and three graduates. In one of his early papers on asylum training schools, Dr. Cowles suggested that by sending out well-trained nurses these institutions would make an indirect return to the communities that supported them. As bearing upon this point, I should like to report that from the South Carolina Asylum Training School, 45 nurses have been sent to different parts of the State within the past year to nurse private cases of bodily illness. A small general hospital recently established in Columbia, about half a mile from the Asylum, now admits the best of our female nurses for four months of their two years' course. Here they get additional experience in surgical nursing.

Another important function of training schools was briefly touched upon by Dr. Billings at the International Congress in Chicago last year, namely, their obligation to promote the public health by increasing and diffusing knowledge as to the causes, nature and best methods of prevention or treatment of disease. To the same Congress Miss Nightingale sent a notable paper on the subject of health nursing as distinct from sick nursing It seems to me that in this direction lies one of the important duties of asylums. Some asylum physicians have felt called upon to apologize for the narrow field of sick nursing offered by hospitals for the insane and to lament the absence of the brilliant and inspiring results of surgery. It seems to me that the achievements of preventive medicine are not without inspiration and where can so good a field be found for the practical training of men and women in hygiene and sanitary science as is afforded by our large State institutions?

One of the most encouraging features about asylum training schools is the improvement in the class of attendants who apply as the years pass on and the usefulness of the schools is recognized. Younger, more energetic and more intelligent men and women make application for positions in the schools. The failures-inlife, middle-aged men of alcoholic habits, and broken down or disappointed women-do not come to the hospital as a last resort, with the idea of doing as little work as possible for their pay. The educational requirement drives them away. In their place we get younger applicants with ambition for the future instead of a past of disappointment. One drawback, however, I must admit. is that these applicants are often too young, even if 21 years of age. I think that from 25 to 35 years would be a better age for probationers..

I question the propriety of establishing a uniform curriculum in all asylum training schools. Make the length of the period the same if you like, two or three years, each comprising nine months' didactic instruction, but leave the choice of text-books and number and subject of lectures open and thereby I am sure the ambition and originality of the teachers will be enhanced. In time we may evolve a text-book of mental nursing that will be suited to many asylums; that time, in my opinion, has not yet arrived. Meanwhile, I am convinced by careful investigation that as a basis for recitations nothing is better than the admirable TextBook of Nursing of Clara Weeks Shaw for the junior year and Miss Hampton's Nursing: Its Principles and Practice for tho senior class. These books, especially the latter, foster the real spirit of the "hospital idea" which we are all striving to introduce into asylum work.

Dr. CowLES: I wish to make a request of the Association in the matter of the constitution of the Committee. It seems to me that it would be desirable to add to it some of the men who have been doing active work and who are representatives of the various classes of hospitals.

Upon motion the Committee was continued for another year and three members were added to it, viz.: Drs. C. P. Bancroft, C. B. Burr and J. W. Babcock.

Dr. GILMAN read the report of the committee on the Relation of State institutions and Politics.

Dr. E. N. BRUSH: I am heartily in favor of every paragraph in this report except that which states that the Trustees should be appointed from the two political parties. The paragraph preceding it I think, suggests the adoption of a thorough and completo civil service for asylum appointments which in spirit should extend to the trustees as well as to asylum officers, attendants, etc., and there is no more propriety in saying that two or three political parties should be included in the trustees than that they should say that the superintendent should be one year a Republican and the next a Democrat, so as to keep on both sides of the fence.

I move as an amendment to the resolution that it be adopted with the exception of that portion recommending the appointment of trustees from two political parties. I think we would better ignore political paties in these matters.

Dr. KILBOURNE: The Committee recommends that any vacancy in the Board of Trustees be filled by one of the same political party. In our State we have a board of five and the law states that not more than three members shall belong to the party in power. It is a point to be discussed whether a vacancy should be filled as the Committee recommends.

Dr. CARLOS F. MACDONALD: I am heartily in accord with the spirit and substantially with the letter of the resolutions contained in the report just read by Dr. Gilman. I also fully agree with Dr. Brush's objection to the use of the term "politics" as embodied in the resolution, that is, to the proposition that in the selection of boards of managers appointments should be equally allotted to political parties. This I regard as an objectionable feature and I would second the amendment offered by Dr. Brush to strike it out. The practice of selecting boards of managers in the manner proposed is a pernicious one and when followed, has never resulted in keeping the institutions governed by them out of politics. In fact, it has usually tended in the opposite direction, as I can testify from personal experience with, and observation of, such boards. I am clearly of the opinion, in common with both my associates in the New York State Commission in Lunacy, that managers should be selected without reference to their political faith and that partizan influences should have no place in the government of hospitals for the insane. Furthermore, we believe that no institution for the care and treatment of the insane can be successfully conducted where such influences obtain. I am pleased to be able to state that in the matter of appointment and retention of their resident officers and subordinate employees the New York State hospitals are practically no longer subject to political favoritism; also, that the element of "politics" in the boards of managers and trustees is rapidly being eliminated, through the agency of a healthy public sentiment in our State, which regards the care and treatment of the dependent insane as something which should be sacredly kept above partizanship, and I feel safe in saying that under the operation of the Civil Service law our State hospitals have now reached a point of safety, in this matter, beyond the danger of a relapse. At the request of the State Commission in Lunacy, the Civil Service commission of our State, with the approval of Governor Hill, adopted a rule in 1890 providing in substance for open competitive examinations for the positions of the

various resident officers of our State hospitals, and raising the standard of eligibility to such examinations so as practically to bar out incompetent and inexperienced persons. Under this rule applicants for examination for the position of superintendent must have had at least five years' actual experience in a hospital for the insane, while those for the position of first assistant must have had three years of similar experience, and junior assistants must have had one year's experience in a general hospital, or one year's continuous service as medical interne in a hospital for the insane. Each must pass a competitive examination, be a graduate of a legally chartered medical college, a resident of the State and possessed of good moral character. Selections for appointment from each class must be made from the three highest on the list of that class. Promotions from the position of junior to intermediate grades, below first assistant, may be without examination.

The effect of this rule, which has now been in operation since 1890, has been to materially raise the standard of the medical service by securing a much better class of men in the lower ranks and paving the way for promotion to the higher ranks of experienced and worthy men who merit promotion; but who seldom obtained it under former methods, unless they happened to have a "pull" with their board or with those who controlled their board. Under the new system four assistant physicians have already become superintendents, and there are several others on the eligible list from which future selections will be made. By thus doing away with the element of favoritism which obtained under the old system one great source of dissatisfaction among assistant physicians in our hospitals has been removed. When the new civil service rule was first proposed, some of our superintendents were opposed to it, but the result has shown that it was a decided step in advance, as I believe all of them are now agreed. We also hope to be able, in the near future, to remove another source of discontent, —a relic of the old system,-by rectifying the marked inequality of salaries and wages now paid to the officers and employes of similar grade in our State hospitals. Another new feature of our State hospitals, of which mention might be made, is a civil service rule adopted at the request of the Lunacy Commission, and of several of our superintendents; providing for the appointment, after non-competitive examination, of medical internes, two in each hospital, at the moderate salary of six hundred dollars per

annum to be selected from recent graduates in medicine of not more than two years' standing. This provision is designed to provide a training school for medical officers from which promotions to the regular staff may be made. These medical internes are required to come up for examination for the position of junior assistant physician at the examination next ensuing after one year's service as interne, and if successful, they may remain in the servico of the hospital pending promotion; but if unsuccessful they must be dropped.

There is another feature of the resolution to which I decidedly object and which I would move to strike out. I refer to the provision that the appointment and removal of employees by the superiutendent shall be subject to approval by the trustees. In my opinion every superintendent should have the absolute right of selecting and discharging his subordinates independently of the trustees.

The superintendent is the responsible head of the hospital and his authority should be commensurate with that responsibility. If given this power superintendents would be spared much embarrassment which lack of it now causes them. I know this to be the case in my own State and I have no doubt the same is true of other States.

Superintendents not infrequently are debarred from making selections with reference to the highest grade of qualifications and the best interests of the hospital, because they fear that their nominations would be rejected by the board or, at least, be displeasing to certain members of that body. Superintendents are also frequently prevented from dismissing incompetent or unworthy subordinates because to do so would not meet the approval of their boards. Were it necessary I could cite numerous instances of managers and trustees successfully using their influence to secure the appointment and retention in the service, of incompetent, dissolute or unworthy relatives or friends, or to advance the same in rank and pay out of their order or beyond their merits, not to speak of schemes to divert the trade of the hospital to certain quarters, favoring contractors in the matter of proposals for supplies, buildings, etc. I therefore second Dr. Brush's amendment respecting the selection of trustees with reference to their political faith, and move to further amend by striking out the clause which provides that appointments and dismissals by the superintendent shall be subject to approval by the trustees.