MANY addresses of this kind take the form of prescriptive arguments, strongly normative in character and resting upon a substratum of philosophical considerations. The present effort will be more in the nature of a report to you—a report in which I shall attempt to analyze some of the more striking developments and changes which are taking place in that particular social structure within which we, as surgeons, spend our working days. Our particular social structure is, of course, the hospital.
The hospital is, in a very special way, the surgeon's bailiwick. No medical specialist is more thoroughly committed to the hospital and to furthering its effectiveness in delivering health services than is the surgeon. In general, however, the hospital is tending to become less predominantly a surgical institution, while its use as a center for clinical diagnosis is increasing. During the past 30 years, the rate of surgical admissions has