University of Virginia Library

FOURTH YEAR.

Theory and Practice of Medicine.—The same plan is followed in the
clinical work as that already described for the third year, each of the
two sections of the class devoting itself for half the year to the medical

service in the wards of the hospital. Full histories are taken of every
case, thorough examinations made, and management indicated by the
students of each division. The records thus obtained are kept up by the
student assigned to the case, which he is expected to follow until its
discharge. The accuracy and completeness with which this is done constitutes
a large element in the determination of fitness for graduation.

The subjects treated with the approximate division of time between
them are as follows:

Nervous Diseases and Insanity.—Three lectures and recitations
weekly supplemented by clinical work during the fall term. In this
course is given also instruction in electro-therapeutics. Dr. Davis.

Pediatrics.—Three lectures and recitations weekly supplemented by
clinical work during the winter term. This course of lectures is intended
to point out in a brief way how disease is modified by childhood and to
indicate how the difficulties of diagnosis and treatment due to early age
may best be encountered. The principles of infant feeding are emphasized
and the student is taught how to prepare the food. Instruction in the
practical details of the subject is given by work at the Dispensary and
in the wards of the Hospital. Dr. Davis and Dr. Rea.

Dermatology.—A brief course of lectures is given on this subject
embodying a consideration of the commoner diseases met with in medical
practice. At the Dispensary two clinics a week throughout the year
are devoted to the diseases of the skin. The senior class is divided
into sections for the work in this branch. After a brief review of the
anatomic and histologic structure and of the physiology of the skin,
the diseases most commonly met with are discussed.

The clinical material available at the University Dispensary is
utilized to the best advantage to give the students a practical working
knowledge of the diagnosis and treatment of affections of the skin.
Dr. Davis and Dr. Rea.

Case Teaching, Medical Ethics and Economics, and Insurance
Examinations.—Two hours weekly during the spring term. Dr. Davis.

Therapeutics.—Two lectures weekly during the second half of the
year, with five hours weekly of ward rounds for one half the session.

The treatment of internal diseases is discussed in a systematic
course of lectures and practically demonstrated in the wards of the
Hospital. Especial attention is given to the clinical side of the teaching
of this subject, the student being required to suggest treatment
for cases assigned to him and to follow closely and make a record of
the results of the therapeutic agents employed throughout the course
of the disease.

The course includes a discussion of the preparation of food for the
sick; demonstrations of the preparation of stupes, plasters, and poultices;
and the methods of giving therapeutic baths, electrical treatment, massage,
and other therapeutic measures. Dr. Flippin.

Surgery and Gynecology.—Two hours weekly of surgical clinic
throughout the session; three hours weekly of ward classes, supplemented
by clinical work in the wards and operating room for one half the session
with each of the two sections of the class.

Instruction in Surgery is carried on by clinics and bedside demonstrations
in the hospital. In the wards the students are assigned cases,
whose histories they must take, make complete physical and clinical
examinations, urine analyses, blood examinations, etc. In the ward rounds
the diagnosis, operative and other treatment, post-operative care of the
cases, complications, prognosis, etc., are discussed in detail. A large
variety of cases is available, and the close contact of the students with
their cases and with the routine of hospital management offer many of the
opportunities that an internship affords.

In the operating rooms the students, in small groups, take part in
the operations, thus acquiring familiarity with technique, anesthetization,
etc. Those of the class who are not assisting, witness the operations, whose
important features are demonstrated to them.

In gynecology the students have the same general work as in surgery,
consisting of the examination and recording of cases in the public wards,
attendance on ward rounds, at which the cases are discussed, and observation
and assistance in the operating rooms. Dr. Watts and Dr. Goodwin.

In addition to the above course, required of all students, the following
elective course is offered in the Department of Surgery.

Surgical Pathology.—Two hours weekly during one half of the year.
The work in this course comprises lectures upon the pathology of surgical
lesions, with especial emphasis upon the clinical diagnosis of tumors and
inflammations, the examination of microscopic sections, and the study
of fresh tissues in the gross, obtained from the operating room. The
purpose of the course is to supplement the general courses in pathology
and surgery, and to acquaint the student with the appearance of fresh
pathological material from surgical cases. Dr. Goodwin.

Obstetrics.—The student attends, under the guidance of an instructor,
the labour cases in the Hospital, is required to prepare the history of
patients, and to follow up the cases through the puerperium. Instruction
is also given in the care of the new born. In addition the student has
the opportunity of attending patients in the outpatient department and
each student is expected to attend at least four cases of labour. Dr.
Macon.

Forensic Medicine.—One lecture weekly during the first term of the
fourth year. Dr. Lambeth.

Diseases of the Eye, Ear, Nose, and Throat.—Two lectures weekly
from the beginning of the session to the first of March, supplemented by
regular clinics twice weekly throughout the year and clinical lectures
to sections of the class as suitable cases occur.

No attempt is made to train specialists, but every effort is made
to render the class familiar with such common diseases of the eye, ear,
nose, and throat as the general practitioner meets in his daily work.
To this end the class is divided into small sections and each student is
taught the methods of examination and the use of the ophthalmoscope,
head-mirror, and of the laryngeal and post-nasal mirrors. In the clinics
each patient is assigned to a student who must take the history and
keep the record of that patient; the case is then demonstrated by the
professor in charge, and, if possible, each student makes his own examination
under the personal supervision of the attending physician. Clinical
cases are abundant, and during the year the student sees and handles
practically all the common diseases of the eye, ear, and upper respiratory
tract.

At the operations in the Hospital only as many students are allowed
to be present as can really see and appreciate what is being done.

Valuable work is also given in the dissecting room, where the technic
of operative work is shown in a way that cannot be employed with the
living patient. Students do this work as far as possible for themselves,
especially in tracheotomy and intubation of the larynx.

Finally the attempt is made so to ground the student in the anatomy,
physiology, general pathology, and in methods of examination and treatment
that he may diagnose and treat intelligently many of the cases that
cannot afford to go to a perhaps distant specialist; that he may treat
successfully that large class of emergency cases that first come to the
general practitioner and in which immediate treatment is imperative; and,
lastly, that he may recognize and intelligently refer those cases that
need the services of one specially trained to this branch of work. Dr.
Hedges and Dr. Compton.

Hygiene.—Three hours weekly throughout the year.

The course begins with a historical sketch of the development of
preventive medicine, including short biographical sketches of the pioneers
of Hygiene. With this introduction the story of the natural history
of contagious and infectious diseases, modes of propagation and methods
of prevention engage the attention of the student. With this preparation,
the chemical and bacteriological contamination of food, water, air, and soil
is made an important study. Instruction is also begun in the proper location

and construction of habitation, hospitals, schoolhouses, etc., with
special reference to the modern methods of heating, ventilating, and draining.
Notice is taken of the special relations involved in military and naval
hygiene. Dr. Lambeth.