June 9, 1916] 



SCIENCE 



803 



roentgenograpliie studies; and (g) many 

 small rooms for special examinations with 

 instruments of precision (ophthalmoscope, 

 pharyngoscope, laryngoscope, esophagos- 

 eope, cystoscope, etc.), for members of the 

 staff, for advanced students (undergraduate 

 or graduate), for an artist, for photog- 

 raphy, for technical assistants, for clinical 

 records and for supplies. The institute 

 should also contain at least a small depart- 

 mental library for immediate reference; 

 though for books and journals not daily in 

 use the general library of the medical school 

 and hospital will suffice. 



THE INSTRUCTION AND EDUCATION OF THE 

 STUDENT IN THE METHODS OP CLIN- 

 ICAL DIAGNOSIS 



At the very beginning of the clinical 

 work, a few general lectures should be 

 given to the students offering a bird's-eye 

 view of the scope of the sciences of diagnosis 

 and therapy, explaining the relation of 

 these sciences to the student's earlier 

 studies, discussing the nature of the under- 

 graduate curriculum in clinical medicine, 

 and giving the reasons for the arrangement 

 of the courses in a certain sequence. The 

 first year of clinical work should consist al- 

 most entirely of a systematic education in 

 the methods of clinical examinaiion of the 

 normal and the diseased human being and 

 of substances derived from normal and 

 from diseased people. Some lectures and 

 demonstrations will be necessary properly 

 to coordinate this work and to determine its 

 being done intelligently, but the education 

 at this time wiU depend mainly on closely 

 supervised personal work of the student 

 in the study and practise of methods of his- 

 tory-taking and of physical and instru- 

 mental examinations of healthy people and 

 of dispensary patients, and in the labora- 

 tory study of materials derived from 

 healthy and diseased living persons. 



In teaching history-taking, the various 

 parts of the clinical history — anmnnesis, 

 status prcEsens, catamnesis, epicrisis — 

 should be systematically described, and each 

 student should be given opportunity for 

 personally questioning dispensary patients 

 and recording the anamnesis he obtains 

 from each. 



In teaching physical diagnosis, a funda- 

 mental course in the clinic, the physical 

 principles involved should be succinctly re- 

 viewed and the application of these prin- 

 ciples to diagnostic methods, especially to 

 auscultation and percussion, should be thor- 

 oughly described and illustrated by a 

 teacher of ability, one that has had a suffi- 

 cient training in the science of physics him- 

 self, and also an extended clinical experi- 

 ence. This course in physical diagnosis will 

 also be a course in medical applied anat- 

 omy ; it should be illustrated by models, by 

 dissected specimens and by sections of for- 

 malinized cadavers. The theoretical and 

 demonstrative side of this course in phys- 

 ical diagnosis should run parallel to a strict, 

 drilling of the student in the practical-tech- 

 nical details of the methods of physical ex- 

 amination, small groups of students carry- 

 ing out the several procedures themselves 

 on fellow students or on dispensary patients 

 (the latter perhaps paid a small sum) under 

 the eyes of young instructors who see to it 

 that skill in the technie is gradually ac- 

 quired. At this stage, too, a course in chem- 

 ical physiology, like that advised by Pro- 

 fessor Lee, will be of great advantage to the 

 student. Much time should be devoted to 

 these practical courses — enough to ensure 

 mastery of method and the confidence of 

 the student in the reports that his sense 

 organs make to him. 



The general course in clinical laboratory 

 work, properly given, is one of the most im- 

 portant courses given in the medical school. 

 It should consist of three half-day exercises 



