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 anatomyкод для вставкиСкачать
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.