952 
mediate consummation of such an ideal, 
results almost as satisfactory may be ob- 
tained by the actual affiliation of munici- 
pal or independent hospitals with the 
stronger medical schools. A. hospital has 
as much to gain by this arrangement as 
has the medical school, for while the chief 
duty of the hospital must always be the 
eare of the sick and injured, this duty, as 
well as its other functions—the instruction 
of men who are to practise medicine and 
the advancement of medical knowledge by 
research—is best served by placing the con- 
duct of the hospital in the hands of men 
highly trained in the methods of scientific 
medicine.> This would not only enable 
the hospitals 
to fulfill a greater function in the development of 
thoroughly qualified physicians, but it would also 
be best for the patients, since they would have the 
benefit of the best methods of treatment under 
recognized experts. A campaign of education 
should be carried on to show our municipal au- 
thorities that the hospital will be the best con- 
ducted in the interests of its patients and the 
community at large, if at the same time it is ful- 
filling its function as a great center of clinical 
teaching and research.” 
Many examples may be presented of the 
ideal association of charity, teaching and 
research as the results of such affiliation; 
the most striking perhaps being the mag- 
nificent clinie of Miller in Munich and 
the clinics of the University of Leipzig. 
Here, as in many other continental cities 
and in England, the university authorities 
by agreement with the municipal authori- 
ties appoint the heads of the hospital clin- 
ies. The long continuance of this arrange- 
ment and the great fame of most of these 
% Wor a discussion of the advantages to be 
gained by the hospital, see Welch, W. H., ‘‘Ad- 
vantages to a Charitable Hospital of Affiliation 
with a University Medical School,’’ The Survey, 
XXVIL., p. 1766, 1912. 
© Bevan, A. D., ‘‘The Modern Medical School,’’ 
Jour. Am. Med. Asso., LVIII., p. 652, 1912. 
SCIENCE 
[N.S. Vou. XXXV. No. 912 
clinies is sufficient proof that both munici- 
pal authorities and university authorities 
find it mutually advantageous. 
We should bring about the same state of affairs 
in this country and, in fact, a start has already 
been made. At Cincinnati the large municipal 
hospital has been placed in charge of the clinical 
teachers of the University of Cincinnati; in St. 
Louis, the Washington University has made a close 
affiliation with the new Barnes Hospital; in Bos- 
ton, Harvard has made an affiliation with the 
Peter Brigham and several other special hospitals; 
in New York, Columbia University and the Pres- 
byterian Hospital have established similar rela- 
tions; in Cleveland, Western Reserve University 
has formed a combination with the Lakeside Hos- 
pital; in Chicago, Rush Medical College has had 
for a number of years the medical control of the 
Presbyterian Hospital, and recently has made sim- 
ilar contracts and arrangements with the Chil- 
dren’s Memorial Hospital, the Home for Destitute 
Crippled Children and the Hospital for Infectious 
Diseases.—Bevan.” 
How much better such an arrangement 
would be than that which now exists. At 
present in most schools the clinical teacher 
is a teacher mainly because he is fortunate 
enough to control a hospital service, and 
for this reason has been appointed on the 
university staff. In his appointment the 
school has no choice, for it must have for 
its students the advantages of the clinical 
material which he controls. Whether he 
be good, bad or indifferent, as physician, 
teacher or investigator, he must be re- 
tained as long as he holds his hospital posi- 
tion. He, on the other hand, is handi- 
capped by the regulations and restrictions 
of a not always sympathetic lay board of 
hospital management and, more important 
still, by the absence of proper laboratory 
facilities and the aid of his own colleagues 
in the departments of bacteriology, im- 
munology, pathology and pathological 
chemistry. These departments are com- 
ing more and more into active participa- 
" Bevan, loc. cit. 
