J. Ross ROBERTSON: I should like to have Dr. Mackintosh's opinion as to what the floors should be made of and how they should be constructed; what led to the construction of radiators so close to the wall, and whether the kitchen should be put on the top story or down in the basement?

DR. MACKINTOSH: If possible, and the site is large enough I have no doubt the kitchen should be built outside on the ground flat. There are restricted sites where it is absolutely necessary to put the kitchen on the top flat. You do not want to put the kitchen under wards or sleeping apartments, and I think the ideal is to have the kitchen out of the hospital proper. In that way you don't get the smell of cooking food passing up to the wards or front entrance. In regard to the construction of floors I am very much interested. The last hospital I was consulted about had a fireproof floor; on top of that we put simply 3-inch red pine. On the top of that again we put teak parquetry, and that is glued to the other wood. In that way we got a very pretty and durable floor, though rather expensive. We did not, however, carry the wood to the side wall. We formed a footing of terrazo on the floor and curved it up the wall. Joining that again we have six feet of tiles so there is practically no joint. The parquetry is right up to the terrazzo, the terrazzo right up to the tiles and the tiles six feet up join the plaster flush. I wish to take the opportunity again of expressing my great pleasure in meeting with you.

DR. Ross: I would like to know why Mr. Sturm recommends roof gardens for porches and lawns. I can see very little advantage therein except in the larger cities.

MR. STURM: The operating light that I mentioned was not an operating light for daylight purposes at all. The ideal operating light is the north light and daylight; but the ideal operating light for night, or when it is so dark that you cannot use the outside light, is what is known as the Moore Tube, and is very much on the style of the Cooper Hewitt light, which you so often see, which has a bad color distortion and which will not do at all for operating rooms. The Cooper-Hewitt light is a mercury vapor light, which makes everything look purple. The Moore Tube is a tube three times as large, about the size of your wrist, and runs continuously around the room. It must be brought out of the box in which the apparatus is located that controls the amount of gas and the amount of feed air. It runs continuously around the room, on small brackets, in lengths of about six feet ,the joints being made at the brackets. The intrinsic brilliancy of the light is so

low that it practically casts no shadow and surrounding the room entirely the operator could not stand in his own light under any circumstances. The color of that light can be taken from an absolutely pure white light down to the practical solar rays or yellow rays of the sunlight. That can be determined merely by the amount of gas that is used.

PRESIDENT:

I would like to ask if you can name a hospital

in which this light is used?

MR. STURM: I cannot. I can name several places in New York and Paris where the light has been used. You can see it in several theaters in New York, and some restaurants, but it has never been used in an operating room. It is an expensive proposition, but after all it is better than a cluster of lights over the operator's head, the heat of which is positively frightful, and often has the disadvantage of throwing a shadow at the wrong time when the operator has to move from one side of the table to the other very quickly. The next question was in reference to the gas stove in the service room. That gas stove was not there for the purpose of heating the room. With that gas stove you can use just one little burner or two burners. It is a small stove for the purpose of making foments or douches handily. The question of an elevator and stair shaft was raised. These are cut off by heavy double doors from the corridors. The elevator shaft is provided with a ventilator over the skylight, and as every floor is absolutely a unit, nothing could be carried up or down. You could have a fire on your first floor and get no smoke on the second floor at all by this means. Those doors are usually made with just a little rubber buffer in between. Dr. Mackintosh said the architect should not be left to develop the plans. I have understood the same thing. I said if it was necessary you should take a year to develop your plan, and then call in the architect to help you. I do not believe there is an architect living any more than there is a hospital superintendent living who knows all about hospitals. If you do not co-operate you will never get anywhere. I am very glad the doctor brought up that point, because I was probably in a false light for a moment in presupposing that the architect knew all about hospitals and nobody else did. He knows less about hospitals probably than anybody else. I want to say a word in reference to the small ward. Dr. Brown spoke of the concensus of opinion being that the 12-bed ward was the best. I differ from that opinion, becaus there is not as much elasticity in a 12-bed ward as there is in a 6 or 8. If you have a 12-bed ward and you have only two patients you have 10 beds empty. Another thing, the nursing is harder to take care of; then there is a better segregation of your patients; you can segregate your acute cases you can put your

convalescents together so that the groaning will not disturb them; when you have medical students in the hospital, the interne or even the externe students can be given a small ward much more readily than a larger ward. These are some of the reasons why I advocate a small ward. It is easier to handle from the nursing side. Dr. Mackintosh's description of his floor and wainscot is very good, but I think that with the adamant plaster, the imperial plaster and the hard wainscoting plasters that we have in this country, such an expensive wainscot is not necessary. If your wall is brought down to within two or three inches of the floor you can put in a cement cove or bring it right down and join it on to your floor; then you have a continuous wall without the expense of the tiles. We have been speaking of small hospitals, and the small hospital cannot afford to put in six feet of tile wainscoting. They have to have another way of treating their walls, and the ideal way is to bring these walls right down to the floor with a cove and bring your floors to it. A word in reference to all these floors that are being put out on the market. They are all good-until they are tried; then there are mighty few of them that are satisfactory. There are now companies like the Karbolite people and Monolithic people and others that at least have good financial responsibility to back up what they say. All those floors have one great disadvantage, and that is that they are made of a mixture of salt that will absolutely come out in a white powder for a good many weeks to come. You should never have them oiled before the salt is pretty well out, because if you do it is going to make unsightly stains on the floor. I have tried it, and have had that experience. Let it lie for a month and dry out thoroughly, and then oil it with a solution of neat's-foot oil and turpentine, half and half. Do not let anybody put a floor of that kind down and oil it to begin with, or you are going to have trouble ever after. In reference to the roof gardens, I am just from the International Congress on Tuberculosis at Washington, and I advocate them because I think nowadays a good many of the cases in hospitals are one form or another of tuberculosis. There are just three things required in that disease tranquility of mind, sufficient rest, and abundance of good food. On a roof garden you are away from the dust, noise and dirt. You can cover part of your roof with an awning so that in inclement weather the patient is protected. Carry the service room and a small toilet room up there. You have the unobstructed sunlight, and it is much easier of access than anywhere else, because your elevator can run right up through your pent house and you can wheel the patient on the roof in the bed; that is why I advocate the roof garden over the lawn. In most instances you do not have spacious lawns.