that hospital were engaged in making a report in regard to 'a village of cottage hospitals,' which was printed in 1876, and is a most careful and thorough study of the subject, from a scientific stand-point, and is most conclusive in favor of the country plan of treating patients. From this report, and also, from the work on hospital construction and organization issued by the Johns Hopkins Hospital, I shall draw various of the facts and statements which I wish briefly to present.
"Careful study has demonstrated beyond peradventure that the nearer the condition of the patient approaches that of a member of a well-ordered household, the better are the chances of recovery; in small and separate hospitals the mortality diminishes with the size of the building, while in larger and more crowded hospitals the mortality is found to increase proportionately, and it reaches its height in those in which these conditions have existed for the longest time.
"In the report referred to is a quotation from Sir James Y. Simpson's essay on 'Hospitalism,' giving the following figures regarding mortality after amputations, which may be well considered in the present connection:
| In large hospitals of Paris | 62 | per | 100 | die. | ||||
| In British hospitals, with | 300 | to | 600 | beds, | 41 | " | " | " |
| """ | 800 | " | 201 | " | 80 | " | " | " |
| """ | 200 | " | 101 | " | 23 | " | " | " |
| """ | 100 | " | 26 | " | 18 | " | " | " |
| """ | 25 beds or less, | 14 | " | " | " | |||
| In isolated rooms in country practice | 11 | " | " | " | " | " | " | " |
In other isolated cottage hospitals in England during the year 1869, the mortality after operations was reduced to 6·7 per cent.
"In Bellevue Hospital there was at one time a mortality of forty-eight per cent after amputations, and at two of the public reception hospitals in New York the deaths in 1870, after amputations, were respectively sixty-five and sixty-two per cent. Other more recently built and better constructed hospitals show, of course, a very much smaller mortality, but the fact can not be gainsaid that large, substantial structures of brick and mortar, in a crowded city, do everywhere show a mortality much higher than that obtaining in locations where pure air, quiet, and sunlight can assist in man's endeavors to combat disease and injury. Spencer Wells, a prominent English surgeon, expressed the view that no surgical operation attended with risk to life should ever be performed in a great general hospital in a large town, except under such circumstances as would render removal to the country, or to a suburban cottage hospital, more dangerous.
"Much more could be added to show the advantages to be derived from securing a country location where a certain proportion of our cases could be sent, but time allows only a brief mention of important points in regard to the scheme actually proposed.
"Several locations have been under consideration for some time;
