"Simplon Express, December 15, 1919

Dear Princess C.--

I am anxious to express to you the very great pleasure it gave me to inspect your splendid Infants' Hospital in Bucharest. The plan of the hospital is so well conceived and the convenience of its installation is so perfect as to make it a model institution for the sort of work it undertakes. It is the existence of such advanced and modern medical equipment that has made America's task of bringing temporary aid to desolated Roumania such a source of satisfaction. I hope we may be of further help to you until the time comes when your own supplies are amply sufficient."

Re-reading this copy of a letter written on my departure from Roumania seven years ago, and just a year after the Armistice, brings back very vividly the picture of medical conditions at that time. The thunderbolt of war had struck Roumania with peculiar violence. Germany's supplies were running low at the moment when her overwhelming armies swept the Kingdom. Medical equipment was especially lacking and on this account laboratories were stripped of their instruments and stock, hospitals were pillaged for beds and material, and all drugs were sequestered and taken out of the country. Furthermore this tremendous loss of essential medical supplies was coincident with a great increase in morbidity arising as the inevitable result of war and post-war privations.

For those of us who live in the midst of American abundance it is impossible to picture the staggering task which confronted the physicians and the Public Health Service of Roumania at that time. It is almost equally difficult to appreciate the steadfastness and courage with which they met the test. Yet what less could one expect of a country which reckons among its medical peers such men as Cantacuzino, Jonescu, Minovici, Obreja, Nanu Muscel, Danielopol, Dumitrescu-Mantea, Poenaru-Caplesti and many more of like fibre?

Fortunately the American Red Cross was able during the spring of 1919 to ship certain supplies to Roumania which helped somewhat to meet the most pressing needs. Going out to that stricken country six months later it was my expectation to find medical affairs still in a state of chaos. The letter quoted above is the clearest proof of the remarkable effort at rehabilitation already made by the medical faculty ably supported by the generous and self-sacrificing work of her loyal citizens.

In this brief resume of the medical situation immediately after the war the specific activities of individuals cannot be cited. A superficial glance at the Hospitals, Medical Schools and Public Health Service must suffice. And of these perhaps the medical schools suffered most from the complete interruption of their activities. In addition, the loss by death of many members of their faculties was an added disaster. It is difficult to imagine my surprise, therefore, on finding the medical school at Bucharest opening for the fall semester with six hundred new students in the entering class, with dissecting rooms supplied with material, laboratories equipped with essentials for experimental studies, with instructors alert and enthusiastic, handling the heavy burden imposed by so large a body of undergraduates with calmness, devotion and success. The buildings themselves, a beautifully arranged modern educational plant, were in excellent condition and when I first visited them gardeners were actually planting the flower beds on the grounds in preparation for the spring glory which had evidently been theirs before the war. It was an interesting little touch, showing the Latin demand for beauty following close on the heels of the more pressing utilitarian needs.

The Medical School at Jassy is housed in less imposing buildings, yet here also were evident the same brave activity and firm resolve. Five hundred new students were enrolled, twice as many as could be cared for, but apparently none were turned away and both instructors and scholars were making the best of the difficult situation. The help which we could give to the laboratory equipment, little enough to be sure, was received with an almost overwhelming gratitude, showing the really desperate need for even the simplest supplies. The reason for these large enrollments was, of course, the fact that all Roumanians of student age had been for three years in army service and professional studies had been deferred. Moreover, business conditions in the country were such as to tempt few of the youth of that period, and they turned to study as the alternative to enforced idleness.

Turning now to the situation at the hospitals immediately following the restoration of the government, we find an even more pathetic picture. The buildings were for the most part intact but through neglect and misuse by the occupying forces they were worn and dirty to the point of bitter discouragement. Here again even the most fundamental supplies were urgently needed. But the personnel, both doctors and nurses, showed that tireless devotion and courage which alone could have put them into effective condition. They were crowded with patients and although many makeshifts were necessary the invalids were made surprisingly comfortable, while as to the medical care they were receiving nothing was left to be desired. It was perhaps most interesting of all to see experimental work starting up in the laboratories, evidence of the untiring enthusiasm of the true research worker even under the most discouraging handicaps.

The cities, especially Bucharest, were crowded with many strangers, making the regular hospital accommodations inadequate. To meet this emergency new enterprises were already well under way. Quoting again from a letter written at that time: "Yesterday afternoon I went with Miss B. to see two maternity homes which we have tried to help. They were small ones, for twelve patients each, run by a charitable society of the city. They were splendidly planned, the babies were very cunning, the places were scrupulously neat and the mothers well cared for, wisely fed, and happy." I might add that here, as well as in the surgical clinics, a high standard of asepsis was maintained in spite of the obvious difficulties, and that cases appeared to convalesce as well as we expect in our best equipped hospitals in America.

"This morning we visited the Children's Hospital, a fine institution for nearly two hundred youngsters. The doctors were most cordial and showed us everything. The cases are of all sorts, some of them most interesting. They were putting on a plaster jacket for a lateral curvature and it looked most natural and made me a bit homesick for my own work. The hospital is modern in every way, well organized, and administered by physicians who have had their training in the best medical schools of Europe." It is a fact that the Roumanians would be the last to deny that American Red Cross supplies had helped materially to enable this speedy revival of hospital work, but it should be a source of genuine gratification to Americans that their gifts fell into the hands of men and women so adequately able to make the best possible use of them.

It is not difficult to visualize the appalling conditions which confronted the Public Health Service after the evacuation of Bucharest and the other large cities of Roumania. Sanitation simply did not exist, the streets and houses were unclean, and the water and sewage systems had been allowed to run down. Overcrowding in the towns threatened to lead to epidemics. Yet in the brief period which had elapsed at the time of my arrival in Bucharest the Service had been reorganized, epidemics were under control, and already elaborate plans were perfected to cope with the great increase of tuberculosis which had come as an inevitable sequence of the war. Typhus, which gained such headway in certain of the Eastern European States, was never allowed to spread in Roumania to epidemic proportions. Under the guidance of the Public Health Service, pre-natal and infant welfare clinics were being established, and other educational and preventive measures installed. The emergency had called forth the best efforts of the trained Public Health workers who had survived the war, and enlisted the interest of a host of younger physicians who were giving unstintingly of their time and interest to promote the improvement of sanitary conditions throughout the country.

It is impossible to conclude this very superficial review of Roumanian medicine immediately after the war without a brief reference to Bucharest's marvelous Medico-Legal Museum and its famous Curator. In my experience its equal is not to be found in this country or elsewhere in Europe. Professor Minovici combines with profound medical knowledge an unsurpassed detective ability, and his collection of studies in criminology is well worth a trip to Roumania to see.

All that I have written has reference to Roumanian medicine at one of the darkest periods in her history. Her medicine of today is the peer of scientific medicine in other progressive countries of the world. Her medical journals, in complete abeyance at the time of which I have written, are today read in all medical centers of the world. I find abstracts of their leading articles in our own Journal of the American Medical Association written by men of international reputation in their specialties. Though it has not been my privilege to visit Roumania since 1919 it is my keen desire to do so, for I know that I should find there the full fruition of that remarkable rehabilitation the first steps of which I had the good fortune to assist.