will be excellent which brings the student into close and active relation with the patient: close, by removing all hindrance to immediate investigation; active, in the sense, not merely of offering opportunities, but of imposing responsibilities.
Clinical teaching has had substantially the same history as anatomical teaching. It was first didactic: the student was told what he would find and what he should do when he found it.[1] It was next demonstrative: things were pointed out in the amphitheater or the wards, those who got the front seats[2] seeing them more or less well. Latterly it has become scientific: the student brings his own faculties into play at close range,-gathering his own data, making his own construction, proposing his own course, and taking the consequences when the instructor who has worked through exactly the same process calls him to account: the instructor, no longer a fountain pouring forth a full stream of knowledge, nor a showman exhibiting marvelous sights, but by turns an aid or an antagonist in a strenuous contest with disease.
The backbone of the structure is the clinic in internal medicine.[3] This central fact cannot in America be too strongly emphasized. The sufficiency of the school's clinical resources depends at bottom on its medical clinic; the value of its training depends on the systematic thoroughness with which it is in position to use an adequate supply of medical cases. To sample a school on its clinical side, one makes in the first place straight for its medical clinic, seeking to learn the number of patients available for teaching, the variety of conditions which they illustrate, and the hospital regu-
- ↑ The reader must not suppose, however, that this method of teaching or practising medicine is extinct. The following is quoted from the Chicago Night University Bulletin, vol. iii., no. 24, p. 169:
"A young married man, wife and babe recently returned from Arkansas. They were all loaded with so-called malaria. . . . The old mother came in to tell me of the cases and get some 'chill medicine.' She said they were all chilling three times a day.... I sent the little tot ipecac 1M. She said the mother chilled every morning about ten o'clock, and that during the chill she had a very severe cough which hurt her right side.... I sent the mother bryonia 200. She said the husband and father chilled at various times. Great thirst during fever, severe cough before and during the chill, with drenching sweat following the fever. I sent him rhus tox, 75M. The prescriptions proved to be rifleshots for the mother and babe, for they never chilled again; but only a glancing shot for the husband. He missed his chill for a few days, when it returned with new symptoms and more severe and with which no medicine seemed to correspond. I saw him then personally. Found he still had cough during chill, but not before; that he wanted to be covered during fever just the same as during the chill, like nux v. and rhus t.; he had other symptoms which ruled these out. After searching several hours with repertory in hand, I decided that this was a mixed case and agreed with no medicine in the book. Hence, following Hahnemann's advice, I gave him cinchona (1M) to clear up his case. After twenty-four hours he chilled again. This time the most peculiar thing noticed was that he was very thirsty during the chill, but in no other stage. He drank large quantities, but during the heat and sweat, not a drop. Also that during the chill the coldness was relieved by the heat of a hot stove. He wanted to get near the hot stove. Remembering ... that for a chill with thirst for large drinks of cold water, and no thirst in any other stage, ignatia stands alone, I gave him ignatia IM. to be taken every two hours until he missed his chill — then to be discontinued. Well, he missed the next chill and also every one which has been due him from that day to this." - ↑ This method, too, survives in both medical and surgical clinics. It is in process of abandonment in medical teaching, just as rapidly as proper arrangements for ward and bedside work can be made. But it is still favored by surgeons, despite its very slight practical value.
- ↑ "For clinical studies proper, internal medicine forms the center at German universities. Medical education there follows the principle that medicine is a scientific whole; ... all its varied disciplines must play upon each other; and from this point of view internal medicine is regarded as the mother of all other clinical divisions.” W. Lexis, Das Unterrichtswesen im Deutschen Reich, vol. i. pp. 138, 139 (Berlin, 1904).
