its present medical department, contracted to keep the clinical professors in their chairs for a term of years. When the term expires, they are free to drop them,—at the cost, however, of cutting down their clinics in the same ratio. In a few places things are held together somewhat more compactly by an arrangement that gives the school faculty the hospital services during term time. Such is the case at Mobile, Birmingham, and Chattanooga. But in general a hospital staff is composed of heterogeneous elements, appointed for reasons that cannot be classified. Representatives of no school and representatives of all schools, serving now through the year, again for a few weeks, now in one ward only, now rotated through several, make up a situation unfavorable to every interest involved. In New York the ancient ecclesiastical evil of plural benefices crops out unexpectedly: one individual may hold several appointments in hospitals so far removed from each other that he cannot possibly do even his perfunctory duty by them; instead of surrendering superfluous perquisites, he sub-lets them at will, according as fancy or personal interest may determine: the staff appointments appended to his name are so many scalps hung about his belt! There is no such thing as hospital policy: the wards have as little wholeness, as little intimacy of relation with each other, as the private homes in which these same physicians treat their personal patients; only a local accident puts one roof over them.
Teaching is obviously but an incident in the routine of these institutions. Not infrequently amphitheaters have been included in their construction; but they usually lack a clinical laboratory in which students may work, not a few lack it altogether. The failure to provide clinical laboratory space thus keeps instruction to the level of passive demonstration. The student has presumably spent two years in mastering certain medical sciences. A large part of this laboratory discipline was designed to enable him to gather a greater variety of facts than the bedside examination will disclose. Blood, sputum, urine, etc., all contain important evidence which the laboratory years equip the student to utilize. He has been taught to do certain things. But at the critical moment, when doing them will count, he may get no chance, in the first place, because at many hospitals, among them those mainly relied on by the University of Nebraska (Omaha), Denver and Gross (Denver), the Hahnemann Medical College (Philadelphia), and most southern schools, there is no clinical laboratory at all. At Denver "there is no equipment to make a culture, and the internes are rarely equal to it, anyway." At Omaha, the clinical microscopist of the university faculty was unable even to get material from the County Hospital; when he wanted gastric juice for demonstration, he had to manufacture it himself. In the second place, where a clinical laboratory is provided, "students" are as a rule not admitted. The work is done by a resident pathologist who has no connection with any of the several "schools" that are permitted to demonstrate cases in the amphitheater or in the wards; or by internes, equally detached and too frequently of very doubtful competency by reason of just the educational limitations we are deploring. To the clinical laboratories connected with the municipal hospitals of St. Louis, Chicago, Minne-
