the control of this branch of the city government are paid $4,000, and the physicians from $1,200 to $2,550.

This elaborate organization has been gradually developed. At present, dental clinics for school children are being tried under the auspices of voluntary organizations. If this experimental work proves successful, this work will become one of the functions of the city government. Just in this way the work of the department of public health has been extended in this city and is now being extended in all leading states and cities. It has fully justified itself not only in this but in European countries. The whole movement is a part of the movement for increasing and promoting the economic efficiency of all citizens, and it is a result of the recent discoveries concerning the real causes of infectious and contagious disease. These discoveries have shown that these public health measures must be supported by the citizen, not alone to help his fellow but for his own protection. At present, however, in most of the cities this kind of work, to which the public is committed, is but partially done. In the matter of school medical inspection, it will be readily seen that 98 medical inspectors for the examination of over 900,000 school children is a very small number with which to realize the ideals of the promoters of this kind of public service; every day we realize that while the principle of food inspection is a good one, the provisions which have been made for the inspection of retail food stores are wholly inadequate. All this means that this field will be greatly expanded during the coming decades.

The heads of these public-service departments are usually appointed from among the men who have established reputations and are specialists in their subjects;

but frequently the appointments are made because of political favoritism. In most of the states and cities the subordinates are selected by civil-service tests which are open alike to men and to women. Young medical men who accept appointments of this kind serve for a limited number of years and then turn to private practice. In the past it has been the custom of these public officials gradually to build up a private practice while holding public appointments. This cannot at present be done so well. The salaries which are paid in the public service are gradually being increased, and the public is demanding full service from its employees.

These salaries are likely to be increased as the demand for trained and experienced men grows. That the supply of such at present is not equal to the demand is proven by the fact that special postgraduate courses for health officers have been established by Harvard University, Tulane University and the universities of Pennsylvania, Michigan and Wisconsin.

At present the positions in the public medical service which are under civil-service regulation are open to graduates of recognized medical colleges under about the same terms as those under which they enter the examinations for licenses to practice medicine, but for the sake of efficiency the new recruit for these services is gradually shifted to special work and the service itself has opened up many new lines of specialization.

CHAPTER XVII.

HOSPITAL SERVICE.

There are nearly 5,000 hospitals, public and private, in the United States, to say nothing of the large number of hospitals which are maintained by corporations for the treatment of their employees. The operations of the hospital staff of the Southern Pacific Railroad. for 1914 show a total of 81,525 cases. This great development of this kind of service in all sections of the country calls for specialists in hospital administration. The general practice of medicine is not such as to give men a chance to develop executive power while getting experience in actual practice; so for this reason the demand for men in this service is greater than the supply, and with the continued increase in the number of hospitals this is likely to continue.

The real development of the modern general hospital for the treatment of disease dates back to 1861, when Lister gave to the world the germ cause of wound infection. He proved that wounds, whether accidental or surgical, will heal quickly if kept free from bacterial contamination. Before this discovery all kinds of ointments and plasters were applied to wounds; today the applications which are made are intended to destroy or to prevent bacterial growths; and going upon the principle that nothing is clean which has not been sterilized, the modern hospital has sprung into existence. Conditions have been created under which the patients can

be surrounded with that absolute cleanliness which is of

prime importance.

Modern hospitals for the treatment of the sick, as distinguished from asylums and hospitals for defectives and dependents, may be built and supported by public taxation, and have free wards for the treatment of the poor; they may be built by private subscriptions and supported by fixed charges or they may be built partly by subscriptions and partly by public funds and supported by appropriations from the public funds and by fees.

In the smaller communities the general hospital may admit all kinds of cases and have a surgical and a medical department, each of which has its subdivisions for treating special types of cases. In large cities there may be special hospitals with their own rules and regulations, which are especially designed to facilitate the handling of particular infirmities.

The management of hospitals is usually vested in a board of trustees appointed by the governor in the case of state institutions; by the mayor or health board in the case of city institutions; and in various ways in the case of private or semi-public institutions. These trustees have the entire control of the business management, the appointment of the superintendent and, sometimes, the staff of physicians; but recently the tendency has been to give the appointment of subordinates to the superintendent.

The superintendent, although the executive head, is not expected to render medical service; but he may direct the internes in the treatment of surgical cases in the absence of the chief surgeon. Although the superintendent of the public hospitals is usually appointed