The development of orthopaedics in the Nottingham area

HORACE W. DAVENPORT, Doctor Dock: teaching and learning medicine at the turn of the century, New Brunswick, NJ, and London, Rutgers University Press, 1987, 8vo, pp. xvi, 342, illus., $35.00. Between 1899 and 1908, George Dock, MD held a diagnostic clinic for senior medical students at the University of Michigan twice a week during the school term. Dock, professor of theory and practice of medicine and clinical medicine, quizzed the student responsible for preparing the history of the patient being exhibited to the group, called on other students to examine the patient and answer questions, and pointed out the broader lessons to be learned from the individual case. What was novel about this particular clinic was not its format but the fact that Dock engaged a stenographer to make a record of everything that he, his students, and their patients said. From these shorthand notes the secretary prepared a typescript, now deposited at the Bentley Historical Library in Ann Arbor, Michigan, a massive account that runs to some 6,800 pages. This remarkable document is the basis for this book. Horace Davenport, professor emeritus of physiology at Michigan, divides his material into chapters that principally correspond to broad disease groups, such as 'Cardiovascular problems' and 'Kidney trouble'. In each, he intersperses substantial extracts from the clinic record with his own comments and summaries of Dock's teachings. He has been liberal in his cut and paste work, sometimes bunching together quotations from disparate parts of the transcript to create composite portraits of how Dock managed particular medical problems. The resulting pastiche is engrossing. We see students struggling to apply their textbook knowledge to the frustrating complexities of real patients, hear a teacher with a developed sense of irony guide them through a clinical world very much in flux, and listen to Dock's advice on everything from eliciting information from patients to getting started in private practice. The account offers fascinating glimpses into turn-of-thecentury American medicine. From such a rich and perhaps unique source, however, it is a little disappointing that we get nothing more panoramic than glimpses. The fragmentation and rearrangement of material means that the reader never gains a solid sense of what any one entire clinical session was like. Davenport writes he has excluded the "irrelevant parts" (p. xii), but does not spell out his criteria of relevance, leaving the historian curious about what might be missing. Nor is much said about Dock to help the reader gauge how typical or odd his views might have been. The question of why he took the singular step of having such an exhaustive record of his clinic kept in the first place goes unaddressed, though one wonders just what purpose Dock thought it would serve. As it stands, though, this volume is both suggestive and a pleasure to read, and does good service not least by drawing attention to an exceptional source.