the benefits arising from the more individual training which those methods afford, that the application of similar methods to clinical teaching is commending itself forcibly to medical educators. The most signal ability upon the part of a clinical teacher cannot make the conduct of a clinic en masse a scientific process. Whether on the medical or on the surgical side numbers in attendance upon a case are a bar to successful teaching. The amphitheatre clinic is spectacular, but it is not educational. It affords an opportunity of eclat to the clinician, but very small benefit to his pupils.

A clinic to be of real value to the student should proceed along the lines of actual practice upon his part. It should follow the case method from beginning to end. It should afford the student the supervised opportunity of personal examination of the patient, of a carefully reviewed diagnosis and prognosis, of preparing and completing the case history, of making urinary analysis, blood studies, etc., of observing the details of preparation for operation, of viewing operative procedures at close hand, and of following the results of treatment and the course of convalescence. One case so studied is worth more than the witness of a dozen brilliant operations or the dictum of the clinician upon a score of selected patients. In short, the clinic should be a continuous one, and the student's work should be individual and directly responsible to the instructor.

All this means clinical organization upon a scientific basis. It means the division of classes into very small sections, the arrangement of required work to required results, the multiplication and compensation of clinical instructors acting in the service of clinical chiefs, the equipment of laboratories for purposes of clinical diagnosis. It means, in brief, as it should mean, the development of the clinical arm of medical education to a place correlative with that of the laboratory arm.

The tendency to specialism which has been so marked a feature of medical practice in the past two decades, to whatsoever course it may be traced, has had its effect, for good or ill, upon medical education. Men, like lines of force,

move in the direction of least resistance, and the easy road to a competence may have been one with the channel in which the current of specialism has run. As a consequence of the dominance of specialism in practice, the specialties have risen to prominence in the curriculum of medicine. It may well be questioned whether this result has been an answer to the need of the student specialist or to the desire of the specialist himself for an announcement and a clientele. Be that as it may, an adjustment of the relationship of the special to the general branches in medical teaching is a recognized necessity. These special branches tend to multiply as new therapeutic measures are discovered, and their place in medical education is an established one. As a method of readjustment, the elective system, which has served the purposes of higher education in general so well, is in process of application to the medical course. Naturally introduced first into the senior year, it is being extended to the third year's work as well. A choice of a certain number of these electives is required, and that choice carries with it the obligation to the successful pursuit of the subjects chosen. An elective chosen has, or should have, the same value as a compulsory study. Experience has already shown that the fact of choice guarantees the peculiar interest of the student and predicates his success. Frequently, other electives than those of required choice are voluntarily pursued.

Well supplied as the professional market is with specialists of many works, there is one field in which specialism, as a matter both of teaching and practice, should be carried to a more distinct development than it has yet attained and that is the field of surgery. So rapid have been the advances and so great have been the temptation to brilliant achievement and large earnings in this field, that it has been invaded by a great army of operators who are not surgeons. To the younger men of the profession this allurement has been peculiarly strong, and many a tyro of hardihood has rushed in where the angel of experience would fear to tread. Fortunately for its own protection, unfortunately for the

credit of the profession, the public is growing as fearsome of the ready and familiar knife of the modern operator as it was of the slow, reluctant, and stranger instrument of his fathers. Medical educators and examining boards alike should meet this occasion by imposing more rigid requirements in the study of surgery and, by providing, as in Great Britain, for special tests of fitness of the would-be practitioner of surgery. There is no field in medical practice which should be so sharply specialized as that of the surgeon.

The rapid development of medical science and the growing need for the application of laboratory methods to clinical service, are making a demand for the training and recognition in practice of a class of men and women who may be distinguished, not as specialists, but as medical scientists—a class of experts in laboratory methods who shall do for the profession at large a recognized and paid service which it cannot, either in point of time or in point of fitness, do for itself.

While the rapid advances which medical education has made and is still making will eventually equalize the opportunities of scientific training for the profession, as a whole, it must always remain true, in the practice of the medicine of the future, that there is room and service for the scientific medical counsellor as for the general medical practitioner.

A STUDY OF ELECTRICAL INJURIES

H. L. STAPLES, A. M., M. D.

Minneapolis

Within the past twenty years electricity has been widely. utilized as an illuminating agent, also as a motive power in the propulsion of cars and machinery. This employment is increasing with marvelous rapidity, and the future applications are well-nigh infinite. Electric cables of high potential are thickly spread through our cities, and injuries are becoming much more frequent, and though usually limited to linemen and electrical power-house employees, yet they constitute a menace to every citizen. Little has been written on the subject of these accidents, although real or supposed injuries are now common, and alleged remote effects are made a basis for litigation. For the past fifteen years I have treated practically all the injured employees of the Minneapolis General Electric Company, and many in the service of other corporations, besides a number of persons who came into contact with their wires.

A brief description of electrical nomenclature and currents may not be misplaced.

The volt represents the unit of electromotive force or potential, and is the force that is generated by an ordinary zinc and copper Daniell cell.

The volume or measure is represented by the ampere. As with a river, we may have a large volume with a slight fall; or as with a mountain stream, we may have a small volume with an intense velocity. The street railway has an ordinary voltage of five or six hundred with an enormous amperage.

The resistance is calculated in ohms, and is an important factor in all electrical computations. In case the epidermis is dry, this is a very great and powerful protection against

electrical harm. It is variously estimated from ten to forty thousand ohms. If the skin is well moistened, the resistance is lowered to 1500 or even 500 ohms.

The street are light in this city is usually made by a direct current having a voltage of 50 to the lamp. The lamps are usually hung in circuits of 50, so that the extreme voltage would be 50 times 50, or 2,500 volts. You will readily observe that there is a great variation in the current which a lineman or bystander may receive.

An alternating current changes its direction about sixty times a second. This forms the primary cable of about 2300 to 2500 volts. Passing through a transformer, it is delivered by the secondary wire to stores and residences in the form of the Edison lamp of about 110 volts. This strength, except for slight burns, is absolutely harmless; but the metal socket should not be grasped in severe storms for fear of crossed wires.

Electrical injuries are of three varieties:

I. Burns of greater or less severity.

2.

Almost instant death.

3. Psychical or functional disorders.

The location of burns is most frequently on the hands, next the wrists, forearms, feet, and legs. Through falls many sustain burns on various parts of the body. The burns vary greatly in intensity, being always more severe than apparent on first examination. The slight blister may develop sloughing to the bone. Often the tissues are charred, and the tendons, muscles, nerves, and blood vessels destroyed, even involving the bony structures in some in

stances.

The burning of the clothing may disseminate the injury. The character of the burns is at first dry, aseptic, and indolent; later oozing and symptoms of moist gangrene may appear. The pain is often severe. These burns should be washed with peroxide or some other weak antiseptic, dressed with protective rubber-tissue strips, and well covered with Lard or vaseline ointments are not to be used at first. Skin grafting, or even amputation, may be necessary.

cotton.