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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 disease met with in
medical practice. 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 fall and winter
terms, 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 beside 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, postoperative
care of the cases, complication, 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 the 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 six cases of labour. Dr. Macon.

Forensic Medicine.—One lecture weekly during one term of the
fourth year.

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
habitations, 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.