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to the antiquarian than to the hospital trustee and the hospital superintendent of today. Furthermore, it is my conviction that it is the duty of this Association to produce a hospital literature of its own, representing, if you like, some historical study (for we must not be too intensely practical and thus lose entirely the pleasure and the enlightenment which come from comparing the work of one generation or country with that of another generation or another country), but representing especially the thought and work, the ideals and achievements, the successes and the failures of the hospital workers of our own day.

We have made a brave beginning, but let us not deceive ourselves—we have only begun. For ten years this Association has cautiously felt its way, slowly but steadily gathering strength and purpose. Its contributions to hospital literature have depended upon the activities of a few devoted minds, each working more or less independently of the others. With its larger membership of today, with its still larger membership and its inevitably greater resources of the immediate future, its progress need no longer be left to the chance interest of temporary executive officers, or to the uncertain contributions of a mere handful of active and willing members. The progress of this Association should proceed in the future according to a plan calculated to turn the light of public investigation and discussion upon every condition which, for good or ill, affects or is capable of affecting the welfare of the institutions with whose management we are charged. But we cannot hope to bring about the sustained, searching, many-sided criticism of hospital methods which is desired, unless our plan is one which will turn to use the great latent resources of our organization.

I would not appear to be lacking in appreciation for or gratitude toward any of those whose efforts have contributed to the development of this Association at any stage of its existence. Without the foundations laid by its older members, our Association would have no existence.

On the other hand, to content ourselves today with a degree of usefulness no greater than that which suited the Association in its first struggling years, would be unworthy of our present organization, great and powerful as it is, and guided as it should be by the wisdom gathered in the course of its growth and development.

As the earlier constitution stated it, the object of this Association was "to meet together for the interchange of ideas”-an object good enough in its way, but vague, indefinite, leading anywhere or nowhere. The present constitution of the Association declares more definitely and concretely that our object is "the promotion of economy and efficiency in hospital management;" and under such a definition of purpose and function we are bound to discover and to bring into play every factor, whether scientific, social, ethical or economic, which makes for hospital efficiency.

The problems involved in hospital management are multitudinous; their proper consideration, therefore, is bound to lead our study into diverse fields of knowledge, many of them reaching far beyond the sphere of the average hospital superintendent's daily thought. We must learn how best to apply to our work the principles of medicine, of sanitation, of public and personal hygiene, of hospital and district nursing and nursing education, of social economics, ethics. law and finance, of business administration and domestic administration, of engineering and architecture. But all of this knowledge, which is to afford us the means to grapple with the various and complex problems of hospital administration, lies within our reach, although, in order to acquire it, we must abandon the doctrine of the superintendent's self-sufficiency and call to our aid all who are able to serve our ends. If in the future our studies are to determine the conduct of legislatures; if they are to have the utmost possible value for ourselves, they must be charged with clear purpose, they must be co-ordinate, comprehensive, thorough; and above all, our conclusions and recommendations must carry with them the overpowering weight of expert knowledge, for on no other footing shall we ever be able to explain and defend them, and to compel their universal adoption and application.

Mr. Ludlam, acting as President of the Association at the Buffalo convention two years ago, advocated the broadening of this Association by the addition of new and needed elements of membership. He showed that the admission to our ranks of trustees of hospitals and of representatives of medical boards would favor the more thorough consideration and the more effective treatment of problems of hospital administration from a variety of points of view; and


he recommended the expansion of the Association into an organization which would be "representative, comprehensive and national.” What Mr. Ludlam wisely and foresightedly urged has in part been accomplished. Our Association today is national; it is more truly representative; it is not, however, fully and satisfactorily comprehensive, nor can it be until we have added to its membership all who are capable of contributing to its studies and deliberations, all who may add to its power for the acquisition and diffusion of such knowledge as lies within its proper sphere.

I believe that we should welcome to membership in this Association all those who are intimately concerned with the study of hospital problems and with the actual conduct of hospitals. We have need not only of trustees, superintendents, and assistant superintendents, but of hospital physicians, hospital surgeons and hospital pathologists (all of whom, in a sense, are directors of hospital departments and therefore should be encouraged to become students of special phases of hospital administration), and we have place and need also for those who are devoting their energies to the welfare of that great aïm of the hospital service, the department of nursing. We want all of these—the light of their science, the testimony of their experience, the inspiration of thir ideals. As superintendents and as trustees of hospitals we co-operate with them individually in our everyday work. Why, then, should we not consult with them collectively here?

Sooner or later, I have no doubt, the gaps in our membership will be filled and our Association will have become truly “representative, comprehensive, national.” When that day comes we should be ready to make use of the gifts of all of our members. This we cannot do, in an Association that will number a thousand or more, by holding an annual conference whose total output cannot well exceed the results of twelve or fiften hours of discussion. With no greater membership than that of today, we shall find that such a conference will afford an opportunity for the presentation of the ideas of only a small fraction of those who ought to be heard. The present form of organization and method of work, applied to a great and numerous body of thinking men and women, can only tend to limit profitable investigation, to discourage research, to suppress debate, to

hamper the diffusion of knowledge. A new working plan, then, appears to be needed-a plan which will afford an outlet large enough for the energies of hundreds of capable members. What shall this plan be?

If I may venture to offer my opinion, it is that we should proceed so to modify our organization as to provide, first, for a central body, presided over by the President of the Association, where all the members could meet in common for the consideration of inatters of interest to the whole Association; and second, for a series of working sections, each with its proper officers, organized to hold separate but simultaneous section meetings for the consideration of problems of special interest and concern to each of the great groups of present and future members. (Thus there would be a section on general internal administration, consisting of superintendents of hospitals; a section on medical administration, made up of medical officers of hospitals; a section on nursing, consisting of the principals of training schools; a section on external administration or general management, composed of hospital trustees.) There should be also, to deal with questions of policy, a central council representing the various sections of the Association, and there should be a joint program committee, made up of the general officers of the Association and the officers of sections. The program of the annual convention should be arranged in such a manner as to strike a proper balance between the wider or more general interests of the Association as a whole, and the special interests of the separate sections. While a member would not be able to attend all the meetings of all the sections, he could attend at least as many meetings as he now attends; and he would have the advantage of obtaining a full report of the proceedings of all the sections, which proceedings would represent, in bulk and in practical value, five times the greatest possible output of the present form of organization.

In the field which this Association covers, or is supposed to cover, there is no true antithesis between a "large” Association and a "good" one. The immensity of our territory and the great number of available elements of membership, foreordain that the American Hospital Association shall include a large body of members. Already, I contend, the Association is too large for its present form of organization;

it has outgrown its old clothing and needs a new outfit. Without some change, the Association must crowd and cramp its members, must fail to develop the strength which is now latent within it, must retard the orderly growth of the knowledge of hospital administration and drag like a dead weight upon the skirts of progress. It is my earnest belief that by the adoption of some such plan as I have just outlined, and in no other way, can this Association attain its full growth and, equipped with every proper and available resource, advance to the complete fulfillment of its duty and its destiny.

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