Laudable pus is no longer tolerated, puerperal septicemia. is a stigma on the care of the physician, traumatic erysipelas is seldom met, tetanus is a rare occurrence, and a hospital gangrene is only a ghost that disturbs the quietude of the shades of the past. These spectres haunt only the memories of earlier surgeons, and we know them now from their biographies, since we have all learned that it is wiser to prevent than to attempt to cure them.

The healing forces of most patients are usually adequate to care for the repair of a clean operation, by a clean surgeon, with a clean knife, in a clean room, with clean surroundings and clean dressings, and cared for by clean nurses. Then most operations will be successful where cleanliness is directed by a clear brain, well stored with a correct knowledge of anatomy and physiology, and the ever-present bacteria is not carried into the wound by the surgeon or nurse. Most nonsurgical acute diseases will recover if we give them plenty of air, sunshine, proper nourishment, and do not kill with "specifics" and polypharmacy.

Then the prime requisite in successfully operating a hospital should be ability to execute the directions of attending physicians; and most of the time, cleanliness, proper diet, air and sunshine comprise the major ingredients in the prescription of the truly learned physician.

Beyond the esthetics and psychologics of hospitals, location plays a minor rôle, since the causes deleterious to hospital work are pathogenic bacteria, which are almost ubiquitous.

The administration departments proper of a modern hospital are two, viz.: 1st, dietary; 2d, nursing. The first of these naturally divides itself into two, feeding the administrative force, and feeding the sick. With efficient heads to these two departments, operating a hospital becomes purely a business enterprise, the chief object of which is to keep adjusted a proper balance between the credit and debit side of the ledger.

Thanks to the paleontologist who exhumed from the débris of Pompeii canned meats and fruits, we have been taught the art of preserving by canning, an art which for so many centuries was lost. This class of foods forms quite an item in

the every day dietary of both executive force and inmates of a hospital. The preparation of foods is one among the questio vexata which have to be closely looked after.

We are a nation of dyspeptics, and each cook seems to thoroughly understand the art of perpetuating this condition, and resents any interference with her arrogated prerogative. That diabolical arrangement called a stomach, and which perhaps is the fons et origo of most human ills, is hard enough to deal with when on good behavior, but becomes incorrigible and implacable when its possessor has habitually violated every law of proper living. Most cooks know how to prepare salads, pastries, cakes and pies, but the very fewest understand the art of broiling a steak, baking a roast, or making a loaf of good, nutritious bread.

The present medical college and its product, the modern physician, are not entirely blameless for this deplorable condition, since hygiene and the art of scientific preparation of foods are entirely omitted from the curriculum of most schools. Physicians usually understand how to write a prescription for a gastritis, but few know how to order a dietary, and fewer still know when it is properly cooked, after theoretically being ordered. A monument awaits the Carnegie who will endow numerous schools of cooking in our cities, and the eternal gratitude of multitudes yet unborn will crown with laurels the memory of the physician who will write a plain, sensible work on every day preparation of foods, and pronounce an anathema on the whole genera of modern cook books.

The ignorance displayed in the preparation of daily food for the well is deplorable in the extreme, but when it comes to the proper conversion of pure raw material into appetizing, and at the same time assimilable viands for the sick, there are few adequate to the task.

There are then two separate departments here, each of which should have its separate head. The relationship between the physician and hospital caterer should be similar to that of physician and pharmacist, and his prescription for food should be as explicit to the one as the other. When we understand as thoroughly the amount of force and nutrition that each class of food, when properly prepared, is capable of giving

zup, and the capabilities of individualized stomachs for extracting this force, as we do the physiologic actions of different drugs, there will be less use for the synergists, pepsin, etidgenera. The pharmacist will not be able to re-fill as many prescriptions, but our patients will fare better, and their periods of typhoid fever will be shorter and there will be less use for intestinal antiseptics. To aid the physicians who have so generally patronized the Presbyterian Home Hospital, in having their diet order properly executed, I am having installed a small diet kitchen where the nurse can execute the orders of the

doctor in the most approved manner. This will be ready by October 1, equipped with neat gas range and aluminum cooking utensils. The nurses will receive a special course in this department after this session. Knowing how to purchase, what to purchase, and in what quantities to purchase, are facts learned only from long experience, and belong properly to the province of the matron or housekeeper. The economic relationship between this department and the contents of the purse is one that demands close scrutiny, and eternal vigilance is demanded to keep them on speaking terms.

Nursing. The trained nurse is comparatively a modern. innovation, but like many of our other concomitants of the nineteenth and twentieth century luxuries, has come to stay. Mark Twain facetiously tells us "that money and women are mighty good things to have about the house;" the sick man readily admits that a pretty nurse is quite essential, and the physician attending acquiesces that money is indispensable. An efficient head nurse lessens materially the operator's burdens. She should be capable of commanding the respect of the sub-nurses, and also of instructing them. She should strictly be held responsible for the execution of all orders, and any complaint of derelictions should reach the offending nurse through her and not indirectly. To properly fill the position demands tact to govern and control, as well as instruct. Without these qualities she cannot have the active coöperation of those under her control, consequently there are breaches of confidence and mechanically performed duties. She must be suavite in modo, but fortiter in re. She must be able to enter into the cares of both patient and nurses, willing to listen to their troubles, and counsel in their love affairs.

The two prominent points that are to be ever kept in the foreground with nurses are surgical cleanliness and silence. A nurse should never be allowed to discuss with a patient other patients, nor other than the attending physician, and then, to at all times speak of him in only complimentary terms. Good nursing is of paramount importance to both patient and attending physician.

The servant problem is one that usually has to be readjusted so often that it is hard to keep up with or treat its kaleidoscopic and every-varying features. Here as in all other business transactions, I have found it better to pay liberal wages, pay them promptly, trust them implicitly-at the same time watch them with both eyes-and to exact good work from each in his or her department. The breakage, loss and chipping of chinaware and general tableware is large, and is a leakage that is hard to discover a means of remedying.

In moderate-sized hospitals the solution of the laundry question is not difficult with the proximity of the modern laundry.

The training school for nurses is quite an economic factor in operating a modern hospital. The proper selection of a nurse for training is very important. Age from eighteen to twenty-five is about the proper limit. Education, health and general fitness are factors in the general make-up of a prospective nurse which should receive close attention.

In selecting a nurse for the training school, I inquire closely into the above and into family history. The uterine functions should be closely investigated, and since the duties of a nurse are arduous, no one with any uterine or pelvis disease should be employed. It goes without saying that carpets and draperies have no place in a hospital. Patients often demand these, but are usually easily satisfied when the attending physician explains the matter.

Operating Room. The advice of Polonius applies to operating room, as well as to the dress; it should be neat, clean, and as costly as the purse will buy, with everything in it aseptible and placed under the charge of one nurse who is held responsible for the room and its entire contents. Operating a modern hospital where there are unlimited means is an easy matter,

but quite another condition when the reverse is the case. Thanks to the liberal patronage of my medical friends I have to date been able to keep the balance on the right side of the ledger.

Hospital work is a subject about which I have read much and thought more within the last eighteen months. Like other branches of business it has many phases, each of which is modified by conditions. I know nothing of operating a charity hospital. The result to be desired and attempted to attain is the welfare of the patients, the reputation and monetary remuneration of the physician.

The unendowed institution which nearest approaches the ideal in these two directions is what is known as the joint stock, or coöperative hospital. The objection urged against this is that the stockholders have almost a trust on the practice of medicine in the city and use the monopoly to the detriment of the non-stockholders. This is not valid to those in the trust. While the discussion of this phase of the subject is hardly germane to the subject assigned and may seem irrelevant, with the permission of the president and indulgence of the society, I will briefly outline the plan and scope of such an organization.

1. The stockholders or physicians who own and operate it, electing from the stockholders a board of directors, or regents, who are to attend to every phase of the business and serve without salaries. The hospital is operated by physicians for the benefit of themselves and patients without interference of churches, societies or politics.

2. The size of coöperative hospitals is limited by amount of stock and number of shares sold. Stock is usually of $100 and sold to physicians at 20 per cent. cash, balance on monthly payments, notes being executed for deferred payments, and said notes of a negotiable kind. There is also usually a coöperative drug and instrument store in connection. Shares in this are usually $10 for each $100 worth of hospital stock. This enables the physicians to procure drugs cheaper and confine their prescriptions within their own proprietorship, thus securing many dollars that jingle the till of the druggist from refilling prescriptions and counter-prescribing.