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and physical signs are demonstrated to all the members of the class, and examinations of urine, sputum, gastric contents, and blood are made, when called for, by the student, under the supervision of the instructors. It is the especial aim in these clinics to familiarize the student with all methods and instruments of diagnostic examination, and the instruction is made as personal as possible. Cases which need to seen at home are put in charge of the senior students, and obstetrical cases are assigned to them. In such cases the professor of clinical medicine or his assistants give counsel whenever called on. At the hospital one medical clinic is held each week; these are general medical clinics, but particular attention is given to the demonstration of the various signs of importance in physical diagnosis. Opportunity is also here provided for the study of those severer cases which the dispensary service does not furnish, and care is taken to have the students see the same patient in various stages of his disease, and, in fatal cases, to demonstrate the lesions."
The clinical out-practice," referred to in the above quotation, illustrates the usage of other schools. At the Jefferson Medical College the professor of practice will, during his clinical term, devote a number of hours to clinical conferences. During these the advanced student will have a case assigned him, which he will be required, with the aid of the chief clinical assistant, to examine beforehand, and which then, with remarks on the diagnosis, prognosis, and treatment, he will present to the class. The Bennett Medical School, of Chicago, goes further. Students in the senior year, by assignment, will be given the care of out-patients from the clinic, thus giving the experience in actual bedside practice, in such cases as fevers, rheumatism, treatment after surgical operations, obstetrical cases, etc.
But it is in the dispensary that this "out" instruction is most frequently given. At the Chicago Medical School of the Northwestern University, for instance, the members of the clinical class may serve as assistants to the physicians and surgeons of the several departments of the dispensary, and to the pharmacist of the dispensary, and receive certificates of such service. Members of the attending staff and the dispensary pharmacist appoint their own assistants, and the term of service is six weeks. At the Kansas City Medical College every member of the senior class served a period of two months in each of the departments of the dispensary during the sessions of 1889-'90.
To illustrate the order of clinical exercises, the following programmes are given:
Roster of hospital practice and laboratories for the third-year students of the Jefferson
SESSION OF 1891-92.
[The class is divided into eleven sections, A to K, inclusive, serving as follows, in periods of two weeks each, the dates being included.]
2 Eye clinic.... Medical clinic, Sept., Oct., Nov., Dec.; children's clinic. after Jan. 1.
11 Juniors, micro
9 to 10.
2 to 3.
3 to 4..
Bellevue Hospital Medical College.
ORDER OF LECTURES-REGULAR SESSION, 1890-1891.
4 Demonstrations of surgical dressings, Dr. Silver.
1.30 to 2.30.
2 to 3..
3 to 4..
2 to 3......
2 to 4..
4 to 5.
Surgical Section teach- Gynecologi-
Surgical Medical Medical Surgical
Schedule of hospital and college clinics for students of second and third years of the Chicago Medical College of the Northwestern University.
ST. LUKE'S HOSPITAL.
Wednesday. Thursday. Friday.
Oral surgery Eye and ear.
Medical clinic and exercises in diagnosis.
Dermatology Diseases of Gynecology. Eye and ear. Laryngol children.
ogy, rhinol ogy.
Schedule of hospital and college clinics for students of second and third years of the Chicago Medical College of the Northwestern University-Continued.
2 to 3.....
9 a. m.
11 a. m.
Eye and ear.
2 to 3 p. m..
4 p. m. Dispensary clinic..
Eye and ear.
8 to 9 a. m. Venereal
4 to 5 p. m.. Surgical
Hospital and dispensary clinics of the medical department of the University of Cali
Eye and ear.
Eye and ear.
children. Nervous diseases.
Examination of the patient by student, etc.
. Clinical surgery.
Especial attention is given, in a ward devoted to the purpose, to the conduct of dis-
Eye and ear clinic twice a week.
College and hospital clinics of the Kentucky School of Medicine at Louisville.
Diseases of Diseases of
Eye and ear.
chest. Gynecological. Eye and ear. Diseases of children.
eases. Skin dis
Outdoor children's department,
Medical Diseases of
The clinics of the New York Homeopathic Medical College and Hospital.
Therapeutics. j Dermatology,
The most noteworthy innovation of the decade has not been the lengthening of the course of instruction, many years ago recognized as too short, not the better and completer organization of the clinic, which in a great part no longer renders the "study under a physician " indispensable, but the introduction of laboratory work in chemistry, physiology, and especially in normal and pathological histology or, more generally, biology. Perhaps the introduction of laboratory work has played a great part in lengthening the course of medical instruc
tion, as it certainly has given it status as a course in science. It is certainly so in the case of the Medical School of the University of Michigan, for its faculty states explicitly that the extension of the course from three to four years" is largely due to the need for the more through instruction in laboratory work," for the student who spends but "three years in attendance upon lectures and one year of study with a preceptor can not reap the advantage of the full course of laboratory instruction.""
Laboratory instruction as given in the American colleges of medicine may, in view of the laboratories in which it is given, be classed under six heads, to wit: 1. Dissection or "Practical Anatomy."
2. Chemical manipulation (general and analytic).
Dissection has already been spoken of; normal histology will be spoken of further on; while other than noting that it affords each student the opportunity to go through a course of chemical experiments, the instruction of the chemical laboratory calls for no special mention except as to that form which at the Yale Medical School is called the course in physiological and medical chemistry.
This course consists of recitations and a practical laboratory study of the composition and reactions of the various animal tissues and fluids, the processes of metabolism and digestion, and the action of ferments. Due attention is paid to the composition of foods, the physiological use of the digestive preparations, and other matters of medical interest, especially to the recent analytical methods employed in clinical work. The study of normal urine is supplemented by abundant practice in the chemical and microscopical examination of pathological specimens. At the Jefferson Medical College, the same tendency towards the pathological side is shown in the instruction in its laboratory of practical chemistry. The student there examines the normal and abnormal products of the human body as aiding diagnosis, and studies practically the "morbid chemistry of the bile and blood" and the most approved methods of examining urine. At the University of Michigan there are two courses, one in qualitative chemistry and the other in urinalysis as applied to chemical uses and physiological study; but, in addition to them and at the option of the student, two other courses are offered, one in physiological chemistry and the other in pathological chemistry. The first of these optional courses deals with the analysis of the solid and fluid parts of the body, the other embraces courses in qualitative and quantitative analysis and the examination of foods and of the tissues and fluids of poisoned animals. One might venture to call this specialization of chemistry diagnostic chemistry. Toxocologic chemistry also appears as a department of the chemical laboratory, but sometimes is connected with medical jurisprodence. The physiological laboratory, of which there are very few in the country, is to the medical school what the mechanical or testing laboratory is to the college of technology, and in some schools (which care to mention the fact) what the biological laboratory is to the vivisectionist. The instruments with which such a laboratory is fitted up and the use made of them may be illustrated by the laboratory of the Jefferson Medical College. The teaching of this college in its course of experimental physiology embraces the demonstration of the essential phenomena of digestion, absorption, circulation, respiration, excretion, the functions of the nervous system, including the special senses, the reproductive apparatus, and development of the embryo. For these demonstrations, as well as for original research, the laboratory is equipped with the following apparatus. For the study of
Digestion and absorption.-Chemical appliances for the investigation of the properties of the albuminous bodies, the chemistry of the tissues, the composition of the digestive fluids, blood, etc., instruments for making gastric and intestinal fistulæ, water baths, and dialysers, and apparatus for recording rate of secretion.
This school, with great propriety, classes dissections as laboratory work. Other schools, seemingly with less propriety, also class the witnessing an autopsy as laboratory work, considering it as a part of the work of the pathological laboratory. It would be scarcely permissible to call a "didactic" lecture on chemistry, illustrated by experiments, a laboratory exercise. In both the autopsy and the chemical lecture the student is a spectator and listener, not an active agent. At Harvard, however, and at the Bellevue College, the student is called upon by turns to make an autopsy.
Circulation.-Czermack's holders; kymographion clockwork motor; Foucault'; regulator and three recording cylinders, including those for continuous tracess mercurial manometers; Bernard's differential manometers; Brindley's and Sanderson's cardiographs, cardiophone with telephonic attachment, Haldat's and other apparatus for demonstrating hydrostatic phenomena; Marey's simple cardiograph and sphygmograph with Sanderson's modification; Marey's apparatus of rigid, elastic, and vertical tube; arterial schema; Hawksley's vascular schema; Majendie's cardiometer; Fick's spring kymograph; Marey's cardiac clamp; Coat's apparatus with Brubaker's modification; Franck's double myograph; Marey's cardiac sounds for horse, apparatus for retardation of pulse, cardiograph for small animals, Ludwig's stronmuhr, and apparatus for studying capillary circulation, the warm and electrical stages, gas chambers, Gower's apparatus for counting blood corpuscles, also a hemoglobinometer.
Respiration.-The Pettenkofer-Voit respiration apparatus; Regnault and Reiset's respiration apparatus; Ludwig's respiration apparatus; Valentin's respiration apparatus; Hutchinson's spirometer; recording stethometer; Marey's pneumograph; Bamberger's apparatus; Rosenthal's apparatus with Brubaker's modification; aerotonometer; Gréhant-Alverguiat gas pump; apparatus for artificial respiration, with water motor; anemometer scales turning the beam at the of a grain, and standard barometer; Calliburce's instrument for vibratile cilia.
Calorimetry. Thomson's and D'Arsonval's calorimeters; thermometers, etc. Secretion.-Roy's kidney onkometer and onkograph. Apparatus for determining rate and amount of urea.
Nervous system.-Du Bois-Reymond's indication apparatus with Helmholtz's modification; spring myograph; muscle telegraph, nonpolarizable electrodes, diverting chambers, key, rheocord, round compensator, resistance box, whippe; commutator; moist chambers; Wiedemann's galvanometer, including telescope and scale; Thomson's Elliott galvanometer, including shunt, scale, lamp, etc.; Bunsen and Daniel batteries; Page's vibrator; metronome; chronograph; tuning forks, marking keys; Bernstein's differential herotome; Helmholtz electro-magnetic rotator and myophone with telephonic attachments and pendulum myograph; Pflüger's myograph; Gréhant's chariot with clockwork motor Brubaker's apparatus for electrotonus; apparatus for reflex movements, and Ludwig's section-cutter for spinal cord.
Vision, voice, and hearing.-Models of eye; Kuhne's artificial eye; Helmholtz's ophthalmometer; models of larnyx and ear; acoustical apparatus, including air pump and bell; Helmholtz's siren; acoustic bellows; sonometer; rods, membranes, plates, pipes, resonators, oboe vox humana; Koeing's manometric apparatus.
Embryology.-An incubator, capable of holding one hundred eggs for the study of development, and numerous microscopic sections.
Comparative physiology.-This collection, embracing several hundred specimens, many of which are extremely rare, illustrates the comparative physiology of the teeth, stomach, etc., of the circulatory, respiratory and genito-urinary organs, of the nervous system, and of the successive stages in the development of the human embryo. The collection is used in supplementing the experimental demonstrations.
Arrangements have been made through which the laboratory can be also supplied from time to time, as required, with living fresh-water and marine objects for biological study, as well as ample material for dissection.
The physiological and histological department has been especially arranged with reference to the wants of the members of the attending class, the laboratory demonstrations constituting a part of the regular instruction during the winter session.
At the Loomis laboratory of the University of the City of New York, in addition to the recording and other instruments used by physiologists, the labora tory contains a large tank for administering to animals air or oxygen, compressed under many atmospheres of pressure; an air pump for experiments upon animals with rarefied air; hot-air chambers for the study of the effects of external heat on body temperature; large automatic models of the heart and spinal cord and of the mechanism of gland secretion, urine secretion, and micturition.
At the University of Michigan medical school the subjects commonly embraced in the practical course relate to the physiology of the special senses, muscular contraction, nerve, reflex action, circulation, and respiration. A smaller room is devoted to advanced work and original investigation. Conveniently situated are an apparatus room, a dark chamber for optical experiments, an incubation closet, and a large workshop containing machinists' and carpenters' appliances.