June 9, 1916] 



SCIENCE 



805 



usefiil in investigating conditions in the 

 circulatory apparatus may now be rapidly 

 acquired. 



It is not as though we were educating 

 raw high-school graduates; the students 

 that are arriving in the clinics now are ac- 

 customed to the use of instruments of pre- 

 cision of various sorts, and are familiar 

 with the general mechanical, optic, acous- 

 tic and electrical principles underlying 

 them; they can, therefore, acquire much 

 more rapidly an acquaintance with and 

 skill in the use of clinical instruments and 

 graphic methods of registration than would 

 be possible for students untrained in the 

 natural sciences. Roentgenoscopy of the 

 cardiovascular stripe, so helpful for ex- 

 amining the configuration of the heart and 

 in the recognition of aortic dilatations, will 

 present no difficulties to our clinical stu- 

 dent, and he will be fascinated by the sim- 

 plicity and precision of teleroentgenog- 

 raphy, which has largely replaced ortho- 

 diagraphy and which serves as a salutary 

 control of the results obtained on percus- 

 sion of the relative cardiac dullness. 



Even the precise methods of mechanical 

 registration of the movements of the heart 

 and blood vessels (sphygmography, cardi- 

 ography), of the heart sounds (phono- 

 cardiography), of the electrical curi'ents 

 generated in the heart during its activity 

 (electrocardiography), and of the pressure 

 of the blood within the arteries and veins 

 (sphygmomanometry or tonometry of the 

 blood vessels) can be speedilj^ acquired, for 

 the student has already had at least a 

 glimpse of them in the laboratory of physi- 

 ology. Though as yet we do not know how 

 to value the results clinically as well as we 

 should like, the methods that have been de- 

 vised for determining the functional ca- 

 pacity of the heart should also be demon- 

 strated. The student thus trained at the 

 beginning of his clinical angiological stud- 



ies, in addition to training in the ordinary 

 physical methods, should have no difficulty 

 in his later studies in accumulating the 

 data necessary for forming a diagnosis 

 when confronted by a cardiac arrhythmia, 

 an inflammatory or a degenerative cardiop- 

 athy, or a hypertensive arterial malady. 



Turning to the special methods useful in 

 investigating the digestive system, the stu- 

 dent has a considerable technic to acquire 

 in addition to the ordinary physical meth- 

 ods of examination of the viscera, and the 

 laboratory studies of the secretions and ex- 

 cretions. Thus, instruction should be given 

 in the methods of examining the teeth and 

 gums, preferably by a dentist attached to 

 the clinic. Dental caries, paradental infec- 

 tions with formation of blind abscesses at 

 the roots of teeth, and pyorrhea alveolaris 

 are now so important, not only for them- 

 selves, but also in their bearings on disease 

 elsewhere in the body that students dare not 

 be permitted to leave the medical school 

 without knowing how they may be recog- 

 nized by inspection, by percussion, and by 

 special roentgenograms on dental films, so 

 that dental aid may, when required, be ob- 

 tained. Then the newer technic of examin- 

 ing the esophagus should be demonstrated, 

 though it may not be possible to give the 

 undergraduate student actual practise in 

 the passage of esophageal bougies, in roent- 

 genology of the esophagus or in esophagos- 

 copy. The physical exploration of the ab- 

 dominal viscera will be taught in the gen- 

 eral course on physical diagnosis. 



Actual practise in gastric intubation of 

 the fasting stomach and of the stomach 

 after a test diet, and actual experience in 

 roentgenoscopy and roentgenography of 

 the stomach and intestines after a contrast- 

 meal and a contrast enema, should now, in 

 my opinion, be required of all students. 

 The roentgenologist of the clinic should 

 have a large demonstration room that stu- 



