demand. There are, for instance, several full-time instructors, but they are without an adequate force of assistants. The needs of the College of Physicians and Surgeons are much greater. Its laboratory facilities and equipment are inadequate even for the present student body; and it has barely begun the development of a full-time teaching staff in the scientific branches. Both these schools face an era of increased investment in plant and of considerably augmented running expenses, coinciding with a period of reduced income from tuition fees.
On the clinical side, Rush and Northwestern do not differ substantially; the College of Physicians and Surgeons is somewhat inferior. Both Rush and Northwestern have an exclusive staff connection with certain hospitals. Their hospital situation is therefore, as things go in this country, tolerable. They command a sufficient number of cases, subject, however, to two defects that will be more acutely felt as clearer ideals become dominant in medical education: (1) they are not in position freely to import clinical teachers, nor (2) can they in general discontinue a professorial appointment without to the same extent abridging their clinical resources; none of them completely controls, even in a single hospital, the conditions under which clinical instruction is given.[1]
The Cook County Hospital is common to all three. Its relations to the medical schools have been subject to variation and disturbance. The institution is conducted by a lay warden, who, though a politician, is now friendly to the schools. At present, the staff is selected by civil service examination every six years. Rush now holds twice as many appointments as either of the other two schools, a discrepancy that may be either emphasized, obliterated, or reversed at the next examination. The main clinical facilities of the several schools are thus precarious. They are also limited: a recent unpleasantness—due, according to one version, to a quarrel between certain doctors and some nurses who objected to the careless way in which the doctors replaced the bed sheets—has resulted in the exclusion of students from the wards. Patients are exhibited in rooms. The incident involves serious limitations upon teaching methods, and illustrates the uncertainty which attaches to mere privileges and courtesies. Cases cannot be assigned for intensive study to particular students; hospital residents make the records and do the clinical laboratory work. The undergraduate student can see conditions in abundance; he cannot at close range observe processes in development. The Cook County Hospital is therefore, from a strictly educational point of view, not a laboratory in which beginners can be trained in a thorough technique. It is, however, immensely valuable as a storehouse of illustrative material for students who have elsewhere received a satisfactory preliminary discipline.
None of the supplementary hospitals used by the schools cures these defects. They
- ↑ Rush comes nearest to desirable conditions at Presbyterian Hospital, for staff appointments there are by contract completely controlled by its faculty. But it is provided that "no patient shall be made the subject of clinical instruction without his or her consent."
