Your committee feels that immediate action on most of these questions would be inadvisable, and that it would be best to refer those that appear to have merit to other committees to take under advisement and report at the next annual meeting. This will prevent hasty and ill-advised action, and leave less to regret in future years.

EXPANSION.

The society during the past two or three years has increased greatly in numbers, and has materially widened its field of operation. The American Hospital Association of today bears only slight resemblance to the Association of Hospital Superintendents of a few years ago. Its growth has been remarkable, and present indications are that in a few years it may dominate the entire hospital world.

Members of the organization, however, hold somewhat opposed views as to what its future course should be. Some think that the policy of expansion should be pushed aggressively. Others urge conservatism. As a result, the Association is today divided into two camps. -the expansionists and the anti-expansionists.

The expansionists desire to cover the whole field of hospital work, administrative, professional, and social. They are anxious to have a large, representative and inclusive membership and to make the Association a power for good wherever hospitals are to be found. They feel that the larger and more varied the membership, the greater will be the influence of the organization. Including all classes of hospital workers, even persons only remotely interested in hospital work, they believe will tend to harmonize all elements and to produce an ideal working whole.

Such a large membership they contend, will result in the public at large getting a better and more favorable knowledge of hospitals, which is, of course, a very desirable thing.

An officer of the Association, who is in favor of enlarging its scope, states that there are many influential people seeking admission to the Association, who are neither trustees nor superintendents of hosptals, namely:

(a) Secretaries and officers of local hospital associations.

(b) Members of associations formed for the purpose of controlling or managing and raising funds for dispensaries.

(c) Delegates from the Medical Board or Attending Medical Staff of each hospital.

(d) Representatives of the auxiliary boards of hospital, such as the Boards of Lady Managers, Auxiliary Committees, etc.

(e) Contributors to the support of hospitals.
(f) Superintendents of training schools.

The anti-expansionists, on the other hand, assert that hospital workers are naturally divided into several classes, which are but indifferently interested in each. other's work. They say that the work of the superintendent is of no particular interest either to the medical profession or to the layman, to whom administrative problems are mere matters of detail. The superintendent on the other hand frequently cares little about the medical matters that interest the doctors.

The anti-expansionists while admitting that size and numbers may be attractive, yet claim they are not always useful, in fact are often unwieldy and friction producing; and again, that it is very difficult to arrange a satisfactory program for an association whose members are not interested in the same subjects. They feel that the larger and more inclusive the membership, the looser the organization and the less its influence in the community.

They mention as another disadvantage of a large mixed membership, that there is not likely to be that free, candid, heart-to-heart discussion of subjects which characterize and make valuable the conferences of small societies. The open, frank exchange of opinions between members of this organization have always been very helpful.

They also maintain that if the medical and nursing. departments are to be represented in the association, that other important departments such as the housekeeping, engineering, and clerical, should not be debarred from membership.

In discussing this question a superintendent said. "We have in this country all sorts of organizations which rapidly outgrow their usefulness when they begin to expand, and try to embrace all phases of every matter intimately or remotely connected with the work of their members as individuals. There are always a few who have some undigested opinions that we ought to be doing some impossible things, but there are plenty of problems right at hand which demand the best thought of every individual to solve properly."

Another said: "I feel that the Association has expanded fully as rapidly as it should, and that we must devote a certain amount of time and attention to educating the men and women who come into our ranks. I should like, however, to see the development of the work of the Association in the line of high class papers, more careful discussions, and better ideals of what the association has to be and to do. There should be a committee on program, who will take in hand the preparation of a good program for the annual meeting. I do not think that we should be stampeded with the idea of making an enormous association. Let us make a good association first, and let it grow, naturally."

Your committee believes that we should definitely decide what is to be the aim of the organization, and having made our decision, after mature deliberation, stick to it. We feel that there is the greatest need for conservatism, and would urge that no action be taken at this time. For the present at least a policy of comprehension a policy that will keep our organization working together in unity toward definite objects seems better than a policy of extension or expansion.

COUNCIL, OR HOUSE OF DELEGATES.

It has been suggested that the Association have a Council or House of Delegates elected, not appointed, serving several years with partial retirement each year, sc as to give greater assurance of continuity of administration and protection of the funds.

The only council that your committee is at all familiar with, is that of the Massachusetts Medical Society, This body has wide powers, elects officers, appoints

committees, fills vacancies in office and its members only are eligible to the office of president. While this council is largely responsible for making the Massachusetts Medical Society one of the best medical organizations in this country, yet we take it that this body being of looser organization would not care to invest its council with such extensive control. It would appear to the committee, that a council or house of delegates, would serve in steadying the American Hospital Association by giving it continuity of administration. Preferably only those who are qualified by years of experience in hospital work should be chosen as councilors.

We would recommend that this matter be referred to the Committee on Constitution and Rules.

SECRETARY AND TREASURER.

It is the opinion of the officers of the Association, who are in the best position to judge, that an attempt should be made to make the Secretaryship of the Association as permanent as possible. Owing to the frequent changes in the office of Secretary in the past, the Association is without a permanent set of records, and does not even own a complete set of the transactions. Copies of letters have not been kept, excepting during the past year. So much is now required of the Secretary, that it does not seem just to ask any member to assume the duties and responsibilities of the office without remuneration, at least to the extent of reimbursement for clerk hire. In addition to the regular duties devolving on the office, the Secretary might secure new members and organize local conferences. If he should prove successful in increasing the membership the resulting increment in fees would in part offset his salary. We have consulted with several members of the Association, and all have agreed that the time has apparently arrived for the appointment of a paid officer.

It has been further suggested, as a business proposition, that the treasurer should be bonded, the Association, of course, paying the cost of bonding. This suggestion should not be construed as a criticism of the present treasurer, or any of the past treasurers, all of whom rendered faithful and unselfish services.

The membership is now approaching 500, and approximately $2,000 comes into the hands of the treasurer each year.

The sending out of bills, paying bills, keeping the cash account, and the prodding of delinquents, entail a large amount of exacting work on the part of the treasurer. The question arises whether it would not be wise to combine the offices of secretary and treasurer and pay the incumbent a small but adequate salary. We recommend that this matter be referred to a committee to consider and report before the close of the conference.

INCORPORATION.

There are some who think it might be wise to have. the Association incorporated. The object in doing this would be to secure a more permanent organization. It would secure for the society a certain legal and official standing which it does not now possess. Being incorporated, it would have the power to take, hold, and convey property, for any purpose not inconsistent with the charter under which it was created. It would be necessary to have it incorporated under the laws of some one state. Under this arrangement the annual meeting would probably have to be held in the state where the Association secured its charter. At this annual meeting the officers would be elected, reports received, etc. The meetings for reading and discussing papers such as we are now holding, could be held in any part of the country. The clerk of the Assocaition, as we understand it, has to reside in the state where the incorporation was effected, and where headquarters are maintained.

To incorporate under the Massachusetts laws would necessitate an expenditure of about $75.00 for attorney fees, books of by-laws and incidentals. We have not ascertained the cost of incorporating in other states.

The committee is not prepared to make any recommendation regarding this matter, but it believes that if a permanent salaried official is decided upon, the matter of incorporation, being then a more simple one, should receive attention at your hands.