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112 hospital superintendents I know of, there are, besides a very few physicians, an ex-newspaper reporter, a ward boss, a china factory hand, various clerks, and a still more varied assortment of clergymen .... In order that domestic complaints may be removed, a committee of ladies is sometimes appointed,... their only claim to knowledge being that of the 'born housekeeper' supposed to be inherent in every woman. The organization and management of institution households, however, having little in common with that of a few maids and no sick people, the management of details by. visiting committees is often but an added discomfort."

Such institutions are mere boarding-houses for the sick. Physicians call there as they call at a private house, seeing twenty patients in the former instance, a single patient in the latter. It is the difference between wholesale and retail, reno other; scientifically the "calls" are on the same level. The visiting staff of physicians is appointed through favor, pull, or bargain, and the schools make the best of it. A small clique occasionally controls the situation. Conspicuous fitness cannot be the sole or main consideration. A school rich in facilities to-day may be beggarly to-morrow. The medical department of Toledo University has just lost its main clinical support as one outcome of a local political overturning. The University of Minnesota has been fortunately hastened in the resolution to build its own hospital because a local upset reduced its former privileges. The Woman's Medical College of Philadelphia adjoins a hospital of which its faculty was once the staff; now there is no commerce between them. The Hering Medical College at Chicago (homeopathic) is in even closer proximity to a homeopathic hospital: a bridge connects them; but the barred doorway bears the legend, "No students admitted." Medical politics are decisive at Albany; to keep control in the hands of the dominant clique of the Albany Medical School (the medical department of Union University), the size of the faculty was recently increased, all the new members being adherents of the side in power. The City Hospital at St. Louis, the County Hospital at Denver, are frankly described as being "in politics." Staff appointments made for personal or political reasons may of course be revoked for reasons that are no better. The uncertainty of any one connection constitutes a good reason for getting hold of as many as possible. Columbia, for example, used to be supreme at Roosevelt Hospital, opposite its laboratories; it is being gradually edged out,—a deplorable condition for all concerned; but it has recompensed itself abundantly elsewhere. The medical department of the George Washington University protects itself by providing that "every clinical teacher shall cease to be such teacher should his facilities for giving clinical instruction cease before the end of his term of service." If a school drops an indifferent teacher, it may be worse off than if it retained him; for he keeps, and the school loses, the "clinical facilities" that he represents. St. Louis University, in purchasing