teaching hospital will not be controlled by the faculty in term-time only; it will not be a hospital in which any physician may attend his own cases. Centralized administration of wards, dispensary, and laboratories, as organically one, requires that the school relationship be continuous and unhampered. The patient's welfare is ever the first consideration; we shall see that it is promoted, not prejudiced, by the right kind of teaching. The superintendent must be intelligent and sympathetic; the faculty must be the staff, solely and alone, year in, year out. There will be one head to each department—a chief, with such aides as the size of the .service, the degree of ditfetntiation feasible, the number of students, suggest. The professor of medicine in the school is physician-in-chief to the hospital; the professor of surgery is surgeon-in-chief; the professor of pathology is hospital pathologist. School and hospital are thus interlocked. Assistants, internes, students, collaborate in amassing data and compiling case records. The student is part of the hospital machine; he can do no harm while all the pressure of its efficient and intelligent routine is used to train him in thorough and orderly method. There comes a time, indeed, in a physician's development when any opportunity to look on is helpful; but only after he is trained: his training he cannot get by looking on. That he gets by doing: in the medical school if he can; otherwise, in his early practice, which in that case furnishes his clinical schooling without a teacher to keep the beginner straight and to safeguard the welfare of the patient.
The relationship here indicated has not thus far, as a rule, proved attainable in the United States except through the separate creation of a university hospital. In Germany, where hospitals and universities belong to the same government, our problem does not mse; nor in England and Scotland, where hospital and school have grown up together. In the United States—outside, once more, the few fortunate institutions like Johns Hopkins, the University of Virginia, and the University of Michigan—the schools developed as detached faculties, craving, after a while, some sort of demonstrative teaching privilege in hospitals conducted by the municipality or by philanthropic associations as temporary homes for sick people. Political reasons in the former instance, prudential in the latter, generally forbade an exclusive relationship. Lack of funds interfered with the establishment of laboratories; competition between rival schools required that privileges be both divided and restricted; finally, the inferiority of the students was an insuperable obstacle to any teaching method which sought to use them, in the wards in any responsible way whatsoever. More intelligent conceptions are becoming current: the student body improves; competition yields here and there to consolidation. Even so, there remain generally insuperable difficulties: purely philanthropic enterprises must be economically conducted, and they cannot in most places play favorites in the local profession. Adequate equipment, effective organization, and continuous staff service are therefore as a rule improbable. The hospital and dispensary which the medical school must provide to obtain these conditions need be large enough to furnish only the funda--
