of it in the latter-named place. I was especially gratified at this opportunity to study and examine these hospitals, their equipments, and the ambulance systems of those parts of Europe, as it was in direct line with my official duties at the Bureau for the past three years as acting medical purveyor in attending to the supply of our own hospitals with similar equipments. In the beginning I might say that I was disappointed, generally speaking, with the comparison of the hospitals of those places and the modern establishments in our American cities and our own hospitals. With some exceptions, which I shall refer to at length, I did not see any institution which equaled the modern municipal hospitals of our large cities, and, indeed, of many of our small cities as welleither in construction, equipment, or ambulance system. I certainly saw none that surpassed them, one only excepted, and my final impression of the entire examination was one of gratification at our national progress in these matters. Judged from the standpoint of aseptic environment, ward equipments, furniture, trained nurses, and ambulance systems, the general run of hospitals that I saw have much to learn from the new world. I shall, therefore, not specifically mention the hospitals which I regarded as of a standard inferior to our own, viewing them from the modern attributes of cleanliness and aseptic equipment, because many of them are, as is well known, old structures, built before the days of antisepsis, and from their internal arrangements not specially fitted for such transformation as our own ideas of construction require, except at great expense and radical rearrangement. In Paris this is particularly true of such hospitals as La Pitié, St. Louis, Necker, Charité, and even the celebrated Hotel Dieu, which in its rebuilt form is about a quarter of a century old. These remarks apply, of course, to the buildings proper, and not to their management. England.—I visited hospitals in Southampton, London, Leeds, Liverpool, Greenwich, and Chatham-fourteen in number. Many of them are extensive institutions, with considerable pretensions to architectural design, but the consumption of soft coal destroys all exterior beauty in the large cities of England. Most of these hospitals are familiar to medical men, and their construction and plans are well known. I found them as a rule indifferently equipped with modern iron and glass ward furniture and surgical operating furniture, now seen in all our own hospitals; or if some was to be found it was only a partial equipment. In one case I saw a modern iron and glass operating table alone; all the rest of the room was fitted with the old-style articles. The floor and walls were unregenerated. This table was shown to me with evident satisfaction. The Royal Infirmary, Liverpool, answered more nearly to our ideas of a model than any English institution I visited. With the splendid basis of stone, brick, iron, and tile, it lends itself easily to the requirements of a modern hospital in its rooms, wards, lavatories, etc., and the management liberally met the conditions imposed by the canons of asepsis. It is one of the most, if not the most, elaborate and elegant institution of its kind in England. In conversation with a dealer in aseptic operating-room furniture in London, I was told that there was very little demand for it in England, and one superintendent of a hospital characterized the use of iron and glass surgical equipment as "fuss and feathers." Of ambulances and ambulance systems I saw none worthy of the name, or anything that could compare with our municipal and Government systems. As a matter of fact, the hospital authorities took the ground that it is a municipal duty to bring the sick to the hospitals, and not, as one superintendent expressed it to me, the business of the hospital" to be running like mad through the streets, clanging a gong as if going to a fire, and advertising your institution with a flaming sign on the side of the wagon." The injured, picked up in the streets, are carried to hospitals in any sort of a public conveyance, of which there are innumer able quantities in all large towns, or, perhaps, in the curious two-wheeled handcarts with a canvas bonnet top, used by the police to transport inebriated persons from the street to the police station. Those with whom I talked on the subject maintained that no harm results from the slight delays which might be due to an absence of ambulances at each hospital, but they contend that by the use of such conveyances as are at hand the victims of accidents or disease on the streets reach the hospital more quickly by that method. It was further stated that the constabulary are instructed in "first aid to the injured," and that "all the hospitals were so fully occupied that they did not need to drum up trade." As above stated, I made a special visit to the seamen's hospital at Greenwich and its branch at Chatham. This hospital in a sense represents a character of work similar to our own marine hospitals, although it is not a government institution. In the last century a hospital for the care of sick and disabled seamen was erected at Greenwich, in accordance with a provision of an act of Parliament, the history and character of which I shall make the subject of a special article in connection with the centennial of the establishment of this Service, and I shall now only refer to it incidentally in connection with my visit. Its successor still exists in Greenwich. The seamen's hospital known as the "Dreadnought " has no connection with the older institution, though it is situated contiguous to it. The seamen's hospital is maintained as a private institution, dependent on public charity, for the benefit of seamen, sick or disabled, both foreign and domestic. No charge is made for such patients, and from the character of the commerce that comes up the Thames it will readily be seen that the nationalities represented by the patients are many and picturesque. I saw sick seamen from all the continents representing the different races of men. This hospital maintains a branch lower down the river near the Chatham dockyards. These institutions are old-style buildings, and, beyond their interest in connection with the work carried on in them similar to our own, merit no special remark. France.-I visited seven hospitals in Paris-Hôtel Dieu, La Pitié, La Charité, St. Louis, Lariboisière, Necker, and Boucicaut. The general character of the Paris hospitals is a part of every medical man's education, and it will not be necessary to undertake a description of them except in the case of the magnificent Boucicaut Hospital, lately completed. La Pitié I found in a state of reconstruction. The other hospitals are old, and present no features of equipment worthy of adoption. At the Hotel Dieu a partial surgical outfit of iron and glass furniture was observed, but no attempt to improve its environment. The Boucicaut is the latest addition to Paris hospitals, and is the gift of the late widow of the proprietor of the celebrated Bon Marché, in memory of her husband and his business enterprise. It is on the south side of the Seine, occupying nearly a square, and constructed on the pavilion plan, with a large central court containing a chapel and statue of Madame Boucicaut and ornamental garden. All the most modern ideas of hospital construction are here engrafted into the ensemble, and after one has walked through the great establishment with its mosaic floors, tiled walls, and seen its elaborate preparations for rendering the structure and its contents aseptic, the acme of design and fulfillment seems to have been reached; and yet it can not be said to compass more than the standards observed in the latest additions to our New York city hospitals, and it only demands unusual notice because it is up to our own best level, and so much superior to anything else in Paris. The equipment was in keeping with the building-every attention being paid to the cleaning of the floors and walls. I noticed the use of hospital suits and a minimum of paraphernalia in the wards. It is a general hospital for both sexes. There is an approach to an ambulance system in Paris, and I saw one of the vehicles used as such, but it is an institutional system-only transporting patients from one hospital to another for special forms of continued treatment. The wagon was an unwieldy closed van, weighing 1 tons, resembling the" Black Maria” in appearance, although it was rubber-tired and had some modern conveniences inside. It is the duty of the police to send persons suffering from accidents or disease, found in the streets, to the hospital in any convenient public vehicle which may be first at hand. The wagon referred to is never used for that purpose. I was informed that the authorities are experimenting with an aluminum ambulance, to secure lightness. Spain. As I was considerably occupied during my stay in Madrid in attendance on the sessions of the congress, and owing to the difficulty of getting accurate information as to the visits to various institutions planned by the committee of arrangements, I was obliged to make such inspections as I could alone. The principal and largest hospital in Madrid is the new military hospital at Carabanchel. It is on the site of a medical university established by Philip V, which was partially built and left in ruins. In 1873 the sanitary military corps pressed their demand for a new military hospital for the garrison of Madrid and the soldiers of the Spanish army in general. The site is a commanding one on the slope of the hill of Almadovar in the municipality of Carabanchel. The extent of the grounds is 84,123 square meters, which does not include some adjacent lands not yet acquired, and which will be devoted to buildings constructed for epidemic diseases. This new military hospital is a magnificent set of buildings, constructed upon the most liberal plan, based upon the most advanced ideas of construction and equipment. It consists of twenty-four buildings or isolated pavilions, four of which are intended for the treatment of internal diseases, two for surgical operations, three for infectious diseases, and the remainder for the medical service proper and quarters for the officials, officers and subalterns, patients and employees. Included in this last class is a building known as the bath house, which is something more than its name implies, for besides the necessary places for the application of hydrotherapy in its various forms, it has apartments for ærotherapy and electrotherapy, with all the modern appurtenances for carrying out same. It also contains a swimming pool for the use and exercise of officers and soldiers. The hospital is practically independent in respect to heating and lighting, having its own plant for each, besides ice-manufacturing plants. To such an extent has the separation of the various classes of buildings been carried to prevent possible contamination, I might mention that the necropsy building has a separate ice plant of its own. The system of ventilation which will be finally adopted is that of the Belgian engineer, M. M. Putzey, with some modifications devised by the Spanish engineers. A provisional system of ventilation, the Bayle system, with air pumps, is now in use. The buildings are to be heated by a system of indirect radiation. The buildings are constructed of iron and stone and glass, and would seem to be incapable of harboring infection for any length of time, if properly administered. The entire hospital is not yet completed, but even in its present state it is a remarkable and altogether creditable institution. It was a wonder to me how provision was made for financing this expensive military hospital during a time when the Spanish nation was engaged in prosecuting two wars and, according to common report, with her fiscal arrangements very unsatisfactory. I also visited the institute of Sr. Ch. Rubio, an institution for the treatment of childrens' diseases, built at his own private expense within the last few years. This also answers every requirement of modern hospital construction and equipment. As far as I could learn there was no ambulance system, as such, at the hospitals at Madrid, excepting such as was attached to the military hospital as a part of the army system. Respectfully, yours, SURGEON-GENERAL MARINE-HOSPITAL SERVICE. CHAS. E. BANKS, REPORT OF SURG. S. D. BROOKS ON THE MEETING OF THE WASHINGTON STATE MEDICAL SOCIETY. Office of MEDICAL OFFICER IN COMMAND M. H. S., PORT TOWNSEND QUARANTINE, Port Townsend, Wash., May 13, 1898. SIR: I have the honor to report that I attended the annual meeting of the Washington State Medical Society at Seattle, as directed by Bureau letter of the 18th ultimo (P. M. C.), and returned to duty this morning. The meeting was quite successfully carried out. At the request of the President, I presented a paper on the necessities for quarantine on the Pacific coast, but practically no discussion was drawn out. Respectfully, yours, S. D. BROOKS, Past Assistant Surgeon, M. H. S. SURGEON-GENERAL, MARINE-HOSPITAL SERVICE. REVISION OF THE REGULATIONS. The revision of the regulations mentioned in my last report, made necessary by the increase in the scope of the Service and the consequent inadequateness of the regulations issued in 1889 has been completed. The new regulations, much enlarged, comprising some 698 paragraphs, and suited, it is hoped, for the proper conduct of the Service in all its details, were submitted to you for approval, and after such was obtained, received the approval of the President on December 1, 1897, and were immediately printed and promulgated. INFORMATION FOR THOSE DESIRING TO ENTER THE MEDICAL CORPS OF THE UNITED STATES MARINE-HOSPITAL SERVICE. The revision of the Service regulations made necessary the issue of the following Department circular, application blank, and specimen set of examination questions. These are now issued to all making application for permission to present themselves before an examining board of surgeons for admission to the corps as assistant surgeons: CIRCULAR. TREASURY DEPARTMENT, OFFICE OF THE SUPERVISING SURGEON-GENERAL M. H. S., The following extract from the Revised Regulations of the Marine-Hospital Service is hereby published for the information of candidates for appointment into that Service. "Medical officers of the Marine-Hospital Service of the United States shall hereafter be appointed by the President, by and with the advice and consent of the Senate; and no person shall be so appointed until after passing a satisfactory examination in the several branches of medicine, surgery, and hygiene before a board of medical officers of the said Service. Said examination shall be conducted according to rules prepared by the Supervising Surgeon-General, and approved by the Secretary of the Treasury and the President. "SEC. 2. That original appointments in the Service shall only be made to the rank of assistant surgeon; and no officer shall be promoted to the rank of passed assistant surgeon until after four years' service and a second examination as aforesaid; and no passed assistant shall be promoted to be surgeon until after due examination: Provided, That nothing in this act shall be so construed as to affect the rank or promotion of any officer originally appointed before the adoption of the regulations of eighteen hundred and seventy-nine; and the President is authorized to nominate for confirmation the officers in the Service on the date of the passage of this act." * * * * * 18. Graduates of medicine desirous of undergoing examination for the position of assistant surgeon in the Marine-Hospital Service of the United States must make an application, addressed to the Supervising Surgeon-General, in their own handwriting, requesting permission to appear before the board of examiners. Applicants for examination should state their age, date, and place of birth, present legal residence, and whether they are citizens of the United States, and name of medical school and college of which they are graduates, and furnish testimonials from at least two persons as to their professional and moral character. 19. Any applicant for appointment who shall submit false testimonials as to his character, or who shall give a false certificate of age, or make any false statement in his application, or to the board of examiners, shall be disqualified for appointment; or, if appointed before such false statement is discovered, shall be dismissed from the Service. 20. No person will be appointed as assistant surgeon whose age is less than 21 or more than 30 years, and, as a preliminary to a recommendation for appointment, the applicant must have been graduated in medicine at some respectable medical college, and must pass a satisfactory physical, academic, and professional examination before a board of commissioned officers. 21. Commissioned officers will not be appointed to any particular station, but to the general service. They will be subject to change of station, as the exigencies of the Service may require, and shall serve in any part of the United States or wherever assigned to duty. 22. A board of commissioned officers will be convened from time to time by the Supervising Surgeon-General for the purpose of examining applicants for appointment. This board shall consist of three or more commissioned officers, of whom the senior shall be chairman and the junior recorder of the board. 23. The board of examiners will make a true report on the merit roll (Form 1936) of the actual and relative standing of applicants and transmit the examination papers, with their recommendation in each case, to the Secretary of the Treasury, through the Supervising Surgeon-General. The maximum mark in any one branch of the examination shall be 100, and no applicant will be recommended for appointment who fails to receive an average grade of 80 in the ratings on the topics named in paragraphs 26 and 28. 24. All academic and professional examinations for appointment shall be conducted by said board of medical officers, and the order of examination shall be: (1) Physical; (2) academic; (3) professional; (4) clinical; (5) personal (including general aptitude and moral fitness). 25. The physical examination will be made according to the rules elsewhere given; the examiners must pay special attention to conditions that may impair efficiency or cause early placing on waiting orders," such as hereditary diseases, overstrain of nervous system, impaired vitality from excesses of any kind. Applicants should be required to give an explicit statement of any severe illness or injury, and the cause of death of near relatives, and certify that they believe themselves free from any ailment-mental or physical-or defect which would disqualify them for active service in any climate. |