PAPERS ON MEDICINE AND PUBLIC HEALTH 453 



cine should be determined by the state, and not by the 

 hospital authorities. 



It has happened occasionally that the nursing person- 

 nel of the hospital has observed certain younger men, who 

 though deemed competent by the state licensing board, 

 have undertaken the performing of surgical procedures 

 for which they were obviously not fitted by experience. 

 When such observations have been made, the man was 

 requested by the Superior of the hospital to associate 

 himself in future undertakings with some one more ex- 

 perienced than himself. It has never been necessary to 

 refuse these men the operating room, as they have al- 

 ways willingly complied with this request, and in fact 

 have seemed grateful that such a request has come from 

 the Superior of the hospital without having their incom- 

 petence advertised among their professional brothers. 

 Apparently these men have held no iU will toward the hos- 

 pital, and have in the future always limited their surgi- 

 cal efforts to work quite within their ability. The fact 

 that they were not forced to associate themselves with 

 any man or group of men, and that they were not forced 

 to relinquish control of their patients, has given these 

 men a freedom of professional action quite satisfactory 

 to themselves, to their patients, and to the hospital au- 

 thorities. 



As to the third standard, the hospital authorities have 

 always reserved the privilege of refusing classes of cases 

 where there was even a doubtful criminal intent. In such 

 cases, the authorities, if they were at all suspicious, have 

 either refused the care or have insisted upon consultation 

 with men of known integrity. It has been very noticeable 

 that after one or two attempts of this kind, the black 

 sheep of the profession have never given any trouble. 



In cases of suspected epidemic diseases, consultations 

 have been insisted upon and obtained without embarras- 

 ment to the attending men and ^\'ith what Ave believe to be 

 a minimum disturbance to the hospital. 



As for the meeting of medical men in conference, a 

 club room has been provided in the hospital where the 

 physicians have daily conferences and discussions of 

 their cases. It is surprising to note the freedom with 



