be concentrated in pipe shaft, easy plan consists of an assemblage of of access for repairs. Sanitary science has developed methods of pipe ventilation, traps, grease traps, etc., that would naturally be used to make a complete and perfect system of drainage. Planning-Historical Summary. From the few ancient examples that still remain to us, the mediaval idea of a hospital ward appears to have been that of a large hall, where patients could be placed together in such a manner as to make supervision as easy as possible. The window openings are placed high up in the wall, the height from floor to sill being about sixteen feet. The interesting examples that remain to us owe their preservation to the monumental character of their architecture, and may be regarded as types of what was thought best in their time. Their faulty characteristics are poor planning, and poor and inadequate means of ventilation. The great aim, up to within almost recent time, appears to have been to aggregate under one roof as many sick as possible, and this end was obtained by adding ward to ward, and story to story, with such extraordinary results as the old Hotel Dieu of Paris were obtained. In the older hospitals in England, what may be called the room system obtained largely, especially among provincial hospitals. In many of the hospitals erected toward the close of the last or beginning of the present century, the rooms of varying sizes, opening out of a corridor, which, in some cases, is lighted and ventilated at the ends only. John Howard says the wards should be fifteen feet high to the ceiling, and distinct ones for medical and chirurgical patients. This is not an arbitrary height, as a less height would be as practicable, providing the system of ventilation is perfect. Windows should be on the opposite walls, or, as at Leeds-openings into a corridor not less than six feet wide. During wars, whenever it happened that men were treated in buildings unprovided with efficient means of ventilation, the cases went badly, and the mortality was high and conversely; no matter how rough a shed might be provided, where there was plenty of free movement of air the best results were obtained. If these lessons taught nothing else, they at least showed the uselessness of a large allowance of cubical space, except in conjunction with perfect ventilation and cleanliness. The tendency of medical opinion is toward a steady development of the pavilion system, until to-day we see its most extreme point in the absolutely detached buildings of hospitals like those of Berlin, Halle and Hamburg. Although this extreme point of isolation has not, and probably will not, be reached in England or the older European countries, it lies in the keen American perception to grasp the great underlying principle, that of the isolation of each ward from all other wards and from the administrative offices, and to put the principle into practice in the future construction and planning of great hospitals. We may fairly hope that no new hospitals will, in the future, be permitted to be erected unless this fundamental law is recognized and complied with. Thus far, we have not touched upon the subject of ventilation, but as we know, it is a most important part of a hospital building. Of course, as in the case of the system of sanitation, it is governed more or less by conditions of individual cases. I would recommend that the services of an expert on the subject of ventilation be employed to act in conjunction with the architect, and with their co-operation a most complete and perfect system of ventilation and heating be evolved. Of course, mechanical means would be Dr. H. C. Dalton in giving his views regarding the new City Hospital, (Tri-State Medical Journal), suggests that among the special features most needed are: A complete pathological laboratory, including a museum for the preservation of pathological speci mens. employed, both to force the air into rooms as well as draw it from them at convenient points. The question of cooling as well as heating processes also comes up in connection with this subject. In this short paper it has been my aim to touch only on the more vital points of planning construction, etc., of a modern hospital, and in closing would urge that our modern hospitals should not only be fine examples of the knowledge that sanitary science affords, but in exterior design and landscape gardening should stand as monuments of a highly cultured and civilized people; should represent the art of architecture in its highest form, and be educators of the people of future generations. I can but repeat that the question has been considered in a very general way, which I think will answer the purpose in view. If more special information is wanted on the various subjects connected with a perfect hospital system, I shall take great pleasure to go into the minutest details. fitted for urinalysis and toxicological investigations. Ample clinical facilities for the proper demonstration of the practical features of both medicine and surgery. It is also desirable that the laundry, kitchen and other necessary departments be removed as far as A chemical laboratory, especially possible from other parts of the hospital. A MONTHLY JOURNAL OF CLINICAL MEDICINE AND SURGERY. EDITOR: THOMAS OSMOND SUMMERS, M.A., M.D., F.S.Sc. London. Subscription, $1.00 per year; single copies, 10 cents; postage free. Advertising Rates made known on application. Remittances should be made by money order, draft or registered letter. Reprints. Until further notice, authors will be presented free of charge with reprints of accepted articles (consisting of three pages or more) provided the CLINIQUE secures the sole right to publish them. The request for reprints should accompany MSS. Contributors of original articles will receive five copies of the issue containing their article. Photo-Engravings to illustrate accepted articles will be made free of charge, if proper drawings or negatives accompany the manuscript. Electrotypes of such cuts furnished at cost. Physicians' Wants, etc.-A department will be devoted to the free publication of physicians' wants, practices for sale, good locations, etc. Secretaries of Medical Societies will do us a favor by keeping us informed of dates of meeting of same, etc. THE RANK AND FILE. There is something always refreshing about the old New York Record, badly as she felinely spits "agin the West." The following article, which, by the way, takes up our last editorial, is rich, rare and racy. We give it editorial place. "In these commencement times, when the colleges parade their graduating classes amid tingling music, fragrant roses and impassioned oratory, the looker-on is apt to put the question to himself, how many of all the flushed anticipations of brilliant futures will be paled before the stern discipline of inevitable disappointment? When we match ordinary professional success against real fame, the proportion which gains the latter is exceedingly small. The higher the degree the less the chance. To attain a pinnacle means the success of one in ten thousand. The law of proportions is founded on a mathematical certainty. The lower grades show more liberal chances, the sweepstakes in the race are not so heavy, and are purposely open to ordinary competitors. Still the training to race develops becoming assurance, creates proper endurance, and in the end makes the essence of actual capabilities. If not a spirited and sweeping record breaker, we get the good and serviceable burden bearer. There are many of these in every field of struggling effort. They are in the majority, which is always respectable, always efficient, and which does the really necessary and valuable work for any community. We speak for such of the aspirants for high places who, in spite of every laudable effort, must be contented eventually to find their actual places with this majority. It may not be on account of any lack of merit on their part, but rather in the elucidation of the general and greater law, which necessarily has the fewer and more definite exceptions. While all should be keenly alive to offered opportunities, the best immediate results and the most lasting benefits are the satisfaction. of the work itself and the healthful contentment which always belongs to judicious effort and reasonable anticipation. While every graduate cannot hope to be a great man, in the more popular sense, he can at least be a good one, safely enjoying the ever-present satisfaction of constantly doing his best. It is such who must make up what is oftentimes affectedly and patronizingly called the rank and file of any profession. But each individual is such an important part of the whole that he very necessarily shares in a credit which is large enough for the freest distribution and varied enough for every particular need. It is every man in his place, with a place for all. No position is so small or so unimportant that it cannot be profitably occupied by an honest worker. In the most obscure village there is always room and place for the one who loves his vocation. The sick are everywhere. Their claims on good service are equal the world over. The size of a town does not govern the character of this skill. It is the glory of the rank and file that it occupies its position so well and so creditably. Each representative of the army medical is a host in himself, a natural leader among his fellow-men, a center of influence for the most practical good, an efficient helper in times of direst need, a trusted and honored citizen in matters which concern the public welfare, and a beloved and cherished neighbor in that family life of a community which reflects the glow of the hearth-fire and brings sunshine in the home. shine in the home. Is not such position enough for any ordinary ambition? What more can any prophet ask than honor in his own country, and a daily welcome among his friends? his friends? Even if fame be not gained, the greater and better part of what remains is not lost. We salute the colors of the rank and file." CONSERVATIVE GYNECOLOGY. It was a judicious conservatism that prompted one of the speakers at the recent banquet of the American Gynecological Society to declare against the prevailing craze among the younger members for newer and more brilliant operations. The criticism was respectfully received, as was to be expected on such occasions, although with some of the hearers there was manifest more of courtesy to opposite opinions than of real contrition for past and future sins. It cannot be denied that gynæcology of late years has more than held its own in devising, executing, and perfecting startling operative procedures. The enthusiasm that naturally follows such successes is always contagious and always dangerous. The cultivated skill of the majority of operating gynæcologists engenders an ominous presumption as to It may ap still greater ventures. pear a little harsh to assert that many of these operations are unnecessary, but we venture to suggest, in view of past history, that such will be proven before very long. Gynecological operations, like everything else belonging to the gentler sex, must have their fashions and their fads. The smaller the field, the higher the cultivation necessary. Operations of different names and different kinds have so densely occupied this well-worked field, that there is hardly room for partition fences. Every conceivable surgical procedure has been practiced within the pelvic limits, while the number of special instruments that have been devised to give the uterus a bare fighting chance, is enough to sink a ship. Sims' spoon-handle has twisted itself into |