The hospital is designed on the colonial type of architecture, and all the adjacent buildings erected in the future will conform to it. It is to be built of red brick with white stone facings, and will have all modern improvements. The ventilation of the hospital will be by the plenum-vacuum system, the air being filtered on entry and carried over coils of hot-water pipe before being distributed to the different rooms. The air ducts have been so constructed as to change the air in the offices and halls three times and in the wards four times, per hour. The heating will be by hot water, mechanically circulated, and the radiators will be only of such size as to supplement the warmed incoming air and to make up for radiation. Lighting will be mainly by electricity, only a sufficient number of gas lights being installed to furnish light should the electric current fail. The plumbing will be most modern in character. No plumbing will be installed in the operating room, this room being kept entirely free, the necessary wash stands, sinks, etc., being placed in adjacent rooms. The floors of the wards and offices will be of wood, -as it is believed that experience has demonstrated that a wooden floor can be kept sufficiently clean and gives the pleasantest surface upon which to walk,-except in those situations where much wear will be had, such as the main hall of the lower floor, which will be laid in Terazzi and marble.

Finally, some statement may be made relative to the expansion of the hospital and its combination with other units as a part of a medical military educational institution. The Medical Department stands greatly in need of a fully-equipped army medical school, and the site of the Walter Reed, Army General Hospital offers excellent facilities for uniting such a school with the hospital and with companies of instruction of the Hospital Corps, so making a complete educational unit. Equally, in time. the library and medical museum of the Surgeon-General's office, now at the corner of Seventh and B Streets, Southwest, will have to be provided for elsewhere. The city improvement plan, which will undoubtedly be quite closely adhered to in the future, disposes of this brick building. For this reason, Congress has not favored further appropriations of money for extensive repairs or extension. The Army Medical School is now carried on in the building, but the quarters are cramped and not suitable; nevertheless, Congress will not enlarge the building to accommodate the school, as the building is not in ac

cord with the city improvement scheme.

With the elaboration

of the improvement scheme it will be necessary to do away with this building, and then a new and suitable one should be erected. The library is such an important institution that it should be continued in its individual existence rather than be absorbed into the Library of Congress. It is hoped that with a suitable place for locating the library, and with the members of the medical profession advocating it, a proper building may be erected on the site of the Walter Reed Hospital when the necessity for such a building occurs. The total expansion upon the site, therefore, covers a medical military institution having for units the academic building of the Army Medical School, and its adjuncts; the Walter Reed U. S. Army General Hospital; barracks for two companies of the Hospital Corps-one a company of instruction and the other a reserve ambulance company; and, finally, the library and museum of the Surgeon-General's office. This scheme, properly carried out on an adequate scale, will give an educational institution for the use of the army in accord with its needs and somewhat on the lines of the large army medical schools and hospitals in Europe. It is now an accepted fact that the practitioner of medicine and surgery graduated in the civil schools must have a supplementary education in the special work of the Medical Department in order to fit him for the duties of a medical officer. The special requirements of the practice of medicine and surgery as adapted to the army in peace and in war must be taught, and thorough instruction must be given in theoretical and practical hygiene as it relates to the military forces. Also, with the extension of our possessions to the tropics, the subject of tropical medicine, which is not extensively taught in the civil schools, must be given due attention in the Army Medical School. With an academic building of suitable size and properly equipped with laboratories, lecture rooms, etc., supplemented by a general hospital having facilities for clinical and administrative teaching, combined with companies of the Hospital Corps being instructed in their duties and used for instruction of student officers, and with the library and museum of the Surgeon-General's office upon the same site, a complete medical military educational institution of great value would be had. It is hoped that in time such an institution may be obtained in its entirety, and that it can be built upon a scale worthy of the object for which it is intended and of the Capitol city in which it is placed.

Dr. Wm. A. White, Superintendent of the Government Hospital for the Insane, said that he had been much interested in Dr. Borden's paper, but was hardly competent to speak upon the subject, as the problems to be dealt with in the construction of an army hospital are different from those to be solved in building asylums for the insane. He could, however, appreciate the vast amount of labor involved in working out the plans described by the essayist, as he had helped in forming the plans for the new Freedmen's Hospital now in course of construction in this city. He had had no conception of the vast extent of the War Department's plans for the Walter Reed Hospital. If carried out as projected, the institution will be a monument to the profession of medicine in America.

Dr. Kober desired to congratulate Dr. Borden upon the plans presented and to point out that the perfect appointments of the proposed hospital should be ascribed largely to Dr. Berden's individual suggestions rather than to the architects. To work out the details of such a complete institution must have been an immense labor. In hospital construction architects must look to the medical man for advice, and usually they are very willing to act upon his suggestions, adding their own special skill to work out the structural details. The general scheme for the Walter Reed General Hospital was Dr. Borden's; and it is peculiarly fitting that he should have been instrumental in planning this great memorial to the great Dr. Reed, whose intimate friend he was.

The location of the Walter Reed Hospital on Brightwood Avenue will place it in proximity to two other large hospitalsthe Freedmen's Hospital, now in course of construction, and the proposed Municipal Hospital. Only one building of the latter institution has as yet been provided for; plans are now being made for a Municipal Tuberculosis Hospital. The tentative plans provide that one side of the building shall be devoted to white, the other to colored, tuberculous patients; the entire roof to be a roof garden, for the open-air treatment of incipient cases. In this way a great saving in expense and space will be made.

He had made the same observation as Dr. Borden in examining the construction of various hospitals, namely, the want or inadequacy of lifts for conveying food carriages from floor to floor.

He desired to use the opportunity to call attention to the Society's committee on the Reed Memorial. The committee had been painfully surprised at the indifference to the project; at present only eight or nine Washington physicians have contributed. It had been proposed to raise a memorial fund of $25,000, and after a lapse of several years less than $20,000 has been secured from the entire United States. Surely Washington has contributed very scantily in view of the fact that most of Dr. Reed's work was done here and much of his life was spent here.

San Francisco, across the continent, has done better; the Medical Society of that city contributed $500. Dr. Kober wished to emphasize the fact that the opportunity is still open for Washington physicians to share in the memorial.

Dr. Cook said that, as a member of the committee referred to by Dr. Kober, he would state that, owing to many discouragements met with heretofore, his committee had been able thus far to accomplish very little. It is the intention of the committee soon to call on each member of the Society for contributions to the Reed Memorial fund.

Gen. Forwood said that he had not anticipated taking part in the discussion, but he wished to observe that it is most unfortunate that the Army Medical Corps can not be allowed to work out the complete plans beforehand and secure Congressional approval of the entire design, with authority to proceed with construction as necessity arises. As Dr. Borden had stated, only an admittedly inadequate amount has been appropriated as yet. That amount must be expended, and the War Department must trust to luck to patch out the institution in the future. In this manner the most expensive buildings will be secured and perhaps the most ill adapted

Dr. D. S. Lamb said that the problems of hospital construction are very far removed from those of former years, when any building of sufficient size was considered suitable for a hospital; when ventilation was on the hit-or-miss plan, and lighting was confined to oil lamps or tallow candles. In the plans presented by Dr. Borden, Dr. Lamb had been impressed by the elaborate details for electric lighting, telephone communications, x-ray rooms and automobile buildings. These things were not dreamed of a very few years ago, and he thought that he was not fanciful in predicting that many details of this sort will require a different treatment as a result of new discoveries before the plans presented can be carried out.

THE HOSPITAL, A PROPER PLACE FOR THE DELIVERY AND MANAGEMENT OF THE PUERPERA.*

By N. P. BARNES, M. D.,

Washington, D. C.

The unrest among the general practitioners of medicine, occasioned by the annoyance of their obstetrical work, has divided the profession into three distinct classes.

The first, realizing that they can not do justice to all the departments of general medicine and surgery and maintain a fair degree of scientific exactness and personal comfort, abandons obstetrical practice entirely. This class of general workers is few in number.

The second class adheres to the principle propagated by the oft repeated statement, "child-bearing is a physiological process" and requires no especial attention, except in a few prolonged labors, when the expert is called to adjust the difficulty or share the responsibility of an unfortunate termination.

This list includes many who are enrolled in the honorable calling; many who enjoy large and more or less lucrative practices, regardless of the cheap and unscientific work they do; many who, by preference, employ the self-made midwife who examines, reports and summons the doctor in time to cut the cord.

These men discover anomalies, unfavorable presentations and positions, unfunctionating kidneys, flat nipples, contracted or deformed pelves after labor has been progressing or rather unprogressing for hours or days. The discovery of injury to the soft parts of the mother is a rare accident for these men who pride themselves, and receive no small commendation, for their ability to deliver a woman without exposing her. A man of this class can even truthfully say: "Out of hundreds or thousands of cases (depending upon the elasticity of the memory) delivered by me personally, not a single perineal tear was discovered." These men deserve the credit of making gynecology a most necessary and profitable business.

The third class comprises those who are anxious to take ad

*Read before the Medical Society October 10, 1906.