades of the profession, analogous to our physician or consulting-surgeon. The

Wunddrzt or general practitioner is a person much inferior to the same class in this country : but his remuneration is equally fixed with those of the higher grade as to what he may demand ; for, unlike them, we suppose he never gets more as an honorarium.

"These practitioners are remunerated according to a regular scale of fees— thus, for bleeding, ten to seventeen kreutzers [A farthing is the nearest English coin to the kreutzer] ; for dressing a flesh wound, twenty-four kreutzers ; if the wound be of any magnitude, forty-five kreutzers ; for the whole attendance on such, from one to two florins in the country, and fifteen to twenty kreutzers in towns ; for fractures or lacerated wounds, or in- juries of the head, the fees are greater, and also for the general attendance on fractures, &c., as well as for the operation of trepanning,—the latter being, by the medical laws of Austria, within the province of persons who are not per- mitted to prescribe a dose of medicine ! If a fire occurs in the neighbourhood, the Wundiirzt in whose district it happens is obliged to attend, to be prepared for any accidents that may take place; and in case of the appearance of epi- demics, he is obliged immediately to notify such to the head physician and the Local Government office.

"The number of these practitioners in each district is limited, and none others are permitted to locate themselves without a special licence from the Government, unless the inhabitants of the place desire it. Each Wundiirzt has under his care a certain number of villages, and no other surgeon is allowed to encroach upon his walk, unless sent for by the desire of a patient. Unless the Wtindiirzt belongs to the Gremium he is not permitted to keep an OffleM, or shop, nor to hang out his sign ; and he is forbidden to treat any internal disease if there is a physician in his district. Circumscribed as is his practice, 7et be enjoys an immunity from all quacks, who are punished with six months' imprisonment for every offence- and physicians are not allowed to bleed, cup, or in any way interfere with the province of the Wundiirzt. If there is not an apothecary within one hour's ride of his residence, then the Wundiirzt is permitted to compound and sell a certain limited quantity of medicine."

The regulation of charges by law is a favourite idea with some persona in this country : but we fancy, before any practical result could flow from it, we must adopt a plan of the " paternal des- potism" and limit the number of persons licensed to practise in any district. There are various other topics connected with medical matters in Austria, which will have an interest for the professional man ; but we will pass them by, for an account of that extraordinary institution

THE LYING-IN HOSPITAL OF VIENNA.

Pregnant women of all grades and of every religious persuasion can avail themselves of the advantages of this asylum : the poor and destitute are ad- mitted gratis, and the rich by paying a certain stated sum : thus it is well adapted to the circumstances of all classes, where poverty and necessity, or where fear and a desire of secrecy induce such to apply for refuge therein, during their hour of trial. Here every comfort is supplied—no visiter can intrude, no law affect, and no authority reach its inmates ; nay, more, the very fact of their having been delivered there is inadmissible either as docu- mentary or personal evidence in a court of justice. The whole institution is divided into two great divisions, the paying and the non-paying. The former is perfectly distinct from the latter, and consists of three classes: to the first, or highest class, are allotted five neat, well-furnished, and secluded chambers, perfectly distinct and separate from each other, and from the rest of the establishment : they are guarded with the greatest strictness, and are inacces- sible to all but the attendant physician, and if necessary the nurse. Each of these is occupied by one person alone, who pays one florin, twenty kreutzers, or about two shillings and eightpence daily for its use. These are said to be for the young ladies of the Imperial city; and are, I have been credibly in- formed, sometimes the resort of females from among the highest circles of

society. • •

Not only in the first, but in all the three paying classes, no admission is per- mitted; none are allowed on any pretext whatever to enter therein, except the immediate attendants ; and besides this, the localities of this part are so arranged as to secure those residing therein from the gaze of the curious. The principle of secrecy is imposed as one of the strictest duties on all those in any way engaged in the institution. Should a female desert her family and take shelter here, the vigilance of the police or the inquiries of her friends may trace her to the door of the Gebiiranstaft, but DO further. Here the ex- ecutive enters not: such is the law, that not only is a father or a husband denied an entrance, but he cannot, as has been already observed, receive from the records of the hospital, or any one connected therewith, any testimony of her reception or delivery. Indeed, in many instances, and in almost all the cases occurring among the first or highest class, such evidence could not pos- sibly be obtained ; as a female may enter, accomplish her delivery, and depart from the hospital, without her name being known, or even her face seen by the physician or any of the attendants. The entrance into these paying wards is not the same as that leading into the general hospital, but by a pri- vate way, ending in a small cul-de-sac, that runs between the ancient Spanish cloister and an adjoining barrack ; and as it is forbidden to have any windows looking into this lane, persons approaching that way are perfectly secure from observation. At the end of this cul-de-sac there is one small door, with a bell attached to it; a.porter remains at the entrance day and night, and conducts the person requiring admission to whatever apartment or division they require, or their means afford. Persons are allowed to appear masked, veiled, or other- wise disguised ; they may enter at any time previous to their delivery, and re- main as long as they wish..., they may carry their infants away with them, or send them to the foundling hospital through the medical attendant. The names and address of persons admitted into this division are not required ; but each female must write her name and residence upon a billet which she seals, and on the back of which the physician inscribes the number of the room and bed she occupies. This ticket is then placed in a small locked-up cabinet be- side her bed, and at her departure it is returned to her unopened ; its object being, that in case of her death the institution may inform her friends, or be

able to produce this testimony of her decease on the demand of her relations, or the police. Females entering the first class apartments of this division are not required to apply to the porter in the usual manner, but may, if they wish, go to the apartments of the attending accoucheur direct, who will conduct them to their appointed chamber ; and with similar secrecy and precaution they may go out. The rooms of this class are likewise provided with cradles and every necessary comfort. Here the patient is permitted to bring her own servants and linen if she desire it ; or she can be supplied from the stores of the hospital with every such requisite, &c. Without her own desire, no one except the doctor, not even a nurse or midwife, is allowed to enter her chamber ; and in case of severe illness she is at liberty to call in another physician along with the usual house- attendant. In the year 1840, twenty-two females were delivered in this part of the establishment.

If this were told of a remote period, the speculation of the moralist and the historian would be employed on the moral state of a society which could conceive the idea of such an institution, much more require it, or permit its establishment, with re- lations checking even the all-potent police. In the case of Aus- tria, we are not driven to speculation, as the statistics of births are at hand.

PROPORTION OF ILLEGITIMATE TO LEGITIMATE BIRTHS.

In Upper Austria 1 in 6. In Moravia 1 in 8.7 In Lower Austria 1 in 7.8

In Carniola and Coast Land 1 in 16.0

In Bohemia 1 in 7.3 In Lombardy 1 in 24.0 In Carynthia

110 3.2

In the City of Vienna I in 2.24 In Gallicia

I in 14.0 Nearly every second child illegitimate in the capital, and the ratio very high in all the dominions of Austria Proper, or Germany ; and this state of things, according to Mr. WILDE, encouraged by the Government !

It may be asked, are there any political reasons for encouraging such a condition of morals—for by thus permitting, it encourages ? Yes the Austrian state, whose political web extends not only into the paths oiliterature and science, but sends its far-stretching fibres into every domestic circle in the laud, has, I have been credibly informed, and I believe it to be true, an object in thus countenancing illegitimacy—it is that of checking over population ; as those who are informed upon the subject of population well know it has the power to do, by decreasing the number of births and increasing the infantile mortality."

Surely there is a laxity after all about the" paternal despotism."