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The teaching of anatomy and the inculcation of scientific methods and interest. The value of the Roentgen-ray and the living model in teaching and research in human anatomy

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A U T H O R ' S ABBTRACf OF T H I S PAPER I 0 8 U E D
BY
THE
BIBLIOGHAPHIC SERVICE, M A Y 4
SYMPOSIUM
THE TEACHING OF ANATOMY AND THE INCULCATION OF SCIENTIFIC METHODS AND INTEREST
Given during the thirty-fourth session of the American Association
of Anatomists, University of Minnesota, December 27, 1917
THE VALUE OF THE ROENTGEN-RAY AND THE LIVING
MODEL I N TEACHING AND RESEARCH I N
HUMAN ANATOMY
C . R. BARDEEN
University of Wisconsin
The practical value of roentgenology in clinical work has led to
extensive studies of the structure of the body as revealed by variations in tissue density. New light has been thrown on the anatomy not only of the skeletal system, but also of other parts of the
body especially of the thoracic and abdominal viscera. In the
main, these studies have been made by clinicians who have had
no highly trained technical knowledge of anatomy and no special
facilities for comparing the anatomy of the living as revealed by
variations in tissue density with the anatomy of the dead as revealed by technical preparation. On the other hand, few anatomists have made themselves familiar with the data revealed by the
x-ray studies of clinicians or with the possibilities of correlatinp
the anatomy of the dead with the anatomy of the living revealed
by the x-rays. Roentgenology offers an attractive field for research to the anatomist and a fertile field for vivifying his work
as a teacher.
Of the various subjects of the medical curriculum, anatomy
offers the best opportunity for training the student in habits of
resourceful independence. The student can be allowed to wander
337
THE ANATOMIC&
RECORD. VOLGME
J U N E , 1918
14. NUMBER 6
338
C . R. BARDEEN
from a straight and narrow path and to make mistakes until he
acquires self-mastery, because the resulting loss is that of a little
time and material. I n the chemical laboratory, if allowed too
much freedom, he may blow up himself and his fellows. In the
physiological laboratory or the clinic he may cause too much
needless suffering. I n the dissecting-room a student may wisely
be allowed considerable freedom when held up strictly for results.
The most important thing he can get from the dissecting-room
is the habit of independent workmanship with constant aim at
results that show skill.
When students are given this sort of training in human anatomy, for which we are largely indebted to the genius of the late
Franklin P. Mall, they gain self-mastery, which carries them far
in their subsequent medical careers. But while they may acquire
considerable manual dexterity and considerable skill in observation, they are apt to neglect the imaginative reflection which is
necessary for translating observation into work of value. As a
means of stimulating the imagination in gross human anatomy
roentgenograms are of considerable value, especially when study
of the roentgenograms is combined with fluoroscopic studies on
the living. The use of the roentgenograms belongs in the realm
of work in which students may be given a free hand, since the
worst that can happen is injury to a few plates. The taking of
the roentgenograms and the use of x-ray machines for fluoroscopy,
on the other hand, has to be carried on under strict supervision
and therefore is of little value as a general means of training in
independent initiative, although of good value in adding interest
to the study of anatomy.
At the University of Wisconsin we have made a beginning in
the systematic use of roentgenology in connection with anatomical study,. but I feel that a far more extensive use might be made
with advantage.
For the benefit of our first-year students who are beginning the
study of human anatomy we have a set of x-ray platesdisplayed
in a room conveniently situated near the dissecting-rooms, and
the students are encouraged to study these plates in connection
with their work in dissecting. So far as possible pairs of stereo-
TEACHING O F ANATOMY
339
suopic plates are used and prismatic stereoscopes are provided for
the study of these plates. The skeleton is well illustrated with
especial reference to the joints in various positions and to the air
sinuses of the skull. Plates are provided to display the anatomy
of the heart and of the lungs. The abdominal viscera are shown
both with and without the preceding ingestion of barium meals.
Most of the plates are made from the living, both children and
adults, but some roentgenograms are provided of specimens
especially injected after death to show blood-vessels and other
features. I believe that this latter feature could wisely be extended. Our plates along these lines have come chiefly from the
research work of Dr. Miller and Dr. Dunham on the lungs.
On the whole, I have thus far been somewhat disappointed a t
the lack of free independent use of the plates by the majority of
the students. They readily go into the room with an instructor
and express great interest in what he points out, but comparatively
few students study the plates carefully on their own initiative.
The same men later in private practice will study x-ray plates
carefully in connection with suspected fracture cases because here
the study is a means to a definite end. It is hard to make the
student feel the same interest in plates that might help him to
understand better the part he is dissecting. It, is probable that
a better arrangement of plates and more careful labeling than we
have provided would help. The students can be made to study
the plates by requesting outline drawings with parts labeled.
During the second semester of the first-year students are taken
in small groups to the fluoroscopic room of the x-ray department
of the medical school and are shown the action of the various
joints, the expansion and contraction of the thoracic cavity,
the beating of the heart, the ingestion of a barium meal, and other
physiological activities of the body, the different members of the
group taking turn as subjects. The students always show more
interest in fluoroscopy of the living than in roentgenograms. If
it could only safely be done, a great deal of interest might be
added to the study of anatomy by turning over an x-ray transformer and a fluoroscopic outfit freely for the use of the students
during the study of anatomy. But the danger of x-ray burns
340
C. R. BARDEEN
precludes this. The supervised and therefore limited use of
fluoroscopy in teaching anatomy can wisely be combined with the
study of structure in action as revealed by visual observation,
palpation, and precussion of the nude living model. We have
endeavored to do this by the employment of students as models
for certain hours each week during the second semester of the
first year, and I believe with profit. Artists’ models trained for
this special work would probably be better than the untrained
models we make use of.
For many of the advanced students in human anatomy roentgenology has proved even more stimulating than for the beginning
students. We make it a regular part of our work in topographical anatomy somewhat along the lines described above for beginning students but more extended. Seniors in the College of
Letters and Science and graduate students who are candidates for
a Master’s degree, while carrying on medical studies, are required
to present a thesis. When this thesis is chosen in topographical
anatomy the student is usually assigned to some topic in which the
recent work in the field of roentgenology has added something to
our knowledge and is encouraged to try to add something of his
town. These students have all shown great interest in this work.
Several papers embodying the results are now in course of revision
for publication. Advanced students of this character can, of
course, be given more latitude in the use of x-ray apparatus than
can be given to beginners.
The ready willingness of students in the dissecting-room t o aid
members of the staff and advanced students by making special
dissections which help to unravel the mysteries of light and shade
in roentgenograms contributes t o scientific research, to the interest
in teaching, and to the interest in study.
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scientific, inculcation, living, mode, method, values, human, anatomy, research, teaching, interest, ray, roentgen
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