804 



SCIENCE 



[N. S. Vol. XLIII. No. 1119 



in the laboratory, extending over a period 

 of at least six months. "With judicious 

 selection, a large amount of ground can be 

 thoroughly covered, each student learning 

 and practising the best methods of the time 

 for the physical, chemical and microscopic 

 study of the urine, the gastric contents, the 

 duodenal contents, the feces, the sputum, 

 the blood and the fluids obtained by ex- 

 ploratory puncture. Many of the methods 

 need only be done once, but certain of them 

 should be practised under control until the 

 student satisfies himself and his instructors 

 that he has acquired skill and accuracy 

 enough in the technic to permit him to par- 

 ticipate, in his last year, in the actual in- 

 vestigation of patients, with recording of 

 his results in the official records of the 

 hospital. This extra practise will be espe- 

 cially necessary in quantitative chemical 

 examinations of urine and stomach eon- 

 tents, in blood counting and hemoglobin- 

 determinations, in differential counting of 

 white blood cells in stained smears, in ex- 

 aminations of cerebrospinal fluid, and in 

 agglutination and complement-fixation 

 tests. 



During this first year of clinical work, 

 the student should also acquire the technic 

 of a whole series of special and instrumental 

 methods of examination. Hitherto, stu- 

 dents have too often been led to think that 

 these special methods are beyond the scope 

 of the work of the general practitioner, that 

 there is something mysterious about them, 

 and that the technic of their use is the pre- 

 rogative of specialists upon whose rights 

 and privileges the general student of medi- 

 cine dare not encroach. Now, I am con- 

 vinced that this is a great mistake. I think 

 it exceedingly important that the minds of 

 students and of general internists should 

 be disabused of this fallacy. Most of the 

 methods are very easy to learn and apply, 

 and these every student should actually 

 learn and practise. 



The mystery should be taken away from 

 all these methods. Even if, later on, as a 

 practitioner, he evoke the aid of specialists 

 in his work, the student will find that the 

 training he has had in the methods of the 

 medical specialists, giving him an acquaint- 

 ance with these means of diagnosis and the 

 power to interpret their applications, will 

 place him distinctly at an advantage over 

 practitioners whose schooling has not in- 

 cluded training in such technic. Thus, in 

 my opinion, every student should at this 

 period of his growth become acquainted 

 with Roentgen-ray apparatus and the tech- 

 nic of roentgenoscopy and roentgenography 

 as applied to the study of different parts of 

 the body. In the clinical, bacteriologic and 

 immunologic laboratories he should learn 

 the clinical applications of bacteriologic 

 methods (collection of materials; diagnostic 

 examinations by microscopic and cultural 

 methods, or by animal inoculations and vir- 

 ulence tests), and the application to the 

 clinic of the doctrines and technic of im- 

 munology (clinical studies of agglutinins, 

 bacteriolysins, hemolysins, precipitins, op- 

 sonins and ergins), with especial emphasis 

 on, say, the Widal reaction, the "Wasser- 

 mann reaction, the Schick reaction and the 

 tuberculin tests. Next might come training 

 in special methods of studying the respira- 

 tory apparatus (rhinoscopy, pharyngo- 

 scopy, transillumination of the paranasal 

 sinuses, laryngoscopj^', a demonstration of 

 the use of the bronchoscope and of explora- 

 tory puncture of the pleural cavity) ; such 

 studies, supplementing the course in gen- 

 eral physical diagnosis of the lungs and 

 pleurffi, the course in the examination of 

 the sputum, and the course in roentgenol- 

 ogy of the thorax, bronchi, lungs, pleura 

 and diaphragm, will be the best possible 

 preparation for the investigation of the 

 special diseases of the respiratory system 

 to follow in the last year of the student's 

 course. Similarly, the special methods 



