On the days alternating with the microscopical studies demonstrations of gross pathological specimens are given to students of the third year, on the material collected from the autopsies. With the viscera of each case are presented an epitome of the clinical history, and, as far as possible, frozen sections of the organs, and the attempt is made to explain the course of the disease and the clinical symptoms from the gross and microscopical changes in the altered tissues. It is expected that the student will see the viscera of many of the fatal cases which he has studied in the wards of the hospital.

Gross pathological diagnosis is also taught as a separate branch of the subject, not bearing directly on the clinical aspect of the case. These demonstrations with recitations occupy six hours each week, each section of the class attending one quarter of the year. An examination is held at the close of the course.

Post-mortem Examinations. Students of the fourth year are required to perform autopsies under the direction of the instructor when they receive instruction in the technical procedures required in ordinary and in medico-legal cases.

In the weekly recitations of the fourth year due attention is paid to the review of the work in gross pathology.

Bacteriology.

Bacteriology is taught as a branch of biology to students of the second year. After instruction in the principles of disinfection, the student is required to prepare the ordinary culture media. The work then proceeds to the methods of staining and examining bacteria; their artificial cultivation and the study of biological character; the methods employed in the separation of species; the general relation of pathogenic bacteria to disease; and concludes with the biological analysis of air, water, soil and milk. The course occupies six hours each week for one quarter of the year.

During the exercises in gross and microscopical pathology the student is required to make cultivations from the viscera in various infectious diseases and to observe the biological charaeters of the more important pathogenic micro-organisms. This work is supplemented, where necessary. by the use of pure cultures, by the exhibition of aërobic cultures, and, to a limited extent, by animal inoculation.

Advanced Courses..-The abundant facilities of the Loomis Laboratory are open for the use of a limited number of properly qualified students or practitioners of medicine to pursue advanced courses of study, or original research, under the direction of the Department.

Medicine.

The Course of Medicine, extending over three years, is so graded that the student pursues a logical sequence of work throughout. No didactic lectures upon Practice of Medicine are delivered, their place being wholly taken by bedside instruction and recitations. The complete course comprises the following subdivisions (the roman numerals indicate the years of the course in medicine, not those of the curriculum):

I. Recitations from an elementary text-book.

Normal Physical Signs of the Chest.

II. Recitations from an advanced text-book, including written reviews.

III.

Abnormal Physical Signs of the Heart and Lungs.

Bedside History-taking.

Bedside course in Symptomatology.

Clinical Microscopy.

Bedside course in General Medical Diagnosis.

Ten lectures on Symptomatology.

General Hospital Medical Clinics.

Advanced bedside course in Symptomatology and Diagnosis.
Demonstrations of patients by the student before the class.

Courses in the Out-Patient Clinic in the Heart and Lungs and
General Medicine Classes.

General Hospital Medical Clinics.

Medical Conferences.

Elective advanced work in Clinical Diagnosis (Clinical Microscopy, History-recording, etc.).

Review quizzes for State Board examinations.

The details of the methods of instruction in medicine for each year of the curriculum are as follows:

I. SECOND-YEAR STUDENTS.

Recitations.-Second-year students begin the study of medicine with systematic recitations from an elementary text-book, in which the subjects of nomenclature, etiology, morbid anatomy and typical symptoms only are dwelt upon.

Physical Diagnosis.-Normal physical diagnosis of the chest is taught to sections of ten students each in Out-Patient Classes from the dispensary under Dr. Bayard. Each student is required to map out upon the patient the normal positions and sounds of the thoracic viscera, and toward the end of each course of ten lessons a few abnormal cases are introduced for comparison.

II. THIRD-YEAR STUDENTS.

Recitations.-Third-year students recite twice a week from an advanced text-book on Practice, special emphasis being given to symptomatology, complications, diagnosis and treatment.

Written reviews are held at intervals to familiarize the student with examinations. All recitations are obligatory and the recitation marks received form an important component of the final examination marks of the year.

Ward Work.-Systematic and obligatory ward work is begun in classes not exceeding fifteen students each, who accompany the Professor of Medicine on routine rounds through the hospital wards. Professor Thompson instructs at the Presbyterian Hospital until January, and at Bellevue thereafter throughout the year. Repeated illustrations of all the common diseases are studied, and the advantage to the student of personally examining dozens of cases of such diseases as typhoid fever, pneumonia, nephritis, cardiac ailments, etc., in different stages of development, and of following their daily progress, far outweighs the antiquated system of attendance upon didactic lectures. The student is first taught to observe and describe symptoms and investigate etiology, and as he attains proficiency is required to make diagnoses, offer prognoses and suggest treatment. At the ward clinic such medical operations are shown as lavage, inflation of the stomach for diagnosis, aspiration for pleurisy and ascites, etc.

General Diagnosis.-Dr. Coleman gives a special course in General Medical Diagnosis, in which at one lesson the student is required to examine, compare and report upon each variety of pulse found in the ward; at another upon each variety of cachexia, anæmia or œdema; at another, upon each variety of abnormal liver or spleen; and so on, comprising all the important physical examinations.

Medical Conferences.-Under Dr. Coleman's direction, also, students are assigned to special cases which they study in detail for several weeks, reviewing the literature of the subject, and then they report in writing at a medical conference, at which their fellow students are called upon to offer criticisms and general discussion.

Clinical Laboratory Courses are conducted under Dr. Camac's supervision, in immediate connection with the study of hospital and dispensary cases. In this laboratory the student acquires methods and technique which he is required to put in practice with patients. The laboratory is also used extensively by the visiting staffs of the Hospital and Out-Patient Clinic for completing the data of their cases. The students are divided into small sections, so that each member

of the class receives the personal assistance of the demonstrator. At the conclusion of the course, a written examination is held, upon the result of which, as well as upon the character of the work done, each successful student is given a certificate to the effect that he has completed the course. Upon the presentation of this certificate to the demonstrator in charge, the student is allowed the use of the laboratory and its apparatus for the study of cases in the wards. When assigned to cases at the general medical clinic, the student is required to report the result of his examination of the sputum, blood, urine, etc. Students reporting at the medical conferences, for which longer time is allowed for preparation, make more extended research in the laboratory. Students are also, from time to time throughout the year, assigned to study cases in the hospital and dispensary; records are kept of these cases from which valuable clinical deductions may be made.

The apparatus employed is of such simple nature that it can readily be transported to the bedside, the work being thus essentially practical and such as is a direct guide to diagnosis. The student himself uses the apparatus so that he may become familiar with its care and application.

Following is a brief outline of the course:

Blood.-Technique of obtaining blood specimens; normal constituents of blood; blood formation in bone marrow; corpuscle counting and hæmoglobin estimation; technique of fixing and staining specimens ; diseased conditions determined by differential counting; study of blood-serum diagnosis; leucocytosis; malarial and other blood parasites; medico-legal value of blood stains.

Sputum.-Collection and examination of the gross specimen; disinfection of sputum cups, etc.; specimens of sputum in asthma, pneumonoconiosis, tuberculosis, gangrene and hemorrhage from the lungs, pneumonia, etc.; diphtheria and other bacilli.

Gastric Contents.-Examination of vomitus; administration of test meals; method of obtaining and examining gastric contents; lavage.

Fæces.-Methods of obtaining and examining; intestinal parasites

and ova.

Urine.-Microscopic examination with reference to diagnosis; gonococci, tubercle bacilli, etc., seminal fluid in its medico-legal aspect, crystalline deposits.

Exudations and Transudations.-Ascitic and pleuritic effusions, cystic contents, vaginal discharges.

Each student is furnished typical specimens which he stains and

studies at the demonstrations and preserves for future reference and comparison.

Physical Diagnosis.—Physical diagnosis of abnormal conditions within the chest is taught by Professor Lambert to classes of a dozen students each. This course is very comprehensive, owing to the large attendance at the Class of Heart and Lung Diseases of the Bellevue Out-Patient Department, from which the patients are derived.

General Medical Clinics.-General medical clinics are held weekly in the amphitheatre of Bellevue Hospital by the Professor of Medicine. At these clinics students read written histories of cases which they have studied on the previous day. They are required to demonstrate their findings upon the patients and are questioned before the entire class in regard to diagnosis, etc. These clinics are also utilized by the Professor of Medicine to exhibit cases of exceptional rarity or difficult diagnosis. A second general medicine clinic is held weekly in the Bellevue amphitheatre by the Professor of Therapeutics, at which the effects of treatment are made the prominent feature.

Lectures.-A course of ten lectures is given by the Professor of Medicine, which is designed as introductory to the systematic bedside teaching which he conducts upon hospital rounds. The course covers such general topics as the theory and nature of infections, the theory and significance of fever, cachexias, diatheses, the blood in disease, etc.

III. Fourth Year Students.

Fourth-year students attend the general ward classes and amphitheatre clinics with the Professor of Medicine, as described for the third year, and also make systematic rounds through the wards with Professors Lambert and Nammack when on duty in Bellevue Hospital, and with Dr. Conner at the Hudson Street Hospital. They attend the medical conferences, present complete histories of dispensary and ward patients, attend special classes in the Out-Patient Department and during the latter part of the year recite in a review quiz in preparation for hospital and State Board examinations. An elective course in advanced clinical microscopy and diagnosis is offered in the fourth year.

Surgery.

Surgery will be taught in the recitation room, at the bedside, and at hospital clinics: a few didactic lectures will be given and conferences will be held in the fourth year.

In the second year the students are required to attend recitations on the principles of surgery throughout the term, two hours a week.