the part of the university to choose its own teachers, finding them where it may; freedom on the part of the teachers to strike out along whatever path they please. An artificial impediment will in general entail barrenness.
The institutions above named are necessarily confined to the local profession for clinical teachers,—a restriction that they would find intolerable in any other department and that they endure under protest in medicine, only because they are not yet financially in position to throw off the yoke. No disrespect to the practising profession in these large cities is implied: they are doubtless as good doctors as can be found anywhere. But they are not teachers; they have neither time for, nor effective interest in, productive teaching. If they were really as much interested in clinical science as in professional prosperity, they could as a body do much to improve hospital conditions on the pedagogical side. As a matter of fact, professional prominence and institutional rivalry keep the college tenure insecure, often chop the hospital services into short terms, compel hospital authorities to abridge teaching privileges in order to avoid friction, and present a solid and opposing front to the importation of outsiders, even though the outsider chance to reside in the same town. Under such conditions it becomes at once impossible to entertain in clinical medicine the ideals set up in the laboratories of pathology, physiology, or chemistry. One pitches one's expectations lower. It becomes a scramble for abundance and variety of "facilities" on the part of the schools; public hospitals split up and overload their services in order to distribute their favors widely; private institutions promote their prosperity by declining exclusive alliances. In Chicago staff positions in the great Cook County Hospital are awarded every six years by competitive examination; and the schools make what terms they can with the winners, who rotate from ward to ward at stated periods. No bedside clinics are allowed; patients are wheeled into teaching-rooms or amphitheaters for demonstration; anyone who purchases a ticket may attend any clinic that he pleases. The student gets an excellent chance to see detached conditions; what he loses is the opportunity to observe individual cases of disease in process of development and to correlate his own laboratory findings with symptoms observed at the bedside. As for the professors, whisked about in rotation, scientific study is out of the question. At Bellevue Hospital (New York), Columbia, Cornell, and New York University have each a "division," within which, however, they are not supreme; the medical board, composed of the entire visiting staff of all three schools and the fourth division,—the outsiders,— limits the freedom of the several parties in interest; final authority is lodged with a lay board, who have, for example, recently overruled Columbia in its own division. At Boston neither Harvard nor Tufts has the initiative in filling staff positions in the hospitals used in teaching. Appointments are made by seniority; it is well-nigh impossible for the school to break the line. In Boston as in New York, the large hospitals tend to have their own pathological departments, the permanence of whose relation to the corresponding department of the medical schools is decidedly uncertain. Money and educational opportunity are
