private hospitals personal considerations nominate the staff, and the school subsequently negotiates with the appointees. Competition, professional and institutional, has molded the hospital situation, and in consequence clinical faculties are organized on a personal rather than a scientific or educational basis. Doubtless if Columbia, New York University, and Cornell had at this moment a free hand, they would retain some of their clinical teachers in their present positions. But at bottom this is a fortunate accident rather than a natural result: it just happens that some competent teachers find themselves in prominent hospital positions; but the system is not designed to pick them out. In the event of their withdrawal, their successors in the hospital would not be sought on the basis of scientific eminence, and if not in the hospital, then not in the school. Under these conditions, the schools can hardly be said to have ideals, policy, or genuinely organized departments, except by fortunate accident. For the nonce, there may be a continuous medical service here, clinical clerks there, post-mortems elsewhere. But the favoring conditions are perishable. The schools skate on thin ice. An accident may shatter the arrangement and convert a "department" into a congeries of courses lacking unity in conduct and aim. Indeed, most of the clinical departments now conform to just this description: there are a half-dozen professors of medicine and surgery in place of one; and no possibility of team-work on their part.
For many years nothing more than this was asked; but meanwhile the school point of view has changed. Doubtless there are professors who ate satisfied to go on producing doctors and to let other institutions produce knowledge; but the productivity of the first and second years has suggested another ideal. The problems of clinical medicine have been the more sharply formulated as the pathologist and the bacteriologist have passed up to the clinician the results of their own scientific activity. The teachers of medicine must attack these problems. To attack them, they require quite another environment. The modus vivendi which enabled rival schools to lecture in the same hospitals does not provide the conditions in which a clinical scientist can work.
We have now suggested two results that medical schools in New York must attain: (1) they must make doctors in sufficient number; (2) they must actively participate in the advance of medical science. If the standpoint previously expounded is correct, the same institutions must do both. Of the eleven medical schools now existing in the state, only the bona-fide university departments can then expect to survive: outside of New York city, Syracuse University alone has just now a chance. The schools of Buffalo, Albany, and Brooklyn belong to the past. None of the three has even yet entirely emerged from the fee-dividing stage. Syracuse, with a smaller total fee income than any of them, devotes every dollar to the development of the fundamental branches and has fairly earned support from outside.
Of the New York city schools, Columbia and Cornell alone have at this moment any financial strength. Neither of them, indeed, is in actual possession of sufficient endowment; but there is little reason to doubt that what is additionally requisite
