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 the 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.
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 Exam-
inations.—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, electric 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, 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.

Clinical Pathological Conferences.—One hour weekly is assigned for
the study of pathologic material in connection with the clinical aspects of
cases coming to autopsy. A history of the case is presented by the student
in charge, the autopsy is reviewed, the tissue and microscopic sections are
examined, and all the information thus derived is collated and contrasted.
Dr. Marshall.

Obstetrics.—The student attends, under the guidance of an instructor,
the labor 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 out-patient department and each student
is expected to attend at least six cases of labor. Dr. Macon.

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

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 can not 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
can not 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 especially 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.