by Professor Maurice Letulle; Professors Rappin and Rouxeau represented the School of Medicine of Nantes, and the General Association of Physicians of France had sent its president, Dr. Bellencontre, of Paris. The spokesman for the local physicians was Dr. Collin, of Quimper. All the speakers paid glowing tributes to the life and labors of the great physician.

The address delivered by Dr. Letulle on that occasion is of such beauty and shows such depths of gratitude that it is quoted here in abbreviated form. Professor Letulle called Laennec's book, "A masterpiece, the beauty of which far from being diminished by age, inModern creases in grandeur as time goes on. medicine recognizes its Magna Charta in Laennec's book on mediate auscultation and the medical world at large piously preserves its unalterable pages. Laennec's book, 100 years old, is as new to-day as it ever was. It attracts the reader and causes him to meditate. In 1819, when this book appeared, there had arisen a young generation of French physicians, such as Cruveilhier, Andral, Louis, Recamier, Piorry, Gendrin, Bretonneau, Bouillaud and others, all eager for clinical and pathological resarch work, but it seemed that they had no leader to guide them until Laennec came forward and proved the master whom they had been seeking. Laennec had already distinguished himself by his studies in pathological anatomy, and a number of publications on this subject had given him an enviable reputation. He was attending physician to the Necker Hospital, where his clinical teachings at the bedside attracted wide attention and his ever-increasing classes did not fail to also arouse the jealousy of his older colleagues. His clinic was not officially recognized as one of the clinics of the faculty, for even in those days there was already a distinction between 'des officiels et des non officiels.'

"The book came as a sudden revelation. It described with wonderful precision a number of diseases which heretofore were only suspected or totally unknown. The perusal of the book shows the practitioner how he can study the diseases of his patients by a simple, practical and easy technique. In a few hundred pages Laennec in his admirable style describes the macroscopic alteration of the lung and pleura in various diseases: pneumonia, gangrene, oedema, emphysema, dilatation of the bronchi, etc.

"Although a master of pathological anatomy, Laennec was, above all, a clinician and considered himself such. One fine day he invented an instrument which helped him in his clinical observations and investigations, and the stethoscope saw the light of day. In the hands of such a practitioner mediate auscultation caused a revolution in the diagnostic art and new world opened itself to the clinician Laennec. He plunged into the study of auscultatory signs with ardor and enthusiasm

a

*La Presse Medicale, Paris, November 15. 1919.

and in less than thirty months he had completed his marvelous work on the diagnostic signs which could be isolated with the aid of a stethoscope."

etc.

Letulle calls Laennec's achievements the work of a giant in intellect and continues: "It is difficult to know what to admire most in this unique personage-the pathologist who spent the best years of his youth in the postmortem rooms, studying and writing down the wonders of pathological anatomy, or the clinician who with the aid of a wooden cylinder acquired the skill or a marvelous diagnostician. In 1819 Laennec published in book form the results of his pathological and clinical observations. In this volume one can find most excellent descriptions of the character of normal respiration, the morbid modifications of the respiratory sounds in pneumonia, pulmonary oedema, bronchial catarrh, tuberculosis, Laennec invented the name "crepitant rale," which alone would suffice to make his name illustrious. Armed with his stethoscope, he diagnosed and named pneumothorax and hydro-pneumothorax. His clinical and pathological descriptions of the finding in tuberculosis from infiltration to cavity formation will always remain classic. His treatise is an original work which does not resemble any other. All therein is of value, all harmoniously put together by a man who was a lover of "belles lettres," an artist, a musician with a wonderfully trained ear, and a sage able to interpret in modern medical phraseology the works of Hippocrates, the father of scientific medicine. The glory of Laennec's works lies in the fact that he utilized his vast knowledge of pathological anatomy in the clinical description of the diseases of the respiratory system."

This is only a fragmentary reproduction in English of Professor Letulle's most eloquent discourse. In laying a wreath of laurels at the foot of the monument of Laennec, he pronounced the following impressive words: "In the name of the Faculty of Medicine of Paris, I bring this tribute to the founder of contemporary medicine as an expression of admiration and profoundest gratitude to the immortal author of 'Le Traite de l'Auscultation Mediate,' to the teacher of our teachers, eternal glory to Laennec."

If apostolic succession holds good of the clergy, it also holds good of the medical profession. Our Clarks, our Bowditchs, our Flints, our Smiths, our Janeways and many others of our teachers were also pupils of the pupils of Laennec, and the present generation of American clinicians should be, and I know is, as grateful to have had his teachings transmitted to us as are our French brethren across the sea.

Our own Osler, though England claims him now, became enthusiastic in his admiration of Laennec whenever he had a chance to mention his name. His gratitude for what that great French physician did to advance our knowledge of tuberculosis, he tried to instill into his pupils. The Laennec Society for the Study of Tuberculosis is a (Continued on page 118)

In continuation of my journeyings in the Spring of 1902, the place of paramount interest to me was Dettweiler's Sanatorium, near the little village of Falkenstein, about eight miles south of Frankfort-on-the-Main. There were several reasons for this interest. One was that Dr. Dettweiler was the Trudeau of Europe in that he was the outstanding figure in tuberculosis and the real pioneer in the rest treatment. He was still active, though nearly seventy years of age and ostensibly retired. Further, he had been the indirect cause of Dr. Trudeau's confidence in the sanatorium treatment of tuberculosis, through his journal articles, which, after being translated, came to the knowledge of Dr. Trudeau.

These two men had some knowledge of each other through patients and had had a somewhat parallel experience in their early lives. Both had experienced the disease in themselves, and from what I had heard of Dettweiler I judged there was much similarity in his character and spirit to that of Dr. Trudeau. I was quite pleased to find this true. The weeks immediately preceding my visit

VILLAGE OF FALKENSTEIN.

VIEW FROM DETTWEILER SANATORIUM.

to Dettweiler's Sanatorium were passed in the beautiful environment of Heidelberg, amid the old university buildings and the freer, more hospitable atmosphere among the students of Southern Germany. The contrast to Northern Germany was easily felt, and I began to find close analogies with my own early life in New Haven, with the customs of Yale student life and their counterpart in the Old World. The journey from Heidelberg to Falkenstein was easily made in one day. I was fortunate enough to arrive at the sanatorium on the day when Dettweiler made his weekly visits. lived near the village, some distance from the sanatorium, in a small villa pointed out to me by the communicative driver of the village conveyance. It was from him I first learned that irreverent people alleged that Dettweiler was deaf! Nevertheless, he admitted that the old doctor was still very much alive and that his opinion on lung disease was much sought.

He

Arrived at my destination after winding gradually up a hill, I was exhilarated by the charm of the surroundings. Beautiful lawns and trees stretched over a long slope, while higher up on the mountain was a ruin of the

veritable Falkenstein castle itself. The landscape was open and the view to the East looked down upon a fertile plain toward the Rhine valley. The institution was an artistic building with outlying verandah and adjoining rest houses.

I was ushered into a waiting-room and presented a card of introduction from my friend, Dr. Klebs, one-time assistant at Dettweiler's Sanatorium. An anxious-faced woman_was already waiting. We were informed that Dettweiler was engaged but would soon be free. The woman asked me sympathetically if I were ill, and was it true that Dettweiler could no longer "hear the lungs"? (Again the slander, evidently circulated by the malicious coachman!) I assured the woman that I was well, and that the story of Dettweiler's disability must be a mistake or he would not be attending patients. She seemed quite relieved, though I perceived in her look a trace of suspicion that I was, after all, a patient, a justifiable thought since I was not of robust, Teutonic build.

Presently the door was partly opened by an attendant and I heard my name called in a remarkably clear, gentle voice, and in measured

tones:

"Doktor Baldwin, kommen sie herein, mein lieber Kollege!"

I protested to the attendant that the woman had preceded me, but was motioned to enter and with an added expression of warm greeting the slight, white-haired and bearded old gentleman grasped my hand. He had rosy cheeks and merry blue eyes and, as I afterward thought, had he only been rotound and equipped with a pack and reindeer, what a perfect St. Nickolas he would have made! And his gentle humor was captivating. It was impossible to be a stranger after that first greeting. "How long have you been in Germany?" And then: "You speak German so well, and to my misfortune, I cannot speak English!"

Then he went on to ask me about Dr. Tru

deau, of whom he had often heard. "How tall was he?" and "How did he look?", "How many children had he?", etc., etc.

After the few minutes of interview he announced that I must take lunch with him and his staff at 11 o'clock. Then, introducing me to an assistant, he saw the woman and later joined me.

The institution was at that time resorted to by numbers of throat patients, some of whom were English. This was due to the reputation of one of the staff, Dr. Besold, who was skilled in operations on the larynx. He also spoke English well and to him was left much of the treatment of the patients.

We had sandwiches and beer, which latter Dettweiler assured me I much needed to improve my figure. He remarked that he was too old to use tuberculin, but Besold was positive in condemning it, and he was equally positive about other things under discussion. Dettweiler always made some gentle, jocular remark in response to such positive opinions by his assistants. After the lunch he went to his office again, saying that we should all work so long as we were able. He gave me an invitation to visit Ruppertshain, a workmen's insurance sanatorium which he had been instrumental in founding. It was three miles away, but a pleasant walk for me on a spring day.

Dettweiler also gave me a card to Professor Paul Ehrlich, at Frankfort, who had once been a patient of his and who was at that time famed for his discoveries in medicine.

In answer to my invitation to come to America, Dettweiler smiled and said he was too old to be "seekrank" (seasick)! But he parted from me affectionately and had an assistant telephone Dr. Nahm, of Ruppertshain, to look for me at luncheon.

Arriving at Ruppertshain after a warm jaunt, alone, but full of enthusiasm at my reception by Dettweiler, I was received by Dr. Nahm, ponderous and phlegmatic, as befitted his bulk. He was about to enter the dininghall for lunch as I appeared. Without much ado he said that he would like to have me say

nothing during the meal! I was quite unprepared to be struck dumb, but realized quite promptly after entering the hall what the request meant.

The doctor and I passed between a double line of men, who bowed low and ejaculated, "Mahlzeit!" (mealtime) as we approached. A university president or a college dean could not have had more homage paid him. The formality appalled me, although apparently good-natured on the part of the patients. About one hundred and fifty men and women, the men on one side of the room, the women on the other, stood at attention until the doctor and guest were seated, on a raised platform midway in the room. No conversation was anywhere heard. This rule amused me, but being hungry I found the savory stew sufficient to absorb my attention while the waiters moved quietly about the room serving the speechless patients.

Whether from hunger or from abstraction while eating, I suddenly roused to find the grave doctor and the hundred and fifty patients watching me-possibly noting my slow eating, or was it some fault in my table manners?

In a panic I swallowed my last mouthful with a gulp and dropped my knife and fork. Instantly, like soldiers on drill, all rose in unison with the doctor. I was myself by this time fully keyed to the point of imitation of all their military antics.

Again the genial salutation: "Mahlzeit!" was smilingly volleyed at us as we passed along the lines. Of course, I was sufficiently self-conscious to feel ill at ease, and the doctor was not at great pains to ease me. However, 1 made bold to ask him why he enforced silence at meals, and he explained that he found the patients ate more when silent, since talking led to political arguments and laughter, prolonging the meal time! If one should take the doctor as a standard example of the success of his method, one must accept it as proved; he weighed not less than two hundred

pounds. When I commented on the opposite system in vogue at Belzig under Dr. Moeller he simply looked a little contemptuous.

Anyhow, when we presently visited the balconies on which the men were reclining, there was plenty of hilarity and semi-horseplay in progress. The reaction was normal, and the doctor lost some of his gravity, I thought.

Cartoons adorned the wall of the gallery. Nicknames with couplets adorned the chairs here and there. It was a cheerful company of working men, who were good friends.

I learned that the support of the institution came from a sickness insurance society, and it was conducted efficiently. without doubt. The outlook from Ruppertshain while not presenting the wide stretch of wooded lawn that surrounded Dettweiler's Sanatorium, was, nevertheless, pleasing to the eye. A long slope of green fields extended to the sunny east and the institution was sheltered to the northwest by rapidly rising ground.

My visit was quickly ended and the gossipy driver was awaiting me as I thanked the doctor for his hospitality at the "silent" lunch.

Dettweiler died two years later at the age of seventy-two, and Nahm also passed away within a few years. The pleasure of this visit will hardly be forgotten, nor the impressions of German sanatorium life. Dettweiler exemplified the genial arts of medicine which, without severity, were yet applied successfully. I cannot imagine any one having feared him, but he was able to impose respect for his orders. He began life as a tuberculous invalid, and in consequence of ill-health was considerably deprived of advantages; but his delicate frame was animated by a determination and spirit that surely carries its lesson to those who look forward with doubts weighing heavily upon them. The writer cherishes the friendship of many who have passed through months of forlorn hope and finally conquered, even as Dettweiler and Trudeau conquered.