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278 compact and complete plant. That they are not so operated cannot but be deplored as a tragic mischance. It is to the world at large of no consequence how they happened to drift apart. There are interests at stake that are entitled to outweigh all personal and historic considerations.

That an effective affiliation is feasible between a department of medicine and an endowed hospital, Western Reserve and Lakeside Hospital assuredly prove, just as Toronto proves the same as between a medical school and a municipal hospital. There are in New York city a dozen hospitals, each of them capable of becoming a teaching hospital in the best sense of the term. Their usefulness from every point of view would increase in precisely the measure in which they lend themselves to this function. They are already comfortable and indeed charming retreats for the sick and injured. Why should they be satisfied to be that, and nothing more? They are favorably known to the poor and to the philanthropic of New York city; and they are deservedly proud of their repute. Is it a defect of intelligence or of imagination that prevents them from reaching out for more substantial laurels? Perhaps neither, so much as a disinclination to depersonalize the hospital staff management; for depersonalization, in hospital management as in faculty appointments, each involving the other, is the condition precedent to reconstitution of medical education in New York. Without sacrificing a jot of their local distinction, without limiting in the slightest degree their usefulness to the sick poor, the New York hospitals may—any or all of them—win a place as scientific laboratories beside Guy's and St. Bartholomew's, the Royal Infirmary of Edinburgh, the Charité of Berlin, the Hôtel-Dieu of Paris. Mount Sinai, the Presbyterian, St. Luke's, and Roosevelt Hospitals might under such conditions be familiar names in medical science; as well known to the progressive clinicians of St. Petersburg, Vienna, Edinburgh, St. Louis, and San Francisco, as they are to the stricken widows of the East Side of New York city itself. What the Sloane Maternity Hospital wisely does for a single department, the general hospitals can do for general medicine and surgery. The great universities on the ground can be trusted with the opportunities and responsibilities which effective affiliation would give them. In the absence of such affiliation, separate endowment, procured for the purpose, must provide teaching hospitals in which the universities will be supreme. Would any contend that these hospitals are likely to be less admirably conducted than the unattached hospitals we have named? or that the university faculty of medicine, freely recruited, is likely to prove a less competent staff than present methods procure?

The issue is one that cannot be much longer fought off: Columbia and Cornell are already graduate schools in medicine. Their laboratories produce a high-grade student, to whom the university is bound to furnish a clinical opportunity of the same quality. Neither school can now do it. An effective affiliation, or endowment adequate to support a teaching hospital and a scientific medical faculty, is therefore their immediate need and desert.