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The wastefulness, the yearly deficits exhib- ited in the financial statements, the extrava- gant architecture which drains the sinking funds, the cry of "no room," the tendency on the part of a few men in the profession Buy Cheap Zaditor to arrogate to themselves so many prerogatives connected with their positions, as virtually to make these insti- tutions their branch offices, so to speak, and thus to create a "medical trust." These were some of the facts brought to light in the discussions of last winter. Already the medical and lay boards have cer- tain reforms under serious consideration by virtue of which old traditions will be wiped out and be replaced by methods inspired l)y the modern spirit of research, and which are intended to adapt themselves to the constantly varying phases of modern society, and to this age of progress and broader thought. And I am not treading on doubtful ground when I venture the prediction that if the pace set be maintained there is no tell- ing to what bounds this radicalism is destined to reach, nor can we predict how far-reaching its influence will be on medical education and medi cal schools. Although, unfortunately, this movement for hospital reform has been allowed to smolder, nevertheless public sentiment is overwhelmingly in its favor to-day ; it is a vital issue in medi- cal thought and is bound to bear results once the public becomes acquainted with the different phases of hospital management, and with the weak points of the system. At the outset I wish it to be understood that I am not arraigning our hospital system, nor do I wish to convey the impression that neither prog- ress nor improvement has been made within re- cent years. I frankly acknowledge that many re- ♦Read at the September meeting of the Metropolitan Medical Society. forms have been instituted lately, and I know of still others that are in contemplation or in prog- ress. What I allude to is the fact that under ex- isting conditions the greatest efficiency of service is not assured, nor are the many services that a hospital can render to the public, and to the medi- cal profession, available as matters stand to-day. In many respects hospitals are Zaditor Drops conducted on the medieval lines laid out when they first were created, and thus their sphere of usefulness has not continuously improved in order to meet exigencies of modern industrial and social life. For convenience of this paper, I have made the following classification of hospitals : Firstly, a class having formal denominational connections, or which require their governing bodies to belong, to a specified denomination or nationality; sec- ondly, hospitals controlled and supported by the state or municipality; Buy Zaditor thirdly, hospitals con- nected with medical seats of learning; fourthly, hospitals whose governing bodies are non-sec- tarian and are supported by voluntary contribu- tions, and fifthly, a number of institutions of an eleemosynary character, which fall below the modern standard of what hospitals should be and are therefore not considered in this paper. A word concerning the third class, namely, hos- pitals connected with medical schools. It is very apparent that such institutions are to all intents not primarily places for the healing of the sick, but are subsidiary instruments for medical edu- cation and clinical instruction. One of the func- tions of such a hospital is to furnish material and subject for study both for the matriculants and the members of the faculty. Of necessity such hospitals must first consult the interests of the student-body rather than that of the indigent sick, for it is upon the revenue derived from the former that the life of the institution depends. Thus we have a type of hospital which savors more of commercialism than of humanitarianism, and therefore it becomes a question of economic and civic interest whether such hospitals are prop- erly entitled to municipal support. In this city we have Cheap Zaditor several notable examples of such insti- tutions, and it is a well-known fact that for a number of j^ears, whenever the city's budget was made up, they found it necessary to have repre- sentatives appear before the Board of Estimate and .Apportionment to oppose the sentiment against their securing a share of the city's bounty. On the part of these "college hospitals" it was claimed that they provided and cared for a quota of the indigent sick of this city, and consequently were entitled to a certain appropriation. On the other side, it was argued that while these hos- pitals did treat some of the city's poor, it was done not from purely charitable motives, or fronj an unselfish disinterestedness, but it was a ques- tion of personal gain and aggrandizement. These institutions furnish facilities for the reception of 642 MEDICAL RECORD. [Oct. 27, 1906 a limited number of patients who are able to make compensation for the treatment they receive ; but the revenue thus derived is not appropriated, as far as I know, for the general uses of the hospital, that is for the relief of the sufiferings of that class which is admitted free, but it finds its way into private channels. Such hospitals partake, in this respect at least, more of the nature of private or pay hospitals for the physicians Alaway Or Zaditor connected with them, who contribute nothing of the incomes de- rived from them towards the maintenance of the hospital. Here we have the unique spectacle of a private hospital, which yields a handsome rev- enue to the members of the faculty, asking for an annual appropriation to help maintain it, when in reality its main purpose is intended as a clini- cal feeder for the students and to furnish material for operating and demonstrating. Regarding hospitals supported by the city or State, it is to be noted Purchase Zaditor Online that these institutions may be made more useful in many ways. The treat- ment of the sick poor should not claim their at- tentions alone. They should become centers for the medical education of the masses, where the people could receive instruction in the rules which govern health and prevent disease. The hospital should be made an auxiliary to the school- house ; in the former the care of the body should receive attention just as in the Zaditor Eye Drop latter the train- ing of the mind, does. The services rendered to the public by an up-to-date hospital should no longer be summed up in the mere statement that it administers to the sick of the community; the modern hospital can be made to have a larger range of usefulness, and thus render a greater service by providing opportunities for instructing the masses in the laws governing Zaditor Tablets health, in sani j tary living and in the prophylaxis of disease. I Eye Drops Zaditor therefore make the suggestion to the metropoli- tan hospital boards and to our municipal authori- ties that a modest beginning be made on the lines here indicated ; that provision be made for Buy Zaditor Online de- livering lectures at one of our larger hospitals dur- ing the Zaditor Coupons winter months on questions relating to the prevention of disease, and conducted in such wise Order Zaditor Online as not to interfere with the general routine work of the hospital. I am confident that this in- novation would be hailed with such satisfaction as to rival in popularity the lectures held under the auspices of the Board of Education. In our own city and elsewhere there are no opportuni- ties offered to the people for Zaditor Eye Drops such a practical and necessary education, although the need of it is nowhere so imperative as it is among the mem- bers of the younger generation, who are growing into manhood and womanhood, ignorant of the dangers that menace their future health Order Zaditor Zaditor Price and hap- piness. As an object lesson in the prevention of communicable diseases this feature would prove a great blessing. It certainly is a misfortune that our schools and universities should be so woe- fully incompetent to supply such a need. Such lectures might be delivered under the auspices of a hospital by selected members of the medical staff', but not necessarily within the hospital itself. The utilization of hospital facilities for pur- poses of instruction could be advantageously ex- tended by appointing to the house staffs a larger proportion of graduates than is now the rule. A study made by me of the number of graduates in 1006 of the leading medical schools in New York shows that about 30 per cent, secured hospital ap- pointments in large general hospitals. Of the re- mainder about 50 per cent, secured positions in minor institutions in which, however, the facili- ties for obtaining a practical knowledge are so Generic Zaditor in- ferior as scarcely to compensate a beginner ac- cepting an interneship of a few years. It appears, therefore, that about 50 per cent, of medical graduates are not sufficiently equipped to prac- tise their calling conscientiously and with justice to their clientele. And yet the clinical facilities in this city are well-nigh inexhaustible. There are in the Boroughs of Manhattan and the Bronx, all told, about sixty hospitals, of which about one-half are devoted to the treatment of general diseases, the other half to the treatment of special diseases and conditions. Of the gen- eral hospitals, about seventeen have a capacity of over one hundred beds, and approximately there are about six thousand free beds in these institu- tions. A study of these figures in connection with the number of "Semi-annual appointments made on the house staffs, makes it very evident that in many of the general hospitals, the number on these staffs could be materially and profit- ably increased, and thus suitable provision could be made for a larger number of our medical graduates. My Purchase Zaditor figures make it evident that this increase could be carried out without impairing the service. All that is required is to make suit- able house provision for such an augmented staff and to reapportion the inmates accordingly. True the economies of the hospital would suffer, but then retrenchments could be easily enforced in other directions whereby the balance sheet would not show a deficit. A hospital with a capacity of two hundred beds, could be made to accommo- date a house staff of eight to ten, one with a capacity of three hundred beds could accommo- date ten or twelve graduates. A fair ratio would be about one physician to twenty-five patients. Arguing in the same vein, the staff of visiting physicians could be likewise augmented without detriment to the Zaditor Coupon hospital management or service. The antiquated policy to which our hospitals so religiously adhere, of centralizing the medical and surgical work in the hands of a few should be brushed aside. There is no justification in theory or in practice of restricting the services of a hos- pital to a selected few to the detriment of the many who are in need and deserving of such ap- pointments and who represent the highest type of physician. Bearing in Zaditor Cost mind that these posi- tions are numerically limited, while the aggre- gate of practitioners is an increasing quantity, it would, it seems to me, appear to be the part of wisdom to regulate the number of visiting physi- cians according to the number of patients. Thus in a hospital whose capacity is two hundred beds, in place of a visiting staff of three physicians, the number could well be increased to five. Such a change would mean that a larger proportion of

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