May 22, 1903.] 



SCIENCE. 



809 



the undergraduates who are aspiring to the 

 degree; secondly, graduate physicians who 

 spend a certain amount of time in the hos- 

 pitals either as internes or as temporary 

 students refurbishing their professional 

 knowledge; and thirdly, experts in certain 

 branches of medicine and surgery. 



The imdergraduates are taught first in 

 the general clinics, where to some extent 

 they learn both by didactic instruction and 

 by seeing the patients, hearing their his- 

 tories and witnessing the institution of 

 proper treatment by prescription, by regi- 

 men, or if necessary, by surgical opera- 

 tion. This is of great value, particularly 

 in the more important cases, and espe- 

 cially, for I speak now as a surgeon, in 

 important operations. It is often objected 

 that students see nothing in large clinics. 

 To some extent this holds good; but no 

 student can look on at an operation when 

 the jugular vein or the lateral sinus is 

 torn, the pleural cavity opened, the bowel 

 lacerated, or other of the great emergen- 

 cies of surgery occur, and fail to be im- 

 pressed by the coolness of the operator, 

 the carefully explained methods adopted 

 for remedying the mischief, and the vari- 

 ous devices used to save life, all of which 

 hereafter will be used by him when similar 

 emergencies may occur. 



Yet far more important than the public 

 clinics are the smaller clinics held with 

 classes of ten to twenty men each, when 

 under an experienced teacher the absolute 

 work of the clinic is divided among the 

 various students in turn, watching the 

 pulse and the respiration, giving an an- 

 esthetic, assisting actively at operations, 

 percussing the chest, palpating the ab- 

 domen, determining inequalities of the 

 surface or the varying density of under- 

 lying organs. Here is the real forum in 

 which our modern medical student ac- 

 quires his skill. In many cases visits in 



the ward itself are made, and to a small 

 group around the bedside the physician 

 or surgeon will point out the phenomena 

 to be recorded, the need for the examina- 

 tion of the blood, the results of bacterio- 

 logical cultures, the facts discovered by 

 the microscope, or the chemical reagent. 

 By the Socratic method also, he will reveal 

 to the student the imperfection of his 

 knowledge, call out— e-ducate— his powers 

 of observation, of reasoning; stimiilate his 

 thought, and give him an impetus which 

 will last throughout life. Who that has 

 'walked the hospitals' with a Skoda, a 

 Trousseau, a Nelaton, a DaCosta or a 

 Mitchell can ever forget their teaching? 

 It is sometimes objected by those who 

 are not familiar with the actual facts, and 

 especially by trustees, that this method of 

 actual bedside instruction does harm to the 

 sick. I speak after an experience of 

 nearly forty years as a surgeon to a half 

 dozen hospitals and can confidently say 

 that I have never known a single patient 

 injured or his chances of recovery lessened 

 by such teaching. Of course, the physi- 

 cian or surgeon uses common sense. He 

 would not allow a number of men to pal- 

 pate the abdomen of a patient with peri- 

 tonitis, or move an acutely inflamed joint, 

 nor would the physician allow a patient 

 with pneumonia to have the chest unduly 

 exposed, or a typhoid fever patient dis- 

 turbed if his condition were such that it 

 would be inadvisable. But such cases are 

 the exception. In fact, many of you are 

 familiar with patients who have responded 

 to repeated percussion by members of such 

 a class by prompt recovery, attributed by 

 the patient to the supposed medication of 

 percussion. Moreover, it is by this actual 

 practice only that the student acquires the 

 necessary skill in the use of modern instru- 

 ments of precision, such as the stethoscope, 

 the laryngoscope, the esthesiometer, the 



