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118 trusted with the responsibilities of the out-patient department. Difficulties and limitations in such matters sit lightly on most of our medical schools. The hospitals of Atlanta and Los Angeles exclude students from the obstetrical ward; at Burlington there is no obstetrical ward, but the "students see more or less;" at Denver a "small amount" of material is claimed; at Birmingham it is "very scarce;" at Chattanooga there are "about ten cases a year," to which students are "summoned," how or by whom is far from clear. At the Hahnemann Medical College (Chicago) students "look on at internes who do the work;" a committee of the Missouri state board reports of the College of Physicians and Surgeons of St. Louis that it could find only incomplete records of 21 cases for a senior class of 57; at Augusta, Georgia, the cases "always come at night when you can't get students;" at Charlotte 15 cases were available from September 15 to February 4; the medical department of Lincoln Memorial University (Knoxville) has no out-patient department, but alleges "a few deliveries before the class;" Vanderbilt relies on out-patient work mostly. There is a senior class of almost 150 at the American School of Osteopathy (Kirksville, Missouri). In two months they had eight clinical cases in obstetrics. Perhaps most lamentable of all, the Woman's Medical College of Baltimore concedes its opportunities to be "inadequate." At Toledo, Louisville, the University of Tennessee, Kansas City, the University of Kansas, Albany, and Yale, obstetrics is practically altogether out-patient work; that is to say, the student gets about the same training as a mid-wife. At Willamette (Salem, Oregon) he probably does not get even that: for "obstetrics depends on private practice and is very precarious. The student sees a delivery when the doctor is willing to take him."

Not a few of the schools mentioned have elevated their entrance requirements until they already demand one or two years of college work for entrance, or expect to do so presently. Meanwhile their clinical facilities remain what they were. Doubtless some of them will make haste to improve,—Yale, for example. Others will probably recede from their announced elevation,—as several have already done. Assuredly, students who improve their preparation will demand that the schools improve their facilities correspondingly. In the laboratory years this has generally taken place: he will be a dull fellow who does not quickly feel and resent the inferiority of the clinical end. In all fairness, the betterment of the facilities, the change of spirit and ideal, ought to have preceded as the warrant for the higher entrance standard. For the two-year college standard proclaims a university department. It still remains to be demonstrated that towns like Omaha, Washington, San Francisco, Topeka, Milwaukee, can recruit university faculties from the local profession. A university connection or a two-year college entrance requirement do not, of themselves, transform a medical school faculty. They merely impose upon it an additional strain.

The strain to which high entrance standards and good laboratory teaching at