The Hospital Bulletin, Vol. V, No. 3, May 15, 1909Various
History
The Hospital Bulletin, Vol. V, No. 3, May 15, 1909
Various
Medical colleges -- Alumni and alumnae -- Maryland -- Baltimore -- Periodicals; Medicine -- Periodicals
general practitioner has not known enough of what was offered him when a
student to make a correct diagnosis. The red eye has been called
conjunctivitis and treated with nitrate of silver, in spite of the
absence of purulency, while the small, inactive pupil has escaped
notice. The ear pain has been called “earache” without an aural
examination, a hops bag and opium have been ordered, and the doctor has
gone home with that false sense of security which is so dangerous. Why?
If his teacher has known his business, it is not because he was not told
how to look for iritis and acute inflammation of the drum, but because
he had not given the subjects sufficient thought to get them drilled
into his thinking apparatus. Probably he could tell the diagnostic
points of iritis, if asked, or the signs of ear-drum inflammation; but
this was “crammed” information, not part of his real knowledge.
If it is the duty of the student, anticipating general practice, to
think about the specialties taught during his undergraduate course, it
is still more the duty of his teacher to present him only such things as
the general man needs. He will make a grievous blunder if he tries to
make specialists of his men. His selection of subjects should be limited
to the diseases which are of common occurrence, and stress should be
laid on _diagnosis_. If one knows, first, what to look for, and secondly
how to recognize signs and symptoms, he will generally find proper
treatment. Troubles which would lead the patient to go to the specialist
_primarily_, without consulting his family physician, should receive
little attention.
Two other classes of lesions in such organs as are usually handed over
to specialists should receive attention in the undergraduate
course—those which are apt to cause remote or reflex disturbances, and
those which are definitely symptomatic of central lesions. The first
should, in my judgment, be dwelt upon only to such an extent as to
enable the student to know causative relation and method of diagnosis.
Treatment, unless very simple and easily within the reach of the medical
man—i. e., the general practitioner—should be given little time. As to
the second class, every neurologist knows that Tabes Dorsalis would
often be diagnosed early, and proper treatment instituted, if the
physician had known the meaning of association of gastric crises with
Argyll-Robertson pupil, and had seen enough of these things to have them
in his every-day thoughts. One could present many other illustrations,
but this shows what is meant. With the student convinced of the
necessity of thinking about the specialty taught, the instructor careful
in selection of his subjects, a duty rests on those who fix the
curriculum.
Public-domain text, read in full here on John Shaqi.
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