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GENERAL AND SPECIAL SESSIONS. In view of the diverse types of hospitals represented, and also of the growth and somewhat varied character of membership, it would seem desirable to arrange for two or three section meetings, where smaller groups of people interested in the same line of work, might have an opportunity for a fuller discussion of their particular problems than is afforded where only general sessions are held. It is not suggested that these section meetings should be held at the hours usually devoted to general sessions, but that the section meetings be short, lasting not over one hour, and held either before or after the general sessions of the day. It might be necessary to slightly shorten the time allotted for general sessions to provide for this.
Neither it is intended that these section meetings should unduly multiply the papers that will be presented, but rather that such meetings may make it possible, by dividing the program, for a fuller discussion in the general sessions, of such papers as are of more general interest and importance to all hospitals. It has been felt in the past that when several papers were presented at one session, too little time was left for discussion of some subjects that should have received fuller consideration.
It might be desirable to establish a rule that not more than two papers should be read at one section meeting and that fifteen minutes should be the limit for each paper in section meetings. That would allow about half the allotted time for discussion.
As to the character of these section meetings, we are not prepared at present to suggest anything further than that one be arranged especially to deal with problems that relate to the larger hospital; another with the matters of special interest to superintendents and trustees of smaller hospitals, and perhaps a round-table conference of women workers at which no set papers would be presented, but at which a dozen or more topics might be briefly and somewhat informally considered.
We would recommend that this matter be referred to the Committee on Constitution and Rules.
Under the constitution and by-laws of the Association, the President, assisted by the chairman of the Executive Committee and the Secretary, arranges the programs for the conventions. We believe that your committee is correct in stating that for several years past the Presidents have assumed practically complete charge of the programs, for the reason that they have very properly recognized that the responsibility of this work rested on them.
It would appear to your committee that this is requiring too much of our chief executive, in labor, time, and responsibility. The President who attempts to build up the membership of the Association, appoints its committees, holds himself in readiness to confer with these committees at all times, prepares the annual address and attends to the other onerous duties of the office, ought not to be burdened with the preparation of a program.
Without in any way reflecting on any of our most excellent programs, it seems reasonable to suppose that a program growing out of the combined forethought of a group of members would ordinarily more nearly represent the average sentiment of the Association, than would one designed wholly by one person. A program committee, moreover, would be no innovation. When Mr. Test was President, he had a committee which relieved him of the detail of getting up a program. The plan worked well that year, and we believe it would always do so, if the committee were not interfered with too much.
Undoubtedly a large part of the responsibility will fall on the chairman of the committee, but he will have none of the other duties and responsibilities that the President by virtue of his office has to assume, and if he is a good executive, (and all hospital superintendents are supposed to be), he will see that the other members of the committee do their part.
A small committee, say of three members, would probably be more efficient than a large one. To insure a continuous line of thought in making up the programs for the different years, and at the same time to provide for new ideas, it might be well to have only one member of the committee retire each year, his successor being appointed by the incoming President. The member who is serving his third year should be chairman.
If it is decided to have general and section sessions the program committee would naturally be made up of the chairmen of the various sections.
We would recommend that the constitution and bylaws be amended to inelude a committee on programi.
In the years since the organization of the Superintendents' Association, many very valuable papers on themes vital to hospital management have been presented, but they are not in form so as to be readily obtainable. They deserve a much wider reading that they have ever received. They are educational, inspirational, and practical. The persons who most need to read and study them are the members of new hospital boards. Most of these do not even know of the existence of any literature on a subject which may be to them the cause of anxiety and grave consideration. A series of pamphlets dealing with all the different phases and departments of hospital work, prepared by members of the association and issued under its auspices, would not only have a distinct educational value, but would tend to increase interest in the organization. A small price put upon the pamphlets would meet the cost in time. In this way a fund of literature at nominal price on hospital subjects, could be accumulated, that would in time have influence on hospitals in general. Instead of a new board or a new superintendent having to write here and there for information, and often appealing to those no better informed than themselves, there should be one central depository for hospital affairs, where leaflets or pamphlets on a great variety of hospital subjects may be secured.
Your committee suggests that you give this matter consideration.
SOME SCIENTIFIC ASPECTS OF HOSPITAL
JOHN A. HORNSBY, M.D.,
Michael Reese Hospital, Chicago.
There are really only two factors in the administration of a hospital that are worthy of serious consideration, the doctor and his patient. All of the other people and all the appurtenances of the hospital are, or should be, mere instruments at the hand of the physician to be used at some stage or in some phase of his patient's illness. The efficiency of a hospital must therefore depend on the fidelity with which we carry out the doctor's orders, and that hospital will succeed best which is equipped with the most modern appliances and the skilled people to handle them, so that the modern practitioner can be intelligently served with modern, scientific methods.
The purpose of this paper is to open a discussion upon some of the most highly important phases of hospital management, in the hope that the discussion itself, rather than the paper, will give us some light on modern methods and modern processes of skilled nursing.
Let us take first, that most important feature of the modern hospital, the operating room. Twenty years ago, when the medical profession began to delve into the abdominal cavity, the reward was sepsis. We then evolved into Listerism or antisepsis. We have now reached a more or less shaky third round on the ladder of progress, which we call asepsis. Asepsis in surgery simply means this: that we build a' fence around the patient, so that by no process, nor through any crack nor crevice, can a pathogenic or harmful germ or microorganism come either at once or in the future into contact with the wound that the surgeon has made. If we are to achieve our purpose every single item that figures in an opration must be sterile in the presence of the wound; not that it was sterile yesterday or last week, but that it is sterile at the time that it is actually used, and at the place where it is wanted. The water must be sterile; not only the water that goes into the wound, and the water that wets the sponges, but the water that washes the surgeon's hands; the water that made the soap he uses; the water that washes the utensils employed; the sponges must be sterile; the dressings and bandages must be sterile; the instruments used must, of course, be sterile; the catgut or sutures or ligatures must be sterile. The people and their clothing must be sterile. The atmosphere of the room, the exhalations of the people present and the patient himself must be sterile. This is the picture of aseptic surgery. Unfortunately the infirmities of humanity invade the precincts of surgery as well as all the environments of life, and at best we do not have ideal aseptic surgery; and hence, even at our best we have infections following our best efforts, and we will continue to sometimes have infections until we have very far surpassed our present knowledge of the habits and characteristics of the microscopic peoples of the earth.
It is not alone necessary that we use perfectly sterilized units in the surgical operation, but it is quite as highly necessary that all of the things used in the operating room, especially those to come in contact with the wound of the patient, must have been clean and as free as possible from the presence of harmful germs before the process of sterilization was begun, for we must understand that although sterilization may destroy all the germs, there may have been, and often are present the products of these germs, which we call toxines, and these toxines are quite as offensive to a wound and quite as likely to bring about infection as the harmful bacteria themselves.
Fortunately, of all the myriads of bacteria known to the microscope only a very few varieties will breed septic conditions in a wound, or will do harm in the human body. Fortunately also, the pathologist knows pretty well the life and habits of these harmful germs, and he has taught us the means by which they may be destroyed, namely, heat. Some of them may be destroyed at a comparatively low