Next in importance to the three vital questions which daily confront the hospital housekeeper, in common with other mortals—“What shall we eat, what shall we drink and wherewithal shall we be clothed?” comes the question of how to prevent waste of the money and materials supplied for carrying on the work of the hospital. Few institutions afford such abundant opportunities for waste, along so many different lines. The sources of leaks seem to be endless. The individuals who are responsible for waste may be found in all departments, and represent all degrees of intelligence. The varied composition of the hospital household, the emergencies of the life and the fact that of necessity in a hospital of even moderate size the work is divided into departments with separate heads, renders the problem of the prevention of waste exceedingly complicated. Then the lack of any thorough system of inspection, the loose method of keeping accounts, and rendering reports of expenditure and income, the absence of uniformity of methods, makes intelligent comparison with other institutions difficult, if not impossible. Because of these conditions, waste may constantly go on in an institution where apparently everyone is trying to be economical. [Sidenote: Main Causes] There are usually three or four main causes existing where habitual waste goes on: Lack of an accurate system of accounting for supplies. Lack of careful supervision in the use of supplies. Lack of a general knowledge as to the average amounts of supplies necessary for each department for a given time. Unwise purchasing and ignorant or careless handling. (Employing people who “do not know how” is also a frequent source of waste.) [Sidenote: First Steps] It has been well said that the first step toward thrift is taking account of the items. A proper system of accounting for the daily supplies sent to each department will go a long way toward checking extravagance. This system of accounting secures facts about the consumption of supplies, that are absolutely necessary for the detection of extravagance or waste, and it should be adhered to as an important part of the work of every department. The surgical department is one which needs special supervision. While perhaps it would not technically come under the head of housekeeping, it often is in charge of the hospital housekeeper, and in considering the sources of waste it cannot be well omitted. In measures for the prevention of waste, the departments of a hospital should be a unit. Only thus can the problem be handled successfully. Referring to the excessive use of surgical supplies, Dr. John W. Brannan, president of the board of trustees of Bellevue and allied hospitals, New York, in an open letter to Charities has said: [Sidenote: Surgical Department]