806 



SCIENCE 



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



dents may visit; there they should see 

 typical normal and pathologic roentgeno- 

 logic findings serially displayed ; moreover, 

 a few systematic demonstrations of these 

 should be made by the roentgenologist to 

 the class, so that every student may become 

 familiar with the roentgenographic ap- 

 pearances of conditions like idiopathic di- 

 latation of the esophagus, filling defects 

 due to ulcer or carcinoma of the stomach 

 and duodenum, intestinal stasis, kinks, ad- 

 hesions and other forms of intestinal ob- 

 struction, diverticula of the sigmoid, etc., 

 and will know how to make use of the 

 Roentgen-ray method for recognizing 

 them. 



The special methods of studying the pan- 

 creatic functions by examination of the 

 duodenal contents (obtained by the duo- 

 denal piunp), the feces, and the urine, will 

 require but little time ; the same applies to 

 the special methods of examining the liver 

 and the biliary passages and their func- 

 tions. Instruction in digital exploration of 

 the rectum and demonstrations of proctos- 

 copy and of rectosigmoidoscopy should 

 form a part of the course. 



As regards the urogenital system, its ex- 

 amination dare not be omitted in the teach- 

 ing of clinical medicine. This part of the 

 body should be as sj'stematically examined 

 as is every other part, for otherwise condi- 

 tions of great importance for the general 

 medical diagnosis frequently will be over- 

 looked. It may be desirable, however, for 

 obvious reasons, to have certain parts of 

 urogenital methodology taught in the surg- 

 ical and gynecologic clinics. The teaching 

 of methods of examining the urine, of 

 physical and roentgenologic methods of ex- 

 amination of the kidneys, and of methods 

 of testing the capacity of the kidneys to ex- 

 crete certain substances, belong in the med- 

 ical clinic ; and if, for any reason, the other 

 clinics do not demonstrate urethroscopy. 



cystoscopy, ureteral catheterization, pyelog- 

 raphy, etc., the medical clinic would have 

 to provide for this teaching. 



As to the special methods of examination 

 of the bones, muscles and joints, only brief 

 instruction will be necessary in the medical 

 clinic, since by custom those methods are 

 usually very extensively taught in the 

 surgical clinic, especially in its orthopedic 

 subdivision. For a rounded view of clin- 

 ical medicine, however, some attention to 

 them is necessary in the medical clinic 

 where examinations for pain, limitations 

 of movement, Roentgen-ray examination, 

 trichinse in muscles, etc., may often have to 

 be made. The examination of the skeleton 

 is often very important for the internist as 

 throwing light on the metabolic functions 

 and especially on the functions of the endo- 

 crine glands. I shall not be surprised if, 

 later on, all the patients entering a general 

 hospital, except those of surgical emer- 

 gency, will first be sent to the medical 

 clinic for thorough diagnostic study, before 

 being distributed to the surgical, gyneco- 

 logic, urogenital or other special clinics for 

 therapy should the diagnostic study re- 

 veal that the patient requires surgical 

 treatment. 



The teaching of neurologic and psycho- 

 logic methods of examination should occupy 

 enough time to enable the students to ac- 

 quire competence in at least the main pro- 

 cedures of clinical medical inquiry. It is 

 best to divide this work into three parts, 

 the first part dealing with the methods of 

 accumulating neurologic and psychologic 

 data from the patient, the second part deal- 

 ing with the utilization of the accumulated 

 data for deciding on the site of any lesions 

 or of any abnormal processes present in the 

 nervous system (topical diagnosis), and the 

 third part dealing with the considerations 

 that permit the drawing of inferences re- 

 garding the nature of the lesions or of the 



